Hydration backpacks could reduce heat illness among farm workers

Six days a week, 53-year-old María Hernández wakes up at 5 a.m. to work the farm fields around Salemburg, North Carolina. Having lived with diabetes for decades, she worries about working summers in tobacco fields, where temperatures in the rows can spike above 110°F.

Liz Mizelle (Photo by Ty Huff)

Coming from a farming family in Bertie County, ECU nursing professor Liz Mizelle is well aware of the struggles workers such as Hernández face in the fields. Together with the Roanoke-Chowan Community Health Center in Ahoskie, North Carolina, she came up with the idea of using hydration backpacks to help workers in the trying conditions. And with $324,000 in funding from the National Institute for Occupational Safety and Health, she’s been putting her idea to work in the fields.

Since 1970, North Carolina’s average summer temperatures have risen by 2.3°F. According to the N.C. Division of Public Health, the summer of 2025 was exceptionally brutal, recording 5,748 heat-related emergency room visits between May and September – higher than the previous five-year average. When body temperatures exceed 104°F, heatstroke triggers organ impairment and can be fatal.

“Every summer I have done this research, we have broken more and more records,” she said.

Unfortunately, many workers ignore heat symptoms out of fear of losing their jobs. While employers are required to provide water, workers in vast fields are often too far from the supply to access it easily. In a 2020 study, Mizelle found 46% of outdoor workers were dehydrated before their shift, and 100% were dehydrated by the end.

To counter this, Mizelle launched the hydration backpack experiment. The idea came from her brothers, who used similar backpacks while serving in the military. These $20 systems include a protective backpack and a 2-to-3-quart water bladder with a drinking tube. Mizelle distributed them to 47 male workers as part of a study published in the Journal of Agromedicine in 2024. The results were promising: 90% of participants reported the backpacks helped them stay hydrated, and preliminary 2025 data showed similar success.

However, challenges remain. A full backpack weighs nearly 9 pounds, which could worsen the lower back pain already common among farmworkers. Cost is another barrier; with a minimum wage of $12.78, workers may hesitate to buy them. Mizelle hopes farmers and workers will share the cost, and she advocates for state lawmakers and growers to officially adopt the backpacks to prevent heat illness.

Read more about Mizelle’s heat research at HEAT RESEARCH.