June 7, 2012

forestsaintregisΠετρελαϊκά και Εξόρυξη

8 Νοε 2013 (πριν από 3 χρόνια και 7 μήνες)

102 εμφανίσεις

1

Elizabeth Rose Mayeda, MPH

Student Case Study Presentation

Environmental and Occupational Epidemiology


University of California, San Francisco

June 7, 2012

Outline


The event


Clean up


Possible health effects


Current studies


Future studies


Implications




2

Deepwater

Horizon


Explosion on a BP offshore oil rig on April 20, 2010
11 workers died immediately


More than 30 workers seriously injured


Oil flowed unabated for 3 months


Wellhead capped July 15, 2010


Oil continues to seep


Millions
of barrels of
oil released into the Gulf

Goldstein, N
Engl

J Med, 2011

3

Deepwater

Horizon oil rig

4

Deepwater

Horizon oil rig

5

Oil sheen

6

Footage
of the leak

7

Tracking the oil spill

8

How did it happen?


National Commission on the BP
Deepwater

Horizon
Oil Spill and Offshore Drilling:


“Regulators failed to keep pace with the industrial
expansion and new technology”


“Inexcusable shortfall in supervision of offshore
drilling”


http://
www.oilspillcommission.gov

9

Unique oil spill


Magnitude


Duration of release


Source of emission (deep sea floor)


Management techniques (dispersants and
controlled burns)


Goldstein, N
Engl

J Med, 2011

10

Population


Vulnerable population


Communities with poor health indexes


Environmental justice concerns


Recurrent natural disasters


Communities still recovering from Hurricane Katrina

Goldstein, N
Engl

J Med, 2011

11

Oil slick control


Dispersant


Used to dissipate oil slicks


Oil effectively spread throughout larger volume of
water than surface


Controlled burns


12

Potential health consequences


Four broad categories:

1.
Worker safety

2.
Toxicologic

effects in workers, community
members, and visitors

3.
Mental health effects from social and economic
disruption

4.
Ecosystem effects that affect human health


Acute and long term effects


Generally unknown!

Goldstein, N
Engl

J Med, 2011

13

Worker health


Thousands of clean
-
up workers and
volunteers


Health concerns:


Chemical exposures


Heat exhaustion


Degree of exposure depends on:


Job assignment


Duration of exposure


Extent of worker training


Use of personal protective equipment


Goldstein, N
Engl

J Med, 2011

14

Toxicologic

effects


Acute:


Respiratory and dermal irritation


Headaches


Eye irritation


Nausea


Long
term


Pulmonary function


Endocrine disorders


Genotoxic

effects


15

Contaminants of concern


Crude oil


>1,000 different hydrocarbons


Polynucular

aromatic hydrocarbons (PAHs)


Trace metals


Sulfur


A lot of variability in composition depending on
source


Dispersant

Goldstein, N
Engl

J Med, 2011

16

Routes of exposure


All 5 elements of a complete exposure pathway
present:

1.
Sources of contaminants

2.
Environmental media

3.
Points of exposure

4.
Routes of exposure

5.
Receptor population

Goldstein, N
Engl

J Med, 2011

17

Mental
health effects


Anxiety


Depression


Post
-
traumatic stress


18

Ecosystem effects


National seafood safety
-
issue


Bioaccumulation and
biomagnitifcation

of crude oil
components (esp. PAHs) in seafood

19


Controversy about FDA
guidelines on Gulf
seafood safety


Ecosystem effects

20

Ecosystem effects

21

Studies

22

Osofsky

et al. 2011

1. What was the objective of this study?


23

Osofsky

et al. 2011

1. What
was the objective of this study?


To
assess
the mental health effects of the
Deepwater

Horizon oil spill on residents of areas of
southeastern Louisiana affected by the spill
.

Osofsky

et al., Disaster Med Public Health Prep. 2011

24

2.
What methods did the researchers use? Do you
these methods were appropriate for the study
objective?


25

Osofsky

et al. 2011

2. What
methods did the researchers use? Do you these
methods were appropriate for the study objective?


C
ross
-
sectional study


Random
and purposive sampling
techniques


Correlation
analyses to assess associations among
occupation, proximity to spill, oil spill disruption, oil spill
concerns, Katrina impact, place satisfaction, and rebound
resilience with PCL
-
C (posttraumatic stress) and K6 scores
(anxiety and depression symptoms).


Multiple
regression analyses
to
assess the extent to which oil
spill variables predicted posttraumatic stress scores and
symptoms of depression and anxiety.


26

Osofsky

et al. 2011

3.
The researchers used both random and purposive
sampling techniques.


Why
did the researchers use these
techniques?


How
could these techniques have affected the
results?


What
implications do the sampling techniques have
on the conclusions of the study?


27

Osofsky

et al. 2011


Purposive sampling was to allow for more detailed
sampling of individuals from fishing, tourism, and
oil drilling
-
related industries.


Difficult to identify study population

what
population
does the study population represent?


Some interviews over the phone and some in
person
---
type of interview may have affected
responses?

28

Osofsky

et al. 2011

4.
The telephone response rate was only 25%.


How
could this have affected the study
results?


How
did the authors attempt to address the low
response rate?


29

Osofsky

et al. 2011


Selection
bias


瑨牥慴⁴漠
楮i敲湡氠癡汩摩v礠潦⁴桥o
study.


Data
collection using landlines also excludes
people from sample.


Purposive
sampling techniques used to address
the low response rate and increase representation
of responses.


30

Osofsky

et al. 2011

5.
What did the authors report about the association
between Hurricane Katrina and mental health effects
of the oil spill?


31

Osofsky

et al. 2011


Losses from Katrina were highly associated with
negative mental health outcomes.


32

Osofsky

et al. 2011

6.
What is the main conclusion from this study?


33

Osofsky

et al. 2011


The largest effect on mental well
-
being was the
extent of disruption that the oil spill created in an
individual’s life: work, family, social
engagement.


This
finding was consistent with findings from
previous oil spills.


34

Osofsky

et al. 2011

7.
How can the findings of this study be used to
improve public health?


35

Osofsky

et al. 2011


Gaining and understanding of the mental health
effects will help determine directions of mental
health services for people affected by the spill and
future oil spills and disasters
.

36

Grattan et al. 2011


Objective:


Examine acute mental health effects of indirect and
direct community oil exposure and income loss.


Methods:


Cross
-
sectional survey of two Gulf Coast
communities


Indirect exposure group in Florida, (
n=71
)


Direct exposure group in Alabama,
(n=23
)



Grattan et al. Environ Health
Perspect
, 2012

37

Grattan et al. 2011


Results:


No
significant differences in psychological impact
between communities.


Individuals
with income loss
reported more
psychological distress symptoms.


Conclusions:


Mental health effects may be underestimated in Gulf
Coast communities that were not directly exposed to
oil.


Income loss after the spill may have the greatest
impact on mental health.


38

GuLF

Study


GuLF

(Gulf Long Term Follow
-
up) Study


Led by National Institute of Environmental Health
Sciences (NIEHS)


Plans to follow 55,000 Gulf oil spill workers and
volunteers for up to 10 years


Open
-
ended study

not focused on specific
endpoints


Launched February 28, 2011


Enrollment ongoing

Goldstein, N
Engl

J Med, 2011,
http://nihgulfstudy.org/reports.html
;
http://www.niehs.nih.gov/news/newsroom/releases/2011/february28/

39

GuLF

study


All
participants: telephone interview asking
questions about:


The
work they did with the oil spill
cleanup


Health
, lifestyle, and job
history


Phase 2 (~20,000 participants): home
visit and
follow
-
up telephone interviews in subsequent
years.


Samples
of blood, urine, toenail clippings, hair, and
house
dust


Clinical measurements: blood
pressure, height and
weight, urine glucose, and lung
function

40

GuLF

Study


Largest study of it’s kind


One component of federal response to the disaster


Findings expected to:


Help inform policy decisions on health care and
services in the region


Influence responses to future oil spills

41

Implications


Potential long
-
term health effects


Recovery


Future disasters


Future oil spills

42

Thank you for your attention

43