The Southwest Pennsylvania Environmental Health Project (EHP) presented findings from their assessment of 113 clients who reported health issues they believe are linked to unconventional natural gas development (UNGD) near their homes. The EHP aims to provide public health information and services related to natural gas extraction. Their assessment found that the majority of clients reported respiratory, neurological, mental/emotional, and dermatological symptoms. They also observed variable exposures and episodic air quality issues near multiple UNGD sites that could contribute to intermittent symptoms experienced by clients. The EHP concludes that both chemical and non-chemical exposures from gas drilling pose health risks and that rapid community changes from UNGD carry mental health risks.

1. HALT the HARM
WEBINAR –
UNGD and Emerging
Health Effects
Southwest Pennsylvania
Environmental Health Project
March 23, 2015
www.environmentalhealthproject.org

2. 724.260.5504
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.

3. 724.260.5504

4. 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.
724.260.5504

5. 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
724.260.5504

6. 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.
724.260.5504

7. 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
724.260.5504

8. 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

9. 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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10. 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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11. 724.260.5504
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

12.  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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13. 724.260.5504
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.

14. 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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15. 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.

16. 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.
724.260.5504
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.

17. Breakdown of Symptoms, Continued
724.260.5504
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.

18. Breakdown of Symptoms, Continued
724.260.5504
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.

19. 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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20. 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.
724.260.5504

21. 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.
724.260.5504

22. 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
724.260.5504

23. For More Information
www.environmentalhealthproject.org
724.260-5504
info@environmentalhealthproject.org
724.260.5504