Exposure to Oil and Gas Fracking Sites Linked to Adverse Birth Outcomes.

Policymakers and regulators are urged to take note as evidence mounts.

Quantification of the global and regional impacts of gas flaring on human health via spatial differentiation.

Globally, gas flaring caused 350 million tonnes of CO2 emissions in 2018. In addition to climate change, this burning practice also has other negative consequences for humans (e.g., respiratory problems) and the environment. The aim of this paper is to quantify the impact of flaring on human health (at the global and country level) via the calculation of the number of disability-adjusted life years (DALYs) caused by the combustion of associated gas. For this quantification, gas flaring emissions were linked with midpoint indicators (e.g., climate change) in life cycle assessment (LCA) for all selected countries. Regionalised characterisation factors (CFs) were applied in the impact assessment to allow for spatial differentiation. The global impact on human health caused by flaring was obtained by taking the sum for all countries. The results show that these flaring emissions globally cause 4.83 × 105 DALYs or 6.19 × 10-5 DALYs/person on an annual basis. This amounts to 0.12% of the total DALYs related to air pollution (from PM2.5) caused by all polluting sectors and 6.51% of the total DALYs related to climate change. To quantify these impacts, this study uses a country perspective rather than considering local characteristics. Thus, if more precise information at a more local level (e.g., city level) is sought, additional factors (e.g., meteorological conditions) should be taken into account. Finally, future research should also focus on the benefits of gas flaring reduction techniques to enable the selection of the most promising technologies for the elimination of gas flaring and its effects.

Risk factors for cooking-related burn injuries in children, WHO Global Burn Registry.

OBJECTIVE: To assess the characteristics of cooking-related burn injuries in children reported to the World Health Organization Global Burn Registry. METHODS: On 1 February 2021, we downloaded data from the Global Burn Registry on demographic and clinical characteristics of patients younger than 19 years. We performed multivariate regressions to identify risk factors predictive of mortality and total body surface area affected by burns. FINDINGS: Of the 2957 paediatric patients with burn injuries, 974 involved cooking (32.9%). More burns occurred in boys (532 patients; 54.6%) than in girls, and in children 2 years and younger (489 patients; 50.2%). Accidental contact and liquefied petroleum caused most burn injuries (729 patients; 74.8% and 293 patients; 30.1%, respectively). Burn contact by explosions (odds ratio, OR: 2.8; 95% confidence interval, CI: 1.4-5.7) or fires in the cooking area (OR: 3.0; 95% CI: 1.3-6.8), as well as the cooking fuels wood (OR: 2.2; 95 CI%: 1.3-3.4), kerosene (OR: 1.9; 95% CI: 1.0-3.6) or natural gas (OR: 1.5; 95% CI: 1.0-2.2) were associated with larger body surface area affected. Mortality was associated with explosions (OR: 7.5; 95% CI: 2.2-25.9) and fires in the cooking area (OR: 6.9; 95% CI: 1.9-25.7), charcoal (OR: 4.6; 95% CI: 2.0-10.5), kerosene (OR: 3.9; 95% CI: 1.4-10.8), natural gas (OR: 3.0; 95% CI: 1.5-6.1) or wood (OR: 2.8; 95% CI: 1.1-7.1). CONCLUSION: Preventive interventions directed against explosions, fires in cooking areas and hazardous cooking fuels should be implemented to reduce morbidity and mortality from cooking-related burn injuries.

Exposure assessment of adults living near unconventional oil and natural gas development and reported health symptoms in southwest Pennsylvania, USA.

Recent research has shown relationships between health outcomes and residence proximity to unconventional oil and natural gas development (UOGD). The challenge of connecting health outcomes to environmental stressors requires ongoing research with new methodological approaches. We investigated UOGD density and well emissions and their association with symptom reporting by residents of southwest Pennsylvania. A retrospective analysis was conducted on 104 unique, de-identified health assessments completed from 2012-2017 by residents living in proximity to UOGD. A novel approach to comparing estimates of exposure was taken. Generalized linear modeling was used to ascertain the relationship between symptom counts and estimated UOGD exposure, while Threshold Indicator Taxa Analysis (TITAN) was used to identify associations between individual symptoms and estimated UOGD exposure. We used three estimates of exposure: cumulative well density (CWD), inverse distance weighting (IDW) of wells, and annual emission concentrations (AEC) from wells within 5 km of respondents' homes. Taking well emissions reported to the Pennsylvania Department of Environmental Protection, an air dispersion and screening model was used to estimate an emissions concentration at residences. When controlling for age, sex, and smoker status, each exposure estimate predicted total number of reported symptoms (CWD, p<0.001; IDW, p<0.001; AEC, p<0.05). Akaike information criterion values revealed that CWD was the better predictor of adverse health symptoms in our sample. Two groups of symptoms (i.e., eyes, ears, nose, throat; neurological and muscular) constituted 50% of reported symptoms across exposures, suggesting these groupings of symptoms may be more likely reported by respondents when UOGD intensity increases. Our results do not confirm that UOGD was the direct cause of the reported symptoms but raise concern about the growing number of wells around residential areas. Our approach presents a novel method of quantifying exposures and relating them to reported health symptoms.

Air Pollutant Exposure and Stove Use Assessment Methods for the Household Air Pollution Intervention Network (HAPIN) Trial.

BACKGROUND: High quality personal exposure data is fundamental to understanding the health implications of household energy interventions, interpreting analyses across assigned study arms, and characterizing exposure-response relationships for household air pollution. This paper describes the exposure data collection for the Household Air Pollution Intervention Network (HAPIN), a multicountry randomized controlled trial of liquefied petroleum gas stoves and fuel among 3,200 households in India, Rwanda, Guatemala, and Peru. OBJECTIVES: The primary objectives of the exposure assessment are to estimate the exposure contrast achieved following a clean fuel intervention and to provide data for analyses of exposure-response relationships across a range of personal exposures. METHODS: Exposure measurements are being conducted over the 3-y time frame of the field study. We are measuring fine particulate matter [PM < 2.5µm in aerodynamic diameter (PM2.5)] with the Enhanced Children's MicroPEM™ (RTI International), carbon monoxide (CO) with the USB-EL-CO (Lascar Electronics), and black carbon with the OT21 transmissometer (Magee Scientific) in pregnant women, adult women, and children <1 year of age, primarily via multiple 24-h personal assessments (three, six, and three measurements, respectively) over the course of the 18-month follow-up period using lightweight monitors. For children we are using an indirect measurement approach, combining data from area monitors and locator devices worn by the child. For a subsample (up to 10%) of the study population, we are doubling the frequency of measurements in order to estimate the accuracy of subject-specific typical exposure estimates. In addition, we are conducting ambient air monitoring to help characterize potential contributions of PM2.5 exposure from background concentration. Stove use monitors (Geocene) are being used to assess compliance with the intervention, given that stove stacking (use of traditional stoves in addition to the intervention gas stove) may occur. CONCLUSIONS: The tools and approaches being used for HAPIN to estimate personal exposures build on previous efforts and take advantage of new technologies. In addition to providing key personal exposure data for this study, we hope the application and learnings from our exposure assessment will help inform future efforts to characterize exposure to household air pollution and for other contexts. https://doi.org/10.1289/EHP6422.

Design and Rationale of the HAPIN Study: A Multicountry Randomized Controlled Trial to Assess the Effect of Liquefied Petroleum Gas Stove and Continuous Fuel Distribution.

BACKGROUND: Globally, nearly 3 billion people rely on solid fuels for cooking and heating, the vast majority residing in low- and middle-income countries (LMICs). The resulting household air pollution (HAP) is a leading environmental risk factor, accounting for an estimated 1.6 million premature deaths annually. Previous interventions of cleaner stoves have often failed to reduce exposure to levels that produce meaningful health improvements. There have been no multicountry field trials with liquefied petroleum gas (LPG) stoves, likely the cleanest scalable intervention. OBJECTIVE: This paper describes the design and methods of an ongoing randomized controlled trial (RCT) of LPG stove and fuel distribution in 3,200 households in 4 LMICs (India, Guatemala, Peru, and Rwanda). METHODS: We are enrolling 800 pregnant women at each of the 4 international research centers from households using biomass fuels. We are randomly assigning households to receive LPG stoves, an 18-month supply of free LPG, and behavioral reinforcements to the control arm. The mother is being followed along with her child until the child is 1 year old. Older adult women (40 to <80 years of age) living in the same households are also enrolled and followed during the same period. Primary health outcomes are low birth weight, severe pneumonia incidence, stunting in the child, and high blood pressure (BP) in the older adult woman. Secondary health outcomes are also being assessed. We are assessing stove and fuel use, conducting repeated personal and kitchen exposure assessments of fine particulate matter with aerodynamic diameter ≤2.5µm (PM2.5), carbon monoxide (CO), and black carbon (BC), and collecting dried blood spots (DBS) and urinary samples for biomarker analysis. Enrollment and data collection began in May 2018 and will continue through August 2021. The trial is registered with ClinicalTrials.gov (NCT02944682). CONCLUSIONS: This study will provide evidence to inform national and global policies on scaling up LPG stove use among vulnerable populations. https://doi.org/10.1289/EHP6407.

Design and Rationale of the Biomarker Center of the Household Air Pollution Intervention Network (HAPIN) Trial.

BACKGROUND: Biomarkers of exposure, susceptibility, and effect are fundamental for understanding environmental exposures, mechanistic pathways of effect, and monitoring early adverse outcomes. To date, no study has comprehensively evaluated a large suite and variety of biomarkers in household air pollution (HAP) studies in concert with exposure and outcome data. The Household Air Pollution Intervention Network (HAPIN) trial is a liquified petroleum gas (LPG) fuel/stove randomized intervention trial enrolling 800 pregnant women in each of four countries (i.e., Peru, Guatemala, Rwanda, and India). Their offspring will be followed from birth through 12 months of age to evaluate the role of pre- and postnatal exposure to HAP from biomass burning cookstoves in the control arm and LPG stoves in the intervention arm on growth and respiratory outcomes. In addition, up to 200 older adult women per site are being recruited in the same households to evaluate indicators of cardiopulmonary, metabolic, and cancer outcomes. OBJECTIVES: Here we describe the rationale and ultimate design of a comprehensive biomarker plan to enable us to explore more fully how exposure is related to disease outcome. METHODS: HAPIN enrollment and data collection began in May 2018 and will continue through August 2021. As a part of data collection, dried blood spot (DBS) and urine samples are being collected three times during pregnancy in pregnant women and older adult women. DBS are collected at birth for the child. DBS and urine samples are being collected from the older adult women and children three times throughout the child's first year of life. Exposure biomarkers that will be longitudinally measured in all participants include urinary hydroxy-polycyclic aromatic hydrocarbons, volatile organic chemical metabolites, metals/metalloids, levoglucosan, and cotinine. Biomarkers of effect, including inflammation, endothelial and oxidative stress biomarkers, lung cancer markers, and other clinically relevant measures will be analyzed in urine, DBS, or blood products from the older adult women. Similarly, genomic/epigenetic markers, microbiome, and metabolomics will be measured in older adult women samples. DISCUSSION: Our study design will yield a wealth of biomarker data to evaluate, in great detail, the link between exposures and health outcomes. In addition, our design is comprehensive and innovative by including cutting-edge measures such as metabolomics and epigenetics. https://doi.org/10.1289/EHP5751.

Noise concerns of residents living in close proximity to hydraulic fracturing sites in Southwest Pennsylvania.

OBJECTIVE: Noise associated with nontraditional gas industry (NTGI) sites (e.g., hydraulic fracturing well pads, compressor stations, processing plants) may create disturbances and anxiety in rural populations. This study evaluated levels of concern among residents of Southwestern Pennsylvania residing near NTGI sites. DESIGN: Noise measurements were collected inside and outside residences, and surveys were administered to residents. RESULTS: Daytime instantaneous sound levels ranged between 45.0 and 61.0 dBA. Dosimeter studies recorded day-night levels (Ldn ) of 53.5-69.4 dBA outside and 37.5-50.1 dBA inside, exceeding United States Environmental Protection Agency guidelines. Respondents indicated the NTGI noise disturbed their sleep, and the majority of respondents (96%) reported being worried about their overall health as a result of the noise. CONCLUSIONS: Health care professionals serving rural areas impacted by hydraulic fracturing (fracking) should be aware of potential noise stressors on the populations they serve.

Shale gas development and infant health: Evidence from Pennsylvania.

This research exploits the introduction of shale gas wells in Pennsylvania in response to growing controversy around the drilling method of hydraulic fracturing. Using detailed location data on maternal addresses and GIS coordinates of gas wells, this study examines singleton births to mothers residing close to a shale gas well from 2003 to 2010 in Pennsylvania. The introduction of drilling increased low birth weight and decreased term birth weight on average among mothers living within 2.5 km of a well compared to mothers living within 2.5 km of a permitted well. Adverse effects were also detected using measures such as small for gestational age and APGAR scores, while no effects on gestation periods were found. In the intensive margin, an additional well is associated with a 7 percent increase in low birth weight, a 5 g reduction in term birth weight and a 3 percent increase in premature birth. These results are robust to other measures of infant health, many changes in specification and falsification tests. These findings suggest that shale gas development poses significant risks to human health.

Unconventional natural gas development and pediatric asthma hospitalizations in Pennsylvania.

BACKGROUND: Pediatric asthma is a common chronic condition that can be exacerbated by environmental exposures, and unconventional natural gas development (UNGD) has been associated with decreased community air quality. This study aims to quantify the association between UNGD and pediatric asthma hospitalizations. METHODS: We compare pediatric asthma hospitalizations among zip codes with and without exposure to UNGD between 2003 and 2014 using a difference-in-differences panel analysis. Our UNGD exposure metrics include cumulative and contemporaneous drilling as well as reported air emissions by site. RESULTS: We observed consistently elevated odds of hospitalizations in the top tertile of pediatric patients exposed to unconventional drilling compared with their unexposed peers. During the same quarter a well was drilled, we find a 25% increase (95% CI: 1.07, 1.47) in the odds of being hospitalized for asthma. Ever-establishment of an UNGD well within a zip code was associated with a 1.19 (95% CI: 1.04, 1.36) increased odds of a pediatric asthma hospitalization. Our results further demonstrate that increasing specific air emissions from UNGD sites are associated with increased risks of pediatric asthma hospitalizations (e.g. 2,2,4-trimethylpentane, formaldehyde, x-hexane). These results hold across multiple age groups and sensitivity analyses. CONCLUSIONS: Community-level UNGD exposure metrics were associated with increased odds of pediatric asthma-related hospitalization among young children and adolescents. This study provides evidence that additional regulations may be necessary to protect children's respiratory health from UNGD activities.

Public Health and Unconventional Oil and Gas Extraction Including Fracking: Global Lessons from a Scottish Government Review.

Unconventional oil and gas extraction (UOGE) including fracking for shale gas is underway in North America on a large scale, and in Australia and some other countries. It is viewed as a major source of global energy needs by proponents. Critics consider fracking and UOGE an immediate and long-term threat to global, national, and regional public health and climate. Rarely have governments brought together relatively detailed assessments of direct and indirect public health risks associated with fracking and weighed these against potential benefits to inform a national debate on whether to pursue this energy route. The Scottish government has now done so in a wide-ranging consultation underpinned by a variety of reports on unconventional gas extraction including fracking. This paper analyses the Scottish government approach from inception to conclusion, and from procedures to outcomes. The reports commissioned by the Scottish government include a comprehensive review dedicated specifically to public health as well as reports on climate change, economic impacts, transport, geology, and decommissioning. All these reports are relevant to public health, and taken together offer a comprehensive review of existing evidence. The approach is unique globally when compared with UOGE assessments conducted in the USA, Australia, Canada, and England. The review process builds a useful evidence base although it is not without flaws. The process approach, if not the content, offers a framework that may have merits globally.

Damp housing, gas stoves, and the burden of childhood asthma in Australia.

OBJECTIVE: To determine the proportion of the national childhood asthma burden associated with exposure to dampness and gas stoves in Australian homes. DESIGN: Comparative risk assessment modelling study. Setting, participants: Australian children aged 14 years or less, 2011. MAIN OUTCOME MEASURES: The population attributable fractions (PAFs) and number of disability-adjusted life years (DALYs) for childhood asthma associated with exposure to damp housing and gas stoves. RESULTS: 26.1% of Australian homes have dampness problems and 38.2% have natural gas as the main energy source for cooktop stoves. The PAF for childhood asthma attributable to damp housing was 7.9% (95% CI, 3.2-12.6%), causing 1760 disability-adjusted life years (DALYs; 95% CI, 416-3104 DALYs), or 42 DALYs/100 000 children. The PAF associated with gas stoves was 12.3% (95% CI, 8.9-15.8%), corresponding to 2756 DALYs (95% CI, 1271-4242), or 67 DALYs/100 000 children. If all homes with gas stoves were fitted with high efficiency range hoods to vent gas combustion products outdoors, the PAF and burden estimates were reduced to 3.4% (95% CI, 2.2-4.6%) and 761 DALYs (95% CI, 322-1199). CONCLUSIONS: Exposure to damp housing and gas stoves is common in Australia, and is associated with a considerable proportion of the childhood asthma burden. Strategies for reducing exposure to indoor dampness and gas combustion products should be communicated to parents of children with or at risk of asthma.

The pertinence of Sutton's law to exposure science: Lessons from unconventional shale gas drilling.

Sutton's Law urges the medical practitioner to utilize the test that goes directly to the problem. When applied to exposure science, Sutton's Law would argue that the major emphasis should be on techniques that directly measure exposure in or close to the human, animal or ecosystem receptors of concern. Exposure science largely and appropriately violates Sutton's Law by estimating exposure based on information on emissions or measurements obtained at a distance from the receptors of concern. I suggest four criteria to help determine whether Sutton's law should be violated for an innovative technology, and explore these criteria in relation to potential human exposure resulting from unconventional gas drilling (UGD): (1) The technological processes possibly leading to release of the chemical or physical agents of concern are reasonably understood; (2) the agents of concern are known; (3) the source and geographical location of the releases can be reasonably identified; and (4) there is information about the likely temporal pattern of the releases and resulting pollutant levels in relation to the temporal patterns of receptor susceptibility. For UGD, the complexity of the technology including many possible release points at different time periods; the existence of three variable mixtures of chemical and physical agents as well as possible unknown reactants; the demonstrated large variation in releases from site to site; and deficiencies in transparency and regulatory oversight, all suggest that studies of the potential health impact of UGD should follow Sutton's Law. This includes the use of techniques that more directly measure exposure close to or within the receptors of concern, such as biological markers or through community-based citizen science. Understanding the implications of Sutton's Law could help focus scientific and regulatory efforts on effective approaches to evaluate the potential health and ecosystem implications of new and evolving technologies.

Desensitization to chemical and food sensitivities by low-dose immunotherapy ascertained by provocation neutralization is associated with reduced influx of calcium ions into lymphocytes.

Background Food and chemical sensitivities have detrimental effects on health and the quality of life. The natural course of such sensitivities can potentially be altered through various types of allergen-specific immunotherapy, including low-dose immunotherapy. The molecular mechanism by which low-dose immunotherapy causes desensitization has not thus far been elucidated. While resting lymphocytes maintain a low cytosolic calcium ion concentration, antigen receptor signaling results in calcium ion influx, predominantly via store-operated calcium channels. We therefore hypothesized that desensitization by low-dose immunotherapy is associated with reduced influx of calcium ions into lymphocytes. The aim of this study was to test this hypothesis. Methods Intracellular lymphocytic calcium ion concentrations were assayed in a total of 47 patients, following incubation with picogram amounts of the test allergens, using a cell-permeable calcium-sensing ratiometric fluorescent dye and fluorescence spectroscopy, both at baseline and following successful provocation neutralization treatment with low-dose immunotherapy. Results Low-dose immunotherapy was associated with a reduction in lymphocytic intracellular calcium ion concentration following treatment of: 23 % for metabisulfite sensitivity (p<0.0004); 12 % for salicylate sensitivity (p<0.01); 23 % for benzoate sensitivity (p<0.01); 30 % for formaldehyde sensitivity (p<0.0001); 16 % for sensitivity to petrol exhaust (p<0.003); 16 % for natural gas sensitivity (p<0.001); 13 % for nickel sensitivity (p<0.05); 30 % for sensitivity to organophosphates (p<0.01); and 24 % for sensitivity to nitrosamines (p<0.05). Conclusions Low-dose immunotherapy may affect baseline levels of intracellular calcium in lymphocytes, supporting the premise that allergens affect cell signaling in immune cells and provocation neutralization immunotherapy helps to promote more normal immune cell signaling.

Genetic polymorphisms of the CYP1A1, GSTM1, and GSTT1 enzymes and their influence on cardiovascular risk and lipid profile in people who live near a natural gas plant.

The aim of this cross-sectional study was to see whether genetic polymorphisms of the enzymes CYP1A1, GSTM1, and GSTT1 are associated with higher risk of coronary artery disease (CAD) and whether they affect lipid profile in 252 subjects living near a natural gas plant, who are likely to be exposed to polycyclic aromatic hydrocarbons (PAHs). Fasting serum concentrations of biochemical parameters were determined with standard methods. Genetic polymorphisms of CYP 1A1 rs4646903, rs1048943, rs4986883, and rs1799814 were genotyped with polymerase chain reaction-restriction fragment length polymorphism (PCR-RFPL), while GSTM1 and GSTT1 deletions were detected with multiplex PCR. Cardiovascular risk was assessed with Framingham risk score, and the subjects divided in two groups: >10% risk and ≤10% risk. The two groups did not differ in the genotype frequencies. MANCOVA analysis, which included lipid parameters, glucose, and BMI with sex, age, hypertension and smoking status as covariates, showed a significant difference between the GSTT1*0 and GSTT1*1 allele carriers (p=0.001). UNIANCOVA with same covariates showed that total cholesterol and triglyceride levels were significantly higher in GSTT1*1 allele carriers than in GSTT1*0 carriers (p<0.001 and p=0.006, respectively). Our findings suggest that CYP1A1, GSTM1, and GSTT1 polymorphisms are not associated with the higher risk of CAD, but that GSTT1 affects lipid profile.

Systematic review of the association between oil and natural gas extraction processes and human reproduction.

This systematic review identified 45 original published research articles related to oil and gas extraction activities and human reproductive endpoints. Reproductive outcomes were categorized as [1] birth outcomes associated with maternal exposure, [2] semen quality, fertility, and birth outcomes associated with adult paternal exposure, [3] reproductive cancers, and [4] disruption of human sex steroid hormone receptors. The results indicate there is moderate evidence for an increased risk of preterm birth, miscarriage, birth defects, decreased semen quality, and prostate cancer. The quality of the evidence is low and/or inadequate for stillbirth, sex ratio, and birth outcomes associated with paternal exposure, and testicular cancer, female reproductive tract cancers, and breast cancer, and the evidence is inconsistent for an increased risk of low birth weight; therefore, no conclusions can be drawn for these health effects. There is ample evidence for disruption of the estrogen, androgen, and progesterone receptors by oil and gas chemicals, which provides a mechanistic rationale for how exposure to oil and gas activities may increase the health risks we have outlined. The results from this systematic review suggest there is a negative impact on human reproduction from exposure to oil and gas activities. Many of the 45 studies reviewed identified potential human health effects. Most of these studies focused on conventional oil and gas activities. Few studies have been conducted to evaluate the impact of unconventional oil and gas operations on human health. The impact of unconventional oil and gas activities may be greater than that of conventional activity, given that unconventional activities employ many of the same approaches and use dozens of known endocrine-disrupting chemicals in hydraulic fracturing.