Parents' perceptions of water safety and quality

Does Individuals' Perception of Wastewater Pollution Decrease Their Self-Rated Health? Evidence from China

Background: This study used original survey data to quantitatively investigate the associations between individuals’ perception of locally present wastewater pollution and their self-rated health. Methods: This research used the data from large-scale surveys covering all the 31 provinces and equivalent administrative units in mainland China and interviewed 6112 participants. The ordered logit method was employed to estimate the models. Results: The results indicated that individuals’ perceptions of local industrial and domestic wastewater pollution significantly decrease their self-rated health. If industrial wastewater pollution was reported, the possibility of the observers indicating lower levels of self-rated current health, comparing to the past year, and comparing with peers, all increased by 26% (p < 0.001), 23% (p = 0.005), and 18% (p = 0.006), respectively. Likewise, perceived domestic wastewater pollution led to the increase by 21% (p = 0.012), 17% (p = 0.034), and 33% (p = 0.000), respectively. Meanwhile, reported industrial wastewater pollution also has an obvious negative effect on individuals’ health performance, such as being more fatigued and upset. Conclusions: The survey clearly shows that Chinese individuals who are aware of water pollution in their living environment tend to experience more negative health outcomes, which adds additional urgency to improving wastewater treatment.

Using Water Intake Dietary Recall Data to Provide a Window into US Water Insecurity

BACKGROUND

In the United States, problems with the provision of safe, affordable water have resulted in an increasing number of adults who avoid their tap water, which could indicate underlying water insecurity. Dietary recalls provide critical nutritional surveillance data, yet have been underexplored as a water insecurity monitoring tool.

OBJECTIVES

This article aims to demonstrate how water intake variables from dietary recall data relate to and predict a key water insecurity proxy, that is, tap water avoidance.

METHODS

Using 2005-2018 NHANES data from 32,329 adults, I examine distributions and trends of mean intakes of total, plain (sum of tap and bottled water), tap, and bottled water, and percentage consuming no tap and exclusive bottled water. Second, I use multiple linear and logistic regressions to test how tap water avoidance relates to plain water intake and sugar-sweetened beverage (SSB) consumption. Next, I use receiver operating characteristics (ROC) curves to test the predictive accuracy of no plain water, no tap, and exclusive bottled water intake, and varying percentages of plain water consumed from tap water compared with tap water avoidance.

RESULTS

Trends indicate increasing plain water intake between 2005 and 2018, driven by increasing bottled water intake. In 2017-18, 51.4% of adults did not drink tap water on a given day, whereas 35.8% exclusively consumed bottled water. Adults who avoided their tap water consumed less tap and plain water, and significantly more bottled water and SSBs on a given day. No tap intake and categories of tap water intake produced 77% and 78% areas under the ROC curve in predicting tap water avoidance.

CONCLUSIONS

This study demonstrates that water intake variables from dietary recalls can be used to accurately predict tap water avoidance and provide a window into water insecurity. Growing reliance on bottled water could indicate increasing concerns about tap water.

An Analysis of Household Perceptions of Water Costs across the United States: A Survey Based Approach

Research analyzing perceptions of water services has focused on water quality, water safety, and the propensity to consume water from different sources. It has not assessed perceptions of water costs. To address this knowledge gap, this study collected nationally representative survey data from households in the United States about water issues and incorporated these data into logistic regression models. In doing so, our study advances the water and public policy literature in three ways. One, it addresses the need for household resolution information about water issues given the absence of data at this scale in the United States. Two, it creates and utilizes one-of-a-kind survey data to understand the perceptions of household water bills and the drivers of these perceptions. Three, we assess the impact of proposed solutions to improve water affordability on household perceptions of water costs. Model results indicate low-income and households in underrepresented groups were more likely to perceive their water bills to be too high. The perception of water costs also varied geographically. From a policy perspective, model results indicate utilities can positively affect perceptions of water bills via the frequency of water billing and provision of payment assistance programs.

Predictors of Water Lead Levels in Drinking Water of Homes With Domestic Wells in 3 Illinois Counties

CONTEXT

Millions of US homes receive water from private wells, which are not required to be tested for lead (Pb). An approach to prioritizing high-risk homes for water lead level (WLL) testing may help focus outreach and screening efforts, while reducing the testing of homes at low risk.

OBJECTIVE

To (1) characterize distribution of WLLs and corrosivity in tap water of homes with private residential wells, and (2) develop and evaluate a screening strategy for predicting Pb detection within a home.

DESIGN

Cross-sectional.

SETTING

Three Illinois counties: Kane (northern), Peoria (central), and Jackson (southern).

PARTICIPANTS

151 private well users from 3 Illinois counties.

INTERVENTION

Water samples were analyzed for WLL and corrosivity.

MAIN OUTCOME MEASURES

(1) WLL and corrosivity, and (2) the sensitivity, specificity, and predictive value of a strategy for prioritizing homes for WLL testing.

RESULTS

Pb was detected (>0.76 ppb) in tap water of 48.3% homes, and 3.3% exceeded 15 ppb, the US Environmental Protection Agency action level for community water systems. Compared with homes built in/after 1987 with relatively low corrosivity, older homes with more corrosive water were far more likely to contain measurable Pb (odds ratio = 11.07; 95% confidence interval, 3.47-35.31). The strategy for screening homes with private wells for WLL had a sensitivity of 88%, specificity of 42%, positive predictive value of 58%, and negative predictive value of 80%.

CONCLUSIONS

Pb in residential well water is widespread. The screening strategy for prioritizing homes with private wells for WLL testing is greater than 85% sensitive.

Birzeit University Students' Perception of Bottled Water Available in the West Bank Market

Water bottling industry has negative environmental impacts due to exploitation and possible pollution of water resources and due to solid waste problems related to the use of plastic bottles. To mitigate these impacts, it is important to study the link between consuming bottled drinking water and the perception of its quality. The objective of the study is to assess the perception of Birzeit University students' of the bottled water marketed in the West Bank and its impact on the humans and the environment. Universities play an important role in providing awareness about environmental issues and sustainability, and university students are thought to be more environmentally conscious about these issues. A quantitative survey was used to analyze the behaviors and perceptions of Birzeit University students. The sample size was 375 students, distributed according to the college, gender, and the academic year at the university. The results show that the factors that affect the perception of the students are mainly the educational year at the university, the income, the family size, and the community type.

Factors influencing perceptions of private water quality in North America: a systematic review

BACKGROUND

An estimated four million and 43 million people in Canada and the USA use private water supplies. Private water supplies are vulnerable to waterborne disease outbreaks. Private water supplies in Canada and the USA are often unregulated and private water management is often a choice left to the owner. Perceptions of water quality become important in influencing the adoption of private water stewardship practices, therefore safeguarding public health.

METHODS

We conducted a systematic literature review to understand factors that shape perceptions of water quality among private water users. We searched six computer databases (Web of science, Medline, Scopus, EBSCO, PubMed and Agricola). The search was limited to primary peer-reviewed publications, grey literature and excluded conference proceedings, review articles, and non-peer review articles. We restricted the search to papers published in English and to articles which published data on surveys of private water users within Canada and the USA. The search was also restricted to publications from 1986 to 2017. The literature search generated 36,478 records. Two hundred and four full text were reviewed.

RESULTS

Fifty-two articles were included in the final review. Several factors were found to influence perceptions of water quality including organoleptic preferences, chemical and microbiological contaminants, perceived risks, water well infrastructure, past experience with water quality, external information, demographics, in addition to the values, attitudes, and beliefs held by well owners.

CONCLUSIONS

Understanding the factors that shape perceptions of water quality among private water users is an important step in developing private water management policies to increase compliance towards water testing and treatment in Canada and the USA. As many jurisdictions in Canada and the USA do not have mandatory private water testing or treatment guidelines, delineating these factors is an important step in informing future research and guiding policy on the public health of private water systems.

Parental perception of fluoridated tap water

PURPOSE

The purpose of this study was to investigate parental knowledge and preference of tap water in a country where faucet water is fluoridated according to international standards and where the average percentage of dental caries in young children reaches up to approximately 73%.

MATERIALS AND METHODS

A cross-sectional perspective study was conducted at Hamad Medical Corporation, the only tertiary care and academic hospital in the state of Qatar. Parents of children older than 1 year of age were offered an interview survey.

RESULTS

A total of 200 questionnaires were completed (response rate = 100%). The mean age of participant children was 6 ± 4 years. One of the main finding in our study was that primary care physicians never discussed the topic of the best water choice for children in our community, as expressed by more than 86% of parents. More than two-third of parents used bottled water. The main concerns of why parents did not allow their children to drink tap water were taste (8.94%), smell (9.76%), concerns of toxins content (32.52%), and concerns that tap water might cause unspecified sickness (52.03%). Amid revealing participants that our tap water is safe and that fluorine can prevent dental caries, 33% of parents would you use tap water due to its fluoride content. The study also showed that 65% of parents would allow their children to drink tap water if it is free from any toxic ingredients.

CONCLUSION

Actions to augment fluoridated water acceptability in the developing world, such as focusing on safety and benefits, could be important in the disseminated implementation of the use of faucet water. Ultimately, a slump in the prevalence of dental caries among children will depend on the ability of pediatricians and dental professionals to institute evidence-based and preventive approach that can benefit oral health in childhood. These data will also allow us to propose the use of tap water safely in young children in the state of Qatar while simultaneously advocating awareness of oral health.

Water quality perceptions and natural resources Extraction: A matter of geography?

Recent events in the United States have shown the vulnerability of water quality in certain communities. Accordingly, we conducted a survey in a large community in north central West Virginia (US) to explore the factors that influence the perceptions of water quality. We sought to assess whether respondent's proximity to a mine, gas/oil well, or bodies of water would affect their perceived health risks and environmental concern. Additionally, we aimed at understanding how these perceptions were affected by the density of these sites and the presence of these sites within defined distances. As West Virginia is rapidly expanding its natural gas production, there is no research that has objectively associated water quality perceptions with geographic location in regard to oil and gas extraction sites. With small effect sizes, our results add some evidence to the link between unconventional oil and gas extraction, geographic location, and water quality perceptions. This study suggests the need for further water quality monitoring and increased public communication about water management practices in West Virginia.

Drinking water in West Virginia (USA): tap water or bottled water - what is the right choice for college students?

West Virginia has had a history of water quality issues. In parallel, the world is facing a plastic pollution crisis. In order to better understand behavioral responses to perceived water quality, a survey was conducted at a major research university to ask participants about water quality perceptions and drinking water behaviors. A total of 4,188 students completed the survey during the Spring 2017 semester. Logistic regression analyses were used to predict behaviors. Results indicated that a third of the student population primarily used bottled water for drinking purposes at home, while 39% used a filter at home and 26% drank water directly from the tap. On campus, bottled water use was reported by 36% of the students, water fountain use represented 31%, and 29% of the students brought their own water with reusable cups/bottles. Health risk perceptions, organoleptic perceptions (i.e., taste, odor, color), and environmental concern were predictors of the different behaviors. Students originally from West Virginia had a higher propensity of using bottled water. We argue that bottled water consumption should be reduced in areas where water quality is not an issue. In this sense, there is a need for education among the student population in West Virginia.

Disparities in plain, tap and bottled water consumption among US adults: National Health and Nutrition Examination Survey (NHANES) 2007-2014

OBJECTIVE

Differences in bottled v. tap water intake may provide insights into health disparities, like risk of dental caries and inadequate hydration. We examined differences in plain, tap and bottled water consumption among US adults by sociodemographic characteristics.

DESIGN

Cross-sectional analysis. We used 24 h dietary recall data to test differences in percentage consuming the water sources and mean intake between groups using Wald tests and multiple logistic and linear regression models.

SETTING

National Health and Nutrition Examination Survey (NHANES), 2007-2014.

SUBJECTS

A nationally representative sample of 20 676 adults aged ≥20 years.

RESULTS

In 2011-2014, 81·4 (se 0·6) % of adults drank plain water (sum of tap and bottled), 55·2 (se 1·4) % drank tap water and 33·4 (se 1·4) % drank bottled water on a given day. Adjusting for covariates, non-Hispanic (NH) Black and Hispanic adults had 0·44 (95 % CI 0·37, 0·53) and 0·55 (95 % CI 0·45, 0·66) times the odds of consuming tap water, and consumed B=-330 (se 45) ml and B=-180 (se 45) ml less tap water than NH White adults, respectively. NH Black, Hispanic and adults born outside the fifty US states or Washington, DC had 2·20 (95 % CI 1·79, 2·69), 2·37 (95 % CI 1·91, 2·94) and 1·46 (95 % CI 1·19, 1·79) times the odds of consuming bottled water than their NH White and US-born counterparts. In 2007-2010, water filtration was associated with higher odds of drinking plain and tap water.

CONCLUSIONS

While most US adults consumed plain water, the source (i.e. tap or bottled) and amount differed by race/Hispanic origin, nativity status and education. Water filters may increase tap water consumption.

Trihalomethane concentrations in tap water as determinant of bottled water use in the city of Barcelona

Bottled water consumption is increasing worldwide, despite its huge economic and environmental cost. We aim to describe personal and tap water quality determinants of bottled water use in the city of Barcelona. This cross-sectional study used data from the Health Survey of Barcelona in 2006 (N=5417 adults). The use of bottled water to drink and to cook was evaluated in relation to age, gender, educational level, district and levels of trihalomethanes (THMs), free chlorine, conductivity, chloride, sodium, pH, nitrate and aluminium in municipal tap water using Robust Poisson Regression. The prevalence of bottled water use to drink and cook was 53.9% and 6.7%, respectively. Chemical parameters in water had a large variability (interquartile range of THMs concentrations: 83.2-200.8μg/L) and were correlated between them, except aluminium. Drinking bottled water increased with educational level, while cooking with bottled water was higher among men than among women and decreased with age. After adjusting by these personal determinants, a dose-response relationship was found between concentrations of all chemicals except aluminium in tap water and bottled water use. The highest association was found for THMs, with a Prevalence Ratio of 2.00 (95%CI=1.86, 2.15) for drinking bottled water and 2.80 (95%CI=1.72, 4.58) for cooking with bottled water, among those with >150μg/L vs. <100μg/L THMs in tap water.

CONCLUSION

More than half of Barcelona residents regularly drank bottled water, and the main determinant was the chemical composition of tap water, particularly THM level.

Predicting water filter and bottled water use in Appalachia: a community-scale case study

A questionnaire survey was conducted in order to assess residents' perceptions of water quality for drinking and recreational purposes in a mid-sized city in northcentral West Virginia. Two logistic regression analyses were conducted in order to investigate the factors that influence bottle use and filter use. Results show that 37% of respondents primarily use bottled water and that 58% use a household filter when drinking from the tap. Respondents with lower levels of environmental concern, education levels, and lower organoleptic perceptions were most likely to perceive health risks from tap water consumption, and were most likely to use bottled water. Income, age, and organoleptic perceptions were predictors of water filter use among respondents. Clean water for recreational purposes was not found to be significant with either of these models. Our results demonstrate that bottle use and filter use are explained differently. We argue that more education and better communication about local tap water quality would decrease the use of bottled water. We demonstrate that household filters could be used as an alternative to bottled water.

A large and persistent outbreak of typhoid fever caused by consuming contaminated water and street-vended beverages: Kampala, Uganda, January - June 2015

Background

On 6 February 2015, Kampala city authorities alerted the Ugandan Ministry of Health of a “strange disease” that killed one person and sickened dozens. We conducted an epidemiologic investigation to identify the nature of the disease, mode of transmission, and risk factors to inform timely and effective control measures.

Methods

We defined a suspected case as onset of fever (≥37.5 °C) for more than 3 days with abdominal pain, headache, negative malaria test or failed anti-malaria treatment, and at least 2 of the following: diarrhea, nausea or vomiting, constipation, fatigue. A probable case was defined as a suspected case with a positive TUBEX® TF test. A confirmed case had blood culture yielding Salmonella Typhi. We conducted a case-control study to compare exposures of 33 suspected case-patients and 78 controls, and tested water and juice samples.

Results

From 17 February–12 June, we identified 10,230 suspected, 1038 probable, and 51 confirmed cases. Approximately 22.58% (7/31) of case-patients and 2.56% (2/78) of controls drank water sold in small plastic bags (OR_M-H = 8.90; 95%CI = 1.60–49.00); 54.54% (18/33) of case-patients and 19.23% (15/78) of controls consumed locally-made drinks (OR_M-H = 4.60; 95%CI: 1.90–11.00). All isolates were susceptible to ciprofloxacin and ceftriaxone. Water and juice samples exhibited evidence of fecal contamination.

Conclusion

Contaminated water and street-vended beverages were likely vehicles of this outbreak. At our recommendation authorities closed unsafe water sources and supplied safe water to affected areas.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-4002-0) contains supplementary material, which is available to authorized users.

Different Choices of Drinking Water Source and Different Health Risks in a Rural Population Living Near a Lead/Zinc Mine in Chenzhou City, Southern China

This study aimed to describe the households' choices of drinking water sources, and evaluate the risk of human exposure to heavy metals via different drinking water sources in Chenzhou City of Hunan Province, Southern China. A cross-sectional face-to-face survey of 192 householders in MaTian and ZhuDui village was conducted. The concentrations of heavy metals in their drinking water sources were analyzed. Carcinogenic and non-carcinogenic risk assessment was performed according to the method recommended by the United States Environmental Protection Agency. In total, 52.60% of the households used hand-pressed well water, and 34.89% used barreled water for drinking. In total, 6.67% of the water samples exceeded the Chinese drinking water standards. The total health risk of five metals is 5.20 × 10(-9)~3.62 × 10(-5). The total health risk of five metals was at acceptable levels for drinking water sources. However, the total risk of using hand-pressed well water's highest value is 6961 times higher than the risk of using tap water. Household income level was significantly associated with drinking water choices. Arsenic (As) and lead (Pb) are priority controlled pollutants in this region. Using safe drinking water (tap water, barreled water and so on) can remarkably reduce the risk of ingesting heavy metals.

Field survey of health perception and complaints of Pennsylvania residents in the Marcellus Shale region

Pennsylvania Marcellus Shale region residents have reported medical symptoms they believe are related to nearby Unconventional Natural Gas Development (UNGD). Associations between medical symptoms and UNGD have been minimally explored. The objective of this descriptive study is to explore whether shale region Pennsylvania residents perceive UNGD as a health concern and whether they attribute health symptoms to UNGD exposures. A questionnaire was administered to adult volunteers with medical complaints in a primary-care medical office in a county where UNGD was present. Participants were asked whether they were concerned about health effects from UNGD, and whether they attributed current symptoms to UNGD or to some other environmental exposure. There were 72 respondents; 22% perceived UNGD as a health concern and 13% attributed medical symptoms to UNGD exposures. Overall, 42% attributed one or more of their medical symptoms to environmental causes, of which UNGD was the most frequent. A medical record review conducted on six participants who attributed their medical symptoms to UNGD revealed that only one of these records documented both the symptoms in question and the attribution to UNGD. The results of this pilot study suggest that there is substantial concern about adverse health effects of UNGD among Pennsylvania Marcellus Shale residents, and that these concerns may not be adequately represented in medical records. Further efforts to determine the relationship between UNGD and health are recommended in order to address community concerns.

Demographic factors associated with perceptions about water safety and tap water consumption among adults in Santa Clara County, California, 2011

The objective of this study was to examine differences in tap water consumption and perceptions of bottle versus tap water safety for Hispanics and non-Hispanic whites, as well as associations with other demographic characteristics. Data are from the Santa Clara County, California, Dietary Practices Survey (2011; N = 306). We used logistic regression to examine associations between demographic characteristics and 1) perceptions that bottled water is safer than tap and 2) primarily consuming tap water. Hispanics were less likely than non-Hispanic whites to primarily drink tap water (OR = 0.33; 95% CI, 0.11–0.99), although there was no significant difference in perceptions that bottled water is safer between these groups (OR = 0.50; 95% CI, 0.11–2.27). Hispanics may be an important population for interventions promoting tap water consumption.

Risk factors associated with the choice to drink bottled water and tap water in rural Saskatchewan

A cross-sectional study investigated risk factors associated with choices to drink bottled water and tap water in rural Saskatchewan. Of 7,500 anonymous postal questionnaires mailed out, 2,065 responses were analyzed using generalized linear mixed models. Those who reported a water advisory (p < 0.001) or living in the area for ≤10 years (p = 0.01) were more likely to choose bottled water. Those who reported tap water was not safe to drink were more likely to choose bottled water, an effect greater for those who had no aesthetic complaints (p ≤ 0.001), while those with aesthetic complaints were more likely to choose bottled water if they believed the water was safe (p < 0.001). Respondents who treated their water and did not use a community supply were more likely to choose bottled water (p < 0.001), while those who did not treat their water were more likely to choose bottled water regardless of whether a community supply was used (p < 0.001). A similar pattern of risk factors was associated with a decreased likelihood of consuming tap water daily; however, the use of a community water supply was not significant. Understanding the factors involved in drinking water choices could inform public health education efforts regarding water management in rural areas.