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<article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" dtd-version="1.3" xml:lang="en" article-type="research-article"><?properties open_access?><?properties manuscript?><processing-meta base-tagset="archiving" mathml-version="3.0" table-model="xhtml" tagset-family="jats"><restricted-by>pmc</restricted-by></processing-meta><front><journal-meta><journal-id journal-id-type="nlm-journal-id">101189458</journal-id><journal-id journal-id-type="pubmed-jr-id">31897</journal-id><journal-id journal-id-type="nlm-ta">J Occup Environ Hyg</journal-id><journal-id journal-id-type="iso-abbrev">J Occup Environ Hyg</journal-id><journal-title-group><journal-title>Journal of occupational and environmental hygiene</journal-title></journal-title-group><issn pub-type="ppub">1545-9624</issn><issn pub-type="epub">1545-9632</issn></journal-meta><article-meta><article-id pub-id-type="pmid">37104117</article-id><article-id pub-id-type="pmc">10443088</article-id><article-id pub-id-type="doi">10.1080/15459624.2023.2205468</article-id><article-id pub-id-type="manuscript">HHSPA1925102</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Updated assessment of occupational safety and health hazards of climate change</article-title></title-group><contrib-group><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0002-0696-0446</contrib-id><name><surname>Schulte</surname><given-names>P. A.</given-names></name><xref rid="A1" ref-type="aff">a</xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0001-9529-6470</contrib-id><name><surname>Jacklitsch</surname><given-names>B. L.</given-names></name><xref rid="A2" ref-type="aff">b</xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0002-4986-5895</contrib-id><name><surname>Bhattacharya</surname><given-names>A.</given-names></name><xref rid="A2" ref-type="aff">b</xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0002-1031-6514</contrib-id><name><surname>Chun</surname><given-names>H.</given-names></name><xref rid="A3" ref-type="aff">c</xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0001-9457-0992</contrib-id><name><surname>Edwards</surname><given-names>N.</given-names></name><xref rid="A4" ref-type="aff">d</xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0002-4054-573X</contrib-id><name><surname>Elliott</surname><given-names>K. C.</given-names></name><xref rid="A5" ref-type="aff">e</xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0001-5338-5360</contrib-id><name><surname>Flynn</surname><given-names>M. A.</given-names></name><xref rid="A2" ref-type="aff">b</xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0001-6841-462X</contrib-id><name><surname>Guerin</surname><given-names>R.</given-names></name><xref rid="A2" ref-type="aff">b</xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0003-3878-8668</contrib-id><name><surname>Hodson</surname><given-names>L.</given-names></name><xref rid="A6" ref-type="aff">f</xref></contrib><contrib contrib-type="author"><name><surname>Lincoln</surname><given-names>J. M.</given-names></name><xref rid="A2" ref-type="aff">b</xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0003-0257-3630</contrib-id><name><surname>MacMahon</surname><given-names>K. L.</given-names></name><xref rid="A2" ref-type="aff">b</xref></contrib><contrib contrib-type="author"><name><surname>Pendergrass</surname><given-names>S.</given-names></name><xref rid="A6" ref-type="aff">f</xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0003-4553-3137</contrib-id><name><surname>Siven</surname><given-names>J.</given-names></name><xref rid="A2" ref-type="aff">b</xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0003-3370-8737</contrib-id><name><surname>Vietas</surname><given-names>J.</given-names></name><xref rid="A2" ref-type="aff">b</xref></contrib></contrib-group><aff id="A1"><label>a</label>Advanced Technologies and Laboratories International, Inc, Cincinnati, Ohio;</aff><aff id="A2"><label>b</label>Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio;</aff><aff id="A3"><label>c</label>Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Atlanta, Georgia;</aff><aff id="A4"><label>d</label>Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Morgantown, West Virginia;</aff><aff id="A5"><label>e</label>Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Anchorage, Alaska;</aff><aff id="A6"><label>f</label>Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH) (retired), Cincinnati, Ohio</aff><author-notes><corresp id="CR1"><bold>CONTACT</bold> B. L. Jacklitsch <email>gwe6@cdc.gov</email> Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), 1090 Tusculum Avenue, Cincinnati, OH 45226.</corresp></author-notes><pub-date pub-type="nihms-submitted"><day>16</day><month>8</month><year>2023</year></pub-date><pub-date pub-type="ppub"><season>May-Jun</season><year>2023</year></pub-date><pub-date pub-type="epub"><day>02</day><month>6</month><year>2023</year></pub-date><pub-date pub-type="pmc-release"><day>22</day><month>8</month><year>2023</year></pub-date><volume>20</volume><issue>5-6</issue><fpage>183</fpage><lpage>206</lpage><permissions><license><ali:license_ref xmlns:ali="http://www.niso.org/schemas/ali/1.0/" specific-use="textmining" content-type="ccbyncndlicense">https://creativecommons.org/licenses/by-nc-nd/4.0/</ali:license_ref><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (<ext-link ext-link-type="uri" xlink:href="https://creativecommons.org/licenses/by-nc-nd/4.0/">http://creativecommons.org/licenses/by-nc-nd/4.0/</ext-link>), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent.</license-p></license></permissions><abstract id="ABS1"><p id="P1">Workers, particularly outdoor workers, are among the populations most disproportionately affected by climate-related hazards. However, scientific research and control actions to comprehensively address these hazards are notably absent. To assess this absence, a seven-category framework was developed in 2009 to characterize the scientific literature published from 1988&#x02013;2008. Using this framework, a second assessment examined the literature published through 2014, and the current one examines literature from 2014&#x02013;2021. The objectives were to present literature that updates the framework and related topics and increases awareness of the role of climate change in occupational safety and health. In general, there is substantial literature on worker hazards related to ambient temperatures, biological hazards, and extreme weather but less on air pollution, ultraviolet radiation, industrial transitions, and the built environment. There is growing literature on mental health and health equity issues related to climate change, but much more research is needed. The socioeconomic impacts of climate change also require more research. This study illustrates that workers are experiencing increased morbidity and mortality related to climate change. In all areas of climate-related worker risk, including geoengineering, research is needed on the causality and prevalence of hazards, along with surveillance to identify, and interventions for hazard prevention and control.</p></abstract><kwd-group><kwd>Health equity</kwd><kwd>heat</kwd><kwd>mortality</kwd><kwd>productivity</kwd><kwd>work</kwd></kwd-group></article-meta></front><body><sec id="S1"><title>Introduction</title><p id="P2">Climate and weather patterns are changing (<xref rid="R57" ref-type="bibr">Dahl et al. 2019b</xref>; <xref rid="R147" ref-type="bibr">Moda et al. 2019</xref>; <xref rid="R107" ref-type="bibr">IPCC 2021</xref>). As a result, the burden of climate change on workers is increasing (<xref rid="R116" ref-type="bibr">Kim and Lee 2020</xref>). However, the attention on this burden in the occupational safety and health (OSH) field, the media, and state and business action plans is limited (<xref rid="R48" ref-type="bibr">Constible et al. 2020</xref>; <xref rid="R220" ref-type="bibr">Toivanen and Uusitalo 2022</xref>). Identifying how all worker populations may be at increasing yet variable risk of adverse effects is essential to implementing preventive measures.</p><p id="P3">Workers are one of the first societal groups exposed to climate-related hazards. Their exposure may be longer and greater than for the rest of the population because often work environments are difficult to modify, work must continue, and tasks must be completed despite changes in climate and weather. Consequently, morbidity, mortality, and injury rates related to climate change hazards appear to be increasing, as is the economic burden (<xref rid="R94" ref-type="bibr">Gubernot et al. 2015</xref>; <xref rid="R67" ref-type="bibr">Dong et al. 2019</xref>; <xref rid="R120" ref-type="bibr">Kjellstrom et al. 2019</xref>; <xref rid="R186" ref-type="bibr">Pradhan et al. 2019</xref>; <xref rid="R64" ref-type="bibr">Dillender 2021</xref>).</p><p id="P4">Historically, no systematic, comprehensive means of identifying OSH hazards from climate change existed. To address this deficit, <xref rid="R198" ref-type="bibr">Schulte and Chun (2009)</xref> reviewed the scientific literature published from 1988&#x02013;2008 to develop a framework that identified these seven categories of climate hazards: (1) increased ambient temperature; (2) air pollution; (3) ultraviolet exposure; (4) extreme weather; (5) vector-borne diseases and expanded habitats; (6) industrial transitions and emerging industries; and (7) changes in the built environment (<xref rid="F1" ref-type="fig">Figure 1</xref>). Workers will likely be exposed to more than one of these hazards, at the same time or at various times, and cumulative effects will probably occur (<xref rid="R226" ref-type="bibr">US EPA 2003</xref>). In 2016, the literature on the framework was updated for 2008&#x02013;2014 (<xref rid="R197" ref-type="bibr">Schulte et al. 2016</xref>), and additional topics related to OSH were considered, including mental health effects, economic burden, and geoengineering. These additional topics are related to the framework and crosscut each of the hazard categories. Additionally, <xref rid="R197" ref-type="bibr">Schulte et al. (2016)</xref> addressed key priorities for actions to better characterize and understand the relationship between climate change and worker health and safety issues. These priorities included research, surveillance, risk assessment, and management. A detailed review of research priority needs was also presented (<xref rid="R197" ref-type="bibr">Schulte et al. 2016</xref>). The current update presents further information from 2014&#x02013;2021.</p></sec><sec id="S2"><title>Methods</title><p id="P5">Building on the previous assessments during 1988&#x02013;008 and 2009&#x02013;2014, this paper updates the literature further during 2014&#x02013;2021 with new studies of climate change&#x02013;related adverse effects that workers experience on the job (<xref rid="F2" ref-type="fig">Figure 2</xref>). The literature update involved searching databases (PubMed, Scopus, PsychInfo, Social Services Abstracts, Sociology Abstracts, ABI Inform, Agricultural &#x00026; Environmental Science Collection, Safety Lit, and GreenFILE) for English-language articles. The keywords were variations of the seven category names for climate-related occupational hazards. The authors used ad hoc searches and snowball techniques to supplement searches of scientific and gray literature. They reviewed the titles and abstracts from the searches and included literature that added new information to the climate hazard categories or the knowledge base for hazard protection and control. The searches also addressed crosscutting issues that the authors considered critical: mental health implications, economic burden, equity issues, and the potential impact on workers of geoengineering. Because of the vast, wide-ranging relevant literature, this article scans the horizon rather than presenting a systematic review (<xref rid="R213" ref-type="bibr">Streit et al. 2021</xref>). For each of the categories in the framework, the authors characterized the literature in terms of hazards and controls. In addition, they addressed new information illustrating the importance of the critical crosscutting topics listed above.</p></sec><sec id="S3"><title>Results: occupational health hazards and effects related to climate change&#x02014;2014&#x02013;2021</title><sec id="S4"><title>Increased ambient temperatures</title><sec id="S5"><title>Hazard update</title><p id="P6">One of the most commonly identified and discussed effects of climate change is increasing ambient temperatures and the resulting additional heat burden placed on populations. Heat stress has long been a major concern for many worker populations, both outdoors and indoors (<xref rid="R119" ref-type="bibr">Kjellstrom et al. 2009</xref>; <xref rid="R198" ref-type="bibr">Schulte and Chun 2009</xref>; <xref rid="R9" ref-type="bibr">Arbury et al. 2014</xref>; <xref rid="R8" ref-type="bibr">Applebaum et al. 2016</xref>; <xref rid="R48" ref-type="bibr">Constible et al. 2020</xref>; <xref rid="R179" ref-type="bibr">Park et al. 2021</xref>). In the United States, outdoor workers are expected to experience a three- to four-fold increase in the number of days with a heat index of above 100 &#x000b0;F (38 &#x000b0;C) by the mid-2000s (<xref rid="R56" ref-type="bibr">Dahl et al. 2019a</xref>; <xref rid="R57" ref-type="bibr">Dahl et al. 2019b</xref>). The heat index is an indicator of heat discomfort and is also known as apparent temperature, which considers temperature and humidity interactions and the associated perceived equivalent (apparent) temperature. It feels hotter than its reported temperature on a thermometer when ambient humidity is high because increasing levels of humidity decrease the water vapor partial pressure gradient between the skin and air, restricting the evaporative process of sweat. Higher humidities and ambient temperatures that exceed the temperature of the skin (approximately 95 &#x000b0;F (35 &#x000b0;C)) result in a net heat gain because sweat does not readily evaporate, interfering with the body&#x02019;s ability for cooling via evaporation of sweat (<xref rid="R127" ref-type="bibr">Larra&#x000f1;aga and Wang 2012</xref>).</p><p id="P7">Outdoor workers such as those in construction, agriculture, and landscaping are at the highest risk of adverse effects from increased ambient temperatures. Many of those work activities are labor intensive, which can cause the body to generate excessive heat (<xref rid="R161" ref-type="bibr">NIOSH 2016</xref>). A substantial proportion of heat-related fatalities occur during the first day on the job, which emphasizes the importance of acclimatization (<xref rid="R9" ref-type="bibr">Arbury et al. 2014</xref>). From 1992&#x02013;2016, 285 construction workers died from heat-related causes, accounting for more than one-third of all U.S. occupational deaths related to heat exposure (<xref rid="R67" ref-type="bibr">Dong et al. 2019</xref>). A study of construction workers in Washington State found a 0.5% increase in the chances of experiencing traumatic injuries per 1 &#x000b0;C increase in maximum daily humidex (a mean of how hot it feels that combines temperature and humidity) (<xref rid="R32" ref-type="bibr">Calkins et al. 2019</xref>). A review of existing epidemiological research on heat stress and construction workers in the United States and internationally found that heat-related health effects among construction workers were a significant but understudied topic (<xref rid="R3" ref-type="bibr">Acharya et al. 2018</xref>).</p><p id="P8">Populations disproportionately affected by heat stress include foreign-born workers, particularly because many work outdoors and in industries such as agriculture, construction, and services. In a review of Nepali migrant construction workers in Qatar, investigators estimated that 200 of the 571 deaths during 2009&#x02013;2017 could have been prevented if effective heat-protective measures had been implemented as part of local OSH programs (<xref rid="R186" ref-type="bibr">Pradhan et al. 2019</xref>). It can be difficult to determine whether a worker&#x02019;s death is heat-related (for example, causes of death are often poorly described, e.g., &#x0201c;cardiac arrest&#x0201d;) and whether the implementation of useful controls has been inadequate (<xref rid="R186" ref-type="bibr">Pradhan et al. 2019</xref>).</p><p id="P9">Agricultural workers are another group at high risk of experiencing adverse health effects caused by extreme heat. As the average ambient temperature increases, farmworkers have been shown to experience an increase in heat-related events leading to morbidity and mortality (<xref rid="R94" ref-type="bibr">Gubernot et al. 2015</xref>; <xref rid="R101" ref-type="bibr">Hesketh et al. 2020</xref>). Likewise, agriculture workers may be at increased risk for traumatic injury when working in elevated and extreme temperatures (<xref rid="R208" ref-type="bibr">Spector et al. 2016</xref>). However, more research is needed to understand the relationship between traumatic injury risks and higher temperatures.</p><p id="P10">Roughly 20% of heat-related deaths reported to the Occupational Safety and Health Administration (OSHA) are in the Agriculture, Fishing, and Forestry sector (<xref rid="R94" ref-type="bibr">Gubernot et al. 2015</xref>; <xref rid="R149" ref-type="bibr">Morris et al. 2019</xref>). A study of workers&#x02019; compensation claims in Washington State during 2006&#x02013;2017 found that Hispanic workers, as well as agriculture and public administration workers, were disproportionately represented in heat-related illness (HRI) cases. Furthermore, many of these cases occurred below the state&#x02019;s 89 &#x000b0;F (31.7 &#x000b0;C) heat rule (<xref rid="R101" ref-type="bibr">Hesketh et al. 2020</xref>). <xref rid="R126" ref-type="bibr">Langer et al. (2021)</xref> concluded that even when farm workers reported compliance with California OSHA (Cal/OSHA) regulations, worker training and hydration replacement were not sufficient to prevent HRI, especially during work at a fast rate.</p><p id="P11">Extreme heat exposure is linked to chronic kidney disease (CKD). The literature shows an increase in the prevalence of kidney disease among agricultural and construction workers, especially in hot regions (<xref rid="R186" ref-type="bibr">Pradhan et al. 2019</xref>; <xref rid="R203" ref-type="bibr">Shih 2023</xref>). Sugarcane work is known to be associated with this disease (<xref rid="R188" ref-type="bibr">Pundee et al. 2021</xref>). However, although the cause(s) of the disease are unknown, at least one group has suggested heat stress nephropathy may be a driver of CKD of unknown etiology as climate change contributes to rising temperatures (<xref rid="R89" ref-type="bibr">Glaser et al. 2016</xref>).</p></sec><sec id="S6"><title>Control update</title><p id="P12">In 2016, the National Institute for Occupational Safety and Health (NIOSH) published an updated guidance document, the NIOSH Criteria for a Recommended Standard: Occupational Exposure to Heat and Hot Environments (<xref rid="R161" ref-type="bibr">NIOSH 2016</xref>). This document, along with stakeholder efforts and the recognition that heat continues to cause heat-related deaths, illnesses, and injuries in working populations, has led to a major push in the United States for a federally mandated occupational heat standard.</p><p id="P13">Currently, there is no OSHA federal heat standard requiring employers to abide by defined rules for heat safety at their workplaces. A few state OSHA programs, such as Cal/OSHA, have implemented heat standards for employers (<xref rid="R30" ref-type="bibr">Cal/OSHA 2005</xref>). In 2021, additional state OSHA programs, recognizing the increasingly extreme temperatures being experienced by workers, created temporary or emergency heat standards (<xref rid="R172" ref-type="bibr">Oregon 2021</xref>; <xref rid="R242" ref-type="bibr">Washington State Department of Labor and Industries 2021</xref>). In addition, OSHA announced plans to launch a rulemaking process to develop a workplace heat standard (<xref rid="R175" ref-type="bibr">OSHA. 2021</xref>). Setting a federal standard for occupational heat stress is an important step toward protecting workers. As previously recognized, many workers are at additional risk of HRIs, not only from environmental exposures (temperature, humidity, direct sun) but also from the exertion of work activities and from wearing necessary personal protective equipment and clothing (<xref rid="R161" ref-type="bibr">NIOSH 2016</xref>).</p><p id="P14">The need for acclimatization programs has been previously recognized in the literature (<xref rid="R9" ref-type="bibr">Arbury et al. 2014</xref>; <xref rid="R197" ref-type="bibr">Schulte et al. 2016</xref>; <xref rid="R150" ref-type="bibr">Morrissey et al. 2021</xref>). However, acclimatization provides little protection for workers during heat waves or other extreme heat events, when temperatures rise too quickly for them to physiologically adjust to working in suddenly hotter environments. For this reason, steps should be taken by employers to implement a heat alert plan that will increase the precautions taken to protect workers during heat waves (<xref rid="R161" ref-type="bibr">NIOSH 2016</xref>).</p><p id="P15">There are several factors associated with heat stress on the body, including clothing, physical fitness level, and activity. Other factors are environmental: relative air velocity, mean radiant temperature, air temperature, and air relative humidity (<xref rid="R177" ref-type="bibr">Pal et al. 2021</xref>). Modifiable factors include providing proper shade, drinking water, and other cooling mechanisms, as well as increasing awareness and prevention training. Agriculture workers have been found to benefit from taking regular breaks and having shifts adjusted to the coolest part of the day. However, shift adjustments must be balanced with controls for sleep disruption and deprivation. Piece-rate payment in agriculture has been associated with an increased risk for HRI (<xref rid="R209" ref-type="bibr">Spector et al. 2015</xref>). The effects of increased heat exposure are also disproportionately borne by foreign-born, migrant, seasonal, and rural workers, who are employed in sectors that work predominantly outside (<xref rid="R151" ref-type="bibr">Moyce and Schenker 2017</xref>).</p><p id="P16">The National Weather Service has created a Weather-Ready Nation Strategic Plan that includes a national early warning system for extreme heat, heat metrics developed with the support of public health research, and a national outline for the systematic tracking of reliable data on extreme heat and HRI (<xref rid="R164" ref-type="bibr">NWS 2020</xref>). Furthermore, the plan explains the importance of developing measures to enhance resilience and targeted interventions to manage extreme heat in the United States.</p></sec></sec><sec id="S7"><title>Air pollution</title><sec id="S8"><title>Hazard update</title><p id="P17">Although numerous studies have captured the negative health impact on the general population of ambient air pollutants, primarily ozone and PM2.5 (particles with a diameter of 2.5 mm or less), few have captured the long-term impact of air pollution due to climate change on worker health (<xref rid="R111" ref-type="bibr">Karita et al. 2001</xref>; <xref rid="R152" ref-type="bibr">Muhammad et al. 2014</xref>). Available studies show that the increasing impact of climate change on levels of air pollutants will disproportionately impact outdoor workers with increased exposure to PM2.5 (<xref rid="R118" ref-type="bibr">Kinney 2018</xref>), ozone (<xref rid="R237" ref-type="bibr">Vinikoor-Imler et al. 2014</xref>; <xref rid="R5" ref-type="bibr">Adam-Poupart et al. 2015</xref>; <xref rid="R35" ref-type="bibr">Carvalho et al. 2018</xref>; <xref rid="R194" ref-type="bibr">Schifano et al. 2019</xref>; <xref rid="R216" ref-type="bibr">Tang et al. 2021</xref>), and allergens (<xref rid="R128" ref-type="bibr">Lee et al. 2021</xref>). The impact of these exposures is often heightened by the physical demands related to many outdoor occupations (<xref rid="R229" ref-type="bibr">US EPA 2020</xref>). Exposure to nitrogen dioxide (NO<sub>2</sub>), mainly in warm months, was associated with work-related injuries, and exposure to PM10 (particles with a diameter of 10 mm or less), sulfur dioxide (SO<sub>2</sub>), and NO<sub>2</sub> was associated with hyperuricemia in traffic police officers (<xref rid="R216" ref-type="bibr">Tang et al. 2021</xref>).</p><p id="P18">Ambient ozone exposures are expected to continue to increase in the United States, particularly affecting outdoor workers (<xref rid="R77" ref-type="bibr">Fann et al. 2015</xref>). The health impacts of ambient ozone are both acute and chronic (<xref rid="R8" ref-type="bibr">Applebaum et al. 2016</xref>). The effects of acute and ambient ozone exposure can occur in healthy adults at concentrations lower than the U.S. occupational limit of 100 parts per billion (ppb) (<xref rid="R8" ref-type="bibr">Applebaum et al. 2016</xref>; <xref rid="R118" ref-type="bibr">Kinney 2018</xref>; <xref rid="R176" ref-type="bibr">OSHA 2022</xref>). In 2020, the EPA completed its review of the body of available scientific evidence and exposure/risk information and decided to retain the existing ozone National Ambient Air Quality Standard (NAAQS) of 70 ppb (<xref rid="R75" ref-type="bibr">EPA 2020</xref>). This applies to tropospheric ozone, which is the ground layer closest to the earth, as opposed to upper-level or stratospheric ozone.</p><p id="P19">One of the most studied groups with increased adverse health risks due to climate change and air pollution is wildland firefighters. The primary exposure of concern to this cohort is PM2.5 (<xref rid="R228" ref-type="bibr">US EPA 2019</xref>), however, there are many additional pollutants of concern, including ozone, polycyclic aromatic hydrocarbons, and aldehydes (<xref rid="R6" ref-type="bibr">Adetona et al. 2016</xref>; <xref rid="R248" ref-type="bibr">Wu et al. 2020</xref>). Although there are many measures of wildland firefighter exposure and acute effects, the long-term impact of exposure is not well studied or understood (<xref rid="R6" ref-type="bibr">Adetona et al. 2016</xref>). A consistent trend across the limited studies shows declines in lung function when post-season and pre-season values are compared (<xref rid="R22" ref-type="bibr">Betchley et al. 1997</xref>; <xref rid="R146" ref-type="bibr">Miranda et al. 2012</xref>), but the long-term impact is uncertain. Further evaluation of significant clinical health endpoints in this population is needed.</p></sec><sec id="S9"><title>Control update</title><p id="P20">Conventional workplace measures to prevent worker exposure to air pollution, such as engineering controls, encapsulation, and ventilation, are not applicable in the outdoor environment, and employers and workers may not have control over sources of air pollution (<xref rid="R244" ref-type="bibr">WHO 2018</xref>). Still, some measures can be taken to protect outdoor workers from ambient air pollution, such as reducing time spent outdoors; rotating workers; restricting work during times of severe air pollution; using a respiratory protection program, medical surveillance, and case reporting; and supporting the development of air quality standards (<xref rid="R244" ref-type="bibr">WHO 2018</xref>).</p><p id="P21">Various organizations and investigators have published guidance to protect wildland firefighters and workers in offices and commercial buildings (<xref rid="R26" ref-type="bibr">Broyles 2013</xref>; <xref rid="R156" ref-type="bibr">National Wildfire Coordinating Group 2013</xref>; <xref rid="R166" ref-type="bibr">Occupational Health and Safety 2019</xref>; <xref rid="R39" ref-type="bibr">CDC 2020</xref>; <xref rid="R241" ref-type="bibr">Washington State Department of Labor and Industries 2020</xref>; <xref rid="R232" ref-type="bibr">US EPA 2021c</xref>). A 2019 workshop sponsored by the American Thoracic Society recommended a unified federal response to wildland fires (<xref rid="R189" ref-type="bibr">Rice et al. 2021</xref>). The dynamic environment of wildland fires makes hazard prevention and control difficult. The workshop recommended multidisciplinary research, policy development, and communication to address hazards for those managing and fighting wildland fires as well as the general public. <xref rid="R201" ref-type="bibr">Semmens et al. (2021)</xref> identified specific wildland firefighter tasks related to direct suppression that could be targets for intervention aimed at wildland firefighters&#x02019; perception of smoke exposure and minimizing smoke exposure.</p></sec></sec><sec id="S10"><title>Ultraviolet radiation</title><p id="P22">Changes in various constituents of the atmosphere, such as a decrease in stratospheric ozone, affect the intensity of ultraviolet (UV) radiation at the earth&#x02019;s surface and the exposure of workers (<xref rid="R13" ref-type="bibr">Bais et al. 2015</xref>). Stratospheric ozone works as a filter to absorb UV radiation before it comes into the lower atmosphere.</p><sec id="S11"><title>Hazard update</title><p id="P23">The health effects of UV radiation have been identified before the time period surveyed by this report and include cancer, eye effects, and disturbed immune function (<xref rid="R198" ref-type="bibr">Schulte and Chun 2009</xref>; <xref rid="R16" ref-type="bibr">Barnes et al. 2019</xref>; <xref rid="R180" ref-type="bibr">Parker 2021</xref>). The extent of outdoor workers&#x02019; exposure to UV radiation varies at different places on the Earth. Despite indications from measurements in a few studies, no statistically significant decreases in UVB radiation attributable to the beginning of stratospheric ozone recovery have yet been detected (<xref rid="R13" ref-type="bibr">Bais et al. 2015</xref>). Nonetheless, the Montreal Protocol (an international treaty to phase out ozone-depleting gases) has &#x0201c;prevented global depletion of stratospheric ozone and consequently large-scale increases in solar UV-B radiation&#x0201d; and played an important role in preventing many adverse effects of high UV exposure (<xref rid="R16" ref-type="bibr">Barnes et al. 2019</xref>).</p></sec><sec id="S12"><title>Control update</title><p id="P24">There are specific measures employers and outdoor workers can take to mitigate exposures, including the use of sunscreens and sun-protective clothing. Certain recommendations for sun-protective clothing may be at odds with choosing appropriate clothing for working in the heat, such as long sleeves, dark versus light colors, and a tighter fabric weave. However, the extent of their use depends on employers&#x02019; and workers&#x02019; perceptions and motivation or direction to implement them (<xref rid="R99" ref-type="bibr">Hault et al. 2016</xref>; <xref rid="R183" ref-type="bibr">Peters et al. 2020</xref>; <xref rid="R42" ref-type="bibr">Cherrie et al. 2021</xref>).</p></sec></sec><sec id="S13"><title>Extreme weather</title><sec id="S14"><title>Hazard update</title><p id="P25">The increase in global temperature has been linked to an increase in the frequency, severity, and impact of extreme weather such as heat waves, floods, landslides, drought, and wildfires (<xref rid="R184" ref-type="bibr">Pinkerton et al. 2019</xref>). Establishing such links is challenging because of combinations of factors, including natural variability (<xref rid="R124" ref-type="bibr">Knutson et al. 2017</xref>). A new type of research called &#x0201c;attribution science&#x0201d; is being developed to determine &#x0201c;not if climate change causes an event but if climate change made some events more severe and more likely to occur, and if so by how much&#x0201d; (<xref rid="R44" ref-type="bibr">Cho 2021</xref>). In the United States from 1980&#x02013;2021, 310 weather events caused at least $1 billion in total damages (<xref rid="R163" ref-type="bibr">NOAA NCEI 2022</xref>). Workers died and were injured in these events, but comprehensive counts are not available for the scope of this update. Previously, it was reported that from 1992&#x02013;2006, 317 workers died or were injured in these events (<xref rid="R198" ref-type="bibr">Schulte and Chun 2009</xref>). One population of workers&#x02014;aptly named &#x0201c;storm chasers,&#x0201d; consisting largely of migrant workers involved in restoring buildings, towns, regions, and waterways&#x02014;has experienced a range of hazards and adverse health effects (<xref rid="R211" ref-type="bibr">Stillman 2021</xref>). In addition, because of a lack of occupational health and safety programs, these workers suffer from concomitant deprivation of food, shelter, labor protection, and health insurance. These factors interact with workplace hazards to negatively affect worker health and safety.</p><p id="P26">Extreme weather directly affects agriculture workers, from landowners to laborers, resulting in a variety of acute and chronic adverse health outcomes such as traumatic injuries, fatigue, and mental stress. These extreme weather events include prolonged drought, flooding, hurricanes, and extreme El Ni&#x000f1;o/La Ni&#x000f1;a weather patterns, as well as severe storms, heatwaves, freezes, and wildfires. In commercial fishing, weather is an important risk factor in vessel sinkings and crewmember survival (<xref rid="R138" ref-type="bibr">Lucas et al. 2018</xref>). As extreme weather events increase and weather patterns change over time, research is needed on the best way to relay accurate, tailored, useful forecasts to fishing workers (<xref rid="R79" ref-type="bibr">Finnis et al. 2019</xref>).</p><p id="P27">Sea levels are rising, contributing to increased storm surges that will cause flooding and high humidity (<xref rid="R18" ref-type="bibr">Beggs 2014</xref>; <xref rid="R131" ref-type="bibr">Levy and Patz 2015a</xref>; <xref rid="R51" ref-type="bibr">D&#x02019;Amato et al. 2016</xref>; <xref rid="R202" ref-type="bibr">Sheehan et al. 2017</xref>; <xref rid="R52" ref-type="bibr">D&#x02019;Amato M et al. 2018</xref>; <xref rid="R61" ref-type="bibr">Demain 2018</xref>; <xref rid="R113" ref-type="bibr">Katelaris and Beggs 2018</xref>; <xref rid="R218" ref-type="bibr">Thien et al. 2018</xref>; <xref rid="R185" ref-type="bibr">Poole et al. 2019</xref>; <xref rid="R1" ref-type="bibr">American Academy of Allergy Asthma and Immunology 2020</xref>; <xref rid="R50" ref-type="bibr">D&#x02019;Amato et al. 2020</xref>; <xref rid="R72" ref-type="bibr">Eguiluz-Gracia et al. 2020</xref>; <xref rid="R112" ref-type="bibr">Katelaris 2021</xref>). Rising sea levels can lead to damp buildings and mold growth. More moisture and higher temperatures are leading to fungal growth, which impacts indoor air quality (<xref rid="R113" ref-type="bibr">Katelaris and Beggs 2018</xref>; <xref rid="R185" ref-type="bibr">Poole et al. 2019</xref>; <xref rid="R62" ref-type="bibr">Deng et al. 2020</xref>).</p><p id="P28">Higher temperatures are integral in creating conditions for lightning. In 2021, 24 million more lightning strikes (an increase of 14%) occurred in the United States, compared with 2020 (<xref rid="R233" ref-type="bibr">Vaisala 2022</xref>). A drastic rise in lightning strikes was also seen in the Arctic, with 7,278 lightning strikes north of 80&#x000b0;N, almost double the total number for the previous 9 years (<xref rid="R233" ref-type="bibr">Vaisala 2022</xref>). The increasing number of workers projected to work in the Arctic will result in a larger population at risk for lightning strikes.</p></sec><sec id="S15"><title>Control update</title><p id="P29">The protection of workers at the macro level will depend on global governments and economic policies. At the micro level of workers and employers, the amount of risk will depend on the response to risk. The primary responsibility for controlling these hazards falls on employers. One major type of response is adaptation, such as hardening physical infrastructure, relocating people and assets, and ensuring backup capacity, which may have an impact on workers who have to perform tasks in extreme weather conditions (<xref rid="R247" ref-type="bibr">Woetzel et al. 2020</xref>). Beyond adaptation, employers and workers need training in preventative practices. They also should be included in the development and implementation of climate mitigation plans that affect worker safety (<xref rid="R184" ref-type="bibr">Pinkerton et al. 2019</xref>). A McKinsey Company report on 105 countries found that &#x0201c;while companies and communities have been adapting to reduce climate risk, the pace and scale of adaptation are likely to need to significantly increase to manage rising levels of physical climate risk&#x0201d; (<xref rid="R247" ref-type="bibr">Woetzel et al. 2020</xref>).</p></sec></sec><sec id="S16"><title>Vector-borne diseases and other biological hazards</title><p id="P30">Infectious diseases, including zoonotic diseases, are affected by changing environments. Climate change can alter the habitat and geographic distribution of disease vectors and other biological hazards. Outdoor workers are at the highest risk of exposure. <xref rid="T1" ref-type="table">Table 1</xref> provides additional details on selected at-risk worker populations for these hazards and associated diseases.</p><sec id="S17"><title>Hazard update</title><sec id="S117"><title>Vector-borne diseases.</title><p id="P31">The potential impact of climate change on vector-borne diseases continues to be a well-researched topic, although the available literature on specific workers or occupations remains limited (<xref rid="R17" ref-type="bibr">Beard et al. 2016</xref>; <xref rid="R169" ref-type="bibr">Ogden 2017</xref>; <xref rid="R130" ref-type="bibr">Levi et al. 2018</xref>; <xref rid="R33" ref-type="bibr">Caminade et al. 2019</xref>; <xref rid="R83" ref-type="bibr">Fouque and Reeder 2019</xref>; <xref rid="R4" ref-type="bibr">Adam-Poupart et al. 2021</xref>). Climate factors such as temperature extremes and precipitation patterns affect the seasonality and distribution of vector-borne diseases (<xref rid="R170" ref-type="bibr">Ogden and Lindsay 2016</xref>; <xref rid="R33" ref-type="bibr">Caminade et al. 2019</xref>; <xref rid="R83" ref-type="bibr">Fouque and Reeder 2019</xref>). A review of studies showed a positive correlation between higher air temperature and the expansion of vector habitats (<xref rid="R130" ref-type="bibr">Levi et al. 2018</xref>). Temperature affects the biting, survival, and reproductive rates of vectors, as well as the survival and development rates of the pathogens they carry (<xref rid="R34" ref-type="bibr">Campbell-Lendrum et al. 2015</xref>; <xref rid="R130" ref-type="bibr">Levi et al. 2018</xref>). Precipitation is an important factor for vectors with aquatic developmental stages, such as mosquitoes, and affects humidity, which impacts many vectors (<xref rid="R34" ref-type="bibr">Campbell-Lendrum et al. 2015</xref>).</p><p id="P32">Mosquitoes are one of the world&#x02019;s deadliest animals (<xref rid="R38" ref-type="bibr">CDC 2019</xref>). In the United States in 2020, West Nile virus was the most common cause of domestic arboviral neuroinvasive disease, with 559 cases reported, for an incidence of 0.17 cases per 100,000 population (<xref rid="R207" ref-type="bibr">Soto et al. 2022</xref>). More than 150,000 cases of mosquito-borne diseases were reported from 2004&#x02013;2016 in the United States (<xref rid="R193" ref-type="bibr">Rosenberg et al. 2018</xref>). During this time, West Nile Virus was the most common mosquito-borne disease in the continental United States (nearly 32,000 reported cases), while epidemics of dengue, chikungunya, and Zika viruses were reported, mainly in U.S. territories (<xref rid="R193" ref-type="bibr">Rosenberg et al. 2018</xref>). Increased rainfall or extreme rainfall associated with climate change is an important factor for mosquito-borne diseases (<xref rid="R34" ref-type="bibr">Campbell-Lendrum et al. 2015</xref>). Worksites (such as construction sites) with poor water drainage collect water from increased precipitation and provide breeding sites for mosquitoes, resulting in an increased risk of bites by infected mosquitoes (<xref rid="R8" ref-type="bibr">Applebaum et al. 2016</xref>; <xref rid="R245" ref-type="bibr">Wilke et al. 2018</xref>).</p><p id="P33">Tick-borne diseases (with the majority being Lyme disease) more than doubled in the United States and U.S. territories during 2004&#x02013;2016, with more than 490,000 cases, made up more than 75% of all reported vector-borne disease cases (<xref rid="R193" ref-type="bibr">Rosenberg et al. 2018</xref>). In 2019, more than 34,900 confirmed and probable cases of Lyme disease were reported to CDC (<xref rid="R40" ref-type="bibr">CDC 2021a</xref>). Although the use of insurance databases is critical for determining the actual number of cases treated each year, Lyme disease is under-reported due to reporting complexities. An analysis of insurance claims data during 2010&#x02013;2018 estimated that Lyme disease was diagnosed and treated in about 476,000 patients annually (<xref rid="R125" ref-type="bibr">Kugeler et al. 2021</xref>).</p><p id="P34">Climate change has been associated with the geographic distribution, local abundance, seasonal tick activity, and expansion of ticks to higher altitudes and latitudes (<xref rid="R73" ref-type="bibr">Eisen et al. 2016</xref>; <xref rid="R200" ref-type="bibr">Semenza and Suk 2017</xref>; <xref rid="R171" ref-type="bibr">Ogden et al. 2021</xref>). Researchers projected that the average annual period of Lyme disease onset in endemic states will be 0.4&#x02013;0.5 weeks earlier for 2025&#x02013;2040 and 0.7&#x02013;1.9 weeks earlier beyond 2065 (<xref rid="R148" ref-type="bibr">Monaghan et al. 2015</xref>), and the activity of nymphs in some areas is predicted to advance 8&#x02013;11 days by the 2050s (<xref rid="R130" ref-type="bibr">Levi et al. 2018</xref>).</p></sec><sec id="S18"><title>Poisonous plants.</title><p id="P35">Changes in temperature and precipitation can affect the distribution and growth rates of a variety of vegetation, including poisonous plants. Giant hogweed, a plant that was purposely imported as a unique ornamental, has become more invasive because of climate change and is spreading in parts of the United States and Europe (<xref rid="R121" ref-type="bibr">Klimaszyk et al. 2014</xref>; <xref rid="R195" ref-type="bibr">Schindler et al. 2018</xref>). Giant hogweed sap contains furanocoumarins, causing skin hypersensitivity to UV light, and resulting in rashes and blistering (<xref rid="R121" ref-type="bibr">Klimaszyk et al. 2014</xref>; <xref rid="R68" ref-type="bibr">Downs et al. 2019</xref>). Outdoor workers have reported serious injuries from blistering skin after mowing or other work after contact with giant hogweed (<xref rid="R121" ref-type="bibr">Klimaszyk et al. 2014</xref>; <xref rid="R68" ref-type="bibr">Downs et al. 2019</xref>). More outdoor workers will be at risk of exposure as this species continues to expand its range.</p></sec><sec id="S19"><title>Allergens and molds.</title><p id="P36">With climate change-related high temperatures and precipitation, it is likely that the amounts of airborne fungal spores (aeroallergens and asthmagens) will increase (<xref rid="R92" ref-type="bibr">Grinn-Gofron et al. 2019</xref>). As climate change brings higher global temperatures and increased precipitation, flooding, storm damage, and indoor mold growth will likely become a more widespread problem, along with changing geographic distributions (<xref rid="R131" ref-type="bibr">Levy and Patz 2015a</xref>; <xref rid="R51" ref-type="bibr">D&#x02019;Amato et al. 2016</xref>; <xref rid="R187" ref-type="bibr">Pugatch 2019</xref>; <xref rid="R27" ref-type="bibr">Buis 2020</xref>; <xref rid="R123" ref-type="bibr">Knutson et al. 2020</xref>; <xref rid="R69" ref-type="bibr">Du et al. 2021</xref>; <xref rid="R112" ref-type="bibr">Katelaris 2021</xref>). Both outdoor and indoor workers may experience higher fungal exposure and higher rates of fungal diseases.</p><p id="P37">Occupational exposure to mycotoxins (including aflatoxins) is a growing concern as climate change is expected to impact the ecology, adaptation, and proliferation of mycotoxins (<xref rid="R142" ref-type="bibr">Marroquin-Cardona et al. 2014</xref>; <xref rid="R235" ref-type="bibr">Viegas et al. 2016</xref>; <xref rid="R234" ref-type="bibr">Valencia-Quintana et al. 2020</xref>; <xref rid="R236" ref-type="bibr">Viegas et al. 2020</xref>). While mycotoxins are a public health concern when ingested, workers can be exposed to fungal toxins and carcinogens via respiratory, dermal, and mucosal routes (<xref rid="R142" ref-type="bibr">Marroquin-Cardona et al. 2014</xref>; <xref rid="R239" ref-type="bibr">Wangia et al. 2019</xref>).</p><p id="P38">As climate change causes drier and windier conditions in the southern and western United States, coccidioidomycosis (also known as Valley fever) continues to be a growing occupational health challenge (<xref rid="R246" ref-type="bibr">Wilken et al. 2015</xref>; <xref rid="R20" ref-type="bibr">Benedict et al. 2017</xref>; <xref rid="R84" ref-type="bibr">Freedman et al. 2018</xref>; <xref rid="R59" ref-type="bibr">de Perio et al. 2019</xref>; <xref rid="R182" ref-type="bibr">Pearson et al. 2019</xref>). By 2100, it is predicted that climate change will more than double the area where <italic toggle="yes">Coccidioides</italic> is present in the soil, and the number of cases will increase by 50% (<xref rid="R91" ref-type="bibr">Gorris et al. 2019</xref>). In California, construction employers in counties where coccidioidomycosis is highly endemic are required to provide annual training to all employees before beginning work that may cause substantial dust disturbance (<xref rid="R31" ref-type="bibr">California Legislature 2019</xref>).</p><p id="P39">Other fungal allergic reactions and diseases may be caused by contact with trees or animal droppings. Maple bark disease is a hypersensitivity pneumonitis illness caused by a fungus, <italic toggle="yes">Cryptostroma corticale</italic>, found on maple trees infested with sooty bark disease (<xref rid="R24" ref-type="bibr">Braun et al. 2021</xref>). This fungus thrives in hot summers and on trees impacted by drought, and thus it is expected to spread in some areas placing more outdoor workers at risk of exposure. Histoplasmosis is a fungal infection often associated with working in areas with bird or bat droppings, or areas where there are spores in the soil (<xref rid="R20" ref-type="bibr">Benedict et al. 2017</xref>). Demolition or construction where the spores in the soil are disturbed may place workers at risk for exposure. The fungus is being found in new regions, and climate change is believed to be partially responsible (<xref rid="R20" ref-type="bibr">Benedict et al. 2017</xref>; <xref rid="R90" ref-type="bibr">Gnat et al. 2021</xref>).</p><p id="P40">There is a growing body of literature concerning increasing levels of aeroallergens, asthma, allergic rhinitis, and occupational exposures. As carbon dioxide levels and temperatures have increased, this has led to longer plant growing seasons with earlier flowering and pollen production, increased length of pollen season, higher levels of pollen production, increased allergenicity of pollen, and later frosts (<xref rid="R18" ref-type="bibr">Beggs 2014</xref>; <xref rid="R131" ref-type="bibr">Levy and Patz 2015a</xref>; <xref rid="R202" ref-type="bibr">Sheehan et al. 2017</xref>; <xref rid="R61" ref-type="bibr">Demain 2018</xref>; <xref rid="R185" ref-type="bibr">Poole et al. 2019</xref>; <xref rid="R1" ref-type="bibr">American Academy of Allergy Asthma and Immunology 2020</xref>; <xref rid="R50" ref-type="bibr">D&#x02019;Amato et al. 2020</xref>; <xref rid="R62" ref-type="bibr">Deng et al. 2020</xref>; <xref rid="R72" ref-type="bibr">Eguiluz-Gracia et al. 2020</xref>; <xref rid="R45" ref-type="bibr">Choi et al. 2021</xref>; <xref rid="R112" ref-type="bibr">Katelaris 2021</xref>; <xref rid="R181" ref-type="bibr">Pawankar and Wang 2021</xref>; <xref rid="R196" ref-type="bibr">Schramm et al. 2021</xref>; <xref rid="R231" ref-type="bibr">US EPA 2021b</xref>). Outdoor workers are at increased risk of pollen exposure, as many jobs involve intense physical activity and resultant increased inhalation rates (<xref rid="R53" ref-type="bibr">D&#x02019;Ovidio et al. 2016</xref>). Similarly, to the previously mentioned poisonous plants, climate change is expected to influence the geographic distribution of a variety of plants and pollens.</p></sec></sec><sec id="S20"><title>Control update</title><p id="P41">Recommendations for protecting workers from the potential impact of climate change on biological hazards have included robust disease and vector surveillance, vector control, training for workers about biological hazards and best preventive practices, and personal protective clothing and equipment for workers where appropriate (<xref rid="R221" ref-type="bibr">Tong et al. 2016</xref>; <xref rid="R162" ref-type="bibr">NIOSH 2021</xref>). One Health is a transdisciplinary approach that recognizes the interrelationships of human health, animal health, and environmental health to achieve optimal health outcomes (<xref rid="R41" ref-type="bibr">CDC 2021b</xref>). Due to its comprehensive approach to hazards, the One Health approach may best protect workers and help OSH and public health communities prepare, plan, and respond to the potential impacts of climate change on biological hazards. The expansion of habitats of vectors and biological hazards may lead to increased use of pesticides and herbicides (<xref rid="R87" ref-type="bibr">Gatto et al. 2016</xref>). Agricultural workers, landscape workers, and other outdoor workers may be at risk of exposure to these substances.</p></sec></sec><sec id="S21"><title>Industrial transitions and emerging industries</title><p id="P42">The greatest driver of climate change is rising planetary temperatures resulting from the production of greenhouse gases (<xref rid="R107" ref-type="bibr">IPCC 2021</xref>). A major cause of greenhouse gases is the burning of fossil fuels. The social and economic pressures involved in reducing fossil fuel use and transitioning to renewable energy frame the view of the types of hazards workers will experience. Further, a growth in recycling (which may be one response to climate change and resource depletion) may increase workers&#x02019; risk of exposure to hazardous materials and conditions (<xref rid="R7" ref-type="bibr">Anderson et al. 2020</xref>).</p><sec id="S22"><title>Hazard update</title><p id="P43">Phasing out fossil fuels has a direct impact on workers in the industries dealing with these energy sources, as well as on the workers in surrounding communities who depend on those industries. Coal is the primary fossil fuel that has been flagged for phasing out globally (<xref rid="R222" ref-type="bibr">UN Environment Programme 2019</xref>). High costs of coal extraction have led to an undercutting of coal prices by natural gas since the early 2010s (<xref rid="R157" ref-type="bibr">Neal 2020</xref>). Coal workers continue to suffer from the adverse health effects (such as pneumoconiosis, silicosis, traumatic injury, and hearing loss) they have experienced since the 1800s (<xref rid="R43" ref-type="bibr">Cho and Lee 1978</xref>; <xref rid="R114" ref-type="bibr">Khanzode et al. 2011</xref>; <xref rid="R160" ref-type="bibr">NIOSH 2011</xref>). However, the impact of industrial transitions may be more in the psychosocial realm. Claudia Strambo of the Stockholm Environment Institute stated, &#x0201c;History shows that when a mining transition is not well managed, the impacts to the environment, economy, and social fabric of former mining regions can be catastrophic,&#x0201d; (<xref rid="R37" ref-type="bibr">Casey 2019</xref>).</p><p id="P44">To reduce global carbon emissions, significant changes in energy production are expected. The number of renewable energy sources, primarily solar, wind, and hydrogen-generated energy (<xref rid="R225" ref-type="bibr">US EIA 2021</xref>). Ultimately, solar and wind energy production are expected to partially replace fossil fuel energy generation. However, nuclear power will likely serve as a growing intermediary energy supply for many decades until solar and wind energy provide ample supply and deliver power continuously (<xref rid="R106" ref-type="bibr">IAEA 2021</xref>). Occupational hazards in the nuclear industry, in terms of injuries and fatalities, are predominantly from the mining and milling of raw materials (<xref rid="R192" ref-type="bibr">Roscoe et al. 1995</xref>). During operations, a potential for ionizing radiation exposure exists, although even at less concerning levels they are likely still important (<xref rid="R190" ref-type="bibr">Richardson et al. 2015</xref>). Unresolved issues associated with the disposal of nuclear waste are potentially a more significant occupational and environmental concern; these may be resolved through the commercial development of nuclear fusion. Nuclear fusion, which is a promising energy source, uses radioactive materials with half-lives substantially less than those for fission, and the risk of a major accident is substantially less (<xref rid="R141" ref-type="bibr">Markandya and Wilkinson 2007</xref>; <xref rid="R15" ref-type="bibr">Ball 2022</xref>).</p><p id="P45">Solar photovoltaic systems and wind turbines are likely to be a major replacement for fossil fuels in the future. Various methods of manufacturing photovoltaic materials involve a variety of different materials, most of which are potentially toxic or hazardous (<xref rid="R155" ref-type="bibr">National Research Council 2010</xref>). Although most of these chemicals have been involved in a fair amount of basic toxicological research (<xref rid="R14" ref-type="bibr">Bakhiyi et al. 2014</xref>), very little quantitative or qualitative risk assessment research has been done on the occupational health issues arising during the mining of component materials, manufacturing, and recycling processes (<xref rid="R23" ref-type="bibr">Bradbrook et al. 2013</xref>; <xref rid="R14" ref-type="bibr">Bakhiyi et al. 2014</xref>). Furthermore, several physical and electrical hazards are associated with the installation and maintenance of photovoltaic systems, including falls and manual-handling concerns, as well as heat stress. However, little data are available for quantifying the rates at which these risks directly affect installers (<xref rid="R70" ref-type="bibr">Duroha et al. 2020</xref>).</p><p id="P46">In the wind energy&#x02013;generation industry, manufacturers of wind turbines have hazards similar to those in the automobile and aerospace industries. Primarily, these involve exposures to epoxy-based resins, glassreinforced plastic, and noise. Installation and maintenance of wind turbines are associated with work in confined spaces, electrical risks, and falls from heights, potentially exacerbated by the unpredictability of wind gusts (<xref rid="R85" ref-type="bibr">Freiberg et al. 2018</xref>). Off-shore wind farm hazards include isolation, delay in emergency care for life-threatening injury, and the potential for longer work shifts (<xref rid="R145" ref-type="bibr">Mette et al. 2018</xref>). Similar to the lack of literature on risks in solar energy production, occupational health hazards in the wind energy industry have been addressed in only limited peer-reviewed scientific literature (<xref rid="R110" ref-type="bibr">Karanikas et al. 2021</xref>).</p><p id="P47">Hydrogen technologies may also provide renewable energy (<xref rid="R78" ref-type="bibr">Federal Ministry for Economic Affairs and Energy 2020</xref>), and the hazards will need to be assessed (<xref rid="R191" ref-type="bibr">Rivikin et al. 2015</xref>). Although hydrogen energy has the potential to replace fossil fuels, its impact on the atmosphere has yet to be fully assessed (<xref rid="R240" ref-type="bibr">Warwick et al. 2022</xref>).</p><p id="P48">Recycling is an important means of energy efficiency, but hazards have arisen in this industry (<xref rid="R7" ref-type="bibr">Anderson et al. 2020</xref>). More broadly, the transition to a circular economy may expose workers to new hazards, and OSH-relevant knowledge for dismantling old infrastructure may be lacking (<xref rid="R55" ref-type="bibr">Daheim et al. 2021</xref>).</p><p id="P49">Another area of transition is the Agriculture, Fishing, and Forestry sector. The agriculture industry is changing because of significant alterations in weather, including rainfall patterns, and more frequent weather extremes, such as high temperatures and longer droughts. The locations where crops have traditionally been grown are moving farther north. Land that has never supported crops is being purchased, anticipating a future opportunity to grow crops. This may result in a need for workers to be located potentially in further remote areas where infrastructure is lacking. In addition, traditional agriculture areas will need to transition to other crops or otherwise adapt.</p></sec><sec id="S23"><title>Control update</title><p id="P50">In general, the prevention and control of adverse effects on workers from industrial transitions and emerging industries will involve anticipation of scenarios in a matrix of old and new hazards by traditional and future jobs (<xref rid="R199" ref-type="bibr">Schulte et al. 2020</xref>). For the most part, the hazards will be known ones but in new situations. A critical control measure will be the use of strategic foresight approaches to protect and promote worker safety, health, and well-being (<xref rid="R213" ref-type="bibr">Streit et al. 2021</xref>). Ultimately, the occupational safety and health field can be a resource to promote a &#x0201c;just transition&#x0201d; for workers who are displaced due to responses to climate change (<xref rid="R223" ref-type="bibr">UNFCCC Secretariat 2020</xref>).</p></sec></sec><sec id="S24"><title>Changes in the built environment</title><sec id="S25"><title>Hazard update</title><p id="P51">Much of the response to climate change may be changes in the built environment, which may present hazards to workers. Clearly, some of the new technologies, such as wind and solar, will involve building and construction with new or exacerbated hazards. Moreover, building and construction are responsible for 39% of carbon emissions globally (<xref rid="R222" ref-type="bibr">UN Environment Programme 2019</xref>). New construction scenarios or expanded construction demands may present hazards to workers beyond those in construction. Additionally, buildings designed to save energy (&#x0201c;tight buildings&#x0201d;) may allow for the buildup of toxic substances, radon gas, and infectious agents, which might affect worker occupants and maintenance staff (<xref rid="R198" ref-type="bibr">Schulte and Chun 2009</xref>). Other potential impacts on workers could arise from commonly used built environment strategies to combat climate change, such as tree planting, road diets (roadway reconfiguration), bike lane installation, and cool roofs, but these have not been specifically characterized in the literature.</p></sec><sec id="S26"><title>Control update</title><p id="P52">As with industrial transitions, anticipating hazards from climate change for construction and maintenance workers will benefit from strategic foresight (<xref rid="R213" ref-type="bibr">Streit et al. 2021</xref>). This may also be useful for identifying hazards for users of built environments, such as workers who are building occupants.</p></sec></sec><sec id="S27"><title>Crosscutting topics</title><p id="P53">The topics of mental health, health equity, economic burden, and geoengineering crosscut the seven-category framework, and the literature on these is growing.</p><sec id="S28"><title>Mental health effects of climate-related occupational hazards</title><p id="P54">Although the attribution of adverse mental health outcomes to climate-related hazards is challenging, exposure to climate- or weather-related disasters can cause or exacerbate mental health effects ranging from stress, anxiety, depression, and substance abuse to post-traumatic stress disorders and suicide (<xref rid="R219" ref-type="bibr">Tiesman et al. 2015</xref>; <xref rid="R65" ref-type="bibr">Dodgen et al. 2016</xref>; <xref rid="R238" ref-type="bibr">Wang et al. 2016</xref>; <xref rid="R25" ref-type="bibr">Bromet et al. 2017</xref>; <xref rid="R36" ref-type="bibr">Casas et al. 2017</xref>; <xref rid="R214" ref-type="bibr">Tallon et al. 2017</xref>; <xref rid="R217" ref-type="bibr">Tempest et al. 2017</xref>; <xref rid="R97" ref-type="bibr">Hanigan et al. 2018</xref>; <xref rid="R174" ref-type="bibr">Orui et al. 2018</xref>; <xref rid="R93" ref-type="bibr">Groot et al. 2019</xref>; <xref rid="R28" ref-type="bibr">Bundo et al. 2020</xref>; <xref rid="R49" ref-type="bibr">Cruz et al. 2020</xref>; <xref rid="R80" ref-type="bibr">Fitzgerald et al. 2020</xref>; <xref rid="R103" ref-type="bibr">Hrabok et al. 2020</xref>; <xref rid="R47" ref-type="bibr">Clayton et al. 2021</xref>). Climate impacts and influencing factors include not only health threats from air quality, wildfires, sea level rise, storms, heat, floods, and droughts but also vulnerability at larger community or societal scales, such as natural and built environments, governance and management, and institutions (<xref rid="R65" ref-type="bibr">Dodgen et al. 2016</xref>). Specific occupations, including first responders, farmers, forestry and fishing workers, public safety workers, and healthcare workers, are at higher risk for adverse mental health outcomes (<xref rid="R65" ref-type="bibr">Dodgen et al. 2016</xref>; <xref rid="R238" ref-type="bibr">Wang et al. 2016</xref>; <xref rid="R54" ref-type="bibr">Daghagh et al. 2019</xref>; <xref rid="R102" ref-type="bibr">Howard et al. 2020</xref>; <xref rid="R144" ref-type="bibr">Metregiste et al. 2020</xref>). Overwork, disaster relief work that interferes with personal lives, loss of family members or homes, and economic instability could increase the risk for adverse mental health, including depression and suicidal ideation (<xref rid="R137" ref-type="bibr">Lowe et al. 2016</xref>; <xref rid="R238" ref-type="bibr">Wang et al. 2016</xref>; <xref rid="R174" ref-type="bibr">Orui et al. 2018</xref>).The link between climate change&#x02013;related occupational hazards and mental health does not appear to be a major consideration of employers. General recommendations have been published but few for employers and workers (<xref rid="R47" ref-type="bibr">Clayton et al. 2021</xref>). Various authors in trade publications have issued a call for employers to take action as climate change increasingly impacts health, productivity, and well-being (<xref rid="R88" ref-type="bibr">Gifford 2018</xref>).</p><p id="P55">Emerging issues include the impacts on the mental health of mass evacuation, inter- and intra-country migration, and relocation related to extreme weather events and the cumulative or mixed effects of hotter temperature, poor air quality, vector-borne risks, and/or extreme events (<xref rid="R65" ref-type="bibr">Dodgen et al. 2016</xref>; <xref rid="R29" ref-type="bibr">Burke et al. 2018</xref>; <xref rid="R139" ref-type="bibr">Maitre et al. 2018</xref>; <xref rid="R133" ref-type="bibr">Li et al. 2020</xref>). Multiple strategies must be undertaken by employers, workers, and communities to enhance adjustment and coping post-disaster, including enhancing access to care, interagency cooperation, and adequate preparation (<xref rid="R140" ref-type="bibr">Marinucci et al. 2014</xref>; <xref rid="R65" ref-type="bibr">Dodgen et al. 2016</xref>; <xref rid="R103" ref-type="bibr">Hrabok et al. 2020</xref>).</p></sec><sec id="S29"><title>Occupational health equity</title><sec id="S30"><title>Work conditions or work-related conditions.</title><p id="P56">Overall, the literature demonstrates that the nature of work and social determinants of health overlap to affect exposure to climate risks (<xref rid="R100" ref-type="bibr">Hayes et al. 2018</xref>; <xref rid="R21" ref-type="bibr">Benevolenza and DeRigne 2019</xref>). In high-income countries like the United States, economically disadvantaged workers (<xref rid="R132" ref-type="bibr">Levy and Patz 2015b</xref>; <xref rid="R230" ref-type="bibr">US EPA 2021a</xref>) are disproportionately affected by the negative health effects caused or exacerbated by climate change. Some of these poor health outcomes include respiratory and allergy disorders, vector-borne diseases, and heat-related disorders (<xref rid="R132" ref-type="bibr">Levy and Patz 2015b</xref>). These populations are also at high risk for the psychosocial impact of climate change, which can include the adverse mental health effects discussed earlier, as well as financial impact (<xref rid="R224" ref-type="bibr">US DOL 2022</xref>). For example, as a result of Hurricane Katrina, permanently displaced residents (who were largely African American single mothers) and workers experienced significantly higher levels of distress and perceived stress than those who were not uprooted by the disaster (<xref rid="R178" ref-type="bibr">Palinkas 2020</xref>).</p><p id="P57">Immigrant workers and those of lower socio-economic status are frequently employed in high-risk occupations (such as agriculture, construction, transportation, and emergency work) that are often subject to extreme weather conditions exacerbated by climate change (<xref rid="R210" ref-type="bibr">Spector and Sheffield 2014</xref>; <xref rid="R115" ref-type="bibr">Kiefer et al. 2016</xref>; <xref rid="R197" ref-type="bibr">Schulte et al. 2016</xref>). Immigrant workers face a combination of risk factors for HRIs, including lack of OSH knowledge and quality training, poverty, language barriers, seasonality of jobs, lack of decision-making autonomy, differences with treatment on the job, and extreme work conditions (<xref rid="R81" ref-type="bibr">Flynn 2014</xref>; <xref rid="R82" ref-type="bibr">Flynn et al. 2014</xref>; <xref rid="R165" ref-type="bibr">O&#x02019;Connor et al. 2014</xref>; <xref rid="R212" ref-type="bibr">Stoecklin-Marois et al. 2015</xref>; <xref rid="R76" ref-type="bibr">Fan and Qian 2017</xref>; <xref rid="R74" ref-type="bibr">Ellis and Stam 2018</xref>). Immigrants and minorities are also overrepresented in outdoor jobs such as construction, farm work, landscaping, and roofing. For example, Latino farmworkers in the United States are disproportionately exposed to extreme heat waves and other climate risks because of the nature of their work (<xref rid="R143" ref-type="bibr">Mera et al. 2015</xref>). Limited access to resources (such as food, discretionary funds, and health care) at home and work can also complicate these workers&#x02019; climate risk and ability to deal with work-related injuries or illnesses. Migrant farmworkers&#x02019; exposure to excess heat is also influenced by other factors such as lack of access to healthcare and living in employer-provided housing that often lacks air conditioning (<xref rid="R10" ref-type="bibr">Arcury et al. 2015</xref>).</p></sec><sec id="S31"><title>Changes to the workforce.</title><p id="P58">Climate change and human migration patterns are interrelated. It is anticipated that the increasing severity and frequency of catastrophic events (such as hurricanes), as well as the negative impact of shifting weather patterns (such as rainfall levels) on agricultural production, will continue to drive more individuals to migrate to the United States (<xref rid="R178" ref-type="bibr">Palinkas 2020</xref>). For example, analysis of state-level data showed a significant effect of climate-driven changes in crop yields on the rate of emigration from Mexico to the United States (<xref rid="R105" ref-type="bibr">Hunter et al. 2015</xref>). Increased migration to the United States will contribute to the increasing diversity within the U.S. workforce, which presents unique challenges to the future of OSH (<xref rid="R215" ref-type="bibr">Tamers et al. 2020</xref>). Due to unequal treatment and opportunity, as the foreign-born proportion of the workforce grows, work-related injuries and illnesses along with the economic burden on society are anticipated to increase (<xref rid="R81" ref-type="bibr">Flynn 2014</xref>; <xref rid="R98" ref-type="bibr">Hargreaves et al. 2019</xref>).</p></sec><sec id="S32"><title>Catastrophic events.</title><p id="P59">Low-wage workers, who are disproportionately racialized ethnic minorities and foreign-born individuals, often reside in neighborhoods and housing more susceptible to extreme weather events (<xref rid="R104" ref-type="bibr">Huang et al. 2011</xref>; <xref rid="R122" ref-type="bibr">Klinenberg 2015</xref>; <xref rid="R178" ref-type="bibr">Palinkas 2020</xref>). Additionally, these workers are more likely to be employed in clean-up and rebuilding efforts, which may expose them to unique and more hazardous or toxic conditions with less government oversight, supervision, and access to protective equipment (<xref rid="R66" ref-type="bibr">Donato et al. 2007</xref>; <xref rid="R60" ref-type="bibr">Delp et al. 2009</xref>). For example, during the Katrina disaster, people of color were the most impacted and also the most employed in the rebuilding of the city; residents of the Lower Ninth Ward in New Orleans, who were predominantly African American, and many Latino workers were involved in the rebuilding (<xref rid="R178" ref-type="bibr">Palinkas 2020</xref>). These OSH concerns will likely rise, given an expected increase in extreme weather events and a surge in foreign-born workers due to increased global climate-related migration to the United States (<xref rid="R178" ref-type="bibr">Palinkas 2020</xref>).</p></sec><sec id="S33"><title>Future needs.</title><p id="P60">Future OSH attention to climate change should consider the interrelationships among health equity, environmental justice, and climate change. Environmental justice is defined by the CDC as the fair treatment and meaningful involvement of all people, regardless of race, color, national origin, or income, to develop, implement, and enforce environmental laws, regulations, and policies (<xref rid="R11" ref-type="bibr">ATSDR 2022</xref>). Economic activity and how it is structured in society are fundamental drivers of both workplace conditions and environmental degradation (pollution and climate change). As a result, the relationships between work, social inequity, and environmental justice must be better understood (<xref rid="R117" ref-type="bibr">Kingsolver 2011</xref>). The practice of externalizing risk (placing the burden of risk on a third party) has negative impacts on workers (<xref rid="R243" ref-type="bibr">Weil 2017</xref>). For example, individuals from groups and communities who are socially disadvantaged are overrepresented in dangerous and low-paying jobs. As a result, these workers are not only at increased risk of workplace injuries but also at increased risk of living near environmental hazards (such as toxic waste sites) (<xref rid="R122" ref-type="bibr">Klinenberg 2015</xref>; <xref rid="R178" ref-type="bibr">Palinkas 2020</xref>).</p></sec></sec><sec id="S34"><title>Economic burden of climate-related OSH hazards</title><p id="P61">Climate change has affected weather patterns, resulting in extreme temperatures. Both high and low temperatures are detrimental to workers&#x02019; health, especially those working outdoors (<xref rid="R64" ref-type="bibr">Dillender 2021</xref>). These workers are mostly employed in the agriculture, construction, emergency response, commercial fishing, paramedic and firefighting, and transportation industries. Extreme temperatures impose costs on employers in the form of increased energy outlays and reduction in labor productivity or labor supply (<xref rid="R63" ref-type="bibr">Desch&#x000ea;nes and Greenstone 2011</xref>; <xref rid="R12" ref-type="bibr">Auffhammer and Mansur 2014</xref>; <xref rid="R179" ref-type="bibr">Park et al. 2021</xref>). Few studies have focused on estimating the economic burden associated with occupational health and climate change. <xref rid="R135" ref-type="bibr">Limaye (2020)</xref> estimated the public health costs of 10 climate-sensitive events in 2012 in the United States as $10 billion. According to the Natural Resources Defense Council, the annual health costs of air pollution and climate change are more than $800 billion and are expected to increase over the years (<xref rid="R136" ref-type="bibr">Limaye 2021</xref>). The International Labor Organization reported that heat stress is gradually becoming an obstacle to economic activities (<xref rid="R120" ref-type="bibr">Kjellstrom et al. 2019</xref>), reducing the productivity of workers in four sectors (agriculture, construction, industry, and services). Even if appropriate resources are utilized to limit global warming to 1.5 &#x000b0;C above pre-industrial levels by the end of the century, the accumulated financial loss due to heat stress is expected to reach $2.4 trillion by 2030 (<xref rid="R120" ref-type="bibr">Kjellstrom et al. 2019</xref>). According to estimates, the impact of heat stress on reducing worker productivity is expected to be 0.91% of total working hours (the equivalent of 800,000 full-time jobs) in 2030 (<xref rid="R120" ref-type="bibr">Kjellstrom et al. 2019</xref>). <xref rid="R134" ref-type="bibr">Licker et al. (2022)</xref> estimated that with a modest greenhouse gas emissions reduction, outdoor workers will be exposed to extreme heat conditions in the mid-twenty-first century which is triple that of the late twentieth century, with earnings of approximately $39.3 billion at risk annually. <xref rid="R158" ref-type="bibr">Neidell et al. (2021)</xref> assessed that workers&#x02019; annual wage loss due to a reduction in time spent working on days with temperatures above 90&#x000b0;F across the United States will range from $36.7 to $80.0 billion in 2090 under intermediate and high emissions, respectively.</p><p id="P62">Studies incorporating economic models have shown that the climate change effects on workers are among the most important drivers of the total economic costs of climate change (<xref rid="R173" ref-type="bibr">Orlov et al. 2019</xref>; <xref rid="R58" ref-type="bibr">Dasgupta et al. 2021</xref>; <xref rid="R206" ref-type="bibr">Somanathan et al. 2021</xref>). <xref rid="R64" ref-type="bibr">Dillender (2021)</xref> examined 6 months of medical costs for workers&#x02019; compensation claims associated with extreme temperatures in Texas in 2015. Higher temperatures were associated with worse health outcomes. He found that a majority of the claims resulting from low temperatures involved above-median medical costs, whereas the claims resulting from high temperatures were more evenly split above and below the median costs. He extrapolated his results, using the assumption that claims arising from temperature have an average work-related injury cost of $20,500 in 2014 dollars (<xref rid="R129" ref-type="bibr">Leigh 2011</xref>). Each day with a high temperature above 90 &#x000b0;F (32.2 &#x000b0;C) leads to costs from incidents of $0.08 per worker, and each day with a high temperature below 40 &#x000b0;F (4.4 &#x000b0;C) leads to costs from occupational health incidents of $0.15 per worker. Since roughly 10% of workers work outdoors at least one day per week and have an average hourly wage of $18 in 2014 dollars, the implied cost of the reduction in hours worked from each day with a high temperature below 40 &#x000b0;F is about $1.82 per worker in warmer climates, when averaged across all U.S. workers (<xref rid="R64" ref-type="bibr">Dillender 2021</xref>). Total annual costs in Texas were estimated to be $69.7 million for days above 90 &#x000b0;F and $97.6 million for days below 40 &#x000b0;F (<xref rid="R64" ref-type="bibr">Dillender 2021</xref>).</p><p id="P63"><xref rid="R173" ref-type="bibr">Orlov et al. (2019)</xref> used an interdisciplinary approach, combining meteorological, epidemiological, and economic analyses, to assess the cost of heat-induced reductions in outdoor worker productivity in Europe caused by the heat waves in August 2003, July 2010, and July 2015 (<xref rid="R173" ref-type="bibr">Orlov et al. 2019</xref>). They estimated that for the top 10 most affected European countries, average direct economic losses (estimated as the productivity losses in specific sectors) in agriculture accounted for $59&#x02013;$90 per worker. In construction, these losses were $41&#x02013;$72 per worker in 2015 U.S. dollar values. According to these authors, the average social costs of these events (estimated as the loss in productivity of other sectors as a result of the heat-induced impacts in agriculture and construction) ranged from $1.6 to $2.7 per capita.</p></sec><sec id="S35"><title>Geoengineering</title><p id="P64">Geoengineering, also known as &#x0201c;climate intervention&#x0201d; or &#x0201c;climate engineering,&#x0201d; is defined as the intentional, large-scale human manipulation or alteration of the environment (<xref rid="R71" ref-type="bibr">Effiong and Neitzel 2016</xref>; <xref rid="R109" ref-type="bibr">Jones et al. 2017</xref>; <xref rid="R2" ref-type="bibr">Abatayo et al. 2020</xref>). Potential geoengineering interventions to address the changing climate are diverse and could include such approaches as the following: the chemical capture of carbon from the atmosphere; the facilitation of the growth and use of carbon-eating plankton; and using large mirrors to reflect sunlight into space and/or creating and injecting a reflective haze (usually chemicals such as carbon black [soot], various sulfate compounds, fine aluminum particles, aluminum oxides, and nanoparticles like barium titanate) to reflect sunlight into space. To date, the use of geoengineering to mitigate climate change is based on predictive models and, as such, remains highly controversial because it carries a strong possibility of unintended consequences (<xref rid="R167" ref-type="bibr">Ocean Studies Board 2015a</xref>, <xref rid="R168" ref-type="bibr">2015b</xref>).</p><p id="P65">The extent to which geoengineering would create risks and hazards or decrease climate-related risks and hazards for workers is unknown. Outdoor workers, especially those of low socio-economic status such as manual laborers, farmworkers, nursery workers, ranch workers, construction workers, and wildland fire-fighters, would be at greatest risk from the effects of climate change and the potential effects of geoengineering. Few studies have been done to determine the human health impacts of exposure to atmospheric aerosols (inorganic sulfates, carbon black, powdered aluminum, aluminum oxides, nanoparticle barium titanates, etc.) proposed for use in geoengineering and the environmental changes that may result from geoengineering. Developing scenarios for different types of geoengineering may help identify potential hazards for workers and would be the first step in identifying prevention and control measures.</p></sec></sec></sec><sec id="S36"><title>Discussion</title><p id="P66">This review is an update of two earlier reports that established and increased awareness of workers&#x02019; risk of exposure to, and adverse effects from, climate change-related hazards (<xref rid="R198" ref-type="bibr">Schulte and Chun 2009</xref>; <xref rid="R197" ref-type="bibr">Schulte et al. 2016</xref>). This current horizon-scanning effort discussed new information in all seven categories of climate-related hazards presented in the original framework. These findings support the importance of the complementary, crosscutting topics of mental health, occupational health equity, economic burden, and geoengineering.</p><p id="P67">The framework initiated in the earlier reviews served as the basis for two reports (<xref rid="R153" ref-type="bibr">NIEHS 2015</xref>, <xref rid="R154" ref-type="bibr">2022</xref>) that described a climate change vulnerability assessment to determine how the impacts of climate change affect workers and how to prepare for these impacts. The findings discussed here imply that workers are at increased risk of exposure to climate-related hazards and that investigators, authorities, employers, trade associations, unions, and workers must make a concerted effort to identify the extent of exposure to these hazards and ways to control them.</p></sec><sec id="S37"><title>Conclusions</title><p id="P68">The literature on the relationship between climate change and OSH hazards has continued to grow since 1988. However, many gaps persist, particularly regarding mental and physical health effects on worker exposure to air pollution, UV radiation, risks in the built environment, and inequities. Scenarios must be developed for identifying hazards in geoengineering, and more interventions should be developed to prevent and control the hazards related to vector-borne diseases. Since employers are not accustomed to dealing with climate-related hazards, programs that address employer and worker behaviors will be critical.</p><p id="P69">Anticipating potential futures and regional variations is necessary for preventing and controlling climate-related occupational hazards. Foresight techniques that predict climate-related OSH hazards can help establish priorities and responsibilities for workers&#x02019; safety and health (<xref rid="R55" ref-type="bibr">Daheim et al. 2021</xref>; <xref rid="R213" ref-type="bibr">Streit et al. 2021</xref>).</p><p id="P70">Although there is a growing literature on health equity and climate change, the surveillance data are insufficient for addressing equity issues related to worker exposures and adverse outcomes with regard to race/ethnicity, nativity, immigration status, and language. Researchers must continue assessing the economic costs of climate-related hazards on workers and employers, assess the impact of such hazards on indoor workers, and find new hazard control and risk management interventions employers can use to protect workers. A bolder front must be opened up for surveillance and research to address the needs of workers exposed to climate-related hazards.</p></sec></body><back><ack id="S38"><title>Acknowledgments</title><p id="P71">The authors thank Marc Bovenschulte, Miranda Dally, and Cecilia Sorensen for comments on earlier drafts, Cheryl Hamilton and Seleen Collins for editing, and Rick Colbert and Joanna Taliano for assisting with the literature searches.</p></ack><fn-group><fn id="FN1"><p id="P72">Disclaimer</p><p id="P73">The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention.</p><p id="P74">At the time the study was initiated, P.A.S. was employed by the U.S. National Institute for Occupational Safety and Health and then subsequently as a contractor with ATL International, Inc.</p></fn></fn-group><ref-list><title>References</title><ref id="R1"><mixed-citation publication-type="webpage"><collab>American Academy of Allergy Asthma and Immunology [AAAAI]</collab>
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<list list-type="bullet" id="L1"><list-item><p id="P178">Phytodermatitis</p></list-item><list-item><p id="P278">Fungal diseases, asthma, and hypersensitivity pneumonitis (<xref rid="R202" ref-type="bibr">Sheehan et al. 2017</xref>; <xref rid="R50" ref-type="bibr">D&#x02019;Amato et al. 2020</xref>)</p></list-item></list>
</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Mycotoxins/Aflatoxins</td><td align="left" valign="top" rowspan="1" colspan="1">Cereal and feed production, storage, and transportation; animal husbandry, including dairy farming, poultry, and swine; bulk food imports; sugar factory workers; grain milling; textile production; bakeries; composting plants; tanneries; museums (<xref rid="R95" ref-type="bibr">Gutarowska et al. 2014</xref>; <xref rid="R235" ref-type="bibr">Viegas et al. 2016</xref>; <xref rid="R205" ref-type="bibr">Sk&#x003cc;ra et al. 2017</xref>; <xref rid="R239" ref-type="bibr">Wangia et al. 2019</xref>; <xref rid="R234" ref-type="bibr">Valencia-Quintana et al. 2020</xref>; <xref rid="R236" ref-type="bibr">Viegas et al. 2020</xref>; <xref rid="R96" ref-type="bibr">Habschied et al. 2021</xref>)</td><td align="left" valign="top" rowspan="1" colspan="1">
<list list-type="bullet" id="L2"><list-item><p id="P78">Mycotoxicoses, liver/kidney damage, immune suppression, cancer, and respiratory issues (<xref rid="R86" ref-type="bibr">Freire and da Rocha 2016</xref>)</p></list-item></list>
</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"><italic toggle="yes">Coccidioides</italic> fungus</td><td align="left" valign="top" rowspan="1" colspan="1">Outdoor workers who perform work that involves ground disturbance in construction, archeology, prison employment, wildland firefighting, outdoor film making, solar panel farm building, military, mining, quarrying, and oil and gas extraction (<xref rid="R246" ref-type="bibr">Wilken et al. 2015</xref>; <xref rid="R84" ref-type="bibr">Freedman et al. 2018</xref>; <xref rid="R59" ref-type="bibr">de Perio et al. 2019</xref>; <xref rid="R182" ref-type="bibr">Pearson et al. 2019</xref>)</td><td align="left" valign="top" rowspan="1" colspan="1">
<list list-type="bullet" id="L3"><list-item><p id="P79">Coccidioidomycosis (Valley Fever)</p></list-item></list>
</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"><italic toggle="yes">Cryptostroma corticale</italic> fungus</td><td align="left" valign="top" rowspan="1" colspan="1">Woodsmen, foresters, sawyers, and paper mill workers (<xref rid="R24" ref-type="bibr">Braun et al. 2021</xref>)</td><td align="left" valign="top" rowspan="1" colspan="1">
<list list-type="bullet" id="L4"><list-item><p id="P80">Hypersensitivity pneumonitis (Maple Bark Disease)</p></list-item></list>
</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"><italic toggle="yes">Histoplasma</italic> fungus</td><td align="left" valign="top" rowspan="1" colspan="1">Bridge inspectors or painters; chimney cleaners, construction workers; demolition workers; farmers; gardeners; heating and air-conditioning system installation/repair workers; microbiology laboratory workers; pest control workers; historic building restorationists; roofers; and water tower maintenance workers (<xref rid="R159" ref-type="bibr">NIOSH 2004</xref>; <xref rid="R19" ref-type="bibr">Benedict and Mody 2016</xref>)</td><td align="left" valign="top" rowspan="1" colspan="1">
<list list-type="bullet" id="L5"><list-item><p id="P81">Histoplasmosis</p></list-item></list>
</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Aeroallergens, pollen</td><td align="left" valign="top" rowspan="1" colspan="1">Outdoor workers</td><td align="left" valign="top" rowspan="1" colspan="1">
<list list-type="bullet" id="L6"><list-item><p id="P281">Increased exacerbation of existing allergic rhinitis and asthma (<xref rid="R204" ref-type="bibr">Shusterman 2014</xref>; <xref rid="R131" ref-type="bibr">Levy and Patz 2015a</xref>)</p></list-item><list-item><p id="P381">Newly developed pollen allergies (<xref rid="R128" ref-type="bibr">Lee et al. 2021</xref>)</p></list-item></list>
</td></tr></tbody></table></table-wrap></floats-group></article>