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Health Risk Analysis Overview:

The following offers a summary of our expertise in providing health risk analysis tools and related professional services:

Description of Services:

Since 1986, Cox Associates has provided scientific risk analyses and related statistical and engineering consulting services in the following areas. Please click on the links for examples of our publications and software.

Balancing real versus theoretical risks to the Canadian blood supply

Causal modeling of antimicrobial resistance

Biologically-based risk assessment of chemical carcinogens

Assessment of attributable risks, probabilities of causation, and shares in causation for risks caused by the joint actions of multiple factors. (See e.g., Cox, L.A., Jr., "Statistical issues in the estimation of assigned shares for carcinogenesis liability," Risk Analysis, 7, 1, 71-80, 1987.)


Design and analysis of long-term animal bioassays

Computer modeling of known and suspected causal toxicological mechanisms of chemically induced health effects. (See e.g., Cox, LA, Jr., 1999. A biomathematical model of hematotoxicity. Environment International, 23, 6/7.)

Advanced statistical data analysis and interpretation of epidemiological data

Exposure and consequence modeling, environmental fate and transport modeling, population mobility models, and engineering safety models. (See e.g., Cox, LA, Jr., 1999. Optimal adaptive sampling of contaminated soils. Forthcoming in Risk Analysis. (Accepted 10-98).)


Risk management decision making and applied decision analysis. (See e.g., Cox, LA, Jr., K. Paige, D. Popken, 1999. Software review of Analytica 1.2. Human and Ecological Risk Assessment, 5, 2, 305-316.)


Artificial intelligence, machine learning, causal modeling, and data mining methods for finding valuable predictive patterns in complex data. (See e.g., Cox, LA, Jr., 1996. Using causal knowledge to learn more useful decision rules from data. Chapter 2 in D. Fisher and H.-J. Lenz (eds.), Learning from Data: AI and Statistics V. Springer-Verlag. See also


Operations research modeling and optimization of business and engineering operations and risky business decisions. (See e.g., Cox, LA, Jr., and J.R. Sanchez, 1999. Designing least-cost survivable wireless backhaul networks. Forthcoming in Journal of Heuristics..)


Uncertainty analysis of exposure-response and dose response relations. (See e.g., Cox, LA, Jr., 1996. More accurate estimates of dose-response functions using Monte-Carlo uncertainty analysis: The Data Cube approach." Human and Ecological Risk Assessment, 2, 1, 146-170.)

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Projects Completed:

Examples of Health, Safety, and Environmental Risk Analysis projects completed by Cox Associates include the following.

Risk Analysis for World Health Organization.


Created computer simulation models (PBPK and pharmacodynamic) of dose-time-response relations for low-level exposures to chemical carcinogens, for Exxon Biomedical Sciences (EBSI).


For the American Petroleum Institute (API), created a computer simulation model of bone marrow and blood cell toxicity caused by cyclophosphamide, an immunosuppressive drug. Designed laboratory experiments to validate the model's predictions. Analyzed clinical and laboratory data to test model's predictive validity. Prepared a software release so that other scientists could use the model.


Developed an artificial intelligence method for improving prediction of likely human chemical carcinogens, also for EBSI.


Critically reviewed epidemiological studies of diesel exhaust and human lung cancer risk for the Engine Manufacturers Association. Presented conclusions in several hearings.


Reviewed literature on air pollution and human lung cancer risks, for the American Petroleum Institute.


Applied adaptive spatial sampling to optimize search and clean-up efforts for remediating residential properties around an abandoned hazardous waste site (for AlliedSignal)


Reassessed human cancer risks from 1,3-butadiene using pharmacokinetic modeling to adjust for interspecies differences in internal doses of epoxybutene (for the Chemical Manufacturers Association)


Reassessed the human leukemia risks from benzene exposure using a physiologically-based pharmacokinetic (PBPK) model to calculate internal dose (for the American Petroleum Association)


Reviewed design of an initiation-promotion experiment for studying the potential carcinogenicity of a rubber additive, for Goodyear Tire and Rubber Company.


Developed a general physiologically-based pharmacokinetic (PBPK) modeling tool for rapidly developing high-quality PBPK models (with ENSR Consulting and Engineering, Inc.)


Reviewed artificial intelligence approaches to characterizing uncertain health risks using weight of evidence, nonmonotonic, and other uncertainty analysis (for Lawrence Berkeley National Laboratory)


Assessed potential health risks associated with occupational exposure to herbicides among roadside workers, using pharmacokinetic models, for a Fortune 100 chemical manufacturer.


Risk screening, exposure modeling, hazard index calculation, and recommendation of cleanup priorities for a large hazardous waste site in Canada


Developed technical reports and a prototype computer modeling tool for biologically based risk assessment of cancer risks from chemical carcinogens, for the Western States Petroleum Association (WSPA) and the American Petroleum Institute (API)


Reviewed new biostatistical and "biologically based" approaches to cancer risk analysis, for the California Department of Health Services


Reviewed regulatory history of benzene risk assessments and of biomathematical approaches to modeling leukemogenesis for the Western Oil and Gas Association and the American Petroleum Institute


Prototype computer modeling of the AIDS epidemic (with Arthur D. Little, Inc.)


Designed a 2-year bioassay experiment for isoprene. Analyzed and reported the resulting experimental data for a multi-client, multinational industry group coordinated by Exxon Biomedical Sciences.


Accident risk analysis and consequence analysis of a petrochemical storage facility in California, for a California-based environmental consulting firm


Implemented a Macintosh version of a physiologically-based pharmacokinetic (PBPK) model for benzene pharmacokinetics and total metabolism in rodents and humans, for the API


Explored new mathematical approaches and conceptual frameworks for dealing with scientific uncertainties in biologically-based risk assessment, for the Western States Petroleum Association (WSPA)


Created an interactive data analysis and graphics package for determining the degree of worker protection provided by different respirators, filters, and face masks (with Arthur D. Little, Inc.)


Microeconomic and applied probability modeling of insurance company business risks for use in tax litigation (with Arthur D. Little, Inc.)


Critically reviewed a transportation risk analysis for liquefied natural gas (LNG) operations in the St. Lawrence seaway. Reviewed progress since 1985 in using decision analysis for accident risk assessments.


Implemented an experimental "intelligent" data base management system for chemical health effects data bases (with Exxon Biomedical Sciences, Inc.)


Uncertainty analysis of PBPK modeling and risk analyses, accounting for model uncertainties and population heterogeneity, for the American Industrial Health Council.


Developed new techniques for assessing and predicting the cancer risks associated with mineral oils and petroleum products, for Mobil Oil.

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For the past twenty years, Cox Associates has been an innovator in many areas of risk analysis methods and models for applications, contributing to areas such as biologically-based risk modeling and improved methods for uncertainty analysis. Examples of publications in various areas of risk analysis in the past five years include the following.

Cox LA Jr.  Regression versus causation, revisited. Risk Analysis. 2010 April; 30(4):535-540.


Cox LA Jr., Popken DA. Assessing potential human health hazards and benefits from subtherapeutic antibiotics in the United States: Tetracyclines as a case study.  Risk Analysis. 2010 March; 30(3):432-455.


Cox T. More general conditions under which mean-variance decision making is unjustified.  Risk Analysis. 2010 March; 30(3):329.


Cox LA Jr.  Why reduced-form regression models of health effects versus exposures should not replace QRA: livestock production and infant mortality as an example. Risk Analysis. 2009 Dec;29(12):1664-71.


Cox LA Jr. Game theory and risk analysis.  Risk Analysis. 2009 Aug;29(8):1062 -8.


Cox LA Jr. What's wrong with hazard-ranking systems? An expository note. Risk Analysis. 2009 Jul;29(7):940-8.


Cox LA Jr., Popken DA, Mathers J.  Human health risk assessment of penicillin / aminopenicillin resistance in enterococci due to penicillin use in food animals. Risk Analysis. 2009 Jun;29(6):796-805


Cox LA Jr. A mathematical model of protease-antiprotease homeostasis failure in chronic obstructive pulmonary disease (COPD). Risk Analysis 2009 Apr;29(4):576-86.


Parnell GS, Borio LL, Cox LA, Brown GG, Pollock S, Wilson AG. Response to Ezell and von WinterfeldtBiosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science. March 2009, 7(1): 111-112


Cox LA JrImproving risk-based decision making for terrorism applications. Risk Analysis 2009 March;29(3):336-341. 


Cox Jr LA. Hormesis without cell killing. Risk Analysis 2009 March 29(3):393-400.


Cox Jr LA. Some limitations of frequency as a component of risk:  An expository note. Risk Analysis 2009 Feb; 29(2):171-175


Cox, LA Jr.  Making Telecommunications Networks Resilient Against Terrorist Attacks.  Chapter 8 in Bier VM and Azaiez MN (Eds).   Game Theoretic Risk Analysis of Security Threats.  Springer, New York. 2009.


Cox LA Jr.  Could removing arsenic from tobacco smoke significantly reduce smoker risks of lung cancer? Risk Analysis 2009 Jan; 29(1):3-17.


Cox LA Jr.  Target Sites – Cardiovascular. In  P. Wexler et al. (Eds.)  Information Resources in Toxicology, Fourth Edition.  Elsevier Inc. New York.  2009


Cox LA Jr.  Target Sites – HematopoiesisIn  P. Wexler et al. (Eds.)  Information Resources in Toxicology, Fourth Edition.  Elsevier Inc. New York.  2009


Bier VM, Cox LA Jr, Azaiez MN.  Why Both Game Theory and Reliability Theory are Important in Defending Infrastructure Against Intelligent Attacks.   Chapter 1 in Bier VM and Azaiez MN (Eds).  Game Theoretic Risk Analysis of Security Threats.  Springer, New York.  2009.


Cox LA Jr., Brown GG, Pollock SM.  When is uncertainty about uncertainty worth characterizing?  Interfaces 2008 Nov.-Dec. 38(6):465-468.


Cox LA Jr.  Some limitations of “Risk = Threat Vulnerability Consequence” for risk analysis of terrorist attacks. Risk Analysis 2008. Dec. 28(6):1749-1762.


Cox Jr LA, Popken DA. Overcoming confirmation bias in causal attribution: A case study of antibiotic resistance risks.  Risk Analysis 2008 Oct; 28(5):1155-1171.


Cox LA Jr.  R&D Planning and Risk Management. Wiley Encyclopedia of Quantitative Risk Analysis and Assessment, 2008.


Cox LA Jr.  Managing Foodborne Risks. Wiley Encyclopedia of Quantitative Risk Analysis and Assessment, 2008.


Cox LA Jr, Greenberg MR, Bostrom A, Haas C, Haimes Y, Landis W, Lowrie KW, Moolgavkar S, North W.  What is the scope of the journal Risk Analysis?  (Invited Editorial).  Risk Analysis 2008 Oct; 28(5):1135-1136.


Cox Jr LA. Why risk is not variance: An expository note. Risk Analysis 2008 Aug 28(4):925-928.


Cox LA Jr, Ricci PF. Causal regulations vs. political will: Why human zoonotic infections increase despite precautionary bans on animal antibiotics.  Environment International 2008 May;34(4):459-75


Cox LA Jr. What's wrong with risk matrices? Risk Analysis 2008 Apr;28(2):497-512.


Cox LA Jr, Huber WA. Symmetry, identifiability, and prediction uncertainties in multistage clonal expansion (MSCE) models of carcinogenesis. Risk Analysis 2007 Dec;27(6):1441-53.


Cox LA Jr..  Regulatory false positives:  True, false, or uncertain?  [letter] Risk Analysis 2007 Oct;27(5):1083-6.


Cox LA Jr. Health Risk Analysis for Risk Management Decision-Making. Chapter 17 in Advances in Decision Analysis. W. Edwards, R. Miles, D. von Winterfeldt, Eds. Cambridge University Press.  2007.


Bier V, Cox LA Jr.  Probabilistic Risk Analysis for Engineered Systems.  Chapter 15 in  Advances in Decision Analysis. W. Edwards, R. Miles, D. von Winterfeldt, Eds.. Cambridge University Press.  2007.


Cox LA Jr, Popken DA.  Some limitations of aggregate exposure metrics.  Risk Analysis 2007 Apr;27(2):439-45.


Cox LA Jr. Does concern-driven risk management provide a viable alternative to QRA? Risk Analysis 2007 Feb;27(1):27-43. 


Cox LA Jr., Popken DA, Carnevale R.  Quantifying human health risks from animal antimicrobials.  Interfaces 2007 Jan-Feb; 37(1): 22-38.


Singer RS, Cox LA Jr, Dickson JS, Hurd HS, Phillips I, Miller GY. Modeling the relationship between food animal health and human foodborne illness.  Preventive Veterinary Medicine. 2007 Jan 29.


Cox LA Jr. Quantifying potential health impacts of cadmium in cigarettes on smoker risk of lung cancer: A portfolio-of-mechanisms approach. Risk Analysis 2006 Dec;26(6):1581-99.


Cox LA Jr, Sanders E..  Estimating preventable fractions of disease caused by a specified biological mechanism: PAHs in smoking lung cancers as an example.  Risk Analysis  2006 August 6(4):881-892.  (Winner, "The Outstanding Published Paper in 2006 Demonstrating an Application of Risk Assessment", awarded by the Risk Assessment Specialty Section of the Society of Toxicology, March, 2007)


Cox LA Jr. and D Babayev.  Networked facilities expansion problem.  International Journal of Information Technology and Decision-Making 2006 June; 5(2):379-396.


Cox LA. Detecting causal nonlinear exposure-response relations in epidemiological data.  Dose Response. 2006 Aug 19;4(2):119-32.


Cox LA. A model of cytotoxic dose-response nonlinearities arising from adaptive cell inventory management in tissues. Dose Response. 2006 May 22;3(4):491-507.


Cox LA Jr, Wong C.  State transition model for customer relationship management.  Direct Marketing Analytics Journal.  May, 2006, 9-15.


Cox LA. Universality of J-Shaped and U-Shaped dose-response relations as emergent properties of stochastic transition systems.  Dose-Response 2006 May 1; 3(3): 353–368.,6,11;journal,13,13;linkingpublicationresults,1:119866,1


Cox LA Jr.  Enrofloxacin in poultry and human health [letter].  Emerging Infectious Diseases.  2006 May;12(5): 872-3.


Cox LA Jr. Routine use of antibiotics in food animals increases protein production and reduces prices [letter]. Clinical Infectious Diseases 2006 Apr 1;42(7):1053.


Cox T.  Potential Human Health Impacts of Banning Antibiotics Used in Food Animals: A Case Study of VirginiamycinChapter in D. Barug, J. de Jong, A.K. Kies and M.W.A. Verstegen (Eds).  Antimicrobial Growth Promoters Where Do We Go From Here? Wageningen Academic Publishers.  The Netherlands.  2006.


Cox LA Jr, Popken DA. Quantifying potential human health impacts of animal antibiotic use: Enrofloxacin and macrolides in chickens. Risk Analysis. 2006 Feb;26(1):135-46.


Cox LA Jr. Animal antibiotic use and human health: No expert judgment is needed to determine that reducing cases reduces risk. Risk Analysis. 2006 Feb;26(1):157-61.


Ricci PF, Cox LA Jr, MacDonald TR. Science-policy in environmental and health risk assessment: If we cannot do without, can we do better? Hum Exp Toxicol. 2006 Jan;25(1):29-43.


Cox LA Jr. Some limitations of a proposed linear model for antimicrobial risk management.  Risk Analysis. 2005 Dec; 25(6): 1327-1332.


Cox LA, Babayev D. Optimization under uncertainty via random sampling of scenarios II.  Applied and Computational Mathematics, 2005;4(1): 20-28


Cox LA Jr., VanSickle JJ, Popken DA, Sahu R.  Optimal tracking and testing of US and Canadian herds for BSE:  A Value-of-Information (VoI) approach.  Risk Analysis, 2005;  25(4): 827-840.


Ricci PF, Cox LA Jr, MacDonald TR.  First do no harm:  Can regulatory science-policy in risk assessment be deleterious to health?  Biological Effects of Low Level Exposures (BELLE) Newsletter, 2005 July;13(10):26-37


Cox, LA Jr.  Precaution and consequences.  Letter to the Editor.  PLoS Medicine.  July, 2005.


Cox LA Jr.  Parkinsonism and welding: testing for statistical vs. causal associationsLetter to the Editor.  Neurology.  June 29, 2005.


Cox LA Jr, Babayev D, Huber W.  Some limitations of qualitative risk rating systems.  Risk Analysis, 2005 Jun;25(3):651-62


Cox LA Jr, Copeland D, Vaughn M. Antimicrobial resistance in Campylobacter.  Letter to the Editor. Emerging Infectious Diseases, 2005 June; 11(6)


Ricci PF, MacDonald TR, Cox LA Jr. Precautionary decision making: Analysis and results. Int. J. Risk Assessment and Management, 2005 6(2-4):237-270.


Cox LA Jr. Potential human health benefits of antibiotics used in food animals:  A case study of virginiamycinEnvironment International, 2005 May;31(4): 549-563.  doi:10.1016/j.envint.2004.10.012  


Cox LA Jr, Copeland D, Vaughn M.Ciprofloxacin resistance does not affect duration of domestically acquired campylobacteriosis.  Letter to the Editor.   Journal of Infectious Diseases.  2005 May 1; 191(1): 1565-6.


Cox LA Jr, Ricci PF..   Causation in risk assessment and management: Models, inference, biases, and a microbial risk-benefit case study. Environ Int. 2005 Apr;31(3):377-97.


Cox, LA Jr. Predicting and optimizing customer behaviors.  Chapter 12 in A. Labbi (Ed.), Handbook of Integrated Risk Management for E-Business:  Measuring, Modeling, and Managing Risk.  J. Ross Publishing.  February, 2005.


Cox LA, VanSickle JJ, Popken DA, Sahu R.  Reply to Comment on Tracking and testing of US and Canadian cattle herds for BSE: A risk management dilemma. CHOICES:  The Magazine of Food, Farm, and Resource Issues.  1st Quarter, 2005.


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