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Unconventional Natural Gas Development and Birth Outcomes in Pennsylvania, USA
Abstract
Background:
Unconventional natural gas development has expanded rapidly. In Pennsylvania, the number of producing wells increased from 0 in 2005 to 3,689 in 2013. Few publications have focused on unconventional natural gas development and birth outcomes.
Methods:
We performed a retrospective cohort study using electronic health record data on 9,384 mothers linked to 10,946 neonates in the Geisinger Health System from January 2009 to January 2013. We estimated cumulative exposure to unconventional natural gas development activity with an inverse-distance squared model that incorporated distance to the mother's home; dates and durations of well pad development, drilling, and hydraulic fracturing; and production volume during the pregnancy. We used multilevel linear and logistic regression models to examine associations between activity index quartile and term birth weight, preterm birth, low 5-minute Apgar score and small size for gestational age birth, while controlling for potential confounding variables.
Results:
In adjusted models, there was an association between unconventional natural gas development activity and preterm birth that increased across quartiles, with a fourth quartile odds ratio of 1.4 (95% confidence interval = 1.0, 1.9). There were no associations of activity with Apgar score, small for gestational age birth, or term birth weight (after adjustment for year). In a posthoc analysis, there was an association with physician-recorded high-risk pregnancy identified from the problem list (fourth vs. first quartile, 1.3 [95% confidence interval = 1.1, 1.7]).
Conclusion:
Prenatal residential exposure to unconventional natural gas development activity was associated with two pregnancy outcomes, adding to evidence that unconventional natural gas development may impact health.
... This study did not include SES as a covariate which could have led to some bias in effect estimates due to confounding. Casey et al. (2016) used electronic clinical health records to study fetal growth outcomes in Pennsylvania and adjusted for a wide range of potential confounders (including primary care provider status, smoking status during pregnancy, pre-pregnancy BMI, parity, antibiotic orders during pregnancy, and receipt of medical assistance). The authors detected a decrease in birthweight in the highest quartile of exposure compared to the first (Q4 versus Q1, β − 31 g, 95% CI − 57, − 5) that lost statistical significance after adjusting for year of birth (Q4 versus Q1, β − 20 g, 95% CI − 15, 16). ...
... There were methodological differences in the treatment of gestational age. For example, while some only included birthweight data for term births (≥ 37 weeks gestation) in their models (Caron-Beaudoin et al., 2021;Casey et al., 2016;Currie et al., 2017;Stacy et al., 2015;Tran et al., 2020;Willis et al., 2021), others adjusted for gestational age as a covariate Erickson et al., 2022;Hill, 2018;McKenzie et al., 2014;Schuele et al., 2022;Willis et al., 2021), while others did not account for gestational age in their models (Hill & Ma, 2022;Whitworth et al., 2017). Despite these differences in exposure metrics, control groups, and statistical models, a majority of studies identified a decrease in birthweight with UOGD exposure. ...
... Several studies reported a significant association with UOGD and preterm birth (Cairncross et al., 2022;Caron-Beaudoin et al., 2021;Casey et al., 2016;Cushing et al., 2020;Erickson et al., 2022;Hill, 2018;Hill & Ma, 2022;Walker Whitworth et al., 2018;Whitworth et al., 2017) (Tables 1 and 2; Online Resource 3). The magnitude of adjusted ORs ranged between 1.11 and 2.00 with trendtested Walker Whitworth et al., 2018) and descriptive evidence of positive linear trends across increasing exposure categories . ...
Objective
Unconventional oil and gas development (UOGD, sometimes termed “fracking” or “hydraulic fracturing”) is an industrial process to extract methane gas and/or oil deposits. Many chemicals used in UOGD have known adverse human health effects. Canada is a major producer of UOGD-derived gas with wells frequently located in and around rural and Indigenous communities. Our objective was to conduct a scoping review to identify the extent of research evidence assessing UOGD exposure–related health impacts, with an additional focus on Canadian studies.
Methods
We included English- or French-language peer-reviewed epidemiologic studies (January 2000–December 2022) which measured exposure to UOGD chemicals directly or by proxy, and where health outcomes were plausibly caused by UOGD-related chemical exposure. Results synthesis was descriptive with results ordered by outcome and hierarchy of methodological approach.
Synthesis
We identified 52 studies from nine jurisdictions. Only two were set in Canada. A majority ( n = 27) used retrospective cohort and case–control designs. Almost half ( n = 24) focused on birth outcomes, with a majority ( n = 22) reporting one or more significant adverse associations of UOGD exposure with: low birthweight; small for gestational age; preterm birth; and one or more birth defects. Other studies identified adverse impacts including asthma ( n = 7), respiratory ( n = 13), cardiovascular ( n = 6), childhood acute lymphocytic leukemia ( n = 2), and all-cause mortality ( n = 4).
Conclusion
There is a growing body of research, across different jurisdictions, reporting associations of UOGD with adverse health outcomes. Despite the rapid growth of UOGD, which is often located in remote, rural, and Indigenous communities, Canadian research on its effects on human health is remarkably sparse. There is a pressing need for additional evidence.
... The Peace River Valley, located in Northeastern British Columbia (Canada), is home to approximately 35,000 oil and gas wells (Adams et al., 2016). This industrial activity may lead to environmental contamination, unwanted exposure and adverse health outcomes in local populations (Caserta et al., 2013;Casey et al., 2016;Katner et al., 2018;Lin et al., 2013;McKenzie et al., 2014;Scientific Hydraulic Fracturing Review Panel, 2019;Takser et al., 2003;Tran et al., 2021;Werner et al., 2015;Wisen et al., 2019;Wisen et al., 2020). Most of the oil and gas wells in this region use hydraulic fracturing, an extraction technique involving the injection of large volumes of water, proppants, and chemicals to fracture the rock formation containing fossil fuel. ...
... Many epidemiologic studies in North America have observed associations between exposure to oil and gas activity during pregnancy and health outcomes. Associations have been observed with preterm birth and low birth weight in many regions (Caron-Beaudoin et al., 2021;Casey et al., 2016;Currie et al., 2017;Gonzalez et al., 2020;Hill, 2018;Lin et al., 2013;McKenzie et al., 2014;Tran et al., 2020;Tran et al., 2021;Willis et al., 2021). Some studies also found associations with birth defects, including cardiac and circulatory defects (Willis et al., 2023), and neural tube defects (Gaughan et al., 2023). ...
... Digits 1-10 refer to the state, county, and well in that order, while digits 11-14 vary in meaning across states but can refer to a wellbore, completion, or conversion of well type. We recommend referring to a specific state's regulatory materials if interested in using digits [11][12][13][14]. Today, the Professional Petroleum Data Management Association owns and issues the API number standard; however, not all regulatory agencies choose to use this standardized identifying system (e.g., Indiana does not issue API numbers, Texas uses only the first 10 digits) [80][81][82]. ...
Purpose of Review
Oil and gas development is a rapidly expanding industry that may impact population health. However, much of the research to date is conducted state-by-state, partially due to exposure data limitations. New developments related to national-scale oil and gas development data sources offer the opportunity to extend studies beyond single-state analyses. We review the current data options, highlighting their advantages, disadvantages, and ideal use-cases.
Recent Findings
Five data sources suitable for national-scale epidemiologic analyses of oil and gas development were identified. Private sector data offer detailed production information but have limited accessibility. Nongovernmental sources are often specialized, focusing on specific aspects like chemical or methane exposure. Government agency data, while typically less detailed, provide useful linkage tools for cross-industry analysis.
Summary
This review clarifies the strengths and limitations of these sources, facilitating national-level exposure assessment and broadening the geographic reach of oil and gas development-related epidemiology in the U.S.
... The study setting included 37 counties in central and northeast Pennsylvania-including several Appalachian counties-within the service area of Geisinger, a large integrated health system whose primary care population is representative of the region's general population [39]. Pennsylvania is among the states with the highest opioid overdose mortality rates [40]. ...
Purpose
To elucidate the role of community socioeconomic conditions in creating opioid-related risk environments, we assessed community-level socioeconomic measures in association with opioid use disorder (OUD) across a diverse geography.
Methods
We conducted a case-control study using medical records (2012–2020) from a Pennsylvania health system to identify cases of OUD (n = 14,674) and controls (n = 58,696; frequency-matched on age, sex, year, medical record duration). Residential addresses were used to assign community-level measures: community socioeconomic deprivation (CSD), high proportional housing costs (HPHC), population in service occupations (PSO), and community credit score (CCS). Logistic regression analyzed associations of community type (city census tracts [CCT], boroughs, townships) and community socioeconomic features (stratified by community type) with OUD, adjusting for demographics and individual-level socioeconomic status.
Results
CCT or borough (versus township) residence was associated with higher OUD odds. CSD, HPHC, and CCS were associated with OUD across community types; PSO was only associated in CCTs. The highest (versus lowest) level of CSD was associated (odds ratio, 95% CI) with higher OUD odds among individuals in townships (1.18 [1.03, 1.36]), boroughs (1.34 [1.09, 1.63]), and CCTs (1.46 [1.13, 1.88]). “Good” (versus “high fair”) CCS was associated with lower odds in townships (0.78 [0.71, 0.86]), boroughs (0.56 [0.41, 0.77]), and CCTs (0.73 [0.44, 1.22]).
Conclusion
Findings indicate poor community socioeconomic conditions are related to higher OUD risk, highlight the value of research regarding opioid-related risk environments, and suggest structural and policy interventions, such as vocational training and rent subsidies, as important for addressing the root causes of OUD.
... Two different exposure metrics were created as follows: an overall UNGD exposure measure, and a proximity measure. There are several previous papers related to UNGD activity and birth/cancer outcomes using an inverse-distance weighted index of UNGD activity [22,28]. We geocoded the residential address at birth for each of the study subjects using ArcGIS 10.6. ...
The rapid growth of unconventional natural gas development (UNGD), also known as hydraulic fracturing, has raised concerns of potential exposures to hazardous chemicals. Few studies have examined the risk of childhood cancer from exposure to UNGD. A case–control study included 498 children diagnosed with leukemia, lymphoma, central nervous system neoplasms, and malignant bone tumors during the period 2010–2019 identified through the Pennsylvania Cancer Registry. Cases were matched to controls using Pennsylvania birth records. For each subject, a new overall UNGD exposure metric was calculated which incorporates both spatial (proximity) and temporal (duration) aspects of well activity. Conditional logistic regression models were used to estimate the risk of combined and individual cancers by overall UNGD exposure, and well proximity. Children with a higher overall UNGD exposure (3rd/4th quartiles) had an increased risk for the four malignancies combined [OR] 1.69 (95% CI 1.01, 2.82) and 1.79 (95% CI 1.00, 3.19) compared to non-exposed children. Overall, individuals living within 0.5 miles of a UNGD site were 3.94 times (95% CI 1.66, 9.30) more likely to develop a malignancy compared to non-exposed children and the risk of lymphoma within 0.5 miles and 0.5–1 miles was also elevated [ORs of 5.05 (95% CI 1.09, 23.39) and 7.71 (95% CI 1.01, 59.00), respectively] compared to non-exposed. Our study found that overall UNGD cumulative activity as well as a proximity to UNGD wells were associated with an increased risk of childhood lymphoma and overall childhood cancers combined.
... As highlighted in recent reviews [19,20], a growing number of epidemiological studies are showing deleterious health effects in communities living in the vicinity of UOG operations. Health effects associated with proximity to UOG include birth outcomes (e.g., preterm birth, low birth weight, and congenital abnormalities) [21][22][23][24][25][26][27][28], self-reported health symptoms (e.g., rashes/skin problems, nose bleeds, stuffy nose, cough, blocked sinuses and fatigue) [29,30], asthma exacerbations [31,32], as well as adverse cardiovascular [33] and mental health [34,35] outcomes. A number of studies found that exposure to ambient air pollutants (e.g., carbon monoxide, nitrogen dioxide, particulate matter and VOCs) in various areas of the world not necessarily impacted by UOG, is associated with many of these health outcomes, including birth outcomes [36,37], and respiratory and cardiovascular diseases [38,39]. ...
Many chemicals associated with unconventional oil and natural gas (UOG) are known toxicants, leading to health concerns about the effects of UOG. Our objective was to conduct a scoping review of the toxicological literature to assess the effects of UOG chemical exposures in models relevant to human health. We searched databases for primary research studies published in English or French between January 2000 and June 2023 on UOG-related toxicology studies. Two reviewers independently screened abstracts and full texts to determine inclusion. Seventeen studies met our study inclusion criteria. Nine studies used solely in vitro models, while six conducted their investigation solely in animal models. Two studies incorporated both types of models. Most studies used real water samples impacted by UOG or lab-made mixtures of UOG chemicals to expose their models. Most in vitro models used human cells in monocultures, while all animal studies were conducted in rodents. All studies detected significant deleterious effects associated with exposure to UOG chemicals or samples, including endocrine disruption, carcinogenicity, behavioral changes and metabolic alterations. Given the plausibility of causal relationships between UOG chemicals and adverse health outcomes highlighted in this review, future risk assessment studies should focus on measuring exposure to UOG chemicals in human populations.
... Tustin et al. conducted a cross-sectional study in which a self-administered questionnaire was completed by 7,785 adult patients of the Geisinger Clinic in Pennsylvania and identified respondents with migraine headache using validated questionnaire items. A previously validated summary UOGD measure incorporated well phase, location, total depth, daily gas production and inverse distance squared to patient residence [69]. Using logistic regression weighted for sampling and response rates with adjustment for sex, race/ethnicity, age, receipt of medical assistance, smoking status, and odds of migraine headache were greater for the highest quartile of UOGD activity than for the lowest quartile (OR = 1.43, 95% CI: 0.94, 2.18). ...
Purpose of Review
In this narrative review, we summarize the peer-reviewed literature published between 2017 and 2022 that evaluated ambient environmental risk factors for primary headache disorders, which affect more than half of the population globally. Primary headache disorders include migraine, tension-type headache (TTH), and trigeminal and autonomic cephalalgias (TAC).
Recent findings
We identified 17 articles that met the inclusion criteria via PubMed or Google Scholar. Seven studies (41%) relied on data from US populations. The remaining studies were conducted in China, Taiwan, Germany, Ghana, Japan, the Netherlands, South Korea, and Turkey. Air pollution was the most frequently assessed environmental risk factor. Most studies were cross-sectional and focused on all-cause or migraine headaches; one study included TTH, and none included TAC. Short-term exposure to fine particulate matter (PM2.5) was not consistently associated with headache endpoints, but long-term exposure to PM2.5 was associated with migraine headache prevalence and severity across multiple studies. Elevated ambient temperature, changes in weather, oil and gas well exposure, and less natural greenspace, but not noise pollution, were also associated with headache. No studies considered water pollution, metal exposure, ultrafine particulate matter, or wildfire smoke exposure.
Summary
There is a need for ongoing research focused on headache and the environment. Study designs with the greatest explanatory power may include longitudinal studies that capture the episodic nature of headache and case-crossover analysis, which control for time-invariant individual-level confounders by design. There is also a clear need for research that considers comorbid psychiatric illness and socioeconomic position as powerful modifiers of the effect of the environment on headache.
... Even in the absence of wildfire or other natech threats, drilling and operating wells has resulted in emissions of air pollutants (21)(22)(23)(24) and contamination of ground and surface water (23,25). There is mounting evidence that living near oil and gas wells is associated with increased risk of adverse cardiovascular, respiratory, perinatal, and mental health outcomes (26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37). Fires at oil and gas wells, unrelated to wildfire, have presented additional hazards such as high levels of radiant heat, explosions, and emissions of air toxics (38,39). ...
The recent increases in wildfire activity in the western United States has coincided with the proliferation of oil and gas development and substantial population growth in the wildland-urban interface. Drilling and operating oil and gas wells is already associated with emissions of harmful pollutants and higher risks of adverse health outcomes for nearby residents. Perturbation from climate-driven disasters such as wildfire could exacerbate these risks and introduce new hazards. Here, we examined historical threats of wildfires for oil and gas wells, the extent to which wildfires are projected to threaten wells as climate change progresses, and exposure of human populations to these wells. Between 1984 and 2019, we found that 102,882 oil and gas wells were located in wildfire burn areas and cumulatively 348,853 people were exposed (resided ≤ 1 km from these wells). During this period, we observed a five-fold increase in the number of wells in wildfire burn areas and a doubling of the population exposed. Approximately 2.9 million people currently reside within 1 km of the 118,409 wells in high wildfire risk areas, with disproportionately high exposure for communities of color. These trends are projected to worsen, with 87,261 additional wells projected to be in high wildfire risk areas by late century. Policymakers have an opportunity to proactively address expected wildfire impacts on oil and gas development and nearby communities by prioritizing wildfire-threatened wells for retirement, monitoring wells for leaks of flammable gases, and restricting drilling in areas projected to have high future wildfire risk.
... Even without comprehensive cradle-to-grave health accounting, studies have consistently reported associations between residential proximity to more and larger natural gas wells and adverse health outcomes. 13,53 The most abundant and consistent evidence points to a relation between natural gas industry exposure and respiratory outcomes [17][18][19] and adverse birth outcomes, [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] as noted in oil and gas rulemaking. 54 In light of this evidence, regulatory actions to extend the allowable distance between extraction sites and sensitive receptors (e.g., homes, hospitals, schools, and ecologically sensitive areas) have been taken in certain states and municipalities such as Colorado; California successfully implemented a 3,200 feet (975 m) setback distance. ...
Energy policy decisions are driven primarily by economic and reliability considerations, with limited consideration given to public health, environmental justice, and climate change. Moreover, epidemiologic studies relevant for public policy typically focus on immediate public health implications of activities related to energy procurement and generation, considering less so health equity or the longer-term health consequences of climate change attributable to an energy source. A more integrated, collective consideration of these three domains can provide more robust guidance to policymakers, communities, and individuals. Here, we illustrate how these domains can be evaluated with respect to natural gas as an energy source. Our process began with a detailed overview of all relevant steps in the process of extracting, producing, and consuming natural gas. We synthesized existing epidemiologic and complementary evidence of how these processes impact public health, environmental justice, and climate change. We conclude that, in certain domains, natural gas looks beneficial (e.g., economically for some), but when considered more expansively, through the life cycle of natural gas and joint lenses of public health, environmental justice, and climate change, natural gas is rendered an undesirable energy source in the United States. A holistic climate health equity framework can inform how we value and deploy different energy sources in the service of public health.
... 9,12 These include increased asthma diagnoses, 13 hospitalizations, 10,14,15,16 and medication orders, 15,16 as well as cardiovascular disease. 17,18,19 The largest body of work links increased proximity to OGD with adverse birth outcomes, including preterm birth, 20,21,22,23 low birth weight, 24,25 and congenital heart defects. 17, 26,27 Both conventional and unconventional OGD can result in community-level stressors, 28,29,30 such as chronic stress, feelings of powerlessness, tension between residents who support and oppose drilling, and distrust between residents and governing bodies. ...
Background
Community socioeconomic deprivation (CSD) may be related to higher oil and natural gas development (OGD) exposure. We tested for distributive and benefit-sharing environmental injustice in Pennsylvania's Marcellus Shale by examining (1) whether OGD and waste disposal occurred disproportionately in more deprived communities and (2) discordance between the location of land leased for OGD and where oil and gas rights owners resided.
Materials and Methods
Analyses took place at the county subdivision level and considered OGD wells, waste disposal, and land lease agreement locations from 2005 to 2019. Using 2005–2009 American Community Survey data, we created a CSD index relevant to community vulnerability in suburban/rural areas.
Results
In adjusted regression models accounting for spatial dependence, we observed no association between the CSD index and conventional or unconventional drilled well presence. However, a higher CSD index was linearly associated with odds of a subdivision having an OGD waste disposal site and receiving a larger volume of waste. A higher percentage of oil and gas rights owners lived in the same county subdivision as leased land when the community was least versus most deprived (66% vs. 56% in same county subdivision), suggesting that individuals in more deprived communities were less likely to financially benefit from OGD exposure.
Discussion and Conclusions
We observed distributive environmental injustice with respect to well waste disposal and benefit-sharing environmental injustice related to oil and rights owner's residential locations across Pennsylvania's Marcellus Shale. These results add evidence of a disparity between exposure and benefits resulting from OGD.
... The health implications and effects of fracking have not been adequately studied [7][8][9][10][11][12]. There is a growing body of research studies on the negative impact of fracking on air and water quality [13][14][15][16][17], as well as public health [18][19][20][21][22]. Although health discussions have focused on drinking water contamination, particularly in the eastern US, there is growing interest in studying a variety of health threats arising from air pollution [7,23]. ...
Hydraulic fracturing or fracking has led to a rapid growth of oil and gas production in the United States, but the impact of fracking on public health is an important but underresearched topic. We designed a methodology to study spatiotemporal correlations between the risk of fracking and stroke mortality. An annualized loss expectancy (ALE) model is applied to quantify the risk of fracking. The geographically and temporally weighted regression (GTWR) model is used to analyze spatiotemporal correlations of stroke mortality, fracking ALE, and nine other socioeconomic- and health-related factors. The analysis shows that fracking ALE is moderately correlated with stroke mortality at ages over 65 in most states of fracking, in addition to cardiovascular disease and drug overdose being positively correlated with stroke mortality. Furthermore, the correlations between fracking ALE and stroke mortality in men appear to be higher than in women near the Marcellus Shale, including Ohio, Pennsylvania, West Virginia, and Virginia, while stroke mortality among women is concentrated in the Great Plains, including Montana, Wyoming, New Mexico, and Oklahoma. Lastly, within two kilometers of the fracking mining activity, the level of benzene in the air was found to be significantly correlated with the fracking activity in Colorado.
... The medical and public health communities have not systematically considered plastic's effects on health and research into health effects has been piecemeal and fragmented. Communitybased epidemiologic studies have documented the dangers of fracking [24,25]. Occupational studies have detailed the impacts of chemical and plastic production on disease and premature death in workers [26,27]. ...
... Previous epidemiological studies using spatial metrics have mainly used a 10 km buffer size or larger. 104,105 However, when considering environmental exposures like water pollution, realistic transport distances should be considered. 106 A study in northeast Pennsylvania measuring the vulnerability of groundwater wells to contamination by UOGD indicates that the extent of a domestic groundwater well's capture zone (the area around the well from which the water is pulled) is generally less than 2 km. ...
Background:
Unconventional oil and gas development (UOGD) releases chemicals that have been linked to cancer and childhood leukemia. Studies of UOGD exposure and childhood leukemia are extremely limited.
Objective:
The objective of this study was to evaluate potential associations between residential proximity to UOGD and risk of acute lymphoblastic leukemia (ALL), the most common form of childhood leukemia, in a large regional sample using UOGD-specific metrics, including a novel metric to represent the water pathway.
Methods:
We conducted a registry-based case-control study of 405 children ages 2-7 y diagnosed with ALL in Pennsylvania between 2009-2017, and 2,080 controls matched on birth year. We used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between residential proximity to UOGD (including a new water pathway-specific proximity metric) and ALL in two exposure windows: a primary window (3 months preconception to 1 y prior to diagnosis/reference date) and a perinatal window (preconception to birth).
Results:
Children with at least one UOG well within 2km of their birth residence during the primary window had 1.98 times the odds of developing ALL in comparison with those with no UOG wells [95% confidence interval (CI): 1.06, 3.69]. Children with at least one vs. no UOG wells within 2km during the perinatal window had 2.80 times the odds of developing ALL (95% CI: 1.11, 7.05). These relationships were slightly attenuated after adjusting for maternal race and socio-economic status [odds ratio (OR) =1.74 (95% CI: 0.93, 3.27) and OR=2.35 (95% CI: 0.93, 5.95)], respectively). The ORs produced by models using the water pathway-specific metric were similar in magnitude to the aggregate metric.
Discussion:
Our study including a novel UOGD metric found UOGD to be a risk factor for childhood ALL. This work adds to mounting evidence of UOGD's impacts on children's health, providing additional support for limiting UOGD near residences. https://doi.org/10.1289/EHP11092.
This chapter elaborates on several fields of electronic health data (EHD) reuse in healthcare, mainly for public interest reasons. Real-life examples of EHD reuse in epidemiology, including insights into how EHD is applied in surveillance and occupational health, are provided in the first section. The second section elaborates how EHD can be reused in supporting institutional activities and policy making: project examples carried out by eminent health institutions around the globe, such as the global World Health Organization (WHO), the continental European Centre for Disease Prevention and Control (ECDC), the American Centres for Disease Control and Prevention (CDC), and some regional institutions, such as the National Institute for Health and Care Excellence (NICE), are illustrated. The third section explores the application of EHD reuse for improving healthcare systems and for carrying out research activities. Specifically, some of the related areas covered include how EHD can be reused in learning healthcare systems, how to advance personalized medicine, how to improve healthcare quality and safety, and how to carry out various research activities. Finally, the fourth section is dedicated to the reuse of EHD for the artificial intelligence (AI) market, which has been experiencing an expansion in healthcare, addressing relevant topics such as administrative costs and associated burden reduction but also training and developing innovative AI-based tools for telemedicine to identify patients at risk for other reuses.
The evidence is clear that fossil fuels—and the fossil fuel industry and its enablers—are driving a multitude of interlinked crises that jeopardize the breadth and stability of life on Earth. Every stage of the fossil fuel life cycle—extraction, processing, transport, and combustion or conversion to petrochemical products—emits planet-heating greenhouse gases and health-harming pollutants, in addition to causing widespread environmental degradation. We review the vast scientific evidence showing that fossil fuels and the fossil fuel industry are the root cause of the climate crisis, harm public health, worsen environmental injustice, accelerate biodiversity extinction, and fuel the petrochemical pollution crisis. Fossil fuels are responsible for millions of premature deaths, trillions of dollars in damages, and the escalating disruption of ecosystems, threatening people, wildlife, and a livable future. The fossil fuel industry has obscured and concealed this evidence through a decades-long, multi-billion-dollar disinformation campaign aimed at blocking action to phase out fossil fuels. We focus on the United States as the world’s largest oil and gas producer and dominant contributor to these fossil fuel crises. We present the science-and-justice-based solutions that already exist for governments and civil society to restrict the influence of the fossil fuel industry, stop fossil fuel expansion, phase out fossil fuel production and use, and make a rapid, just transition to clean, renewable energy and materials across the economy, while holding the fossil fuel industry accountable for its deception and damages. The necessary transition away from fossil fuels will provide innumerable societal and planetary benefits and forge a path forward to sustaining life on Earth.
Introduction:
Residential proximity to unconventional natural gas development (UNGD) has been shown to be associated with asthma exacerbations, but there is limited evidence regarding whether exacerbations are associated with a particular distance or phase of well activity.
Objective:
To study the impact of proximity to UNGD activity by well phase and buffer distance.
Methods:
We included asthma patients 5-90 years old with a primary diagnosis of asthma and at least one order for medications prescribed for asthma residing in one of eight Southwestern Pennsylvania counties between 2011 and 2020. We matched events (severe exacerbation, emergency department visit, hospitalization) by age group, sex, and year to cohort members without an event of the same or greater severity. The primary exposure measure was an inverse distance-weighted index of UNGD activity up to 10 miles of a patient's residence. We fit a series of adjusted multilevel logistic regression models using tertiles of exposure activity by well phase and buffer distance.
Results:
Our cohort consisted of 46,676 asthma patients. We found strong evidence for an increased risk specifically during the production phase for all buffer distances examined for all three event types, as based on consistent, statistically significantly elevated odds ratios. Elevations ranged from 2 to 8 times the baseline of no wells within 10 miles of the patient's residence.
Conclusion:
This study provides evidence of increased risk of asthma events with the production phase. This should be considered in determining risk communication and assessment for these vulnerable populations, particularly during the production phase.
This chapter introduces environmental health data types for use in health analytics. We discuss how various factors lead to the overall health risk and safety of individual persons, and that while the official physical environment contribution to an individual’s overall health and wellbeing is reported as being 10% the actual contribution is greater. We discuss the intersectionality between the environment and an individual’s overall healthcare (including healthcare access), and impact on socioeconomic factors and other aspects that contribute more to an individual’s overall health and wellbeing. Therefore, the contribution of the environment is greater than often appreciated. With this in mind, we cover environmental datasets at different levels of geographic granularity, including country-level, state-level, county-level, census-tract level, and point level (latitude/longitude). We provide insights and examples of datasets developed by Governmental agencies, non-profit organizations, and researchers. We cover how to integrate data at the country-level to provide insights, models, and analysis. We lightly touch on geospatial analysis. We instruct the readers on how to make visual maps showing the different exposures in different countries around the world.
After reading this chapter, you should be able to confidently answer the following questions:
What percentage contribution to an individual’s overall health risk and safety does the physical environment contribute?
What percentage contribution to an individual’s overall health risk and safety does socioeconomic exposures contribute?
How physical environment and healthcare can be intersectional, especially when the physical environment results in a restriction in access to healthcare?
What is the potential future impact of climate change on environment and also healthcare?
How to visualize differences across regions using color-based maps?
Income is positively correlated with pregnancy health and birth outcomes, but the causal evidence for this association is limited. Leveraging a natural experiment based on the Pennsylvania boom economy created by the extraction of natural gas from the Marcellus Shale geological formation, we test whether area-level income gains impact birth outcomes (birth weight, gestational length, and preterm birth) and pregnancy health (prepregnancy and prenatal smoking, prepregnancy weight status, gestational weight gain, and the timing and adequacy of prenatal care). We append tax data to birth certificate data and compare health outcomes before and after the boom for births occurring in school districts above the Marcellus Shale. We also explore income effects with a subsample of siblings and test for nonlinear income effects by considering preboom district poverty rates. Using instrumented difference-in-differences models, we find that plausibly exogenous income gains increase the likelihood of having adequate prenatal care in the full sample. In the sibling sample, income gains decrease the likelihood of low birth weight but increase the likelihood of prepregnancy underweight among birthing parents. Results are statistically significant in initially high-poverty districts. We thus affirm prior findings of a causal effect of income on birth weight and prenatal care use but find minimal area-level income effects on other pregnancy-related health behaviors and birth outcomes.
Background:
Risk of preterm birth (PTB) and low birth weight (LBW) due to hydraulic fracturing (HF) exposure is a growing concern. Regional studies have demonstrated links, but results are often contradictory among studies.
Objectives:
This is the first US national study to our knowledge linking fracturing fluid ingredients to the human hormone pathways targeted-estrogen, testosterone, or other hormones (e.g., thyroid hormone)-to assess the effect of HF ingredients on rates of PTB and LBW.
Methods:
We constructed generalized linear regression models of the impact of HF well density and hormone targeting chemicals in HF fluids (2001-2018) on the county-level average period prevalence rates of PTB and LBW (2015-2018) with each outcome measured in separate models. Our data sources consisted of publicly available datasets, including the WellExplorer database, which uses data from FracFocus, the March of Dimes Peristats, the US Census Bureau, the US Department of Agriculture, and the Centers for Disease Control and Prevention. We conducted additional stratified analyses to address issues of confounding. We used stratification to address issues regarding outcomes in rural vs. urban communities by assessing whether our models achieved similar results in nonmetro counties, as well as farming and mining counties. We also stratified by the year of the HF data to include HF data that was closer to the time of the birth outcomes. We also added covariate adjustment to address other important factors linked to adverse birth outcomes, including the proportion of the population belonging to various racial and ethnic minority populations (each modeled as a separate variable); education (bachelor's degree and high school); use of fertilizers, herbicides, and insecticides, acres of agricultural land per square mile; poverty; insurance status; marital status; population per square mile; maternal care deserts; and drug deaths per 100,000 people.
Results:
We found that the density of HF wells in a county was significantly associated with both PTB and LBW rates (percentage of live births) in our fully adjusted models. We report the results from our more restrictive stratified analysis with a subset including only the 2014-2018 data, because this resulted in the most meaningful time frame for comparison. Across all models, the magnitude of effect was highest for wells with ingredients that include estrogen targeting chemicals (ETCs), testosterone targeting chemicals (TTCs) and other hormone targeting chemicals (OHTCs), and, finally, all wells grouped regardless of chemical type. For every unit increase in well density per square mile of wells that use chemicals that include an ETC, we observed a 3.789-higher PTB rate (95% CI: 1.83, 5.74) compared with counties with no ETC wells from 2014 to 2018 and likewise, we observed a 1.964-higher LBW rate (95% CI: 0.41, 3.52). Similarly, for every unit increase in well density per square mile of wells that use TTC, we observed a 3.192-higher PTB rate (95% CI: 1.62, 4.77) compared with counties with no TTC wells. Likewise, for LBW, we found a 1.619-higher LBW rate (95% CI: 0.37, 2.87). We also found that an increase in well density per square mile among wells that use chemicals that include an OHTC resulting in a 2.276-higher PTB rate (95% CI: 1.25, 3.30) compared with counties with no OHTC wells, and for LBW, we found a 1.244-higher LBW rate (95% CI: 0.43, 2.06). We also explored the role of HF well exposure in general (regardless of the chemicals used) and found that an increase in total well density (grouped regardless of hormonal targeting status of the chemicals used) resulted in a 1.228-higher PTB rate (95% CI: 0.66, 1.80) compared with counties with no wells, and for LBW, we found a 0.602-higher LBW rate (95% CI: 0.15, 1.05) compared with counties with no wells. We found similar results in our primary analysis that used all data without any exclusions and the statistical significance did not change.
Discussion:
Our findings reinforce previously identified regional associations between HF and PTB and LBW, but on a national scale. Our findings point to dysregulation of hormonal pathways underpinning HF exposure risk on birth outcomes, which warrants further exploration. Future research must consider the specific ingredients used in HF fluids to properly understand the differential effects of exposure. https://doi.org/10.1289/EHP12628.
In Brief
Unconventional oil and natural gas (UOG) operations, particularly hydraulic fracturing, have revolutionized oil and gas production, using and containing complex mixtures of chemicals that may impact reproductive health. While there is growing evidence for effects on births in hydraulic fracturing/UOG regions and good mechanistic evidence for potential reproductive toxicity, there is much research still needed to make firm conclusions about these practices and reproductive health.
Abstract
Unconventional oil and natural gas (UOG) operations have emerged over the last four decades to transform oil and gas production in the United States and globally by unlocking previously inaccessible hydrocarbon deposits. UOG development utilizes many compounds associated with conventional oil and gas, as well as some specific to UOG extraction, particularly during hydraulic fracturing (HF). While research is increasing on UOG chemicals and their mixtures, this review discusses the current evidence for reproductive toxicity following exposures to UOG/HF mixtures. These complex chemical mixtures have been demonstrated to interact with numerous mechanisms known to influence reproductive health. A growing number of environmental and controlled laboratory testing studies have reported adverse reproductive health effects in animals exposed to various UOG chemical mixtures. An expanding body of epidemiological literature has assessed adverse birth outcomes, although none has directly examined reproductive measures such as time to pregnancy, semen quality, and other direct measures of fertility. The existing literature provides moderate evidence for decreased birth weights, increased risk of small for gestational age and/or preterm birth, increased congenital abnormalities, and increased infant mortality, though importantly, studies are widely variable in methods used. Most studies utilized distance from UOG operations as an exposure proxy and did not measure actual chemical exposures experienced by those living near these operations. As such, while there is growing evidence for effects on births in these regions and good mechanistic evidence for potential reproductive toxicity, there is much research still needed to make firm conclusions about UOG development and reproductive health.
Objectives. To evaluate associations between oil and gas development (OGD) and mental health using cross-sectional data from a preconception cohort study, Pregnancy Study Online.
Methods. We analyzed baseline data from a prospective cohort of US and Canadian women aged 21 to 45 years who were attempting conception without fertility treatment (2013–2023). We developed residential proximity measures for active OGD during preconception, including distance from nearest site. At baseline, participants completed validated scales for perceived stress (10-item Perceived Stress Scale, PSS) and depressive symptoms (Major Depression Inventory, MDI) and reported psychotropic medication use. We used log-binomial regression and restricted cubic splines to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs).
Results. Among 5725 participants across 37 states and provinces, residence at 2 km versus 20 to 50 km of active OGD was associated with moderate to high perceived stress (PSS ≥ 20 vs < 20: PR = 1.08; 95% CI = 0.98, 1.18), moderate to severe depressive symptoms (MDI ≥ 20 vs < 20: PR = 1.27; 95% CI = 1.11, 1.45), and psychotropic medication use (PR = 1.11; 95% CI = 0.97, 1.28).
Conclusions. Among North American pregnancy planners, closer proximity to OGD was associated with adverse preconception mental health symptomatology. ( Am J Public Health. Published online ahead of print July 11, 2024:e1–e12. https://doi.org/10.2105/AJPH.2024.307730 )
Northeastern British Columbia is a region of prolific unconventional oil and gas (UOG) activity. UOG activity can release volatile organic compounds (VOCs) which can elevate oxidative stress and disrupt antioxidant activity in exposed pregnant individuals, potentially increasing the risk of adverse pregnancy outcomes. This study measured biomarkers of oxidative stress and antioxidant activity in pooled urine samples of 85 pregnant individuals living in Northeastern British Columbia, to analyze associations between indoor air VOCs, oil and gas well density and proximity metrics, and biomarker concentrations. Concentrations of catalase, superoxide dismutase (SOD), glutathione S-transferase, total antioxidant capacity, 6-hydroxymelatonin sulfate (aMT6s), malondialdehyde (MDA), 8-hydroxy-2′-deoxyguanosine (8-OHdG), and 8-isoprostane were measured using assay kits. Associations between exposure metrics and biomarker concentrations were determined using multiple linear regression models adjusted for biomarker-specific covariables. UOG proximity was associated with decreased SOD and 8-OHdG. Decreased 8-OHdG was associated with increased proximity to all wells. Decreased aMT6s were observed with increased indoor air hexanal concentrations. MDA was negatively associated with indoor air 1,4-dioxane concentrations. No statistically significant associations were found between other biomarkers and exposure metrics. Although some associations linked oil and gas activity to altered oxidative stress and antioxidant activity, the possibility of chance findings due to the large number of tests cannot be discounted. This study shows that living near UOG wells may alter oxidative stress and antioxidant activity in pregnant individuals. More research is needed to elucidate underlying mechanisms and to what degree UOG activity affects oxidative stress and antioxidant activity.
Background
Area-level credit scores (the mean of credit scores for persons in a community) may be a unique indicator of community-level socioeconomic conditions associated with health outcomes. We analysed community credit scores (CCS) in association with new onset type 2 diabetes (T2D) across a geographically heterogeneous region of Pennsylvania and evaluated whether associations were independent of community socioeconomic deprivation (CSD), which is known to be related to T2D risk.
Methods
In a nested case–control study, we used medical records to identify 15 888 T2D cases from diabetes diagnoses, medication orders and laboratory test results and 79 435 diabetes-free controls frequency matched on age, sex and encounter year. CCS was derived from Equifax VantageScore V.1.0 data and categorised as ‘good’, ‘high fair’, ‘low fair’ and ‘poor’. Individuals were geocoded and assigned the CCS of their residential community. Logistic regression models adjusted for confounding variables and stratified by community type (townships (rural/suburban), boroughs (small towns) and city census tracts). Independent associations of CSD were assessed through models stratified by high/low CSD and high/low CCS.
Results
Compared with individuals in communities with ‘high fair’ CCS, those with ‘good’ CCS had lower T2D odds (42%, 24% and 12% lower odds in cities, boroughs and townships, respectively). Stratified models assessing independent effects of CCS and CSD showed mainly consistent associations, indicating each community-level measure was independently associated with T2D.
Conclusion
CCS may capture novel, health-salient aspects of community socioeconomic conditions, though questions remain regarding the mechanisms by which it influences T2D and how these differ from CSD.
Growth in unconventional oil and gas development (UOGD) in the United States has increased airborne emissions, raising environmental and human health concerns. To assess the potential impacts on air quality, we deployed instrumentation in Karnes City, Texas, a rural area in the middle of the Eagle Ford Shale. We measured several episodes of elevated Cl2 levels, reaching maximum hourly averages of 800 ppt, the highest inland Cl2 concentration reported to date. Concentrations peak during the day, suggesting a strong local source (given the short photolysis lifetime of Cl2) and/or a photoinitiated production mechanism. Well preproduction activity near the measurement site is a plausible source of these high Cl2 levels via direct emission and photoactive chemistry. ClNO2 is also observed, but it peaks overnight, consistent with well-known nocturnal formation processes. Observations of organochlorines in the gas and particle phases reflect the contribution of chlorine chemistry to the formation of secondary pollutants in the area. Box modeling results suggest that the formation of ozone at this location is influenced by chlorine chemistry. These results suggest that UOGD can be an important source of reactive chlorine in the atmosphere, impacting radical budgets and the formation of secondary pollutants in these regions.
This paper examines how the price of home heating affects mortality in the US. Exposure to cold is one reason that mortality peaks in winter, and a higher heating price increases exposure to cold by reducing heating use. Our empirical approach combines spatial variation in the energy source used for home heating and temporal variation in the national prices of natural gas and electricity. We find that a lower heating price reduces winter mortality, driven mostly by cardiovascular and respiratory causes. Our estimates imply that the 42% drop in the natural gas price in the late 2000s, mostly driven by the shale gas boom, averted 12,500 deaths per year in the US. The effect appears to be especially large in high-poverty communities.
Industrial sources emit airborne pollutants that impact health. Concentrations of these pollutants near emitting facilities vary according to local weather conditions but can frequently be high— especially at night. This study's methodology used historical hourly weather data and Pasquill air dispersion calculations to quantitatively model the dispersion and hourly concentrations of toxins at discreet distances and directions relative to the emitting source. The example used in this study is a natural gas compressor station's VOCs. This weather-based analytical methodology is applicable to almost any type of polluting site emitting any mix of airborne toxins. The objective was to estimate hourly concentration levels of airborne toxins, frequency of health-hazardous concentrations and therefore frequency of health risk to residents of varying sensitivities at discreet distances near an emitting source. A continuous air monitor confirmed the weather model's results. Based on EPA methodology and NIOSH data, this study provides charts that tabulate risk levels and frequency for individuals with varying sensitivities. Key findings include: 1. People in close proximity to toxin-emitting facilities are frequently exposed to health-hazardous air. 2. EPA's National Ambient Air Quality Standards (NAAQS) do not separately identify the high levels of toxins in close proximity to emitting facilities and therefore do not adequately protect the tens of millions of nearby residents. 3. A weather-based model can estimate exposure levels and the health-hazardous frequency for those in close proximity to most polluting facilities where emissions information is available.
Northeastern British Columbia (Canada) is an area of oil and gas exploitation, which may result in release of fine (PM2.5) and inhalable (PM10) particulate matter. The aims of this study were to: 1) apply extrapolation methods to estimate exposure to PM2.5 and PM10 concentrations among EXPERIVA (Exposures in the Peace River Valley study) participants using air quality data archives; and 2) conduct exploratory analyses to investigate correlation between PM exposure and metrics of oil and gas wells density, proximity, and activity. Gestational exposure to PM2.5 and PM10 of the EXPERIVA participants (n = 85) was estimated by averaging the concentrations measured at the closest or three closest air monitoring stations during the pregnancy period. Drilling metrics were calculated based upon the density and proximity of conventional and unconventional oil and gas wells to each participant's residence. Phase-specific metrics were determined for unconventional wells. The correlations (ρ) between exposure to PM2.5 and PM10 and metrics of well density/proximity were determined using Spearman's rank correlation test. Estimated PM ambient air concentrations ranged between 4.73 to 12.13 µg/m3 for PM2.5 and 7.14 to 26.61 µg/m3 for PM10. Conventional wells metrics were more strongly correlated with PM10 estimations (ρ between 0.28 and 0.79). Unconventional wells metrics for all phases were positively correlated with PM2.5 estimations (ρ between 0.23 and 0.55). These results provide evidence of a correlation between density and proximity of oil and gas wells and estimated PM exposure in the EXPERIVA participants.
Background:
During 2008-15, the Marcellus shale region of the US state of Pennsylvania experienced a boom in unconventional natural gas development (UNGD) or "fracking". However, despite much public debate, little is known about the effects of UNGD on population health in local communities. Among other mechanisms, air pollution from UNGD might affect individuals living nearby through cardiovascular or respiratory disease, and older adults could be particularly susceptible.
Methods:
To study the health impacts of Pennsylvania's fracking boom, we exploited the ban on UNGD in neighbouring New York state. Using 2002-15 Medicare claims, we conducted difference-in-differences analyses over multiple timepoints to estimate the risk of living near UNGD for hospitalisation with acute myocardial infarction (AMI), chronic obstructive pulmonary disease (COPD) and bronchiectasis, heart failure, ischaemic heart disease, and stroke among older adults (aged ≥65 years).
Findings:
Pennsylvania ZIP codes that started UNGD in 2008-10 were associated with more hospitalisations for cardiovascular diseases in 2012-15 than would be expected in the absence of UNGD. Specifically, in 2015, we estimated an additional 11·8, 21·6, and 20·4 hospitalisations for AMI, heart failure, and ischaemic heart disease, respectively, per 1000 Medicare beneficiaries. Hospitalisations increased even as UNGD growth slowed. Results were robust in sensitivity analyses.
Interpretation:
Older adults living near UNGD could be at high risk of poor cardiovascular outcomes. Mitigation policies for existing UNGD might be needed to address current and future health risks. Future consideration of UNGD should prioritise local population health.
Funding:
University of Chicago and Argonne National Laboratories.
Background:
Chronic rhinosinusitis (CRS) is accompanied by burdensome co-morbid conditions. Understanding the relative timing of these conditions' onset could inform disease prevention, detection, and management.
Objective:
To evaluate the association between CRS and new onset and prevalent asthma, non-cystic fibrosis bronchiectasis (NCFBE), chronic obstructive pulmonary disease (COPD), gastroesophageal reflux disease (GERD), and obstructive sleep apnea (OSA).
Methods:
We conducted a prospective cohort study among primary care patients using a detailed medical and symptom questionnaire in 2014 and again in 2020. We used questionnaire and electronic health record (EHR) data to determine CRS status: CRSSE (moderate to severe symptoms with EHR evidence), CRSE (limited symptoms with EHR evidence), CRSS (moderate to severe symptoms without EHR evidence), CRSneg (limited symptoms and no EHR evidence; reference). We evaluated the association between CRS status and new onset and prevalent disease using logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI).
Results:
There were 7,847 and 4,445 respondents to the 2014 and 2020 questionnaires, respectively. CRSSE (versus CRSneg ) was associated with increased odds of new onset asthma (OR:1.74; CI:1.09, 2.77), NCFBE (OR:1.87, CI:1.12, 3.13), COPD (OR:1.73; CI:1.14, 2.68), GERD (OR:1.95, CI:1.61, 2.35), and OSA (OR:1.91; CI:1.39, 2.62). Similarly increased odds were observed for associations with the prevalence of these conditions.
Conclusion:
The findings from the study support further exploration of CRS as a target for the prevention and detection of asthma, NCFBE, COPD, GERD, and OSA. This article is protected by copyright. All rights reserved.
Taking stock of environmental justice (EJ) is daunting. It is at once a scholarly field, an ongoing social movement, and an administrative imperative adopted by government agencies and incorporated into legislation. Moreover, within academia, it is multidisciplinary and multimethodological, comprising scholars who do not always speak to one another. Any review of EJ is thus necessarily restrictive.
This article explores several facets of EJ activism. One is its coalitional and “inside-outside” orientation. EJ activists are constantly forming alliances with other stakeholders, but these coalitions do not flout the importance of engaging with formal institutions. The review next turns to one set of such institutions—the courts and regulatory agencies—to see how well EJ claims have fared there. I then survey scientific findings that have been influenced by EJ. The review concludes with future directions for activists and scholars to consider: the changing nature of EJ coalitions, fragmentation within EJ and with other fields, the historical roots of environmental injustice, and opportunities for stronger infusion of the EJ lens.
Expected final online publication date for the Annual Review of Public Health, Volume 44 is April 2023. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
Background
Located in Northeastern British Columbia, the Montney formation is an important area of unconventional oil and gas exploitation, which can release contaminants like trace elements. Gestational exposure to these contaminants may lead to deleterious developmental effects.
Objectives
Our study aimed to (1) assess gestational exposure to trace elements in women living in this region through repeated urinary measurements; (2) compare urinary concentrations to those from North American reference populations; (3) compare urinary concentrations between Indigenous and non-Indigenous participants; and (4) evaluate inter- and intra-individual variability in urinary levels.
Methods
Eighty-five pregnant women participating in the Exposures in the Peace River Valley (EXPERIVA) study provided daily spot urine samples over 7 consecutive days. Samples were analyzed for 20 trace elements using inductively-coupled mass spectrometry (ICP-MS). Descriptive statistics were calculated, and inter- and intra-individual variability in urinary levels was evaluated through intraclass correlation coefficient (ICC) calculation for each trace element.
Results
When compared with those from North American reference populations, median urinary levels were higher in our population for barium (~2 times), cobalt (~3 times) and strontium (~2 times). The 95th percentile of reference populations was exceeded at least 1 time by a substantial percentage of participants during the sampling week for barium (58%), cobalt (73%), copper (29%), manganese (28%), selenium (38%), strontium (60%) and vanadium (100%). We observed higher urinary manganese concentrations in self-identified Indigenous participants (median: 0.19 µg/g creatinine) compared to non-Indigenous participants (median: 0.15 µg/g of creatinine). ICCs varied from 0.288 to 0.722, indicating poor to moderate reliability depending on the trace element.
Significance
Our results suggest that pregnant women living in this region may be more exposed to certain trace elements (barium, cobalt, copper, manganese, selenium, strontium, and vanadium), and that one urine spot sample could be insufficient to adequately characterize participants’ exposure to certain trace elements.
Impact statement
Unconventional oil and gas (UOG) is an important industry in the Peace River Valley region (Northeastern British Columbia, Canada). Information on the impacts of this industry is limited, but recent literature emphasizes the risk of environmental contamination. The results presented in this paper highlight that pregnant women living near UOG wells in Northeastern British Columbia may be more exposed to some trace elements known to be related to this industry compared to reference populations. Furthermore, our results based on repeated urinary measurements show that one urine sample may be insufficient to adequately reflect long-term exposure to certain trace elements.
Hydraulic fracturing (fracking) has enabled the United States to lead the world in gas and oil production over the past decade; 17.6 million Americans now live within a mile of a fracked oil or gas well (Czolowski et al., 2017). This major expansion in fossil fuel production is possible in part due to the 2005 Energy Policy Act and its “Halliburton Loophole,” which exempts fracking activity from regulation under the Safe Drinking Water Act (SDWA). To begin quantifying the environmental and economic impacts of this loophole, this study undertakes an aggregate analysis of chemicals that would otherwise be regulated by SDWA within FracFocus, an industry-sponsored fracking disclosure database. This paper quantifies the total disclosures and total mass of these chemicals used between 2014 and 2021, examines trends in their use, and investigates which companies most use and supply them. We find that 28 SDWA-regulated chemicals are reported in FracFocus, and 60–80% of all disclosures (depending on year) report at least one SDWA-regulated chemical. Of these, 19,700 disclosures report using SDWA-regulated chemicals in masses that exceed their reportable quantities as defined under the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA). Finally, while the most common direct-supplier category is “company name not reported,” Halliburton is the second-most named direct supplier of SWDA regulated chemicals. Halliburton is also the supplier most frequently associated with fracks that use SDWA regulated chemicals. These results show the necessity of a more robust and federally mandated disclosure system and suggest the importance of revisiting exemptions such as the Halliburton Loophole.
Appalachia’s health outcomes are inextricably linked to its political and environmental development. Many former lumber yards and coal towns are now ageing communities with diminished environments and few opportunities for employment. ARC Appalachia has faced deforestation, widescale fires, coal-related pollution and water contamination as a direct result of its courtship of powerful (yet environmentally destructive) industries. Further, its historic reliance on a single industry (first timber, and then coal) leaves communities vulnerable to labor market restructuring. What are communities to do in the face of rising pressure for economic diversification when they have little infrastracture with which to attract external investors? This chapter tackles this and other questions, arguing that by combining prudent environmental planning with long-term regional investment, Appalachia can achieve sustainable, economic security. However, doing so will require a fundamental paradigm shift away from short-term gains, toward future-oriented sustainable development.
Appalachian Health explores major challenges and opportunities for promoting the health and well-being of the people of Appalachia, a historically underserved population. It considers health's intersection with social, political, and economic factors to shed light on the trends affecting mortality and morbidity among the region's residents. Editors F. Douglas Scutchfield and Randy Wykoff have assembled high-profile experts working in academia, public health, and government to offer perspectives on a wide range of topics including health behaviors, environmental justice, and pandemic preparedness. This volume also provides updated data on issues such as opioid abuse, "deaths of despair," and the social determinants of health. Together, the contributors illuminate the complex health status of the region and offer evidence-based programs for addressing the health problems that have been identified.
Background. Prior studies have found that residential proximity to upstream oil and gas production is associated with increased risk of adverse health outcomes. Emissions of ambient air pollutants from oil and gas wells in the preproduction and production stages have been proposed as conferring risk of adverse health effects, but the extent of air pollutant emissions and resulting nearby pollution concentrations from wells is not clear.Objectives. We examined the effects of upstream oil and gas preproduction (count of drilling sites) and production (total volume of oil and gas) activities on concentrations of five ambient air pollutants in California.Methods. We obtained data on approximately 1 million daily observations from 314 monitors in the EPA Air Quality System, 2006-2019, including daily concentrations of five routinely monitored ambient air pollutants: PM2.5, CO, NO2, O3, and VOCs. We obtained data on preproduction and production operations from Enverus and the California Geographic Energy Management Division (CalGEM) for all wells in the state. For each monitor and each day, we assessed exposure to upwind preproduction wells and total oil and gas production volume within 10 km. We used a panel regression approach in the analysis and fit adjusted fixed effects linear regression models for each pollutant, controlling for geographic, seasonal, temporal, and meteorological factors.Results. We observed higher concentrations of PM2.5 and CO at monitors within 3 km of preproduction wells, NO2 at monitors at 1-2 km, and O3 at 2-4 km from the wells. Monitors with proximity to increased production volume observed higher concentrations of PM2.5, NO2, and VOCs within 1 km and higher O3 concentrations at 1-2 km. Results were robust to sensitivity analyses.Conclusion. Adjusting for geographic, meteorological, seasonal, and time-trending factors, we observed higher concentrations of ambient air pollutants at air quality monitors in proximity to preproduction wells within 4 km and producing wells within 2 km.
Building on nascent literature examining the health-related effects of vicarious structural racism, we examined indirect exposure to the Flint Water Crisis (FWC) as a predictor of birth outcomes in Michigan communities outside of Flint, where residents were not directly exposed to lead-contaminated water. Using linear regression models, we analyzed records for all singleton live births in Michigan from 2013 to 2016, excluding Flint, to determine whether birth weight (BW), gestational age (GA), and size-for-gestational-age (SzGA) decreased among babies born to Black people, but not among babies born to White people, following the highly publicized January 2016 emergency declaration in Flint. In adjusted regression models, BW and SzGA were lower for babies born to both Black and White people in the 37 weeks following the emergency declaration compared to the same 37-week periods in the previous 3 years. There were no racial differences in the association of exposure to the emergency declaration with BW or SzGA. Among infants born to Black people, GA was 0.05 weeks lower in the 37-week period following the emergency declaration versus the same 37-week periods in the previous 3 years (95% CI: −0.09, −0.01; p = 0.0177), while there was no change in GA for infants born to White people following the emergency declaration (95% CI: −0.01, 0.03; p = 0.6962). The FWC, which was widely attributed to structural racism, appears to have had a greater impact, overall, on outcomes for babies born to Black people. However, given the frequency of highly publicized examples of anti-Black racism over the study period, it is difficult to disentangle the effects of the FWC from the effects of other racialized stressors.
We aimed to determine if long-term fine particulate matter (PM2.5) concentrations are associated with increased risk of testing positive for COVID-19 among pregnant individuals who were universally screened at delivery and if socioeconomic status (SES) modifies this relationship. We used obstetric data from Columbia University Irving Medical Center in New York City from March–December 2020, which included Medicaid use (low-SES surrogate) and coronavirus disease 2019 (COVID-19) test results. We linked 300m resolution estimated 2018-2019 PM2.5 concentrations and census tract-level population density, household size and income, and mobility estimates. Analyses included 3318 individuals; 5% tested positive for COVID-19 at delivery, 8% tested positive during pregnancy, 48% used Medicaid, and average long-term PM2.5 concentrations were 7.4 μg/m3 (SD = 0.8). In adjusted multilevel logistic regression models, we saw no association between PM2.5 and ever-testing positive for COVID-19; however, odds were elevated among those using Medicaid (odds ratio = 1.6, 95% CI 1.0, 2.5 per 1-μg/m3 increase). Further, while only 22% of those testing positive showed symptoms, 69% of symptomatic individuals used Medicaid. SES, including unmeasured occupational exposures or increased susceptibility to the virus due to co-social and environmental exposures, may explain the increased odds of testing positive for COVID-19 confined to vulnerable pregnant individuals using Medicaid.
In this review, we present an update on maternal exposure to nitrates in drinking water in relation to possible adverse reproductive and developmental effects, and discuss nitrates in drinking water in the United States. The current standard for nitrates in drinking water is based on retrospective studies and approximates a level that protects infants from methemoglobinemia, but no safety factor is built into the standard. The current standard applies only to public water systems. Animal studies have found adverse reproductive effects resulting from higher doses of nitrate or nitrite. The epidemiologic evidence of a direct exposure-response relationship between drinking water nitrate level and adverse reproductive effect is still not clear. However, some reports have suggested an association between exposure to nitrates in drinking water and spontaneous abortions, intrauterine growth restriction, and various birth defects. Uncertainties in epidemiologic studies include the lack of individual exposure assessment that would rule out confounding of the exposure with some other cause. We conclude that the current literature does not provide sufficient evidence of a causal relationship between exposure to nitrates in drinking water and adverse reproductive effects.
Significance
New techniques of high-volume hydraulic fracturing (HVHF) are now used to unlock oil and gas from rocks with very low permeability. Some members of the public protest against HVHF due to fears that associated compounds could migrate into aquifers. We report a case where natural gas and other contaminants migrated laterally through kilometers of rock at shallow to intermediate depths, impacting an aquifer used as a potable water source. The incident was attributed to Marcellus Shale gas development. The organic contaminants—likely derived from drilling or HVHF fluids—were detected using instrumentation not available in most commercial laboratories. More such incidents must be analyzed and data released publicly so that similar problems can be avoided through use of better management practices.
Background: Radon is the second-leading cause of lung cancer worldwide. Most indoor exposure occurs by diffusion of soil gas. Radon is also found in well water, natural gas and ambient air. Pennsylvania has high indoor radon concentrations; buildings are often tested during real estate transactions with results reported to the Department of Environmental Protection (PADEP).
Objectives: To evaluate predictors of indoor radon concentrations.
Methods: Using first floor and basement indoor radon results reported to the PADEP between 1987-2013, we evaluated associations of radon concentrations (ln-transformed) with geology, water source, building characteristics, season, weather, community socioeconomic status, community type and unconventional natural gas development measures based on drilled and producing wells.
Results: Primary analysis included 866,735 first measurements by building, the large majority from homes. The geologic rock layer on which the building sat was strongly associated with radon concentration (e.g., Axemann Formation, median = 365 Bq/m3, IQR = 167-679 vs. Stockton Formation, median = 93 Bq/m3, IQR = 52-178). In adjusted analysis, buildings using well water had 21% higher concentrations (β = 0.191, 95% CI: 0.184, 0.198). Buildings in cities (vs. townships) had lower concentrations (β = -0.323, 95% CI: -0.333, -0.314). When we included multiple tests per building, concentrations declined with repeated measurements over time. Between 2005-2013, 7469 unconventional wells were drilled in Pennsylvania. Basement radon concentrations fluctuated between 1987-2003, but began an upward trend from 2004-2012 in all county categories (p < 0.001), higher levels in counties with ≥100 drilled wells vs. counties with none, and with highest levels in the Reading Prong.
Conclusions: Geologic unit, well water, community, weather and unconventional natural gas development were associated with indoor radon concentrations. Future studies should include direct environmental measurement of radon, and building features unavailable for this analysis.
Arsenic is a known human carcinogen,1 although it’s unclear how it causes cancer. Some studies have suggested that epigenetic modifications—specifically DNA methylation—may play a role in arsenic toxicity.2 In this issue of EHP, investigators identify gene-specific DNA methylation targets in white blood cells in a large study of Bangladeshi adults.3
Exposure to particulate air pollution and socioeconomic risk factors are shown to be independently associated with adverse pregnancy outcomes; however, their confounding relationship is an epidemiological challenge that requires understanding of their shared etiologic pathways affecting fetal-placental development. The purpose of this paper is to explore the etiological mechanisms associated with exposure to particulate air pollution in contributing to adverse pregnancy outcomes and how these mechanisms intersect with those related to socioeconomic status. Here we review the role of oxidative stress, inflammation and endocrine modification in the pathoetiology of deficient deep placentation and detail how the physical and social environments can act alone and collectively to mediate the established pathology linked to a spectrum of adverse pregnancy outcomes. We review the experimental and epidemiological literature showing that diet/nutrition, smoking, and psychosocial stress share similar pathways with that of particulate air pollution exposure to potentially exasperate the negative effects of either insult alone. Therefore, socially patterned risk factors often treated as nuisance parameters should be explored as potential effect modifiers that may operate at multiple levels of social geography. The degree to which deleterious exposures can be ameliorated or exacerbated via community-level social and environmental characteristics needs further exploration.
Rapid global expansion of unconventional natural gas development (UNGD) raises environmental health concerns. Many studies present information on these concerns, yet the strength of epidemiological evidence remains tenuous. This paper is a review of the strength of evidence in scientific reporting of environmental hazards from UNGD activities associated with adverse human health outcomes. Studies were drawn from peer-reviewed and grey literature following a systematic search. Five databases were searched for studies published from January 1995 through March 2014 using key search terms relevant to environmental health. Studies were screened, ranked and then reviewed according to the strength of the evidence presented on adverse environmental health outcomes associated with UNGD. The initial searches yielded > 1000 studies, but this was reduced to 109 relevant studies after the ranking process. Only seven studies were considered highly relevant based on strength of evidence. Articles spanned several relevant topics, but most focussed on impacts on typical environmental media, such as water and air, with much of the health impacts inferred rather than evidenced. Additionally, the majority of studies focussed on short-term, rather than long-term, health impacts, which is expected considering the timeframe of UNGD; therefore, very few studies examined health outcomes with longer latencies such as cancer or developmental outcomes. Current scientific evidence for UNGD that demonstrates associations between adverse health outcomes directly with environmental health hazards resulting from UNGD activities generally lacks methodological rigour. Importantly, however, there is also no evidence to rule out such health impacts. While the current evidence in the scientific research reporting leaves questions unanswered about the actual environmental health impacts, public health concerns remain intense. This is a clear gap in the scientific knowledge that requires urgent attention.
Background: Horizontal drilling, hydraulic fracturing, and other drilling and well stimulation technologies are now used widely in the United States and increasingly in other countries. They enable increases in oil and gas production, but there has been inadequate attention to human health impacts. Air quality near oil and gas operations is an underexplored human health concern for five reasons: (1) prior focus on threats to water quality; (2) an evolving understanding of contributions of certain oil and gas production processes to air quality; (3) limited state air quality monitoring networks; (4) significant variability in air emissions and concentrations; and (5) air quality research that misses impacts important to residents. Preliminary research suggests that volatile compounds, including hazardous air pollutants, are of potential concern. This study differs from prior research in its use of a community-based process to identify sampling locations. Through this approach, we determine concentrations of volatile compounds in air near operations that reflect community concerns and point to the need for more fine-grained and frequent monitoring at points along the production life cycle.
Methods: Grab and passive air samples were collected by trained volunteers at locations identified through systematic observation of industrial operations and air impacts over the course of resident daily routines. A total of 75 volatile organics were measured using EPA Method TO-15 or TO-3 by gas chromatography/mass spectrometry. Formaldehyde levels were determined using UMEx 100 Passive Samplers.
Results: Levels of eight volatile chemicals exceeded federal guidelines under several operational circumstances. Benzene, formaldehyde, and hydrogen sulfide were the most common compounds to exceed acute and other health-based risk levels.
Conclusions: Air concentrations of potentially dangerous compounds and chemical mixtures are frequently present near oil and gas production sites. Community-based research can provide an important supplement to state air quality monitoring programs.
Background: Little is known about the environmental and public health impact of unconventional natural gas extraction activities, including hydraulic fracturing, that occur near residential areas.
Objectives: Our aim was to assess the relationship between household proximity to natural gas wells and reported health symptoms.
Methods: We conducted a hypothesis-generating health symptom survey of 492 persons in 180 randomly selected households with ground-fed wells in an area of active natural gas drilling. Gas well proximity for each household was compared with the prevalence and frequency of reported dermal, respiratory, gastrointestinal, cardiovascular, and neurological symptoms.
Results: The number of reported health symptoms per person was higher among residents living < 1 km (mean ± SD, 3.27 ± 3.72) compared with > 2 km from the nearest gas well (mean ± SD, 1.60 ± 2.14; p = 0.0002). In a model that adjusted for age, sex, household education, smoking, awareness of environmental risk, work type, and animals in house, reported skin conditions were more common in households < 1 km compared with > 2 km from the nearest gas well (odds ratio = 4.1; 95% CI: 1.4, 12.3; p = 0.01). Upper respiratory symptoms were also more frequently reported in persons living in households < 1 km from gas wells (39%) compared with households 1–2 km or > 2 km from the nearest well (31 and 18%, respectively) (p = 0.004). No equivalent correlation was found between well proximity and other reported groups of respiratory, neurological, cardiovascular, or gastrointestinal conditions.
Conclusion: Although these results should be viewed as hypothesis generating, and the population studied was limited to households with a ground-fed water supply, proximity of natural gas wells may be associated with the prevalence of health symptoms including dermal and respiratory conditions in residents living near natural gas extraction activities. Further study of these associations, including the role of specific air and water exposures, is warranted.
Citation: Rabinowitz PM, Slizovskiy IB, Lamers V, Trufan SJ, Holford TR, Dziura JD, Peduzzi PN, Kane MJ, Reif JS, Weiss TR, Stowe MH. 2015. Proximity to natural gas wells and reported health status: results of a household survey in Washington County, Pennsylvania. Environ Health Perspect 123:21–26; http://dx.doi.org/10.1289/ehp.1307732
Background: Half the world’s population lives in urban areas. It is therefore important to identify characteristics of the built environment that are beneficial to human health. Urban greenness has been associated with improvements in a diverse range of health conditions, including birth outcomes; however, few studies have attempted to distinguish potential effects of greenness from those of other spatially correlated exposures related to the built environment.
Objectives: We aimed to investigate associations between residential greenness and birth outcomes and evaluate the influence of spatially correlated built environment factors on these associations.
Methods: We examined associations between residential greenness [measured using satellite-derived Normalized Difference Vegetation Index (NDVI) within 100 m of study participants’ homes] and birth outcomes in a cohort of 64,705 singleton births (from 1999–2002) in Vancouver, British Columbia, Canada. We also evaluated associations after adjusting for spatially correlated built environmental factors that may influence birth outcomes, including exposure to air pollution and noise, neighborhood walkability, and distance to the nearest park.
Results: An interquartile increase in greenness (0.1 in residential NDVI) was associated with higher term birth weight (20.6 g; 95% CI: 16.5, 24.7) and decreases in the likelihood of small for gestational age, very preterm (< 30 weeks), and moderately preterm (30–36 weeks) birth. Associations were robust to adjustment for air pollution and noise exposures, neighborhood walkability, and park proximity.
Conclusions: Increased residential greenness was associated with beneficial birth outcomes in this population-based cohort. These associations did not change after adjusting for other spatially correlated built environment factors, suggesting that alternative pathways (e.g., psychosocial and psychological mechanisms) may underlie associations between residential greenness and birth outcomes.
Citation: Hystad P, Davies HW, Frank L, Van Loon J, Gehring U, Tamburic L, Brauer M. 2014. Residential greenness and birth outcomes: evaluating the influence of spatially correlated built-environment factors. Environ Health Perspect 122:1095–1102; http://dx.doi.org/10.1289/ehp.1308049
Pennsylvania Marcellus Shale region residents have reported medical symptoms they believe are related to nearby Unconventional Natural Gas Development (UNGD). Associations between medical symptoms and UNGD have been minimally explored. The objective of this descriptive study is to explore whether shale region Pennsylvania residents perceive UNGD as a health concern and whether they attribute health symptoms to UNGD exposures. A questionnaire was administered to adult volunteers with medical complaints in a primary-care medical office in a county where UNGD was present. Participants were asked whether they were concerned about health effects from UNGD, and whether they attributed current symptoms to UNGD or to some other environmental exposure. There were 72 respondents; 22% perceived UNGD as a health concern and 13% attributed medical symptoms to UNGD exposures. Overall, 42% attributed one or more of their medical symptoms to environmental causes, of which UNGD was the most frequent. A medical record review conducted on six participants who attributed their medical symptoms to UNGD revealed that only one of these records documented both the symptoms in question and the attribution to UNGD. The results of this pilot study suggest that there is substantial concern about adverse health effects of UNGD among Pennsylvania Marcellus Shale residents, and that these concerns may not be adequately represented in medical records. Further efforts to determine the relationship between UNGD and health are recommended in order to address community concerns.
The United States has experienced a boom in natural gas production due to recent technological innovations that have enabled this resource to be produced from shale formations.
This review discusses the body of evidence that focuses on exposure pathways to evaluate the potential environmental public health impacts of shale gas development. It highlights what is currently known and identifies data gaps and research limitations by addressing matters of toxicity, exposure pathways, air quality, and water quality.
There is evidence of potential environmental public health risks associated with shale gas development. A number of studies suggest that shale gas development contributes to levels of ambient air concentrations known to be associated with increased risk of morbidity and mortality. Similarly, an increasing body of studies suggest water contamination risks exist through a variety of environmental pathways, most notably during wastewater transport and disposal and via poor zonal isolation of gases and fluids due to structural integrity impairment of cement in gas wells.
Despite a growing body of evidence, a number of data gaps persist. Most importantly, there is a need for more epidemiological studies to assess associations between risk factors, such as air and water pollution and health outcomes among populations living in close proximity to shale gas operations.
Birth defects are a leading cause of neonatal mortality. Natural gas development (NGD) emits several potential teratogens and US production is expanding.
We examined associations between maternal residential proximity to NGD and birth outcomes in a retrospective cohort study of 124,842 births between 1996 and 2009 in rural Colorado.
We calculated inverse distance weighted natural gas well counts within a 10-mile radius of maternal residence to estimate maternal exposure to NGD. Logistic regression, adjusted for maternal and infant covariates, was used to estimate associations with exposure tertiles for congenital heart defects (CHDs), neural tube defects (NTDs), oral clefts, preterm birth, and term low birth weight. The Association with term birth weight was investigated using multiple linear regression.
Prevalence of CHDs increased with exposure tertile, with an odds ratio (OR) of 1.3 for the highest tertile (95% CI: 1.2, 1.5) and NTD prevalence was associated with the highest tertile of exposure (OR = 2.0, 95% CI: 1.0, 3.9, based on 59 cases), compared to no gas wells within a 10-mile radius. Exposure was negatively associated with preterm birth and positively associated with fetal growth, though the magnitude of association was small. No association was found between exposure and oral clefts.
In this large cohort, we observed an association between density and proximity of natural gas wells within a 10-mile radius of maternal residence and prevalence of CHDs and possibly NTDs. Greater specificity in exposure estimates are needed to further explore these associations.
Ambient air pollution has been associated with restricted fetal growth, which is linked with adverse respiratory health in childhood. We assessed the effect of maternal exposure to low concentrations of ambient air pollution on birthweight.
We pooled data from 14 population-based mother-child cohort studies in 12 European countries. Overall, the study population included 74 178 women who had singleton deliveries between Feb 11, 1994, and June 2, 2011, and for whom information about infant birthweight, gestational age, and sex was available. The primary outcome of interest was low birthweight at term (weight <2500 g at birth after 37 weeks of gestation). Mean concentrations of particulate matter with an aerodynamic diameter of less than 2·5 μm (PM2·5), less than 10 μm (PM10), and between 2·5 μm and 10 μm during pregnancy were estimated at maternal home addresses with temporally adjusted land-use regression models, as was PM2·5 absorbance and concentrations of nitrogen dioxide (NO2) and nitrogen oxides. We also investigated traffic density on the nearest road and total traffic load. We calculated pooled effect estimates with random-effects models.
A 5 μg/m(3) increase in concentration of PM2·5 during pregnancy was associated with an increased risk of low birthweight at term (adjusted odds ratio [OR] 1·18, 95% CI 1·06-1·33). An increased risk was also recorded for pregnancy concentrations lower than the present European Union annual PM2·5 limit of 25 μg/m(3) (OR for 5 μg/m(3) increase in participants exposed to concentrations of less than 20 μg/m(3) 1·41, 95% CI 1·20-1·65). PM10 (OR for 10 μg/m(3) increase 1·16, 95% CI 1·00-1·35), NO2 (OR for 10 μg/m(3) increase 1·09, 1·00-1·19), and traffic density on nearest street (OR for increase of 5000 vehicles per day 1·06, 1·01-1·11) were also associated with increased risk of low birthweight at term. The population attributable risk estimated for a reduction in PM2·5 concentration to 10 μg/m(3) during pregnancy corresponded to a decrease of 22% (95% CI 8-33%) in cases of low birthweight at term.
Exposure to ambient air pollutants and traffic during pregnancy is associated with restricted fetal growth. A substantial proportion of cases of low birthweight at term could be prevented in Europe if urban air pollution was reduced.
The European Union.
The rapid rise in natural gas extraction utilizing hydraulic fracturing increases the potential for contamination of surface and ground water from chemicals used throughout the process. Hundreds of products containing more than 750 chemicals and components are potentially used throughout the extraction process, including over one hundred known or suspected endocrine disrupting chemicals. We hypothesized that a selected subset of chemicals used in natural gas drilling operations and also surface and ground water samples collected in a drilling-dense region of Garfield County, CO would exhibit estrogen and androgen receptor activities. Water samples were collected, solid-phase extracted, and measured for estrogen and androgen receptor activities using reporter gene assays in human cell lines. Of the 39 unique water samples, 89%, 41%, 12%, and 46% exhibited estrogenic, anti-estrogenic, androgenic, and anti-androgenic activities, respectively. Testing of a subset of natural gas drilling chemicals revealed novel anti-estrogenic, novel anti-androgenic, and limited estrogenic activities. The Colorado River, the drainage basin for this region, exhibited moderate levels of estrogenic, anti-estrogenic, and anti-androgenic activities, suggesting that higher localized activity at sites with known natural gas related spills surrounding the river might be contributing to the multiple receptor activities observed in this water source. The majority of water samples collected from sites in a drilling-dense region of Colorado exhibited more estrogenic, anti-estrogenic, or anti-androgenic activities than reference sites with limited nearby drilling operations. Our data suggest that natural gas drilling operations may result in elevated EDC activity in surface and ground water.
Horizontal drilling and hydraulic fracturing are transforming energy production, but their potential environmental effects remain controversial. We analyzed 141 drinking water wells across the Appalachian Plateaus physiographic province of northeastern Pennsylvania, examining natural gas concentrations and isotopic signatures with proximity to shale gas wells. Methane was detected in 82% of drinking water samples, with average concentrations six times higher for homes <1 km from natural gas wells (P = 0.0006). Ethane was 23 times higher in homes <1 km from gas wells (P = 0.0013); propane was detected in 10 water wells, all within approximately 1 km distance (P = 0.01). Of three factors previously proposed to influence gas concentrations in shallow groundwater (distances to gas wells, valley bottoms, and the Appalachian Structural Front, a proxy for tectonic deformation), distance to gas wells was highly significant for methane concentrations (P = 0.007; multiple regression), whereas distances to valley bottoms and the Appalachian Structural Front were not significant (P = 0.27 and P = 0.11, respectively). Distance to gas wells was also the most significant factor for Pearson and Spearman correlation analyses (P < 0.01). For ethane concentrations, distance to gas wells was the only statistically significant factor (P < 0.005). Isotopic signatures (δ(13)C-CH4, δ(13)C-C2H6, and δ(2)H-CH4), hydrocarbon ratios (methane to ethane and propane), and the ratio of the noble gas (4)He to CH4 in groundwater were characteristic of a thermally postmature Marcellus-like source in some cases. Overall, our data suggest that some homeowners living <1 km from gas wells have drinking water contaminated with stray gases.
The development of natural gas wells is rapidly increasing, yet little is known about associated exposures and potential public health consequences. We used health impact assessment (HIA) to provide decision-makers with information to promote public health at a time of rapid decision making for natural gas development. We have reported that natural gas development may expose local residents to air and water contamination, industrial noise and traffic, and community changes. We have provided more than 90 recommendations for preventing or decreasing health impacts associated with these exposures. We also have reflected on the lessons learned from conducting an HIA in a politically charged environment. Finally, we have demonstrated that despite the challenges, HIA can successfully enhance public health policymaking. (Am J Public Health. Published online ahead of print April 18, 2013: e1-e9. doi:10.2105/AJPH.2012.301017).
The ethnographer's toolbox has within it a variety of methods for describing and analyzing the everyday lives of human beings that can be useful to public health practitioners and policymakers. These methods can be employed to uncover information on some of the harder-to-monitor psychological, sociocultural, and environmental factors that may lead to chronic stress in individuals and communities. In addition, because most ethnographic research studies involve deep and long-term engagement with local communities, the information collected by ethnographic researchers can be useful in tracking long- and short-term changes in overall well-being and health. Set within an environmental justice framework, this article uses examples from ongoing ethnographic fieldwork in the Marcellus Shale gas fields of Pennsylvania to describe and justify using an ethnographic approach to monitor the psychological and sociocultural determinants of community health as they relate to unconventional oil and gas development projects in the United States.
Background: A growing body of evidence has associated maternal exposure to air pollution with adverse effects on fetal growth; however, the existing literature is inconsistent.
Objectives: We aimed to quantify the association between maternal exposure to particulate air pollution and term birth weight and low birth weight (LBW) across 14 centers from 9 countries, and to explore the influence of site characteristics and exposure assessment methods on between-center heterogeneity in this association.
Methods: Using a common analytical protocol, International Collaboration on Air Pollution and Pregnancy Outcomes (ICAPPO) centers generated effect estimates for term LBW and continuous birth weight associated with PM10 and PM2.5 (particulate matter ≤ 10 and 2.5 µm). We used meta-analysis to combine the estimates of effect across centers (~ 3 million births) and used meta-regression to evaluate the influence of center characteristics and exposure assessment methods on between-center heterogeneity in reported effect estimates.
Results: In random-effects meta-analyses, term LBW was positively associated with a 10-μg/m3 increase in PM10 [odds ratio (OR) = 1.03; 95% CI: 1.01, 1.05] and PM2.5 (OR = 1.10; 95% CI: 1.03, 1.18) exposure during the entire pregnancy, adjusted for maternal socioeconomic status. A 10-μg/m3 increase in PM10 exposure was also negatively associated with term birth weight as a continuous outcome in the fully adjusted random-effects meta-analyses (–8.9 g; 95% CI: –13.2, –4.6 g). Meta-regressions revealed that centers with higher median PM2.5 levels and PM2.5:PM10 ratios, and centers that used a temporal exposure assessment (compared with spatiotemporal), tended to report stronger associations.
Conclusion: Maternal exposure to particulate pollution was associated with LBW at term across study populations. We detected three site characteristics and aspects of exposure assessment methodology that appeared to contribute to the variation in associations reported by centers.
Traffic-related air pollution is recognized as an important contributor to health problems. Epidemiologic analyses suggest
that prenatal exposure to traffic-related air pollutants may be associated with adverse birth outcomes; however, there is
insufficient evidence to conclude that the relation is causal. The Study of Air Pollution, Genetics and Early Life Events
comprises all births to women living in 4 counties in California's San Joaquin Valley during the years 2000–2006. The probability
of low birth weight among full-term infants in the population was estimated using machine learning and targeted maximum likelihood
estimation for each quartile of traffic exposure during pregnancy. If everyone lived near high-volume freeways (approximated
as the fourth quartile of traffic density), the estimated probability of term low birth weight would be 2.27% (95% confidence
interval: 2.16, 2.38) as compared with 2.02% (95% confidence interval: 1.90, 2.12) if everyone lived near smaller local roads
(first quartile of traffic density). Assessment of potentially causal associations, in the absence of arbitrary model assumptions
applied to the data, should result in relatively unbiased estimates. The current results support findings from previous studies
that prenatal exposure to traffic-related air pollution may adversely affect birth weight among full-term infants.
Technological advances (e.g. directional drilling, hydraulic fracturing), have led to increases in unconventional natural gas development (NGD), raising questions about health impacts.
We estimated health risks for exposures to air emissions from a NGD project in Garfield County, Colorado with the objective of supporting risk prevention recommendations in a health impact assessment (HIA).
We used EPA guidance to estimate chronic and subchronic non-cancer hazard indices and cancer risks from exposure to hydrocarbons for two populations: (1) residents living >½ mile from wells and (2) residents living ≤ ½ mile from wells.
Residents living ≤ ½ mile from wells are at greater risk for health effects from NGD than are residents living >½ mile from wells. Subchronic exposures to air pollutants during well completion activities present the greatest potential for health effects. The subchronic non-cancer hazard index (HI) of 5 for residents ≤ ½ mile from wells was driven primarily by exposure to trimethylbenzenes, xylenes, and aliphatic hydrocarbons. Chronic HIs were 1 and 0.4. for residents ≤ ½ mile from wells and >½ mile from wells, respectively. Cumulative cancer risks were 10 in a million and 6 in a million for residents living ≤ ½ mile and >½ mile from wells, respectively, with benzene as the major contributor to the risk.
Risk assessment can be used in HIAs to direct health risk prevention strategies. Risk management approaches should focus on reducing exposures to emissions during well completions. These preliminary results indicate that health effects resulting from air emissions during unconventional NGD warrant further study. Prospective studies should focus on health effects associated with air pollution.
In this review, we present an update on maternal exposure to nitrates in drinking water in relation to possible adverse reproductive and developmental effects, and discuss nitrates in drinking water in the United States. The current standard for nitrates in drinking water is based on retrospective studies and approximates a level that protects infants from methemoglobinemia, but no safety factor is built into the standard. The current standard applies only to public water systems. Animal studies have found adverse reproductive effects resulting from higher doses of nitrate or nitrite. The epidemiologic evidence of a direct exposure-response relationship between drinking water nitrate level and adverse reproductive effect is still not clear. However, some reports have suggested an association between exposure to nitrates in drinking water and spontaneous abortions, intrauterine growth restriction, and various birth defects. Uncertainties in epidemiologic studies include the lack of individual exposure assessment that would rule out confounding of the exposure with some other cause. We conclude that the current literature does not provide sufficient evidence of a causal relationship between exposure to nitrates in drinking water and adverse reproductive effects.
(Obstet Gynecol. 2011;118(2 Pt 1):201–8)
Natural gas extraction, often referred to as "fracking," has increased rapidly in the U.S. in recent years. To address potential health impacts, passive air samplers were deployed in a rural community heavily affected by the natural gas boom. Samplers were analyzed for 62 polycyclic aromatic hydrocarbons (PAHs). Results were grouped based on distance from each sampler to the nearest active well. PAH levels were highest when samplers were closest to active wells. Additionally, PAH levels closest to natural gas activity were an order of magnitude higher than levels previously reported in rural areas. Sourcing ratios indicate that PAHs were predominantly petrogenic, suggesting that elevated PAH levels were influenced by direct releases from the earth. Quantitative human health risk assessment estimated the excess lifetime cancer risks associated with exposure to the measured PAHs. Closest to active wells, the risk estimated for maximum residential exposure was 2.9 in 10,000, which is above the U.S. EPA's acceptable risk level. Overall, risk estimates decreased 30% when comparing results from samplers closest to active wells to those farthest. This work suggests that natural gas extraction may be contributing significantly to PAHs in air, at levels that are relevant to human health.
We examined the association between shale gas drilling and motor vehicle accident rates in Pennsylvania.Methods
Using publicly available data on all reported vehicle crashes in Pennsylvania, we compared accident rates in counties with and without shale gas drilling, in periods with and without intermittent drilling (using data from 2005 to 2012). Counties with drilling were matched to non-drilling counties with similar population and traffic in the pre-drilling period.ResultsHeavily drilled counties in the north experienced 15–23% higher vehicle crash rates in 2010–2012 and 61–65% higher heavy truck crash rates in 2011–2012 than control counties. We estimated 5–23% increases in crash rates when comparing months with drilling and months without, but did not find significant effects on fatalities and major injury crashes. Heavily drilled counties in the southwest showed 45–47% higher rates of fatal and major injury crashes in 2012 than control counties, but monthly comparisons of drilling activity showed no significant differences associated with drilling.Conclusions
Vehicle accidents have measurably increased in conjunction with shale gas drilling.
Experiencing psychological distress such as depression, anxiety, and/or perceived stress during pregnancy may increase the risk for adverse birth outcomes, including preterm birth. Clarifying the association between exposure and outcome may improve the understanding of risk factors for prematurity and guide future clinical and research practices.
The aims of the present review were to outline the evidence on the risk of preterm associated with antenatal depression, anxiety, and stress.
Four electronic database searches were conducted to identify quantitative population-based, multi-centre, cohort studies and randomised-controlled trial studies focusing on the association between antenatal depression, anxiety, and stress, and preterm birth published in English between 1980 and 2013.
Of 1469 electronically retrieved articles, 39 peer-reviewed studies met the final selection criteria and were included in this review following the PRISMA and MOOSE review guidelines. Information was extracted on study characteristics; depression, anxiety and perceived stress were examined as separate and combined exposures. There is strong evidence that antenatal distress during the pregnancy increases the likelihood of preterm birth.
Complex paths of significant interactions between depression, anxiety and stress, risk factors and preterm birth were indicated in both direct and indirect ways. The effects of pregnancy distress were associated with spontaneous but not with medically indicated preterm birth. Health practitioners engaged in providing perinatal care to women, such as obstetricians, midwives, nurses, and mental health specialists need to provide appropriate support to women experiencing psychological distress in order to improve outcomes for both mothers and infants.
Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
Traditionally, methicillin resistant Staphylococcus aureus (MRSA) has been a nosocomial pathogen, but in the past decade the epidemiology of MRSA has changed. Three major epidemiologic profiles have emerged, hospital- (HA), community- (CA), and livestock-associated (LA) MRSA. Two of the three, CA and LA, have been linked to environmental exposures, specifically animal husbandry and industrialized animal production. We evaluated associations of MRSA with animal feeding operations (AFOs) using 10 years of electronic health record (EHR) data from the Geisinger Clinic (GC). GC provides primary care services from 41 community practice clinics and 4 hospitals in a 31-county region of central and northeastern Pennsylvania, a region with a large number of AFOs. Data were available from > 440,000 primary care patients involving > 157,000,000 records. The number of diagnosed MRSA infections rose from 6 in 2003 to 436 in 2009, with increases in both HA and CA-MRSA; during these years, > 60% of total cases were CA-MRSA. In the 38 Geisinger and bordering counties there are 1350 AFOs with 328,000 animal equivalent units (AEUs, 1 AEU = 1,000 pounds live weight), including 170 concentrated AFOs (CAFOs). To investigate the association between AFOs and human MRSA infection we defined four patient groups using specific ICD-9 codes: (1) community-onset MRSA without health care system contact risk factors; (2) hospital-onset MRSA with risk factors; (3) skin and soft tissue infections (SSTIs); and (4) controls. The spatial distribution of the 1926 MRSA cases will be examined in various definitional groupings to improve sensitivity and specificity of the case definition, and logistic regression will be used to explore associations with the environment. A random sample of isolates from 25 patients from each of groups (1) and (2) will undergo genotyping by multilocus sequence typing (MLST), spa typing and ascertainment of presence of PVL toxin genes.
Objective
This study aims to summarize evidence on the relation between neighborhood deprivation and the risks for preterm birth, small-for-gestational age, and stillbirth.DesignSystematic review and meta-analysis.Main outcome measuresStudies that directly compared the risk of living in the most deprived neighborhood quintile with least deprived quintile for at least one perinatal outcome of interest (preterm delivery, small-for-gestational age and stillbirth).Methods
Study selection was based on a search of Medline, Embase and Web of Science for articles published up to April 2012, reference list screening, and email contact with authors. Data on study characteristics, outcome measures, and quality were extracted by two independent investigators. Random-effects meta-analysis was preformed to estimate unadjusted and adjusted summary odds ratios (ORs) with the associated 95% confidence intervals.ResultsWe identified 2863 articles of which 24 were included in a systematic review. A meta-analysis (n = 7 studies, including 2 579 032 pregnancies) assessed the risk of adverse perinatal outcomes by comparing the most deprived neighborhood quintile with the least deprived quintile. Compared to the least deprived quintile, ORs for adverse perinatal outcomes in the most deprived neighborhood quintile were significantly increased for preterm delivery (OR 1.23, 95%CI: 1.18-1.28), small-for-gestational age (OR 1.31, 95%CI: 1.28-1.34), and stillbirth (OR 1.33, 95%CI: 1.21-1.45).Conclusion
Living in a deprived neighborhood is associated with preterm birth, small-for-gestational age and stillbirth.This article is protected by copyright. All rights reserved.
Maternal residential proximity to roads has been associated with adverse pregnancy outcomes. However, there is no study investigating mediators or buffering effects of road-adjacent trees on this association. We investigated the association between mothers' residential proximity to major roads and term low birth weight (LBW), while exploring possible mediating roles of air pollution (PM2.5, PM2.5-10, PM10, PM2.5 absorbance, nitrogen dioxide, and nitrogen oxides), heat, and noise and buffering effect of road-adjacent trees on this association.
This cohort study was based on 6438 singleton term births in Barcelona, Spain (2001-2005). Road proximity was measured as both continuous distance to and living within 200 m from a major road. We assessed individual exposures to air pollution, noise, and heat using, respectively, temporally adjusted land-use regression models, annual averages of 24-hour noise levels across 50 m and 250 m, and average of satellite-derived land-surface temperature in a 50-m buffer around each residential address. We used vegetation continuous fields to abstract tree coverage in a 200-m buffer around major roads.
Living within 200 m of major roads was associated with a 46% increase in term LBW risk; an interquartile range increase in heat exposure with an 18% increase; and third-trimester exposure to PM2.5, PM2.5-10, and PM10 with 24%, 25%, and 26% increases, respectively. Air pollution and heat exposures together explained about one-third of the association between residential proximity to major roads and term LBW. Our observations on the buffering of this association by road-adjacent trees were not consistent between our 2 measures of proximity to major roads.
An increased risk of term LBW associated with proximity to major roads was partly mediated by air pollution and heat exposures.
Unlabelled:
The Marcellus Shale is one of the largest natural gas reserves in the United States; it has recently been the focus of intense drilling and leasing activity. This paper describes an air emissions inventory for the development, production, and processing of natural gas in the Marcellus Shale region for 2009 and 2020. It includes estimates of the emissions of oxides of nitrogen (NOx), volatile organic compounds (VOCs), and primary fine particulate matter (< or = 2.5 microm aerodynamic diameter; PM2.5) from major activities such as drilling, hydraulic fracturing, compressor stations, and completion venting. The inventory is constructed using a process-level approach; a Monte Carlo analysis is used to explicitly account for the uncertainty. Emissions were estimated for 2009 and projected to 2020, accounting for the effects of existing and potential additional regulations. In 2020, Marcellus activities are predicted to contribute 6-18% (95% confidence interval) of the NOx emissions in the Marcellus region, with an average contribution of 12% (129 tons/day). In 2020, the predicted contribution of Marcellus activities to the regional anthropogenic VOC emissions ranged between 7% and 28% (95% confidence interval), with an average contribution of 12% (100 tons/day). These estimates account for the implementation of recently promulgated regulations such as the Tier 4 off-road diesel engine regulation and the US. Environmental Protection Agency's (EPA) Oil and Gas Rule. These regulations significantly reduce the Marcellus VOC and NOx emissions, but there are significant opportunities for further reduction in these emissions using existing technologies.
Implications:
The Marcellus Shale is one of the largest natural gas reserves in United States. The development and production of this gas may emit substantial amounts of oxides of nitrogen and volatile organic compounds. These emissions may have special significance because Marcellus development is occurring close to areas that have been designated nonattainment for the ozone standard. Control technologies exist to substantially reduce these impacts. PM2.5 emissions are predicted to be negligible in a regional context, but elemental carbon emissions from diesel powered equipment may be important.
Motorized traffic is an important source of both air pollution and community noise. While there is growing evidence for an adverse effect of ambient air pollution on reproductive health, little is known about the association between traffic noise and pregnancy outcomes.
We evaluated the impact of residential noise exposure on small size for gestational age, preterm birth, term birth weight, and low birth weight at term in a population-based cohort study, for which we previously reported associations between air pollution and pregnancy outcomes. We also evaluated potential confounding of air pollution effects by noise and vice versa. Linked administrative health data sets were used to identify 68,238 singleton births (1999-2002) in Vancouver, British Columbia, Canada, with complete covariate data (sex, ethnicity, parity, birth month and year, income, and education) and maternal residential history. We estimated exposure to noise with a deterministic model (CadnaA) and exposure to air pollution using temporally adjusted land-use regression models and inverse distance weighting of stationary monitors for the entire pregnancy.
Noise exposure was negatively associated with term birth weight (mean difference = -19 [95% confidence interval = -23 to -15] g per 6 dB(A)). In joint air pollution-noise models, associations between noise and term birth weight remained largely unchanged, whereas associations decreased for all air pollutants.
Traffic may affect birth weight through exposure to both air pollution and noise.
The rapid increase in unconventional natural gas (UNG) development in the United States during the past decade has brought wells and related infrastructure closer to population centers. This review evaluates risks to public health from chemical and nonchemical stressors associated with UNG, describes likely exposure pathways and potential health effects, and identifies major uncertainties to address with future research. The most important occupational stressors include mortality, exposure to hazardous materials and increased risk of industrial accidents. For communities near development and production sites the major stressors are air pollutants, ground and surface water contamination, truck traffic and noise pollution, accidents and malfunctions, and psychosocial stress associated with community change. Despite broad public concern, no comprehensive population-based studies of the public health effects of UNG operations exist. Major uncertainties are the unknown frequency and duration of human exposure, future extent of development, potential emission control and mitigation strategies, and a paucity of baseline data to enable substantive before and after comparisons for affected populations and environmental media. Overall, the current literature suggests that research needs to address these uncertainties before we can reasonably quantify the likelihood of occurrence or magnitude of adverse health effects associated with UNG production in workers and communities.
Preterm premature rupture of membranes (PROM) is the leading identifiable predisposing factor for preterm birth. Although
maternal exposure to air pollution can potentially have an impact on preterm PROM, there is no available evidence on such
an impact. In this study, based on 5,555 singleton births occurring in Barcelona, Spain (2002–2005), we investigated the associations
of maternal exposure to nitrogen dioxide, nitrogen oxides, and particulate matter with aerodynamic diameters of ≤2.5 µm (PM2.5), 2.5 µm–10 µm, and ≤10 µm and PM2.5 light absorption with preterm PROM and gestational age at the rupture of membranes (ROM). We utilized temporally adjusted
land-use regression models to predict pollutant levels at each subject's home address during each week of her pregnancy. We
conducted matched (according to the length of exposure) case-control analyses to estimate the preterm PROM risk associated
with 1 interquartile-range increase in exposure levels during the entire pregnancy and during the last 3 months prior to ROM.
We found an increase in preterm PROM risk of up to 50% (95% confidence interval: 4, 116) and a 1.3-day (95% confidence interval:
−1.9, −0.6) reduction in gestational age at ROM associated with PM2.5 absorbance, nitrogen dioxide exposure, and nitrogen oxide exposure during the entire pregnancy and the last 3 months prior
to ROM.
Several studies have examined associations between particulate matter with aerodynamic diameter of 2.5 µm or less (PM2.5) and preterm birth, but it is uncertain whether results were affected by individual predispositions (e.g., genetic factors,
social conditions) that might vary considerably between women. We tested the hypothesis that a woman is at greater risk of
preterm delivery when she has had elevated exposure to ambient PM2.5 during a pregnancy than when she has not by comparing pregnancies in the same woman. From 271,204 births, we selected 29,175
women who had vaginal singleton livebirths at least twice in Connecticut in 2000–2006 (n = 61,688 births). Analyses matched pregnancies to the same woman. Adjusted odds ratios per interquartile range (2.33-µg/m3) increase in PM2.5 in the first trimester, second trimester, third trimester, and whole pregnancy were 1.07 (95% confidence interval (CI): 1.00,
1.15), 0.96 (95% CI: 0.90, 1.03), 1.03 (95% CI: 0.97, 1.08), and 1.13 (95% CI: 1.01, 1.28), respectively. Among Hispanic women,
the odds ratio per interquartile range increase in whole-pregnancy exposure was 1.31 (95% CI: 1.00, 1.73). Pregnancies with
elevated PM2.5 exposure were more likely to result in preterm birth than were other pregnancies to the same woman at lower exposure. Associations
were most pronounced in the first trimester and among Hispanic women.
Evaluate whether childhood cancer incidence is associated with counties with hydraulic fracturing (HF).
We compared cancer incidence in children in Pennsylvania counties before and after HF drilling began, using standardized incidence ratios (SIRs) and 95% confidence intervals (CIs).
The total number of cancers observed was close to expected both before drilling began (SIR = 0.94; 95% CI, 0.90 to 0.99) and after drilling (SIR = 1.02; 95% CI, 0.98 to 1.07) for counties with oil and natural gas wells. Analyses for childhood leukemia were also unremarkable (SIR for leukemia before drilling = 0.97 [95% CI, 0.88 to 1.06]; SIR for leukemia after drilling = 1.01 [95% CI, 0.92 to 1.11]). A slightly elevated SIR was found for central nervous system tumors after drilling (SIR = 1.13; 95% CI, 1.02 to 1.25). This was because of a slight excess in those counties with the fewest number of wells.
This study offers comfort concerning health effects of HF on childhood cancers.
Across the United States, the race for new energy sources is picking up speed and reaching more places, with natural gas in the lead. While the toxic and polluting qualities of substances used and produced in shale gas development and the general health effects of exposure are well established, scientific evidence of causal links has been limited, creating an urgent need to understand health impacts. Self-reported survey research documenting the symptoms experienced by people living in proximity to gas facilities, coupled with environmental testing, can elucidate plausible links that warrant both response and further investigation. This method, recently applied to the gas development areas of Pennsylvania, indicates the need for a range of policy and research efforts to safeguard public health.
Low birth weight and preterm birth have a substantial public health impact. Studies examining their association with outdoor air pollution were identified using searches of bibliographic databases and reference lists of relevant papers. Pooled estimates of effect were calculated, heterogeneity was quantified, meta-regression was conducted and publication bias was examined. Sixty-two studies met the inclusion criteria. The majority of studies reported reduced birth weight and increased odds of low birth weight in relation to exposure to carbon monoxide (CO), nitrogen dioxide (NO(2)) and particulate matter less than 10 and 2.5 microns (PM(10) and PM(2.5)). Effect estimates based on entire pregnancy exposure were generally largest. Pooled estimates of decrease in birth weight ranged from 11.4 g (95% confidence interval -6.9-29.7) per 1 ppm CO to 28.1g (11.5-44.8) per 20 ppb NO(2), and pooled odds ratios for low birth weight ranged from 1.05 (0.99-1.12) per 10 μg/m(3) PM(2.5) to 1.10 (1.05-1.15) per 20 μg/m(3) PM(10) based on entire pregnancy exposure. Fewer effect estimates were available for preterm birth and results were mixed. Pooled odds ratios based on 3rd trimester exposures were generally most precise, ranging from 1.04 (1.02-1.06) per 1 ppm CO to 1.06 (1.03-1.11) per 20 μg/m(3) PM(10). Results were less consistent for ozone and sulfur dioxide for all outcomes. Heterogeneity between studies varied widely between pollutants and outcomes, and meta-regression suggested that heterogeneity could be partially explained by methodological differences between studies. While there is a large evidence base which is indicative of associations between CO, NO(2), PM and pregnancy outcome, variation in effects by exposure period and sources of heterogeneity between studies should be further explored.
Hydraulic fracturing, commonly called fracking, allows access to previously inaccessible natural gas reserves. Fracking in the United States is being touted as a panacea, creating much-needed jobs following a brutal recession, reducing dependence on foreign energy supplies, and lowering emissions of greenhouse gases that might contribute to global warming. As this natural gas production ramps up, however, there are few scientific findings on the effects of fracking on the environment and animal and human health. Moreover, anecdotal evidence suggests it may cause harm by contaminating well and ground water and releasing gases into the air.
No prior studies in children have evaluated how age may modify relationships of the built and social environments with BMI, nor evaluated the range of scales and contexts over which places may influence health.
To systematically evaluate associations of 33 environmental measures in three domains (land use, physical activity, and social environments) with BMI in children and adolescents in five geographies.
A cross-sectional, multilevel analysis was completed in 2009-2010 of electronic health record data (2001-2008) from 47,769 children aged 5-18 years residing in a 31-county region of Pennsylvania. Associations of environmental measures with BMI were evaluated using 0.5-mile network buffers; census tracts; minor civil divisions (i.e., townships, boroughs, cities); a mixed definition of place (townships, boroughs, and census tracts in cities); and counties, overall and by age strata.
Among all children, lower levels of community socioeconomic deprivation and greater diversity of physical activity establishments were associated with lower BMI. Associations of environmental measures differed by age, depending on scale and context. For example, higher population density was associated with lower BMI in older children; this effect was strongest in the larger geographies. Similarly, a lower level of county sprawl was associated with lower BMI in older children.
Associations differed by age and definition of place, suggesting that the benefits of environmental intervention may not be uniform across the childhood age range. The study demonstrated the utility of using electronic patient information for large-scale, population-based epidemiologic research, a research area of growing interest and investment in the U.S.
To estimate the association between an Apgar score of less than 7 at 5 minutes after birth and long-term cognitive function.
A linkage between the Swedish Medical Birth Registry and the Swedish School Grade Registry was performed. All singletons born from 1973 to 1986 after 36 6/7 weeks of gestation to Swedish-born women were included. Fetuses that were stillborn, newborns who had congenital malformations or were small for gestational age, and children who died or emigrated before 16 years of age were excluded from the analysis.
The study included 877,618 individuals in the analysis. Newborns with Apgar scores less than 7 at 5 minutes after birth showed a significantly increased risk of never receiving graduation grades, presumably because they went to special schools because of cognitive impairment or other special educational needs (odds ratio 1.93, 95% confidence interval 1.75-2.14). One out of 44 newborns (numbers needed to harm) with an Apgar score of less than 7 at 5 minutes after birth will go to a special school because of the antenatal or perinatal factors that caused the low Apgar score. Nearly all school children who had Apgar scores of less than 7 at 5 minutes after birth showed an increased risk of graduating from compulsory school without graduation grades in that specific subject or receiving the lowest possible grades and were also less likely to receive the highest possible grade.
An Apgar score of less than 7 at 5 minutes after birth is associated with subtle cognitive impairment, as measured by academic achievement at 16 years of age.
II.
Metcalfe A, Lail P, Ghali WA, Sauve RS. The association between neighbourhoods and adverse birth outcomes: a systematic review and meta‐analysis of multi‐level studies. Paediatric and Perinatal Epidemiology 2011; 25 : 236–245.
Many studies have examined the role of neighbourhood environment on birth outcomes but, because of differences in study design and modelling techniques, have found conflicting results. Seven databases were searched (1900–2010) for multi‐level observational studies related to neighbourhood and pregnancy/birth. We identified 1502 articles of which 28 met all inclusion criteria. Meta‐analysis was used to examine the association between neighbourhood income and low birthweight. Most studies showed a significant association between neighbourhood factors and birth outcomes. A significant pooled association was found for the relationship between neighbourhood income and low birthweight [odds ratio = 1.11, 95% confidence interval: 1.02, 1.20] whereby women who lived in low income neighbourhoods had significantly higher odds of having a low birthweight infant. This body of literature was found to consistently document significant associations between neighbourhood factors and birth outcomes. The consistency of findings from observational studies in this area indicates a need for causal studies to determine the mechanisms by which neighbourhoods influence birth outcomes.
Low birth weight (LBW) is one of the main predictors of infant mortality. The global incidence of LBW is around 17%, although estimates vary from 19% in the developing countries (countries where it is an important public health problem) to 5-7% in the developed countries. The incidence in Spain in the decade 1980-1989 was about 5.7%. LBW is generally associated with situations in which uterine malnutrition is produced due to alterations in placental circulation. There are many known risk factors, the most important of which are socio-economic factors, medical risks before or during gestation and maternal lifestyles. However, although interventions exist to prevent many of these factors before and during pregnancy, the incidence of LBW has not decreased.