Instruments for assessing the impacts of oil spills: an integrated approach to health, the environment and the socioeconomic profile of exposed areasAbstract
Advances in the oil industry have been associated with major disasters involving oil spills in offshore fields, negatively impacting life and the environment. We considered the importance of monitoring and evaluating these events, using various instruments, according to three research axes: health; the environment; and the socioeconomic situation of exposed populations. Thus, the objective was to survey, through a scoping review, scientific evidence involving the application of these instruments to assess the impacts of oil spills. Different databases and languages were used to search for the works. The data were reviewed by a pair of researchers, who carried out the qualitative evaluation. For synthesis of the results, we considered 45 studies distributed among observational studies with no control group, cohort studies with control group, and cross-sectional studies, with a predominance of studies focused on the health axis (n = 39; 86.66%) and with interview method (n = 29; 64.44%). We found 75 records of instruments used, with Likert-type scales, combined scales and free response patterns. In addition, there was a gap in studies on the environmental and socioeconomic axes, especially in an integrated manner. Finally, we considered the importance of new research including essential characteristics of the instruments (consistency, reliability, faithfulness, cross-cultural adaptations) for the possibility of building multidimensional matrices to monitor disasters caused by human action, facilitating decision-making in the formulation of government policies and actions.
Keywords:
Petroleum Pollution; Surveys and Questionnaires; Disaster Evaluation
Resumo
Os avanços da indústria de petróleo estiveram associados a grandes desastres envolvendo derramamento do material em campos marítimos, impactando negativamente a vida e o ambiente. Considera-se a importância do acompanhamento e da avaliação desses eventos, a partir de instrumentos variados, sobre três eixos de investigação: a saúde; o ambiente; e a situação socioeconômica das populações expostas. Desse modo, pretendeu-se mapear, por meio de uma revisão de escopo, as evidências científicas envolvendo a aplicação desses instrumentos sobre os impactos de derramamentos de petróleo. Foram utilizadas diferentes bases de dados e idiomas para a busca dos trabalhos. Os dados foram revisados por dupla de pesquisadores, que realizaram a avaliação qualitativa. Para a síntese dos resultados, foram considerados 45 estudos distribuídos entre os tipos observacionais sem grupo controle, de coorte com grupo controle e transversais, com predomínio daqueles voltados para o eixo saúde (n = 39; 86,66%) e com método de entrevista (n = 29; 64,44%). Foram identificados 75 registros de instrumentos utilizados, com escalas do tipo Likert, escalas combinadas e padrões de respostas livres. Ademais, observou-se a carência de estudos com investigação nos eixos ambiental e socioeconômico, sobretudo de forma integrada. Ao fim, considera-se a importância de novas pesquisas que incluam características essenciais dos instrumentos (consistência, confiabilidade, fidedignidade, adaptações transculturais) para a possibilidade de construir matrizes multidimensionais de acompanhamento de desastres motivados pela ação humana, facilitando tomadas de decisões na elaboração de políticas e ações governamentais.
Palavras-chave:
Poluição por Petróleo; Inquéritos e Questionários; Avaliação de Desastres
Resumen
Los avances en la industria petrolera están asociados a grandes desastres que involucran derrames en campos marítimos, con repercusiones negativas en la vida y en el medioambiente. Es importante monitorear y evaluar estos eventos a partir de diversas herramientas divididas en tres ejes de investigación: la salud; el medioambiente; y la situación socioeconómica de las poblaciones expuestas. A partir de una revisión de alcance, este estudio pretende mapear la evidencia científica sobre la aplicación de estas herramientas acerca de los impactos de los derrames de petróleo. Se utilizaron diferentes bases de datos e idiomas en la búsqueda de estudios. Los datos fueron revisados por dos investigadores, quienes realizaron la evaluación cualitativa. Para la síntesis de los resultados se consideraron 45 estudios distribuidos entre observacionales sin grupo control, de cohorte con grupo control y transversales, con predominio en el eje salud (n = 39; 86,66%) y como método la entrevista (n = 29; 64,44%). Se identificaron 75 registros de herramientas utilizadas, con escalas Likert, escalas combinadas y patrones de respuesta libre. Además, se observó la falta de estudios centrados en los ejes ambiental y socioeconómico, sobre todo de manera integrada. Por último, se destaca la importancia de que futuras investigaciones incluyan características esenciales de los instrumentos (consistencia, confiabilidad, fiabilidad, adaptaciones transculturales) para que se construyan matrices multidimensionales de monitoreo de desastres causados por la acción humana, facilitando la toma de decisiones en la elaboración de políticas y acciones gubernamentales.
Palabras-clave:
Contaminación por Petróleo; Encuestas y Cuestionarios; Evaluación de Desastres
Introduction
Historically, industrial development and increasing demand for energy have driven global economic growth. In this context, the oil industry - which originated in the 19th century United States - was prominent as one of the world’s main energy sources 1,2,3. In addition, the economic growth of several nations has become heavily dependent on fossil fuels, such as oil, natural gas and coal, which directly drive the global economy and international trade 4.
The main oil reserves are in deep offshore fields, whose exploration requires constant technological advances. These advances are essential for extraction, transportation, and refining, but they also face geological, climatic, and operational challenges, which, when not adequately overcome, can result in major human, material, and environmental damage 3,5,6,7. Thus, it is important to emphasize that oil exploration is among the most polluting human activities, as it generates huge volumes of solid waste and harmful gases that degrade the environment and affect human health 8.
Accordingly, safety along the production chain is crucial to avoid major accidents, such as oil spills, which cause serious environmental damage and risks to the health of living beings, which become vulnerable to the increased incidence of cancer and neurological and psychological, integumentary, hepatic, cardiovascular and respiratory diseases 9,10.
Consistently, throughout history, several disasters involving oil have demonstrated the devastating impact of these occurrences. The first major case recorded was the Sinclair Petrolore (1960) disaster, followed by others such as Torrey Canyon (1967), Exxon Valdez (1989), Hebei Spirit (2007) and, more recently, Deepwater Horizon (2010) 11,12,13,14,15,16,17,18,19. Each of these disasters had severe consequences, both for the affected ecosystems and local populations, exposing them to serious health problems and economic losses.
In Brazil, the 2019 disaster showed the severity of oil spills. The oil slicks that appeared on the Northeastern coast affected more than 3,400km of coastline, directly impacting the ecosystem, the local economy and public health. In addition, the spill continues to pose environmental challenges, as oil fragments continue to appear on the beaches and the source of the problem has not been identified 20,21.
In the face of these disasters, the use of assessment and monitoring instruments has been fundamental to deal with the consequent impacts. Such instruments - including scales, questionnaires and checklists - are used to measure the consequences of spills and support decision-making in emergency situations 22,23. However, appropriately choosing these instruments is vital, as the diversity of involved variables can directly influence the reliability of the results 24.
Considering the gap in studies correlating the application of these instruments in contexts of oil spills, it is assumed, therefore, that, by identifying them, the monitoring, response, and intervention on the situation become more efficient and effective, enabling a better management of actions in different approaches, whether they are geared toward aspects of healthcare, environmental protection and recovery, and socioeconomic repairs.
Thus, the present study aims to survey scientific evidence related to the application of these instruments to assess and monitor the impacts of oil spills on the health, environment and socioeconomic profile of affected areas.
Method
This is a scoping review, used to map a gap in a field of research of interest, being considered a preliminary stage to a systematic review with methodological rigor and reproducibility, in terms of nature, characteristics and volume 25,26,27.
For this approach, we adopted the international guide called Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) and the recommendation proposed by the Joanna Briggs Institute that is widely disseminated and adopted by several studies that use the scope review methodology in six stages: (i) definition of the question; (ii) identification of studies; (iii) selection of studies based on inclusion and exclusion criteria; (iv) data extraction; (v) organization of results; and (vi) dissemination of research reports 28,29,30.
This study was registered in the Open Science Framework (https://osf.io/y792v/) for storage and transparency regarding the protocol used. In addition, regarding the guiding question, the Population-Concept-Context (PCC) method was used to identify key topics, as follows: how are the instruments for measuring and monitoring impacts of oil spills used to assess the health, environment and socioeconomic profile of exposed populations and areas?
For the purposes of this study, the following databases were used: MEDLINE via PubMed; Cochrane Library; Virtual Health Library (VHL); Portal de Periódicos CAPES; Scopus; Web of Science; Embase; and SciELO. All databases present the scope of studies that meet the objective and the guiding question presented. In addition, we did not consider sources of gray literature, which were not formally published.
For the development of this study, the bibliographic search considered the relation of terms pertinent to the central object of the study, with boolean operators AND and OR, filtering the results in the different databases. The terms used and the search strategy were guided by the Medical Subject Headings (MeSH) - petroleum pollution, surveys and questionnaires and their respective entry terms, as shown in Box 1.
We identified 2,055 records in the databases. After eliminating 167 duplicates, 1,888 records remained for reading of titles and abstracts. Of these, 1,780 records were excluded for lack of relevant information, resulting in 108 records for full reading. Finally, 45 records were selected for review and narrative synthesis (Figure 1).
Flowchart indicating the study selection process adapted from Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).
We included all original studies in English, Portuguese and Spanish published and available in full, including different methodologies, which should answer the guiding question so as to address the correlation between exposure to oil spill disasters and the consequent impacts, using instruments to measure the effects.
The selected studies, published between 2011 and 2023, reflect the significant increase in research on oil spills after the Deepwater Horizon explosion in 2010, the second largest oil disaster in history and the largest in the aquatic environment 31.
We excluded studies of secondary data, reviews, single cases or case series, personal accounts, expert opinions, editorials and similar items. We also excluded academic works (theses, dissertations), books, book chapters, event proceedings, reports and documents. In addition, duplicate or irrelevant studies were removed according to the reading of titles, abstracts or full texts.
For the study selection stage, two independent reviewers were assisted by the Rayyan QCR platform (https://www.rayyan.ai/) in the following steps: reading of titles and abstracts; and reading of full text. In case of disagreement, a third independent reviewer would be required for final decision. In the next step, the extracted information was exported to the Microsoft Excel software (https://products.office.com/), following the characterization of studies selected for sample extraction (author(s); journal; place of publication; objectives; type of study; population; research axis; main results; preliminary training research; level of evidence) and the characterization of instruments used in the studies (identification; instrument application by study; dimensions analyzed; additional information and response patterns as to the instruments used).
The level of evidence used to characterize the studies also followed the recommendations of the Joanna Briggs Institute in five levels and their subclassifications 32, with a scale from the level of highest recommendation (1) for experimental studies to the level of lowest recommendation (5) for expert opinions and bench research, the latter not being applicable to the present study, according to the exclusion criteria adopted.
The extracted data were presented in charts, analyzed using descriptive statistics (absolute and relative frequency), followed by narrative synthesis for building the results of this study. Finally, as this study was produced with secondary data, with free access, without direct exposure of humans and/or animals for data collection, it required no submission to the competent Research Ethics Committee.
This study has financial support from the Research Program for SUS: Shared Health Management - PPSUS/Pernambuco (Brazilian National Research Council, Department of Science and Technology of the Secretariat of Science, Technology and Innovation of the Brazilian Ministry of Health, Secretariat of Health of Pernambuco State, Pernambuco Foundation for the Support of Science and Technology [CNPq/Decit/SCTIE/MS/SES/Facepe, acronyms in Portuguese]), the Inova Fiocruz Program - Strategic Orders: Sustainable and Healthy Territories in the Context of the COVID-19 Pandemic, and the call for projects and territorialized strategic actions for implementation of the 2030 Agenda, the Presidency of the Oswaldo Cruz Foundation (FIOCRUZ, acronym in Portuguese), and the Brazilian Coordination for the Improvement of Higher Education Personnel (CAPES, acronym in Portuguese; Financial Code 001).
Results
Regarding the characterization of the selected records (Box 2), it was observed that most studies were carried out in the United States (71.11%), with less frequency in South Korea (13.33%), Nigeria (6.66%), Spain (4.44%), United Kingdom (2.22%) and Brazil (2.22%). The highest volume of publications was in 2019 (20%), followed by 2022 (15.55%) and 2012 (11.11%). Only one study was published in 2023, by researchers from the United States.
The studies identified were: Observational Studies without Control Group (44.44%; level of evidence 3.e), Cohort Studies with Control Group (33.33%; level of evidence 3.c) and Cross-Sectional Studies (22.22%; level of evidence 4.b).
As for the relation between research objectives and axes of the selected articles, it was observed that most studies focused on the health field (86.66%), with little emphasis on the environment (4.44%) and no exclusive research on socioeconomic aspects. The review found mixed approaches: health and socioeconomic aspects (6.66%); health and the environment (2.22%); and health, the environment and socioeconomic aspects (2.22%). No study mentioned the preliminary training research in the methodological design.
As for the characterization of instruments used by the selected articles (Box 3), it was observed that most studies used their own questionnaire applied through interviews (64.44%), in contrast to the isolated use of other assessment instruments (6.66%). In addition, we identified records that combined different instruments (28.88%).
In total, 75 records of use of instruments were observed. In addition to own questionnaires, we identified 29 different instruments to assess the impacts of oil spills. Among them, the 20-item Center for Epidemiological Studies Depression Scale (CES-D) and the 8-item Patient Health Questionnaire (PHQ-8) were the most used, each in three studies. They were followed by the 7-item Generalized Anxiety Disorder (GAD-7), the Kessler-6 (K6), and the Primary Care PTSD (PC-PTSD) screen, each in two studies. Only four instruments focused on environmental aspects and respondents’ perceptions: Community and Environment in Rural America Gulf Coast Module, Environmental Exposure Questions, Risky Events Self-Report Questionnaire and Environmental Risk Tolerance. Other instruments are shown in Box 3.
Nine articles provided insufficient information on the instruments used, limiting a detailed analysis. The use of binary scales, Likert-like scales, combined scales and free responses was observed in the design of the instruments (Box 3).
Among the dimensions analyzed by the instruments (Box 3), there was a predominance of focus on mental and emotional aspects in the health dimension (41.33%), followed by general aspects of physical health (13.33%), and cardiovascular, respiratory and obstetric/neonatal aspects (6.66% each). Neurological aspects were addressed in 2.66% of the studies.
In the general dimension, we analyzed perceptions of exposure and impact (8%), while, in the environmental dimension, we evaluated perceptions of environmental risks and impacts (8%). Multidimensional variables were also identified to assess socioeconomic and general health aspects (2.66%), and socioeconomic aspects with obstetric health, perception of exposure and environmental impact (1.33% each).
Considering Boxes 2 and 3 and the objectives of the articles, exposure to petroleum/crude oil and containment responses are associated with the following findings:
(a) In health: increased neurological and behavioral disorders, such as anxiety disorder, depression, and post-traumatic stress disorder (PTSD); cardiovascular and respiratory disorders, such as hypertension, heart attack, asthma, and lung diseases; and adverse obstetric and neonatal events, such as miscarriages and stillbirths.
(b) In the environment: perceptions of increased risk associated with exposure and impacts on marine life, leading to reduced seafood consumption.
(c) In the socioeconomic context: negative impacts on tourism and fishing, loss of livelihood for local workers and changes in cultivation routes, highlighting the importance of social cohesion in recovering damage.
Discussion
The studies identified show a variety of instruments used in oil spill disasters, although most adopted their own models of research groups and scale-based data collection methods to examine impacts. These impacts affect both the environment and humans, especially the coastal population, and nearby territories, causing major vulnerability 33. This highlights the importance of understanding changes in socioeconomic dynamics, in the occupation of spaces and in the determination of the health-disease process in these areas 34.
When comparing oil spill-related disaster management with that of other natural, technological and chemical disasters, both potential and limitations are found. As for potential, we note improved coordination and rapid response, the use of advanced technologies, and effective training of teams. Clear communication strategies and collaboration between institutions also optimize resources and promote an integrated response. However, limitations such as inadequate assessment and management can cause delays in access to affected areas, increased numbers of victims, psychological suffering, loss of coordination in relief actions, cultural destruction, greater vulnerability and migration in search of resources 35.
Therefore, it is crucial to continuously improve assessment methodologies to address the diversity of scenarios and the complexity of impacts on affected communities. The analysis of instruments used, especially in disasters caused by oil spills, shows the importance of tools such as CES-D, PHQ-8, GAD-7, K6 and PC-PTSD. These instruments are effective for screening and monitoring post-disaster psychological conditions, being standardized and easy to apply to trace symptoms of depression, anxiety and PTSD. However, despite their usefulness, these instruments may not provide a complete diagnosis and may not represent the complexity of the experiences lived by the affected populations, as well as the social, economic and cultural factors that contribute to the development of mental disorders 36,37,38,39,40,41.
In the context of health, exposure to petroleum is associated with physical and mental, genotoxic and endocrine symptoms with different severities in various organic systems. In addition, both acute and chronic intoxication increase mental health vulnerability, especially in individuals affected by the destruction of territories and loss of survival mechanisms 42. We note the predominance of articles focused on mental health, justified by the concern with increased disorders in the survivors’ life, work, family and social life, as well as with impacts on subsistence activities and economic loss 43.
The instruments also showed perceptions about environmental impacts and risks, in addition to negative effects on socioeconomic conditions of exposed populations, similar to those found in studies on occupation of territories by polluting industries and environmental unsustainability of these activities 44.
Importantly, the articles selected for this review do not address the intimate aspects of environmental injustices and socioeconomic vulnerability caused by exposure to oil. This contributes to a biased knowledge production that hides risk contexts and is unfavorable to human groups that are vulnerable in this impact assessment design model 10.
The gap in studies on the perceptions and responses of communities affected by oil spills can lead to inadequate interventions and deficient policies, aggravating inequalities and injustices and intensifying the impact of environmental racism. This review shows the need for an interdisciplinary and systemic approach, with integrated public policies, to understand the relation between health, the environment, and social and economic aspects and to address the adverse effects on living conditions and territory occupation.
In addition, it is suggested that the coordination between the different levels of government should be strengthened, especially at the municipal level, where the formulated policy is directly implemented, strengthening social participation and enabling local communities to collaborate in building solutions for their specific situations - in this case, dealing with disasters 45,46,47.
Given the challenges in managing disasters, it is important to adopt measures such as standardization of rapid response protocols, efficient environmental monitoring systems, and effective inspection mechanisms, integrating these tools with decision-making processes in a context of democratic governance 48,49,50.
Discussion on the research axes - addressed here in a conceptual field - enables understanding causalities and determinations of the impacts caused by human activity, in an attempt to establish equitable and sustainable solutions 51. Accordingly, we note the highly polluting characteristics of the process of producing oil and its derivatives, as well as the potential damages in several aspects, such as culture, which drive, in isolation, approaches of studies on impacts 52.
In dealing with oil spill disasters, which affect physical, social and economic aspects of populations, community recovery requires integrated efforts to understand risks to health and community sustainability. Therefore, the use of instruments that provide systematic and detailed data collection is advocated, for a complete understanding of the impacts and effectiveness of recovery actions.
The investigation of the Deepwater Horizon explosion found that difficulties in containing the disaster were related to inadequate estimates of oil flows and poor assessment of the risks of exposure and seafood consumption. Fishing activities and the seafood industry, which are essential to the local economy, were significantly affected by the spills. In addition, there is a lack of information on training and specialization in the assessment of environmental exposure of the professionals involved 53,54,55.
There was a lack of studies that integrate the assessment and monitoring of events, especially considering social issues beyond health. This gap can be attributed to the biomedical paradigm, which tends to resist approaches that include subjectivity, values and symbolic aspects of social relations, focusing mainly on the application of research instruments 56.
It is important to note that, although this study has focused on the subject of oil spills, other events involving chemicals, such as pesticides, are considered in the scope of this discussion, as these also produce significant socioeconomic and environmental impacts, which are of interest to public health. In this sense, we identified dynamics of exposure combined with consequences for the organic systems of individuals and the socioeconomic structures of affected areas, also associated with mechanisms that produce vulnerability and injustices in a constant cycle of degradation 57,58. Therefore, it is necessary to consider the risks of chemical accidents as a public health issue.
Industrial development and chemical handling have catastrophic potential that drives the need for accident and disaster planning and prevention policies, with emergency control and safety measures for each process 59. Moreover, in the context of exposure to toxic substances, toxicological information centers play a crucial role in the management of serious incidents while treatment services reach victims. To promote appropriate policies, it is necessary to adapt this tool to ensure the efficient flow of information, notifications and referrals between diagnostic, laboratory, statistical, epidemiological and community surveillance subsystems 60.
The predominance of observational methods (analytical and descriptive) in the selected studies reflects the traditional epidemiological interest in establishing causality between events, especially between contextual factors and health repercussions. This reinforces the biomedical contribution, while ignoring the importance of integrating social aspects into the construction of scientific knowledge 61.
Although observational studies are more adequate to assess the incidence of events, at a lower cost, it is important to consider the occurrence of confounding factors between the groups under observation, during the construction of the methodological design, especially for the proper application of instruments 62. Moreover, we note their lower degree of evidence and recommendation when compared to experimental or quasi-experimental studies, in addition to the need to analyze the methodological quality by different strategies, considering the particularities existing in observational cohort studies with a control group, without a control group, and cross-sectional as presented here 32,63.
A relevant point is the researchers’ distance from the objects of study and the affected communities. This distance is evidenced by the lack of preliminary research that guides the methodological design and the choice of assessment instruments. The relation between the method and the object is crucial to define the scientific approach, the appropriate tool and the results, ensuring an integrated and concrete view of the issue 64.
In other words, the choice of assessment instruments for a scientific method must be preceded by immersion and approach to the reality experienced, to understand it and enable its transformation; not just its critical and fragmented analysis 65. Thus, for a more holistic and accurate understanding, and better analysis of impacts, greater involvement of communities and immersion of researchers in affected territories is suggested.
The preference for questionnaires in the reviewed studies seems to be justified by the search for information directly from respondents, allowing inferences with lower costs, in less time and with greater standardization. However, there are challenges such as low response rate, the exclusion of individuals with low education, superficial responses and inadequacies to the context, which can compromise the representativeness of the sample and of the analyses 66.
Given this context, participatory and collaborative approaches, using instruments, can provide a more detailed view of the impacts and needs of affected populations. They overcome the limitations of traditional methods, which often do not sufficiently involve affected communities, enabling a more complete and shared understanding of disasters 53.
The choice of binary elements in the reviewed studies allows respondents to choose between two options, facilitating reflection before answering. In contrast, Likert-type scales provide variations in the intensity of responses, offering a more detailed analysis. However, scales with more points require greater analysis and can be challenging for respondents with lower educational level or higher cognitive load 67,68,69.
The use of free response patterns in interviews favors the interaction between researcher and participant, allowing access to subjective information with common sense language and free answers 70. It is noted, however, that the limitations for this type of instrumental approach, associated with individuals’ own reasons in providing the answers or the influence of the personal aspect of the applying researcher, among other disadvantages that compromise the perspective on the analyzed situation 70.
Final considerations
The reviewed articles used different instruments to assess exposure to oil spills and health impacts, mainly mental and psychological impacts, perception of environmental risks and damages, in addition to effects on socioeconomic aspects and social cohesion issues. Although these instruments provide an expanded view of the events, there is a gap in studies with an integrated approach to the environmental and socioeconomic dimensions of the impacts. Future research should expand the analysis on the consistency, reliability and cross-cultural adaptations of the instruments. These pieces of information can help create a multidimensional matrix for monitoring disasters, facilitating quick and effective decisions in designing protection and recovery policies.
Acknowledgments
To Research Program for SUS: Shared Health Management of the Inova Fiocruz Program.
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Source: prepared by the authors.