PA Environment Digest

Share this:

Part II - Health Impacts: State Dept. Of Health, Penn State Medical Webinars On Caring For Persons Living & Working In Communities With Oil & Natural Gas Extraction

The state Department of Health Bureau of Epidemiology and Penn State Medical Project ECHO hosted two webinars in January and February for medical professionals and the public on Caring for Persons Living and Working in Communities Involved in Oil and Natural Gas Extraction.

In April 2023, the state Department of Health the State Health Improvement Plan identified rising health issues related to natural resource extraction-- including oil and gas development-- as one of the top five threats affecting health outcomes of Pennsylvanians. Read more here.

In August 2023, the University of Pittsburgh School of Public Health released the results of several health studies funded by the Department of Health on unconventional shale gas development in Southwest Pennsylvania that found links to public health impacts like making asthma worse and increasing the risk of lymphoma in children. Read more here.

Later that month the second highest ranking official in the Department of Health took the extraordinary step of apologizing to residents for not listening to residents near shale gas operations about their health concerns. Read more here.

These webinars are part of an effort to follow-up on those studies to educate health providers and the public about the health impacts of oil and gas development impacts.

The objective of the webinars was to answer these questions--

-- What can providers do and say to alleviate patient fear and frustration in the face of chronic exposure to fracking?

-- What chronic health impacts should be monitored for based on these types of chemical exposures?

-- How can providers and health systems advocate for patients and communities when health and safety are threatened by the oil and gas industry?

The webinars--

-- Identify the potential health risks associated with oil and gas development exposure

-- Describe the impact of oil and gas development on the environment

-- Discuss techniques for addressing patient concerns

-- Identifying additional resources for addressing concerns

Part I - Agenda

The first webinar on January 9 discussed--

-- The process of unconventional oil and gas development

-- Identifies where oil and gas development occurs in Pennsylvania

-- Describes how oil and gas development can impact the environment

The webinar included discussion of a medical case study of an anonymous, but real worker in the oil and gas industry and concerns he expressed

Part II - Agenda

The second webinar on February 13 discussed--

--The potential health risks associated with oil and gas development

-- The techniques for addressing patient concerns

-- Identified additional resources to help answer patient questions about health impacts

The webinar discusses a medical case study of the real exposures a Washington County family had to hazardous air emissions from a shale gas pipeline facility. Read more here.

Opening Presentations

Dr. Julie Miller, a board-certified Public Health Toxicologist with the state Department of Health, gave the opening presentations at both webinars.

Dr. Miller's primary training and area of expertise includes analytical chemistry, toxicology study design, data analysis and interpretation and human health risk assessments.

Dr. Miller has also managed occupational health and safety projects and has received postdoctoral training at the U.S. Centers for Disease Control and Prevention – National Institute for Occupational Safety and Health.

Dr. Miller has over 50 published manuscripts, abstracts, and book chapters related to toxicology.

Part II Opening Presentation

Here is a transcript of Dr. Miller’s opening presentation to the first webinar.

Click Here for a copy of the presentation slides from the webinar. Click Here for medical case study summary. Read more about the case study.

Thank you so much for joining us today for part two of our two-part ECHO series presentation.

If you are not able to attend the first part of this presentation, we created this resource for healthcare professionals covering the impact of unconventional oil and gas development on health.

The term fracking is commonly used to refer to this industry and will likely be how your patients refer to it.

However, fracking is only one step of the development process, in this development process. So we will use the term unconventional oil and gas development or UOGD for accuracy to avoid any confusion.

My name's Julie Miller. I'm the public health state toxicologist with the Pennsylvania Department of Health.

I'm located in the Bureau of Epidemiology division of Environmental Health Epidemiology with DOH, and we cover the entire Commonwealth in terms of response to environmental exposures and how that may impact an individual or community's health.

So today we'll be discussing three new topics, but before jumping into anything new, we will begin with a short overview of the first presentation.

This review includes what UOGD is, what environmental impacts are associated with it, and where in Pennsylvania UOGD is the most prevalent.

Then we will identify the potential health risks noted in current scientific literature.

Next, we will discuss techniques for addressing patient's concerns and then we'll wrap it up with a quick overview of additional resources.

Summary of the Part I Presentation

So let's begin with a quick review of the first ECHO presentation.

Before moving along, I want to draw your attention to the photo on the right here. It is a well pad that looks, this is what it looks like while under the initial construction.

Each of these red vehicles here is a semi truck.

I think this image wonderfully demonstrates just how large, loud, and busy these operations can be during the construction phase.

And then on the screen here is an overview of the phases of unconventional well development.

An unconventional well will go through five to six main phases throughout its lifetime.

Well preparation, drilling, hydraulic fracturing, flowback, production, and plugging. Those in yellow are the pre-production or construction period. Not all wells will be plugged.

There are quite a few potential environmental impacts from unconventional oil and gas development.

The two most commonly reported concerns to the Department of Health are those related to air pollution and water contamination, specifically individuals on private well water.

I also want to highlight fracking fluid and flaring from this list.

Fracking fluid is a mixture of water and chemicals used during the hydraulic fracturing stage.

While water is the main ingredient in fracking fluid, some of the chemical additives used are carcinogenic to humans, which means they could potentially cause cancer. Each well uses millions of gallons of fracking fluid.

So while these chemicals might be low in concentration, they are high on an absolute scale and have the potential to cause significant health impacts if they leak into water sources.

Flaring, demonstrated in the photo on the right, is the uncontrolled burning of excess or unwanted petroleum pools such as, excuse me, flaring can be a significant source of air pollution such as nitrogen oxides and greenhouse gas emissions.

It is also an additional source of noise and light pollution. Flaring can occur the entire time a well is in the production phase, so roughly 25 to 40 years.

[Editor’s Note: Flaring is used in the beginning development stages of shale gas well development. However, with 20 to 30 shale gas wells now developed on each well pad flaring can occur for years.]

And before we jump into the health impacts portion, I want to quickly look exclusively at Pennsylvania for a moment.

As of mid-2024, there are over 12,800 unconventional wells drilled in the state. 36 of Pennsylvania's 67 counties have active unconventional wells primarily in the northeast and the southwest portions of the state with the majority in Washington and Susquehanna counties.

This equates to one in 10 Pennsylvanians living within half of a mile of oil and gas activity.

For a general idea of exposure distances, unconventional wells are allowed to be drilled within 500 feet of an existing structure such as a home, school or private water well.

They are allowed to be drilled within 1,000 feet of a water extraction point for a public water source.

Many scientific articles do not find this distance to be protective against potential health impacts.

Potential Negative Health Outcomes

Now that you have an understanding of what UOGD is, how patients may be exposed, and where the risks are most prevalent, we can discuss potential negative health outcomes identified in the literature.

Now, while not all studies have found a relationship between exposure to oil and gas development and negative health impacts, the growing body of research suggests that there are potential risks due to living near UOGD.

These risks may include cancer, cardiovascular effects, respiratory effects, poor birth outcomes, and mental health effects.

As shown here, the risk depends on multiple factors. You must also consider how vulnerable an individual is as well as how hazardous the substance is.

Cancer

Cancer is the first impact we'll discuss as it is often a concern mentioned by residents.

I want to highlight a couple recent studies that looked into cancer among Pennsylvanians.

The University of Pittsburgh conducted a study in 2023 and found children living within one mile of one or more of unconventional wells had approximately five to seven times the chance of developing lymphoma.

They did not find an increased risk for childhood leukemia, brain, and bone cancer.

A study from 2022 found an increased odds of developing acute lymphoblastic leukemia.

However, these results were attenuated once social and environmental factors were adjusted for.

Cardiovascular Disease

Next is cardiovascular disease. Increased cardiovascular disease is also a concern, especially considering it is already the leading cause of death worldwide.

Some elevated risks include increased hospitalizations in patients with heart failure, elevated cardiovascular disease indicators, stroke, and heart attack hospitalizations and mortality.

For example, a 2023 study found an association between higher hospitalization for cardiovascular disease in older adults living in zip codes known to have UOGD.

In 2021, a study found an increase in acute myocardial infarction hospitalization and mortality in middle-aged men that lived in counties with more than 100 wells.

Finally, a separate study found an increased odds of hospitalization among individuals with heart failure. This increased odds was present for all phases of UOGD.

Air Pollution

Unfortunately, it comes as no surprise that along with increased air pollution is an increased risk for respiratory disease.

Many studies have found associations between diseases such as asthma and silicosis and UOGD.

A few studies we would like to highlight include a 2023 study that found individuals are four to five times more likely of having an asthma exacerbation if they live near unconventional wells during the production phase.

A 2018 study found pediatric asthma hospitalization was associated with the community level UOGD activity.

And finally, another study noted residential UOGD activity was associated with an increased risk of mild, moderate, and severe asthma exacerbations.

It is well known that pregnant people are more susceptible to exposure and illness.

Multiple studies have found associations between UOGD exposure and various negative birth outcomes such as preterm birth, small for gestational age, low birth weight, and spontaneous abortion.

Some Pennsylvania studies include a 2017 article that found an increased probability of having a child with low birth weight for mothers living within three kilometers of UOGD sites with the largest impact within one kilometer.

A different study from 2017 identified an increase in early infant deaths in 10 heavily fracked counties when comparing before and after unconventional oil and gas development entering the area.

In 2016, a study was published that identified an association between UOGD and preterm birth as well as physician recorded high-risk pregnancies.

Lastly, a study from 2013 found an increased risk of small for gestational age and decreased birth weight for those living near UOGD.

Mental Health Impacts

Next, mental health impacts, while less frequently studied, are more important to consider for those living near UOGD.

Some of the most common impacts include anxiety, stress, depression, and sleep disturbances.

At the Department of Health, we are frequently told individuals are experiencing stress

and anxiety over the lack of control over their surroundings, uncertainty over the future health of their family, as well as feeling their concerns are not being taken seriously.

A few studies I would like to highlight include a 2024 study on women of childbearing age in the United States and Canada, which found that those living near UOGD were more likely to report elevated depressive symptoms, were more likely to use psychotropic medications, and were more likely to report an increase in perceived stress.

Additionally, a 2022 study identified an increased odds of new onset internalizing disorders in females living in areas with higher UOGD activity and in a separate study from 2018 found an increased frequency of depressive symptoms in individuals living closer to UOGD.

Occupational Health

There are also a few health impacts specific to individuals working in the oil and gas industry that I would like to highlight.

As this industry can have frequent work-related travel, we have selected four studies from around the United States to share.

This includes a 2020 study that found retired oil and gas workers experienced a significantly higher prevalence of both hearing loss and self-reported poor health status than all other retirees.

Additionally, the US Bureau of Labor Statistics found the industry category that includes oil and gas extraction workers experienced the third-highest fatality rate in the nation in 2020.

In 2016, the Centers for Disease Control and Prevention or CDC analyzed violent death data among 20 major industry groups and found men working in the mining, quarrying, and oil and gas extraction field had the highest suicide rates.

Lastly, silica, as we mentioned, is used in the oil and gas industry during the hydraulic phase. A NIOSH study found US workers were often exposed to silica at high levels.

79% of samples were above the NIOSH, or the National Institutes for Occupational Safety and Health, recommended exposure levels or REL and 31% of samples were 10 times greater than the REL for silica.

Direct Health Impacts

Finally, some other health impacts such as direct impacts that are rarely studied or indirect impacts that are frequently studied are also important to keep in mind during a patient visit.

Direct impacts can include itching or burning eyes, dry skin and lightheadedness or dizziness according to a 2020 study.

In fact, as of June 2024, some of the most common self-reported symptoms the Department of Health receives were neurological and dermal in nature.

Indirect impacts include a 45% to 47% increase in fatal and major injury crashes according to a 2014 study.

Additionally, increased prevalence of gonorrhea, chlamydia and prostitution-related arrests after UOGD was introduced to an area was noted in a 2018 article.

It is essential to note that we are not critically analyzing the studies mentioned in this presentation.

We collected a sample of recent studies to highlight the spectrum of health effects that may be present in patients living or spending time near UOGD.

The studies referenced here are various types of environmental health studies. These types of studies have many inherent limitations and will not compare to a laboratory-controlled study.

For example, the extent of various daily exposures each participant in a study is subjected to outside of UOGD cannot be known or controlled for.

Additionally, when reviewing the potential health impacts related to the oil and gas industry, it is important to remember the unconventional well practice is still relatively new.

Health impacts related to UOGD exposure have only been studied for roughly 10 years.

Also, not all these studies have found an association between oil and gas activity and negative health impacts.

In fact, a few studies have even found potential health protective findings as well.

Duty To Take A Health Protective Stance

That being said, it is our duty to take a health protective stance.

Prevention is the backbone of public health, so advising methods to limit and prevent exposure as much as possible should be utilized.

Now we're going to switch to talk more about how you can use this information to better address the concerns your patients might have.

Take An Exposure History

The first suggestion that we have is to take an environmental exposure history.

Many environmental diseases present with non-specific symptoms and may be difficult to discern from other common medical conditions.

It can be difficult to identify the cause of these symptoms without having an accurate and detailed exposure history, which will aid in diagnosis, treatment, and exposure reduction or elimination.

The first step of an environmental exposure history is to investigate potential exposures.

When you talk through potential exposures, you will need to keep in mind what roots of exposure your patients may have.

Exposure Pathways

The four main exposure roots for unconventional oil and gas development.

The first is ingestion. Activities such as drinking or preparing food. With contaminated well water would fall under this root of exposure.

Children can also ingest contaminated water while bathing, brushing teeth, or drinking formula made with contaminated water.

In terms of inhalation, poor air quality is a concern both in and outside of the home.

Spending outdoors doing strenuous activity, causing elevated respiratory rates and keeping windows open are potential ways for inhalation exposure to occur.

Contact exposure is the third exposure root. Bathing and contaminated water is an example of contact exposure.

Finally, transplacental transfer may occur between a pregnant individual and their fetus or newborn.

If a pregnant individual was exposed via ingestion, inhalation or contact exposure, their child may have also been exposed through subsequent transplacental transfer.

If you do not commonly collect exposure histories, the Environmental Health Project compiled a list of questions that can be asked during an exposure history for patients with UOGD concerns.

These include, do you or anyone in your family live, work or attend school in proximity to an industrial plant, dump site, or a shale gas facility?

What is the source of your drinking water?

Have you experienced any changes in the water quality such as color, taste, or smell?

Have you ever changed your residence because of a health problem?

And do you or anyone in your family work in the shale gas industry?

Additionally, the table to the right by the Agency for Toxic Substances and Disease Registry or ATSDR walks through the components of a complete exposure history.

If you would like to see examples of case studies in environmental medicine, including those that cover taking a pediatric or adult environmental exposure history, ATSDR has published quite a few.

The table to the right demonstrates which organ systems are affected by select toxic exposures [page 21 of slides]. Any in bold denotes a relevant case study is available.

I want to note, these case studies are not limited to unconventional oil and gas development, but are examples of toxic environmental exposures.

A helpful resource to recommend for your patients, or if you have time yourself, is the Pennsylvania Department of Health's Environmental Health Indicators Map.

This map demonstrates various environmental exposures throughout the state that can help identify potential exposures near any given location.

For example, some items such as oil and gas wells, compressor stations, pipelines, and hazardous waste storage can all be found on this map, in addition to other demographic information.

Key Clinical Recommendations

As we start to wrap up here, here's a list of our key clinical recommendations [page 23 of slides]..

If your patient lives in an area with unconventional oil and gas development, encourage them to have a physical exam annually.

Next, remember to provide reassurance and validation to their concerns following trauma-informed care principles.

Third, something to keep in mind is that while there are lab tests for some chemicals of concern, laboratory results will not always help determine the source or timing of exposure.

Completing an environmental exposure history and going through those exposure pathways with your patient is a very important first step.

Related to that, there are no specific laboratory assessments that are recommended for individuals living near oil and gas development outside of those indicated by their normal clinical assessment.

Next, don't make environmental health recommendations without considering routine environmental exposures. This includes workplace, school and residential exposures, along with anywhere else they spend a considerable amount of time.

Finally, make sure you ask what your patient's water supply is. Are you on public water or do you have private well water?

In Pennsylvania, private well owners are responsible for maintenance, inspection, and testing of their wells to ensure the safety of their water supply.

If you find that your patient's water source is a private well, encourage them to regularly test through a certified laboratory.

If they mention oil and gas development is coming into their area, it is ideal if they can have a sample of their water taken before the drilling occurs and after hydraulic fracturing is complete.

Some private well owners may be eligible for free water testing through the Penn State Extension's Drinking Water program. You can encourage them to visit their website to see if they qualify.

If there are any issues with their water quality, they should contact a water treatment company to discuss what their options are.

If your patient uses public water, they can request a consumer confidence report from their water supply company that will outline detected contaminants in their public water.

Now, we've mentioned quite a few times that poor air quality may be a risk throughout every stage of oil and gas development, but here are a few air quality actions that you could recommend for your patients if they are concerned about air in their area.

First, AirNow is a great resource and website. It translates current air quality conditions into a simple number for the lay population.

Second, if the air quality outside is poor, make sure that they're closing their windows and running an HVAC or air purifier if they have one.

If applicable, advocate for local schools and other community locations to participate in the US Environmental Protection Agency or EPA's Air Quality Flag Program.

Through this program, participating locations use brightly colored flags to notify individuals of what the current outdoor air quality is in their area.

We would also recommend you encourage your patients to have their homes tested for current radon levels.

While radon is a risk across Pennsylvania, a 2015 study found there may be an increased level of radon inside homes near unconventional oil and gas activity.

If you have any additional questions or comments, please feel free to reach out to the division of Environmental Health Epidemiology.

We manage the oil and natural gas production health information database where statewide health concern information is gathered to help better understand what individuals living near oil and gas are experiencing.

Additionally, [go to the Report an Environmental Health Concern webpage] if you would like to refer your patients to us [or report an environmental health concern].

And I'll end with a list of our environmental health physician partners that helped with reviewing this resource. I think some of you are on the line today.

Finally, we have gone through quite a bit of information and different recommended resources throughout this presentation. The next couple of slides are a selection of what we have covered.

Here are some resources that can look into Pennsylvania specifically. Organizations include the Department of Health, the Department of Environmental Protection, or DEP, and more. And here are some trauma-informed care and air quality trainings.

[Resources and study references for Dr. Miller’s presentation begin on page 29.]

So again, thank you so much and feel free to contact us at DEHE@pa.gov with any questions.

Click Here for a copy of the presentation slides from the webinar. Click Here for medical case study summary. Read more about the case study.

Resource Links From Presentation:

-- Dept. Of Health Oil & Natural Gas Production Health Concerns

-- Dept. Of Health PA Health Alert Network

-- FracFocus Chemical Disclosure Registry

-- DEP Office of Oil & Gas Management

-- DEP Oil and Gas Reports

-- Penn State Marcellus Center for Outreach and Research [Oil & Gas Graphics]

Additional Resource Links:

-- Environmental Health Project - Shale Gas Health Impacts