Adverse Physical and Mental Health Effects of the Deepwater Horizon Oil Spill Among Gulf Coast Children: An Environmental Justice Perspective

Introduction

This year marks the tenth anniversary of the Deepwater Horizon oil spill (DHOS), one of the largest technological disasters in U.S. history. On April 20, 2010, British Petroleum (BP)'s Macondo oil well blew out roughly 50 miles southeast of Louisiana, and the subsequent explosion of the Deepwater Horizon drill rig killed 11 workers and injured 17 others. Over the course of 87 days, the spill released 171 million gallons of crude oil into the biodiverse Gulf Coast, and 1.8 million gallons of toxic dispersant were used in cleanup efforts. ^{1 , 2} The damage caused was far-reaching: 1100 miles of coastline were contaminated, fisheries lost $8.7 billion and 22,000 jobs, and the tourism industry lost $22.7 billion. ³

In addition to the severe economic impacts of the spill, low-income communities of color were particularly affected. Such communities tend to be more vulnerable to effects of disasters, including worse health outcomes and recovery due to factors such as lack of insurance; inaccessible transportation; material losses; discriminatory residential policies; low-quality housing; social and political exclusion; and strain on health care resources in medically underserved areas. ^{4 , 5 , 6 , 7} These impacts were evident during and after Hurricanes Katrina and Rita, which had occurred only five years before DHOS and from which Gulf Coast communities had still not fully recovered. ^{8 , 9} After DHOS, Black-owned fishing businesses did not receive cleanup contracts and BP disproportionately dumped waste in low-income communities of color who had unequal access to compensation. ^{10 , 11}

A 2017 study by Cope and Slack also found that areas with greater place-based social vulnerability had greater prevalence of poor mental health. ¹² Numerous studies have demonstrated that physical and/or economic exposure to DHOS is associated with adverse physical, reproductive, and mental health outcomes in adults. ^{13 , 14 , 15} However, there has been little to no empirical examination of how pre-event disparities shaped individual-level health outcomes. Further research is needed on how exposure to DHOS exacerbated pre-existing vulnerabilities and health disparities related to race/ethnicity and socioeconomic status.

In addition, few studies have explored the health implications of DHOS exposure among children and adolescents. Beedasy et al.'s cross-sectional study in areas of Louisiana impacted by DHOS, predicated on the sampling frame of the four-state Gulf Coast Population Impact (GCPI) study, found that three out of five and nearly one-third of children experienced physical and mental health issues, respectively, and that these were significantly predicted by physical and household economic DHOS exposure. ¹⁶ A longitudinal extension of this study in southern Louisiana by Slack, et al. found that familial physical and economic oil spill exposure negatively influenced initial child health, and the effects of job or income loss persisted. ¹⁷ Studies of Louisiana and Mississippi adolescents found significant associations between oil spill-related stress and post-traumatic stress disorder and poor self-reported competence and well-being. ^{18 , 19}

However, there remains a gap in the literature on DHOS's impact on children throughout the entire Gulf Coast, including Alabama and Florida, as well as how children's post-DHOS health outcomes were shaped by race/ethnicity and socioeconomic status. Our analyses contribute to this area of study by applying an environmental justice lens to expand our understanding of how racial/ethnic minority and low socioeconomic status fundamentally influence post-DHOS health outcomes among children and adolescents, taking into account potential direct physical and household economic exposure routes. ²⁰

This study's objectives are fourfold: (1) to evaluate whether children in racial/ethnic minority and lower income households in communities highly impacted by DHOS (based on rates of oil washed ashore and claims submitted to BP) were at greater risk of coming into direct contact with crude oil or dispersant; (2) whether racial/ethnic minority and lower income households in these communities were at greater risk of DHOS-related income or job loss; (3) whether children in racial/ethnic minority and lower income households were at greater risk of experiencing new physical and mental health problems compared with their White, middle- and upper-class counterparts; and (4) whether the risk of new physical and mental health problems was increased by children's direct physical exposure to the oil or dispersant and/or their households' oil spill-related income or job loss.

Methods

The 2012 GCPI study sought to identify communities of children in coastal Louisiana, Mississippi, Alabama, and Florida who were adversely impacted by DHOS and to understand their prevalence of new physical and mental health issues (see Beedasy, et al., 2020). Fifteen communities were identified as highly impacted by using standardized z-scores based on (1) higher numbers of filed BP individual and business compensation claims using data from the Gulf Coast Claims Facility and (2) higher rates of oil washed ashore by using monitoring data from the National Oceanic and Atmospheric Administration. ²¹

After identification of these communities, census blocks with at least 70% occupancy were randomly selected (to avoid secondary residences), and trained interviewers knocked on 6800 doors from April through August 2012. Eligible households had at least one child between ages 3 and 18 and an adult caregiver present. Of the 1700 eligible households, 1437 were administered a survey (84.5% response rate) on child and household physical and economic oil spill exposure, children's health outcomes, access to care, and other sociodemographics. All procedures were approved by the Columbia University Institutional Review Board. ²²

Results

The majority of survey respondents were non-Hispanic White (63.2%), and 23.4% had an annual household income less than $20,000. Slightly more than half of children were female (51.6%) and were an average of 10.6 years old. The majority of respondents (61.8%) resided in Louisiana. More than 40% of children had direct exposure to oil or dispersants, and 41.4% lived in households with job or income loss due to DHOS. Almost all children had access to a primary care provider (91.4%) and health insurance (95.5%) (Table 1). Approximately 33% of children reported new physical health problems (Table 1), and 22% reported new mental health problems (Table 2).

We conducted binomial logistic regression to assess the association between race/ethnicity, annual household income, and children's physical oil spill exposure. Neither race/ethnicity nor annual household income significantly predicted children's direct oil spill exposure adjusting for a child's age, gender, and state of residence. As compared with those in Louisiana, Alabama children had more than five times greater odds of coming into physical contact with the oil or dispersants (prevalence odds ratios [POR] 5.43; 95% confidence interval [CI] 3.36–8.78), those in Mississippi had 54% greater odds (POR 1.54; 95% CI 1.04–2.26), and those in Florida had 41% greater odds (POR 1.41; 95% CI 1.01–1.97) (Table 3).

We found an interaction between race/ethnicity and annual household income in predicting DHOS-related household income or job loss, adjusting for state of residence. Compared with White households earning more than $50,000, non-White households earning more than $50,000 (POR 1.68, 95% CI 1.01–2.82), White households earning $20,000–$50,000 (POR 2.55; 95% CI 1.83–3.55), and White households earning less than $20,000 (POR 3.53; 95% CI 2.20–5.65) were all at greater risk of job or income loss. However, non-White households earning $20,000–$50,000 (POR 0.51; 95% CI 0.27–0.95) and non-White households earning less than $20,000 (POR 0.45; 95% CI 0.22–0.93) had lower odds of experiencing job or income loss. Alabama households as compared with those in Louisiana had greater odds of experiencing DHOS-related income or job loss (POR 2.42; 95% CI 1.58–3.71) (Table 4).

We used binomial logistic regression to evaluate the association between race/ethnicity, annual household income, and new child physical health problems adjusting for a child's age, gender, state of residence, direct oil or dispersant exposure, and household DHOS-related income or job loss (Table 5). Non-White children had 1.40 times (95% CI 1.04–1.89) the odds of having new physical health problems than White children. In addition, Florida children had lower odds of experiencing new physical health problems compared with those in Louisiana (POR 0.66; 95% CI 0.45–0.98). Children who had direct contact with crude oil or dispersants had 3.68 times (95% CI 2.78–4.87) the odds of having new physical health problems than those without any direct exposure.

We observed an interaction effect between annual household income and DHOS-related household income or job loss. Compared with households earning greater than $50,000 with no income or job loss, children in households earning $20,000 to $50,000 (POR 2.72; 95% CI 1.77–4.18) and less than $20,000 without job or income loss (POR 4.39; 95% CI 2.59–7.44) had greater odds of experiencing new physical health problems. Children in households earning greater than $50,000 who had DHOS-related income or job loss also had greater odds of having new physical health problems (POR 2.76; 95% CI 1.66–4.58). Most notably, children in households earning $20,000 to $50,000 (POR 0.38; 95% CI 0.20–0.73) and less than $20,000 annually (POR 0.29; 95% CI 0.14–0.61) that had experienced oil spill-related job or income loss had lower odds of experiencing new physical health problems.

We then used binomial logistic regression to evaluate the association between race/ethnicity, annual household income, and new child mental health problems, adjusting for a child's age, gender, state of residence, direct oil or dispersant exposure, and household DHOS-related income or job loss (Table 6). Unlike new physical health problems, race/ethnicity was not associated with new child mental health problems. Children in households earning less than $20,000 annually had 2.90 times (95% CI 1.88–4.48) greater odds of having new mental health problems than those in households earning greater than $50,000. Although physical exposure to oil or dispersants was associated with new mental health problems (POR 3.74; 95% CI 2.72–5.14), household DHOS-related income or job loss was not. A one-year increase in age was associated with 5% increased (POR 1.05; 95% CI 1.02–1.09) odds of new mental health problems.

Discussion

This is the first study to examine the health effects of DHOS on Gulf Coast children and adolescents through an environmental justice lens, exploring whether racial/ethnic minority and low socioeconomic status were risk factors for new physical and mental health problems. The study also assessed whether these risk factors were affected by children's physical exposure to oil or dispersant and household economic exposure from DHOS-related income or job loss. Both racial/ethnic minority status and lower household income as a function of job loss significantly predicted children's new physical health problems, but only lower household income significantly predicted children's new mental health problems. Both direct physical exposure to oil or dispersant and household DHOS-related income or job loss predicted children's new physical health problems, whereas only direct physical exposure predicted children's new mental health problems. Neither racial/ethnic minority nor low-income children were at greater risk of direct crude oil or dispersant exposure.

Children in Alabama, Florida, and Mississippi were at greater risk of coming into direct contact with crude oil or dispersant than those in Louisiana. This may be the result of divergent individual state policies in response to the oil spill. For instance, 2010 Louisiana law required those who saw spilled oil to call both the Louisiana Emergency Hazardous Materials Hotline and the National Response Center. ²⁴

Race/ethnicity and annual household income interacted to either increase or decrease the risk of household DHOS economic exposure. These findings may reflect the occupational, racial/ethnic, and socioeconomic demographics of the highly impacted fishing communities in GCPI, but further research is needed to better understand why low-income racial/ethnic minority households were at significantly reduced risk of DHOS-related job or income loss given their presumed greater vulnerability to disaster exposure. ²⁵ In addition, older children may have been at greater risk of poor mental health compared with younger children due to heightened awareness of their families' post-DHOS circumstances and more vivid memories of past environmental traumas such as Hurricane Katrina.

We observed a compelling interaction effect between annual household income and household economic DHOS exposure, where households with higher annual incomes and DHOS-related job or income loss were at greater risk of new child physical health problems than their lower income counterparts. One potential explanation warranting future research may be that family members who lost their jobs as a result of DHOS also lost insurance coverage, while remaining ineligible for Medicaid, which disrupted access to their usual sources of timely and high-quality health care in states that opted not to expand eligibility under the 2010 Affordable Care Act. ²⁶ In addition, underfunded pediatric health care systems still recovering from previous hurricanes may have been overwhelmed and understaffed in the post-disaster context. ²⁷

This study had several limitations. Its cross-sectional nature precluded the ability to determine causal relationships between race/ethnicity and socioeconomic status, physical and economic DHOS exposure, and children's new physical and mental health issues. However, it is able to distinguish between physical and mental health problems that existed before the spill and those that parents reported as new issues after the event. The analysis was also limited to those items in the survey and was unable to address potentially salient concepts that contribute to childhood resilience, including personality attributes, attachment relationships, agency and self-efficacy, cognition and self-regulation, and perceived social support. ^{28 , 29}

In addition, GCPI had inherent selection bias due to the intent to study highly exposed children by sampling from those communities most impacted by DHOS. It is often the case that highly vulnerable and impacted communities have less access to post-disaster claims, which, in turn, may influence children's physical and mental health outcomes. ^{30 , 31}

From an environmental justice perspective, the pre-existing elements of racial/ethnic minority and low socioeconomic status that influence social vulnerability were independent risk factors for children's new physical health problems, and children from low-income households were at greater risk of new mental health problems. ³² This was not due to inaccessible primary care or health insurance, and racial/ethnic minority children and low-income households were not necessarily at greater risk of physical or economic DHOS exposure.

Although certain low-income households were at greater risk of DHOS-related job or income loss, economic exposure did not predict new child mental health issues. The persistent effects of race/ethnicity and low socioeconomic status on children's physical and mental health could be a manifestation of the accumulation of toxic stress associated with poverty, discrimination, and chaotic home environments as described in Shonkoff and Garner's ecobiodevelopmental framework, concepts that were not captured in the brief household survey that was administered. ³³

These findings highlight the complicated dynamics of race/ethnicity and socioeconomic status in determining post-disaster recovery disparities, potentially expanding the traditional environmental justice framework. Not only do racial/ethnic minority and low socioeconomic status shape disaster exposure and post-event health outcomes, but future earnings and socioeconomic status are also shaped by disaster exposure, which, in turn, influence children's physical and mental health. These complex patterns of environmental injustice are especially important to study in the Gulf Coast, a disadvantaged region not only prone to more frequent and intense natural hazards, but also where residents “shoulder the burden of the region's oil and gas industry, while seeing disproportionately few of the benefits” as they lose their place-based livelihoods. ^{34 , 35}

Because children are dependent on others' decisions that influence the post-disaster environment, their physical and mental well-being in the aftermath of these events is indicative of either a wider community's successful or failed recovery. ³⁶ Additional research should, therefore, examine the pathways through which the fundamental causes of race/ethnicity and low socioeconomic status place children at risk of new adverse health issues that are attributable to technological disasters such as the DHOS. ³⁷