Commercial fishing poses numerous hazards to workers that may result in injuries and chronic health problems. US occupational surveillance and intervention efforts have reduced fatal and non-fatal injuries [1,2]. However, health and well-being concerns within fishing communities such as general physical health, mental health, lifestyle and behavioral factors, and healthcare access remain less explored [1–4]. Work-related risk factors may contribute to obesity, cardiovascular disease, depression, sleep disorders, and other health disorders previously considered unrelated to work [5–10]. Surveillance in England and Wales found fishing amongst the top industries with the poorest general health and the highest incidence of long-term work-limiting illness [11]. However, analyses of US household-based national surveys (National Health Interview Survey [NHIS] and Behavioral Risk Factor Surveillance System [BRFSS]) that document worker health trends have not focused on fishermen [3,4,12].

We used the National Institute for Occupational Safety and Health – Worker Health Charts (NIOSH-WHC) interactive online tool to create customized charts to obtain occupation-specific estimates of workplace exposures, safety behaviors, health status, illnesses, and injuries, as well as working and employment conditions. We sought to determine if NIOSH-WHC national survey data could identify risk factors and health outcomes disproportionately affecting fishermen, and identify opportunities for future research, training, and engagement with fishing communities.

NHIS-OHS (2015) survey found fishermen had a higher prevalence of non-standard work arrangements (independent contractor) (29%), frequent night shifts (40%), shift work (99%), and supervisory responsibility (69%) relative to agricultural workers and all occupations combined. Fishermen commonly reported psychosocial exposures such as high job demands, low supervisory support, work-life interference, workplace perceived as unsafe, and worry about losing a job (Table 1).

NHIS-OHS (2015) also showed that fishermen reported universal exposure to frequent lifting, pulling, or bending, and frequent standing or walking, higher than agricultural workers and all-workers. Musculoskeletal conditions such as low-back pain and carpal tunnel syndrome, which can result from those work task exposures, were also common in fishermen and more prevalent than in all worker populations (Table 1).

The prevalence of excessive alcohol use (binge drinking and heavy drinking) was similar (8.9 vs. 5.0 and 6.8) across all three groups in the BRFSS (2013–2015) survey. But more fishermen reported current smoking (BRFSS (2013–2015) and exposure to second-hand smoke (NHIS-OHS (2015) than their counterparts (Tables 1 & 2).

BRFSS (2013–2015) survey found one in ten fishermen rated their health as fair or poor, and about one in five reported no health care coverage, both lower than agriculture workers. Fewer than one in five fishermen reported influenza vaccination. The self-reported prevalence of chronic health conditions was similar across all three groups except obesity, which was lower amongst the fishermen (Table 2).

While fishermen had rates of chronic medical conditions comparable to all-workers, they more often reported chronic musculoskeletal conditions, including back pain and carpal tunnel syndrome and the frequent lifting, pulling, or bending which can underlie such conditions [17–19]. Commercial fishing is physically demanding and strenuous work where the tasks often comprise continuous repetitive activities (e.g. using a line with a net, hooks, or pots to harvest the fish) in long cycles [20]. Routine tasks include loading bait, hauling frozen blocks, unloading the catch, and boat clean-up [21,22]. Repeated strenuous movements contribute to musculoskeletal conditions including low-back pain and carpal tunnel syndrome, and fishing tasks with ergonomic stressors have been associated with low-back pain [22–27]. Other low-back pain risk factors include age, work-years, fishing and gear type, job title, and fishing part-time or multiple jobs [22,26]. Obesity is a risk factor for musculoskeletal conditions but prevalence was lower among fishermen than all workers [28,29].

Psychosocial exposures are associated with musculoskeletal conditions; a study using NHIS-OHS found independent associations between low-back pain and work-family imbalance, job insecurity, and hostile work environments [30]. Others have reported associations between musculoskeletal conditions and psychosocial exposures as well as work organization characteristics such as non-standard work arrangements, multiple jobs, and long work hours [18,19,31]. The high prevalence of musculoskeletal conditions among US fishermen could be related to commonly reported psychosocial exposures such as work-life interference, high job demand, low job control, low supervisory control, and workplaces perceived as unsafe.

Work-life interference can be associated with unhealthy behaviors and negative health outcomes and may be linked to mental strain leading to muscle tension or other physiological processes, resulting in low-back injury/pain [32,33]. The work organization characteristics of fishing—including seasonal work, quotas or permitting seasons, competition for limited catches, weather patterns, crew availability, boat size, crew size, and distant fishing grounds—lead to a high prevalence of non-standard work arrangements [3,20]. The fluctuating economics of commercial fishing may contribute to increased job insecurity, anxiety, and unusual work hours [20,34]. Therefore, prevention strategies for musculoskeletal conditions among fishers need to address both individual physical and psychosocial exposures as well as address fishery-wide working conditions.

Both smoking and second-hand smoke exposures were relatively common among fishermen, increasing the risk of smoking-associated health disorders, including musculoskeletal conditions [35–37]. Fishing generally requires continuous work for extended hours that may promote smoking [20,38]. A study in Washington State found significantly higher cigarette and marijuana smoking rates among fishers compared to the general population [4].

Our research had limitations, several of which are inherent in health surveys: uncertainty of diagnosis for reported conditions, and reliance on subjective perceptions. None of the NHIS-OHS or BRFSS surveys were designed to produce representative samples of each occupational category hence the small subsamples for fishermen may have led to unreliable estimates. Moreover, the NHIS-OHS and BRFSS do not survey fishermen independently from professional hunters [15]; though hunters may be relatively rare compared to fishermen since a recent BLS report observed no hunters and trappers amongst the fishing-hunting subcategory [16]. Conducting national surveys with a representative sample of fishermen would be expensive and logistically challenging whereas general population surveys can provide insights with little effort. We could not associate the exposure data with health conditions since NIOSH-WHC charts yielded prevalence estimates but not the individual-level data., BRFSS only included data from the states that voluntarily collected industry and occupation information, which excluded the coastal states of Alaska, Texas, and South Carolina [16].

Despite these limitations, we identified important indicators of health status among US fishermen, including high rates of musculoskeletal conditions. We also identified key aspects of employment conditions, such as the unpredictability of working arrangements and the work itself, which may underlie both exposures and health status. Our review indicates access to health care and health promotion programs should be prioritized. Our findings also demonstrated the utility of national household surveys (i.e., NHIS-OHS, BRFSS) to examine fishermen’s health, though the estimates should be interpreted with caution. A more comprehensive evaluation of available data for individual occupation categories can provide a robust understanding of work-associated health and wellbeing.