title: Aggregate Exposure and Cumulative Risk Assessment--Integrating Occupational and Non-occupational Risk Factors.
abstract: Occupational exposure limits have traditionally focused on preventing morbidity and mortality arising from inhalation exposures to individual chemical stressors in the workplace. While central to occupational risk assessment, occupational exposure limits have limited application as a refined disease prevention tool because they do not account for all of the complexities of the work and non-occupational environments and are based on varying health endpoints. To be of greater utility, occupational exposure limits and other risk management tools could integrate broader consideration of risks from multiple exposure pathways and routes (aggregate risk) as well as the combined risk from exposure to both chemical and non-chemical stressors, within and beyond the workplace, including the possibility that such exposures may cause interactions or modify the toxic effects observed (cumulative risk). Although still at a rudimentary stage in many cases, a variety of methods and tools have been developed or are being used in allied risk assessment fields to incorporate such considerations in the risk assessment process. These approaches, which are collectively referred to as cumulative risk assessment, have potential to be adapted or modified for occupational scenarios and provide a tangible path forward for occupational risk assessment. Accounting for complex exposures in the workplace and the broader risks faced by the individual also requires a more complete consideration of the composite effects of occupational and non-occupational risk factors to fully assess and manage worker health problems. Barriers to integrating these different factors remain, but new and ongoing community-based and worker health-related initiatives may provide mechanisms for identifying and integrating risk from aggregate exposures and cumulative risks from all relevant sources, be they occupational or non-occupational.
authors.affiliation: a Education and Information Division, Centers for Disease Control and Prevention , National Institute for Occupational Safety and Health , Cincinnati , Ohio.
authors.forename: T J
authors.initials: TJ
authors.lastname: Lentz
authors.affiliation: a Education and Information Division, Centers for Disease Control and Prevention , National Institute for Occupational Safety and Health , Cincinnati , Ohio.
authors.forename: G S
authors.initials: GS
authors.lastname: Dotson
authors.affiliation: b E Risk Sciences , LLP , Boulder , Colorado.
authors.forename: P R D
authors.initials: PR
authors.lastname: Williams
authors.affiliation: c Department of Environmental Health , University of Cincinnati College of Medicine , Cincinnati , Ohio.
authors.forename: A
authors.initials: A
authors.lastname: Maier
authors.affiliation: d Toxicology Excellence for Risk Assessment , Cincinnati , Ohio.
authors.forename: B
authors.initials: B
authors.lastname: Gadagbui
authors.affiliation: a Education and Information Division, Centers for Disease Control and Prevention , National Institute for Occupational Safety and Health , Cincinnati , Ohio.
authors.forename: S P
authors.initials: SP
authors.lastname: Pandalai
authors.affiliation: e Office of Pollution Prevention and Toxics , Environmental Protection Agency , Washington , DC.
authors.forename: A
authors.initials: A
authors.lastname: Lamba
authors.affiliation: f Office of the Director, Centers for Disease Control and Prevention , National Institute for Occupational Safety and Health , Washington , DC.
authors.forename: F
authors.initials: F
authors.lastname: Hearl
authors.affiliation: g Agency for Toxic Substances and Disease Registry , Centers for Disease Control and Prevention , Atlanta , Georgia.
authors.forename: M
authors.initials: M
authors.lastname: Mumtaz
mesh_terms: D004781:Environmental Exposure / Q000009:adverse effects; D015438:Health Behavior; D006801:Humans; D009784:Occupational Diseases / Q000209:etiology; D016273:Occupational Exposure / Q000009:adverse effects* / Q000592:standards; D018570:Risk Assessment / Q000941:ethics / Q000379:methods*; D012307:Risk Factors; D013312:Stress, Physiological; D014116:Toxicology / Q000379:methods
keywords: aggregate exposure; cumulative risk; occupational