Background Coccidioidomycosis is an emerging fungal disease caused by inhaling Coccidioides spp. spores. As spores reside in the soil, activities that disturb soil may aerosolize and transport the pathogen, yet the types of activities facilitating transmission remain poorly understood. Methods We conducted a case-crossover study to estimate the association between exposure to new oil and gas wells (ie, those in preproduction) and risk of coccidioidomycosis among nearby residents. We obtained information on coccidioidomycosis cases reported between 2007 and 2022 in Kern County, California — a county among the top in both oil and gas production and coccidioidomycosis incidence. We compared exposure to preproduction wells within 5 km of each patient residence during 'hazard' and 'control' periods using conditional logistic regression. Findings During the study period, 73% of Kern County residents lived within 5 km of at least one preproduction well, and 13% lived within 5 km of ≥23 preproduction wells within a single 90-day period. We estimated that the odds of coccidioidomycosis were 11.0% higher (95% CI: 4.3-18.1%) in the 90 days following exposure to at least one preproduction well within 5 km of the patient residence and that the odds of infection increased by 0.7% (95% CI: 0.4-1.0%) for each additional preproduction well within this distance. Interpretation We identified a previously unrecognized association between oil and gas development and the transmission of an emerging infectious disease. Given the prevalence of oil and gas development in the study region, its impact on coccidioidomycosis incidence there may be large. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by the National Institute of Allergy and Infectious Diseases (Award Number: R01AI148336) ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Committee for Protection of Human Subjects of the California Health and Human Services Agency (CHHS) gave ethical approval for this work (protocol no. 17-05-2993). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The R script used to conduct the data analysis is available in the publicly available GitHub repository: https://github.com/lcouper/OilWellsAndCocci. Human case data are protected health information and can only be obtained by submitting a formal data use request to the California Department of Public Health (CDPH), Infectious Disease Branch, Surveillance and Statistics Section. Oil and gas data are publicly available from the California Geologic Energy Management Division (CalGEM) or through purchase from Enverus, a private data aggregation platform.

The parametric g-formula is a causal inference method that appropriately adjusts for time-varying confounding affected by prior exposure. Like all parametric methods, it assumes correct model specification, usually assessed by comparing the observed outcome with the simulated outcome under no intervention (natural course). However, it is unclear how to evaluate natural course performance and whether other variables should also be considered. We reviewed current practices for evaluating model misspecification in applications of the parametric g-formula. To illustrate the pitfalls of current practices, we then applied the parametric g-formula to examine cardiovascular disease mortality in relation to occupational exposure in the United Autoworkers-General Motors cohort (UAW-GM), comparing 20 parametric model sets and qualitatively assessing natural course performance for all time-varying variables over follow-up. We found that current practices of evaluating model misspecification are often insufficient, increasing risk of bias and statistical cherry-picking. Based on our motivational analyses of the UAW-GM cohort, good natural course performance of the outcome does not guarantee good simulations of other covariates; poor predictions of exposures and covariates may still exist. We recommend reporting natural course performance for all time-varying variables at all time points. Objective criteria for evaluating model misspecification in the parametric g-formula need to be developed.

Wildfires have become more frequent and intense due to climate change and outdoor wildfire fine particulate matter (PM 2.5 ) concentrations differ from relatively smoothly varying total PM 2.5 . Thus, we introduced a conceptual model for computing long-term wildfire PM 2.5 and assessed disproportionate exposures among marginalized communities. We used monitoring data and statistical techniques to characterize annual wildfire PM 2.5 exposure based on intermittent and extreme daily wildfire PM 2.5 concentrations in California census tracts (2006 to 2020). Metrics included: 1) weeks with wildfire PM 2.5 > 5 μg/m 3 ; 2) days with non-zero wildfire PM 2.5 ; 3) mean wildfire PM 2.5 during peak exposure week; 4) smoke waves (≥2 consecutive days with >15 μg/m 3 wildfire PM 2.5 ); and 5) mean annual wildfire PM 2.5 concentration. We classified tracts by their racial/ethnic composition and CalEnviroScreen (CES) score, an environmental and social vulnerability composite measure. We examined associations of CES and racial/ethnic composition with the wildfire PM 2.5 metrics using mixed-effects models. Averaged 2006 to 2020, we detected little difference in exposure by CES score or racial/ethnic composition, except for non-Hispanic American Indian and Alaska Native populations, where a 1-SD increase was associated with higher exposure for 4/5 metrics. CES or racial/ethnic × year interaction term models revealed exposure disparities in some years. Compared to their California-wide representation, the exposed populations of non-Hispanic American Indian and Alaska Native (1.68×, 95% CI: 1.01 to 2.81), white (1.13×, 95% CI: 0.99 to 1.32), and multiracial (1.06×, 95% CI: 0.97 to 1.23) people were over-represented from 2006 to 2020. In conclusion, during our study period in California, we detected disproportionate long-term wildfire PM 2.5 exposure for several racial/ethnic groups.

Air pollution can affect the immune response via epigenetic dysregulation of the cellular system, leading to adverse pregnancy outcomes. There are limited studies on the effects of PM2.5 and how it affects maternal and cord blood immune responses. Moreover, there is no report on the impact of PM2.5 exposure on histone post-translational modifications (HPTMs) at the single-cell resolution. Blood was collected from pregnant women (n = 168) in the second trimester of pregnancy and neonates (n = 33) from the matching mothers, along with non-pregnant women (control group; n = 151). We quantified immune biomarkers from plasma samples and cell-type specific HPTMs from both pregnant and non-pregnant women. Multivariable linear regression and network analysis were used to elucidate the dysregulated components in pregnant women due to high PM2.5 exposure. We found a significant association between PM2.5 exposure and levels of immune biomarkers (IL1RA, IL8/CXCL8, IL18, IL27) and of HPTMs (H3K9ac, H3S10ph, H3K23ac, H4K20me1) at B cells, classical monocytes, and NKT. The impact of PM2.5 differs between pregnant and non-pregnant women. Neonates with high maternal exposure had lower IL27 and higher IL4. Maternal exposure affected co-expression of immune markers between pregnant women and their neonates. Three out of six HPTM interactions were preserved in pregnant women between low vs. high exposure but not in non-pregnant women. Exposure to PM2.5 was significantly associated with pregnancy, and it is due to a competing effect between exposure and the maternal immune response altered during the pregnancy to help prevent adverse pregnancy outcomes.

Objectives: In recent decades, risk of job loss in America after age 50 has been high, potentially causing significant stress during the period preceding retirement. Yet no study has quantified the burden of clinically relevant depressive symptoms attributable to job loss in this age group over this period or identified the most vulnerable populations. Methods: Participants aged 50+ in the Health and Retirement Study (recruited 1992-2016) who were employed and scored <5 on the Center for Epidemiologic Studies-Depression 8-item scale (CESD-8) at baseline (N = 18,571) were followed for depressive symptoms until they first had CESD-8 >= 5 or died, or through the 2018 survey. Parametric g-formula analyses examined the difference in cumulative risk of having CESD-8 >= 5 if there had been no involuntary job loss compared to the observed scenario, adjusting for sex, race/ethnicity, age, and dynamic measures of recent marriage end (divorce or widowhood), having a working spouse, assets/debt, and health changes. Results: We estimated that risk of CESD-8 >= 5 would have been 1.1% (95% confidence interval [0.55, 1.37]) lower if no involuntary job loss had occurred; job loss accounted for 11% of the total burden among those who lost a job. Stronger associations were observed for women (1.2% [0.7, 1.8] vs men 0.5% [0.2, 1.1]), White respondents (1.0% [0.6, 1.5] vs Black respondents 0.5% [-0.1, 1.4]), and those in the lowest quartile of baseline assets (1.1% [0.4, 1.9] vs wealthiest quartile 0.5% [-0.4, 0.9]). Discussion: Involuntary job loss is associated with high depressive symptom burden in older persons, suggesting that screening and intervention soon after job loss may help mitigate depression.

Exposure to high levels of air pollution during pregnancy can negatively impact the health of both mother and fetus; however, the role of the immune system has not been fully investigated. Therefore, we aimed to investigate the effect of PM2.5 exposure, during a 3-month window, in the second trimester of pregnancy on maternal and neonatal immune responses. Using Luminex assays, we quantified cytokines in plasma samples of the neonatal umbilical cord blood (n=33), pregnant women (n=168, age=29±6years) in the second trimester of pregnancy and non-pregnant women (n=151, age=27±8years) who were exposed to varying levels of PM2.5. Multivariable linear regression was used to evaluate an association between PM2.5 exposure during pregnancy and maternal immune responses. Moreover, an interaction term analysis using a standard least squares model was applied to assess the effect modification of an association between the maternal and neonatal immune responses by maternal PM2.5 exposure during pregnancy. We found associations between PM2.5 exposure and levels of the immune biomarkers in pregnant women, including: IL1RA, IL8/CXCL8, and IL18. These associations were negative in pregnant women, but positive in non-pregnant women. Furthermore, PM2.5 exposure during pregnancy was associated with a higher MCP2/CCL8 level in pregnant women compared to their neonates at low levels of exposure, but was increased in neonates at higher exposure levels. We found that short-term (3 months) ambient PM2.5 exposure in pregnant women is associated with pregnancy-specific modulation of plasma levels of immunoregulatory biomarkers, suggesting potential adverse impacts of environmental air pollution that uniquely affect pregnant women.

BACKGROUND:Evidence in the literature suggests that air pollution exposures experienced prenatally and early in life can be detrimental to normal lung development, however the specific timing of critical windows during development is not fully understood. OBJECTIVES:We evaluated air pollution exposures during the prenatal and early-life period in association with lung function at ages 6-9, in an effort to identify potentially influential windows of exposure for lung development. METHODS:Our study population consisted of 222 children aged 6-9 from the Fresno-Clovis metro area in California with spirometry data collected between May 2015 and May 2017. We used distributed-lag non-linear models to flexibly model the exposure-lag-response for monthly average exposure to fine particulate matter (PM2.5) and ozone (O3) during the prenatal months and first three years of life in association with forced vital capacity (FVC), and forced expiratory volume in the first second (FEV1), adjusted for covariates. RESULTS:PM2.5 exposure during the prenatal period and the first 3-years of life was associated with lower FVC and FEV1 assessed at ages 6-9. Specifically, an increase from the 5th percentile of the observed monthly average exposure (7.55 μg/m3) to the median observed exposure (12.69 μg/m3) for the duration of the window was associated with 0.42 L lower FVC (95% confidence interval (CI): -0.82, -0.03) and 0.38 L lower FEV1 (95% CI: -0.75, -0.02). The shape of the lag-response indicated that the second half of pregnancy may be a particularly influential window of exposure. Associations for ozone were not as strong and typically CIs included the null. CONCLUSIONS:Our findings indicate that prenatal and early-life exposures to PM2.5 are associated with decreased lung function later in childhood. Exposures during the latter months of pregnancy may be especially influential.

Previous studies have reported increased risk of specific cancers associated with metalworking fluid (MWF) exposure. This report broadly examines the incidence of fourteen cancer types, with a focus on digestive, respiratory, and hormonal cancers, in the United Autoworkers-General Motors (UAW-GM) cohort exposed to MWFs (1973-2015). The cohort includes 39,132 workers followed for cancer incidence. Cox models yielded estimates of adjusted hazard ratios (HR) with categorical variables for lagged cumulative exposure to three MWF types (straight, soluble, synthetic). Penalized splines were fit to examine the shape of the exposure-response relationships. There were 7,809 incident cancer cases of interest. Oil-based straight and soluble MWF were each modestly associated with all cancers combined. Exposure-response patterns were consistent with prior reports from this cohort and results of splined exposures generally reflected their categorically-modeled counterparts. We found significantly increased incidence of stomach and kidney cancer with higher levels of straight MWF and increased rectal and prostate cancer with increasing water-based synthetic MWF. Only Non-Hodgkin lymphoma and prostate cancer were associated with soluble MWF. All results for colon and lung cancers were null. Our results provide updated evidence for associations between MWF exposure and incidence of several types of cancer.

BACKGROUND:Although recent studies have identified important risk factors associated with incident carpal tunnel syndrome (CTS), risk factors associated with its severity have not been well explored. OBJECTIVE:To examine the associations between personal, workplace psychosocial and biomechanical factors and incident work disability among workers with CTS. METHODS:Between 2001 and 2010 five research groups conducted coordinated prospective studies of CTS and related work disability among US workers from various industries. Workers with prevalent or incident CTS (N=372) were followed for up to 6.4 years. Incident work disability was measured as: (1) change in work pace or work quality, (2) lost time or (3) job change following the development of CTS. Psychosocial factors were assessed by questionnaire. Biomechanical exposures were assessed by observation and measurements and included force, repetition, duty cycle and posture. HRs were estimated using Cox models. RESULTS:Disability incidence rates per 100 person-years were 33.2 for changes in work pace or quality, 16.3 for lost time and 20.0 for job change. There was a near doubling of risk for job change among those in the upper tertile of the Hand Activity Level Scale (HR 2.17; 95% CI 1.17 to 4.01), total repetition rate (HR 1.75; 95% CI 1.02 to 3.02), % time spent in all hand exertions (HR 2.20; 95% CI 1.21 to 4.01) and a sixfold increase for high job strain. Sensitivity analyses indicated attenuation due to inclusion of the prevalent CTS cases. CONCLUSION:Personal, biomechanical and psychosocial job factors predicted CTS-related disability. Results suggest that prevention of severe disability requires a reduction of both biomechanical and organisational work stressors.

Background Coccidioidomycosis is an emerging infection in the southwestern United States. We examined the effects of precipitation and temperature on the incidence of coccidioidomycosis in California during 2000-2020, and estimated incident cases attributable to the California droughts of 2007-09 and 2012-15. Methods We analyzed monthly California coccidioidomycosis surveillance data from 2000-2020 at the census tract-level using generalized additive models. Models included distributed lags of precipitation and temperature within each endemic county, pooled using fixed-effects meta-analysis. An ensemble prediction algorithm of incident cases per census tract was developed to estimate the impact of drought on expected cases. Results Across 14 counties examined, coccidioidomycosis was strongly suppressed during, and amplified following, the 2007-2009 and 2012-2015 droughts. An estimated excess of 1,358 and 2,461 drought-attributable cases were observed in California in the two years following the 2007-2009 and 2012-2015 droughts, respectively. These post-drought excess cases more than offset the drought-attributable declines of 1,126 and 2,192 cases, respectively, that occurred during the 2007-2009 and 2012-2015 droughts. Across counties, a temperature increase from the 25th to 75th percentile (interquartile range) in the summer was associated with a doubling of incidence in the following fall (incidence rate ratio (IRR): 2.02, 95% CI: 1.84, 2.22), and a one IQR increase in precipitation in the winter was associated with 1.45 (95% CI: 1.36, 1.55) times higher incidence in the fall. The effect of winter precipitation was stronger (interaction coefficient representing ratio of IRRs: 1.36, 95% CI: 1.25, 1.48) when preceded by two dry rather than average winters. Incidence in arid lower San Joaquin Valley counties was most sensitive to winter precipitation fluctuations, while incidence in wetter coastal counties was most sensitive to summer temperature fluctuations. Conclusions In California, wet winters along with hot summers, particularly those following previous dry years, increased risk of coccidioidomycosis in California. Drought conditions may suppress incidence, then amplify incidence in subsequent years. With anticipated increasing frequency of drought in California, continued expansion of incidence, particularly in wetter, coastal regions, is expected.

Introduction The highest suicide rates in the U.S. have been found among males in construction, mining, and extraction occupations. In recent years, the rate has increased dramatically, which may reflect the lack of economic opportunities for miners. Objectives We examined the impact of job loss, both permanent and temporary, on risk of suicide and overdose among a cohort of 11,817 male miners from the Diesel Exhaust in Miners Study II. Methods We calculated directly standardized age-adjusted incidence rates per 100,000 person-years from 1947 through 2015 by calendar period. We fit Cox models to estimate hazard ratios (HRs) for suicide and overdose in relation to leaving work, age at leaving work, and intermittent time-off work. Separate models were fit for job loss pre- and post-1980 to examine effect modification by time period as the industry curtailed its workforce in the early 1980s. Results The age-adjusted incidence suicide/overdose death rate was 64.7 (95% CI: 56.4, 73.9) per 100,000. Suicide deaths peaked between 1980 and 1989 at 67.2 before declining. Based on 248 suicides and overdoses, miners who left work were more likely to die by suicide/overdose compared to those remained at work (HR 1.59 (95% CI: 1.10, 2.29)). Effect modification by decade was present as the HRs for suicide/overdose and age at leaving work differed significantly between the stratified analyses (job loss pre-1980 vs. post-1980). Among miners who left work prior to 1980, HRs for age at leaving work and suicide/overdose were null. Yet, among miners with post-1980 job loss, leaving work before age 30 and between ages 30–40 increased the risk of suicide/overdose compared with leaving work after age 55 (1.94 (1.05, 3.58) and 1.46 (0.78, 2.72), respectively). Conclusions Our results suggest an elevated risk of suicide among male miners in the 1980s, and that the risk increases after leaving work.

The recently revised ACGIH TLV for Hand Activity (TLV2018) is a widely used tool for assessing risk for upper limb musculoskeletal disorders. The purpose of this analysis was to compare the strength of the exposure-response relationships between the TLV2018 and carpal tunnel syndrome (CTS) between men and women and across age strata. Heterogeneity of the effect size by sex or age would be important to specialists using the method for prevention of CTS among working populations. Data from two large prospective studies were combined to allow for stratification of exposure-response models assessing the association between the TLV2018 and CTS by gender and age. Results show greater risk for women than men and for younger workers than older workers for TLV2018 values above the action limit. Although the TLV2018 is an effective surveillance tool for estimating increased risk of CTS with increasing exposure, these analyses show that such increase are not homogeneous across sex and age.

Introduction Metalworking fluids (MWF) are complex mixtures of oils and chemical additives used to cool and lubricate metal machining operations. Previous studies have reported increased risk of specific cancers associated with MWF exposure. Objectives This report broadly examines cancer incidence in the United Auto Workers-General Motors (UAW-GM) cohort exposed to MWFs with extended follow-up (through 2015). The outcomes of interest were melanoma, leukemia, non-Hodgkin lymphoma and cancers of the colon, rectum, pancreas, esophagus, stomach, larynx, lung and bronchus, breast, prostate, kidney and renal pelvis, and bladder. Methods The cohort includes 39,132 workers followed for cancer incidence in Detroit area Surveillance, Epidemiology, and End Results Program (SEER) and Michigan cancer registries, from 1973–2015. Cox models yielded estimates of adjusted hazard ratios (HR) with categorical variables for lagged cumulative exposure to each MWF (straight, soluble, and synthetic). Results There were 7,809 cancer cases of interest. Over 43 years of follow-up, the incidence of several types of cancers was significantly elevated in relation to at least one type of MWF; exposure–response patterns were consistent with prior reports from this cohort. We found significantly increased incidence of stomach and kidney cancer associated with higher levels of straight fluid exposure and increased rectal and pancreatic cancer with increasing synthetic fluid exposure. Only Non-Hodgkin lymphoma was associated with soluble MWF, with HRs significantly elevated in the highest exposure category at 1.70 (95% Confidence Interval (CI): 1.13–2.54). Conclusions Our results provide further evidence of associations between MWF exposure and several types of cancer. This study summarizes information on the incidence of the fourteen cancer types with reduced bias from both the healthy worker hire effect and left truncation. However, the HRs presented do not address potential downward bias from the healthy worker survivor effect which may be necessary to correct in future targeted analyses.

Respiratory effects of work in retail food stores: 11 Respiratory symptoms. Scand J Work Environ Health 13 (1987) 209-212. This study ex amined the relationships between the prevalence of respiratory tract symptoms and estimates of environ mental exposures in retail food stores, in particular exposures to emissions from the cutting of polyvinyl chloride wrap. When respiratory symptoms were compared with a measure of cumulative exposure, there was evidence that the prevalence of symptoms of episodic airway narrowing was higher for workers who had been exposed directly or indirectly to meat wrapping operations independent of a significant associa tion of these symptoms with allergic or asthmatic history. Whether this finding reflects a nonspecific irri tant effect or allergic sensitization cannot be determined from these data. No single substance present in the work environment studied has, as yet, been identified as associated with these effects .

Background Relatively few studies have examined the effects of layoffs on remaining workers, although the effects of layoffs and downsizing events may extend beyond those employees who lose their jobs. Methods We examined the effects of layoffs on mental healthcare utilisation and injury risk among workers at 30 US plants between 2003 and 2013. We defined layoffs as reductions in the hourly workforce of 20% or more at each plant. Using a difference-in-differences approach, we compared the change in outcomes during layoffs versus the same 3-month period 1year previously, accounting for secular trends with control plants. Results Our study population included 15502 workers and 7 layoff events between 2003 and 2013. Layoffs were associated with only minor decreases in injuries (-0.006, 95%CI -0.013 to 0.001). The probability of outpatient visits related to mental health increased by 1% during layoffs (0.010, 95%CI 0.003 to 0.017), and the probability of mental health-related prescriptions increased by 1.4% (0.014, 95%CI -0.0006 to 0.027). Among women, the increase in outpatient visits was more pronounced (0.017, 95%CI 0.003 to 0.031). Increased prescription utilisation appeared attributable primarily to opioid use (0.016, 95%CI 0.005 to 0.027). Conclusion Our results indicate an association between layoffs and remaining workers' mental health and safety, although changes mental healthcare utilisation may reflect both changes in underlying mental health and changes in care-seeking. Future research on concordance of service utilisation and underlying health may yield valuable insight into the experiences employed workers in the wake of layoffs.

IntroductionShort-term disability leave can be considered as a measure of not being well enough to work. The American Manufacturing Cohort, followed 1996–2013, consists of employees of a light-metal company that provided short-term disability insurance to all employees: coverage to replace wages for up to 6 months of work absence due to medical issues. We hypothesized that since brief short-term disability leave allows workers time to recover from illness or injury without losing their jobs, it should be protective against employment termination.MethodsWe analyzed 18 386 (83% male, 80% white) hourly employees. We censored workers once their accumulated disability leave exceeded 6 weeks because longer time spent on short-term disability leave suggests more serious illness or injury that may prevent return to work. To analyze the effect of short-term disability leave on employment termination, we applied a marginal structural pooled logistic model that allowed for a time-varying hazard function. We adjusted for time-varying confounding by occupational exposures and health-related variables using inverse probability weighting. Using the estimated coefficients, we compared the predicted probabilities (by person-month) of terminating employment with the corresponding counterfactual probabilities if the worker had never taken disability leave. These probabilities yielded estimated survival curves under the two scenarios.ResultsThe average worker was followed for 5.5 years. Approximately 42% of the workers took at least one day of disability leave, and 48% terminated employment during follow-up. We estimated that 1058 (29%) more workers would have terminated employment within 5 years from cohort entry if the company had had no disability leave benefit than were predicted under the natural course.ConclusionShort-term disability leave is a potentially relevant health variable for occupational epidemiologists. This analysis suggests that short-term disability leave can help employees retain their jobs when a temporary health issue prevents them from working.

BackgroundRelatively few studies have examined the effects of layoffs on remaining workers, although the effects of layoffs and downsizing events may extend beyond those employees who lose their jobs.MethodsWe examined the effects of layoffs on mental healthcare utilization and injury risk among workers at 30 U.S. plants between 2003 and 2013. We defined layoffs as reductions in the hourly workforce of 20% or more at each plant. Using a difference-in-differences approach, we compared the change in outcomes during layoffs versus the same three-month period one year previously, accounting for secular trends with control plants.ResultsOur study population included 15 502 workers and seven layoff events between 2003 and 2012. Layoffs were associated with decreases in reported injuries (−0.006, 95% CI −0.013, 0.001), and increased probability of outpatient visits (0.010, 95% CI 0.003, 0.017) and prescriptions (0.014, 95% CI −0.0006, 0.027) for mental health. Among men, injury risk decreased more substantially (−0.010, 95% CI −0.018,–0.001) and among women the increase in outpatient visits was more pronounced (0.017, 95% CI 0.003, 0.031). Most notably, the observed increase in prescription utilization appeared attributable primarily to increased frequency of opioid prescriptions (0.016 95% CI 0.005–0.027).ConclusionOur results indicate an association between layoffs and remaining workers’ mental health and safety. However, decreased injury may reflect changes in reporting practices, and changes mental healthcare utilization may reflect changes in care-seeking. Future research on concordance of service utilization and underlying health and safety may yield valuable insight into the experiences employed workers in the wake of layoffs.