Agency for Toxic Substances and Disease Registry 
Case Studies in Environmental Medicine (CSEM) 
Pediatric Environmental Health
Exposure-Disease Model

Figure 1. Exposure-Disease Model

^*Contamination of environmental medium: air, water, soil, or food. Assessment tools: exposure history and environmental monitoring.
^†Primary routes of exposure: respiratory, oral, and dermal. Secondary routes of exposure: breast milk, transplacental, nonplacental/intrauterine, and parenteral. Assessment tools: exposure history and biologic monitoring.
^‡Assessment tools: biologic monitoring.
^§Assessment tools: history, physical, biologic monitoring (to include advanced diagnostic testing of target organ), and specialty referral (if necessary).

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