Residential Proximity to Oil and Gas Development and Birth Outcomes in California: A Retrospective Cohort Study of 2006-2015 Births

Residential Proximity to Oil and Gas Development and Mental Health in a North American Preconception Cohort Study: 2013-2023

Objectives. To evaluate associations between oil and gas development (OGD) and mental health using cross-sectional data from a preconception cohort study, Pregnancy Study Online. Methods. We analyzed baseline data from a prospective cohort of US and Canadian women aged 21 to 45 years who were attempting conception without fertility treatment (2013-2023). We developed residential proximity measures for active OGD during preconception, including distance from nearest site. At baseline, participants completed validated scales for perceived stress (10-item Perceived Stress Scale, PSS) and depressive symptoms (Major Depression Inventory, MDI) and reported psychotropic medication use. We used log-binomial regression and restricted cubic splines to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). Results. Among 5725 participants across 37 states and provinces, residence at 2 km versus 20 to 50 km of active OGD was associated with moderate to high perceived stress (PSS ≥ 20 vs < 20: PR = 1.08; 95% CI = 0.98, 1.18), moderate to severe depressive symptoms (MDI ≥ 20 vs < 20: PR = 1.27; 95% CI = 1.11, 1.45), and psychotropic medication use (PR = 1.11; 95% CI = 0.97, 1.28). Conclusions. Among North American pregnancy planners, closer proximity to OGD was associated with adverse preconception mental health symptomatology. (Am J Public Health. Published online ahead of print July 11, 2024:e1-e12. https://doi.org/10.2105/AJPH.2024.307730).

Wildfires increasingly threaten oil and gas wells in the western United States with disproportionate impacts on marginalized populations

The western United States is home to most of the nation's oil and gas production and, increasingly, wildfires. We examined historical threats of wildfires for oil and gas wells, the extent to which wildfires are projected to threaten wells as climate change progresses, and exposure of human populations to these wells. From 1984-2019, we found that cumulatively 102,882 wells were located in wildfire burn areas, and 348,853 people were exposed (resided ≤ 1 km). During this period, we observed a five-fold increase in the number of wells in wildfire burn areas and a doubling of the population within 1 km of these wells. These trends are projected to increase by late century, likely threatening human health. Approximately 2.9 million people reside within 1 km of wells in areas with high wildfire risk, and Asian, Black, Hispanic, and Native American people have disproportionately high exposure to wildfire-threatened wells.

Ambient Environment and the Epidemiology of Preterm Birth

Preterm birth (PTB) is associated with substantial mortality and morbidity. We describe environmental factors that may influence PTB risks. We focus on exposures associated with an individual's ambient environment, such as air pollutants, water contaminants, extreme heat, and proximities to point sources (oil/gas development or waste sites) and greenspace. These exposures may further vary by other PTB risk factors such as social constructs and stress. Future examinations of risks associated with ambient environment exposures would benefit from consideration toward multiple exposures - the exposome - and factors that modify risk including variations associated with the structural genome, epigenome, social stressors, and diet.

The human health effects of unconventional oil and gas development (UOGD): A scoping review of epidemiologic studies

OBJECTIVE

Unconventional oil and gas development (UOGD, sometimes termed "fracking" or "hydraulic fracturing") is an industrial process to extract methane gas and/or oil deposits. Many chemicals used in UOGD have known adverse human health effects. Canada is a major producer of UOGD-derived gas with wells frequently located in and around rural and Indigenous communities. Our objective was to conduct a scoping review to identify the extent of research evidence assessing UOGD exposure-related health impacts, with an additional focus on Canadian studies.

METHODS

We included English- or French-language peer-reviewed epidemiologic studies (January 2000-December 2022) which measured exposure to UOGD chemicals directly or by proxy, and where health outcomes were plausibly caused by UOGD-related chemical exposure. Results synthesis was descriptive with results ordered by outcome and hierarchy of methodological approach.

SYNTHESIS

We identified 52 studies from nine jurisdictions. Only two were set in Canada. A majority (n = 27) used retrospective cohort and case-control designs. Almost half (n = 24) focused on birth outcomes, with a majority (n = 22) reporting one or more significant adverse associations of UOGD exposure with: low birthweight; small for gestational age; preterm birth; and one or more birth defects. Other studies identified adverse impacts including asthma (n = 7), respiratory (n = 13), cardiovascular (n = 6), childhood acute lymphocytic leukemia (n = 2), and all-cause mortality (n = 4).

CONCLUSION

There is a growing body of research, across different jurisdictions, reporting associations of UOGD with adverse health outcomes. Despite the rapid growth of UOGD, which is often located in remote, rural, and Indigenous communities, Canadian research on its effects on human health is remarkably sparse. There is a pressing need for additional evidence.

Cardiovascular health and proximity to urban oil drilling in Los Angeles, California

BACKGROUND

Although ~18 million people live within a mile from active oil and gas development (OGD) sites in the United States, epidemiological research on how OGD affects the health of nearby urban residents is sparse. Thousands of OGD sites are spread across Los Angeles (LA) County, California, home to the largest urban oil production in the country. Air pollution and noise from OGD may contribute to cardiovascular morbidity.

OBJECTIVE

We examined the association between proximity to OGD and blood pressure in a diverse cohort of residents in LA.

METHODS

We recruited residents in South LA who lived <1 km from an OGD site. We collected three blood pressure measurements for each participant and used the second and third measurements to calculate averages for systolic blood pressure (SBP) and diastolic blood pressure (DBP) separately. We conducted multivariable linear regression to examine the relationship between distance to OGD sites and continuous SBP and DBP, adjusting for BMI, smoking status, distance to freeway, sex, age, and use of antihypertension medications, with a random effect for household. We examined effect measure modification by BMI category and smoking category.

RESULTS

Among the 623 adult participants, we found that for every 100 meter increase in distance from the OGD site, DBP was reduced by an average of 0.73 mmHg (95% CI: -1.26, -0.21) in this population. We observed stronger effects of proximity to OGD site on DBP among never smokers and among participants with a healthy BMI. The associations observed between proximity to OGD site and SBP were weaker but followed the same patterns as those for DBP.

IMPACT

Our study suggests that living near urban oil drilling sites is significantly associated with greater diastolic blood pressure in urban Los Angeles communities. This research improves understanding of impacts from living nearby drilling operations on the health and welfare of this community, which is critical to inform public health relevant strategies.

Climate Change and Children's Health: Building a Healthy Future for Every Child

The warming of our planet matters to every child. Driven by fossil fuel-generated greenhouse gas emissions, climate conditions stable since the founding of modern pediatrics in the mid-nineteenth century have shifted, and old certainties are falling away. Children's physical and mental health are threatened by climate change through its effects on temperature, precipitation, and extreme weather; ecological disruption; and community disruption. These impacts expose and amplify existing inequities and create unprecedented intergenerational injustice. Fossil fuel extraction and combustion cause harm today and reach centuries into the future, jeopardizing the health, safety, and prosperity of today's children and future generations. Appreciating the unique vulnerability of their patients, pediatricians have become leading health advocates for climate actions necessary to protect all living and future children. Policies that reduce reliance on fossil fuels and promote cleaner air, facilitate walking and bicycling, encourage more sustainable diets, increase access to nature, and develop more connected communities lead to immediate gains in child health and equity, and build a foundation for generations of children to thrive.

Density and proximity of oil and gas wells and concentrations of trace elements in urine, hair, nails and tap water samples from pregnant individuals living in Northeastern British Columbia

BACKGROUND

Oil and gas exploitation can release several contaminants in the environment, including trace elements, with potentially deleterious effects on exposed pregnant individuals and their developing fetus. Currently, there is limited data on pregnant individuals' exposure to contaminants associated with oil and gas activity.

OBJECTIVES

We aimed to 1)measure concentrations of trace elements in biological and tap water samples collected from pregnant individuals participating in the EXPERIVA study; 2)compare with reference populations and health-based guidance values; 3)assess correlations across matrices; and 4)evaluate associations with the density/proximity of oil and gas wells.

METHODS

We collected tap water, hair, nails, and repeated urine samples from 85pregnant individuals, and measured concentrations of 21trace elements. We calculated oil and gas well density/proximity (Inverse Distance Weighting [IDW]) for 4buffer sizes (2.5 km, 5 km, 10 km, no buffer). We performed Spearman's rank correlation analyses to assess the correlations across elements and matrices. We used multiple linear regression models to evaluate the associations between IDWs and concentrations.

RESULTS

Some study participants had urinary trace element concentrations exceeding the 95th percentile of reference values; 75% of participants for V, 29% for Co, 22% for Ba, and 20% for Mn. For a given trace element, correlation coefficients ranged from -0.23 to 0.65 across matrices; correlations with tap water concentrations were strongest for hair, followed by nails, and urine. Positive (e.g., Cu, Cr, Sr, U, Ga, Ba, Al, Cd) and negative (e.g., Fe) associations were observed between IDW metrics and the concentrations of certain trace elements in water, hair, and nails.

SIGNIFICANCE

Our results suggest that pregnant individuals living in an area of oil and gas activity may be more exposed to certain trace elements (e.g., Mn, Sr, Co, Ba) than the general population. Association with density/proximity of wells remains unclear.

Social and Environmental Stressors of Urban Oil and Gas Facilities in Los Angeles County, California, 2020

Objectives. To examine patterns of cumulative environmental injustice with respect to operations of urban oil and gas development in Los Angeles County, California. Methods. Using CalEnviroScreen (CES) 4.0, oil and gas data permit records, and US census data, we examined the association between CES score (grouped into equal quintiles, with the lowest representing low cumulative burden) and oil and gas development (presence or absence of an oil and gas production well) within 1 kilometer of a census block centroid. Results. Among census blocks in the highest quintile of CES score, we observed 94% increased odds of being within 1 kilometer of a well compared with census blocks in the lowest quintile of CES score (odds ratio = 1.94; 95% confidence interval = 1.83, 2.10). In our multivariable model, the proportion of Black residents and higher quintiles of CES score were also associated with increased odds of a nearby oil and gas well. Conclusions. These findings suggest that oil and gas facilities are operating in neighborhoods already cumulatively burdened and with higher proportions of Black residents. (Am J Public Health. 2023;113(11):1182-1190. https://doi.org/10.2105/AJPH.2023.307360).

It's electric! An environmental equity perspective on the lifecycle of our energy sources

Energy policy decisions are driven primarily by economic and reliability considerations, with limited consideration given to public health, environmental justice, and climate change. Moreover, epidemiologic studies relevant for public policy typically focus on immediate public health implications of activities related to energy procurement and generation, considering less so health equity or the longer-term health consequences of climate change attributable to an energy source. A more integrated, collective consideration of these three domains can provide more robust guidance to policymakers, communities, and individuals. Here, we illustrate how these domains can be evaluated with respect to natural gas as an energy source. Our process began with a detailed overview of all relevant steps in the process of extracting, producing, and consuming natural gas. We synthesized existing epidemiologic and complementary evidence of how these processes impact public health, environmental justice, and climate change. We conclude that, in certain domains, natural gas looks beneficial (e.g., economically for some), but when considered more expansively, through the life cycle of natural gas and joint lenses of public health, environmental justice, and climate change, natural gas is rendered an undesirable energy source in the United States. A holistic climate health equity framework can inform how we value and deploy different energy sources in the service of public health.

Temporal Trends of Racial and Socioeconomic Disparities in Population Exposures to Upstream Oil and Gas Development in California

People living near oil and gas development are exposed to multiple environmental stressors that pose health risks. Some studies suggest these risks are higher for racially and socioeconomically marginalized people, which may be partly attributable to disparities in exposures. We examined whether racially and socioeconomically marginalized people in California are disproportionately exposed to oil and gas wells and associated hazards. We longitudinally assessed exposure to wells during three time periods (2005-2009, 2010-2014, and 2015-2019) using sociodemographic data at the census block group-level. For each block group and time period, we assessed exposure to new, active, retired, and plugged wells, and cumulative production volume. We calculated risk ratios to determine whether marginalized people disproportionately resided near wells (within 1 km). Averaged across the three time periods, we estimated that 1.1 million Californians (3.0%) lived within 1 km of active wells. Nearly 9 million Californians (22.9%) lived within 1 km of plugged wells. The proportion of Black residents near active wells was 42%-49% higher than the proportion of Black residents across California, and the proportion of Hispanic residents near active wells was 4%-13% higher than their statewide proportion. Disparities were greatest in areas with the highest oil and gas production, where the proportion of Black residents was 105%-139% higher than statewide. Socioeconomically marginalized residents also had disproportionately high exposure to wells. Though oil and gas production has declined in California, marginalized communities persistently had disproportionately high exposure to wells, potentially contributing to health disparities.

Congenital anomalies associated with oil and gas development and resource extraction: a population-based retrospective cohort study in Texas

BACKGROUND

Oil and gas extraction-related activities produce air and water pollution that contains known and suspected teratogens. To date, health impacts of in utero exposure to these activities is largely unknown.

OBJECTIVE

We investigated associations between in utero exposure to oil and gas extraction activity in Texas, one of the highest producers of oil and gas, and congenital anomalies.

METHODS

We created a population-based birth cohort between 1999 and 2009 with full maternal address at delivery and linked to the statewide congenital anomaly surveillance system (n = 2,234,138 births, 86,315 cases). We examined extraction-related exposures using tertiles of inverse distance-squared weighting within 5 km for drilling site count, gas production, oil production, and produced water. In adjusted logistic regression models, we calculated odds of any congenital anomaly and 10 specific organ sites using two comparison groups: 1) 5 km of future drilling sites that are not yet operating (a priori main models), and 2) 5-10 km of an active well.

RESULTS

Using the temporal comparison group, we find increased odds of any congenital anomaly in the highest tertile exposure group for site count (OR: 1.25; 95% CI: 1.21, 1.30), oil production (OR: 1.08; 95% CI: 1.04, 1.12), gas production (1.20; 95% CI: 1.17, 1.23), and produced water (OR: 1.17; 95% CI: 1.14, 1.20). However, associations did not follow a consistent exposure-response pattern across tertiles. Associations are highly attenuated, but still increased, with the spatial comparison group in the highest tertile exposure group. Cardiac and circulatory defects are strongly and consistently associated with all exposure metrics.

SIGNIFICANCE

Increased odds of congenital anomalies, particularly cardiac and circulatory defects, were associated with exposures related to oil and gas extraction in this large population-based study. Future research is needed to confirm findings, examine specific exposure pathways, and identify potential avenues to reduce exposures among local populations.

IMPACT

About 5% of the U.S. population (~17.6 million people) resides within 1.6 km of an active oil or gas extraction site, yet the influence of this industry on population health is not fully understood. In this analysis, we examined associations between oil and gas extraction-related exposures and congenital anomalies by organ site using birth certificate and congenital anomaly surveillance data in Texas (1999-2009). Increased odds of congenital anomalies, particularly cardiac and circulatory defects, were associated with exposures related to oil and gas extraction in this large population-based study. Future research is needed to confirm these findings.

Historic redlining and the siting of oil and gas wells in the United States

BACKGROUND

The presence of active or inactive (i.e., postproduction) oil and gas wells in neighborhoods may contribute to ongoing pollution. Racially discriminatory neighborhood security maps developed by the Home-Owners Loan Corporation (HOLC) in the 1930s may contribute to environmental exposure disparities.

OBJECTIVE

To determine whether receiving worse HOLC grades was associated with exposure to more oil and gas wells.

METHODS

We assessed exposure to oil and gas wells among HOLC-graded neighborhoods in 33 cities from 13 states where urban oil and gas wells were drilled and operated. Among the 17 cities for which 1940 census data were available, we used propensity score restriction and matching to compare well exposure neighborhoods that were similar on observed 1940 sociodemographic characteristics but that received different grades.

RESULTS

Across all included cities, redlined D-graded neighborhoods had 12.2 ± 27.2 wells km^-2, nearly twice the density in neighborhoods graded A (6.8 ± 8.9 wells km^-2). In propensity score restricted and matched analyses, redlined neighborhoods had 2.0 (1.3, 2.7) more wells than comparable neighborhoods with a better grade.

SIGNIFICANCE

Our study adds to the evidence that structural racism in federal policy is associated with the disproportionate siting of oil and gas wells in marginalized neighborhoods.

Association between residential proximity to municipal solid waste incinerator sites and birth outcomes in Shanghai: a retrospective cohort study of births during 2014-2018

We tested the hypothesis of whether maternal residential proximity to municipal solid waste incinerator (MSWI) sites could significantly affect birth outcomes. This retrospective birth cohort study conducted at the International Peace Maternity and Infant Hospital, Shanghai, China, included 59,606 mothers with singleton live births during 2014-2018. Multivariate generalized linear models were used to examine associations between residential proximity to MSWI sites and birth outcomes. Small for gestational age (SGA) was significantly more common among children with maternal residential proximity to MSWI sites (odds ratio [OR]=1.20, 95% confidence interval [CI]: 1.07-1.34). Maternal prepregnancy body mass index (BMI) influenced this association. Infants of underweight mothers (prepregnancy BMI <18.5 kg/m2) with MSWI exposure (OR=2.00, 95% CI: 1.58-2.52) had higher risks of SGA than their counterparts. Our findings underscore the need to prevent adverse environmental effects of MSWI on birth outcomes; improved exposure assessment measures are warranted in future studies.

Associations between proximity to gas production activity in counties and birth outcomes across the US

Despite mounting evidence on the health effects of natural gas development (NGD), including hydraulic fracturing (“fracking”), existing research has been constrained to high-producing states, limiting generalizability. To expand the scope of previous research, we examined the associations between prenatal exposure and NGD production activity in 28 states on birth outcomes overall and by race/ethnicity. We linked 2005–2018 county-level microdata natality files on 33,849,409 singleton births from 1984 counties in 28 states with nine-month county-level averages of NGD production by both conventional and unconventional production methods, based on month/year of birth. We estimated linear regression models for birth weight and gestational age and probit models for the dichotomous outcomes of low birth weight, preterm birth, and small-for-gestational age. We subsequently examined interactions between women’s race/ethnicity and NGD production. We found that 53.8% of counties had NGD production activity. A 10% increase in NGD production in a county was associated with a decrease in mean birth weight by 1.48 g (95% CI = −2.60, −0.37), with reductions of 10.19 g (−13.56, −6.81) for infants born to Black women and 2.76 g (−5.05, −0.46) for infants born to Asian women. A 10% increase in NGD production in a county was associated with an increased risk of infants born low birth weight (0.0008; 95% CI = 0.0006, 0.0010) or small-for-gestational age (0.0018; 95% CI = 0.0015, 0.0022), particularly among infants born to Black women. In sum, NGD for energy production has negative impacts on the health of infants, with greatest effects in infants born to minoritized women.

The association of unconventional natural gas development with diagnosis and treatment of internalizing disorders among adolescents in Pennsylvania using electronic health records

BACKGROUND

Unconventional natural gas development (UNGD) introduces physical and psychosocial hazards into communities, which could contribute to psychosocial stress in adolescents and an increased risk of internalizing disorders, common and impactful health outcomes.

OBJECTIVES

To evaluate associations between a 180-day composite UNGD activity metric and new onset of internalizing disorders, overall and separately for anxiety and depressive disorders, and effect modification by sex.

METHODS

We used a nested case-control design from 2008 to 2016 in 38 Pennsylvania counties using electronic health records from adolescent Geisinger subjects. Cases were defined by at least two diagnoses or medication orders indicating new onset of an internalizing disorder, and controls frequency-matched 4:1 on age, sex, and year. To evaluate associations, we used generalized estimating equations, with logit link, robust standard errors, and an exchangeable correlation structure within community.

RESULTS

We identified 7,974 adolescents (65.9% female, mean age 15.0 years) with new onset internalizing disorders. There were no associations when we used data from the entire study period. When restricted to years with higher UNGD activity (2010-2016), comparing the highest to lowest quartile, UNGD activity was associated (odds ratio [95% confidence level]) with new onset internalizing disorders (1.15 [1.06, 1.25]). Associations were slightly stronger for depressive disorders. Associations were only present in females (p = 0.009).

DISCUSSION

This is the first epidemiologic study of UNGD in relation to adolescent mental health, an important health outcome in a potentially susceptible group to the environmental and community impacts of UNGD. UNGD activity was associated with new onset internalizing disorders in females in this large sample in an area of active UNGD.

Assessing Exposure to Unconventional Oil and Gas Development: Strengths, Challenges, and Implications for Epidemiologic Research

PURPOSE OF REVIEW

Epidemiologic studies have observed elevated health risks in populations living near unconventional oil and gas development (UOGD). In this narrative review, we discuss strengths and limitations of UOG exposure assessment approaches used in or available for epidemiologic studies, emphasizing studies of children's health outcomes.

RECENT FINDINGS

Exposure assessment challenges include (1) numerous potential stressors with distinct spatiotemporal patterns, (2) critical exposure windows that cover long periods and occur in the past, and (3) limited existing monitoring data coupled with the resource-intensiveness of collecting new exposure measurements to capture spatiotemporal variation. All epidemiologic studies used proximity-based models for exposure assessment as opposed to surveys, biomonitoring, or environmental measurements. Nearly all studies used aggregate (rather than pathway-specific) models, which are useful surrogates for the complex mix of potential hazards. Simple and less-specific exposure assessment approaches have benefits in terms of scalability, interpretability, and relevance to specific policy initiatives such as set-back distances. More detailed and specific models and metrics, including dispersion methods and stressor-specific models, could reduce exposure misclassification, illuminate underlying exposure pathways, and inform emission control and exposure mitigation strategies. While less practical in a large population, collection of multi-media environmental and biological exposure measurements would be feasible in cohort subsets. Such assessments are well-suited to provide insights into the presence and magnitude of exposures to UOG-related stressors in relation to spatial surrogates and to better elucidate the plausibility of observed effects in both children and adults.

Maternal proximity to mountain-top removal mining and birth defects in Appalachian Kentucky, 1997–2003

Extraction of coal through mountaintop removal mining (MTR) alters many dimensions of the landscape. Explosive blasts, exposed rock, and coal washing have the potential to pollute air and water. Previous research suggests that infants born to mothers living in areas with MTR have a higher prevalence of birth defects. In this cross-sectional study, we further examine the relationship between MTR activity and several types of birth defects. Maternal exposure to MTR was assessed using remote sensing data from Skytruth, which captures MTR activity in the Central Appalachian region of the United States. Active MTR area was quantified within a five-kilometer buffer surrounding geocoded maternal address captured on birth records for live births to Appalachian Kentucky mothers between 1997 and 2003 (N = 95,581). We assigned high, medium, and low exposure based on the tertile of total MTR area within 5-km, and births with no MTR within this buffer were assigned zero exposure. The presence or absence of a birth defect grouped into six major organ systems was identified using birth records alone. Finally, we applied conditional multiple imputation for variables with missing values before conducting separate multivariable log-binomial regression models for each birth defect group. Prevalence ratio (PR) estimates were adjusted for individual level covariates from birth records. The prevalence of gastro-intestinal defects was significantly higher in birth records with high and low active MTR exposure compared to records with no exposure. (High exposure: PR = 1.99, 95% CI = 1.14–3.47; low exposure PR = 1.88, 95% CI = 1.06–3.31). This study supports some of the existing findings of previous ecological studies. Research addressing the relationship between gastro-intestinal birth defects and MTR coal mining is warranted but should carefully consider temporal dimensions of exposure.

Ambient temperature and risk of urinary tract infection in California: A time-stratified case-crossover study using electronic health records

BACKGROUND

In the United States (US), urinary tract infections (UTI) lead to more than 10 million office visits each year. Temperature and season are potentially important risk factors for UTI, particularly in the context of climate change.

METHODS

We examined the relationship between ambient temperature and outpatient UTI diagnoses among patients followed from 2015 to 2017 in two California healthcare systems: Kaiser Permanente Southern California (KPSC) and Sutter Health in Northern California. We identified UTI diagnoses in adult patients using diagnostic codes and laboratory records from electronic health records. We abstracted patient age, sex, season of diagnosis, and linked community-level Index of Concentration at the Extremes (ICE-I, a measure of wealth and poverty concentration) based on residential address. Daily county-level average ambient temperature was assembled from the Parameter-elevation Regressions on Independent Slopes Model (PRISM). We implemented distributed lag nonlinear models (DLNM) to assess the association between UTI and lagged daily temperatures. Main analyses were confined to women. In secondary analyses, we stratified by season, healthcare system, and community-level ICE-I.

RESULTS

We observed 787,186 UTI cases (89% among women). We observed a threshold association between ambient temperature and UTI among women: an increase in daily temperature from the 5th percentile (6.0 ˚C) to the mean (16.2 ˚C) was associated with a 3.2% (95% CI: 2.4, 3.9%) increase in same-day UTI diagnosis rate, whereas an increase from the mean to 95th percentile was associated with no change in UTI risk (0.0%, 95% CI: -0.7, 0.6%). In secondary analyses, we observed the clearest monotonic increase in the rate of UTI diagnosis with higher temperatures in the fall. Associations did not differ meaningfully by healthcare system or community-level ICE-I. Results were robust to alternate model specifications.

DISCUSSION

Increasing temperature was related to higher rate of outpatient UTI, particularly in the shoulder seasons (spring, autumn).

Upstream oil and gas production and ambient air pollution in California

BACKGROUND

Prior studies have found that residential proximity to upstream oil and gas production is associated with increased risk of adverse health outcomes. Emissions of ambient air pollutants from oil and gas wells in the preproduction and production stages have been proposed as conferring risk of adverse health effects, but the extent of air pollutant emissions and resulting nearby pollution concentrations from wells is not clear.

OBJECTIVES

We examined the effects of upstream oil and gas preproduction (count of drilling sites) and production (total volume of oil and gas) activities on concentrations of five ambient air pollutants in California.

METHODS

We obtained data on approximately 1 million daily observations from 314 monitors in the EPA Air Quality System, 2006-2019, including daily concentrations of five routinely monitored ambient air pollutants: PM_2.5, CO, NO₂, O₃, and VOCs. We obtained data on preproduction and production operations from Enverus and the California Geographic Energy Management Division (CalGEM) for all wells in the state. For each monitor and each day, we assessed exposure to upwind preproduction wells and total oil and gas production volume within 10 km. We used a panel regression approach in the analysis and fit adjusted fixed effects linear regression models for each pollutant, controlling for geographic, seasonal, temporal, and meteorological factors.

RESULTS

We observed higher concentrations of PM_2.5 and CO at monitors within 3 km of preproduction wells, NO₂ at monitors at 1-2 km, and O₃ at 2-4 km from the wells. Monitors with proximity to increased production volume observed higher concentrations of PM_2.5, NO₂, and VOCs within 1 km and higher O₃ concentrations at 1-2 km. Results were robust to sensitivity analyses.

CONCLUSION

Adjusting for geographic, meteorological, seasonal, and time-trending factors, we observed higher concentrations of ambient air pollutants at air quality monitors in proximity to preproduction wells within 4 km and producing wells within 2 km.

Residential proximity to hydraulically fractured oil and gas wells and adverse birth outcomes in urban and rural communities in California (2006-2015)

Supplemental Digital Content is available in the text.

Background:

Prenatal exposure to hydraulic fracturing (HF), a chemically intensive oil and gas extraction method, may be associated with adverse birth outcomes, but no health studies have been conducted in California.

Methods:

We conducted a retrospective cohort study of 979,961 births to mothers in eight California counties with HF between 2006 and 2015. Exposed individuals had at least 1 well hydraulically fractured within 1 km of their residence during pregnancy; the reference population had no wells within 1 km, but at least one oil/gas well within 10 km. We examined associations between HF and low birth weight (LBW), preterm birth (PTB), small for gestational age birth (SGA), and term birth weight (tBW) using generalized estimating equations and assessing urban-rural effect modification in stratified models.

Results:

Fewer than 1% of mothers (N = 1,192) were exposed to HF during pregnancy. Among rural mothers, HF exposure was associated with increased odds of LBW (odds ratio [OR] = 1.74; 95% confidence interval [CI] = 1.10, 2.75), SGA (OR = 1.68; 95% CI = 1.42, 2.27) and PTB (OR = 1.17; 95% CI = 0.64, 2.12), and lower tBW (mean difference: –73 g; 95% CI = –131, –15). Among urban mothers, HF exposure was positively associated with SGA (OR = 1.23; 95% CI = 0.98, 1.55), inversely associated with LBW (OR = 0.83; 95% CI = 0.63, 1.07) and PTB (OR = 0.65; 95% CI = 0.48, 0.87), and not associated with tBW (mean difference: –2 g; 95% CI = –35, 31).

Conclusion:

HF proximity was associated with adverse birth outcomes, particularly among rural Californians.

Associations between residential proximity to oil and gas extraction and hypertensive conditions during pregnancy: a difference-in-differences analysis in Texas, 1996-2009

BACKGROUND

Oil and gas extraction produces air pollutants that are associated with increased risks of hypertension. To date, no study has examined residential proximity to oil and gas extraction and hypertensive conditions during pregnancy. This study quantifies associations between residential proximity to oil and gas development on gestational hypertension and eclampsia.

METHODS

We utilized a population-based retrospective birth cohort in Texas (1996-2009), where mothers reside <10 km from an active or future drilling site (n = 2 845 144.) Using full-address data, we linked each maternal residence at delivery to assign exposure and evaluate this exposure with respect to gestational hypertension and eclampsia. In a difference-in-differences framework, we model the interaction between maternal health before (unexposed) or after (exposed) the start of drilling activity (exposed) and residential proximity near (0-1, >1-2 or >2-3 km) or far (≥3-10 km) from an active or future drilling site.

RESULTS

Among pregnant women residing 0-1 km from an active oil or gas extraction site, we estimate 5% increased odds of gestational hypertension [95% confidence interval (CI): 1.00, 1.10] and 26% increased odds of eclampsia (95% CI: 1.05, 1.51) in adjusted models. This association dissipates in the 1- to 3-km buffer zones. In restricted models, we find elevated odds ratios among maternal ages ≤35 years at delivery, maternal non-Hispanic White race, ≥30 lbs gained during pregnancy, nulliparous mothers and maternal educational attainment beyond high school.

CONCLUSIONS

Living within 1 km of an oil or gas extraction site during pregnancy is associated with increased odds of hypertensive conditions during pregnancy.

Climate Justice and California's Methane Superemitters: Environmental Equity Assessment of Community Proximity and Exposure Intensity

Methane superemitters emit non-methane copollutants that are harmful to human health. Yet, no prior studies have assessed disparities in exposure to methane superemitters with respect to race/ethnicity, socioeconomic status, and civic engagement. To do so, we obtained the location, category (e.g., landfill, refinery), and emission rate of California methane superemitters from Next Generation Airborne Visible/Infrared Imaging Spectrometer (AVIRIS-NG) flights conducted between 2016 and 2018. We identified block groups within 2 km of superemitters (exposed) and 5-10 km away (unexposed) using dasymetric mapping and assigned level of exposure among block groups within 2 km (measured via number of superemitter categories and total methane emissions). Analyses included 483 superemitters. The majority were dairy/manure (n = 213) and oil/gas production sites (n = 127). Results from fully adjusted logistic mixed models indicate environmental injustice in methane superemitter locations. For example, for every 10% increase in non-Hispanic Black residents, the odds of exposure increased by 10% (95% confidence interval (CI): 1.04, 1.17). We observed similar disparities for Hispanics and Native Americans but not with indicators of socioeconomic status. Among block groups located within 2 km, increasing proportions of non-White populations and lower voter turnout were associated with higher superemitter emission intensity. Previously unrecognized racial/ethnic disparities in exposure to California methane superemitters should be considered in policies to tackle methane emissions.

The effects of hydraulic fracturing activities on birth outcomes are evident in a non-individualized county-wide aggregate data sample from Colorado

Background: There is growing concern about the recent increase in oil and gas development using hydraulic fracturing. Studies linking adverse birth outcomes and maternal proximity to hydraulic fracturing wells exist but tend to use individualized maternal and infant data contained in protected health care records. In this study, we extended the findings of these past studies to evaluate if analogous effects detected with individualized data could be detected from non-individualized county-wide aggregated data.

Design and methods: This study used a retrospective cohort of 252,502 birth records from 1999 to 2019 gathered from a subset sample of 5 counties in the state of Colorado where hydraulic fracturing activities were conducted. We used Generalized Linear Models to evaluate the effect of county-wide well density and production data over unidentified birth weight, and prematurity data. Covariates used in the model were county-wide statistics sourced from the US Census.

Results: Our modeling approach showed an interesting effect where hydraulic fracturing exposure metrics have a mixed effect directional response. This effect was detected on birth weight when well density, production and their interaction are accounted for. The interaction effect provides an additional interpretation to discrepancies reported previously in the literature. Our approach only detected a positive association to prematurity with increased production.

Conclusions: Our findings demonstrate two main points: First, the effect of hydraulic fracturing is detectable by using countywide unidentified data. Second, the effect of hydraulic fracturing can be complicated by the number of operations and the intensity of the activities in the area.

Environmental impact and human health risks of air pollutants near a large chemical/petrochemical complex: Case study in Tarragona, Spain

Chemical industries and oil refineries are known emission sources of environmental contaminants, such as metals/metalloids, polycyclic aromatic hydrocarbons (PAHs), volatile organic compounds (VOCs) and polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs), among others. Based on the toxicological potential of these pollutants, harmful health effects can be expected for the population living near these facilities. One of the largest chemical/petrochemical complexes in Europe is located in Tarragona County (Catalonia, Spain). In the last two decades, a number of investigations aimed at assessing the environmental impact of air pollutants potentially emitted by this industrial complex have been carried out. The present paper is a review of the available scientific information on the levels of air pollutants related with the activities of this chemical/petrochemical complex. Although there are currently some data on the environmental burdens of metals/metalloids, PAHs, VOCs and PCDD/Fs, there is an evident lack of specific biological monitoring studies on human health. Taking into account the amount of chemicals released to air and their toxicity, it is essential to perform an in-depth analysis of the current health status of the population living in Tarragona County.

Changes in neighborhood air quality after idling of an urban oil production site

Oil and gas development is occurring in urban, densely populated neighborhoods; however, the impacts of these operations on neighborhood air quality are not well characterized. In this research, we leveraged ambient air monitoring adjacent to an oil and gas production site in Los Angeles, California during active and idle periods. This study analyzed continuous methane (CH4) and non-methane hydrocarbon (NMHC) measurements, together with triggered grab samples and 24 hour integrated canister samples collected by the South Coast Air Quality Management District. Ambient air pollutant levels and trends were evaluated during active and idle well operations to assess changes in neighborhood air quality after the suspension of oil and gas production. We find that mean concentrations of methane, NMHC, benzene, toluene, ethylbenzene, xylenes, styrene, n-hexane, n-pentane, ethane, and propane decreased following the stop in production activities. Using a source apportionment approach, we observed that the "natural gas" drilling source contributed 23.7% to the total VOCs measured during the active phase, and only 0.6% to the total measured VOCs in the idle phase. Near urban oil and gas production sites, residents may face poorer air quality due to the oil and gas activities which may pose adverse health and environmental risks among proximate communities.

Characterizing methane and total non-methane hydrocarbon levels in Los Angeles communities with oil and gas facilities using air quality monitors

Over the past decade, sensor networks have been proven valuable to assess air quality on highly localized scales. Here we leverage innovative sensors to characterize gaseous pollutants in a complex urban environment and evaluate differences in air quality in three different Los Angeles neighborhoods where oil and gas activity is present. We deployed monitors across urban neighborhoods in South Los Angles adjacent to oil and gas facilities with varying levels of production. Using low-cost sensors built in-house, we measured methane, total non-methane hydrocarbons (TNMHCs), carbon monoxide, and carbon dioxide during three deployment campaigns over four years. The multi-sensor linear regression calibration model developed to quantify methane and TNMHCs offers up to 16% improvement in coefficient of determination and up to a 22% reduction in root mean square error for the most recent dataset as compared to previous models. The deployment results demonstrate that airborne methane concentrations are higher within a 500 m radius of three urban oil and gas facilities, as well as near a natural gas distribution pipeline, likely a result of proximity to sources. While there are numerous additional sources of TNMHCs in complex urban environments, some sites appear to be larger emitters than others. Significant methane emissions were also measured at an idle site, suggesting that fugitive emissions may still occur even if production is ceased. Episodic spikes of both compounds suggested an association with oil and gas activities, demonstrating how sensor networks can be used to elucidate community-scale sources and differences in air quality moving forward.

Associations between Residential Proximity to Oil and Gas Drilling and Term Birth Weight and Small-for-Gestational-Age Infants in Texas: A Difference-in-Differences Analysis

BACKGROUND

Oil and natural gas extraction may produce environmental pollution at levels that affect reproductive health of nearby populations. Available studies have primarily focused on unconventional gas drilling and have not accounted for local population changes that can coincide with drilling activity.

OBJECTIVE

Our study sought to examine associations between residential proximity to oil and gas drilling and adverse term birth outcomes using a difference-in-differences study design.

METHODS

We created a retrospective population-based term birth cohort in Texas between 1996 and 2009 composed of mother-infant dyads (n=2,598,025) living <10km from an oil or gas site. We implemented a difference-in-differences approach to estimate associations between drilling activities and infant health: term birth weight and term small for gestational age (SGA). Using linear and logistic regression, we modeled interactions between births before (unexposed) or during (exposed) drilling activity and residential proximity near (0-1, 1-2, or 2-3km) or far (3-10km) from an active or future drilling site, adjusting for individual- and neighborhood-level characteristics.

RESULTS

The adjusted mean difference in term birth weight for mothers living 0-1 vs. 3-10km from a current or future drilling site was -7.3g [95% confidence interval (CI): -11.6, -3.0] for births during active vs. future drilling. The corresponding adjusted odds ratio for SGA was 1.02 (95% CI: 0.98, 1.06). Negative associations with term birth weight were observed for the 1-2 and 2-3km near groups, and no consistent differences were identified by type of drilling activity. Larger, though imprecise, adverse associations were found for infants born to Hispanic women, women with the lowest educational attainment, and women living in cities.

CONCLUSIONS

Residing near oil and gas drilling sites during pregnancy was associated with a small reduction in term birth weight but not SGA, with some evidence of environmental injustices. Additional work is needed to investigate specific drilling-related exposures that might explain these associations. https://doi.org/10.1289/EHP7678.

Respiratory health, pulmonary function and local engagement in urban communities near oil development

BACKGROUND

Modern oil development frequently occurs in close proximity to human populations. Los Angeles, California is home to the largest urban oil field in the country with thousands of active oil and gas wells in very close proximity to homes, schools and parks, yet few studies have investigated potential health impacts. The neighborhoods along the Las Cienagas oil fields are situated in South LA, densely populated by predominantly low-income Black and Latinx families, many of whom are primarily Spanish-speakers.

METHODS

A cross-sectional community-based study was conducted between January 2017 and August 2019 among residents living <1000 m from two oil wells (one active, one idle) in the Las Cienagas oil field. We collected self-reported acute health symptoms and measured FEV1 (forced expiratory volume in the first second of exhalation) and FVC (forced vital capacity). We related lung function measures to distance and direction from an oil and gas development site using generalized linear models adjusted for covariates.

RESULTS

A total of 961 residents from two neighborhoods participated, the majority of whom identify as Latinx. Participants near active oil development reported significantly higher prevalence of wheezing, eye and nose irritation, sore throat and dizziness in the past 2 weeks. Among 747 valid spirometry tests, we observe that living near (less than 200 m) of oil operations was associated with, on average, -112 mL lower FEV1 (95% CI: -213, -10) and -128 mL lower FVC (95% CI: -252, -5) compared to residents living more than 200 m from the sites after adjustments for covariates, including age, sex, height, proximity to freeway, asthma status and smoking status. When accounting for predominant wind direction and proximity, we observe that residents living downwind and less than 200 m from oil operations have, on average, -414 mL lower FEV1 (95% CI: -636, -191) and -400 mL lower FVC (95% CI: -652, -147) compared to residents living upwind and more than 200 m from the wells.

CONCLUSIONS

Living nearby and downwind of urban oil and gas development sites is associated with lower lung function among residents, which may contribute to environmental health disparities.

Birth defects and unconventional natural gas developments in Texas, 1999-2011

Unconventional natural gas developments (UNGD) may release air and water pollutants into the environment, potentially increasing the risk of birth defects. We conducted a case-control study evaluating 52,955 cases with birth defects and 642,399 controls born between 1999 and 2011 to investigate the relationship between UNGD exposure and the risk of gastroschisis, congenital heart defects (CHD), neural tube defects (NTDs), and orofacial clefts in Texas. We calculated UNGD densities (number of UNGDs per area) within 1, 3, and 7.5 km of maternal address at birth and categorized exposure by density tertiles. For CHD subtypes with large case numbers, we also performed time-stratified analyses to examine temporal trends. We calculated adjusted odds ratios (aOR) and 95% confidence intervals (CI) for the association with UNGD exposure, accounting for maternal characteristics and neighborhood factors. We also included a bivariable smooth of geocoded maternal location in an additive model to account for unmeasured spatially varying risk factors. Positive associations were observed between the highest tertile of UNGD density within 1 km of maternal address and risk of anencephaly (aOR: 2.44, 95% CI: 1.55, 3.86), spina bifida (aOR: 2.09, 95% CI: 1.47, 2.99), gastroschisis among older mothers (aOR: 3.19, 95% CI: 1.77, 5.73), aortic valve stenosis (aOR: 1.90, 95% CI: 1.33, 2.71), hypoplastic left heart syndrome (aOR: 2.00, 95% CI: 1.39, 2.86), and pulmonary valve atresia or stenosis (aOR: 1.36, 95% CI: 1.10, 1.66). For CHD subtypes, results did not differ substantially by distance from maternal address or when residual confounding was considered, except for atrial septal defects. We did not observe associations with orofacial clefts. Our results suggest that UNGDs were associated with some CHDs and possibly NTDs. In addition, we identified temporal trends and observed presence of spatial residual confounding for some CHDs.

Urinary carboxylic acid metabolites as possible novel biomarkers of exposures to alkylated polycyclic aromatic hydrocarbons

Previous studies have found that alkylated polycyclic aromatic hydrocarbons (alkyl-PAHs) were more abundant in petrogenic sources (e.g., crude oil and its refined products) than pyrogenic sources of incomplete combustion. While urinary hydroxylated metabolites of unsubstituted PAHs have been widely used as biomarkers of PAHs exposures, little information is available as to the occurrence of alkyl-PAH metabolites. In this study, we have detected carboxylic acid metabolites of alkyl-naphthalene (2-NAPCA) and alkyl-phenanthrene (2-PHECA) in 314 urine samples repeatedly collected from 45 Los Angeles residents before, during, and after they spent ten weeks in Beijing in summers of 2014-2017. We found that traveling from Los Angeles to Beijing led to 348% (95% CI: 243 to 485%) and 209% (95% CI: 149 to 282%) increases in 2-NAPCA and 2-PHECA concentrations, respectively, which returned to baseline levels after participants came back to Los Angeles. The concentration ratio between 2-PHECA and hydroxy-phenanthrenes was significantly (p < 0.05) lower in Beijing (median: 0.40, IQR: 0.27-0.53) than in Los Angeles (median: 0.51, IQR: 0.32-0.77), where more than 5,000 active gas and oil wells were located. From 2014 to 2017, the concentration ratio of 2-PHECA to hydroxy-phenanthrenes increased by 28.7 (95%CI: 12.3 to 47.6) %/yr in Los Angeles and 18.6 (95%CI: 7.9 to 30.3) %/yr in Beijing, likely resulted from both cities' efforts to reduce pyrogenic emissions (e.g. vehicle exhaust). These results provided indirect evidence supporting the use of 2-PHECA to hydroxy-phenanthrene ratio as an index to reflect the relative exposure contributions from petrogenic and pyrogenic sources. While our study suggested that urinary PAHCAs may be novel biomarkers of exposure to alkyl-PAHs, future studies with external exposure characterization are warranted to further validate these biomarkers.

Mobile Measurement System for the Rapid and Cost-Effective Surveillance of Methane and Volatile Organic Compound Emissions from Oil and Gas Production Sites

In this study, a ground-based mobile measurement system was developed to provide rapid and cost-effective emission surveillance of both methane (CH₄) and volatile organic compounds (VOCs) from oil and gas (O&G) production sites. After testing in several controlled release experiments, the system was deployed in a field campaign in the Eagle Ford basin, TX. We found fat-tail distributions for both methane and total VOC (C4-C12) emissions (e.g., the top 20% sites ranked according to methane and total VOC (C4-C12) emissions were responsible for ∼60 and ∼80% of total emissions, respectively) and a good correlation between them (Spearman's R = 0.74). This result suggests that emission controls targeting relatively large emitters may help significantly reduce both methane and VOCs in oil and wet gas basins, such as the Eagle Ford. A strong correlation (Spearman's R = 0.84) was found between total VOC (C4-C12) emissions estimated using SUMMA canisters and data reported from a local ambient air monitoring station. This finding suggests that this system has the potential for rapid emission surveillance targeting relatively large emitters, which can help achieve emission reductions for both greenhouse gas (GHG) and air toxics from O&G production well pads in a cost-effective way.

Petro-riskscapes and environmental distress in West Texas: Community perceptions of environmental degradation, threats, and loss

Unconventional oil and gas development (UOGD) expanded rapidly in the United States between 2004-2019 with resultant industrial change to landscapes and new environmental exposures. By 2019, West Texas' Permian Basin accounted for 35% of domestic oil production. We conducted an online survey of 566 Texans in 2019 to examine the implications of UOGD using three measures from the Environmental Distress Scale (EDS): perceived threat of environmental issues, felt impact of environmental change, and loss of solace when valued environments are transformed ("solastalgia"). We found increased levels of environmental distress among respondents living in counties in the Permian Basin who reported a 2.75% increase in perceived threat of environmental issues (95% CI = -1.14, 6.65) and a 4.21% increase in solastalgia (95% CI = 0.03, 8.40). In our subgroup analysis of women, we found higher EDS subscale scores among respondents in Permian Basin counties for perceived threat of environmental issues (4.08%, 95% CI= -0.12, 8.37) and solastalgia (7.09%, 95% CI= 2.44, 11.88). In analysis restricted to Permian Basin counties, we found exposure to at least one earthquake of magnitude ≥ 3 was associated with increases in perceived threat of environmental issues (4.69%, 95% CI = 0.15, 9.23), and that county-level exposure to oil and gas injection wells was associated with increases in felt impact (4.38%, 95% CI = -1.77, 10.54) and solastalgia (4.06%, 95% CI = 3.02, 11.14). Our results indicate increased environmental distress in response to UOGD-related environmental degradation among Texans and highlight the importance of considering susceptible sub-groups.

California oil: Bridging the gaps between local decision-making and state-level climate action

California has set ambitious climate policies, including economy-wide carbon neutrality by 2045. Yet levels of oil production and consumption remain high in the state. This gap between California's oil politics and its climate ambitions is deepened by decentralized decision-making processes. County officials are tasked with extractive planning decisions that have wide-ranging implications. In this Viewpoint article, we analyze proposals for enhanced extraction at the Cat Canyon oilfield in Santa Barbara County. After two of three proposals were withdrawn in recent months, we highlight how it has been oil industry volatility and public opposition - rather than state regulations - that have brought county development plans into closer alignment with state climate goals. As California pursues a goal of 'managing the decline' of domestic oil production, we identify strategies for bridging such gaps between local decision-making and state-level climate action, including: a comprehensive state-wide ban on new enhanced oil extraction projects; a 2,500 ft buffer zone around extraction sites; and revenue generation schemes that support a just transition. As Covid-19 forces an oil surplus and lowered production, there are opportunities to enact such changes - particularly by redirecting oil industry labor toward the growing problem of well decommissioning.

Flaring from Unconventional Oil and Gas Development and Birth Outcomes in the Eagle Ford Shale in South Texas

BACKGROUND

Prior studies suggest exposure to oil and gas development (OGD) adversely affects birth outcomes, but no studies have examined flaring-the open combustion of natural gas-from OGD.

OBJECTIVES

We investigated whether residential proximity to flaring from OGD was associated with shorter gestation and reduced fetal growth in the Eagle Ford Shale of south Texas.

METHODS

We conducted a retrospective cohort study using administrative birth records from 2012 to 2015 (N=23,487) and satellite observations of flaring activity during pregnancy within 5km of maternal residence. Multivariate logistic and linear regression models were used to estimate associations between four outcomes (preterm birth, small-for-gestational age, continuous gestational age, and term birthweight) and exposure to a low (1-9) or high (≥10) number of nightly flare events, as compared with no exposure, while controlling for known maternal risk factors. We also examined associations with the number of oil and gas wells within 5km using data from DrillingInfo (now Enverus).

RESULTS

Exposure to a high number of nightly flare events was associated with a 50% higher odds of preterm birth [odds ratio (OR)=1.50 (95% CI: 1.23, 1.83)] and shorter gestation [mean difference=-1.9 (95% CI: -2.8, -0.9) d] compared with no exposure. Effect estimates were slightly reduced after adjustment for the number of wells within 5km. In stratified models these associations were present only among Hispanic women. Flaring and fetal growth outcomes were not significantly associated. Women exposed to a high number of wells (fourth quartile, ≥27) vs. no wells within 5km had a higher odds of preterm birth [OR=1.31 (95% CI: 1.14, 1.49)], shorter gestation [-1.3 (95% CI: -1.9, -0.8) d], and lower average birthweight [-19.4 (95% CI: -36.7, -2.0) g].

DISCUSSION

Our study suggests exposure to flaring from OGD is associated with an increased risk of preterm birth. Our findings need to be confirmed in other populations. https://doi.org/10.1289/EHP6394.