J Community Health DOI 10.1007/s10900-014-9968-x
ORIGINAL PAPER
Popular Epidemiology and ‘‘Fracking’’: Citizens’ Concerns Regarding the Economic, Environmental, Health and Social Impacts of Unconventional Natural Gas Drilling Operations Martha Powers • Poune Saberi • Richard Pepino • Emily Strupp • Eva Bugos • Carolyn C. Cannuscio
Springer Science+Business Media New York 2014
Abstract Pennsylvania sits atop the Marcellus Shale, a reservoir of natural gas that was untapped until the 2004 introduction of unconventional natural gas drilling operations (UNGDO) in the state. Colloquially known as fracking, UNGDO is a controversial process that employs large volumes of water to fracture the shale and capture gas; it has become a multi-billion dollar industry in Pennsylvania. We analyzed letters to the editor of the most widely circulated local newspaper in the most heavily drilled county in
M. Powers Master of Public Health Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA P. Saberi Department of Emergency Medicine – Occupational and Environmental Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA R. Pepino Department of Earth and Environmental Science, University of Pennsylvania, Philadelphia, PA, USA E. Strupp C. C. Cannuscio Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA E. Bugos University of Pittsburgh, Pittsburgh, PA, USA C. C. Cannuscio Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA C. C. Cannuscio (&) Perelman School of Medicine, University of Pennsylvania, Anatomy and Chemistry Room 145, 3620 Hamilton Walk, Philadelphia, PA 19104, USA e-mail:
[email protected]
Pennsylvania (Bradford County) in order to characterize residents’ concerns and their involvement in popular epidemiology—the process by which citizens investigate risks associated with a perceived environmental threat. We reviewed 215 letters to the editor that referenced natural gas operations and were published by The Daily Review between January 1, 2008 and June 8, 2013. We used NVivo 10 to code and analyze letters and identify major themes. Nvivo is qualitative data analysis software (http://www.qsrinterna tional.com/products_nvivo.aspx) that allows researchers to code and analyze ‘‘unstructured’’ data, including text files of any type (e.g., interview transcripts, news articles, letters, archival materials) as well as photographs and videos. Nvivo can be used to classify, sort, query, comment on, and share data across a research group. Letters demonstrated citizen engagement in beginning and intermediate stages of lay epidemiology, as well as discord and stress regarding four main issues: socio-economic impacts, perceived threats to water, population growth and implications, and changes to the rural landscape. Residents called for stronger scientific evidence and a balance of economic development and health and environmental protections. Citizens’ distress regarding UNGDO appeared to be exacerbated by a dearth of information to guide economic growth and health, environmental, and social concerns. This analysis proposes locally informed questions to guide future surveillance and research. Keywords Natural gas Environmental health Fossil fuels Environmental pollution Gas wells Fracking
Introduction In the search for new energy sources, the United States has increasingly explored domestic sources of natural gas like
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Pennsylvania’s Marcellus Shale. The emerging model for unconventional natural gas drilling operations (UNGDO) is high volume slick-water hydraulic fracturing with horizontal drilling—colloquially known as ‘‘fracking.’’ UNGDO uses large quantities of water and chemicals to fracture shale and release natural gas [1]. UNGDO was initiated in 2004 in the Marcellus Shale and is projected to add up to $20 billion to the Pennsylvania economy by 2020 [2, 3]. Little is known about the health and environmental implications of UNGDO. Health scientists have hypothesized that chemicals used in UNGDO may harm the skin, brain, blood, lungs, liver, and kidneys [4, 5]. Environmental scientists have hypothesized that UNGDO may harm wildlife [5] and damage water, air, and soil [6]. In places with longer histories of UNGDO, like Pavillion, Wyoming, the U.S. Environmental Protection Agency (EPA) has reported possible groundwater contamination [7]. However, limited data are available to support or refute health-related claims [8–10], leaving residents in areas affected by UNGDO unsure of the relative risks and benefits. To characterize the public discourse surrounding the health, environmental, social, and economic effects of Marcellus Shale UNGDO, we examined letters to the editor of The Daily Review, the most widely circulated local newspaper in rural Bradford County, the Pennsylvania county with the highest natural gas production in 2012 [11]. These letters about UNGDO reflect the state of popular epidemiology, through which citizens question and investigate the causes and distribution of disease in the context of a perceived environmental threat [12]. This qualitative analysis highlights citizens’ hypotheses, questions, and concerns regarding natural gas drilling in Pennsylvania’s Marcellus Shale.
Methods UNGDO began in Bradford County in 2008. We reviewed letters to the editor of The Daily Review, identified by area reference librarians as the most widely read local newspaper, published from January 1, 2008 to June 8, 2013. Circulation data from standard rate and data service confirmed weekday circulation at nearly 7,500 copies [13]. We searched NewsBank to identify relevant letters to the editor, using the search terms edit* AND (frack* OR gas). This search strategy returned 358 results, of which 215 were included in the analysis after excluding editorials written by newspaper staff, articles containing only an editor’s note, or content paid for by a gas company. We conducted line-by-line review of all letters written between January 2008 and June 2013 (n = 215) in order to
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propose categories for coding content. Thirty-one people had more than one letter published (mode = 2 letters). Each letter was treated as an individual data source. Two team members (MP and CCC) reduced the original list of several dozen potential codes to a list of ten, including: perceived socio-economic effects of UNGDO; industry influence and manipulation; citizens’ rights; perceived threats to air, water, and soil; local or ‘‘American’’ values; politicians and their responsibilities; population growth and implications; changes to the landscape; calls for further research and surveillance; and media coverage of UNGDO. We then applied those ten codes to a subset of six letters and refined the operational definitions of the codes until we reached consensus. Then all letters were coded using NVivo and four team members (MP, CCC, ES, and EB) read the resulting ‘‘node reports,’’ which included all content classified under each particular code. The reviewers summarized findings from these reports, incorporating quotes with corroborating and dissenting commentary. From these summary memos we engaged in intensive team discussion to identify the most salient crosscutting themes. We conducted our analysis using an iterative process that involved multiple rounds of data review, summary, and discussion including all members of the research team [14– 17]. We discuss the major themes below.
Results Our analysis was guided by a social determinants of health framework, which considers individual, family, institutional, environmental, and policy influences on population health. In addition, we employed the framework of popular epidemiology, which prioritizes citizens’ perspectives in the study of community health. Throughout letters, citizens described hypotheses, concerns, and actions that reflected early and intermediate, but not late, stages of engagement in popular epidemiology, as defined by sociologist Phil Brown [12] and summarized in Table 1. Citizens were beginning the process of observing possible pollution and short-term effects of UNGDO (stages 1 and 2). They emphasized impacts on general wellbeing and the social determinants of health, rather than on long-term disease risk. Letters reflected a high degree of information exchange among citizens (stage 3) but this appears primarily as disagreement rather than a shared perspective on the links between UNGDO and health. Letters reflected a modicum of progress in engaging medical professionals and scientists in the investigation of local health and environmental concerns (stage 4) and organizing to conduct research (stage 5), but these were not yet fully developed. Writers called for increased evidence to resolve controversies and guide UNGDO activities. As one writer
J Community Health Table 1 Stages of citizen involvement in popular epidemiology, as observed in letters written to the editor of The Daily Review Stages of citizen involvement, as described by sociologist Brown [12]
Evidence in letters written to the editor
A group of people in a contaminated community notice separately both health effects and pollutants
Citizens commented on their own and others’ wellbeing as well as changes in water and surrounding landscape
These residents hypothesize something out of the ordinary, typically a connection between health effects and pollutants
Residents wrote about changes in water quality and adverse health effects observed in wildlife as a harbinger for anticipated adverse human health effects of exposure, especially to ‘‘fracking fluid’’
Community residents share information, creating a common perspective
Letters showed evidence that community members shared information, but that citizens had not yet reached consensus about relative harms or benefits of UNGDO. Instead, they vigorously debated socioeconomic benefits of increased industry in the area and whether the ‘‘economic opportunities’’ outweighed the unknown and largely unmeasured health effects and ‘‘tremendous potential’’ for environmental ‘‘disasters’’
Community residents read about, ask around, and talk to government officials and scientific experts about the health effects and the putative contaminants
Letters called upon ‘‘Congressmen,’’ ‘‘Township supervisors,’’ Department of Environmental Protection and Department of Environmental Conservation staff, and ‘‘Harrisburg,’’ to protect ‘‘citizens,’’ ‘‘groundwater,’’ ‘‘quality of life,’’ and ‘‘the interests of the people.’’ Letters commented on the nascent research efforts of the Northeast Regional Cancer Institute and other groups studying health effects, calling for accelerated pace of research
Residents organize groups to pursue their investigation
Homeowner and landowner groups, such as the National Association of Royalty Owners, PA chapter and the Sullivan Bradford Landowners Association, believed landowners were ‘‘being deliberately deceived’’ and wrote letters advocating for and educating members about their rights
Government agencies conduct official studies in response to community groups’ pressure. These studies usually find no association between contaminants and health effects
Not seen in letters
Community groups bring in their own experts to conduct a health study
Not seen in letters
Community groups engage in litigation and confrontation
Not seen in letters, though this has occurred elsewhere in the state (e.g., residents of Dimock, PA received $4.6 million in settlements from Cabot Oil and Gas Corporation of America for leaks and contaminated aquifers) [25]
Community groups press for corroboration of their findings by official experts and agencies
Not seen in letters
UNGDO unconventional natural gas drilling operations
noted, ‘‘science is struggling to keep up with the dangers of fracking.’’ The analysis below focuses on four specific themes that elicited extensive citizen commentary across the time period studied. Three themes mapped directly to original codes: socio-economic effects of UNGDO; perceived threats to air, water, and soil (with an almost exclusive emphasis on water); and changes to the landscape. A fourth theme, population growth and its implications, was evident across several codes. In Table 2, we provide relevant supporting quotes as well as research questions that should be addressed to validate or neutralize citizens’ concerns. Socio-Economic Effects of UNGDO Of the 215 letters reviewed, 107 letters referred to socioeconomic effects of UNGDO, with two topics most often
discussed: job creation and mistrust of the gas companies and their mechanisms for sharing financial gains. Job Creation Twenty-nine writers supported the idea that UNGDO would create much needed, and in some cases well-compensated, local jobs. One citizen from Towanda commented on his newfound hope for sustained local employment—which eliminated his having to ‘‘travel outside the county to work, as I have had to do.’’ Additional opinions regarding the socioeconomic effects of UNGDO varied widely. Some letters expressed skepticism about the number of new jobs created by UNGDO. Writers questioned whether positions were being filled by local residents or by more highly skilled, experienced workers from other parts of the country. In some cases, writers expressed
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J Community Health Table 2 Residents’ concerns, as expressed in letters to the editor, and research questions to address their concerns Theme
Quote
Research question
Debate regarding growth of local economy and job creation
‘‘The bottom line is that we are all standing on a tremendous resource that would allow us to become more energy independent as a country, realize thousands of well-paying job opportunities and allow us to see an influx of capital and investment that has been absent from many of our areas for a long time. Are there risks? Perhaps, there are some inherent risks with all forms of energy production.’’
How many new jobs have been created by UNGDO? How many new jobs have been filled by local residents? Has UNGDO reduced unemployment and poverty in Bradford County?
Mistrust of gas industry’s commitment to sharing their financial gains
‘‘I would like to know why the other states in our nation where gas drilling is taking place have taxed the gas companies far more than what Pennsylvania is preparing to do…This county deserves the same consideration. Do you or anyone else realize the magnitude of the wealth of these energy companies, including those from overseas…’’ ‘‘Many farmers are waiting for the hope and promise that they will become rich as soon as the well is hooked up to the pipeline, but because of our old leases that were signed, usually you will find the gas companies don’t have to pay royalties on your entire property, you may be paying double production cost before receiving royalties, and you may be waiting a long time before you receive any royalties if your lease doesn’t provide a time frame on when the gas produced must go to market.’’
How does the impact fee in Pennsylvania compare to taxes on UNGDO in other states? Is the Impact Fee adequate to offset health and social impacts of UNGDO?
Loss of potable water
‘‘It’s fine that the gas situation has profited many in the county, but what are we going to do when our wells run dry? Not just the rural families, but the Towanda water system also, which gets its water from wells also…’’
How has UNGDO impacted water availability, quality, and safety?
Water as most valuable local resource
‘‘Remember there are no guarantees with the natural gas industry. No one knows how long you will receive a royalty check, or how much you will receive each month. There have been farms that have lost their water. The water is not fit for human or animal consumption. The farm that once was prime marketable farmland becomes worthless…’’
What steps should be taken to prevent water contamination? How is water quality actively monitored? How is this information disseminated to local residents?
Socioeconomic effects
Mistrust of the royalty payment system
What is the system for auditing the royalty payment process? Are payments to landowners fair and timely? How does engagement in lease agreements influence landowner wellbeing, stress and mental health?
Perceived threats to water
Implications of population growth Influx of out-of-state gas workers
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‘‘Has anyone given a moment’s thought to what will happen to this quiet neighborhood of single family homes and small farms? Where will water for this development come from? And where will it go? Where will 100 men eat? Will there be vandalism, property trespass issues, disorderly conduct, firearms, alcohol and drug use? Who will handle law enforcement in this development?…What will be the impact of additional hunters on our wildlife populations? Will there be noise pollution, more truck traffic, more trash thrown along our roadsides and more beer cans tossed in our yards?’’
How has population growth contributed to changes in local crime? How well are local service providers, including law enforcement, handling demands due to increased population size?
J Community Health Table 2 continued Theme
Quote
Research question
‘‘The recent and tragic death of former Dallas High School football coach John Jones III who was killed in a collision by a natural gas drilling vehicle from Arizona, driven by a man from Texas serves to highlight the extreme dangers of ‘fracking’ vehicles and winding, country roads…The roads in those counties are not interstate and the drivers or the gas companies should not treat them as such. We also plead with those working for the natural gas industry to slow down and remember that the roads of Northeastern Pennsylvania can be treacherous…’’
How have traffic patterns, volume, violations, and number of accidents changed since the introduction of UNGDO?
Loss of agricultural subsistence
‘‘Because of the uncertainty that accompanies the natural gas industry, I feel that it would be irrational for a Bradford County commissioner to tout that the energy industry will save the family farms. And I don’t believe a politician has the right to tell anyone, even a farmer what he/she can do with their property. It is unacceptable for a politician to mislead the public due to uncertainties!’’
How much farmland has been converted for UNGDO? What are the long-term economic and environmental consequences of that conversion?
Ecosystem impact
‘‘Natural gas, wherever it goes and whatever stage of development it’s in from beginning stages to end, destroys our countrysides. It cuts across woodlands, altering its local ecology forever. Our farm culture is being destroyed, not augmented by gas…’’
How has UNGDO impacted the local ecosystem?
Increased traffic on local roads
Changes to the landscape
UNGDO unconventional natural gas drilling operations
concerns that local residents were only eligible for the least desirable of the new gas company jobs, and that those jobs could ‘‘not support the cost of living in Bradford County.’’ Other writers cited indirect benefits of the cash infused into the local economy as a result of UNGDO, noting that ‘‘hotels, landlords, restaurants, dentists’ and doctors’ offices, car repair shops, hair salons and barber shops,’’ and other small businesses had experienced substantial increases in their customer volume. Still other writers questioned the sustainability of this economic ‘‘boom,’’ suggesting that it would be followed by a ‘‘bust’’ that would ‘‘leave rural Pa. a toxic and unlivable industrial and economic wasteland when all those ‘industry jobs’ move on.’’ Concern Over Disbursement of Fees from UNGDO Activity Within the 107 letters that referenced the socio-economic effects of UNGDO, a subcategory of letters (n = 55) raised concerns regarding the complex mechanisms through which UNGDO activity would (or would not) lead to personal and community financial gains. These letters focused primarily on the royalty payment system and the Impact Fee, described below. Nineteen writers expressed questions or concerns regarding the royalty payment process through which gas
companies compensated local landowners in exchange for drilling on their properties. Writers perceived this process to be complex, difficult to track, and stressful to navigate. Landowners, who had highly variable agreements with gas companies, were unable to assess whether or not they were being paid fairly; they could not measure the flow of gas from their own wells on their land. Though well operators are required to submit production reports to the Department of Environmental Protection for 6 month periods [18], writers were concerned that ‘‘gas companies could be taking advantage of our inexperience’’ by manipulating royalty payments and ‘‘under measuring’’ gas quantities. Thirty-six letters discussed the implications of the Impact Fee. The Impact Fee was assessed to gas companies in order to offset statewide impacts of UNGDO, including the increased use of public services and elevated demands on the Department of Environmental Protection, Department of Transportation, and the Pennsylvania Emergency Management Agency [19]. Writers questioned whether local communities would receive adequate funds from the Impact Fee; they suspected that the dollars would be distributed disproportionately to urban population centers while their own rural communities—the sites of active drilling—would be neglected. Comments about the geographic distribution of funds reflected an undercurrent of rural–urban mistrust, including the belief that Philadelphia
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and Pittsburgh (referred to in one letter as the ‘‘Philadelphia and Pittsburgh Government Workers Union Pot O’ Gold’’) would unfairly benefit. Several writers feared that the Impact Fee could lead to lower royalty payments to individual landowners or dissuade gas companies from working in the county at all. Other writers objected, including one who contended that ‘‘it would take a good sized militia to drive them out’’ because the gas companies are ‘‘not going to make millions here, they are going to make billions.’’
Perceived Threats to Water Sixty-five of the 215 letters referred to perceived threats to water. Rather than focusing on anticipated diseases that would result from contaminated water, writers framed their concerns in more general terms. Writers feared that, as a result of UNGDO, they would lose access to potable water for human and animal consumption. This was both a practical worry and a symbolic one, as captured in a letter from a citizen of Sonestown, Pennsylvania, who lamented that he no longer has ‘‘a ‘sense of place,’ or a feeling of ‘home’ here,’’ because his house ‘‘has not had safe potable water for two months, and may never have again.’’ Other writers reported that they felt unprotected from potential water contamination and perceived that residents of more powerful parts of the state were more protected and were spared the contamination of their water. Writers questioned why Bradford County residents were expected to simply trust that their water was safe during natural gas development. They had access to limited information or data to assuage their anxiety and wanted ‘‘Congressman Sestak,’’ ‘‘The Department of Environmental Protection,’’ and ‘‘Harrisburg’’ to protect Bradford County’s aquifer and groundwater and provide more information on its suitability for human and animal consumption. Other writers observed that UNGDO consumed massive quantities of water. One writer presented being asked to conserve water at home while she observed ‘‘all the water tankers filling up at the hydrants (taking treated water) now since they can’t take it out of the Susquehanna River…Just two tankers are taking about as much water as Monroeton uses in a day.’’ Another resident explained that clean water was the community’s most valuable asset, and that ‘‘There is nothing more important in determining our quality of life than having good potable water and fresh clean air to breathe.’’ Several writers contended that the local community previously had good water (‘‘some of the best in the country’’) prior to the introduction of UNGDO. For some, UNGDO represented an untenable trade off, in which basic human needs, like the need for clean water, were being sacrificed for industry profits.
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Population Growth and Its Implications Forty-four letters discussed the influx of out-of-state gas workers. Thirty-four of those letters expressed apprehension regarding UNGDO-associated truck traffic. Citizens wrote about traffic volume, speeding trucks, damage to local roads, and ultimately, accidents and injuries. Several letters included entreaties to gas company workers to stop speeding and ‘‘be a little more aware of the possibility of catastrophic loss of life…The water, or stone, or pipe you are carrying is not a perishable item, and there is no need to endanger the lives of innocent people by ignoring the laws and common courtesy.’’ A minority of writers commented positively on population growth, saying things like ‘‘this group of men and women became family’’ who were hard-working and ‘‘trying to make better lives for their families.’’ Several writers (n = 13) were worried about rising housing costs because of the increased demand from out-of-state gas workers, who one writer described as ‘‘…young men, unsupervised, with nothing to do in their off hours and each with a pickup truck.’’ The writer anticipated that these new residents would have ‘‘…a more profound impact on the quality of life in this area than any windmill or gas well project.’’ Changes to the Rural Landscape Forty-six letters referred to perceived changes to the landscape with the advent of UNGDO, including seven letters that mentioned the loss of agricultural land and farming traditions. Writers acknowledged that many farms had voluntarily become inactive or non-producing, while others were ‘‘forced to go out of business’’ after the introduction of UNGDO. Eight writers expressed sadness regarding the destruction of the countryside, including threats to local ecology and wildlife populations. In a letter from 2011, a writer from East Troy explained that he had moved to Bradford County 25 years ago ‘‘for a nice, clean, quiet living in a healthful setting.’’ He added, ‘‘That’s all gone now in less than three years.’’
Discussion These letters to the editor—which covered the period from inception of UNGDO in Bradford County—reflected citizens’ questions regarding the relative benefits and harms of UNGDO, as well as substantial mistrust regarding available information. Letters provided evidence of early stages of engagement in popular epidemiology, and their stated concerns were consistent with a social determinants of health framework. Citizens were mindful of economic
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benefits of UNGDO but were concerned about threats to local assets, like high quality water, public safety, and the rural landscape. Residents questioned the links between UNGDO and human and environmental health. The letters also demonstrated ample citizen disagreement rather than a unified view of the risks and benefits of UNGDO. While writers called upon elected officials, government agencies, and scientists for assistance and information, there was little evidence of lay-professional alliances to advance a locally informed scientific agenda. Residents in other parts of Pennsylvania have demonstrated more advanced engagement, according to Brown’s stages of popular epidemiology [12]. For example, citizens in Dimock, Pennsylvania, filed a federal lawsuit against a drilling company for contaminated water (stage 8). After citizen petitioning, the EPA determined that the water quality data did not indicate an immediate health threat (stage 9) [20]. Through analysis of letters to the editor in Bradford County, we identified four major areas of citizen concern, which could guide a locally-informed research agenda: (1) socio-economic impact of fracking, (2) perceived threats to water, (3) population growth and its implications, and (4) changes to landscape. The concerns reflected in the letters were in some cases validated by available data. First, writers debated the socio-economic impacts of UNGDO, alternately lauding the industry for creating jobs and questioning the number of jobs created. This is an active controversy in the state, with estimates of new jobs ranging from a low of 28,155 to a high of 200,000—so the scale of the workforce expansion is truly unknown [21]. Writers were also concerned that local residents and communities would not receive a fair share of funds collected through the Impact Fee, and that funds would instead be distributed to counties that were not directly affected by UNGDO. Pennsylvania collected $204 million fees in 2012. Earmarks constituted $25.5 million of the funds allocated, while 60 % of the remaining funds were allocated to drilled counties and municipalities and 40 % went to statewide initiatives [19]. According to Pennsylvania news sources, the Department of Health does not receive funds from the Impact Fee [22]. Additionally, Governor Corbett and the Senate cut $2 million that had been approved by the House to build a registry for surveillance of fracking-related health concerns. Second, residents described concerns that UNGDO threatened local water quality. While definitive studies of health effects as a result of changes in water quality have not been performed, several anecdotal reports have raised concerns. In one incident, 17 cows died within one hour of consuming water contaminated with chemicals used during UNGDO [8]. In addition, the EPA commissioned a study in Pavillion, Wyoming, after residents complained about
domestic well water contamination from UNGDO. According to the draft report, ‘‘the data indicates likely impact to ground water that can be explained by hydraulic fracturing,’’ a finding that the state of Wyoming was further evaluating [7]. A third concern raised by writers was the rapid local population growth and its stress on services and roads. This concern was validated by recent traffic data from Bradford County, where the average number of trucks along U.S. Highway 6 rose 134 % from 2007 to 2010. Crashes increased by 25 % over the same time period, with most of the crashes involving heavy trucks [23]. Arrests for driving under the influence of alcohol increased 60 % in Bradford County, and non-traffic related crime rose 20 % from 2009 to 2010 [24]. Finally, writers regretted changes to the rural landscape. In Bradford County, there were over 1,000 active wells at the time of this study—more than in any other county in the state [25]. For each drilling site, an estimated nine acres per well pad, with an additional 21 acres of indirect edge effects, are converted for UNGDO operations, altering habitat and landscape through loss and fragmentation [26]. Our findings reflect the perspectives of vocal, engaged citizens who wrote to The Daily Review; results may not be generalizable to the population of Bradford County or to other drilled communities. The effects of non-participant bias are unknown. According to Publisher Greg Zyla, The Daily Review attempts to present a balanced set of opinion letters. However, less than 50 % of submissions are published. Letters containing personal insults, referring to civil lawsuits, or lacking a confirmable author are deemed ineligible for print [27]. Letters disproportionately focused on short-term effects of UNGDO, including changes in the context for health in Bradford County, Pennsylvania. Issues like job creation and increased traffic were the focus of many letters, while fewer letters referred to longer-term health and social implications of UNGDO. With less than a decade of experience with UNGDO, Bradford County is adjusting to the immediate challenges of rapid population growth and related stresses. Given that there is no systematic surveillance of the health effects of fracking, the true scope of any adverse effects cannot be estimated with accuracy. Systematic epidemiologic study will be the only way to track and estimate disease occurrence, if any, related to fracking. Citizens’ concerns, as described in this project, offer several physical and mental health issues that should be considered for incorporation into surveillance efforts. Public health surveillance and research should address both shortterm concerns, as described in citizens’ letters, and longerterm concerns about possible environmental exposures, including water contamination and associated health
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effects. Residents of communities involved in UNGDO are motivated to protect community health and wellbeing and have important hypotheses, questions, and concerns to add to the epidemiological agenda [28–30]. Acknowledgments We thank Lauris Olson, Van Pelt reference librarian, and Greg Zyla, publisher of The Daily Review, for their assistance. This was an unfunded research project.
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