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On the basis of the level of drilling activity in the Marcellus Shale, the Center of Excellence in Environmental Toxicology (CEET), an Environmental Health Sciences Core Center (EHSCC) at the University of Pennsylvania, felt an obligation to address the public health impact of UNGDO on Pennsylvania’s citizens. The CEET recognized that UNGDO will be part of the energy landscape of the future and that credible science is needed to determine their safety in order to establish evidence-based decision making. The CEET realized that the environmental health concerns related to UNGDO could best be addressed by scientists with complementary expertise working together. Concurrently, several Community Outreach and Engagement Cores of the EHSCC identified the growing concerns of citizens and the lack of health-related information. This led to the formation of the Inter-EHSCC Working Group (for a list of members, see ). A search in PubMed () using the search term “hydraulic fracturing” identified 111 citations at the time of writing this article. Only a handful were peer-reviewed studies on environmental health, and many are cited here. In addition, the working group considered reports by government and health agencies and nonprofit organizations, as well as reports from the gas and oil industry. This led to several unanimous recommendations.

In addition, the need for crystalline silica (frac sand) for use in the hydraulic fracturing process has prompted expansion of mining operations in the upper Mississippi watershed (Wisconsin, Minnesota, and Iowa). This expansion has become a contentious issue in communities because of environmental degradation, lost income from tourism, and risk to respiratory health ().

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Risk perceptions encompass cognitive evaluations of the likelihood of harm as well as emotional responses. Risks that are most feared are those that are unknown, experienced involuntarily, potentially catastrophic, and risky for future generations—all factors that are in play with UNGDO (; ). Having an understanding of the nature of community perceptions on UNGDO will inform risk communication and risk management. It will also determine whether credible sources of information are being used to set view points and will identify critical information gaps. Inter-EHSCC Working Group recommendation: Research should be conducted on risk perception, including the effects on community polarization.

Communities have identified a need to understand the regulations that govern UNGDO. Only six states allow health-care providers access to proprietary chemical constituents, and four of the six require the health-care provider to sign a confidentiality agreement restricting disclosure to others (). Denying health-care providers access to chemical information for patient care purposes is unprecedented, as is restricting disclosure to individuals who are exposed. Inter-EHSCC Working Group recommendation: Research should be conducted to determine how existing regulations affect reporting of environmental health consequences of UNGDO in order to enable the development of more health-protective regulations.

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The research recommendations of the inter-EHSCC working group are similar to those proposed by others (; ; ) with one significant difference: We advocate for a CBPR approach in communities affected by UNGDO. Implementation of these recommendations would inform the debate on the potential environmental health affects of UNGDO and lead to decisions by individuals, communities, agencies, and industry that would protect human health. Implementation requires dedicated funding sources that are insulated from conflicts of interest so that the science generated is trustworthy. One trusted model is federal agencies funding research that is conducted at academic institutions. Oversight by a single organization would avoid duplication of effort and unnecessary expenditure of resources. There should be harmonization of study designs, data collection, and analytical procedures, which may require a data coordination center that could also assess data quality and missing data. There should also be a publicly available data repository so that all stakeholders, including industry and communities, can access data, and appropriate firewalls and limited access should be in place for patient- or population-based health data. Implementation of these recommendations would permit a risk assessment of UNGDO, enabling decision makers to identify and reduce the most serious environmental health threats.

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Emmett EA, Zhang H, Shofer FS, Rodway N, Desai C, Freeman D, et al. 2009. Development and successful application of a “Community-First” communication model for community-based environmental health research. J Occup Environ Med 51:146–156.

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CBPR requires that study results be communicated to the communities in a timely manner (). recommended a “Community-First” communication model, which shares research findings with the affected community before publishing them in scientific literature in order to empower the community by reducing information disparities. Inter-EHSCC Working Group recommendation: Communities should be engaged in determining the most effective ways to disseminate research findings, and dissemination of aggregated data should be timely and transparent.

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Community-based participatory research (CBPR) provides a framework for engaging community members in research and has been effectively applied to a number of environmental health problems (; ). CBPR goes beyond sharing research results with community members to creating meaningful opportunities for community participation in all stages of research (i.e., project scoping, data collection, analysis, and dissemination). Inter-EHSCC Working Group recommendation: CBPR principles should be embraced in designing and conducting studies on environmental and health impacts of UNGDO so that a range of community perspectives are addressed. All stakeholders (individual/community/industry/advocacy groups/decision makers) should be engaged early to foster multidirectional communication and accountability.

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Impacted communities demand transparency in the research process, especially with respect to who is funding the research. This, in part, stems from mistrust of industry and efforts to limit access to either information on chemicals used in hydraulic fracturing or on-site environmental testing results (). Inter-EHSCC Working Group recommendation: The sources of funding for research on the environmental health impacts of UNGDO need to be openly disclosed.

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Recommendations on integrating community perspectives in environmental health research. Health impacts and stressors are perceived to exist in communities with UNGDO (; ). Given that elements of a property owner’s control may cease once UNGDO begins, these perceptions are consistent with an involuntary risk model, based on a lack of control of an unknown hazard with little opportunity for independent verification of safety (; ). Issues raised by UNGDO are similar to those of communities impacted by other industrial operations in early stages of development: Limited data on health indicators and health impacts make it difficult to identify and track health effects as well as the latency of effects. Limited to no baseline or monitoring data makes it challenging to track environmental health impacts over time.

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Recommendations for epidemiologic research. Prospective longitudinal epidemiologic studies to measure the association between health effects with proximity to UNGDO can be conducted only if the health end point is known. A good starting point would be to use health outcome and utilization data from national and local databases to associate illness and health-care visits with proximity to UNGDO. The working group recognized that baseline data in control communities, by census block, in which UNGDO is not occurring is key to identifying differences that could become end points in a prospective epidemiologic study. For example, using health outcome data, observed an association between well density and proximity of natural gas wells within a 10-mile radius of maternal residence with the prevalence of congenital heart defects in newborns. Epidemiologic studies should also include environmental sampling and/or biomonitoring of exposures to demonstrate a dose- or exposure-dependent association with the end point(s) being measured. Studies should include occupational exposure and vulnerable populations (e.g., pregnant women, children, the elderly, individuals with asthma).

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Recommendations for research on air pollution. Hazardous air pollutants related to UNGDO include a) silica dust from mining, handling, transport, and disposition of sand (); b) diesel emissions from delivery trucks, compressor stations, power generators, and drilling rigs (); c) volatile organic compounds in the flow-back and produced water as well as their reaction with NOx to increase ground level ozone (); and d) fugitive gas emissions during the production phase and from well ruptures (). Increased local and regional ambient air pollution has been associated with intensive gas extraction regions (; ; ). However, the spatial and temporal release of these pollutants will depend on the intensity of the various sources (emission rates) and their locations (e.g., frac sand mines, frac sand transfer stations, and truck transport routes to and from the well pad; and the proximity of well pads, produced-water containment ponds, and waste impoundments to each other and to affected communities) is not well characterized and needs to be addressed. Inter-EHSCC Working Group recommendation: Ambient and occupational air-quality should be measured at active drilling sites and be compared with baseline measurements in adjacent areas without UNGDO.

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