NEHA November 2022 Journal of Environmental Health

November 2022 • Journal of Environmental Health 29 chemicals that were contained and/or generated through the CIPP manufacture (Supplemental Table 2). This lack of understanding impedes deployment of critical controls to eliminate or substitute hazards and formulate engineering solutions that isolate people from hazards, implement administrative controls, and use personal protective equipment and actions (Morris & Cannady, 2019). A system realignment is strongly recommended so that public health o…cials can act on behalf of the population by participating in oversight and response (Figure 2C). Considering the limitations and widespread practice of waste discharge to the environment, public health agencies and emergency responders should approach CIPP emission exposure settings as uncontrolled hazardous material releases. Respiratory protection for health o…cials and emergency responders can be necessary due to documented and predicted styrene levels at work sites and in buildings (Noh et al., 2022a). Individuals experiencing exposure-related symptoms should be removed from the exposure source and seek medical assistance. Additionally, odors and symptoms should be reported to the local health department. Due to CIPP emission complexity (i.e, containing numerous components beyond VOCs), unique toxicity and health concerns arise that could present more robustly in susceptible populations. Beyond waste management, the general public and CIPP contractors should be educated and systematic communication among relevant stakeholders should be initiated. Conclusion To further understand and address the human health risks posed by CIPP sewer projects, we recommend the following changes for policy, practice, and future research: 1. Educate health departments about CIPP risks, appropriate response, and public notification practices using media to reach a broader audience. 2. Develop public health guidelines for preventing and responding to CIPP-related incidents. Address inadequate practices by 1) identifying risks from the chemical exposure and countermeasures for infants, older adults, or anyone who is immunocompromised; 2) expanding safety data sheets to ensure they list all the material composition; and 3) generating capture policies for CIPP-generated chemical waste. 3. Evaluate the circumstances and conditions where CIPP manufacturing sites or companies require air pollution permits to protect the public from HAP exposures and environmental degradation. 4. Chemically characterize the materials brought on-site, created, and discharged by CIPP manufacturing sites (i.e., quantity and composition of the wastes, transport pathways of the wastes, public health risks). Evidence shows that CIPP has been utilized with little consideration of the public health risks it can cause. As it is the mission of public health to protect the well-being of populations—and chemical exposures will continue to occur—public health stakeholders should examine and define their roles for chemical incident prevention and mitigation. Acknowledgements: The authors thank the following agencies for their work group participation: American Public Health Association, Association of State and Territorial Health O…cials, California Department of Public Health, Centers for Disease Control and Prevention, Colorado Department of Public Health and Environment, Florida Department of Public Health, Indiana State Department of Health, Michigan Department of Health and Human Services, National Environmental Health Association, National Institute for Occupational Safety and Health, Pennsylvania Department of Health, U.S. EPA, and Virginia Department of Health. Appreciation is also extended to Yana Genchanok and Alexis Cain at U.S. EPA and Professor Azizur Molla at Grand Valley State University for their feedback and support. Any opinions expressed in this article are those of the author(s) and do not necessarily reflect the o…cial positions and policies of the participating organizations. This research was supported by the National Institute of Environmental Health Sciences (R03 1R03ES030783-01, 1R01 ES032396-01, P42 ES007380), U.S. EPA (R5 XA 00E02898), and National Science Foundation (CBET-2129166, CBET-1452800). Corresponding Author: Andrew Whelton, Professor, Lyles School of Civil Engineering, Division of Ecological and Environmental Engineering, Purdue University, 550 Stadium Mall Drive, West Lafayette, IN 47907-2051. Email: American Society of Civil Engineers. (2021). 2021 report card for America’s infrastructure. Balog-Way, D., McComas, K., & Besley, J. (2020). The evolving field of risk communication. 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