Cumulative health risk estimation for exposure to mixtures is a current issue, which would present a useful tool for environmental and public health management. Cumulative risks were estimated with response and dose addition methods for individual multi-route – multi-pathway exposure to trihalomethanes and associated carcinogenic toxic risks in Izmir, Turkey. Exposure levels were estimated for ingestion, dermal, and inhalation routes using measured tap water and bottled water THM concentrations. Drinking, showering, hand and dish washing were the considered pathways. THM concentrations in air during the showering were modeled with two-resistance theory using tap water concentration data. The estimated carcinogenic risk levels for ingestion route were in the range of safe (<10⁻⁶) to low priority (<10⁻⁴), for dermal route all were in the safe zone (<10⁻⁶), and for inhalation route were in the range of safe to high priority (>10⁻⁴) zones, indicating ingestion and inhalation routes were of similar significance ahead of dermal exposure. Cumulative carcinogenic risks of THM compounds were estimated using simple (response) addition and dose addition using cumulative relative potency factor (CRPF) methods. CRPF method estimated the risks at lower levels compared to the simple addition, which originated from the use two different risk factor values for the index chemical in the method. Cumulative chronic-toxic risks were also assessed, rendering below the threshold risk levels for all routes. This study showed that multi-route – multi-pathway exposure assessment and cumulative risk assessment should together be considered for better environmental and public health management.

暴露于混合物中的累积健康风险估计是当前的问题，这将为环境和公共卫生管理提供有用的工具。在土耳其伊兹密尔，使用应对和剂量增加方法针对个别多途径-多途径暴露于三卤甲烷的累积风险进行了估算，并估计了相关的致癌毒性风险。使用测得的自来水和瓶装水THM浓度估算摄入，皮肤和吸入途径的暴露水平。饮酒，淋浴，洗手和洗碗都是考虑的途径。淋浴期间空气中的THM浓度使用自来水浓度数据通过两阻力理论建模。摄入途径的估计致癌风险水平在安全（<10 ^-6）至低优先级（<10）的范围内^-4），对于皮肤途径，所有途径均处于安全区（<10 ^-6），对于吸入途径，其均处于安全至高优先级范围内（> 10 ^-4））区域，表明在皮肤接触之前，摄入和吸入途径具有相似的意义。THM化合物的累积致癌风险是通过简单（响应）添加和剂量累积（使用累积相对效能因子（CRPF）方法）估算的。与简单添加相比，CRPF方法估计的风险较低，这是由于该方法中使用了两种不同的危险因素值来指示化学物质。还评估了累积的慢性毒性风险，使所有途径的风险均低于阈值风险水平。这项研究表明，应综合考虑多途径，多途径接触评估和累积风险评估，以改善环境和公共卫生管理。