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Natural Gas Health Effects Survey - Wheeling, WV

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Information about Natural Gas Health Effects Survey - Wheeling, WV
News & Politics

Published on March 14, 2014

Author: MarcellusDN

Source: slideshare.net

Description

A survey being sponsored by the Wheeling-Ohio County Health Department that supposedly will determine if natural gas drilling in that part of WV is having an impact on so-called public health. The survey asks questions about common ailments suffered by everyone at one time or another, and then will compare the results to see if people living near drilling have an increase in those symptoms. The fatal problem with the survey is that it's completely self-reported. People lie and will do so on this survey. Therefore, the results will be null and void.
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3/14/2014 OCH Health Survey http://www.ohiocountyhealth.com/survey/ 1/5 Disclaimer: Answers to all questions are voluntary. Confidentiality of data will be maintained. If sufficient responses and data are received, the data may be used for research purposes. You need to fill in all the details again if you exit without submitting. Please fill out only one form for person. If any friend or member of your family is affected or sick, please fill out a separate form for each individual. View Survey Data If you want to keep a health diary for your family, please download the PDFs on the left by clicking the links and saving them to your computer. Health Effects – Heart Health Effects – Lungs If you have any questions regarding this survey, please contact: Somu Chatterjee, MD, MPH Regional Epidemiologist Wheeling-Ohio County Health Department City-County Building, Room 106, 1500 Chapline Street, Wheeling WV 26003 Email: somu.k.chatterjee@wv.gov Health Survey Our overall goal: To provide an avenue for voluntarily sharing real and perceived environmental health concerns. Our overall goal is to also empower the community with resources where individuals can maintain a health diary to keep track of their personal and family’s health. Estimated time to complete: 15-20 minutes. , I declare that the information disclosed here is true to the best of my knowledge. (Required) , I authorize the use of data provided here for research purposes. Your Name (optional): Your Street Address (Use 911 compatible address. No P.O. Box please): Your State: Your County: Your Zip: Your Email Address: Phone (optional): Do you want us to contact you in the future for research purposes? Yes Yes AL Yes No

3/14/2014 OCH Health Survey http://www.ohiocountyhealth.com/survey/ 2/5 Age: Sex: Do you live near a gas well site or compressor station? If yes, what is the shortest distance to the gas well site or compressor station (in feet/miles/meters/kilometers)? Distance: Health Questionnaire Question 1: Have you ever been told by a physician that you have or had a LUNG DISEASE? If yes, please write the name of the disease or diseases below: Lung Disease 1: • When was it diagnosed? • Have you visited the ER for this disease? • Do you still have the disease? • Are you under treatment? • Has there been a revision of, or a change in diagnosis? • Have you increased frequency of treatment? • Have you increased or decreased dose of medications? Lung Disease 2: • When was it diagnosed? • Have you visited the ER for this disease? • Do you still have the disease? • Are you under treatment? • Has there been a revision of, or a change in diagnosis? • Have you increased frequency of treatment? • Have you increased or decreased dose of medications? Lung Disease 3: • When was it diagnosed? • Have you visited the ER for this disease? • Do you still have the disease? • Are you under treatment? • Has there been a revision of, or a change in diagnosis? • Have you increased frequency of treatment? • Have you increased or decreased dose of medications? Question 2: Have you ever been told by a physician that you have or had a HEART DISEASE? If yes, please write the name of the disease or diseases below: Heart Disease 1: Male Female Yes No Less than 5 Feet Yes No mm/dd/yyyy Yes No Yes No Yes No Yes No Yes No Yes No mm/dd/yyyy Yes No Yes No Yes No Yes No Yes No Yes No mm/dd/yyyy Yes No Yes No Yes No Yes No Yes No Yes No Yes No

3/14/2014 OCH Health Survey http://www.ohiocountyhealth.com/survey/ 3/5 • When was it diagnosed? • Have you visited the ER for this disease? • Do you still have the disease? • Are you under treatment? • Has there been a revision of, or a change in diagnosis? • Have you increased frequency of treatment? • Have you increased or decreased dose of medications? Heart Disease 2: • When was it diagnosed? • Have you visited the ER for this disease? • Do you still have the disease? • Are you under treatment? • Has there been a revision of, or a change in diagnosis? • Have you increased frequency of treatment? • Have you increased or decreased dose of medications? Heart Disease 3: • When was it diagnosed? • Have you visited the ER for this disease? • Do you still have the disease? • Are you under treatment? • Has there been a revision of, or a change in diagnosis? • Have you increased frequency of treatment? • Have you increased or decreased dose of medications? Question 3: Have you ever been told by a physician that you have or had HYPERTENSION? • When was it diagnosed? • Have you visited the ER for this disease? • Are you under treatment? • Have you increased or decreased dose of medications? Question 4: Have you had any other disease? If yes, please write the name of the disease or diseases below: Other Disease 1: • When was it diagnosed? • Have you visited the ER for this disease? • Do you still have the disease? • Are you under treatment? • Has there been a revision of, or a change in diagnosis? • Have you increased frequency of treatment? • Have you increased or decreased dose of medications? Other Disease 2: mm/dd/yyyy Yes No Yes No Yes No Yes No Yes No Yes No mm/dd/yyyy Yes No Yes No Yes No Yes No Yes No Yes No mm/dd/yyyy Yes No Yes No Yes No Yes No Yes No Yes No Yes No mm/dd/yyyy Yes No Yes No Yes No Yes No mm/dd/yyyy Yes No Yes No Yes No Yes No Yes No Yes No

3/14/2014 OCH Health Survey http://www.ohiocountyhealth.com/survey/ 4/5 • When was it diagnosed? • Have you visited the ER for this disease? • Do you still have the disease? • Are you under treatment? • Has there been a revision of, or a change in diagnosis? • Have you increased frequency of treatment? • Have you increased or decreased dose of medications? Other Disease 3: • When was it diagnosed? • Have you visited the ER for this disease? • Do you still have the disease? • Are you under treatment? • Has there been a revision of, or a change in diagnosis? • Have you increased frequency of treatment? • Have you increased or decreased dose of medications? Question 5: Are you allergic to anything? If yes, what are you allergic to? Allergy 1: Allergy 2: Allergy 3: Allergy 4: Allergy 5: Question 6: What factors aggravate your respiratory, heart problems, allergy or asthma? Explain: Question 7: Do you or did you have trouble sleeping? If yes, have you discussed it with a physician? Question 8: Which of the following do you think is disturbing your sleep the most? Question 9 (optional): Details of family members in your household who have been sick since January 2006/2010 and seen by a physician. Please fill out a separate survey for each family member. Question 10: Have you noticed any changes in road conditions in your region since 2010? mm/dd/yyyy Yes No Yes No Yes No Yes No Yes No Yes No mm/dd/yyyy Yes No Yes No Yes No Yes No Yes No Yes No Yes No Cold Air Humidity Exercise Medication Change of Seasons Dust or Animal Dander Other Yes No Yes No Age Related Noise Light Other Not Applicable Children under 1 year Children 1 year to less than 5 years Children 5 years to less than 18 years Children 18 years to less than 60 years Above 60 Pregnant

3/14/2014 OCH Health Survey http://www.ohiocountyhealth.com/survey/ 5/5 If yes, explain: Question 11: Do you smoke? Question 12: Do you work in the gas industry? Question 13: What is your occupation? Additional Comments: Enter the code in the box: Submit Survey Credits: Michael McCawley, PhD, WVU Somu Chatterjee, MD, MPH, WOCHD The Diary and Environmental Health Survey Questionnaire (EHSQ) were developed as part of Priscah Mujuru, Dissertation Study: The Allegheny County Short-term Air Pollution Effects (SHAPE) Study on the Elderly, April 2005. The EHSQ format was modified from Rosero Zareba et.al (1999), and the Asthma Diary from Delfino et al (2002, 2003) ©2014, Ohio County Health Department. | Login Yes No Yes No Yes No

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