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ORAU experts contribute to first-ever Total Exposure Health book

ORAU experts contribute to first-ever Total Exposure Health book

The first-ever book about the concept of Total Exposure Health includes a chapter written by three ORAU subject matter experts and their research related to the National Supplemental Screening Program (NSSP), which ORAU manages for the U.S. Department of Energy.

The book, Total Exposure Health: An Introduction, was published by Routledge and CRC Press in June. Chapter 12, Identifying Exposures and Health Outcomes in Former Worker Populations, was written by Jeffrey Miller, Ph.D., Ashley Golden, Ph.D., and Zachariah Hubbell, Ph.D.

Total Exposure Health is the concept of evaluating an individual’s exposure to hazards, like radiation and chemicals, at work, at home, from the environment and through their lifestyle choices during the entire course of their life and how those exposures relate to health. The measure of life-long exposures is known as an individual’s exposome.

“The Air Force Research Laboratory in Dayton, Ohio, is spearheading the concept of Total Exposure Health,” Golden said.

She and Miller attended AFRL’s first-ever conference on Total Exposure Health in September 2018. While there, they talked to Dirk Yamamoto, Ph.D., senior industrial hygienist and Total Exposure Health team lead at AFRL, whom Miller knew. They discussed how the concept of the NSSP, a longitudinal medical surveillance program for former workers, could be used by the Air Force and other agencies to monitor the long-term health effects from all the exposures that people receive during their lifetime.

“Typically what happens is that while a person is working or active duty, they’re being monitored by their employer, and then they retire,” Golden said. “They go on Medicare and are usually monitored through primary care, but a lot of physicians don’t know to look for signs and symptoms that are latent from an occupational exposure.”

The NSSP, on the other hand, uses medical screenings to identify occupational disease, such as chronic respiratory illnesses and some forms of cancer, among former energy workers. The process also identifies other health problems—potentially caused by lifestyle and environmental exposures—such as diabetes and hypertension. This approach improves the ability of former energy workers to address not only work-related illnesses but their overall health.

“We thought DOE had a great idea with how they set up their former worker program and how it could be one piece of the Total Exposure Health puzzle,” Golden said. “It could serve as a framework for a preventive surveillance mechanism for early identification of disease, especially for military veterans, so that an airman isn’t waiting until he or she has stage-4 lung cancer before going to the Veterans Administration for healthcare services.”

Hubbell, Golden and Miller developed a poster that was presented at the Total Exposure Health Conference. Yamamoto liked it so much, he asked them to write it up as part of the book he was developing.

“Jeff, Zac and I worked together to explain the NSSP and how we thought that fit into the exposome,” Golden said.

Now their chapter is helping medical providers, industrial hygienists and others gain a better understanding of how epidemiologic surveillance programs like the NSSP fit into the greater concept of Total Exposure Health.

Jeff Miller, Ph.D, is acting director for Health, Energy and Environment Programs; Ashley Golden, Ph.D. is health studies group manager for ORISE; Zac Hubbell, Ph.D., is a research associate for the National Supplemental Screening Program.