Cense: a tool to assess combined exposure to environmental health stressors in urban areas.

This paper describes the structure of the Combined Environmental Stressors' Exposure (CENSE) tool. Individuals are exposed to several environmental stressors simultaneously. Combined exposure represents a more serious hazard to public health. Consequently, there is a need to address co-exposure in a holistic way. Rather than viewing chemical and physical health stressors separately for decision making and environmental sustainability considerations, the possibility of an easy-to-comprehend co-exposure assessment is herein considered. Towards this aim, the CENSE tool is developed in the programming environment of Delphi. The graphical user's interface facilitates its tractable application. Studying different scenarios is easy since the execution time required is negligible. The tool incorporates co-exposure indicators and takes into account the potential dose of each chemical stressor by considering the physical activities of each citizen in an urban (micro)environment. The capabilities of the CENSE tool are demonstrated through its application for the case of Thessaloniki, Greece. The test case highlights usability and validation insights and incorporates health stressors and local characteristics of the area considered into a well identified user/decision maker interface. The main conclusion of the work reported is that a decision maker can trust CENSE for urban planning and environmental sustainability considerations, since it supports a holistic assessment of the combined potential damage attributed to multiple health stressors. CENSE abandons the traditional approach of viewing chemical and physical stressors separately, which represents the most commonly adopted strategy in real life decision support cases.