NEHA November 2022 Journal of Environmental Health

November 2022 • Journal of Environmental Health 27 health and environmental risks. The lack of detection methods and biomarker studies that can affect exposure and health risks are described in Supplemental SI-2. Chemical Risk Assessment for the Public Challenges arise when attempting to quantify a health risk involving exposure to a complex mixture such as CIPP emissions. These challenges stem mostly from limited toxicology knowledge and long-standing cumulative risk limitations. Further, CIPP exposures are also occurring beyond the occupational setting, with public exposures occurring in homes, schools, other large buildings, and even outdoors. Subsequently, the exposures represent poorly understood concentrations of a complex chemical waste with unknown risk outcomes. Various exposure scenarios described in Supplemental SI-2 define a complex set of exposures and exposure pathways that require assessment. Cumulative risk over a resident’s location timeline, a worker’s lifetime, or other longterm exposures is a topic that has received no scrutiny for CIPP to date. Until cumulative risk data addressing inhibitory or acceleratory effects from combinations of chemicals produced by the emissions can be generated, risk assessment for CIPP exposures will be significantly challenged. Subsequently, initial risk assessments will need to be single hazard-specific and use standard metrics such as the hazard quotient or lifetime excess cancer risk. Further complicating risk assessment is that information on reference dose, concentrations, and other information to conduct these assessments is lacking. Development of monolayer and organoid methods for in-laboratory assessments of toxicity and cellular response could be promising. Nationally, several states use ATSDR risk assessment tools, such as the Partnership to Promote Local Efforts to Reduce Environmental Exposure as a part of the Comprehensive Environmental Response, Compensation, and Liability Act. More work, however, is needed in understanding these risk assessment components to reliably address CIPP risks (Supplemental Table 3). Risk Communication Many mixed public messages about CIPP chemical exposures exist and communicating risk is challenging when emergent evidence is involved (Balog-Way et al., 2020). In addition to information uncertainty that typically bounds health-related hazards, guidance and policies may change regarding potential controls and other protective actions. These changes can erode stakeholder trust if engagement is not central to the communication process (Hoover et al., 2021). Because CIPP installations lack enforcement from the air pollution regulatory framework that is applied to other resin-reliant pollution-generating industries, minimal familiarity with the process and potential risks likely exists among those outside the industry. Different levels of CIPP-related environmental health literacy (Hoover, 2019) exist among various stakeholder groups, and multiple communication tools are necessary (Table 1). In many cases, stakeholders and their potential roles in prevention and mitigation have yet to be identified, so health officials cannot create targeted, meaningful messages. By identifying and engaging key groups, health officials can ensure messages are delivered by trusted messengers through preferred communication channels. Several frameworks exist for supporting public health practitioners in developing and deploying messages regarding potential CIPP exposure threats and prevention approaches (Supplemental Figure 2). The Crisis and Emergency Risk Communication Framework can be helpful for addressing emergency incidents, while best practices for risk communication can assist in longer-range Current Cured-in-Place Pipe (CIPP) Practice, Measures, and Suggested Desired System Note. CDC = Centers for Disease Control and Prevention; NEPA = National Environmental Policy Act; PH = public health; U.S. EPA = U.S. Environmental Protection Agency. FIGURE 2