HALT the HARM WEBINAR – UNGD and Emerging Health Effects

Southwest Pennsylvania Environmental Health Project March 23, 2015

www.environmentalhealthproject.org

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Our mission is to respond to individuals’ and communities’ need

for access to accurate, timely and trusted public health information and

health services associated with natural gas extraction.

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EHP Outreach

1. Respond to clients in need Assess individual health issues ID pathways of environmental exposure Air and water quality monitoring Soil impacts (under development)

2. Work with clients to manage and improve their health and wellbeing.

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EHP Outreach

Communities that reach out to us: Regional watershed groups Clients/groups concerned about the placement

of UNGD in their communities Clients/groups specifically concerned about the

placement of UNGD near schools

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EHP Data Collection With clients/community permission, aggregate

data are collected on health, air, water impacts. EHP seeks to establish strong associations

between the presence of surrogate chemicals, particulate matter (PM) and health impacts that are associated with the chemicals identified as part of UNGD.

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Episodic Air Exposures Clients experience symptoms that come and go (e.g. respiratory problems, headaches, nausea, skin rashes, etc.). Factors that might contribute to this include: Variable emissions Homes are surrounded by multiple sites Weather causes further patterns of variability

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Health Issues Category Researcher/author

Behavioral/mood/stress *

Earthworks (2012) Ferrar et al. (2013) Subra (2009) Perry (2013) Resick (2013)

Birth Outcomes Hill (2012) McKenzie (2014)

Cancer risk McKenzie (2012)

Dermal * Earthworks (2012) Subra (2009)

Ear, nose, mouth, throat *

Earthworks (2012) Subra (2010) Subra (2009)

Eye * Earthworks (2012) Bamberger & Oswald (2012) Subra (2010) Subra (2009)

Category Researcher/author

Gastrointestinal * Earthworks (2012) Bamberger & Oswald (2012) Ferrar et al. (2013)

High Blood pressure *

Subra (2010)

Muscle/joint pain * Earthworks (2012) Subra (2010) Subra (2009)

Neurological * Bamberger & Oswald (2012) Subra (2010) Subra (2009)

Respiratory * Earthworks (2012) Bamberger & Oswald (2012) Subra (2009)

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* EHP has observed these generalized symptoms in our categorization of health symptoms

Health Findings EHP Health Assessments include: Full health history of client; Recording of vital signs and symptoms; Documentation of occupational and household

exposures; and Recommendations for further medical consultations

and/or steps to cut off pathways of exposure (air, water, or soil)

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UNGD Acute Symptom Inventory (113 clients who met screening criteria)*

NOSE AND THROAT SYMPTOMS sore throat, sinus pain, nose bleed

NEUROLOGICAL SYMPTOMS headache, difficulty concentrating, dizziness, numbness/ tingling, word recall trouble MENTAL/EMOTIONAL HEALTH SYMPTOMS difficulty sleeping, moody/ irritable, anxiety, panic attacks, stress RESPIRATORY SYMPTOMS cough, shortness of breath, wheezing GASTRO-INTESTINAL SYMPTOMS nausea, abdominal pain, diarrhea

* Screening criteria: Complete intake process, plausible exposure, temporal relationship between exposure and symptom, absence of another likely cause of symptom

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UNGD Acute Symptom Inventory, cont. (113 clients who met screening criteria)*

DERMATOLOGICAL SYMPTOMS rash, itching, burning OPTHAMOLOGICAL SYMPTOMS itching and burning, blurred vision, dry eye, pain CONSTITUTIONAL SYMPTOMS fatigue, dizziness, weight change CARDIAC SYMPTOMS heart rate, chest pain ENDOCRINE SYMPTOMS hair loss, thinning hair AUDITORY SYMPTOMS tinnitus, hearing loss * Screening criteria: Complete intake process, plausible exposure, temporal relationship between exposure and symptom, absence of another likely cause of symptom

A complete health history was taken;

Majority of exposures were environmental (97%) with a few occupational (3%);

A potential exposure to UNGD had occurred, AND

symptoms were present where there may have been an exposure.

Criteria for Inclusion

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Symptoms Reported to EHP Nurse Practitioner N=113*

Individuals reporting

Percentage of total cases

Nose & throat 68 60%

Neurological 65 58%

Mental/emotional health 64 57%

Respiratory 60 53%

Gastro-Intestinal 56 50%

Dermatological 55 49%

Ophthalmological 44 39%

Constitutional 40 35%

Cardiac 33 29%

Endocrine 21 19%

Auditory 19 17%

*Clients report multiple symptoms so the numbers do not total 113.

Breakdown of Symptoms

Nose & throat • 69 people reported nose and throat symptoms. • That’s 61% of the cases. • Of these 69 people, 58% report sore throat, 45% report sinus pain,

and 23% report nosebleeds.

Neurological • 65 people reported neurological symptoms. • That’s 58% of the cases. • Of these 65 people, 78% reported headaches, 31% reported

difficulty concentrating, 25% reported dizziness, 34% reported numbness and tingling, 20% reported memory loss and 20% reported difficulty speaking.

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Mental /Emotional Health • 64 people reported mental/behavioral health symptoms. • That’s 57% of the cases. • Of those 64 people, 58% reported difficulty sleeping, 53% reported

stress, 41% reported anxiety, 34% reported irritability/moodiness and 19% reported depression.

Breakdown of Symptoms, Continued

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Respiratory • 60 people reported respiratory symptoms. • That’s 53% of the cases. • Of these 60 people, 63% reported coughing, 60% reported

shortness of breath, and 50% reported wheezing.

Breakdown of Symptoms, Continued Gastro-Intestinal • 56 people reported gastro-intestinal symptoms. • That’s 50% of the cases. • Of these 22 people, 46% report nausea, 38% report abdominal

pain, and 20% report diarrhea.

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Dermatological • 55 people reported dermatological symptoms. • That’s 49% of the cases. • Of these 55 people, 49% reported rashes, 33% reported itching,

and 13% reported burning.

Breakdown of Symptoms, Continued

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Ophthalmological • 44 people reported ophthalmological symptoms. • That’s 39% of the cases. • Of these 44 people, 68% reported itching and burning, 30%

reported blurred vision and 14% reported dry eyes

Constitutional • 40 people reported constitutional symptoms. • That’s 35% of the cases. • Of these 40 people, 73% reported fatigue and 20% reported

weight change.

Breakdown of Symptoms, Continued

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Endocrine • 21 people reported endocrine symptoms. • That’s 19% of the cases. • Of these 21 people, 74% reported thinning/loss of hair and 42%

reported issues with urination.

Cardiac • 33 people reported cardiac symptoms. • That’s 29% of the cases. • Of these 33 people, 45% reported palpitations and 39% reported

chest pain.

Auditory • 19 people reported auditory symptoms. • That’s 17% of the cases. • Of these 19 people, 89% reported ringing in ears.

Review of Reported Symptoms Symptoms might be

persistent, transient, or intermittent. These variations in symptom presentation are consistent with the changing and episodic* nature of exposures.

Cases are based on concern of a resident or evidence of exposure potential, not a random survey of all clients in Washington County.

*See image

Speck PM 2.5 Air Monitor Screenshot

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Conclusions: UNGD-Related Potential Health Concerns Both chemical and non-

chemical exposures produced by gas drilling activities pose health risks to human and animal residents of gas production areas.

Rapid change resulting

from introduction of gas drilling activities into rural communities carries risk of social disruption and mental health consequences.

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Help Clients at Risk Clients need to know and understand conditions that make

them susceptible to adverse health effects. EHP provides and/or recommends the following:

Real time air and water monitors. Devices to remove particulate and gases from home air. Provide an air model to determine periods of high risk. Management guidance for cleaning homes. Worry and anxiety support systems. Warning signs of health effects. Access to appropriate medical care.

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EHP Team Raina Rippel, BA – Director Norman Anderson, MPH – Environmental Health Consultant David R. Brown, ScD – Environmental Health Consultant Jessa Chabeau, MSW – Case Manager Larry Choby, MPH – Operations Manager Ryan Grode, BS – Environmental Health Educator Lydia Greiner, BSN, MSN – Health and Wellness Consultant Michael Thorne Kelly, PhD – Strategic Planning Consultant Jill Kriesky, MS, PhD – Associate Director Celia Lewis, PhD – Research and Communications Consultant Carole L. Perry, RN, PhD – Nurse Educator Lenore K. Resick, PhD, CRNP, FNP-BC – Family Nurse Practitioner Leslie Walleigh, MD, MPH – Medical and Occupational Health Consultant Beth Weinberger, MPH, PhD – Research and Communications Consultant

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For More Information www.environmentalhealthproject.org

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info@environmentalhealthproject.org

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