Heatstroke Awareness and Preventive Behaviors Among Automotive Maintenance Workers in Outdoor Environments: A Cross-Sectional Study in Japan.

Background/Objectives: Global climate change has increased occupational heat exposure, posing significant risks to outdoor workers. Automotive maintenance workers face high temperatures, radiant heat from machinery, and physically demanding tasks; however, their awareness and preventive behaviors regarding heat-related illness remain insufficiently understood. This study examined heatstroke awareness and preventive behaviors among automotive maintenance workers in Japan. Methods: A cross-sectional web-based survey was conducted among 371 automotive maintenance workers. Self-reported heat-related illness experience was assessed based on subjective judgment without formal medical diagnosis. Associations between heat-related illness experience and behavioral, physical, and health-related factors were analyzed using chi-square tests with Bonferroni correction and multivariable logistic regression. Results: Approximately 39.6% of participants reported experiencing heat-related illness during summer work. In multivariable analysis, headache (OR: 2.66, 95% CI: 1.25-5.64), dizziness (OR: 2.06, 95% CI: 1.12-3.80), obesity (OR: 1.86, 95% CI: 1.06-3.27), and lower self-perceived health (OR: 2.19, 95% CI: 1.36-3.55) were independently associated with heat-related illness experience. Some preventive behaviors, including wearing cooling garments and frequent hydration, showed associations in the multivariable analysis; however, these findings should be interpreted with caution due to possible reverse causation, small cell sizes, and residual confounding. Conclusions: Behavioral and individual health-related factors, particularly symptom recognition and self-perceived health, are associated with heat-related illness experience among automotive maintenance workers. Interventions focusing on early symptom awareness, risk perception, and self-monitoring may be important components of workplace-based heat illness prevention. Future studies incorporating objective environmental and physiological measurements are needed to clarify causal relationships.