NEHA November 2022 Journal of Environmental Health

28 Volume 85 • Number 4 A D VANC EME N T O F T H E PRACTICE communication planning e orts (Sellnow et al., 2009). The U.S. EPA Strategy, Action, Learning, and Tools (SALT) framework provides additional guidance, from developing communication strategies to providing tools and resources for communicators. Insights From Public Health Practitioners Practices and Feedback Feedback from public health o‚cials was wide-ranging, and representatives had many questions about the complexity of CIPP health issues (Supplemental Table 4). Approximately 40–50% of o‚cials had some knowledge of CIPP technology before participating. Some agencies directly responded to assistance requests from individuals who self-reported emission exposure. One organization conducted chemical air testing in response to a public request. Participants identified practitioner information needs that included the specific chemicals and concentrations brought on-site, the specific byproducts and concentrations released during manufacture, and potential chemical exposure di erences among types of CIPP practices. Additionally, practitioners were interested in whether UV light curing was safer than the steam-based curing. Inquiries were also made about if some available CIPP resins develop less-toxic emissions. Practitioners also sought guidance on real-time air sampling approaches. To better understand health concerns, participants inquired about available worker safety data, indoor air testing procedures, and building decontamination methods. Practitioners also inquired about roles and responsibilities regarding public communication about exposures as well as responsibility for consequences (i.e., human harm, building contamination), including if infrastructure owners could use contract language to limit waste discharge incidents. Key Groups Needing Information and Incident Response Knowledge Gaps The structural framework for preventing CIPP chemical exposures was identified as a shared responsibility across multiple organizations and sectors. Numerous audiences were identified as needing information before, during, and after a chemical exposure incident (Table 2). Emergency responders were identified as an important group needing information; however, agencies contacted were unable to participate. Practitioners identified that the public needs more information about potential health impacts of exposure. The work group noted environmental justice implications; while less expensive and faster infrastructure repair processes such as CIPP can work to a community’s advantage, the potential for exposure to a ect marginalized populations was a concern. Overall, knowledge gaps associated with CIPP exposure response included: 1. What hazardous materials are generated before, during, and after CIPP manufacture? 2. How emissions distribute and migrate? 3. What specific health e ects are related to exposure? 4. How can o‚cials better engage and control CIPP-related exposure incidents? 5. What are the best risk assessment and communication strategies? Primary, secondary, and tertiary prevention and mitigation actions identified are shown in Table 3. Prioritized Actions of Public Health Associations to Mitigate Health Risks and Improve Knowledge Representatives from public health associations identified several priorities for followup work (Supplemental Table 4). In terms of CIPP manufacture and waste, a better understanding of how to minimize emissions and vapor transport pathways in sewers was recommended. Understanding chemical transport was deemed a high priority for routine conditions (without pressure) and during CIPP manufacture (with pressure). Practitioners desired information and tools to help predict potential health e ects given exposure details. Other priorities included better understanding how and when municipalities notify residents of CIPP and what health advice to provide after an exposure. Public health associations frequently proposed educational activities (i.e., conferences, newsletters, blog posts) as a means for sharing new knowledge. A multi-association e ort was proposed in which evidence-based public health practice and emergency incident response information could be posted on a website. Brief educational modules for public health professionals that incorporate CIPP definitions, general hazards and risks, and complaint case studies also were recommended. Development of informational materials (e.g., health department fact sheets, a frequently asked questions (FAQ) list, research progress updates) was mentioned. The creation of a downloadable mobile phone app was proposed so that populations could report CIPP use, emission discharges into air, and exposures (i.e., detection of odor or symptoms). All association representatives sought better documentation of chemical exposures nationwide. Discussion System Realignment There is an acute lack of systems-level knowledge on protecting the public from harm when CIPP is implemented, and thus explicit participation of public health professionals is needed (Figure 2A, 2B). Environmental regulatory oversight of CIPP air discharges has yet to be implemented, unlike in other composite manufacturing industries (U.S. EPA, 2020). The social amplification of a risk framework indicates health o‚cials who lack direct experience with or lack lines of communication about CIPP likely are unaware of the exposure risks (Penders et al., 2012). Community stakeholders and the general public also lack su‚cient knowledge of CIPP emissions to recognize and avoid exposure hazards. The use of handouts and mailers by CIPP contractors, infrastructure owners, and consulting engineers has diverted exposure notifications away from health departments. By removing chemical evidence from buildings before emergency responders arrive, improperly using air-testing devices, or using devices that provide erroneous information, some CIPP companies and municipalities might reduce the chance of victims seeking medical assistance. Although past CIPP emission exposures have posed immediate health hazards, the CIPP industry (and municipalities distributing their literature) compares building occupant styrene exposures to “strawberries” and “co ee,” both of which naturally contain styrene. Their messaging potentially creates an interpretive disconnect by presenting often desirable (rather than risk-laden) images. Evidence also indicates CIPP workers and companies are not informed about all

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