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                          HUMAN HEALTH AND
                       IN THE GULF OF MEXICO
                                                     By Paul A. Sandifer, Alesia Ferguson, Melissa L. Finucane, Melissa Partyka,
                               Helena M. Solo-Gabriele, Ann Hayward Walker, Kateryna Wowk, Rex Caffey, and David Yoskowitz

                                           In the wake of the Deepwater Horizon oil spill, hundreds of miles of floating barriers, known as
                                           boom, were anchored in place to prevent oil from stranding on the shore and to reduce impacts to
                                           sensitive areas such as marshes and bird nesting grounds, as well as areas valued for human use
                                           like this fishing spot north of Dauphin Island, Alabama. Photo credit: US Navy Photo by Chief Mass
                                           Communication Specialist Joe Kane, Fleet Combat Camera Group Pacific (Released)

174   Oceanography   | Vol.34, No.1
ABSTRACT. The Deepwater Horizon (DWH) oil spill is the only declared Spill of                   were extensive, and they compounded
National Significance in US history, and it significantly impacted the health of people         negative effects of previous disasters
and communities in the Gulf of Mexico region. These impacts amplified adverse effects           such as Hurricane Katrina in the Gulf.
of prior disasters and may compound those of future traumas. Studies, both to date and          In turn, these effects are likely to exac-
ongoing, show some negative mental and physical health outcomes associated with                 erbate traumas of subsequent disasters
DWH in some spill workers, as well as some coastal residents in all Gulf States. The            as well as ongoing threats from chem-
spill was also associated with negative effects in the living resources, tourism, and rec-      ical pollution, oil seeps, and harmful
reation sectors, at least in the short term. Compared with others, people dependent on          algal blooms. In this article, we describe
these sectors reported more health and financial concerns. Consumer concerns about              potential, perceived, and actual impacts,
the safety and marketability of seafood persisted well after data demonstrated very low         beginning with the people expected to
risk. Parents were concerned about possible exposures of children as they played on             be most exposed to toxic substances­—
beaches, but this risk was found to be minor. Spill-related stress was an overarching fac-      the response and cleanup workers—​
tor associated with adverse health outcomes, and some residents reported greater stress         followed by effects on those who resided
from navigating the legal and claims processes following the spill than from the spill          in spill-affected areas, possible hazards
itself. Research revealed a serious lack of baseline health, environmental, and socio-          to children at play on beaches, seafood
economic data against which to compare spill effects. This finding highlighted the need         contamination risks, and socioeconomic
for ongoing observing systems to monitor health and socioeconomic parameters and                effects on the Gulf ’s iconic fisheries and
establish continuous baselines of such information.                                             tourism industries and communities. We
                                                                                                conclude with a discussion of the need for
INTRODUCTION                                    demographic, economic, social, physi-           a human health observing system in the
The Deepwater Horizon (DWH) oil spill           cal, and other variables (McEwen, 2005;         Gulf and a list of major findings and criti-
was the largest ever in United States           Norris et al., 2008). Inhabitants of the        cal research needs for the future.
(National Commission, 2011) and the             Gulf region are particularly susceptible
only Spill of National Significance. How-       to oil spill health impacts due to wide-        HEALTH EFFECTS ON
ever, large oil spills, defined by NOAA         spread, preexisting health disparities,         RESPONDERS AND
(2017) as exceeding 100,000 barrels             continuing exposure to contaminants,            CLEAN-UP WORKERS
(420,000 gal) of oil are relatively rare, and   and location in a disaster-prone region         Oil spill response and cleanup workers
very large ones even more so. Between           (Lichtveld et al., 2016; Slack et al., 2020).   (hereafter referred to as workers) can be
1969 and 2017, only 44 large oil spills         Not surprisingly, the DWH oil spill, like       exposed to a variety of hazards, includ-
(45 including the long-leaking Taylor           Hurricane Katrina and other disasters,          ing the oil and its components, burning
Energy wells in the Gulf of Mexico;             “had its greatest impact among those            oil, dispersants, and cleaning agents, plus
Mason et al., 2019) have occurred in US         with the least” (Abramson et al., 2010).        mixtures of oil, dispersants, and other
waters (NOAA, 2017), with about one-                From its beginning, the Gulf of Mexico      chemicals. Other work stressors include
third of these in the Gulf.                     Research Initiative (GoMRI) recog-              high heat and humidity, musculoskeletal
   Although they are rare, large oil            nized the need for human-focused as             strain, long working hours, and finan-
spills can adversely impact the health of       well as environmental impact research.          cial (e.g., job loss) and psychological
responders, cleanup workers, and resi-          It sponsored a public health workshop           (e.g., depression, anxiety) effects.
dents, and the public welfare of affected       and broadly advertised a request for               Between 1970 and 2009, there were
communities (Walker et al., in press;           research proposals focused on human             458 tanker spills greater than 700 metric
Figure 1). The DWH spill also resulted          health effects. Although articles explic-       tonnes (approximately 222,500 gals) of oil
in deaths of 11 oil industry workers.           itly focused on human health comprised          (IOTPF, 2009); 38 of those spills affected
Physical and mental health effects have         only a small portion of research publica-       human populations. Of those 38 spills,
been reported and are closely related           tions supported by GoMRI funding, they          only eight that occurred between 1989
in disaster contexts (Aguilera et al.,          present important findings (Eklund et al.,      and 2007 were studied in some detail
2010; Palinkas, 2015; Ohrnberger et al.,        2019). Additional health-related research       for human health effects (Kwok et al.,
2017; H.J. Osofsky et al., 2018), in part       was supported via the US National               2017a): Exxon Valdez (US), Braer (UK),
because environmental contamination             Institute of Environmental Health               Sea Empress (UK), Prestige (Spain),
results in significant stress (Hallman and      Sciences (NIEHS), in part with BP fund-         Tasman Spirit (Pakistan), Erika (France),
Wandersman, 1992). How people adapt             ing, some of which is summarized here.          Nadhodka (Japan), and the Hebei Spirit
to repeated exposure to stress depends              DWH impacts on individuals, fami-           (South Korea) (B.-M. Kim et al., 2009;
on an array of psychological, socio-            lies, groups, businesses, and communities       Aguilera et al., 2010; Jung et al., 2013).

                                                                                                        Oceanography   | March 2021    175
Response to the Exxon Valdez oil spill led          primarily investigated acute health symp-              Human health studies following the
to many changes in oil spill preparedness,          toms. Acute health impacts were studied             DWH spill, the largest of their kind in
training, response, and worker safety and           for up to one year after oil spill exposure         history, are ongoing. Two epidemiologi-
health, including use of personal protec-           in workers and affected community mem-              cal studies examine effects on the health
tive equipment (PPE) in the United States           bers to assess anxiety and post-​traumatic          of workers: the NIEHS Gulf Long Term
(OSHA, 2020) and globally. Most stud-               stress, eye and skin irritation, and respi-         Follow-Up Study (GuLF STUDY; Kwok
ies of human health effects occurred in             ratory tract consequences (Palinkas                 et al., 2017a) and the US Coast Guard
non-US countries where many workers                 et al., 1993; Zock et al., 2007; Na et al.,         (USCG) Deepwater Horizon Oil Spill
from the community as well as volun-                2012). Several studies reported longer-             Cohort study (Rusiecki et al., 2018).
teers engaged in oil spill cleanup with lit-        term respiratory symptoms in workers                These study teams have collaborated, and
tle protective gear. Studies that included          responding to the Hebei Spirit (Gwack               both are assessing potential long-term
pre-disaster health data were generally             et al., 2012) and Prestige (Zock et al.,            effects, including cancer.
small, had shorter follow-up periods, and           2012) oil spills.                                      The GuLF STUDY is assessing a

FIGURE 1. A summary of human effects research findings from studies on nine large oil spills: Exxon Valdez (USA), Braer (UK), Sea Empress (UK),
Prestige (Spain), Tasman Spirit (Pakistan), Erika (France), Nadhodka (Japan), Hebei Spirit (South Korea), and Deepwater Horizon (USA). Relatively few
spills have been shown to directly and adversely affect human mental and/or physical health, although many may have socioeconomic, ecological,
or other effects of concern (Murphy et al., 2016). Whether any direct human effects occur from future spills will depend upon incident-specific condi-
tions such as spilled oil type and volume, location, time of year, response actions, and safety and health protocols. Human susceptibilities to oil spill
effects may be increased by pre-existing conditions, incident-specific and general life stressors, traumas, and previous disaster experience. Original
concept developed by NASEM (2017) and adapted from Figure 3 in Beyer et al. (2016). Redrawn with permission from Sandifer and Walker (2018),
with modifications.

176     Oceanography    | Vol.34, No.1
range of human health effects, includ-         Worker Exposures                                 documented in workers exposed to oily
ing worker access to mental health ser-        To determine effects, physical health            plants and wildlife compared to unex-
vices (Lowe et al., 2015). It uses extensive   assessments evaluate elements of expo-           posed workers (Gam et al., 2018a). While
data on actual and estimated exposures         sure pathways (ATSDR, 2005). THC                 Kwok et al. (2017b) linked reduced lung
and health outcomes derived from sur-          and BTEX are generally considered to be          function with adverse mental health out-
veys, home visits, and clinical records.       the more toxic components of oil. THC            comes, Gam et al. (2018 a,b,c) found
Such limitations as self-reporting errors,     is a composite of the volatile chemi-            no association of depression and post-
confounding factors, and potential biases      cals from the oil and was used as a sur-         traumatic stress with lung function.
are documented in all papers and are fre-      rogate for the workers’ “oil experience.”        Lawrence et al. (2020) reported improve-
quently investigated with sensitivity anal-    The exposure assessment used BP mon-             ments in lung function decrements four
yses. The full cohort includes 32,608 peo-     itoring samples and agency short-term            to six years after the spill, with those
ple. Approximately 25,000 of these were        studies and accounted for oil changes due        with the highest exposure exhibiting the
actual workers, and the remainder were         to weathering.                                   greatest improvement.
non-workers for comparison (i.e., peo-            Kwok et al. (2017a), Rusiecki et al.             When Strelitz et al. (2018) compared
ple who were trained but not hired). The       (2018), and Ng et al. (2019) provided            individual workers involved in DWH
period of oil spill work activities was        details of potential worker exposures            cleanup work with non-workers, they
from April 20, 2010, through June 2011.        and their measurements and estima-               found a positive association between sev-
Workers performed a variety of tasks           tions. Primary exposure pathways to the          eral oil spill related exposures and an
with different exposure profiles under the     oil, burning oil (particulates), and oil spill   increased risk of nonfatal heart attacks
primary categories of response, support        chemicals are inhalation and direct con-         one to three years post spill. Factors asso-
operations, cleanup on water, decontam-        tact (skin and eye). Due to the way off-         ciated with oil spill work, such as heat,
ination, cleanup on land, and adminis-         shore and onshore air quality measure-           strenuous conditions, physical exertion,
tration (Kwok et al., 2017a). The ultimate     ments and exposure estimates were                and the health limitations of the indi-
goal of the GuLF STUDY was to quantify         made, reported or observed symptoms              vidual worker, make it difficult to ascer-
exposures to total hydrocarbons (THC)          cannot be linked to a specific crude oil         tain whether the risk of heart disease
and BTEX-H (benzene, toluene, ethyl-           chemical. From available data, it appears        can be related directly to exposure to
benzene, xylene, hexane) via air measure-      that total hydrocarbon exposure levels           oil spill pollutants (Strelitz et al., 2019a).
ments as a means of estimating poten-          for workers likely were low compared to          However, risk of heart disease has been
tial toxic effects of THC and BTEX-H on        occupational standards (Middlebrook              associated with oil pollutants, cleanup
workers (Kwok et al., 2017a).                  et al., 2012). However, an onshore study         activities, burned oil particulates, and
   The USCG cohort study consisted of          conducted from May 1 to September 30,            volatile organic compounds (Strelitz
53,519 USCG personnel, 8,696 of whom           2010, assessed coastal ambient air qual-         et al., 2019b). The emotional stress related
responded to the spill and 44,823 who          ity for benzene and particulate con-             to the spill was also a possible cause of
were not responders. The USCG study            centrations (PM2.5; Nance et al., 2016)          increased physical health risks such as
used health data from military medical         using air monitoring data from the US            heart attacks (Strelitz et al., 2018). Other
encounters and cross-sectional survey          Environmental Protection Agency (EPA)            analyses suggest that physical health
data. Importantly, the USCG study can          and BP. The EPA’s Air Quality Index was          symptoms contribute to cleanup workers’
access a substantial amount of baseline        compared prior to and during the spill.          risk for mental health issues (Lowe,
health data for its participants, because      Onshore concentrations were generally            2016). However, fishers who had longer
medical data are available for all active-     higher following the spill, with benzene         periods of cleanup work and thus poten-
duty Coast Guard members from 2007             2 to 19 times higher and PM2.5 10 to             tially higher work-related oil exposure
forward (Rusiecki et al., 2018). For the       45 times higher. Both concentrations were        also had higher income, which in turn is
study, exposure levels and symptoms            high enough to exceed public health cri-         associated with lower anxiety and depres-
were based on self-reported and clinical       teria, with coastal areas near the spill and     sion (Lowe et al., 2016).
data from the total cohort. While many         cleanup activities indicating measurable            The USCG study reported posi-
health studies use self-reported informa-      exposure disparities.                            tive associations between exposure to
tion, including for toxic exposures, such                                                       crude oil, and in some cases oil and
data can be subject to recall and other        Worker Health Findings                           dispersant mixtures, and acute respi-
biases (IOM, 1994; Williamson, 2007).          GuLF STUDY findings to date have                 ratory symptoms (Alexander et al.,
Both the GuLF and USCG studies are             included nonfatal and fatal heart dis-           2018); neurological symptoms includ-
continuing, with additional health effect      ease and reduced lung function in some           ing headache, lightheadedness, difficulty
papers expected.                               workers. Reduced lung function has been          concentrating, numbness/​tingling sensa-

                                                                                                        Oceanography    | March 2021      177
tion, blurred vision, and memory loss/         ent at the time of study enrollment one to        Physical health problems or indica-
confusion (Krishnamurthy et al., 2019);        three years after the spill). Although only   tors identified with oil exposure include
heat stress (Erickson et al., 2018); and       5% of the Coast Guard personnel who           assorted respiratory issues; irritation
skin issues, as well as some gastrointes-      responded to the Deepwater Horizon Oil        of skin, eyes, nose, throat; chest pain;
tinal and genitourinary symptoms that          Spill Cohort study health questionnaire       cardiovascular disease; gastrointesti-
have not previously been well evaluated        reported contact with both oil and dis-       nal complaints; headaches, dizziness,
(Rusiecki et al., 2018).                       persants, for example, through assign-        fatigue, memory issues; and abnormal
                                               ments to conduct Special Monitoring of        blood cell counts and liver and kidney
Dispersants                                    Applied Oil Spill Technologies (Levine        function tests (e.g., Nance et al., 2016;
Dispersants warrant separate mention           et al., 2011), self-reported adverse neuro-   Singleton et al., 2016; Afshar-Mohajer
given the widespread public concern            logical health effects were worse for those   et al., 2018, 2019; Strelitz et al., 2019a).
about their unprecedented use during           workers than for those exposed only to        Laboratory experiments suggest that dis-
DWH (Starbird et al., 2015; Kwok et al.,       oil, and heat exposure also exacerbated       persant and dispersant-​oil mixtures pro-
2017a). Although studied for decades by        symptoms (Krishnamurthy et al., 2019).        duce effects indicative of lung diseases
oil spill scientists, dispersants remain a     However, these authors cautioned that         such as asthma and chronic obstructive
controversial response option (Bostrom         self-reported information can be subject      pulmonary disease (Liu et al., 2016) and
et al., 2015; Walker et al., 2018). Robust     to bias, and they did not have informa-       mixtures may affect the gut microbiome
protocols for their application on the         tion about who was where and when in          (J.N. Kim et al., 2012).
water surface were implemented during          reference to possible exposures.                  Evidence for mental health dis-
DWH (Houma ICP, 2010; ASTM, 2018),                                                           tress associated with the DWH oil spill
including monitoring for environmen-           HEALTH EFFECTS ON                             is mixed (Finucane et al., 2020a). Two
tal effects and some air monitoring for        NON-WORKERS                                   large, population-based surveys in the
2-butoxyethanol, one of the compo-             Human impacts of oil spills are much          Gulf Coast region suggest only modest
nents in Corexit EC9527A. Although             less studied than environmental impacts       or minimal changes in mental or behav-
2-butoxyethanol had been removed from          (Murphy et al., 2016), physical health        ioral health—at the aggregate level—
Corexit EC9500A as a result of health          effects are better researched among           before versus after the DWH spill (Gould
concerns related to the Exxon Valdez           spill workers than in other populations       et al., 2015). However, results across a
spill (NRC, 2005), it remained in Corexit      (Laffon et al., 2016; Eklund et al., 2019),   range of other, more targeted studies indi-
EC9527A, which was used only in surface        and mental health distress is better          cate increased reports from individu-
applications for about a month during          researched among community residents          als of symptoms consistent with depres-
the DWH spill (McGowan et al., 2017).          (Finucane et al., 2020a). Many, if not all,   sion, anxiety, and post-traumatic stress
Dispersants were also applied at the well-     of the health effects noted for workers       (Grattan et al., 2011; H.J. Osofsky et al.,
head to mitigate impacts from surface          probably also apply to the general popu-      2011, 2015; Buttke et al., 2012a,b; Gill et al.
oil slicks and to reduce levels of vola-       lation that may be exposed, although the      2012, 2014; Morris et al., 2013; Drescher
tile organic compounds near the source.        magnitude of the exposures may be con-        et al., 2014; Cherry et al., 2015; Fan et al.,
Because the measurements and sup-              siderably greater for workers.                2015; Aiena et al., 2016; Rung et al., 2016,
port documentation related to the dis-            Oil and associated chemical com-           Gaston et al., 2017; Kwok et al., 2017b).
persants were insufficient to allow reli-      ponents have a wide range of known            Substantial portions of coastal house-
able estimation of exposure levels across      or putative toxic outcomes, includ-           holds (e.g., nearly 38% of an Alabama
the Gulf (Stewart et al., 2018), the GuLF      ing endocrine disrupting, carcino-            sample; Ritchie et al., 2018) were involved
STUDY used responses to survey ques-           genic, cytotoxic, immunotoxic, muta-          directly or indirectly in DWH-related
tions to assess dispersant exposure and        genic, and genotoxic effects (Solomon         claims, settlements, or litigation activ-
estimated that about 10% of its cohort         and Janssen, 2010; Bhattacharya et al.,       ity. Research on the compensation pro-
could have been exposed to disper-             2016; Du et al., 2016; Laffon et al., 2016;   cess suggests it was perceived by residents
sants (Kwok et al., 2017a). Findings by        Doctors for Environment Australia, 2019;      as random and lacking transparency, and
McGowan et al. (2017) suggest associa-         Holme et al., 2019). Exposures can occur      resulted in additional psychological stress
tions between exposure to dispersants,         through physical contact with contami-        for individuals and corrosive effects on
specifically Corexit EC9527A or Corexit        nants in air, water, or on materials; dis-    communities (Mayer et al, 2015; Ritchie
EC9500A, and acute adverse health effects      ruptions of routine behaviors; socio-         et al., 2018; Halmo et al., 2019).
(e.g., respiratory and eye irritation and      economic impacts; or other pathways               Even years after the spill, Gulf Coast
chest tightness at the time of the oil spill   (Hobfoll, 1991; Eisenberg and McKone,         residents report DWH-associated dis-
work as well as symptoms that were pres-       1998; Slack et al., 2020).                    tress, but this may vary for different

178    Oceanography   | Vol.34, No.1
social groups, in part because of differing         Cope et al. (2013) evaluated suites of     Hodler, 2019). Among patients (predom-
prior trauma, life disruption (especially        self-reported mental and physical health      inantly African American women) seek-
income loss), or available support (Arata        issues via the Louisiana Community Oil        ing care at a Federally Qualified Health
et al., 2000; Grattan et al., 2011; Morris       Spill Survey, conducted in spill-affected     Center in an underserved area affected
et al., 2013, Cherry et al., 2015; Rung          parishes in June 2010 while the DWH oil       by DWH, post-traumatic stress dis-
et al., 2016; Ayer et al., 2019; Ramchand        spill was ongoing, and again in October       order was associated with headaches,
et al., 2019; Bell et al., 2020; Parks et al.,   2010 and April 2011. A physical health        chest pains, dizziness, or trouble sleep-
2020). Higher levels of social support,          index was calculated based on responses       ing (Langhinrichsen-Rohling et al.,
sense of community, and perceived resil-         to questions about how worries about          2017). However, where patients received
iency seem to be protective against spill-​      the spill manifested as physical symp-        post-disaster, integrated health services,
related stress. However, social support          toms. The index was significantly higher      perceptions of personal resilience
was not ameliorative for all groups, such        (indicating more health concerns) among       increased and negative physical symp-
as those with high attachment to dam-            fishing households, and while the index       toms decreased (H.J. Osofsky et al., 2018).
aged resources (e.g., fishing households;        declined in subsequent survey waves for          Children are especially vulnerable to
Parks et al., 2020) or nonreligious people       those not involved in the fishing industry,   oil spills due to their physiology (high
living in highly religious areas (Drakeford      it grew stronger over time for people in      respiratory and metabolic rates, devel-
et al., 2019). Ayer et al. (2019) reported       the industry. Parks et al. (2018) used the    oping immune and hormonal systems,
that, after controlling for other traumatic      same data source to examine disruption        small stature), behavior (e.g., inquisitive
experiences, individuals with higher lev-        of routine behaviors, including sleep, fol-   play; Tipre et al., 2017; Slack et al., 2020),
els of DWH exposure were not at greater          lowing the spill. On average, respondents     and poorly developed ability to estimate
risk for behavioral health problems,             reported difficulty with about one-third      risk (Fischhoff et al., 2010) (see section
except for illness anxiety.                      of the activities. Again, respondents with    on Beach Exposures). Children exposed
                                                 ties to the fishing industry were more        to the DWH oil spill were twice as likely
Fishers and Seafood Workers                      likely than non-fishers to report disrup-     to have mental and physical health prob-
Fishers and seafood workers are often            tion to routine behaviors.                    lems compared to those who were not
members of tight-knit cultural communi-                                                        exposed, and African American children
ties (Picou and Gill, 1996; Marshall et al.,     Women, Pregnant Women,                        and those from low-income households
2007), and the cultural identity of the Gulf     and Children                                  had higher prevalence of health effects
Coast region is intertwined with fishing         Results of previous studies revealing         (Abramson et al., 2010). Based on health
(Henry and Bankston, 2002). Short-term           adverse reproductive health effects for       status reports for children four, six, and
fishing moratoria were enacted immedi-           people exposed to petroleum hydro-            eight years after the spill, general health
ately following DWH (see Seafood Safety          carbons led to concerns about poten-          and numbers of recent physical health
section), and even when the moratoria            tial impacts on pregnant women in the         problems (respiratory symptoms, eye
were lifted, uncertainty about the con-          Gulf following the DWH spill (Merhi,          and/or vision issues, skin problems, head-
tamination of fishing grounds continued          2010). In the case of the DWH event,          aches, or unusual bleeding) were worse
for fishers and seafood workers (Simon-          women physically exposed to the spill         in households that experienced physi-
Friedt et al., 2016). In addition to pre-        or who experienced negative economic          cal exposure to the spill or job/​economic
existing economic pressures (Harrison,           impacts reported physical symptoms            losses (Slack et al., 2020).
2020), the ongoing disruption and stress         such as wheezing or irritated eyes and
from the DWH spill contributed to the            nose (Peres et al., 2016). Similarly, preg-   PHYSICAL HEALTH EFFECTS
unique vulnerability of these workers            nant women who lived near the Hebei           TO POPULATIONS FOLLOWING
(Gill et al., 2012; Lee and Blanchard,           Spirit spill site in South Korea reported     BEACH CONTAMINATION:
2012; Cope et al., 2013, 2016; Parks et al.,     more eye irritation, headaches, and pain      CHILDREN’S EXPOSURES
2018). While greater social support is typ-      than those further away (B.-M. Kim            AS AN EXAMPLE
ically helpful in bolstering mental health,      et al., 2009). With regard to reproductive    Health-related exposures associated with
it may operate differently among renew-          health, Harville et al. (2018) found little   oil spills can be estimated through quan-
able resource communities (Freudenburg,          evidence of DWH spill exposure being          titative risk assessment of health impacts.
1992; Gill et al., 2014). Indeed, Parks et al.   associated with increased miscarriages or     The risk assessment process addresses
(2020) found that fishing households with        infertility in women from southeastern        hazard identification (chemicals of con-
greater social support were more suscep-         Louisiana, although spills in Nigeria have    cern and their environmental concen-
tible to depressive symptoms six years           been linked with increased mortality rates    trations), exposure assessment (human
after the DWH oil spill.                         among newborn children (Bruederle and         activities that lead to exposure through

                                                                                                       Oceanography    | March 2021      179
ingestion, skin contact, or inhalation),            cals were available within environmen-             mouth and nose are generally closer to
and dose-response evaluation (amounts               tal matrices, including nearshore water            the ground than an adult’s, resulting in
of the chemicals likely to enter and be             and beach sediments, where beachgoers              greater inhalation of pollutants that accu-
absorbed in the body (Figure 2; NRC,                could be affected. Although these data             mulate in sediments. Also, children’s play
2009; Ferguson et al., 2020a). The effect           provide snapshots of chemical concen-              habits involve intimate contact with and
is an estimate of risk typically provided in        trations, a more complete picture in time          potential ingestion of beach sand (Shoaf
units of probability.                               and space possibly could be obtained by            et al., 2005), and they tend to dig, bury
                                                    using the data in oil spill models to predict      themselves, and sit in the very shal-
Hazard Assessment                                   oil spill chemical concentrations in near-         low water, which typically has the high-
The first step in quantifying risks is to esti-     shore environments. The General NOAA               est levels of contaminants (Shah et al.,
mate the concentrations of oil spill chem-          Operational Modeling Environment                   2011; Wright et al., 2011). Although these
icals within human exposure zones such              (GNOME) was used to help inform the                behaviors are specific to the beach envi-
as beaches. Thousands of chemicals can be           Coast Guard-led response efforts about             ronment, they had not been quantified
found in crude oils. They can be broadly            the areal extent of oil contamination.             prior to research supported by GoMRI
categorized into hydrocarbon, non-                  Initial efforts have been made to evalu-           following the DWH. GoMRI-supported
hydrocarbon, organometallic, and metal-             ate how well predictions from GNOME                studies have quantified children’s behav-
lic compounds (Huba and Gardinali,                  coincide with chemical concentration               iors on beaches in Miami, Florida,
2016). Chemicals of concern in crude oil,           measurements (Montas et al., 2020; J. Xia          and Galveston, Texas, through surveys
those potentially toxic to humans, are the          et al., 2020, 2021), opening the possibil-         (Ferguson et al., 2019), sand adherence
volatile aromatic hydrocarbons, BTEX-H,             ity for future use of operational models to        studies (Ferguson et al., 2020b,c; Perone
and the polycyclic aromatic hydrocarbons            forecast oil spill chemical concentration          et al., 2020; Tomenchok et al., 2020), and
(PAHs) (ATSDR, 2005). Mitigation of oil             distributions and provide an important             videotaping of children and translat-
spills can also include the use of disper-          first step for risk assessment.                    ing the videos to quantitative values that
sants, for which potential toxicities to                                                               describe child beach play behavior (Alicia
humans are under debate (Ferguson et al.,           Exposure Assessment                                Ferguson, North Carolina Agricultural
2020a; NASEM, 2020; Quigg et al., 2021,             Different groups of humans can be                  and Technical State University, pers.
in this issue); their use would need to be          exposed to oil spill chemicals at beaches,         comm., 2021). Collectively, these stud-
considered in risk assessments for future           including response workers who actively            ies have documented child beach play
oil spills. Of the chemicals listed above,          engage in cleanup of contaminated shore-           behaviors that can now be utilized in risk
the PAHs and their degradation prod-                lines and recreational users of these areas.       assessment analyses.
ucts have the most significant impacts              Here, we focus on the recreational user
at beaches because they weather slowly              category, and specifically on children who         Dose-Response Assessment
and are generally the most toxic (ATSDR,            may be exposed to incidental residual oil          Effects from the uptake of chemicals
2005). Also, toxicological profiles are not         that remains after beach cleaning and also         are typically separated into two types:
currently available for many oil chemicals          to low level oiling that may occur from            non-cancerous (acute and chronic) and
and degradation products and for vulner-            continuous leaks (e.g., Taylor Energy              cancerous. Non-cancerous effects are
able populations for which information is           wells, seeps) and the redistribution of            evaluated by comparing the estimated
very limited (e.g., pregnant women and              sunken oil. As noted elsewhere, children           dose to minimum risk levels for chemi-
children; Aeppli et al., 2012; White et al.,        are a vulnerable constituency for expo-            cal compounds. If the dose is greater than
2016; Farrington, 2019).                            sures to contaminants in soil and sands,           the corresponding minimum risk level,
   Immediately after the DWH explosion,             including potentially at beaches (Freeman          then non-cancerous illnesses are likely
large-scale sampling efforts were initiated         et al., 2005; Xue et al., 2007; Beamer et al.,     to occur. To estimate the probability of
by the EPA, BP, and other organizations.            2012; Ferguson et al., 2019). In addi-             cancer, a slope factor is needed and can
Their measurements of oil spill chemi-              tion to factors noted previously, a child’s        be obtained for some oil chemicals from

                        transport, fate                    activity                   intake                interaction

               source                concentration                    exposure                  dose                      effect

                                          FIGURE 2. Framework for a risk assessment modeling platform.

180     Oceanography    | Vol.34, No.1
toxicological profiles available through      ination, surveillance testing of seafood       followed a similar approach to that used
the US Center for Disease Control’s           around the periphery of the spill began on     in the response to the Exxon Valdez spill
(CDC’s) Agency for Toxic Substances &         April 28, 2010. Just four days later, May 2,   in 1990, with minor modifications based
Disease Registry and EPA’s Integrated         2010, the first emergency fishery closure      on the difference in the nature of the Gulf
Risk Information System.                      was announced. This was only the second        oil and the environmental conditions in
                                              time in US history that a fishery in federal   which the spill occurred (Ylitalo et al.,
Risk Assessment Framework                     waters was closed because of an oil spill      2012; Dickey and Huettel, 2016). Finfish
Available information about hazard            (Fitzgerald and Gohlke, 2014). Shortly         and shellfish samples were collected from
characterization, exposure assessment,        thereafter, on May 24, the federal govern-     multiple seafood sources and at multi-
and dose-​   response assessment has          ment declared a fisheries disaster for the     ple locations and depths in areas free or
been incorporated in a risk assessment        states of Alabama, Mississippi, Louisiana,     cleared of oil (Ylitalo et al., 2012). Seafood
framework. Although work is currently         and Florida (K. Xia et al., 2012). By early    samples were not collected from areas
ongoing to quantify children’s activities,    June, at the height of the spill, nearly       where oil was visibly present on the sur-
results to date indicate that children who    37% of federal waters in the Gulf of           face or chemically detected in the water
play at beaches that were cleaned after oil   Mexico Exclusive Economic Zone were            column since these locations were closed
contamination are unlikely to experience      closed to fishing along with state waters      to fishing (USFDA, 2010). Samples were
non-cancerous acute or chronic health         extending from Louisiana to the panhan-        screened for the presence and concentra-
effects. Additionally, increased cancer       dle of Florida and some public beaches         tions of 13 PAHs determined to have the
risks are very low, within the 10–6 order     (Ylitalo et al., 2012). Though federal         most potential to harm consumers as well
of magnitude (i.e., about one in a mil-       fishing waters began to reopen as early        as dioctyl sodium sulfosuccinate (DOSS),
lion; Black et al., 2016, Altomare et al.,    as the end of June 2010, it was not until      an indicator compound for the disper-
2021), given toxicological information        April 2011 that all federal waters, includ-    sant Corexit 9500A. Levels of concern for
available at the time. Also, simultaneous     ing those immediately surrounding the          each targeted compound were calculated
exposure to multiple chemical contami-        wellhead, were fully opened. Sampling          based on a variety of factors that included
nants was not compounded in the anal-         of previously closed waters continued          estimated dose, mean adult body weight,
ysis. Moreover, mental health outcomes        through June 2011 (Ylitalo et al. 2012).       and averaged seafood consumption rates
can manifest in physical outcomes from        Although most fishery closures in state        for the 90th percentile of seafood con-
chemical exposures and were not inte-         waters were lifted by August/September         sumers (USFDA, 2010). These levels were
grated into the analysis.                     2010, it was several more years before the     considered to be safe or associated with
                                              most heavily impacted coastal waters in        negligible cancer and non-cancer risk for
SEAFOOD SAFETY                                Louisiana were considered safe for fishing     the US population (Ylitalo et al., 2012).
Oil Spills and Fisheries Closures             (Deepwater Horizon Natural Resource            However, the risk level, estimated dura-
Following all oil spills in marine waters,    Damage Assessment Trustees, 2016).             tion of exposure, and the use of national
the potential contamination of seafood                                                       demographic values for body weight, con-
supplies and the subsequent risks posed       Federal Response to Human                      sumption rate, and longevity were exten-
to human health from seafood consump-         Health Concerns                                sively scrutinized (Gohlke et al., 2011;
tion are of major concern to government       Higher molecular weight PAHs, like those       Ylitalo et al., 2012; Wilson et al., 2015;
authorities and community members             that made up ~3.9% of the oil from the         Dickey and Huettel, 2016). There was
where the spill occurred (Gohlke et al.,      DWH well, are of particular concern for        particularly strong criticism around the
2011; Dickey and Huettel, 2016; Wickliffe     seafood safety because of their persistence    adequacy of information about exposure
et al., 2018). The magnitude and duration     in the environment, potential for uptake       risks and how those risks were communi-
of the DWH spill posed a significant threat   in aquatic species, and toxic or carcino-      cated to vulnerable populations (Rotkin-
to the well-being of Gulf Coast communi-      genic effects (Goldstein et al., 2011; Allan   Ellman et al., 2012; K. Xia et al., 2012;
ties, many of which depend upon safe and      et al., 2012). Though the use of disper-       Sathiakumar et al., 2017), such as preg-
productive fisheries (Dickey and Huettel,     sants (Corexit 9500A and 9527) had been        nant women and Vietnamese-American
2016). At the time of the spill, Gulf fish-   approved by the EPA, and they were deter-      fishers and their families.
eries accounted for around 16% of all         mined to have minimal toxicity in labo-           After nearly 10,000 samples and
US domestic landings (Shepard et al.,         ratory experiments (Judson et al., 2010),      months of testing, federal and state
2013), fueling concerns of Gulf residents     their unprecedented use led to public con-     authorities determined that Gulf seafood
and non-residents about the safety of the     cern about potential accumulation in sea-      from reopened areas was safe for con-
nation’s seafood supply.                      food supplies (Ylitalo et al., 2012).          sumption (Ylitalo et al., 2012; Dickey and
   In anticipation of potential contam-          The federal response to seafood safety      Huettel, 2016). While individual PAHs

                                                                                                     Oceanography    | March 2021       181
of the 13 considered to be most harm-           ers found shortcomings in the federal           total economic losses to commercial and
ful and/or carcinogenic were detected in        approach, including the narrow scope of         recreational fishing, US $4.9 billion and
many seafood samples, the concentra-            the PAHs included in chemical screening         $3.5 billion, respectively. The largest com-
tions were at least two orders of magni-        (Andersson and Achten, 2015; Dickey             mercial fisher losses were predicted for
tude below levels of public health con-         and Huettel, 2016; Farrington, 2019),           shrimpers, which accounted for almost
cern (Ylitalo et al., 2012). Further, DOSS      based on toxicity information available         85% of the study’s projected impact to
was detected in less than 1% of samples         at the time, no studies concluded that          that sector. In a separate analysis, Asche
and at very low concentrations. Though          there was an excess exposure risk from          et al. (2012) suggested that, due to mar-
heavy metals were also a concern for            consuming Gulf seafood in the months            ket integration, any increase in prices
many, particularly for vulnerable popula-       and years after the oil spill (Gohlke et al.,   (driven by spill-related reductions in
tions (Zilversmit et al., 2017), they were      2011; Dickey and Huettel, 2016; Wickliffe       supply) would not offset expected reve-
not included in the federal or state testing    et al., 2018). However, it is also largely      nue losses to domestic shrimpers. Rather,
protocols (Fitzgerald and Gohlke, 2014).        agreed that the communication of expo-          imports of farmed shrimp would rapidly
However, trace metal levels in both fin-        sure risks in general, and to vulnerable        increase to satisfy demand, meaning that
fish and shellfish samples did not exceed       populations specifically, left much to be       while consumers would be mostly unaf-
background levels as determined by inde-        desired (Greiner et al., 2013; Dickey and       fected, producers could face significant
pendent testing (Fitzgerald and Gohlke,         Huettel, 2016).                                 and additive supply shocks. Overall, such
2014; Zilversmit et al., 2017).                                                                 impacts were expected to result in signif-
   Sathiakumar et al. (2017) specifically       SOCIOECONOMIC IMPACTS                           icant loss of income to shrimpers, as well
examined additional exposure risks to           ON FISHERIES, TOURISM, AND                      as in boat building or repair, restaurants,
children from the coastal area of Mobile,       COMMUNITIES                                     and other businesses.
Alabama, compared to children living            The DWH spill resulted in numerous                 Notably, analysis is still needed to
inland. They concluded that there was no        socioeconomic impacts, including effects        confirm economic impacts to fisher-
increased risk of exposure despite higher       on the fishing, tourism, and transporta-        ies 10 years after the spill. For exam-
seafood consumption rates among coastal         tion sectors, and others that may affect        ple, while studies alluded to signifi-
children compared to the general pop-           community vulnerability and resil-              cant impacts to US shrimpers, in 2011,
ulation. Further, Wickliffe et al. (2018)       ience. Similar to investigations related        the year following the DWH spill, the
found that, even with consumption rates         to human health impacts, GoMRI sup-             Gulf produced >216 million pounds
of both shrimp and finfish set at highly        ported research on DWH socioeconomic            (98 million kilograms) of heads-on
conservative values for human health            effects but at comparatively modest levels,     shrimp at a commercial landings value
(0.7 lbs [0.3 kg] per week and upward of        with resulting publications constituting        of >US $421 million (NOAA, 2020),
8.3 lbs [3.8 kg] per week, respectively),       only approximately 6% of total GoMRI-           accounting for about 68% of US shrimp
nearly three times the rates used to cal-       funded publications and about 4.2% of           landings that year (NRC, 2013). For com-
culate the federal threshold levels of con-     total competitive grant funds awarded           parison, average Gulf shrimp landings for
cern, concentrations in seafood samples         (Petrolia, 2014; Finucane et al., 2020a).       the period 1990–2009 were 236 million
did not constitute an unacceptable life-        While much progress has been made in            pounds (107 million kilograms), with
time cancer risk.                               longitudinal monitoring of biophysical          a range of 181–290 million pounds/yr
   Widespread fisheries closures follow-        parameters, there is a lack of similarly        (82–132 million kilograms/yr). While evi-
ing the DWH event reduced the proba-            robust efforts to monitor a suite of socio-     dence does show reduced demand and a
bility of contaminated seafood entering         economic variables that could be used to        decrease in seafood sales directly after the
into commerce. However, comparisons             assess the value of non-market resources,       spill (McGill, 2011), it is not clear whether
of pre- and post-spill consumption of           or identify cultural attributes, attitudes,     these effects persisted. For example, the
seafood in multiple populations found           social connectivity, or resilience in an        total commercial landings value for all
a significant decrease in consumption           oil spill or other disaster context (NRC,       species in the Gulf (Texas, Louisiana,
in the immediate aftermath of the spill         2013; Yoskowitz et al., 2015).                  Mississippi, Alabama, and Florida West
(Sathiakumar et al., 2017; Zilversmit                                                           Coast) for the seven years following the
et al., 2017; Wickliffe et al., 2018). Though   Economic Impacts                                spill (2011–2017) was US $6.8 billion
the federal response to the spill, including    In an initial study, Sumaila et al. (2012)      (Consumer Price Index [CPI] adjusted),
the seafood testing program, drew much          utilized input-output analysis to esti-         whereas landings for the seven years pre-
public scrutiny and concern, results from       mate economic impacts for commercial            ceding the spill (2003–2009) had a total
independent studies largely corroborated        fishing, recreational fishing, and marine       CPI adjusted value of US $5.9 billion
the federal effort. While some research-        aquaculture. They projected the highest         (NOAA Fisheries data, CPI adjusted).

182    Oceanography   | Vol.34, No.1
Using biophysical projections from the         were most impacted. Effects differed          from non-market value losses at a mean
Atlantis ecosystem model (Ainsworth            among the states, with Texas receiv-          of US $585 million with a 95% confi-
et al., 2018) with input-output analysis,      ing a relatively small amount of paid         dence interval. Petrolia (2014) offers that
Court et al. (2020) modeled total eco-         claims, while individuals in Florida and      perhaps the most prominent change for
nomic impacts for the 10 years following       Louisiana received US $340 million and        research resulting from the disaster was
the spill for commercial fishing revenues      $227 million, respectively, and businesses    an expansion to an ecosystem services
and recreational fishing expenditures.         US $164 million and $88 million, respec-      approach to damage assessment. The
Results indicate that, across both sec-        tively (Eastern Research Group, 2014).        National Research Council (NRC, 2013)
tors, impacts could include losses totaling    Though individuals and businesses clearly     assessed oil spill impacts on the provi-
US $2.3 billion composed of $1.2 billion       suffered economic losses, counties with       sioning ecosystem service of seafood and
in gross regional product, $700 million in     over 1,000 employees in tourism experi-       fish-based products, as well as the cul-
labor income, and $160 million each in         enced only temporary or no declines in        tural services provided through recre-
federal and state tax revenues. However,       tourism-related employment, followed          ational fishing (among other case stud-
more research is needed to reconcile           by growth, though there were excep-           ies). Results suggested that, while fishery
modeled outputs and actual landings            tions. For example, Hancock County,           closures may have decreased landings
data, particularly for sectors anticipated     Mississippi, experienced a 7.7% decline in    in the immediate aftermath of the spill
to incur significant impacts such as the       tourism employment compared to 2009           (McCrea-Strub et al., 2011; NRC, 2013),
shrimping industry.                            (Eastern Research Group, 2014).               increased catch rates were later observed
   With nearly 223,000 km2 of fishable            An important finding is that consumer      for a large group of regularly harvested
waters and public beaches closed or show-      perception matters and is an important        species (Fodrie and Heck, 2011; NRC,
ing oil spill advisories during the months-    driver of economic impacts. A review          2013). However, impacts from the spill
long spill event (Ylitalo et al., 2012), the   of news articles and interviews found         to fishery harvest may take years or
tourism industry was also impacted.            numerous inaccurate portrayals of condi-      even decades to materialize, particu-
Misperception also contributed to tour-        tions, with media sensationalism contrib-     larly regarding cascading effects through
ism impacts, with one report demonstrat-       uting to a perception that the entire Gulf    marine food chains (NRC, 2013).
ing that the public was unaware of loca-       coast was contaminated with oil (Eastern
tions and extent of damage and believing       Research Group, 2014). To counter such        Community Resilience Impacts
Louisiana waterways to be closed when          misinformation in the future, Nelson et al.   Resilience is “the capacity of a system
they remained open (MDRG, 2010). Of            (2018) offer a spatially explicit approach    to absorb shocks and disturbance and
those surveyed, 44% believed the oil spill     for evaluating and visualizing risks to       still maintain function” (Berkes and
caused damages on par with Hurricane           tourism or other economic sectors.            Folke, 1998), or “the capacity of a social-​
Katrina, and 29% of tourists canceled or          Other studies also lend insights for       ecological system to adapt to change
postponed planned trips to Louisiana           future research. In a case study of New       through self-organization and learn-
due to the spill (MDRG, 2010). Another         Orleans, Porter (2011) argues that fishing    ing” (Berkes et al., 2003). Finucane et al.
study found that about US $147 million         and tourism should be viewed as a cluster     (2020a) examined a set of adaptive capac-
in tourism and recreation claims were          of overlapping geographic space, knowl-       ities that may diminish impacts of an
paid between August 2010 and March             edge, and impact, for example, with tour-     ecological disaster like the DWH, find-
2012. While this amount only represented       ism concentrated on recreational fishing      ing that although the spill resulted in dif-
2% of total claims, it spanned 23 differ-      and the seafood culture. Such interdepen-     fering economic impacts across fisher-
ent business types within the industry,        dence may limit opportunities for growth      ies, tourism, and oil and gas sectors with
including airlines, aquaria, entertain-        where risks of economic and environ-          location, the aggregate impacts were pri-
ment, water sports, wildlife watching, and     mental crisis persist, yet innovation could   marily short term. However, at the house-
more. Claims for impacts to retail, sales,     address some risks to external shocks. For    hold level, and particularly in poorer
and services were about US $1.9 billion        example, a tourism subsector could focus      households, financial impacts were still
representing 31% of total claims, while        on ecotourism and demonstrate how the         being felt years later. Further, commu-
those for food, beverage, and lodging          city and ecosystem remained resilient         nity well-being showed signals of distress
amounted to US $1.6 billion and 26% of         to the DWH disaster, which could pro-         related to the spill across multiple studies.
the total (Eastern Research Group, 2014).      vide a new kind of growth (Porter, 2011).     Distress was expressed differently across
Analysis of claims across the Gulf fur-        Researchers also investigated non-market      different groups, with those tied to natu-
ther found significant impacts on resorts,     impacts of the oil spill. Alvarez et al.      ral resources for their livelihoods exhib-
charter fishing, and marinas/​     docks/​
                                         ice   (2014) used choice modeling to estimate       iting higher rates, including through an
houses, though hotels and restaurants          compensation due to marine anglers            erosion of trust (Finucane et al., 2020a).

                                                                                                     Oceanography   | March 2021     183
Similarly, Cope et al. (2016) found levels      pounded by subsequent disasters such            known to be particularly vulnerable to
of distrust across communities regard-          as Hurricane Harvey in 2017, and others         disasters, and include mental and phys-
ing information provided by both BP             (J.D. Osofsky et al., 2014; Shultz et al.,      ical health assessments and measures of
and the federal government, with trust          2015; SAMHSA, 2018). Recurrent disas-           stress. In addition to collecting and pro-
in state government being somewhat              ters take a heavy toll on human health in       viding information on direct and indi-
stable. Mayer et al. (2015) reported that,      the region, where many people already           rect health impacts to individuals, the
although the compensation process               suffer significant health and economic          system should also incorporate commu-
helped to mitigate economic impacts,            disparities (Lichtveld and Arosemena,           nity data. As far as we are aware, this is
apparent confusion, lack of transpar-           2014; Lichtveld et al., 2016). Climate          the only observing system designed for a
ency, and perceived inequality in the pro-      change, land subsidence, and popula-            disaster-prone area and focused explicitly
cess eroded trust and strained commu-           tion and development pressures are all          on disaster-related health effects.
nity relations. In addition to those reliant    likely to increase the incidence and sever-        Components of the proposed Gulf
on natural resources, other groups iden-        ity of environmental disasters in the           of Mexico Community Health Observ-
tified as having higher vulnerability to        Gulf region, along with their accompa-          ing System would include: three cross-​
the spill included populations that exhibit     nying adverse effects on human health           sectional surveys, the National Health and
disadvantages related to rural environ-         (Sandifer et al., 2020).                        Nutrition Examination Survey (NHANES;
ment, dependence, older age, and socio-            Previous studies of health effects of​n chs/​n hanes/),
economic and/or educational disparities,        Gulf disasters, as well as other sections of    the Behavioral Risk Factor Surveillance
as well as living in mobile homes (Cope         this article, demonstrate the lack of, and      Survey (BRFSS;​
and Slack, 2017), being of minority eth-        critical need for, baseline health infor-       brfss/), and the National Health Inter-
nicity (e.g., Vietnamese; Patel et al. 2018),   mation with which to compare effects            view Survey (NHIS;​
or being female (Lightfoot et al., 2020).       of future disasters (Sandifer et al., 2020).    nchs/nhis/); a proposed new Augmented
In a case study of Apalachicola, place,         Ongoing health monitoring is essential to       BRFSS survey for the Gulf states; the
heritage, and moral identity were found         develop and maintain such a baseline and        new National Institutes of Health (NIH)
not to be fixed community attributes but        capture acute, chronic, and long-term           All of Us national longitudinal study
rather to provide individuals with vary-        health impacts, as well as secondary com-       (; and proposed
ing resources, which in turn impact             plicating events that occur in the intervals    new Large, Small, and Disaster-Specific
disaster recovery (Clarke and Mayer,            between major disasters. Recognizing the        Gulf of Mexico longitudinal cohort stud-
2017). This has important implications          urgent need for a health observing sys-         ies (Figure 3). The cohort studies are
for institutional recovery frameworks—          tem in the Gulf of Mexico region anal-          designed to build upon one another and
often crafted by external actors—in a           ogous to the kinds of atmospheric and           are the unique and most important parts
precarious Gulf region where resilience         oceanic observing systems well estab-           of the observing system. Another signif-
may vary locally. For future spills and         lished for monitoring and predicting            icant strength of the system is its abil-
other disasters, more attention should be       hurricanes and other extreme weather            ity to adapt rapidly as needs arise and
given to the researcher-community rela-         events, GoMRI commissioned a design             new biomedical and other technologies
tionship, where cultural norms and trust        study. The intent was to devise a frame-        are developed.
are critical for successful engagement          work that would provide for continuous             The geographic focus of the proposed
with local residents (Lesen et al., 2019;       collection of health information to ensure      observing system is the 68 coastal coun-
Finucane, 2020b).                               existence of adequate pre-, during, and         ties of the five Gulf states. These are
                                                post-​disaster information for compara-         counties that either have a Gulf shore-
NEED FOR A COMMUNITY                            tive purposes and to improve emergency          line or are near the coast and contain
HEALTH OBSERVING SYSTEM                         planning and public health response.            Federal Emergency Management Agency
Environmental disasters of various kinds        The resulting framework (Sandifer et al.,       (FEMA)-identified areas with high risk
and magnitudes occur frequently in              2020) builds upon and leverages exist-          for tidal and/or storm surge flooding
the Gulf region (NOAA, 2020; Sandifer           ing ongoing national health surveys and         (Ache et al., 2013). A statistically repre-
et al., 2020; Smith, 2020), with one often      includes new longitudinal cohort studies        sentative sample of volunteers from the
following another and compounding               designed to elucidate long-term health          populations in these counties is proposed,
the impacts of the previous incident.           trends and disaster-associated health           with stratification to ensure proportion-
Examples include the 2010 DWH oil               effects in the five Gulf states. The system’s   ate inclusion of both urban and rural
spill that followed the catastrophic effects    new cohort studies must continue indef-         populations and with additional, targeted
of Hurricane Katrina in 2005, and the           initely, be large enough to represent the       recruitment as necessary to enroll ade-
health effects of which were then com-          risk-prone coastal areas and populations        quate numbers of people deemed par-

184    Oceanography   | Vol.34, No.1
ticularly vulnerable or typically under-
represented (e.g., ethnic minorities,
the underserved, and those who suffer
health, health care, and economic dis-
parities). Initially, volunteer participants
are expected to be recruited using a mail-
address sampling frame, followed by use
of electronic communication means to
the greatest extent possible.
   If implemented, assessments of men-
tal and physical health in the new cohort
studies will include information obtained
via detailed health questionnaires, clin-
ical examinations, biological speci-
mens, electronic health records, and use
of wearable health devices. These will
be augmented with data from second-
ary sources such as information from
State Health Departments and the CDC,
national community surveys, environ-
mental exposure databases, social media,
remote sensing, and others. Biomarker
data derived from biological samples
are expected to be used as indicators of
health status, including for calculation of
measures of chronic stress and its impacts
on physical and mental health.                              FIGURE 3. A conceptual framework for a Gulf of Mexico Community
                                                            Health Observing System. From Sandifer et al. (2020)
   Primary users of information from
the health observing system will be
public health and medical profession-
als, emergency managers and respond-           effects and their interactions are inad-      spill, heavy reliance on self-reported and
ers, and clinical and academic research-       equately studied for oil spill workers,       cross-sectional survey data, limited collec-
ers. Secondary users are likely to include     their families, and others who may be         tion of clinical health information, and a
political, community, and business lead-       exposed to or affected by them. Besides       paucity of long-term, longitudinal cohort
ers, and many others. Data and infor-          spill workers, special attention is needed    studies. Health studies need to be initiated
mation products are expected to be used        to vulnerable people, including individ-      before, during, or immediately following a
to assess disaster-related health effects;     uals with chronic illness or who suffer       large spill and must continue long enough
enhance disaster planning and response;        health and health-care disparities and/or     to identify long-term effects and second-
improve protection for disaster respond-       socioeconomic deprivations, lack strong       ary surges of chronic illnesses. Critically
ers and workers; build individual and          social support, the elderly, and natural-     needed are cohort studies that start before
community resilience; and promote new          resource-dependent communities.               a major spill and continue through it and
clinical, biomedical, and public health           A common theme across studies is           onward for a long period after.
research and practice.                         the overarching role of stress (e.g., from       Considerable information about com-
                                               physical exposure, job or income loss,        ponents of oil (e.g., benzene) and their
CONCLUSIONS, GAPS,                             compensation/​  litigation processes, or      potential toxicity to humans was avail-
AND OPPORTUNITIES                              behavioral disruption) as an important        able before the DWH spill, but many gaps
A broad range of mental and physical           factor associated with poor mental and        in knowledge were identified, including
health impacts has been attributed to          physical health outcomes.                     effects of field-relevant exposures to oil
oil spills in general and the DWH disas-          Human health findings were severely        components, engine exhaust, and other
ter in particular, but in most cases defin-    limited by a lack of baseline health data,    chemicals (e.g., dispersants and decon-
itive cause-and-effect linkages are lack-      long delays in implementing major             tamination cleaners) as well as these in
ing. Overall, mental and physical health       health research activities following the      combination with additional stressors

                                                                                                     Oceanography   | March 2021     185
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