Article

Unconventional Natural Gas Development and Birth Outcomes in Pennsylvania, USA

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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.

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... The only report evaluating such effect in Colorado found positive associations between density and proximity to natural gas wells within a 10-mile radius of maternal residence and prevalence of congenital heart disease and possibly neural tube defects 9 However, several other studies evaluating the effects of hydraulic fracturing on birth outcomes, including, birth weight in other states and Canada; have had mixed results 12,13 . The majority of studies have reported a negative association that varies in effect size [14][15][16][17] but contradictory results that include positive associations with certain caveats have also been reported in addition to Colorado 18,19 . Birth weight of an infant is an important determinant of its chances of survival and healthy growth and development 20 . ...
... In the literature, the most common exposure metric used to evaluate the effect of hydraulic fracturing activities is well proximity to the mother's residence, which is determined by geographical location. In addition to the previous studies, other studies have incorporated well density into the equation 9,16,17,19 with some of them reporting mixed results; however, by not incorporating additional metrics to account for the production intensity, no further explanation of the results could be offered. Some covariate categories in the full model were also significant, including sex of the infant, Term (denominated as preterm or normal at birth) and gender ratio as the strongest effect variables based on absolute values of parameter estimates. ...
... Although not all variables in the exposure category were significant, parameter estimate effect directions were the same as in birth weight with the main effects positively associated while the interaction effect was negatively associated. Our findings closely resemble previous reports where increased preterm risk is consistently associated with exposure to hydraulic fracturing activities 9,16,18,19,28 . For this model, demographic covariates more consistently remained as statistically significant when included in the full model. ...
Article
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Background: There is growing concern about the recent increase in oil and gas development using hydraulic fracturing. Studies linking adverse birth outcomes and maternal proximity to hydraulic fracturing wells exist but tend to use individualized maternal and infant data contained in protected health care records. In this study, we extended the findings of these past studies to evaluate if analogous effects detected with individualized data could be detected from non-individualized county-wide aggregated data. Design and Methods: This study used a retrospective cohort of 252,502 birth records from 1999 to 2019 gathered from a subset sample of 5 counties in the state of Colorado where hydraulic fracturing activities were conducted. We used Generalized Linear Models to evaluate the effect of county-wide well density and production data over unidentified birth weight, and prematurity data. Covariates used in the model were county-wide statistics sourced from the US Census. Results: Our modeling approach showed an interesting effect where hydraulic fracturing exposure metrics have a mixed effect directional response. This effect was detected on birth weight when well density, production and their interaction are accounted for. The interaction effect provides an additional interpretation to discrepancies reported previously in the literature. Our approach only detected a positive association to prematurity with increased production. Conclusions: Our findings demonstrate two main points: First, the effect of hydraulic fracturing is detectable by using county-wide unidentified data. Second, the effect of hydraulic fracturing can be complicated by the number of operations and the intensity of the activities in the area.
... We obtained electronic health record data for 15,888 Geisinger patients diagnosed with T2D between 2008-2016 who resided in the 37-county study area ( Figure 1). Geisinger, an integrated health system, serves central and northeast Pennsylvania and has a primary care population representative of the age and sex distribution of the region's general population [19]. As previously described [20], among individuals with at least two visits to a Geisinger primary care provider, we identified individuals as having T2D if they had at least two encounters with a T2D diagnosis based on Epic (Verona, WI) electronic diagnosis group names (more granular clinical terms selected by clinicians for diagnosis during encounters) or International Classification of Diseases [ICD] 9th and 10th Revision codes (ICD-9: 250.00, 250.02, 250. 10, 250.12, 250.20, 250.22, ...
... a primary care population representative of the age and sex distribution of the region's general population [19]. As previously described [20], among individuals with at least two visits to a Geisinger primary care provider, we identified individuals as having T2D if they had at least two encounters with a T2D diagnosis based on Epic (Verona, WI) electronic diagnosis group names (more granular clinical terms selected by clinicians for diagnosis during encounters) or International Classification of Diseases [ICD] 9th and 10th Revision codes (ICD-9: 250.00, 250.02, 250. 10, 250.12, 250.20, 250.22, ...
... Third, we did not have information on past residential history and so were unable to determine the length of time study individual's had lived at their current residence and experienced its specific level of greenness. This potential misclassification bias was somewhat minimized by studying the largely residentially stable population served by Geisinger [19]. Finally, our findings are subject to unmeasured confounding by air pollution and road traffic noise, which tend to be lower in greener areas; this may have resulted in overestimation of the association of NDVI and blood pressure [35]. ...
Article
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Greenness may impact blood pressure (BP), though evidence is limited among individuals with type 2 diabetes (T2D), for whom BP management is critical. We evaluated associations of residential greenness with BP among individuals with T2D in geographically diverse communities in Pennsylvania. To address variation in greenness type, we evaluated modification of associations by percent forest. We obtained systolic (SBP) and diastolic (DBP) BP measurements from medical records of 9593 individuals following diabetes diagnosis. Proximate greenness was estimated within 1250-m buffers surrounding individuals’ residences using the normalized difference vegetation index (NDVI) prior to blood pressure measurement. Percent forest was calculated using the U.S. National Land Cover Database. Linear mixed models with robust standard errors accounted for spatial clustering; models were stratified by community type (townships/boroughs/cities). In townships, the greenest communities, an interquartile range increase in NDVI was associated with reductions in SBP of 0.87 mmHg (95% CI: −1.43, −0.30) and in DBP of 0.41 mmHg (95% CI: −0.78, −0.05). No significant associations were observed in boroughs or cities. Evidence for modification by percent forest was weak. Findings suggest a threshold effect whereby high greenness may be necessary to influence BP in this population and support a slight beneficial impact of greenness on cardiovascular disease risk.
... A growing body of literature has examined associations between residential proximity to the oil and gas industry and adverse birth outcomes (Caron-Beaudoin et al. 2021;Casey et al. 2015Casey et al. , 2019Currie et al. 2017;Cushing et al. 2020;Gonzalez et al. 2020;Hill 2018;McKenzie et al. 2014;Stacy et al. 2015;Tran et al. 2020;Walker et al. 2018;Whitworth et al. 2017). Health risks associated with drilling-related exposures can be difficult to accurately characterize due to local socioeconomic and demographic shifts that occur from the industrial boom that accompanies oil and gas extraction, such as increases in minority racial and ethnic populations and needs for skilled labor at drilling sites (Brown 2015;Fry et al. 2015;Zwickl 2019). ...
... Most of the studies in the epidemiological literature used spatial study designs (as opposed to spatial temporal designs with quasi-experimental components), where the main comparison groups are close to drilling in comparison with far away from drilling. For instance, Casey et al. used an electronic medical records cohort in eastern Pennsylvania and observed no association between a drilling activity index and term birth weight after accounting for birth year (Casey et al. 2015). Their main unconventional natural gas drilling exposure metric is an activity index incorporating proximity, stage of activity (including fracking vs. drilling), and production volume, which makes it difficult to directly compare with our present study. ...
... Fourth, although we adjusted for census tract-level characteristics and county, residual confounding due to spatial variation in risk factors is possible. Finally, given the need for a definitive before-and-after time in the counterfactual group for a DiD analysis (Abadie 2005), it is difficult to apply more complex oil and gas drilling exposure metrics (e.g., inverse distance weighting, activity index) that would be comparable to existing work (Casey et al. 2015;McKenzie et al. 2014) and align better with estimated pollution exposure gradients. ...
Article
Background: Oil and natural gas extraction may produce environmental pollution at levels that affect reproductive health of nearby populations. Available studies have primarily focused on unconventional gas drilling and have not accounted for local population changes that can coincide with drilling activity. Objective: Our study sought to examine associations between residential proximity to oil and gas drilling and adverse term birth outcomes using a difference-in-differences study design. Methods: We created a retrospective population-based term birth cohort in Texas between 1996 and 2009 composed of mother-infant dyads (n=2,598,025) living <10km from an oil or gas site. We implemented a difference-in-differences approach to estimate associations between drilling activities and infant health: term birth weight and term small for gestational age (SGA). Using linear and logistic regression, we modeled interactions between births before (unexposed) or during (exposed) drilling activity and residential proximity near (0-1, 1-2, or 2-3km) or far (3-10km) from an active or future drilling site, adjusting for individual- and neighborhood-level characteristics. Results: The adjusted mean difference in term birth weight for mothers living 0-1 vs. 3-10km from a current or future drilling site was -7.3g [95% confidence interval (CI): -11.6, -3.0] for births during active vs. future drilling. The corresponding adjusted odds ratio for SGA was 1.02 (95% CI: 0.98, 1.06). Negative associations with term birth weight were observed for the 1-2 and 2-3km near groups, and no consistent differences were identified by type of drilling activity. Larger, though imprecise, adverse associations were found for infants born to Hispanic women, women with the lowest educational attainment, and women living in cities. Conclusions: Residing near oil and gas drilling sites during pregnancy was associated with a small reduction in term birth weight but not SGA, with some evidence of environmental injustices. Additional work is needed to investigate specific drilling-related exposures that might explain these associations. https://doi.org/10.1289/EHP7678.
... H ydraulic fracturing, commonly referred to as fracking, is a component of a cost-efficient technology used to drill horizontal wells that extract gas from unconventional (eg, shale) formations. 1,2 Although the relationship between hydraulic fracturing and human development is not well understood, members of the public and environmental groups have expressed concern over potential adverse health outcomes. 3 Presently, the World Health Organization classifies the association between fracking and human health as "mostly unknown." 4 Legislation and regulations attempt to mitigate the health and environmental hazards of hydraulic fracturing; nonetheless, exposure to potential exposures cannot be entirely eliminated through the regulatory regime alone. ...
... 6,7 Few studies have examined the association between residential exposure to hydraulic fracturing and human reproductive outcomes. In a 2019 systematic review, significant associations were identified between unconventional natural gas development and preterm birth, 2,8,9 infant mortality, 10 low birth weight, 8,11,12 and small for gestational age (SGA). 2,8,9 Most of these studies were conducted in the US; hence their findings might not be generalizable to other countries. ...
... In a 2019 systematic review, significant associations were identified between unconventional natural gas development and preterm birth, 2,8,9 infant mortality, 10 low birth weight, 8,11,12 and small for gestational age (SGA). 2,8,9 Most of these studies were conducted in the US; hence their findings might not be generalizable to other countries. ...
Article
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Importance: The association between hydraulic fracturing and human development is not well understood. Several studies have identified significant associations between unconventional natural gas development and adverse birth outcomes; however, geology and legislation vary between regions. Objective: To examine the overall association between residential proximity to hydraulic fracturing sites and adverse birth outcomes, and investigate whether well density influenced this association. Design, setting, and participants: This population-based retrospective cohort study of pregnant individuals in rural Alberta, Canada, took place from 2013 to 2018. Participants included reproductive-aged individuals (18-50 years) who had a pregnancy from January 1, 2013, to December 31, 2018, and lived in rural areas. Individuals were excluded if they lived in an urban setting, were outside of the age range, or were missing data on infant sex, postal code, or area-level socioeconomic status. Exposures: Oil and gas wells that underwent hydraulic fracturing between 2013 to 2018 were identified through the Alberta Energy Regulator (n = 4871). Individuals were considered exposed if their postal delivery point was located within 10 km of 1 or more wells that was hydraulically fractured during 1 year preconception or during pregnancy. Main outcomes and measures: Outcomes investigated were spontaneous and indicated preterm birth, small for gestational age, major congenital anomalies, and severe neonatal morbidity or mortality. Results: After exclusions, the sample included 26 193 individuals with 34 873 unique pregnancies, and a mean (SD) parental age of 28.2 (5.2) years. Small for gestational age and major congenital anomalies were significantly higher for individuals who lived within 10 km of at least 1 hydraulically fractured well after adjusting for parental age at delivery, multiple births, fetal sex, obstetric comorbidities, and area-level socioeconomic status. Risk of spontaneous preterm birth and small for gestational age were significantly increased in those with 100 or more wells within 10 km. Conclusions and relevance: Results suggest that individuals who were exposed to hydraulic fracturing within pregnancy may be at higher risk of several adverse birth outcomes. These results may be relevant to health policy regarding legislation of unconventional oil and gas development in Canada and internationally.
... [16][17][18][19] Studies indicate associations between prenatal exposure to oil and gas development (OGD) activities (HF [most studies] and conventional extraction methods) and reductions in birth weight (tBW), 6,20,21 increased odds or incidence of low birth weight (LBW), 20,22 preterm birth (PTB) 6,23-27 and small for gestational age birth (SGA). 20,21 Statistically insignificant 6,23,26 or inverse associations 21,28 for some birth outcomes have also been observed. Our previous California study found exposure to all OGD (mostly not involving HF) was associated with decreased tBW and increased odds of LBW and SGA in rural areas, and increased odds of SGA in urban areas. ...
... Evidence of a relationship between HF and LBW has been sparse; two studies observed increased risk of LBW associated with HF exposure in Pennsylvania. 20,22 Evidence of associations between HF exposure and tBW has been mixed; among five studies, two found no relationship (Pennsylvania, Texas), 23,26 and three found decreased tBW in Pennsylvania. [20][21][22] Cohort studies in Pennsylvania and Texas suggested that prenatal exposure to HF significantly increased odds of PTB by 14% to 100%. ...
... [20][21][22] Cohort studies in Pennsylvania and Texas suggested that prenatal exposure to HF significantly increased odds of PTB by 14% to 100%. 23,25,26 We observed a PTB estimate similar in magnitude and direction to those findings among the rural population, while the association was inverse in urban areas. Among the three studies that evaluated SGA, two studies (Pennsylvania, Texas) found no association 23,26 while the other Pennsylvania study observed a similar magnitude of increased odds of SGA as in our study. ...
Article
Full-text available
Background: Prenatal exposure to hydraulic fracturing (HF), a chemically intensive oil and gas extraction method, may be associated with adverse birth outcomes, but no health studies have been conducted in California. Methods: We conducted a retrospective cohort study of 979,961 births to mothers in eight California counties with HF between 2006 and 2015. Exposed individuals had at least 1 well hydraulically fractured within 1 km of their residence during pregnancy; the reference population had no wells within 1 km, but at least one oil/gas well within 10 km. We examined associations between HF and low birth weight (LBW), preterm birth (PTB), small for gestational age birth (SGA), and term birth weight (tBW) using generalized estimating equations and assessing urban-rural effect modification in stratified models. Results: Fewer than 1% of mothers (N = 1,192) were exposed to HF during pregnancy. Among rural mothers, HF exposure was associated with increased odds of LBW (odds ratio [OR] = 1.74; 95% confidence interval [CI] = 1.10, 2.75), SGA (OR = 1.68; 95% CI = 1.42, 2.27) and PTB (OR = 1.17; 95% CI = 0.64, 2.12), and lower tBW (mean difference: -73 g; 95% CI = -131, -15). Among urban mothers, HF exposure was positively associated with SGA (OR = 1.23; 95% CI = 0.98, 1.55), inversely associated with LBW (OR = 0.83; 95% CI = 0.63, 1.07) and PTB (OR = 0.65; 95% CI = 0.48, 0.87), and not associated with tBW (mean difference: -2 g; 95% CI = -35, 31). Conclusion: HF proximity was associated with adverse birth outcomes, particularly among rural Californians.
... We obtained electronic health record data from the 1.6 million patients who had a medical encounter at Geisinger from January 2001 through December 2016. Geisinger's primary care population is representative of the region's general population in terms of age and sex and has high residential stability (Casey et al., 2016). We conducted a nested case-control study to evaluate associations of residential proximity to blue space and new onset T2D, linking individual health data via geocoded residential addresses, obtained through the electronic health record, to geospatial hydrography data. ...
... As is common in studies of nature and health (Hartig, Mitchell, de Vries, & Frumkin, 2014), the primary limitation is that our measure of blue space captured proximity to blue space but did not account for other exposure types (indirect, incidental, or intentional ), or quality of blue space, which likely influence the degree to which blue spaces are utilized for health-promoting experiences such as physical activity and stress reduction. We did not have residential history information and so could not account for exposure duration, although the study region experiences low rates of out-migration (Casey et al., 2016). Due to the ubiquity of waterbodies in the region, the majority of the study population lived close to a waterbody and so categories of residential distance to blue space did not differ widely. ...
Article
Salutogenic effects of living near aquatic areas (blue space) remain underexplored, particularly in non-coastal and non-urban areas. We evaluated associations of residential proximity to inland freshwater blue space with new onset type 2 diabetes (T2D) in central and northeast Pennsylvania, USA, using medical records to conduct a nested case-control study. T2D cases (n = 15,888) were identified from diabetes diagnoses, medication orders, and laboratory test results and frequency-matched on age, sex, and encounter year to diabetes-free controls (n = 79,435). We calculated distance from individual residences to the nearest lake, river, tributary, or large stream, and residence within the 100-year floodplain. Logistic regression models adjusted for community socioeconomic deprivation and other confounding variables and stratified by community type (townships [rural/suburban], boroughs [small towns], city census tracts). Compared to individuals living ≥ 1.25 miles from blue space, those within 0.25 miles had 8% and 17% higher odds of T2D onset in townships and boroughs, respectively. Among city residents, T2D odds were 38–39% higher for those living 0.25 to < 0.75 miles from blue space. Residing within the floodplain was associated with 16% and 14% higher T2D odds in townships and boroughs. A post-hoc analysis demonstrated patterns of lower residential property values with nearer distance to the region’s predominant waterbody, suggesting unmeasured confounding by socioeconomic disadvantage. This may explain our unexpected findings of higher T2D odds with closer proximity to blue space. Our findings highlight the importance of historic and economic context and interrelated factors such as flood risk and lack of waterfront development in blue space research.
... 13,22,50,79−81 Given the complexity of UOG exposure, specific models may be needed to explicate distinct exposure pathways. For example, Casey et al. (2016) introduced an activity-based inverse distance-squared weighted metric where the numerator varies by the UOG phase. 93 Allshouse et al. (2017) introduced an activity-based metric to assess exposure to UOG-related air pollution. ...
... For example, Casey et al. (2016) introduced an activity-based inverse distance-squared weighted metric where the numerator varies by the UOG phase. 93 Allshouse et al. (2017) introduced an activity-based metric to assess exposure to UOG-related air pollution. 94 Furthermore, recent studies have applied exposure models specific to flaring (the intentional burning of natural gas), 95 earthquakes, 96 and radioactivity. ...
Article
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Health studies report associations between metrics of residential proximity to unconventional oil and gas (UOG) development and adverse health endpoints. We investigated whether exposure through household groundwater is captured by existing metrics and a newly developed metric incorporating groundwater flow paths. We compared metrics with detection frequencies/concentrations of 64 organic and inorganic UOG-related chemicals/groups in residential groundwater from 255 homes (Pennsylvania n = 94 and Ohio n = 161). Twenty-seven chemicals were detected in ≥20% of water samples at concentrations generally below U.S. Environmental Protection Agency standards. In Pennsylvania, two organic chemicals/groups had reduced odds of detection with increasing distance to the nearest well: 1,2-dichloroethene and benzene (Odds Ratio [OR]: 0.46, 95% confidence interval [CI]: 0.23-0.93) and m- and p-xylene (OR: 0.28, 95% CI: 0.10-0.80); results were consistent across metrics. In Ohio, the odds of detecting toluene increased with increasing distance to the nearest well (OR: 1.48, 95% CI: 1.12-1.95), also consistent across metrics. Correlations between inorganic chemicals and metrics were limited (all |ρ| ≤ 0.28). Limited associations between metrics and chemicals may indicate that UOG-related water contamination occurs rarely/episodically, more complex metrics may be needed to capture drinking water exposure, and/or spatial metrics in health studies may better reflect exposure to other stressors.
... The region is part of the core service area served by the Geisinger health system. Geisinger's primary care patients have been shown to represent the demographics of the region as a whole and to have residential stability (Casey et al., 2016). ...
... This study also had several limitations. First, although the Geisinger patient population historically represented the demographic characteristics of the region (Casey et al., 2016), we did not re-evaluate the representativeness of the study's sample population. Our study population was less racially diverse than the overall diversity of the study counties, but not necessarily the study boroughs, which tend to be less diverse (World Population Review). ...
Article
Blue space exposure may benefit health and well-being, but salutogenic effects remain underexplored in non-coastal and non-urban areas, as do correlates of visit frequency to freshwater blue space (FBS). We mailed a questionnaire to adults in 40 small towns in central and northeast Pennsylvania, USA, with varying proximity to the region’s primary waterbody to assess FBS visits, benefits and barriers of visiting, restoration experienced, and mental health and well-being (perceived stress, general mental health, life satisfaction). We used multivariate multinomial regression to examine predictors of FBS visit frequency and linear and logistic regression to evaluate associations of FBS visit frequency with health outcomes, using mixed effects models that accounted for spatial clustering. Of 10,871 mailed questionnaires, 1,122 individuals (11%) responded and provided information to characterize FBS visits. Responders were older than non-responders but did not differ by sex or community setting. Nearly one-fifth (19%) never visited FBS, and 27%, 35%, and 19% reported low, moderate, and high visit frequency, respectively. Correlates of visit frequency included perceived proximity, higher education, younger age, better self-reported health, and more frequent physical activity. Relaxation/stress-relief was identified as the most important benefit to visiting FBS, and among the 868 individuals who visited FBS, restoration was associated with visit frequency. FBS visit frequency was associated with perceived stress, but not mental health or life satisfaction. Findings highlight the socioeconomic patterning of FBS visits, the importance of access in facilitating visits, and reveal opportunities to develop FBS access points that increase its use, bringing potential restorative benefits.
... [56][57][58] Emerging data suggest that exposures to fracking may increase risk of certain adverse birth outcomes, including congenital anomalies, preterm birth, and being small for gestational age. [59][60][61] Additional evidence needs to be amassed to understand the role of air pollution in infant mortality, stillbirth, sudden infant death syndrome, and congenital anomalies. ...
Article
Ambient air pollution is produced by sources including vehicular traffic, coal-fired power plants, hydraulic fracturing, agricultural production, and forest fires. It consists of primary pollutants generated by combustion and secondary pollutants formed in the atmosphere from precursor gases. Air pollution causes and exacerbates climate change, and climate change worsens health effects of air pollution. Infants and children are uniquely sensitive to air pollution, because their organs are developing and they have higher air per body weight intake. Health effects linked to air pollution include not only exacerbations of respiratory diseases but also reduced lung function development and increased asthma incidence. Additional outcomes of concern include preterm birth, low birth weight, neurodevelopmental disorders, IQ loss, pediatric cancers, and increased risks for adult chronic diseases. These effects are mediated by oxidative stress, chronic inflammation, endocrine disruption, and genetic and epigenetic mechanisms across the life span. Natural experiments demonstrate that with initiatives such as increased use of public transportation, both air quality and community health improve. Similarly, the Clean Air Act has improved air quality, although exposure inequities persist. Other effective strategies for reducing air pollution include ending reliance on coal, oil, and gas; regulating industrial emissions; reducing exposure with attention to proximity of residences, schools, and child care facilities to traffic; and a greater awareness of the Air Quality Index. This policy reviews both short- and long-term health consequences of ambient air pollution, especially in relation to developmental exposures. It examines individual, community, and legislative strategies to mitigate air pollution.
... There is great concern that exposure to UNG operations (e.g., noise, light) and associated contamination (e.g., VOCs) may lead to adverse health effects, especially in vulnerable populations. Recent epidemiologic studies in the United States reported that living in close proximity of UNG wells was associated with negative birth outcomes such as higher prevalence of birth defects, low birth weights and fetal death (Casey et al., 2016;Currie et al., 2017;Hill, 2012;McKenzie et al., 2014;Whitworth et al., 2018Whitworth et al., , 2017. In Northeastern British Columbia, we previously reported that the density and proximity of UNG wells was associated with increased odds of preterm birth and decreased birthweight, although association estimates were inconsistent across the different search radiuses used to estimate the exposure of pregnant women to UNG activity (Caron-Beaudoin et al., 2020). ...
Article
Background Northeastern British Columbia (Canada) is an area of unconventional natural gas (UNG) exploitation by hydraulic fracturing, which can release several contaminants, including volatile organic compounds (VOCs). To evaluate gestational exposure to contaminants in this region, we undertook the Exposures in the Peace River Valley (EXPERIVA) study. Objectives We aimed to: 1) measure VOCs in residential indoor air and tap water from EXPERIVA participants; 2) compare concentrations with those in the general population and explore differences related to sociodemographic and housing characteristics; and 3) determine associations between VOC concentrations and density/proximity to UNG wells. Methods Eighty-five pregnant women participated. Passive air samplers were analyzed for 47 VOCs, and tap water samples were analyzed for 44 VOCs. VOC concentrations were compared with those from the Canadian Health Measure Survey (CHMS). We assessed the association between different metrics of well density/proximity and indoor air and tap water VOC concentrations using multiple linear regression. Results 40 VOCs were detected in >50% of air samples, whereas only 4 VOCs were detected in >50% of water samples. We observed indoor air concentrations >95th percentile of CHMS in 10–60% of samples for several compounds (acetone, 2-methyl-2-propanol, chloroform, 1,4-dioxane, hexanal, m/p-xylene, o-xylene, styrene, decamethylcyclopentasiloxane, dodecane and decanal). Indoor air levels of chloroform and tap water levels of total trihalomethanes were higher in Indigenous participants compared to non-Indigenous participants. Indoor air levels of chloroform and acetone, and tap water levels of total trihalomethanes were positively associated with UNG wells density and proximity metrics. Indoor air BTEX (benzene, toluene, ethylbenzene, xylenes) levels were positively correlated with well density/proximity metrics. Conclusion Our results suggest higher exposure to certain VOCs in pregnant women living in an area of intense unconventional natural gas exploitation compared with the general Canadian population, and that well density/proximity is associated with increased exposure to certain VOCs.
... Fossil fuel air pollution is particularly prevalent in these communities with unequal burden for those living closest [176]. The pollution from natural gas flaring has been linked with up to a 50% increase in preterm birth in mothers living near oil and gas wells, most of them being Latina [177][178][179]. Even the location of natural gas pipelines is positively associated with social vulnerability, highlighting the link between health hazards and energy infrastructure [180]. ...
Article
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The intersecting negative effects of structural racism, COVID-19, climate change, and chronic diseases disproportionately affect racial and ethnic minorities in the US and around the world. Urban populations of color are concentrated in historically redlined, segregated, disinvested, and marginalized neighborhoods with inadequate quality housing and limited access to resources, including quality greenspaces designed to support natural ecosystems and healthy outdoor activities while mitigating urban environmental challenges such as air pollution, heat island effects, combined sewer overflows and poor water quality. Disinvested urban environments thus contribute to health inequity via physical and social environmental exposures, resulting in disparities across numerous health outcomes, including COVID-19 and chronic diseases such as cancer and cardiovascular diseases (CVD). In this paper, we build off an existing conceptual framework and propose another conceptual framework for the role of greenspace in contributing to resilience and health equity in the US and beyond. We argue that strategic investments in public greenspaces in urban neighborhoods impacted by long term economic disinvestment are critically needed to adapt and build resilience in communities of color, with urgency due to immediate health threats of climate change, COVID-19, and endemic disparities in chronic diseases. We suggest that equity-focused investments in public urban greenspaces are needed to reduce social inequalities, expand economic opportunities with diversity in workforce initiatives, build resilient urban ecosystems, and improve health equity. We recommend key strategies and considerations to guide this investment, drawing upon a robust compilation of scientific literature along with decades of community-based work, using strategic partnerships from multiple efforts in Milwaukee Wisconsin as examples of success.
... There is growing evidence, from laboratory and epidemiological studies, suggesting potential adverse health effects for humans and animals exposed to UOG operations (Elliott et al., 2016;Werner et al., 2015). Epidemiological studies have documented associations between UOG operations and human health nearby, including but not limited to increased prevalence of congenital heart defects (McKenzie et al., 2014), lower birth weight and small-for-gestational-age births (Stacy et al., 2015), preterm births and high-risk pregnancies (Casey et al., 2016), higher rates of certain cancers (Finkel, 2016;McKenzie et al., 2017;Mokry, 2010;Rawlins, 2014;Texas Dept State Health Services, 2014), and other adverse outcomes (Jemielita et al., 2015a;Jemielita et al., 2015b;Rabinowitz et al., 2015), though further research is needed to evaluate these associations. Laboratory studies have reported causative impacts of actual or laboratory-created UOG chemicals, mixtures, or fluids on diverse organisms. ...
Article
The rise of hydraulic fracturing and unconventional oil and gas (UOG) exploration in the United States has increased public concerns for water contamination induced from hydraulic fracturing fluids and associated wastewater spills. Herein, we collected surface and groundwater samples across Garfield County, Colorado, a drilling-dense region, and measured endocrine bioactivities, geochemical tracers of UOG wastewater, UOG-related organic contaminants in surface water, and evaluated UOG drilling production (weighted well scores, nearby well count, reported spills) surrounding sites. Elevated antagonist activities for the estrogen, androgen, progesterone, and glucocorticoid receptors were detected in surface water and associated with nearby shale gas well counts and density. The elevated endocrine activities were observed in surface water associated with medium and high UOG production (weighted UOG well score-based groups). These bioactivities were generally not associated with reported spills nearby, and often did not exhibit geochemical profiles associated with UOG wastewater from this region. Our results suggest the potential for releases of low-saline hydraulic fracturing fluids or chemicals used in other aspects of UOG production, similar to the chemistry of the local water, and dissimilar from defined spills of post-injection wastewater. Notably, water collected from certain medium and high UOG production sites exhibited bioactivities well above the levels known to impact the health of aquatic organisms, suggesting that further research to assess potential endocrine activities of UOG operations is warranted.
... Geisinger provides primary care services at community practice clinics and hospitals in central and northeastern Pennsylvania, in communities ranging along the spectrum from rural to urban. Prior work has found the Geisinger] population to be representative of the general population in the region based on age, sex, and race/ethnicity (Casey et al., 2016a). The study was nested within the open, dynamic cohort that Geisinger patients represent. ...
Article
We evaluated associations of community types and features with new-onset internalizing disorders among Pennsylvania adolescents to identify the location and scale of risk. Using a nested case-control study, we drew subjects from electronic health records 2008–2016, requiring cases (n = 7974) to have two medication orders or diagnoses indicating an internalizing disorder; controls (n = 31,895) were frequency-matched. Subjects were assigned to three community classifications: townships, boroughs, city census tracts; urbanized areas, urban clusters, rural areas; and a combination. Using logistic regression with generalized estimating equations, we found that compared to rural-townships, the highest odds were in urban cluster-city census tracts (odds ratio, 95% confidence interval: 1.78, 1.41–2.26); lowest in urbanized area-city census tracts (0.85, 0.74–0.97). Higher community socioeconomic deprivation was associated with increased odds in urban clusters (1.21, 1.00–1.48) and higher greenness with decreased odds in urban clusters (0.73, 0.62–0.86).
... Multiple studies have found leaks of methane, a potent greenhouse gas, to be common near hydrofracturing facilities (Lyon et al. 2016;Omara et al. 2016). Hydrocarbon gases with known capability to affect human health are associated with those methane leaks (Macey et al. 2014;Paulik et al. 2018) and appear to be causing negative human health effects to parties residing close to hydrofracturing sites (Jemielita et al. 2015;Stacy et al. 2015;Casey et al. 2016;Currie et al. 2017). Water-quality degradation has also been found in the vicinity of hydrofracturing (Vidic et al. 2013); while the methane leaks have significant climate implications (Alverez et al. 2018;Howarth 2019). ...
Chapter
Rivers and streams of Appalachia harbor some of the most biologically diverse, endemically rich, freshwater faunas in the world. Many aquatic species, however, are threatened by a wide array of anthropogenic stressors, including past and present mining. This chapter reviews impacts of mining on aquatic life in Appalachia, including interactive effects on food web dynamics, effects on ecosystem functional processes, and effects that are manifested in aquatic communities at watershed scales. Responses to mining depend on whether mine effluent is acidic in nature or highly alkaline; this dichotomy structures much of the discussion. Mining directly impacts aquatic biota because effluents can be toxic due to elevated major ions, trace metals, notably selenium, and/or acidity. Drainage from mined areas also affects complicated changes to biota indirectly by altering food webs, biotic interactions, and movement processes in stream networks. Finally, we review the response and recovery of aquatic biota to remediation efforts that treat mine effluent, and we discuss the use of aquatic organisms in assessing and managing impacts of mining activities. Throughout, we present uncertainties and gaps in our knowledge about impacts of mining activity on aquatic life in Appalachia, which represent important directions for future research.
... The PM from indoor and outdoor air has a wide range of EDC actions, including estrogenicity, anti-androgenicity, and thyroidicity (Darbre, 2018). Based on environmental assessments, occupational exposure records, and responses to questionnaire surveys, the linkage of gestational exposure to PM and air pollution to adverse gestational outcomes, have been reported (Bai et al., 2020;Casey et al., 2016;Currie, Ray, & Neidell, 2011;Grippo et al., 2018;Hyder et al., 2014;Lee, Roberts, Catov, Talbott, & Ritz, 2013;Mukherjee & Agrawal, 2018;McKenzie et al., 2014;Stacy et al., 2015;van den Hooven et al., 2012). For instance, higher incidences of PTB, IUGR, LBW, and shorter birth lengths have been reported for the offspring from pregnant women exposed to the 9/11 dust cloud from the collapse of the World Trade Center towers (Currie & Schwandt, 2016;Landrigan et al., 2008). ...
Chapter
With the advent of industrialization, humans are exposed to a wide range of environmental chemicals, many with endocrine disrupting potential. As successful maintenance of pregnancy and fetal development are under tight hormonal control, the gestational exposure to environmental endocrine disrupting chemicals (EDC) have the potential to adversely affect the maternal milieu and support to the fetus, fetal developmental trajectory and birth outcomes. This chapter summarizes the impact of exposure to EDCs both individually and as mixtures during pregnancy, the immediate and long-term consequences of such exposures on the mother and fetus, the direct and indirect mechanisms through which they elicit their effects, factors that modify their action, and the research directions to focus future investigations.
... 18 Two of these studies report positive trends between gas production volume and frequency of adverse birth outcomes. 17,18 Emerging evidence suggests that exposure to gas extraction may increase risk for congenital heart defects and paediatric leukaemia. 19,20 The sophisticated study by Mary Willis and her colleagues 21 in this issue of the International Journal of Epidemiology adds to the growing literature on the hazards to children's health of fracking. ...
... To the best of our knowledge, this comprehensive casecontrol analysis is the first epidemiological investigation regarding the impacts of UNGD on heart failure outcomes. The exposure metric, which captures not only distance to wells but also the number of wells, their depth, and stages of production, has been used in previous papers, most notably by Casey et al. (10). ...
... The application of horizontal drilling and hydraulic fracturing techniques has made it possible for the cost-efficient extraction of shale gas. However, shale gas production process has also caused many environmental issues (Zhang and Yang 2015), such as the large consumption of freshwater resources (Vandecasteele et al. 2015;Chen and Carter 2016), the adverse impacts of regional water, air, and soil quality (Vidic et al. 2013;Chen et al. 2017;Gordalla et al. 2013;Rish and Pfau 2017;Entrekin et al. 2011;Purvis et al. 2019;Vinciguerra et al. 2015), the increase of road traffic, waste management, and noise impacts (Graham et al. 2015;Sun et al. 2019), and the adverse health impacts (Durant et al. 2016;Blewett et al. 2017;Casey et al. 2015;Stacy 2017). Among these issues, water-related environmental issues in the shale gas production have aroused great concerns. ...
Article
Full-text available
Cost-efficient and environmentally friendly treatment of hydraulic fracturing effluents is of great significance for the sustainable development of shale gas exploration. We investigated the synergistic effects of plant-microbial treatment of shale gas fracturing waste fluid. The results showed that illumination wavelength and temperature are direct drivers for microbial treatment effects of CODCr and BOD5, while exhibit little effects on nitrogen compounds, TDS, EC, and SS removals as well as microbial species and composition. Plant-microbial synergism could significantly enhance the removal of pollutants compared with removal efficiency without plant enhancement. Additionally, the relative abundance and structure of microorganisms in the hydraulic fracturing effluents greatly varied with the illumination wavelength and temperature under plant-microbial synergism. 201.24 g water dropwort and 435 mg/L activated sludge with illumination of 450–495 nm (blue) at 25 °C was proved as the best treatment condition for shale gas fracturing waste fluid samples, which showed the highest removal efficiency of pollutants and the lowest algal toxicity in treated hydraulic fracturing effluents. The microbial community composition (36.73% Flavobacteriia, 25.01% Gammaproteobacteria, 18.55% Bacteroidia, 9.3% Alphaproteobacteria, 4.1% Cytophagia, and 2.83% Clostridia) was also significantly different from other treatments. The results provide a potential technical solution for improved treatment of shale gas hydraulic fracturing effluents. Graphical abstract
... Geisinger serves patients across 45 Pennsylvania counties. The primary care population represents the age and sex distribution of the region's population (14). We mailed questionnaires to 5,314 adult patients who met previously described EHR-based criteria for Lyme disease between 2015 and 2017 (15). ...
Article
Full-text available
Background: Longer time between symptom onset and treatment of Lyme disease has been associated with poor outcomes. Reducing time-to-treatment requires knowledge of risks for treatment delays. We conducted a population-based study to evaluate factors associated with delayed treatment of Lyme disease and the relation between delayed treatment and post-treatment Lyme disease syndrome (PTLDS). Methods: We mailed questionnaires to 5,314 individuals with a Lyme disease diagnosis or blood test followed by an antibiotic order in the medical record of a Pennsylvania health system from 2015 to 2017. Analyses were confined to 778 respondents who reported that they were treated for Lyme disease within the past 5 years and reported a rash and/or a positive blood test for Lyme disease. Time-to-treatment was calculated as the sum of two windows before and after seeking care for Lyme disease symptoms: time to first medical contact and time under care. We used logistic regression to evaluate factors associated with delayed time-to-treatment in each time window (>14 days vs. ≤14 days) and the association between total time-to-treatment (>30 days vs. ≤30 days) and PTLDS. We used inverse probability weighting to calculate estimates for the study's source population (5,314 individuals sent questionnaires). Results: In the source population, 25% had time to first contact >14 days, 21% had time under care >14 days, and 31% had a total time-to-treatment >30 days. Being uninsured and attributing initial symptoms to something other than Lyme disease were positively associated with delayed time to first medical contact, while seeking care at an urgent care or emergency setting (vs. primary care) was negatively associated. Diagnoses between November and April, and the absence of rash were positively associated with delays. Individuals whose treatment was delayed, defined as time-to treatment >30 days had 2.26 (95% confidence interval: 1.25, 4.05) times the odds of PTLDS as those who were treated within 30 days of symptom onset. Conclusions: In a population-based study in Pennsylvania, one-third of Lyme disease patients reported delayed treatment, which was associated with PTLDS. To improve Lyme disease outcomes, prevention efforts should aim to reduce the time before and after seeking care.
... Individuals represent the general population in the region with high residential stability. 25 The study area included 37 counties in Pennsylvania (figure 1). These data were used in a nested case-control study. ...
Article
Full-text available
Objectives To evaluate associations of community types and features with new onset type 2 diabetes in diverse communities. Understanding the location and scale of geographic disparities can lead to community-level interventions. Design Nested case–control study within the open dynamic cohort of health system patients. Setting Large, integrated health system in 37 counties in central and northeastern Pennsylvania, USA. Participants and analysis We used electronic health records to identify persons with new-onset type 2 diabetes from 2008 to 2016 (n=15 888). Persons with diabetes were age, sex and year matched (1:5) to persons without diabetes (n=79 435). We used generalised estimating equations to control for individual-level confounding variables, accounting for clustering of persons within communities. Communities were defined as (1) townships, boroughs and city census tracts; (2) urbanised area (large metro), urban cluster (small cities and towns) and rural; (3) combination of the first two; and (4) county. Community socioeconomic deprivation and greenness were evaluated alone and in models stratified by community types. Results Borough and city census tract residence (vs townships) were associated (OR (95% CI)) with higher odds of type 2 diabetes (1.10 (1.04 to 1.16) and 1.34 (1.25 to 1.44), respectively). Urbanised areas (vs rural) also had increased odds of type 2 diabetes (1.14 (1.08 to 1.21)). In the combined definition, the strongest associations (vs townships in rural areas) were city census tracts in urban clusters (1.41 (1.22 to 1.62)) and city census tracts in urbanised areas (1.33 (1.22 to 1.45)). Higher community socioeconomic deprivation and lower greenness were each associated with increased odds. Conclusions Urban residence was associated with higher odds of type 2 diabetes than for other areas. Higher community socioeconomic deprivation in city census tracts and lower greenness in all community types were also associated with type 2 diabetes.
... Analysis of associations of EDC mixture with inflammatory cytokines also showed both positive and negative relationships that varied depending on the EDC mixture and cytokine (334). Emerging studies in humans exposed to complex chemical mixtures used in fracking industries or air pollution through geographical proximity or occupation, have also manifested poor gestational and birth outcomes (335)(336)(337)(338)(339)(340). Animal studies substantiate causal relationships by demonstrating the association of exposure to fracking chemical mixture (341) or biosolids (185) with adverse developmental health and reproductive outcomes. ...
Article
The burden of adverse pregnancy outcomes such as preterm birth and low birth weight is considerable across the world. Several risk factors for adverse pregnancy outcomes have been identified. One risk factor for adverse pregnancy outcomes that is receiving considerable attention in recent years is gestational exposure to endocrine disrupting chemicals (EDCs). Humans are exposed to multitude of environmental chemicals with known endocrine disrupting properties and evidence suggest that exposure to these EDCs have the potential to disrupt maternal-fetal environment culminating in adverse pregnancy and birth outcomes. This review addresses the impact of maternal and fetal exposure to environmental EDCs of natural and man-made chemicals in disrupting the maternal-fetal milieu in human leading to adverse pregnancy and birth outcomes - a risk factor for adult onset non-communicable diseases, the role lifestyle and environmental factors play in mitigating or amplifying the effects of EDCs, the underlying mechanisms and mediaries involved, and the research directions to focus future investigations on to help alleviate the adverse effects from EDC exposures.
... Hill (2018) finds that an additional well is associated with a 7% increase in low birth weight, a 5-gram reduction in term birth weight and a 3% increase in premature birth and, consequently, conclude that shale gas development poses significant risks to human health. Casey et al. (2016) examine the impact of UNGD activities on birth outcomes using electronic health data on 10,946 birth records in Pennsylvania from January 2009 to January 2013. The results document a statistically significant relationship between maternal proximity to active fracking operations and premature births and high-risk pregnancies. ...
Article
The expansion of unconventional oil and gas development (UNGD) in the US has been highly controversial so far with no consensus on its health, economic, environmental, and social implications. This paper examines the effects of UNGD on the health profile of the population in the context of Oklahoma using a unique data set. To this end, the analysis assembles a panel data set including 76 counties of Oklahoma, spanning the period 1998–2017. The analysis estimates the long-run relationship between the health profile and its determinants using the Common Correlated Effects (CCE) method. The empirical setup allows for cross-sectional dependence and accounts for both observed and unobserved heterogeneity. The main findings provide strong evidence that UNGD activities have negative effects on human health-related outcomes across all counties in Oklahoma. Specifically, an increase in the number of (unconventional) wells has a positive impact on mortality rates, and incidences of cancer, cardiac, and respiratory diseases in communities in close spatial proximity, and a negative impact on life expectancy. These findings provide evidence that UNGD activities pose significant risks to the public health profile across the Oklahoma population. Such findings are expected to have substantial implications for the national debate on the regulation of UNGD.
... As of 2017, over 120,000 onshore UOGD wells had been drilled via a practice involving directional drilling combined with multistage high-volume hydraulic fracturing (fracking) 1 . Meanwhile, numerous controversies have arisen, partially due to the potential harmful impacts on the local environment [2][3][4][5][6][7] , and on the health of nearby residents [8][9][10][11] . ...
Article
Full-text available
Unconventional oil and natural gas development (UOGD) expanded extensively in the United States from the early 2000s. However, the influence of UOGD on the radioactivity of ambient particulate is not well understood. We collected the ambient particle radioactivity (PR) measurements of RadNet, a nationwide environmental radiation monitoring network. We obtained the information of over 1.5 million wells from the Enverus database. We investigated the association between the upwind UOGD well count and the downwind gross-beta radiation with adjustment for environmental factors governing the natural emission and transport of radioactivity. Our statistical analysis found that an additional 100 upwind UOGD wells within 20 km is associated with an increase of 0.024 mBq/m³ (95% confidence interval [CI], 0.020, 0.028 mBq/m³) in the gross-beta particle radiation downwind. Based on the published health analysis of PR, the widespread UOGD could induce adverse health effects to residents living close to UOGD by elevating PR.
... 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]. ...
Article
Full-text available
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.
... Although EDG name diagnoses may have limited generalizability to non-Epic EHR, Epic is one of the largest providers of EHR to hospitals in the US. Geisinger's primary care population is representative of the region's general population in terms of age and sex [44]; however, findings from a largely rural and suburban, majority non-Hispanic white population may not be transportable to other populations. ...
Article
Full-text available
Background Little is known about risk factors for early (e.g., erythema migrans) and disseminated Lyme disease manifestations, such as arthritis, neurological complications, and carditis. No study has used both diagnoses and free text to classify Lyme disease by disease stage and manifestation. Methods We identified Lyme disease cases in 2012–2016 in the electronic health record (EHR) of a large, integrated health system in Pennsylvania. We developed a rule-based text-matching algorithm using regular expressions to extract clinical data from free text. Lyme disease cases were then classified by stage and manifestation using data from both diagnoses and free text. Among cases classified by stage, we evaluated individual, community, and health care variables as predictors of disseminated stage (vs. early) disease using Poisson regression models with robust errors. Final models adjusted for sociodemographic factors, receipt of Medical Assistance (i.e., Medicaid, a proxy for low socioeconomic status), primary care contact, setting of diagnosis, season of diagnosis, and urban/rural status. Results Among 7310 cases of Lyme disease, we classified 62% by stage. Overall, 23% were classified using both diagnoses and text, 26% were classified using diagnoses only, and 13% were classified using text only. Among the staged diagnoses (n = 4530), 30% were disseminated stage (762 arthritis, 426 neurological manifestations, 76 carditis, 95 secondary erythema migrans, and 76 other manifestations). In adjusted models, we found that persons on Medical Assistance at least 50% of time under observation, compared to never users, had a higher risk (risk ratio [95% confidence interval]) of disseminated Lyme disease (1.20 [1.05, 1.37]). Primary care contact (0.59 [0.54, 0.64]) and diagnosis in the urgent care (0.22 [0.17, 0.29]), compared to the outpatient setting, were associated with lower risk of disseminated Lyme disease. Conclusions The associations between insurance payor, primary care status, and diagnostic setting with disseminated Lyme disease suggest that lower socioeconomic status and less health care access could be linked with disseminated stage Lyme disease. Intervening on these factors could reduce the individual and health care burden of disseminated Lyme disease. Our findings demonstrate the value of both diagnostic and narrative text data to identify Lyme disease manifestations in the EHR.
... Higher levels of UOGD-associated non-chemical exposures, such as noise 14 and night light 15 , have also been reported in nearby neighbourhoods. Previous health-effects studies have found significant associations between proximity-based exposure to UOGD and adverse prenatal [16][17][18][19] , respiratory 20 , cardiovascular 21 and carcinogenic outcomes 22 . ...
Article
Full-text available
Little is known about whether exposure to unconventional oil and gas development is associated with higher mortality risks in the elderly and whether related air pollutants are exposure pathways. We studied a cohort of 15,198,496 Medicare beneficiaries (136,215,059 person-years) in all major US unconventional exploration regions from 2001 to 2015. We gathered data from records of more than 2.5 million oil and gas wells. For each beneficiary’s ZIP code of residence and year in the cohort, we calculated a proximity-based and a downwind-based pollutant exposure. We analysed the data using two methods: a Cox proportional hazards model and a difference-in-differences design. We found evidence of a statistically significant higher mortality risk associated with living in proximity to and downwind of unconventional oil and gas wells. Our results suggest that primary air pollutants sourced from unconventional oil and gas exploration can be a major exposure pathway with adverse health effects in the elderly.
... Living near UNG operations has been adversely associated with health (Deziel et al., 2020), including birth outcomes (e.g., preterm birth, gestational weight, and congenital abnormalities) (Caron-Beaudoin et al., 2021a;Casey et al., 2016;Currie et al., 2017;Gonzalez et al., 2020;Hill, 2018;Janitz et al., 2019;Tran et al., 2021;Walker Whitworth et al., 2018;Whitworth et al., 2017;Willis et al., 2021), self-reported health symptoms (e.g., upper respiratory and dermal symptoms) (Rabinowitz et al., 2015;Tustin et al., 2017), asthma exacerbations Willis et al., 2020), cardiovascular health (Denham et al., 2021), hypertensive conditions during pregnancy and mortality (Li et al., 2022). More recently, studies have explored the impact of nearby UNG sites on mental illness (Casey et al., 2018(Casey et al., , 2019 given the well-documented heightened psychosocial stress experienced by community members (McDermott-Levy and Garcia, 2016;Perry, 2013;Sangaramoorthy et al., 2016;Soyer et al., 2020), and environmental contamination as a result of UNG processes and waste (Gonzalez et al., 2022;Li et al., 2020;Wollin et al., 2020). ...
Article
Full-text available
Background Hydraulic fracturing (fracking) is a method used to extract unconventional natural gas (UNG). Living near UNG operations has been associated with various health outcomes, but few have explored the association between UNG and mental health and substance use. Our objective was to evaluate the association between metrics of residential UNG well density/proximity and mental illness and substance use among pregnant individuals in Northeastern British Columbia, Canada. Methods Individuals who gave birth at the Fort St John hospital between December 30, 2006 and December 29, 2016 (n = 6278) were included in the study. Exposure was determined using inverse distance weighting (IDW) to calculate the density and proximity of UNG wells to the postal code centroid ofindividual's residential address at delivery. Four exposure metrics, categorized by quartiles, were calculated based on 50, 10, 5 and 2.5 km buffer zones around each postal code centroid. Logistic regression was used to separately evaluate associations between IDW quartiles of each metric and diagnosis of depression and anxiety prior to or during pregnancy, and self-reported substance use during pregnancy, controlling for relevant and available confounders. Results The second and third quartile (Q) of the 10 km IDW were associated with greater odds of depression (Q2: adjusted (aOR) 1.30, 95% (confidence interval) CI 1.03–1.64; Q3: aOR 1.35, 95% CI 1.07–1.70) compared to the first quartile, but not the fourth. Using the 5 km IDW, we observed a suggestive positive association with depression in the second and third quartile (aOR Q2: 1.21, 95% CI 0.96–1.53; aOR Q3: 1.24, 95% CI 0.98–1.57) compared to the first quartile. No statistically significant association was observed using the 2.5 km IDW exposure metric. Conclusion We observed some evidence of greater odds of mental illness prior to or during pregnancy, and substance use during pregnancy in pregnant individuals living in postal codes with increased UNG well density/proximity, although associations were not observed in smaller buffer zones. This study adds to the growing literature on the adverse health outcomes surrounding living in proximity to UNG operations.
... 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]. ...
Preprint
Full-text available
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 under-researched topic. We design a methodology to study spatio-temporal 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 spatio-temporal correlations of stroke mortality, fracking ALE, and nine other socioeconomic and health-related factors. The analysis shows that ALE from fracking 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, it was found that the level of benzene in the air was significantly correlated with the fracking activity in Colorado.
... 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. ...
Article
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.
... 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]. ...
Article
Full-text available
Pregnancy is a complex process requiring tremendous physiological changes in the mother in order to fulfill the needs of the growing fetus, and to give birth, expel the placenta and nurse the newborn. These physiological modifications are accompanied with psychological changes, as well as with variations in habits and behaviors. As a result, this period of life is considered as a sensitive window as impaired functional and physiological changes in the mother can have short- and long-term impacts on her health. In addition, dysregulation of the placenta and of mechanisms governing placentation have been linked to chronic diseases later-on in life for the fetus, in a concept known as the Developmental Origin of Health and Diseases (DOHaD). This concept stipulates that any change in the environment during the pre-conception and perinatal (in utero life and neonatal) period to puberty, can be “imprinted” in the organism, thereby impacting the health and risk of chronic diseases later in life. Pregnancy is a succession of events that is regulated, in large part, by hormones and growth factors. Therefore, small changes in hormonal balance can have important effects on both the mother and the developing fetus. An increasing number of studies demonstrate that exposure to endocrine disrupting compounds (EDCs) affect both the mother and the fetus giving rise to growing concerns surrounding these exposures. This review will give an overview of changes that happen during pregnancy with respect to the mother, the placenta, and the fetus, and of the current literature regarding the effects of EDCs during this specific sensitive window of exposure.
Chapter
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.
Article
Unconventional oil and gas development (UOGD) expanded rapidly in the United States between 2004-2019 with resultant industrial change to landscapes and new environmental exposures. By 2019, West Texas' Permian Basin accounted for 35% of domestic oil production. We conducted an online survey of 566 Texans in 2019 to examine the implications of UOGD using three measures from the Environmental Distress Scale (EDS): perceived threat of environmental issues, felt impact of environmental change, and loss of solace when valued environments are transformed ("solastalgia"). We found increased levels of environmental distress among respondents living in counties in the Permian Basin who reported a 2.75% increase in perceived threat of environmental issues (95% CI = -1.14, 6.65) and a 4.21% increase in solastalgia (95% CI = 0.03, 8.40). In our subgroup analysis of women, we found higher EDS subscale scores among respondents in Permian Basin counties for perceived threat of environmental issues (4.08%, 95% CI= -0.12, 8.37) and solastalgia (7.09%, 95% CI= 2.44, 11.88). In analysis restricted to Permian Basin counties, we found exposure to at least one earthquake of magnitude ≥ 3 was associated with increases in perceived threat of environmental issues (4.69%, 95% CI = 0.15, 9.23), and that county-level exposure to oil and gas injection wells was associated with increases in felt impact (4.38%, 95% CI = -1.77, 10.54) and solastalgia (4.06%, 95% CI = 3.02, 11.14). Our results indicate increased environmental distress in response to UOGD-related environmental degradation among Texans and highlight the importance of considering susceptible sub-groups.
Article
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.
Article
Unconventional natural gas developments (UNGD) may release air and water pollutants into the environment, potentially increasing the risk of birth defects. We conducted a case-control study evaluating 52,955 cases with birth defects and 642,399 controls born between 1999 and 2011 to investigate the relationship between UNGD exposure and the risk of gastroschisis, congenital heart defects (CHD), neural tube defects (NTDs), and orofacial clefts in Texas. We calculated UNGD densities (number of UNGDs per area) within 1, 3, and 7.5 km of maternal address at birth and categorized exposure by density tertiles. For CHD subtypes with large case numbers, we also performed time-stratified analyses to examine temporal trends. We calculated adjusted odds ratios (aOR) and 95% confidence intervals (CI) for the association with UNGD exposure, accounting for maternal characteristics and neighborhood factors. We also included a bivariable smooth of geocoded maternal location in an additive model to account for unmeasured spatially varying risk factors. Positive associations were observed between the highest tertile of UNGD density within 1 km of maternal address and risk of anencephaly (aOR: 2.44, 95% CI: 1.55, 3.86), spina bifida (aOR: 2.09, 95% CI: 1.47, 2.99), gastroschisis among older mothers (aOR: 3.19, 95% CI: 1.77, 5.73), aortic valve stenosis (aOR: 1.90, 95% CI: 1.33, 2.71), hypoplastic left heart syndrome (aOR: 2.00, 95% CI: 1.39, 2.86), and pulmonary valve atresia or stenosis (aOR: 1.36, 95% CI: 1.10, 1.66). For CHD subtypes, results did not differ substantially by distance from maternal address or when residual confounding was considered, except for atrial septal defects. We did not observe associations with orofacial clefts. Our results suggest that UNGDs were associated with some CHDs and possibly NTDs. In addition, we identified temporal trends and observed presence of spatial residual confounding for some CHDs.
Preprint
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.
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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.
Article
Background Growing literature linking unconventional natural gas development (UNGD) to adverse health has implicated air pollution and stress pathways. Persons with heart failure (HF) are susceptible to these stressors. Objectives This study sought to evaluate associations between UNGD activity and hospitalization among HF patients, stratified by both ejection fraction (EF) status (reduced [HFrEF], preserved [HFpEF], not classifiable) and HF severity. Methods We evaluated the odds of hospitalization among patients with HF seen at Geisinger from 2008 to 2015 using electronic health records. We assigned metrics of UNGD activity by phase (pad preparation, drilling, stimulation, and production) 30 days before hospitalization or a frequency-matched control selection date. We assigned phenotype status using a validated algorithm. Results We identified 9,054 patients with HF with 5,839 hospitalizations (mean age 71.1 ± 12.7 years; 47.7% female). Comparing 4th to 1st quartiles, adjusted odds ratios (95% confidence interval) for hospitalization were 1.70 (1.35 to 2.13), 0.97 (0.75 to 1.27), 1.80 (1.35 to 2.40), and 1.62 (1.07 to 2.45) for pad preparation, drilling, stimulation, and production metrics, respectively. We did not find effect modification by HFrEF or HFpEF status. Associations of most UNGD metrics with hospitalization were stronger among those with more severe HF at baseline. Conclusions Three of 4 phases of UNGD activity were associated with hospitalization for HF in a large sample of patients with HF in an area of active UNGD, with similar findings by HFrEF versus HFpEF status. Older patients with HF seem particularly vulnerable to adverse health impacts from UNGD activity.
Article
Worldwide demand for petroleum products has resulted in increased oil and gas activities in many countries. Conventional and unconventional oil and gas extraction, production, and transport lead to increased levels of petroleum‐derived polycyclic aromatic hydrocarbons (PAHs) in the environment. PAH exposure has profound effects on reproduction by affecting pathways involved in placental trophoblast cell function and impairing normal placental development and function—key contributors to reproductive success. However, other components found in petroleum and wastewaters from oil and gas extraction, including the sulfur‐containing heterocyclic aromatic compounds such as dibenzothiophene (DBT) and its alkylated derivatives, may also impact reproductive success. The goal of this study was to examine the effect of exposure to DBT, a compound commonly detected in the environment, and one of its alkylated analogues, 2,4,7‐trimethyldibenzothiophene (2,4,7‐DBT), on steroidogenic and angiogenic pathways critical for mammalian development in placental trophoblast cells (HTR‐8/SVneo cells). 2,4,7‐DBT but not DBT increased estradiol output in association with increased tube‐like formation (surrogate for angiogenesis). These changes in angiogenesis did not appear to be related to altered expression of the key placental angiogenic gene targets (ANGPTL4, VEGFA, and PGF). Neither compound showed a concentration related effect on progesterone synthesis or its receptor expression. Our results suggest that 2,4,7‐DBT can disrupt key pathways important for placental trophoblast function and highlight the importance of determining the impact of exposure to both parent and alkylated compounds. Further, these data suggest that exposure to sulfur‐containing heterocyclic aromatic compounds may lead to placental dysfunction and impact reproductive success at environmentally relevant levels.
Article
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.
Article
Hydraulic fracturing (“fracking”) is a process in which subterranean natural gas-laden rock is fractured under pressure to enhance retrieval of gas. Sand (a “proppant”) is present in the fracking fluid pumped down the well bore to stabilize the fissures and facilitate gas flow. The manipulation of sand at the well site creates respirable dust (fracking sand dust, FSD) to which workers are exposed. Because workplace exposures to FSD have exceeded exposure limits set by OSHA, a physico-chemical characterization of FSD along with comprehensive investigations of the potential early adverse effects of FSDs on organ function and biomarkers has been conducted using a rat model and related in vivo and in vitro experiments involving the respiratory, cardiovascular, immune systems, kidney and brain. An undercurrent theme of the overall hazard identification study was, to what degree do the health effects of inhaled FSD resemble those previously observed after crystalline silica dust inhalation? In short-term studies, FSD was found to be less bioactive than MIN-U-SIL® 5 in the lungs. A second theme was, are the biological effects of FSD restricted to the lungs? Bioactivity of FSD was observed in all examined organ systems. Our findings indicate that, in many respects, the physical and chemical properties, and the short-term biological effects, of the FSDs share many similarities as a group but have little in common with crystalline silica dust.
Article
Background Oil and gas extraction produces air pollutants that are associated with increased risks of hypertension. To date, no study has examined residential proximity to oil and gas extraction and hypertensive conditions during pregnancy. This study quantifies associations between residential proximity to oil and gas development on gestational hypertension and eclampsia. Methods We utilized a population-based retrospective birth cohort in Texas (1996–2009), where mothers reside <10 km from an active or future drilling site (n = 2 845 144.) Using full-address data, we linked each maternal residence at delivery to assign exposure and evaluate this exposure with respect to gestational hypertension and eclampsia. In a difference-in-differences framework, we model the interaction between maternal health before (unexposed) or after (exposed) the start of drilling activity (exposed) and residential proximity near (0–1, >1–2 or >2–3 km) or far (≥3–10 km) from an active or future drilling site. Results Among pregnant women residing 0–1 km from an active oil or gas extraction site, we estimate 5% increased odds of gestational hypertension [95% confidence interval (CI): 1.00, 1.10] and 26% increased odds of eclampsia (95% CI: 1.05, 1.51) in adjusted models. This association dissipates in the 1- to 3-km buffer zones. In restricted models, we find elevated odds ratios among maternal ages ≤35 years at delivery, maternal non-Hispanic White race, ≥30 lbs gained during pregnancy, nulliparous mothers and maternal educational attainment beyond high school. Conclusions Living within 1 km of an oil or gas extraction site during pregnancy is associated with increased odds of hypertensive conditions during pregnancy.
Article
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Purpose of Review Epidemiologic studies have observed elevated health risks in populations living near unconventional oil and gas development (UOGD). In this narrative review, we discuss strengths and limitations of UOG exposure assessment approaches used in or available for epidemiologic studies, emphasizing studies of children’s health outcomes. Recent Findings Exposure assessment challenges include (1) numerous potential stressors with distinct spatiotemporal patterns, (2) critical exposure windows that cover long periods and occur in the past, and (3) limited existing monitoring data coupled with the resource-intensiveness of collecting new exposure measurements to capture spatiotemporal variation. All epidemiologic studies used proximity-based models for exposure assessment as opposed to surveys, biomonitoring, or environmental measurements. Nearly all studies used aggregate (rather than pathway-specific) models, which are useful surrogates for the complex mix of potential hazards. Summary Simple and less-specific exposure assessment approaches have benefits in terms of scalability, interpretability, and relevance to specific policy initiatives such as set-back distances. More detailed and specific models and metrics, including dispersion methods and stressor-specific models, could reduce exposure misclassification, illuminate underlying exposure pathways, and inform emission control and exposure mitigation strategies. While less practical in a large population, collection of multi-media environmental and biological exposure measurements would be feasible in cohort subsets. Such assessments are well-suited to provide insights into the presence and magnitude of exposures to UOG-related stressors in relation to spatial surrogates and to better elucidate the plausibility of observed effects in both children and adults.
Article
Background Unconventional natural gas development (UNGD) introduces physical and psychosocial hazards into communities, which could contribute to psychosocial stress in adolescents and an increased risk of internalizing disorders, common and impactful health outcomes. Objectives To evaluate associations between a 180-day composite UNGD activity metric and new onset of internalizing disorders, overall and separately for anxiety and depressive disorders, and effect modification by sex. Methods We used a nested case-control design from 2008 to 2016 in 38 Pennsylvania counties using electronic health records from adolescent Geisinger subjects. Cases were defined by at least two diagnoses or medication orders indicating new onset of an internalizing disorder, and controls frequency-matched 4:1 on age, sex, and year. To evaluate associations, we used generalized estimating equations, with logit link, robust standard errors, and an exchangeable correlation structure within community. Results We identified 7,974 adolescents (65.9% female, mean age 15.0 years) with new onset internalizing disorders. There were no associations when we used data from the entire study period. When restricted to years with higher UNGD activity (2010–2016), comparing the highest to lowest quartile, UNGD activity was associated (odds ratio [95% confidence level]) with new onset internalizing disorders (1.15 [1.06, 1.25]). Associations were slightly stronger for depressive disorders. Associations were only present in females (p = 0.009). Discussion This is the first epidemiologic study of UNGD in relation to adolescent mental health, an important health outcome in a potentially susceptible group to the environmental and community impacts of UNGD. UNGD activity was associated with new onset internalizing disorders in females in this large sample in an area of active UNGD.
Article
Background Chronic rhinosinusitis (CRS) and bronchiectasis commonly co-occur, but most prior studies were not designed to evaluate temporality and causality. Objectives In a sample representing the general population in 37 counties in Pennsylvania, and thus the full spectrum of sinonasal and relevant lung diseases, we evaluated temporality and strength of associations of CRS with non-cystic fibrosis bronchiectasis. Methods We completed case-control analyses for each of three primary bronchiectasis case finding methods. We used electronic health records to identify CRS and bronchiectasis with diagnoses, procedure orders, and/or specific text in sinus or chest computerized tomography (CT) scans. Controls never had any indication of bronchiectasis and were frequency-matched to the three bronchiectasis groups on age, sex, and encounter year. There were 5,329 unique persons with bronchiectasis and 33,363 without in the three analyses. Important co-occurring conditions were identified with diagnoses, medication orders, and encounter types. Logistic regression was used to evaluate associations (odds ratios [OR], 95% confidence intervals) of CRS with bronchiectasis while adjusting for confounding variables. Results In adjusted analyses, CRS was consistently and strongly associated with all three bronchiectasis definitions. Associations (odds ratio, 95% confidence interval) were strongest for CRS based on sinus CT scan text and were generally stronger for CRS without nasal polyps (e.g., OR = 4.46 [2.09, 9.51] for diagnosis-based bronchiectasis). On average, CRS was identified over six years before bronchiectasis. Conclusion Precedent CRS was strongly and consistently associated with increased risk of bronchiectasis. Clinical Implication Early treatment of sinonasal disease may offer therapeutic strategies for prevention of bronchiectasis.
Article
Oil and natural gas are the largest primary global energy sources, and upstream gas emissions from these fuels can impact global climate change and local public health. This paper employs a public health-oriented perspective that reviews grey and academic literature, industry data, technical reports, and policy trends to highlight issues of emissions monitoring. We identify gaps in the existing landscape of emissions reduction strategies and highlight options for addressing them. Policy recommendations include the use of new digital monitoring technologies to better understand causes of emission events, to create data-driven oil and gas regulations, and to begin accurately measuring the volumes of gases released during oil and gas production. Areas for future research relating to emissions and public health impacts are outlined to further enable oil and gas policy discussions.
Article
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.
Article
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.
Article
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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.
Article
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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.
Article
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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.
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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
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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.
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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.
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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.
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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
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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
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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.
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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.