Drinking water disinfection by-products (DBPs) are an unintended consequence of using chemical disinfectants to kill harmful pathogens in water. DBPs are formed by the reaction of disinfectants with naturally occurring organic matter, bromide, and iodide, as well as from anthropogenic pollutants. Potential health risks of DBPs from drinking water include bladder cancer, early-term miscarriage, and birth defects. Risks from swimming pool DBP exposures include asthma and other respiratory effects. Several DBPs, such as trihalomethanes (THMs), haloacetic acids (HAAs), bromide, and chlorite, are regulated in the U.S. and in other countries, but other “emerging” DBPs, such as iodo-acids, halonitromethanes, haloamides, halofuranones, and nitrosamines, are not widely regulated. DBPs have been reported for the four major disinfectants: chlorine, chloramines, ozone, and chlorine dioxide (and their combinations), as well as for newer disinfectants, such as UV treatment with post-chlorination. Each disinfectant can produce its own suite of by-products. Several classes of emerging DBPs are increased in formation with the use of alternative disinfectants (e.g., chloramines), including nitrogen-containing DBPs (“N-DBPs”), which are generally more genotoxic and cytotoxic than those without nitrogen. Humans are exposed to DBPs not only through ingestion (the common route studied), but also through other routes, including bathing, showering, and swimming. Inhalation and dermal exposures are now being recognized as important contributors to the overall human health risk of DBPs. Analytical methods continue to be developed to measure known DBPs, and research continues to uncover new highly polar and high-molecular-weight DBPs that are part of the missing fraction of DBPs not yet accounted for. New studies are now combining toxicology and chemistry to better understand the health risks of DBPs and uncover which are responsible for the human health effects.