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The objective of this research was to determine the association between LBP that limited or interrupted fishing work and ergonomic low back stress measured by (1) self-reported task and (2) two ergonomic assessment methods of low back stress.Eligible participants were from a cohort of North Carolina commercial fishermen followed for LBP in regular clinic visits from 1999 to 2001 (n = 177). Work history, including crab pot and gill net fishing task frequency, was evaluated in a telephone questionnaire (n = 105). Ergonomic exposures were measured in previous study of 25 fishermen using two methods. The occurrence rate of LBP that limited or interrupted fishing work since last visit (severe LBP) was evaluated in a generalized Poisson regression model.Predictors of severe LBP included fishing with crew members and a previous history of severe LBP. Among crab pot and gill net fishermen (n = 89), running pullers or net reels, sorting catch, and unloading catch were associated with an increased rate of LBP. Percent of time in forces >20 lb while in non-neutral trunk posture, spine compression > 3,400 N, and National Institute of Occupational Safety and Health lifting indices >3.0 were associated with LBP.Tasks characterized by higher (unloading boat and sorting catch) and lower (running puller or net reel) ergonomic low back stress were associated with the occurrence of severe LBP. History of LBP, addition of crew members, and self-selection out of tasks were likely important contributors to the patterns of low back stress and outcomes we observed. Based on the results of this study, a participatory ergonomic intervention study is currently being conducted to develop tools and equipment to decrease low back stress in commercial crab pot fishing. Am. J. Ind. Med. 52:311-321, 2009. ©2009 Wiley-Liss, Inc.