Feasibility and limitations of using commercial databases to evaluate residential mobility in registry-based research on childhood cancer.

BACKGROUND: Researchers have used commercial databases containing residential addresses to reduce exposure misclassification in case-control studies. Our objective is to evaluate the potential systematic bias regarding case status when reconstructing residential locations from commercial databases. METHODS: Our study population of 3640 Colorado-born children includes 520 children diagnosed with acute lymphocytic leukemia between 2002 and 2019. We aligned addresses and date ranges obtained from LexisNexis with registry dates to determine three dichotomous outcomes: Found in LexisNexis, conception date found in LexisNexis, and reference date/diagnosis date found in LexisNexis. We applied logistic regression to determine whether outcomes differed by case status. RESULTS: Mothers of cases were 39% more likely to be found in LexisNexis than mothers of controls (OR = 1.39, 95% CI: 0.97, 2). Of the mothers found in LexisNexis, a conception address was 33% more likely (OR= 1.33, 95% CI: 1.06, 1.66) and a reference/diagnosis address was 60% more likely (OR= 1.60, 95% CI: 1.21, 2.12) to be found for mothers of cases than mothers of controls. CONCLUSION: This study indicates that use of commercial databases to reconstruct residential locations may systematically bias results in case-control studies of childhood cancers.

Evaluating the sensitivity of mortality attributable to pollution to modeling Choices: A case study for Colorado.

We evaluated the sensitivity of estimated PM2.5 and NO2 health impacts to varying key input parameters and assumptions including: 1) the spatial scale at which impacts are estimated, 2) using either a single concentration-response function (CRF) or using racial/ethnic group specific CRFs from the same epidemiologic study, 3) assigning exposure to residents based on home, instead of home and work locations for the state of Colorado. We found that the spatial scale of the analysis influences the magnitude of NO2, but not PM2.5, attributable deaths. Using county-level predictions instead of 1 km2 predictions of NO2 resulted in a lower estimate of mortality attributable to NO2 by âˆ¼ 50 % for all of Colorado for each year between 2000 and 2020. Using an all-population CRF instead of racial/ethnic group specific CRFs results in a 130 % higher estimate of annual mortality attributable for the white population and a 40 % and 80 % lower estimate of mortality attributable to PM2.5 for Black and Hispanic residents, respectively. Using racial/ethnic group specific CRFs did not result in a different estimation of NO2 attributable mortality for white residents, but led to âˆ¼ 50 % lower estimates of mortality for Black residents, and 290 % lower estimate for Hispanic residents. Using NO2 based on home instead of home and workplace locations results in a smaller estimate of annual mortality attributable to NO2 for all of Colorado by 2 % each year and 0.3 % for PM2.5. Our results should be interpreted as an exercise to make methodological recommendations for future health impact assessments of pollution.

Health Symptoms and Proximity to Active Multi-Well Unconventional Oil and Gas Development Sites in the City and County of Broomfield, Colorado.

City and County of Broomfield (CCOB) residents reported over 500 health concerns between January 2020 and December 2021. Our objective was to determine if CCOB residents living within 1 mile of multi-well unconventional oil and gas development (UOGD) sites reported more frequent health symptoms than residents living > 2 miles away. We invited 3993 randomly selected households to participate in a health survey. We applied linear regression to test associations between distance to UOGD and summed Likert scores for health symptom categories. After covariate adjustment, respondents living within 1 mile of one of CCOB's UOGD sites tended to report higher frequencies of upper respiratory, lower respiratory, gastrointestinal and acute symptoms than respondents living more than 2 miles from the sites, with the largest differences for upper respiratory and acute symptoms. For upper respiratory and acute symptoms, scores differed by 0.81 (95% CI: 0.06, 2.58) and 0.75 (95% CI: 0.004, 1.99), respectively. Scores for adults most concerned about air pollution, noise and odors trended higher within 1 mile for all symptom categories, while scores among adults least concerned trended lower. Scores trended higher for lower respiratory, gastrointestinal and acute symptoms in children living within 2 miles of UOGD, after covariate adjustment. We did not observe any difference in the frequency of symptoms reported in unadjusted results. Additional study is necessary to understand relationships between proximity to UOGD and health symptoms.

Understanding Emerging Environmental Health Concerns and Environmental Public Health-Tracking Priorities Among State and Local Professionals in Colorado.

CONTEXT: Colorado is experiencing dramatic changes related to population growth, climate change, and expanded industrial activity. Local and state public health professionals are trying to address a growing array of unique public health issues with stagnant or limited resources. OBJECTIVES: To understand, through perspectives from local and state public health professionals, the alignment of contemporary environmental and community health issues with state and local capacity and state environmental public health-tracking priorities. DESIGN: During 2014-2015, we conducted semistructured interviews which informed the development of a statewide survey of Colorado's professionals from public health, emergency management, forestry, and transportation. SETTING: This work took place in Colorado. PARTICIPANTS: Fifteen professionals from public (n = 9), academic (n = 4), and private (n = 2) sectors were interviewed. Forty-seven professionals, representing 34 counties and 40 public agencies, completed the 25-minute online survey. MAIN OUTCOME MEASURES: Environmental and community health concerns; contributing factors to environmental concerns; strengths and limitations of capacity to respond to issues; and frequency of community engagement activities. RESULTS: Top environmental health concerns were indoor air pollution (eg, radon), outdoor air pollution, and waste management. Transportation, extreme weather (eg, wildfires), and oil and gas development were most frequently reported as major contributing factors to concerns. Obesity, physical inactivity, and mental illness were the top community health concerns. To remain prepared for emerging challenges, professionals cited a need for more spatiotemporal-refined data related to their top concerns in the environmental public health-tracking database, and support from local, state, and federal agencies, in addition to personnel and funding. To address concerns, participants reported frequently working with government officials, advisory committees, and media outlets. CONCLUSIONS: This project illuminates opportunities to strengthen connections between the state's environmental public health-tracking priorities and local-level capacity related to professionals' top concerns. It also suggests reinforcing and broadening partnerships to improve data infrastructure and inform environmental public health priorities.

Congenital heart defects and intensity of oil and gas well site activities in early pregnancy.

BACKGROUND: Preliminary studies suggest that offspring to mothers living near oil and natural gas (O&G) well sites are at higher risk of congenital heart defects (CHDs). OBJECTIVES: Our objective was to address the limitations of previous studies in a new and more robust evaluation of the relationship between maternal proximity to O&G well site activities and births with CHDs. METHODS: We employed a nested case-control study of 3324 infants born in Colorado between 2005 and 2011. 187, 179, 132, and 38 singleton births with an aortic artery and valve (AAVD), pulmonary artery and valve (PAVD), conotruncal (CTD), or tricuspid valve (TVD) defect, respectively, were frequency matched 1:5 to controls on sex, maternal smoking, and race and ethnicity yielding 2860 controls. We estimated monthly intensities of O&G activity at maternal residences from three months prior to conception through the second gestational month with our intensity adjusted inverse distance weighted model. We used logistic regression models adjusted for O&G facilities other than wells, intensity of air pollution sources not associated with O&G activities, maternal age and socioeconomic status index, and infant sex and parity, to evaluate associations between CHDs and O&G activity intensity groups (low, medium, and high). RESULTS: Overall, CHDs were 1.4 (1.0, 2.0) and 1.7 (1.1, 2.6) times more likely than controls in the medium and high intensity groups, respectively, compared to the low intensity group. PAVDs were 1.7 (0.93, 3.0) and 2.5 (1.1, 5.3) times more likely in the medium and high intensity groups for mothers with an address found in the second gestational month. In rural areas, AAVDs, CTDs, and TVDs were 1.8 (0.97, 3.3) and 2.6 (1.1, 6.1); 2.1 (0.96, 4.5) and 4.0 (1.4, 12); and 3.4 (0.95, 12) and 4.6 (0.81, 26) times more likely than controls in the medium and high intensity groups. CONCLUSIONS: This study provides further evidence of a positive association between maternal proximity to O&G well site activities and several types of CHDs, particularly in rural areas.

Community Noise and Air Pollution Exposure During the Development of a Multi-Well Oil and Gas Pad.

Unconventional oil and gas development (UOGD) in the United States is increasingly being conducted on multiwell pads (MWPs) and in residential areas. We measured air pollution, noise, and truck traffic during four distinct phases of UOGD: drilling, hydraulic fracturing, flowback, and production. We monitored particulate matter (PM2.5), black carbon (BC), A-weighted (dBA), and C-weighted (dBC) noise using real-time instruments on 1 and 5 min time scales, and truck traffic for 4-7 days per phase at a large 22-well pad sited in a residential area of Weld County, Colorado. Hydraulic fracturing, which requires frequent truck trips to move supplies and diesel engines to power the process, had the highest median air pollution levels of PM2.5 and BC and experienced the greatest number of heavy trucks per hour compared to other phases. Median air pollution was lowest during drilling at this MWP, possibly because an electric drill rig was used. The equivalent continuous noise level ( Leq) exceeded guidelines of 50 dBA and 65 dBC for A-weighted and C-weighted noise, respectively, during all development phases. Our data show that these multiple stressors are present around the clock at these sites, and this work provides baseline measurements on likely human exposure levels near similarly sized MWPs.

Environmental Justice in Unconventional Oil and Natural Gas Drilling and Production: A Critical Review and Research Agenda.

The drilling phase of oil and natural gas development is a growing area of environmental justice (EJ) research, particularly in the United States. Its emergence complements the longstanding EJ scholarship on later phases of the oil and gas commodity chain, such as pipeline transport, refining, and consumption. The growing scholarly attention to the EJ implications of drilling has been prompted by the surge in development of unconventional oil and gas resources in recent decades. More specifically, the oil and gas industry's adoption of horizontal drilling and hydraulic fracturing (a.k.a., "fracking" or "fracing") as methods for extracting oil and gas from a wider range of geologic formations has simultaneously heightened oil and gas production, brought extractive activities closer to more people, intensified them, and made well pad siting more flexible. Here, we provide a critical review of the novel EJ research questions that are being prompted by these on-the-ground changes in extractive techniques and patterns, propose an interdisciplinary conceptual framework for guiding EJ inquiry in this context, discuss key methodological considerations, and propose a research agenda to motivate future inquiry.

Relationships between indicators of cardiovascular disease and intensity of oil and natural gas activity in Northeastern Colorado.

BACKGROUND: Oil and natural gas (O&G) extraction emits pollutants that are associated with cardiovascular disease, the leading cause of mortality in the United States. OBJECTIVE: We evaluated associations between intensity of O&G activity and cardiovascular disease indicators. METHODS: Between October 2015 and May 2016, we conducted a cross-sectional study of 97 adults living in Northeastern Colorado. For each participant, we collected 1-3 measurements of augmentation index, systolic and diastolic blood pressure (SBP and DBP), and plasma concentrations of interleukin (IL)- 1ß, IL-6, IL-8 and tumor necrosis factor alpha (TNF-α). We modelled the intensity of O&G activity by weighting O&G well counts within 16 km of a participant's home by intensity and distance. We used linear models accounting for repeated measures within person to evaluate associations. RESULTS: Adjusted mean augmentation index differed by 6.0% (95% CI: 0.6, 11.4%) and 5.1% (95%CI: -0.1, 10.4%) between high and medium, respectively, and low exposure tertiles. The greatest mean IL-1ß, and α-TNF plasma concentrations were observed for participants in the highest exposure tertile. IL-6 and IL-8 results were consistent with a null result. For participants not taking prescription medications, the adjusted mean SBP differed by 6 and 1 mm Hg (95% CIs: 0.1, 13 mm Hg and -6, 8 mm Hg) between the high and medium, respectively, and low exposure tertiles. DBP results were similar. For participants taking prescription medications, SBP and DBP results were consistent with a null result. CONCLUSIONS: Despite limitations, our results support associations between O&G activity and augmentation index, SBP, DBP, IL-1ß, and TNF-α. Our study was not able to elucidate possible mechanisms or environmental stressors, such as air pollution and noise.

Effect of an opioid management program for Colorado workers' compensation providers on adherence to treatment guidelines for chronic pain.

OBJECTIVE: The aim of this study was to examine adherence of state guidelines for Colorado workers' compensation physicians/providers treating individuals as injured workers with chronic pain after initiation of an opioid management program and provider incentives. METHODS: A retrospective cohort of chronic, non-cancer pain claims was constructed from the Colorado's workers' compensation database. Adherence to treatment guidelines and opioid prescribing practices were evaluated during implementation of a new billing code to incentivize adherence. RESULTS: Overall, less than 33% of claims showed evidence of opioid management. Comprehensive opioid management was observed in only 4.4% of claims. In 2010, after implementing the new billing code, the ratio of long acting opioids to short acting opioids decreased from 0.2 to 0.13; returning to 0.2 in one year. Similarly, morphine equivalent doses declined for a short period. CONCLUSIONS: Incentivizing physicians to adhere to chronic pain management guidelines only temporarily improves prescribing practices.

Measuring environmental noise from airports, oil and gas operations, and traffic with smartphone applications: laboratory and field trials.

Environmental noise from sources such as traffic, airports, and oil and gas (O&G) operations is associated with nuisance and health concerns. Smartphones with external microphones have been recommended for environmental noise monitoring and may be useful tools for citizen science, but are not validated against reference methods. We evaluated laboratory performance of three smartphone/application (app) configurations recommended for environmental noise measurement. Two smartphone/app configurations were also compared to a reference sampler, a type 1 sound level meter (SLM) at ten outdoor sites with traffic, airport, and O&G noise. To evaluate performance, we compared the mean squared error, variance, bias, and Krippendorff's Alpha by smartphone/app combination and testing location for both audible (A-weighted) and low-frequency (C-weighted) noise. We observed that laboratory measurements were in strong agreement with a reference sampler. The field A-weighted noise level results had strong agreement with the SLM at several outdoor sites, but our C-weighted noise results ranged from moderate to substantial agreement. For our tested configurations, we find that smartphones with external microphones are reliable proxies for measuring A- and C-weighted noise in a laboratory setting. Outdoor performance depends on noise source type, weighting, and precision and accuracy needs of the investigation.

Truck and Multivehicle Truck Accidents with Injuries Near Colorado Oil and Gas Operations.

Unconventional and conventional oil and gas (O&G) operations raise public health concerns, such as the potential impacts from trucking activity in communities that host these operations. In this work, we used two approaches to evaluate accidents in relation to O&G activities in the State of Colorado. First, we calculated the rate of truck accidents by computing the ratio of accident count and county population. When comparing counties with increased O&G operations to counties with less activity, we found that counties with more activity have greater rates of truck traffic accidents per capita (Rate Ratio = 1.07, p < 0.05, 95% CI: 1.01⁻1.13). Second, we laid a grid over the eleven counties of interest and counted, for each cell, the number of truck accidents, the number of multivehicle accidents with injuries, the number of homes, and the number of O&G wells. We then applied hurdle count models, using the accident counts as the outcomes and the number of homes and number of wells as independent variables. We found that both independent variables are significant predictors of truck accidents and multivehicle truck accidents. These accidents are of concern since they can have an impact on the people who live near O&G operations.

Residential noise from nearby oil and gas well construction and drilling.

Public concern about oil and gas (O&G) operations in residential areas is substantial. Noise from construction and drilling related to O&G operations may be greater than other phases of O&G operations; yet the impacts of audible and low-frequency noise during these operations are not extensively explored nor the effects on health well understood. This study documents the noise levels at a multi-well O&G well pad during construction and drilling in a residential area in Colorado. A-weighted (dBA) and C-weighted (dBC) noise measurements were collected at four locations during development over a 3-month period. The maximum 1-min equivalent continuous sound levels over a 1-month period were 60.2 dBA and 80.0 dBC. Overall, 41.1% of daytime and 23.6% of nighttime dBA 1-min equivalent continuous noise measurements were found to exceed 50 dBA, and 97.5% of daytime and 98.3% of nighttime measurements were found to exceed 60 dBC. Noise levels exceeding 50 dBA or 60 dBC may cause annoyance and be detrimental to health; thus, these noise levels have the potential to impact health and noise levels and associated health effects warrant further investigation.

Ambient Nonmethane Hydrocarbon Levels Along Colorado's Northern Front Range: Acute and Chronic Health Risks.

Oil and gas (O&G) facilities emit air pollutants that are potentially a major health risk for nearby populations. We characterized prenatal through adult health risks for acute (1 h) and chronic (30 year) residential inhalation exposure scenarios to nonmethane hydrocarbons (NMHCs) for these populations. We used ambient air sample results to estimate and compare risks for four residential scenarios. We found that air pollutant concentrations increased with proximity to an O&G facility, as did health risks. Acute hazard indices for neurological (18), hematological (15), and developmental (15) health effects indicate that populations living within 152 m of an O&G facility could experience these health effects from inhalation exposures to benzene and alkanes. Lifetime excess cancer risks exceeded 1 in a million for all scenarios. The cancer risk estimate of 8.3 per 10 000 for populations living within 152 m of an O&G facility exceeded the United States Environmental Protection Agency's 1 in 10 000 upper threshold. These findings indicate that state and federal regulatory policies may not be protective of health for populations residing near O&G facilities. Health risk assessment results can be used for informing policies and studies aimed at reducing and understanding health effects associated with air pollutants emitted from O&G facilities.

Spatiotemporal Industrial Activity Model for Estimating the Intensity of Oil and Gas Operations in Colorado.

Oil and gas (O&G) production in the United States has increased in the last 15 years, and operations, which are trending toward large multiwell pads, release hazardous air pollutants. Health studies have relied on proximity to O&G wells as an exposure metric, typically using an inverse distance-weighting (IDW) approach. Because O&G emissions are dependent on multiple factors, a dynamic model is needed to describe the variability in air pollution emissions over space and time. We used information on Colorado O&G activities, production volumes, and air pollutant emission rates from two Colorado basins to create a spatiotemporal industrial activity model to develop an intensity-adjusted IDW well-count metric. The Spearman correlation coefficient between this metric and measured pollutant concentrations was 0.74. We applied our model to households in Greeley, Colorado, which is in the middle of the densely developed Denver-Julesburg basin. Our intensity-adjusted IDW increased the unadjusted IDW dynamic range by a factor of 19 and distinguishes high-intensity events, such as hydraulic fracturing and flowback, from lower-intensity events, such as production at single-well pads. As the frequency of multiwell pads increases, it will become increasingly important to characterize the range of intensities at O&G sites when conducting epidemiological studies.

Childhood hematologic cancer and residential proximity to oil and gas development.

BACKGROUND: Oil and gas development emits known hematological carcinogens, such as benzene, and increasingly occurs in residential areas. We explored whether residential proximity to oil and gas development was associated with risk for hematologic cancers using a registry-based case-control study design. METHODS: Participants were 0-24 years old, living in rural Colorado, and diagnosed with cancer between 2001-2013. For each child in our study, we calculated inverse distance weighted (IDW) oil and gas well counts within a 16.1-kilometer radius of residence at cancer diagnosis for each year in a 10 year latency period to estimate density of oil and gas development. Logistic regression, adjusted for age, race, gender, income, and elevation was used to estimate associations across IDW well count tertiles for 87 acute lymphocytic leukemia (ALL) cases and 50 non-Hodgkin lymphoma (NHL) cases, compared to 528 controls with non-hematologic cancers. FINDINGS: Overall, ALL cases 0-24 years old were more likely to live in the highest IDW well count tertiles compared to controls, but findings differed substantially by age. For ages 5-24, ALL cases were 4.3 times as likely to live in the highest tertile, compared to controls (95% CI: 1.1 to 16), with a monotonic increase in risk across tertiles (trend p-value = 0.035). Further adjustment for year of diagnosis increased the association. No association was found between ALL for children aged 0-4 years or NHL and IDW well counts. While our study benefited from the ability to select cases and controls from the same population, use of cancer-controls, the limited number of ALL and NHL cases, and aggregation of ages into five year ranges, may have biased our associations toward the null. In addition, absence of information on O&G well activities, meteorology, and topography likely reduced temporal and spatial specificity in IDW well counts. CONCLUSION: Because oil and gas development has potential to expose a large population to known hematologic carcinogens, further study is clearly needed to substantiate both our positive and negative findings. Future studies should incorporate information on oil and gas development activities and production levels, as well as levels of specific pollutants of interest (e.g. benzene) near homes, schools, and day care centers; provide age-specific residential histories; compare cases to controls without cancer; and address other potential confounders, and environmental stressors.

Population Size, Growth, and Environmental Justice Near Oil and Gas Wells in Colorado.

We evaluated population size and factors influencing environmental justice near oil and gas (O&G) wells. We mapped nearest O&G well to residential properties to evaluate population size, temporal relationships between housing and O&G development, and 2012 housing market value distributions in three major Colorado O&G basins. We reviewed land use, building, real estate, and state O&G regulations to evaluate distributive and participatory justice. We found that by 2012 at least 378,000 Coloradans lived within 1 mile of an active O&G well, and this population was growing at a faster rate than the overall population. In the Denver Julesburg and San Juan basins, which experienced substantial O&G development prior to 2000, we observed a larger proportion of lower value homes within 500 feet of an O&G well and that most O&G wells predated houses. In the Piceance Basin, which had not experienced substantial prior O&G development, we observed a larger proportion of high value homes within 500 feet of an O&G well and that most houses predated O&G wells. We observed economic, rural, participatory, and/or distributive injustices that could contribute to health risk vulnerabilities in populations near O&G wells. We encourage policy makers to consider measures to reduce these injustices.