Agua Superficial

This section reviews the results of the SI-65, with a discussion on the weekly and monthly self-reported symptoms, as well as symptoms experienced sometimes. While there were significant differences between the study areas in terms of prevalence of several symptom groupings that were experienced weekly, monthly, and sometimes, overall, the three areas were not different compared to one another in terms of the total number of symptoms experienced weekly, monthly, or sometimes.

3.4.1 Symptoms experienced weekly

The percentage of respondents in each study area who reported experiencing symptoms (within each symptom grouping) in the last week is shown in Figure 5.5.

Figure 5.5. Percentage of respondents reporting weekly symptoms according to symptom grouping, by study area. Note: CSG = coal seam gas; CM = coal mining; and RA = rural/agricultural.

A significantly higher proportion of participants in the CM area reported symptoms in the

‘behavioural’ (CSG: 26.9%, C: 42.9%, RA: 28.2%) and ‘skin’ (CSG: 11.4%, CM: 22.2%, RA: 8.5%) categories during the past week (χ² (2) = 9.522, p = 0.009 and χ² (2) = 10.980, p = 0.004, respectively). No differences were observed between the three study areas in relation to ‘circulatory’, ‘digestive’, ‘ear, nose, mouth’, ‘immunological’, ‘muscles/joints’, ‘neurological’, ‘other/general’, ‘reproductive’,

‘sinus/respiratory’, ‘urinary’, or ‘vision/eyes’ symptoms reported weekly (p > 0.05).

The respondent with the highest number of symptoms reported in the past week (n = 45) came from the CSG area; however, the mean number of weekly reported symptoms did not differ significantly by study area (p > 0.05).

In the CSG area, the individual symptom most commonly self-reported was ‘joint pain’, with 23.4% of CSG area respondents reporting joint pain in the past week. This was followed by ‘back pain’

and ‘headaches’ (22.8%), ‘muscle pain’ (20.4%), ‘sinus problems’ (19.2%), and ‘neck pain’ (17.4%). The most prevalent symptom in the CM area was ‘problems with sleeping’, with 27.8% of the CM

respondents reporting problems with sleeping in the past week. This was followed by ‘back pain’ and

‘headaches’ (25.4%), ‘stuffy nose’ (22.2%), ‘unusual fatigue’ (21.4%), and ‘sinus problems’ (20.6%). In the RA area, the most common self-reported symptom was ‘headaches’, with 26.5% of the RA

respondents reporting headaches in the past week. This was followed by ‘back pain’ (25.6%), ‘joint pain’

(24.8%), ‘muscle pain’ (22.2%), ‘heartburn’ (17.9%), and ‘problems with sleeping’ (17.9%).

3.4.2 Symptoms experienced monthly

The percentage of respondents in each study area who reported symptoms within each symptom grouping in the last month is shown in Figure 5.6.

Figure 5.6. Percentage of respondents reporting monthly symptoms according to symptom grouping, by study area. Note: CSG = coal seam gas; CM = coal mining; and RA = rural/agricultural.

Significantly more participants in the CM area reported ‘behavioural’ (CSG: 10.2%, CM: 18.3%, RA: 8.5%), ‘neurological’ (CSG: 12.6%, CM: 21.4%, RA: 6.0%), and ‘skin’ (CSG: 5.4%, CM: 12.7%, RA: 6.0%) symptoms in the last month (χ² (2) = 6.407, p = 0.041, χ² (2) = 12.632, p = 0.002, and χ² (2) = 6.087, p = 0.048, respectively). No differences were observed between the three study areas in relation to

‘circulatory’, ‘digestive’, ‘ear, nose, mouth’, ‘immunological’, ‘muscles/joints’, ‘other/general’,

‘reproductive’, ‘sinus/respiratory’, ‘urinary’, or ‘vision/eyes’ symptoms reported monthly (p > 0.05).

The CM area had the respondent who reported the highest number of symptoms experienced monthly (n = 22), but the mean number of monthly symptoms did not differ significantly by study area (p > 0.05).

In terms of symptoms experienced monthly, the most prevalent symptoms in the CSG area were:

‘headaches’ (7.2%), ‘feeling sickly’ (7.2%), and ‘weight gain’ (7.2%), followed by ‘sinus problems’

(6.6%), ‘muscle pain’ (6.0%) and ‘cough’ (6.0%), and ‘back pain’ (5.4%) and ‘joint pain’ (5.4%). The most prevalent symptoms experienced monthly in the CM area were: ‘headaches’ (11.9%), ‘muscle pain’

(11.1%), ‘problems with sleeping’ (10.3%) and ‘weight loss’ (10.3%), and ‘feeling sickly’ (9.5%) and

‘stuffy nose’ (9.5%). The most prevalent symptoms experienced monthly in the RA area were: ‘weight loss’ (10.3%), ‘back pain’ (7.7%), ‘feeling sickly’ (6.0%) and ‘heart pounding’ (6.0%), and ‘stomach pain’ (5.1%) and ‘stuffy nose’ (5.1%).

3.4.3 Symptoms experienced ‘sometimes’

The percentage of respondents from each study area who reported symptoms experienced sometimes, according to the symptom groupings, is shown in Figure 5.7.

Figure 5.7. Percentage of respondents reporting symptoms experienced sometimes according to symptom grouping, by study area. Note: CSG = coal seam gas; CM = coal mining; and

RA = rural/agricultural.

Significantly more participants in the CM area (CSG: 12.0%, CM: 23.0%, RA: 16.2%) reported sometimes experiencing ‘immunological’ symptoms (χ² (2) = 6.341, p = 0.042). Likewise, over one-third of RA participants reported sometimes experiencing ‘circulatory’ symptoms, compared with 24.0% of CSG participants and 19.8% of CM participants (χ² (2) = 7.845, p = 0.020). No differences were observed between the three study areas in relation to ‘behavioural’, ‘digestive’, ‘ear, nose, mouth’, ‘muscles/joints’,

‘neurological’, ‘other/general’, ‘reproductive’, ‘sinus/respiratory’, ‘skin’, ‘urinary’, or ‘vision/eyes’

symptoms experienced sometimes (p > 0.05).

The respondent who reported the highest number of symptoms experienced sometimes came from the CM area (n = 25); however, the mean number of monthly symptoms did not differ significantly by study area (p > 0.05).

The most prevalent symptoms experienced sometimes in the CSG area were: ‘headaches’ (21.0%),

‘heartburn’ (20.4%), ‘weight gain’ (19.8%), ‘back pain’ (18.6%), and ‘muscle pain’ (17.4%). The most prevalent symptoms experienced in the CM area were: ‘fever’ (23.0%) and ‘weight gain’ (23.0%), ‘back pain’ (19.8%), ‘problems with sleeping’ (15.1%), and ‘feeling sickly’ (15.0%). Finally, the most prevalent symptoms experienced sometimes in the RA area were: ‘headaches’ (26.5%), ‘weight gain’ (25.6%),

‘feeling sickly’ (23.9%), ‘heartburn’ (22.2%), and ‘unusual fatigue’ (21.4%).

The percentage of respondents in each study area reporting symptoms within any of the 13 symptoms groupings can be found in Appendix H.

3.4.4 Discussion of symptoms (SI-65 outcomes)

While the three study areas did not differ in terms of the mean number of symptoms experienced weekly, monthly, or sometimes, the three study areas did differ in terms of the proportion of respondents reporting symptoms within certain symptom groupings for each of the time intervals. These symptom

groupings included ‘behavioural’ and ‘skin’ for weekly symptoms, ‘behavioural’, ‘neurological’, and

‘skin’ for monthly symptoms, and ‘immunological’ and ‘circulatory’ for symptoms experienced

sometimes. Significantly more respondents in the CM area reported symptoms for all of these groupings on a weekly, monthly, and sometimes basis, except for ‘circulatory’ symptoms, where a higher

proportion of RA area respondents noted experiencing symptoms sometimes.

A number of studies have been conducted that examined symptoms reported by residents near UNGD operations. Some of the most prevalent symptoms reported in UNGD areas in DISH/Clark, Texas;

Pavillion, Wyoming; and Pennsylvania included sinus problems, throat irritation, allergies,

weakness/fatigue, eye irritation, nasal irritation, memory loss, and joint pain (Steinzor et al., 2013; Subra, 2009, 2010). In Pennsylvania, a survey in counties with shale gas revealed symptom groupings of

sinus/respiratory, behavioural, neurological, muscles/joints, and digestive to be the most prevalent (Steinzor et al., 2013). Additionally, another survey in Pennsylvania noted that dermal and respiratory conditions were more prevalent amongst residents living nearer to UNGD (Rabinowitz et al., 2015).

Some of the symptom groupings reported in the literature align with the most prevalent symptom groupings found in the CSG study area (‘muscles/joints’ and ‘digestive’). Likewise, while some of the most prevalent symptoms reported in the USA-based studies overlapped with the most prevalent symptoms in this study (‘joint pain’ and ‘sinus problems’), a number of these symptoms were not as prevalent in the CSG setting in Queensland. However, it should be noted from above that CSG respondents in this study reported fewer symptoms overall than CM or RA respondents.

In terms of risk perception and self-reported health, a survey in Pennsylvania found that 12.5% of participants presenting to a primary care clinic believed UNGD contributed to their current symptoms, and 22% of participants were concerned about UNGD and its harm to health (Saberi et al., 2014). The data obtained for this part of the study did not allow for discerning whether self-reported symptoms differed amongst residents in the three study areas based on their perceptions of resource development exposures and the impact on health; however, this would be beneficial to include in future studies to determine if the level of community concern (risk perception) aligns with the reported health outcomes.

In terms of symptom reporting in coal mining areas, Hendryx (2013) examined the number of self-reported symptoms in residents of coal mining areas versus those in other areas without coal mining and found that residents in the coal mining area had a significantly higher number of symptoms for the eight symptom groupings used in that study (cardiovascular, eye/ear/nose/throat, gastrointestinal,

muscle/joint/bone, neurological, respiratory, skin, and other). In this chapter, it was noted that a significantly higher proportion of CM respondents reported symptoms within certain groupings

experienced weekly or monthly. While the eight symptoms groupings reported by Hendryx (2013) did not include a behavioural category, the equivalent of the digestive symptom grouping found here was the fourth most prevalent category in coal mining areas. Likewise, some of the most common symptoms reported in the Appalachian coal mining community included chest pain, cough, skin rashes, muscle/joint pain, headaches, and fatigue (Hendryx, 2013), some of which align with the most common symptoms reported in the CM area (i.e., muscle/joint pain, headaches, and fatigue).

One of the strengths of this component of the ERHI assessment was the assessment of health symptoms through the SI-65. To the author’s knowledge, previous studies that have included questions on symptomatology did not include multiple time intervals, which was done in this survey. A review of symptoms inventories in the literature revealed recall periods from one week through a person’s lifetime.

‘Life-time prevalence’ was intentionally not used in the current study because it was considered an inappropriate measure of self-reported health due to the high risk of recall bias. A systematic review that assessed common somatic symptoms in large-scale studies identified two potential symptoms checklists (Zijlema et al., 2013); however, these lists focused on somatic symptoms and were limited in the number of physical symptoms (Petrie, Faasse, Crichton, & Grey, 2014). Based on this, a comprehensive

symptoms inventory was compiled for this programme of work that was better suited to meet the study objectives, and participants were asked to rate their experience of these symptoms in relation to three distinct time periods. This was intentionally done to reduce recall bias as much as possible.