title: Heat stress, health and well-being: findings from a large national cohort of Thai adults.
abstract: OBJECTIVE
  This study aims to examine the association between self-reported heat stress interference with daily activities (sleeping, work, travel, housework and exercise) and three graded-holistic health and well-being outcomes (energy, emotions and life satisfaction).
  
  
  METHODS
  A cross-sectional study.
  
  
  METHODS
  The setting is tropical and developing countries as Thailand, where high temperature and high humidity are common, particularly during the hottest seasons.
  
  
  METHODS
  This study is based on an ongoing national Thai Cohort Study of distance-learning open-university adult students (N=60 569) established in 2005 to study the health-risk transition.
  
  
  METHODS
  Health impacts from heat stress in our study are categorised as physical health impacts (energy levels), mental health impacts (emotions) and well-being (life satisfaction). For each health and well-being outcome we report ORs and 95% CIs using multinomial logistic regression adjusting for a wide array of potential confounders.
  
  
  RESULTS
  Negative health and well-being outcomes (low-energy level, emotional problems and low life satisfaction) associated with increasing frequency of heat stress interfering with daily activities. Adjusted ORs for emotional problems were between 1.5 and 4.8 and in general worse than energy level (between 1.31 and 2.91) and life satisfaction (between 1.10 and 2.49). The worst health outcomes were when heat interfered with sleeping, followed by interference with daily travel, work, housework and exercise.
  
  
  CONCLUSIONS
  In tropical Thailand there already are substantial heat stress impacts on health and well-being. Increasing temperatures from climate change plus the ageing and urbanisation of the population could significantly worsen the situation. There is a need to improve public health surveillance and public awareness regarding the risks of heat stress in daily life.
authors.affiliation: National Centre for Epidemiology and Population Health, ANU College of Medicine, Biology and Environment, the Australian National University, Canberra, Australia.
authors.forename: Benjawan
authors.initials: B
authors.lastname: Tawatsupa
authors.forename: Vasoontara
authors.initials: V
authors.lastname: Yiengprugsawan
authors.forename: Tord
authors.initials: T
authors.lastname: Kjellstrom
authors.forename: Sam-Ang
authors.initials: SA
authors.lastname: Seubsman
authors.forename: Adrian
authors.initials: A
authors.lastname: Sleigh