Assessing the Effects of the Gulf of Mexico Oil Spill on Human Health A Summary of the June 2010 Workshop (2010) / Chapter Skim
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3 Short- and Long-Term Effects on Human Health
3 Short- and Long-Term Effects on Human Health
Pages 43-74
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outcomes; both physical and psychological effects of exposure; both physical stressors (e.g., heat stress and fatigue) and chemical stressors (e.g., the oil and dispersants)
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Drawing from non-oil-spill studies, she explored the types of health outcomes that could be monitored in a surveillance system, identified various sources for immediate biomonitoring activities, and explained the importance of adhering to the precautionary principle when working with pregnant women and children. Finally, Irwin Redlener focused on child physical and psychological development and health, describing the crucial characteristics that make children uniquely vulnerable to short- and long-term adverse health effects stemming from the Gulf oil spill.
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. Short-Term Physical Effects Nalini Sathiakumar, University of Alabama, Birmingham The Gulf oil spill and its related response efforts pose various hazards to individuals, which can increase the risk of adverse health outcomes, including acute toxicity and physical injuries.
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found that clean-up workers reported increased acute toxic symptoms (primarily neurological, ocular, and upper respiratory symptoms) and physical injuries (lower back pain)
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In 2009, Meo and colleagues used a spirometer to identify a significant reduction in lung function among clean-up workers, but found that lung function improved when workers were removed from the polluted environment. Summary of Results Previous studies provide important lessons about acute toxicity symptoms, genotoxicity, endocrine toxicity, injuries, and PPE usage.
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Although not all studies measured particular exposure levels, among those that did, hydrocarbons were below occupational safety levels, levels of benzene did not exceed threshold limit values, and VOCs were within the range observed in urban environments, according to Sathiakumar. In communities living in the vicinity of the oil spills, even after controlling for preexisting allergies and medical conditions, there was consistent evidence of acute toxic effects (mainly neurological, ocular, and respiratory but not dermal)
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A few studies also analyzed the effect that use of PPE had on the reporting of acute toxicity symptoms. Results indicate that PPE usage (especially protective eyewear)
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Although these studies provide valuable information about the types of health outcomes that may be appropriate for surveillance activities related to the Gulf oil spill, Sathiakumar described some methodological limitations that should also be considered. First, in addition to relatively small sample sizes and low rates of participation within affected populations, most of the past studies on short-term effects of oil spill exposures were cross-sectional.
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Despite a strong understanding of how limited exposure to heat stress can affect the health of individuals, said Bernard, more information is needed on the cumulative effects of exposure to extreme heat or "heat fatigue." Understanding heat fatigue is especially important in the context of the Gulf oil spill where people are working 12 hours a day each day of the week. Borrowing from work-physiology models and studies of military recruits and the general population during documented heat waves, Bernard stated that repeated exposures to heat stress also increase the occurrence of injuries and place more strenuous demands on the cardiovascular system.
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Workers may also underestimate the risk associated with their jobs -- believing that, because they work in familiar heat environments, occupational exposure limits are too conservative. Although Bernard observed that the Gulf oil spill management and supervision system appears "highly adaptive," he also suggested that bottom-up communications, such as social marketing, could improve risk communication, better ensuring the recognition and treatment of serious adverse health outcomes, such as heat stroke.
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Much of what is known about the neurotoxic potential of chemicals in crude oil has been obtained largely from the administration of large chemical doses to laboratory animals in experimental settings. Additionally, because the underlying mechanisms for short- and long-term effects may be entirely different, the presence of acute health effects, such as headaches and dizziness, may or may not accurately predict the development of long-term effects.
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Human Reproduction and Child Development Brenda Eskenazi, University of California, Berkeley Chemical exposures before conception, during gestation, and after birth can affect a child's health. Direct chemical exposures can occur to a fetus or a child across the placenta or by ingestion, inhalation, or dermal absorption.
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. Paternal exposures to certain chemicals can also affect offspring, which is important because many of the Gulf oil disaster clean-up workers are fathers or future fathers, said Eskenazi.
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Researchers can also petition local health departments to add questions to birth certificates to help fill existing data gaps. For example, one study of pregnant women after the 2001 World Trade Center disaster found a much higher proportion of lower birth weight children and more females than expected (Eskenazi et al., 2007)
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x Children are highly susceptible to short- and long-term stress. As a result of their unique characteristics, children are more susceptible to adverse outcomes related to the Gulf oil spill and its response activities.
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In fact, the well-being of children is directly related to the resiliency and stability of their parents, said Redlener. Hurricane Katrina is a recent memory and trauma for many children, and the Gulf oil spill is likely to increase the risks associated with stress and anxiety in children's environments.
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Questions remain about the effects of multiple exposures to largescale disasters, such as Hurricane Katrina, the recession, the Gulf oil crisis, and the possibility of another hurricane. Accordingly, there is a need to identify effective interventions for prevention and mitigation of trauma across populations, as well as identifying best practices for bolstering family resiliency, ensuring stability and access to health care and other essential services, and maintaining academic continuity in the face of large-scale disasters like the Gulf oil catastrophe.
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Osofksy described some of the mental health data that he and colleagues collected after Hurricane Katrina and explained that they would continue to collect modified forms of these same data in the wake of the Deepwater Horizon disaster. Sheldon Cohen described the different ways that the Gulf oil disaster may be producing the same type of psychological stress that other, more common events (e.g., job loss)
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Retraumatization may increase the risk of developing adverse psychological-health effects. Following Hurricane Katrina, Osofsky and his colleagues collected 5 years of pre-oil spill data on children, adolescents, and some first responders.
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Long-Term Psychological Stress and Disease: Implications for the Gulf Oil Spill Sheldon Cohen, Carnegie Mellon University Drawing on scientific literature that addresses a wide range of stressful events that have been associated with adverse health effects (such as job loss and personal stressors such as divorce) , Sheldon Cohen explained how the existing literature on the connection between psychological stress and disease can provide information about the long-term effects that could be expected as a result of the Gulf oil spill.
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Together, these physiological changes and poor health practices can lead to an increased risk of physical disease. Cohen stated that psychological stress is also known to be associated with several physical health outcomes in both adults and children, including total mortality and increased risks of coronary heart disease, hypertension, and upper respiratory infections.
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Psychological Impacts of Oil Spills: The Exxon Valdez Disaster Lawrence Palinkas, University of Southern California A number of studies have been conducted on the social and psychological consequences of the Exxon Valdez spill. Lawrence Palinkas was involved with one of the largest of those studies, the "Oiled Mayors" study.
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post-traumatic stress disorder, and depressive symptoms as reported by study participants. Widely defined exposures to oil spills and clean-up activities were also associated with increased use of mental health services, as indicated by an increase in the number of mental health visits to the Seward Life Action Council in Seward, Alaska, between July and December 1989 (compared to July-December 1988)
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SOURCES: Palinkas et al., 1993b; Russell et al., 1996. Palinkas explained that the studies following the Exxon Valdez disaster were noteworthy because they were the first to document posttraumatic stress disorder without any loss of human life.
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. Applying Lessons Learned from the Exxon Valdez Studies to the Gulf Oil Spill Palinkas echoed other panelists' recommendations to monitor populations particularly vulnerable to psychological stress.
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For example, have there been efforts in the mental health field to ramp up services as data are collected? Osofsky replied that, while the Deepwater Horizon disaster has not interrupted services like Hurricane Katrina did, resources are nonetheless very limited and are only just being re-established.
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Bernard replied that particular attitudes can be a problem. It is important to have an effective heat stress management program in place to contain that enthusiasm so that workers protect themselves.
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But in order to answer the question in the context of the Deepwater Horizon disaster, he said that he would need to know the likely levels of exposure, as there are thresholds for the effects, and it is not clear whether they will be reached. Eskenazi stated that she was very concerned about heavy metals, noting that recent evidence indicates that even low levels of manganese may affect neurobehavioral development in children.
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He stated that Redlener agreed that biomarkers are not a practical means of monitoring changes to inform care, particularly in children, and emphasized instead the importance of clinical "psychomarker" monitoring -- the monitoring of sleep difficulties, changes in behavior, difficulties interacting with siblings or peers, etc. Palinkas mentioned the Millennium Cohort Study, a large population-based study that emerged after the first Gulf War in response to concerns about Gulf War syndrome, as a good example of how standardized mental health assessment protocols and tools can be incorporated into the surveillance process in a timely manner and in such a way that the data can be used to inform policy and mitigate adverse health outcomes.
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What can be done today with the information already available to mitigate the adverse health consequences of exposure? Based on lessons learned from the Exxon Valdez spill and Hurricane Katrina, Palinkas and Redlener both identified the need to establish a way for the community to feel in control of the situation.
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Some studies have shown that some of the mental health consequences are greater in women than in men, and pregnant women are particularly vulnerable because they are not just protecting themselves but also their developing fetuses. She asked how pregnant women can obtain accurate information from a trusted source about the risks (e.g., of eating seafood)
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74 ASSESSING THE HUMAN HEALTH EFFECTS OF THE GULF OIL SPILL stress; there is a genetically based loss of muscle function that has been shown to be associated with increased susceptibility to heat stress. Spencer emphasized the need to determine whether people involved with clean-up are more susceptible to heat stress or other risks because of their genetic make-up or other factors.
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