“…However, there have been comparatively few CRAs that attempt to incorporate nonchemical stressors, such as psychosocial factors (e.g ., discrimination, poverty), physical agents (e.g ., heat, noise) or biological stressors (e.g ., pathogens) into the formal analysis process (Callahan and Sexton 2007;NRC 2009;Sexton 2012). Efforts are currently underway to develop methods for integrating analysis of psychological, social and economic factors-such as low income, deficient education, unemployment, inadequate housing, high-crime neighborhoods, substandard diet, and lack of access to health care-into CRAs (deFur et al 2007;Menzie et al 2007;Ryan et al 2007;NJDEP 2009;CalEPA 2010;NEJAC 2010;Lewis et al 2011;Zartarian et al 2011;Linder and Sexton 2011;Sexton and Linder 2011;Alexeeff et al 2012). The objective of this Perspective is to describe the inherent challenges of putting CRA principles into practice, with particular emphasis on effects-based approaches.…”