Understanding stewardship behaviour: factors facilitating and constraining private water well stewardship

Individual and environmental correlates of tap water consumption among adolescents in Canada

The study objective was to identify correlates of tap water consumption among adolescents. French-speaking adolescents from the province of Québec (Canada) were recruited in person and online from March to July 2023 using diverse recruitment strategies. Water consumption was measured using the validated French version of a questionnaire specifically designed to measure adolescents' beverage intake. Participants answered an online survey on their attitude towards tap and bottled water which also measured individual and environmental factors that can influence tap water consumption. A total of 218 adolescents (14-17 years; 55.5% female) completed the survey. On average, 79.2% of adolescents' water intake came from tap and 33.5% of them consumed exclusively tap water. Thinking that bottled water is more convenient than tap water was a significant correlate of adolescents' tap water consumption (OR = 0.70; 95% CI: 0.51, 0.95; p = 0.0219). Adolescents who believed that bottled water is more convenient than tap water were less likely to consume exclusively tap water. Public health interventions aimed at promoting adolescents' tap water should strive to make tap water intake be perceived as convenient as bottled water, such as encouraging teenagers to always carry along a reusable water bottle, installing drinking fountains in popular public areas, and increasing the visibility of such fountains.

Private well water stewardship in rural Georgia

This study sought to identify the psychosocial influences on the practice of well stewardship behaviors (water testing, water treatment, and well maintenance) in rural Georgia, USA. Three interventions (education, the provision of household water treatment systems [HWTS], and both education and HWTS) were evaluated using a four-group, randomized controlled trial. A total of 64 private well owners completed a pretest measuring psychosocial factors and stewardship behaviors before receiving an intervention. Following a 104-day waiting period, participants completed a posttest and interviews were conducted to identify the barriers and facilitators to use (S1 File). Pretest results showed that 34% of well owners have ever tested their water and that only 25% treat their water before consumption. The education-only intervention showed no influence on stewardship behaviors, resulted in no new water tests and had no impact on psychosocial factors. The HWTS-only intervention had no significant effect on testing and treatment behaviors, though it had a significant effect on abilities (R2 = .87, p< 0.05) and self-regulation (R2 = 1.0, p<0.01). The intervention of both education and HWTS had no effect on testing and no significant effect on treatment behaviors, though had a significant effect on abilities (R2 = .84, p<0.05) and self-regulation (R2 = .93, p<0.05). This study identified three barriers to the use of HWTS: beliefs, knowledge, and functionality. Two factors (piece of mind and ease of use) were identified as facilitators to the use of HWTS. The results of this study indicate that providing water treatment systems does not guarantee use and that current educational efforts provided by state and local health departments may be ineffective.

Private groundwater contamination and risk management: A comparative scoping review of similarities, drivers and challenges across two socio-economically developed regions

Consolidation of multi-domain risk management research is essential for strategies facilitating the concerted government (educational) and population-level (behavioural) actions required to reduce microbial private groundwater contamination. However, few studies to date have synthesised this literature or sought to ascertain the causal generality and extent of supply contamination and preventive responses. In light of the Republic of Ireland (ROI) and Ontario's high reliance and research focus on private wells and consequent utility for empirical comparison, a scoping review of pertinent literature (1990-2022) from both regions was undertaken. The SPICE (Setting, Perspective, Intervention, Comparison, Evaluation) method was employed to inform literature searches, with Scopus and Web of Science selected as primary databases for article identification. The review identified 65 relevant articles (Ontario = 34, ROI = 31), with those investigating well user actions (n = 22) and groundwater quality (n = 28) the most frequent. A markedly higher pooled proportion of private supplies in the ROI exhibited microbial contamination (38.3 % vs. 4.1 %), despite interregional similarities in contamination drivers (e.g., weather, physical supply characteristics). While Ontarian well users demonstrated higher rates of historical (≥ 1) and annual well testing (90.6 % vs. 71.1 %; 39.1 % vs. 8.6 %) and higher rates of historical well treatment (42.3 % vs. 24.3 %), interregional levels of general supply knowledge were analogous (70.7 % vs. 71.0 %). Financial cost, organoleptic properties and residence on property during supply construction emerged as predictors of cognition and behaviour in both regions. Review findings suggest broad interregional similarities in drivers of supply contamination and individual-level risk mitigation, indicating that divergence in contamination rates may be attributable to policy discrepancies - particularly well testing incentivisation. The paucity of identified intervention-oriented studies further highlights the importance of renewed research and policy agendas for improved, targeted well user outreach and incentivised, convenience-based services promoting routine supply maintenance.

Factors Influencing Customer Participation in a Program to Replace Lead Pipes for Drinking Water

Many public water systems are struggling to locate and replace lead pipes that distribute drinking water across the United States. This study investigates factors associated with customer participation in a voluntary lead service line (LSL) inspection and replacement program. It also uses quasi-experimental and experimental methods to evaluate the causal impacts of two grant programs that subsidized homeowner replacement costs on LSL program participation. LSLs were more prevalent in areas with a higher concentration of older housing stock, Black and Hispanic residents, renters, and lower property values. Owner-occupied and higher valued properties were more likely to participate in the LSL program. Results from the two grant program evaluations suggest that subsidies for low-income homeowners to cover LSL replacement costs can significantly boost participation, but only when the programs are well publicized and easy to access. Even then, there was still significant non-participation among properties with confirmed LSLs.

The Two Routes of Collective Psychological Ownership: Rights and Responsibilities Explain Intentions to Exclude Outsiders and Engage in Stewardship Behavior

People can have a sense of collective ownership of a particular territory, such as "our" country, "our" neighborhood, and "our" park. Collective psychological ownership is argued to go together with rights and responsibilities that have different behavioral implications. We found that collective psychological ownership leads to perceived determination right, and indirectly to the exclusion of outsiders from "our" place. Simultaneously, collective psychological ownership leads to perceived group responsibility, and indirectly to engagement in stewardship behavior. These results were found among Dutch adults, cross-sectionally in relation to their country (Study 1; N = 617) and a neighborhood (Study 2; N = 784), and experimentally in relation to an imaginary local park (Study 3; N = 384, Study 4; N = 502, both pre-registered). Our research shows that the feeling that a place is "ours" can, via perceived rights and responsibilities, result in both exclusionary and prosocial behavioral tendencies.

Differential exposure to drinking water contaminants in North Carolina: Evidence from structural topic modeling and water quality data

To better understand water security of communities in North Carolina, this research uses structural topic modeling (STM) and geographic mapping to identify the main topics and pollutant categories being researched and the areas exposed to drinking water contaminants. The textual data derived from the journal article abstracts that examined water pollution in North Carolina is from 1964 to present. The STM analysis of textual data is paired with socio-demographic data from the 2015-2019 American Community Survey (ACS) 5-year estimates and water pollution data from North Carolina state agencies. The STM findings show that the most discussed topics relate to runoff management, wastewater from concentrated agricultural feeding operations, emerging contaminants, land development, and health impacts as a result of water contamination. The article discusses how the topics especially threaten groundwater resources used by community water systems and private wells. Those communities served by private wells are predominantly low-income and minority populations. As a result, threats to groundwater supplies exacerbate existing issues of environmental justice in North Carolina, especially in the Coastal Plains Region. The STM findings revealed that several key threats to safe drinking water are less covered by academic literature, such as poultry concentrated agricultural feeding operations and climate impacts, which may increase disparities in water access in North Carolina.

Integrating consumer risk perception and awareness with simulation-based quantitative microbial risk assessment using a coupled systems framework: A case study of private groundwater users in Ontario

Private well users in Ontario are responsible for ensuring the potability of their own private drinking water source through protective actions (i.e., water treatment, well maintenance, and regular water quality testing). In the absence of regulation and limited surveillance, quantitative microbial risk assessment (QMRA) represents the most practical and robust approach to estimating the human health burden attributable to private wells. For an increasingly accurate estimation, QMRA of private well water should be represented by a coupled model, which includes both the socio-cognitive and physical aspects of private well water contamination and microbial exposure. The objective of the current study was to determine levels of waterborne exposure via well water consumption among three sub-groups (i.e., clusters) of private well users in Ontario and quantify the risk of waterborne acute gastrointestinal illness (AGI) attributed to Giardia, shiga-toxin producing E. coli (STEC) and norovirus from private drinking water sources in Ontario. Baseline simulations were utilized to explore the effect of varying socio-cognitive scenarios on model inputs (i.e., increased awareness, protective actions, aging population). The current study uses a large spatio-temporal groundwater quality dataset and cross-sectional province-wide survey to create socio-cognitive-specific QMRA simulations to estimate the risk of waterborne AGI attributed to three enteric pathogens in private drinking waters source in Ontario. Findings suggest significant differences in the level of exposure among sub-groups of private well users. Private well users within Cluster 3 are characterised by higher levels of exposure and annual illness attributable to STEC, Giardia and norovirus than Clusters 1 and 2. Provincial incidence rates of 520.9 (1522 illness per year), 532.1 (2211 illness per year) and 605.5 (5345 illness per year) cases/100,000 private well users per year were predicted for private well users associated with Clusters 1 through 3. Established models will enable development of necessary tools tailored to specific groups of at-risk well users, allowing for preventative public health management of private groundwater sources.

Assessing the risk of acute gastrointestinal illness attributable to three enteric pathogens from contaminated private water wells in Ontario

The province of Ontario compromises the largest groundwater reliant population in Canada serving approximately 1.6 million individuals. Unlike municipal water systems, private well water is not required to meet water quality regulatory standards and thus source maintenance, treatment and testing remains the responsibility of the well owner. Infections associated with private drinking water systems are rarely documented given their typically sporadic nature, thus the human health effects (e.g., acute gastrointestinal illness (AGI)) on consumers remains relatively unknown, representing a significant gap in water safety management. The current study sought to quantify the risk of waterborne AGI attributed to Giardia, shiga-toxin producing E. coli (STEC) and norovirus from private drinking water sources in Ontario using Monte Carlo simulation-based quantitative microbial risk assessment (QMRA). Findings suggest that consumption of contaminated private well water in Ontario is responsible for approximately 4823 AGI cases annually, with 3464 (71.8%) and 1359 (28.1%) AGI cases predicted to occur in consolidated and unconsolidated aquifers, respectively. By pathogen, waterborne AGI was attributed to norovirus (62%; 2991/4823), Giardia (24.6%; 1186/4823) and STEC (13.4%; 646/4823). The developed QMRA framework was used to assess the potential health impacts of partial and total well water treatment system failure. In the unlikely event of total treatment failure, total mean annual illnesses are predicted to almost double (4217 to 7064 cases per year), highlighting the importance of effective water treatment and comprehensive testing programs in reducing infectious health risks attributable to private well water in Ontario. Study findings indicate significant underreporting of waterborne AGI rates at the provincial level likely biasing public health interventions and programs that are effective in monitoring and minimizing the health risk associated with private well water.

Evaluation of a water arsenic filter in a participatory intervention to reduce arsenic exposure in American Indian communities: The Strong Heart Water Study

Many rural populations, including American Indian communities, that use private wells from groundwater for their source of drinking and cooking water are disproportionately exposed to elevated levels of arsenic. However, programs aimed at reducing arsenic in American Indian communities are limited. The Strong Heart Water Study (SHWS) is a randomized controlled trial aimed at reducing arsenic exposure among private well users in American Indian Northern Great Plains communities. The community-led SHWS program installed point-of-use (POU) arsenic filters in the kitchen sink of households, and health promoters delivered arsenic health communication programs. In this study we evaluated the efficacy of these POU arsenic filters in removing arsenic during the two-year installation period. Participants were randomized into two arms. In the first arm households received a POU arsenic filter, and 3 calls promoting filter use (SHWS mobile health (mHealth) & filter arm). The second arm received the same filter and phone calls, and 3 in-person home visits and 3 Facebook messages (SHWS intensive arm) for program delivery. Temporal variability in water arsenic concentrations from the main kitchen faucet was also evaluated. A total of 283 water samples were collected from 50 households with private wells from groundwater (139 filter and 144 kitchen faucet samples). Ninety-three percent of households followed after baseline had filter faucet water arsenic concentrations below the arsenic maximum contaminant level of 10 μg/L at the final visit during our 2 year study period with no difference between study arms (98 % in the intensive arm vs. 94 % in the mHealth & filter arm). No significant temporal variation in kitchen arsenic concentration was observed over the study period (intraclass correlation coefficient = 0.99). This study demonstrates that POU arsenic filters installed for the community participatory SHWS program were effective in reducing water arsenic concentration in study households in both arms, even with delivery of the POU arsenic filter and mHealth program only. Furthermore, we observed limited temporal variability of water arsenic concentrations from kitchen faucet samples collected over time from private wells in our study setting.

Classification of sub-populations for quantitative risk assessment based on awareness and perception: A cross-sectional population study of private well users in Ontario

Private well users in Ontario are responsible for protective actions, including source maintenance, treatment, and submitting samples for laboratory testing. However, low participation rates are reported, thus constituting a public health concern, as risk mitigation behaviours can directly reduce exposure to waterborne pathogens. The current study examined the combined effects of socio-demographic profile, experience(s), and "risk domains" (i.e., awareness, attitudes, risk perceptions and beliefs) on behaviours, and subsequently classified private well users in Ontario based on cognitive factors. A province-wide online survey (n = 1228) was employed to quantify Ontario well owners' awareness, perceptions, and behaviours in relation to their personal groundwater supply and local contamination sources. A scoring protocol for four risk domains was developed. Two-step cluster analysis was used to classify respondents based on individual risk domain scores. Logistic regression was employed to identify key variables associated with cluster membership (i.e., profile analysis). Overall, 1140 survey respondents were included for analyses. Three distinct clusters were identified based on two risk domains; groundwater awareness and source risk perception. Profile analyses indicate "low awareness and source risk perception" (Low A/SRP) members were more likely male, while "low awareness and moderate source risk perception" (Low A/Mod SRP) members were more likely female and bottled water users. Well users characterised as "high awareness and source risk perception" (High A/SRP) were more likely to report higher educational attainment and previous well water testing. Findings illustrate that socio-cognitive clusters and their components (i.e., demographics, awareness, attitudes, perceptions, experiences, and protective actions) are distinct based on the likelihood, frequency, and magnitude of waterborne pathogen exposures (i.e., risk-based). Risk-based clustering, when incorporated into quantitative microbial risk assessment, enables the development of effective risk management and communication initiatives that are demographically focused and tailored to specific sub-groups.

Proximity of Water Wells to Public Water Testing Facilities in Alberta Using Drive Times

Approximately 10% of Albertans rely on well water for domestic purposes. The responsibility of water testing and stewardship is left to private well owners. Few well water owners conduct routine testing of their well water supplies. Drive times to public water testing facilities may be an important factor limiting a well owner's ability to conduct routine water testing. The objective of this study is to describe the proximity of water wells, using drive times, to public water testing facilities and describe the availability of facilities based on hours of operation. Using network analysis, we determined the proportion of a sample of wells within 3 estimated drive times of public water testing facilities. 5872 wells were included in the sample. One hundred and seven water testing facilities were mapped within the province. Of the 5872 wells mapped, 89% were located within 30 minutes of a water testing facility, 15% were located within 0 to 10 minutes of a water testing facility, 48% were located between 10 and 20 minutes of a water testing facility and 37% were located within 20 to 30 minutes of a water testing facility. Further analysis revealed that access to water testing facilities may be influenced by the hours of operation of the facilities.

Early life lead exposure from private well water increases juvenile delinquency risk among US teens

Early life exposure to environmental lead (Pb) has been linked to decreased IQ, behavior problems, lower lifetime earnings, and increased criminal activity. Beginning in the 1970s, limits on Pb in paint, gasoline, food cans, and regulated water utilities sharply curtailed US environmental Pb exposure. Nonetheless, hundreds of thousands of US children remain at risk. This study reports on how unregulated private well water is an underrecognized Pb exposure source that is associated with an increased risk of teenage juvenile delinquency. We build a longitudinal dataset linking blood Pb measurements for 13,580 children under age 6 to their drinking water source, individual- and neighborhood-level demographics, and reported juvenile delinquency records. We estimate how early life Pb exposure from private well water influences reported delinquency. On average, children in homes with unregulated private wells had 11% higher blood Pb than those with community water service. This higher blood Pb was significantly associated with reported delinquency. Compared to children with community water service, those relying on private wells had a 21% (95% CI: 5 to 40%) higher risk of being reported for any delinquency and a 38% (95% CI: 10 to 73%) increased risk of being reported for serious delinquency after age 14. These results suggest that there could be substantial but as-yet-unrecognized social benefits from intervention programs to prevent children's exposure to Pb from private wells, on which 13% of the US population relies.

User experience of point-of-use water treatment for private wells in North Carolina: Implications for outreach and well stewardship

Private well users are potentially exposed to a range of chemical contaminants through their drinking water. Point-of-use (POU) water treatment represents one potential solution to reduce harmful exposures through well water, but well users frequently do not adopt household treatment even if they learn their water is contaminated. This study elucidates the experiences, perceptions, and beliefs of 17 households on private wells in North Carolina that participated in a pilot-scale POU water treatment intervention to better understand the drivers and barriers of POU treatment adoption among well users. The intervention consisted of an under-sink activated carbon block POU filter designed to remove lead and two long-chain perfluoroalkyl acids. Filter effluents and influents were tested monthly for eight months. Questionnaires administered before and after the intervention showed a significant decrease in participants' perceived vulnerability to well water contamination, with 77% feeling vulnerable to poor well water quality before, compared to 23% after the filter was installed. However, the POU filters did not fully eliminate feelings of water insecurity (for example, concerns about exposure to contaminants when bathing remained). Lack of knowledge and skills associated with installing and maintaining POU treatment were important barriers to adoption for some well users. Perceptions of POU treatment were also significantly correlated with the intent to implement other well stewardship behaviors such as well water testing. The results highlight the need for strengthened outreach and support programs that provide technical assistance, education, and financial support for households relying on private wells.

Private wells as potential sources of heavy metal exposure: a pilot study in northwest Slovakia

OBJECTIVES

The aim of this study is to analyse levels of selected heavy metals: chromium (Cr), cadmium (Cd), copper (Cu), manganese (Mn), and lead (Pb), and to recognize factors related to wells' stewardship.

METHODS

The pilot study was realized in May 2018 in three villages in northwest of Slovakia. We analysed 69 water samples from private wells. The data on wells and well owners were obtained by self-administered questionnaire. The samples were analysed by atomic absorption spectroscopy with graphite furnace GF AAS (AAS GBC XplorAA 5000 with GBC GF 5000) equipped with hollow cathode lamps. Levels of heavy metals were compared with parametric values for drinking water stated in the Resolution of the Ministry of Health of the Slovak Republic No. 247/2017 Coll.

RESULTS

The results indicated spatial variability in some heavy metal levels. Cadmium was not quantified in any sample. Copper and chromium levels were below the parametric value. Parametric values for manganese and lead were exceeded in 19 (27.5%) and 2 (2.9%) samples, respectively. Only 18 owners tested water quality. Busyness and financial cost most frequently discouraged users to carry out the water quality analysis.

CONCLUSIONS

The presence of heavy metals in well water can pose a serious public health problem, especially in rural areas without public water supply. Education on heavy metals' risks targeted at well owners could increase the awareness of the issue and minimize possible public health consequences.

Evaluating the impact of free private well testing outreach on participants' private well stewardship in New Jersey

Over 1 million people in New Jersey (NJ) are estimated to receive drinking water from private wells. The most commonly detected contaminants in NJ private well water are naturally occurring arsenic and gross alpha (8.3 and 10.9%, respectively). Between 2015 and 2018, three free and voluntary private well testing events tested a total of 571 at-risk wells and 226 (40%) were identified as having one or more contaminants exceeding drinking water standards. Participants were invited to complete a survey to evaluate household characteristics, participant experience, and private well stewardship behavior patterns. Of 529 delivered surveys, 211 (40%) participants completed surveys. Among respondents, 63% reported plans to test their private wells in the future. Among failed wells, 45% of households reported performing mitigative action in response to the event, either through the installation of water treatment system or switching to bottled water. The survey evaluation identified previous knowledge of well contamination risks and discussing test results with a third party as important factors for promoting self-reported stewardship behavior. The evaluation provides guidance for outreach organizers to develop effective testing events and further considers the private well owners' experience of the outreach events to identify information for 'best practices' and improvements of future programs.

Private groundwater management and risk awareness: A cross-sectional analysis of two age-related subsets in the Republic of Ireland

Risk communication represents the optimal instrument for decreasing the incidence of private groundwater contamination and associated waterborne illnesses. However, despite attempts to promote voluntary well maintenance in high groundwater-reliant regions such as the Republic of Ireland, awareness levels of supply status (e.g. structural integrity) have remained low. As investigations of supply awareness are often thematically narrow and homogeneous with respect to sub-population, revised analyses of awareness among both current and future supply owners (i.e. adults of typical well owner and student age) are necessary. Accordingly, the current study utilised a national survey of well users and an age-based comparison of supply awareness. Awareness was measured among 560 Irish private well users using a multi-domain scoring framework and analysed in conjunction with experiential variables including experience of extreme weather events and previous household infections, and perceived self-efficacy in maintaining supply. Respondents displayed a median overall awareness score of 66.7%, with supply owners (n = 399) and students (n = 161) exhibiting median scores of 75% and 58.3%. Awareness among both combined respondent subsets and well owners was significantly related to gender, well use factors and self-perceived behavioural efficacy while awareness among students was not correlated with any independent variable. Cluster analysis identified three distinct respondent groups characterised by awareness score and gender in both current and future well owner subsets. Male well owners and students displayed higher perceived self-efficacy irrespective of awareness score while female well owners that demonstrated high awareness were significantly more likely to report postgraduate educational (p < 0.001). Findings suggest that recent experience of extreme weather events does not significantly influence supply awareness and mirror previously identified knowledge differences between well owners and young adults. Age, gender, supply use and perceived self-efficacy emerge as recurring focal points and accordingly merit consideration from groundwater and health communication practitioners for future risk interventions.

Characteristics and Behaviors Among a Representative Sample of New Jersey Adults Practicing Environmental Risk-Reduction Behaviors

CONTEXT

Environmental exposure to groundwater contamination from agricultural runoff, chemical pollution, or geology and indoor air hazards from misuse of consumer products or naturally occurring radon contributes to adverse health outcomes. Individuals can reduce exposure to environmental hazards by practicing risk-reduction behaviors.

OBJECTIVE

To characterize the demographic and behavioral characteristics of the population practicing environmental risk-reduction behaviors in order to identify gaps in current prevention outreach efforts.

DESIGN

The New Jersey Behavioral Risk Factor Survey captures data on self-reported environmental risk-reduction behaviors and health-promoting behaviors (cancer screenings, vaccinations, smoking). To account for complex survey data, weighted analyses were performed in SAS v9.4.

SETTING

New Jersey, 2014-2015.

PARTICIPANTS

The New Jersey Behavioral Risk Factor Survey is an ongoing telephone health survey of NJ residents. About 1000 NJ residents are selected randomly each month to derive statewide representative prevalence estimates.

MAIN OUTCOME MEASURES

Self-reported private well testing, radon screening, and carbon monoxide (CO) detector ownership.

RESULTS

Statewide prevalence of the practice of environmental risk-reduction practices includes 56.6% for private well testing, 44.3% for radon screening, and 86.1% for CO detector ownership. A larger percentage of individuals who are white or Asian, college-educated, earn more than $50 000, and own their homes reported CO detector ownership and radon screening. Age was the only demographic factor associated with private well testing. Screening for radon and CO detector ownership was positively associated with receiving an influenza shot, colonoscopy, aerobic exercise, and positive self-reported health and not smoking.

CONCLUSIONS

There is a need to improve rates of environmental risk-reduction behaviors and reduce disparities in the practice of these behaviors through efforts to increase awareness. Public health officials should target outreach to specific populations that do not practice risk-reduction behaviors.

Are carbon water filters safe for private wells? Evaluating the occurrence of microbial indicator organisms in private well water treated by point-of-use activated carbon block filters

Point-of-use (POU) water treatment is highly relevant to private well users vulnerable to chemical contamination, but uncertainty remains around the effects of activated carbon based POU devices on the microbial quality of the treated water. In this study, under-sink activated carbon block water filters were installed in 17 homes relying on private well water in North Carolina. The influent and effluent water in each home was evaluated for bacterial and viral microbial indicator organisms monthly for five months. Multiple logistic regression was used to identify water quality and water usage variables that were significant predictors of each indicator organism occurring in the filter effluent. The odds of total coliforms occurring in the effluent decreased by 84% with each 1-log₁₀ increase in the influent HPC (p < 0.05), suggesting a protective effect by native heterotrophic bacteria, but increased by over 50 times with low cumulative water use (p < 0.05). The filters were not protective against coliphages in the influent and viral shedding may occur after periods of increased virus concentrations in the raw well water. Specific bacteria were also found to increase in the effluent, causing a shift in the bacterial community composition, although potential opportunistic pathogens were detected in both the influent and the effluent. Overall, under normal conditions of use, the filters tested in this study did not represent a significant additional risk for well users beyond the existing exposures from undisinfected well water alone.

Drinking Water Consumption Patterns among Private Well Users in Ontario: Implications for Exposure Assessment of Waterborne Infection

Understanding the water consumption patterns within a specific population informs development of increasingly accurate, spatially specific exposure and/or risk assessment of waterborne infection. The current study examined the consumption patterns of private well users in Ontario while considering potentially influential underlying sociodemographics, household characteristics, and experiential factors. A province-wide online survey was circulated between May and August 2018 (n = 1,162). Overall, 81.5% of respondents reported daily well water consumption (i.e., tap water). Results indicate a mean daily well water consumption rate of 1,132 mL/day (SD = 649 mL/day) among well water consumers. Gender was significantly associated with well water consumption, with higher consumption rates found among female respondents. The experience of acute gastrointestinal illness (AGI) symptoms or diagnosis in the past 12 months did not impact the volume of water consumed, suggesting that experiencing previous AGI does not decrease consumption volumes, and therefore exposure over time. Significantly higher rates of well water consumption were found among respondents who reported previous testing or ongoing water treatment. Approximately 45.5% of survey respondents who stated that they do not consume well water selected bottled water as their primary household drinking water supply. Bottled water consumption was also not associated with previous AGI experiences. Findings will inform future quantitative microbial risk assessments associated with private well water use by providing spatially and demographically specific estimates of well water consumption.

Arsenic: Various species with different effects on cytochrome P450 regulation in humans

Arsenic is well-recognized as one of the most hazardous elements which is characterized by its omnipresence throughout the environment in various chemical forms. From the simple inorganic arsenite (iAsIII) and arsenate (iAsV) molecules, a multitude of more complex organic species are biologically produced through a process of metabolic transformation with biomethylation being the core of this process. Because of their differential toxicity, speciation of arsenic-based compounds is necessary for assessing health risks posed by exposure to individual species or co-exposure to several species. In this regard, exposure assessment is another pivotal factor that includes identification of the potential sources as well as routes of exposure. Identification of arsenic impact on different physiological organ systems, through understanding its behavior in the human body that leads to homeostatic derangements, is the key for developing strategies to mitigate its toxicity. Metabolic machinery is one of the sophisticated body systems targeted by arsenic. The prominent role of cytochrome P450 enzymes (CYPs) in the metabolism of both endobiotics and xenobiotics necessitates paying a great deal of attention to the possible effects of arsenic compounds on this superfamily of enzymes. Here we highlight the toxicologically relevant arsenic species with a detailed description of the different environmental sources as well as the possible routes of human exposure to these species. We also summarize the reported findings of experimental investigations evaluating the influence of various arsenicals on different members of CYP superfamily using human-based models.

Examining influential drivers of private well users' perceptions in Ontario: A cross-sectional population study

Private well users are responsible for managing and maintaining the quality of their drinking water source. Previous studies in Canada have reported low testing rates among well users, a cornerstone of well stewardship behaviours that can prevent the consumption of contaminated groundwater. To improve well stewardship, it is important to understand the interactions between, and the impacts of, various factors that may influence behaviours. Accordingly, the objective of the current study was to investigate the impact of socio-demographics, property characteristics, and experiences with well construction and acute gastrointestinal illness (AGI) (i.e., previous experiences) on levels of awareness, attitudes, risk perceptions, and beliefs (i.e., risk domains) among private well users in Ontario. A link to a province-wide online survey was circulated between May and August 2018 and novel "risk domain" scoring protocols were developed to classify and summarize response data. The survey was undertaken by 1228 respondents, of which 1030 completed the survey in full. Results indicate a low level of waterborne pathogen awareness, with 50.8% of respondents unaware of any groundwater associated pathogens. Respondents' geographic location, gender, and well type were significantly associated with well users' attitudes and perceptions of risk regarding their personal well water supply and the quality and quantity of local groundwater sources. Higher levels of awareness and lower risk perception scores (i.e., lower perceptions of risk) were associated with residential presence during well construction (p < 0.001 and p = 0.017, respectively). Previous case(s) of AGI within the respondent's household were significantly associated with negative attitudes towards their well water (p < 0.001) and higher risk perception scores (p = 0.025) with respect to the quantity of local groundwater sources. Results may be used to identify critical experiential control points (e.g., during well construction or after a physician confirmed AGI diagnosis) and develop improved risk management and communication strategies aimed at private well users.

Planning for the health impacts of climate change: Flooding, private groundwater contamination and waterborne infection - A cross-sectional study of risk perception, experience and behaviours in the Republic of Ireland

The frequency and severity of flooding events will increase over the coming decades due to global climate change. While close attention has typically been paid to infrastructural and environmental outcomes of flood events, the potential adverse human health consequences associated with post-event consumption from private groundwater sources have received minimal attention, leading to a poor understanding of private well users' preparedness and the drivers of positive behavioural adoption. The current study sought to quantify the capacity of private well users to cope with flood-triggered contamination risks and identify the social psychological determinants of proactive attitudes in the Republic of Ireland, using a cross-sectional questionnaire incorporating two distinct models of health behaviour, the Health Belief Model and Risk-Attitude-Norms-Ability-Self Regulation model. Adoption of healthy behaviours prior to flooding was evaluated with respect to respondents' risk exposure, risk experience and risk perception, in addition to systematic supply stewardship under normal conditions. Associations between adoption of protective behaviours and perception, experience and socio-demographic factors were evaluated through multinomial and multiple logistic regressions, while a multi-model inferential approach was employed with the predictors of health behaviour models. Findings suggest that floods are not considered likely to occur, nor were respondents worried about their occurrence, with 72.5% of respondents who reported previous flooding experience failing to adopt protective actions. Prior experience of well water contamination increased adoption of proactive attitudes when flooding occurred (+47%), with a failure to adopt healthy behaviours higher among rural non-agricultural residents (136%). Low levels of preparedness to deal with flood-related contamination risks are a side-effect of the general lack of appropriate well stewardship under normal conditions; just 10.1% of respondents adopted both water treatment and frequent testing, in concurrence with limited risk perception and poor awareness of the nexus between risk factors (e.g. floods, contamination sources) and groundwater quality. Perceived risk, personal norms and social norms were the best predictors of protective behaviour adoption and should be considered when developing future awareness campaigns.

Contamination of domestic groundwater systems by verotoxigenic escherichia coli (VTEC), 2003-2019: A global scoping review

Verocytotoxin-producing E. coli (VTEC) are important agents of diarrhoeal disease in humans globally. As a noted waterborne disease, emphasis has been given to the study VTEC in surface waters, readily susceptible to microbial contamination. Conversely, the status of VTEC in potable groundwater sources, generally regarded as a "safe" drinking-water supply remains largely understudied. As such, this investigation presents the first scoping review seeking to determine the global prevalence of VTEC in groundwater supply sources intended for human consumption. Twenty-three peer-reviewed studies were identified and included for data extraction. Groundwater sample and supply detection rates (estimated 0.6 and 1.3%, respectively) indicate VTEC is infrequently present in domestic groundwater sources. However, where generic (fecal indicator) E. coli are present, the VTEC to E. coli ratio was found to be 9.9%, representing a latent health concern for groundwater consumers. Geographically, extracted data indicates higher VTEC detection rates in urban (5.4%) and peri‑urban (4.9%) environments than in rural areas (0.9%); however, this finding is confounded by the predominance of research studies in lower income regions. Climate trends indicate local environments classified as 'temperate' (14/554; 2.5%) and 'cold' (8/392; 2%) accounted for a majority of supply sources with VTEC present, with similar detection rates encountered among supplies sampled during periods typically characterized by 'high' precipitation (15/649; 2.3%). Proposed prevalence figures may find application in preventive risk-based catchment and groundwater quality management including development of Quantitative Microbial Risk Assessments (QMRA). Notwithstanding, to an extent, a large geographical disparity in available investigations, lack of standardized reporting, and bias in source selection, restrict the transferability of research findings. Overall, the mechanisms responsible for VTEC transport and ingress into groundwater supplies remain ambiguous, representing a critical knowledge gap, and denoting a distinctive lack of integration between hydrogeological and public health research. Key recommendations and guidelines are provided for prospective studies directed at increasingly integrative and multi-disciplinary research.

LESI: A quantitative indicator to measure local environmental stewardship

This method develops a local environmental stewardship indicator (LESI), which represents the level of stewardship action of a person at a place. The goal of the indicator is to quantify stewardship activity and allow it to be compared and modelled. LESI requires a brief interview to ascertain an individual's past and current stewardship activities, which are scored on a frequency scale for each of seven action categories. Scores are then combined using the LESI equation to:

• Quantify reported stewardship behaviour (as opposed to attitudes or intentions) as a single number.

• Enable comparisons of stewardship between individuals and places.

• Allow development of models to understand the predictors of stewardship, and

• Inform evidence-based strategies for stewardship improvement.

Disparities in well water outreach and assistance offered by local health departments: A North Carolina case study

Drinking water supplied by private wells is a national concern that would benefit from improved outreach and support to ensure safe drinking water quality. In North Carolina (NC), local health departments (LHDs) have private well programs that enforce statewide well construction standards, offer water testing services, and provide well water outreach and assistance. Programs were evaluated to determine their capacity and capability for well water outreach and assistance and identify differences among programs. All LHDs reported overseeing the construction of new wells as required by law. However, services provided to existing well users were offered infrequently and/or inconsistently offered. Lack of uniformity was observed in the number of LHD staff and their assigned responsibilities; the costs and availability of well water testing; and the comfort of LHD staff communicating with well owners. While the total number of staff was lower in LHDs in rural counties, the number of outreach activities and services offered was typically not related to the number of well users served. Variations in structure and capacity of well programs at LHDs have created unequal access to services and information for well users in NC. This research underscores the need to examine infrastructure that supports the well water community on a national scale.

Improve private well testing outreach efficiency by targeting households based on proximity to a high arsenic well

Research into precautionary action suggests outreach with personally-relevant risk information may help overcome optimistic biases, which have been shown to impede voluntary testing for arsenic by at-risk private well households. Since 2002, New Jersey's Private Well Testing Act (PWTA) has required testing for arsenic during real estate transactions. The PWTA database of over 35,000 geocoded well arsenic tests offers a unique opportunity to evaluate the efficacy of targeted outreach to neighbors living in proximity to a known high arsenic well with variable risk messaging to motivate testing. In this study, residents of properties (n = 1743) located within 500 ft and between 500 and 1000 ft of a known high arsenic well (>5 μg/L, New Jersey's drinking water arsenic standard) were mailed a notice of the high arsenic result in their neighborhood and offered a free water test. Overall 274 households (16%) requested a test kit and 230 (13%) ultimately submitted a water sample; with significantly higher participation rates among those told their neighborhood well had an arsenic concentration "over 5 times higher" than the standard, compared to those told the concentration was "above." Overall, 25% of wells tested (n = 230), and 47% (n = 66) of non-treated wells located within 500 ft of a well with >25 μg/L arsenic, exceeded the standard for arsenic. Both the arsenic concentration and distance to the neighboring well were significant predictors of exceedance. Given the high proportion of previously untested wells (70%) and their owners' lack of awareness of arsenic in their area (80%), this targeting approach succeeded not only in identifying a much higher proportion of at risk wells than blanket testing by town or county, but also in motivating testing among households unreached by prior awareness-raising activities. In conclusion, geographically and personally-relevant risk targeted messaging and outreach are both efficient and effective.

Water quality perceptions and private well management: The role of perceived risks, worry and control

Mismanagement of drinking water supplies can pose serious public health risks. There are many concerns about water source management among private well owners, as they are often solely responsible for maintaining their wells, and monitoring and testing of their own water quality. Lack of worry about contamination and a strong sense of control over risks in relation to drinking water quality have been identified as important factors that influence peoples' perceptions and behaviour. In this paper, we investigated how worry and perceived control moderate the influence of risk perceptions on water quality perceptions and well owners' maintenance behaviours. We compare a sample of private well owners (N = 167) with a sample of members of Group Water Schemes (GWS) (N = 160) and people who are supplied via the public mains (N = 195), to validate our results. We found that, in comparison to the other groups, well owners believe that water from private wells is superior and they express a higher level of control over contamination risks of their drinking water. Moreover, strong feelings of control suppress their perceptions of risk in relation to water quality. However, well owners who feel largely in control also maintain their well more frequently. We discuss the implications of these results for communication strategies with well owners.

Private well stewardship within a rural, agricultural Latino community: a qualitative study

BACKGROUND

Nitrate contamination in groundwater disproportionately impacts agricultural Latino communities, creating a significant hazard for Latinos that rely on private wells. Private well users must conduct water testing and other well stewardship behaviors to ensure that their well water is safe to drink. This study sought to identify the key factors impacting private well water testing behavior in rural, agricultural Latino communities.

METHODS

We conducted 4 focus groups with private well users, 2 in Spanish and 2 in English. We recruited 37 participants from the Lower Yakima Valley, Washington State, a rural, agricultural community with a large Latino population and elevated nitrate concentrations in groundwater. A semi-structured interview guide was developed to capture factors impacting testing as guided by the Risk, Attitudes, Norms, Ability, and Self-Regulation (RANAS) model. Inductive thematic analysis was conducted by two coders to identify common themes.

RESULTS

Themes emerged around the factors impacting well stewardship, including well water testing, treatment, and maintenance, and were not specific to nitrate contamination. Private well users reported many of the same factors reported in other communities, with the exception of home repair experience and challenges around landlords and neighbors on shared wells, which have not been reported previously. In addition to landlords and neighbors, lack of actionable information, economic limitations, and lack of technical support emerged as factors that made well stewardship burdensome for individuals. The majority of participants reported using bottled water, including many who used point-of-use or point-of-entry water treatment systems.

CONCLUSIONS

The burden of well stewardship in rural, agricultural Latino communities may suggest the need for interventions at the community, county, or state levels and not at the individual level alone. Additionally, the role of landlords, neighbors on shared wells, and home repair experience in well stewardship represent important areas of exploration for researchers and public health practitioners.

A geostatistical study of socioeconomic status (SES), rurality, seasonality and index test results as drivers of free private groundwater testing in southern Ontario, 2012-2016

Approximately 12% of the Canadian population uses private wells for daily water consumption; however, well water testing rates are on the decline, resulting in an increased risk of waterborne acute gastrointestinal illness. To date, limited research has explored the determinants influencing well testing practices. Accordingly, the current study sought to investigate the drivers of "one-off" and repeat well water testing in southern Ontario during the 5-year period 2012-2016, using the worlds largest private groundwater testing data-frame. Data from >400,000 wells were geospatially integrated with all tests conducted by the provincial laboratory in southern Ontario. The Ontario Marginalization Index (ON-Marg) was used as a proxy measure of socioeconomic status (SES), with rurality, based on population density, season, and index (1st) test results assessed as effect modifiers. Multivariate analysis was undertaken using log-binomial regression. Approximately 27.5% of wells (n = 417,406) were tested during the study period, 66.7% of which were sampled more than once; 3% of all samples tested positive for E. coli (>0 colony forming unit/100 mL). In rural regions (<150 people/km²), wells located in low SES areas were 13% more likely to be tested compared to high SES areas (95% CI: 1.11, 1.15). In urban (>400 people/km²) and peri-urban regions (>150 and <400 people/km²), wells located in low SES areas were 14% (95% CI: 0.78, 0.95) and 15% (95% CI: 0.76, 0.94) less likely to be tested compared to high SES areas. Wells located in low SES areas were 6% more likely to be re-tested (95% CI: 1.04, 1.07). Positive index tests were associated with a 17% increased likelihood of repeat testing (95% CI: 1.16, 1.18). Accordingly, the authors conclude that location and SES are significant predictors of well water testing, with index test status being the most influential predictor of repeat well testing.

Modeling the persistence of viruses in untreated groundwater

Several factors can affect virus behavior and persistence in water sources. Historically linear models have been used to describe persistence over time; however, these models do not consider all of the factors that can affect inactivation kinetics or the observed patterns of decay. Meanwhile, applying the appropriate persistence model is critical for ensuring that decision makers are minimizing human health risk in the event of contamination and exposure to contaminated groundwater. Therefore, to address uncertainty in predictions of decay or virus concentrations over time, this study fit seventeen different linear and nonlinear mathematical models to persistence data from a previously conducted sampling study on drinking water wells throughout the United States. The models were fit using Maximum Likelihood Estimation and the best fitting models were determined by the Bayesian Information Criterion. The purpose of the study was to identify the best model for estimating decay of viruses in groundwater and to determine if model uncertainty contributes to erroneous predictions of viral contamination when only conventional models are considered. For the datasets analyzed in this study, the Juneja and Marks models and the exponential damped model were more representative of the persistence of viruses in groundwater than the traditionally used linear models. The results from this study were then evaluated with classification trees in order to identify more relevant modeling methodology for future research. The classification trees aid in narrowing the scope of appropriate persistence models based on characteristics of the experimental conditions and water sampled.

Knowledge and behavioural interventions to reduce human health risk from private groundwater systems: A global review and pooled analysis based on development status

Groundwater contamination constitutes a significant health risk for private well users residing in rural areas. As the responsibility to safeguard rural private domestic groundwater typically rests with non-expert homeowners, interventions promoting risk mitigation and awareness represent the most viable means of preventing supply contamination. However, no global review or pooled analyses of these interventions has been undertaken to date. The current study sought to identify and quantify the performance of private well interventions from 1990 to 2018 via a global systematised review and pooled analysis. The PICO (Population-Intervention-Comparison-Outcome) approach was employed for literature identification. Relevant studies were statistically analysed across two quantitative outcome (performance) types, namely knowledge and behaviour, controlling for intervention characteristics and country development status. Mean behavioural and knowledge attainment across interventions was 53% and 48%, respectively, with interventions in economically developed regions exhibiting higher behavioural outcomes (56% vs. 45%) than those in developing regions. Geographically, interventions were located in southern or southeast Asia (n = 23), North America (n = 15), Central America (n = 1) and Africa (n = 1), with none identified in Australia/Oceania, Europe, or South America. Behavioural outcomes were significantly associated with presence of educational/research coordinator (p = 0.023), with these interventions attaining higher levels of efficacy (+74%) than those implemented by other coordinator types. Findings indicate that instructor-led, practical interventions allied with both large- and local-scale awareness-raising campaigns represent an optimum approach for future private well risk interventions. Subsequent adoption of such interventions may lead to increased levels of private well maintenance and provide a point of reference for myriad water and health communication contexts.

How do biosphere stewards actively shape trajectories of social-ecological change?

The biosphere faces an uncertain future! Embracing change, uncertainty and complexity calls for creative transformative pathways. Biosphere stewardship provides a novel multi actor approach towards sustainability. Despite the critical role of individual environmental stewards, biosphere stewardship emphasizes the importance of collective action, and therefore governance. Biosphere stewardship denotes novel governance configurations with the capacity to effectively approach to sustainability transformation. In this paper we seek to advance understanding of how biosphere stewardship actively shapes trajectories of change to foster social-ecological resilience and human wellbeing. Considering the crucial role of governance and more specifically its two pillars of collaboration and learning, we conduct our study of biosphere stewardship through the lens of adaptive co-management. We first set out a framework for diagnosing and analyzing the process of biosphere stewardship. Secondly, we provide evidenced-based insights from applying the framework in four UNESCO biosphere reserves situated in Canada and Sweden to shed light on how active collective shaping of biosphere stewardship occurs and what it produces. In view of the lack of framework for environmental stewardship, we suggest that the present study makes a considerable contribution by providing an appropriate holistic and systemic framework with operational measures. The study also highlights how the comprehensive and consensual understanding of stewardship is proving to be a means of catalyzing biosphere stewardship by enabling effective crafting of policy design and strategic interventions. Moreover, the application of the framework to four case studies reveals the importance of the governance process attributes (collaboration and learning) in mediating outcomes from biosphere stewardship. Finally, the framework provides the basis to address new stewardship enquiries, which require further research in this field.

Analysis of Kansas Water Well Policies and Proposal of Nonpublic Household Water Well Recommendations

BACKGROUND

Many nonpublic water well users unknowingly consume contaminated groundwater containing unsafe levels of pollutants. This has important implications for more than 13 million households in the United States that rely upon nonpublic water wells for drinking, cooking, and other household uses. Although public water quality is regulated through the Safe Drinking Water Act, there are no drinking water standards for nonpublic water well quality in Kansas, nor is there an adequate public health infrastructure in place to prevent or address potential exposures to contamination.

OBJECTIVES

This project was conducted to identify promising action steps that would protect Kansans relying on nonpublic water wells for drinking, cooking, and other household purposes.

METHODS

The project team consisted of public health, environmental health, and legal professionals with experience working on groundwater quality issues impacting nonpublic water wells in Kansas. From 2015 through 2018, the team established and convened an advisory group; reviewed relevant state statutes and regulations, all Kansas county environmental codes, and a representative sample of 23 city water well codes; conducted an extensive review of academic literature to identify best practices; conducted dozens of key informant interviews; proposed recommendations; engaged dozens of stakeholders through a survey of these proposed recommendations; and conducted interactive webinars to identify which organizations need to lead each of the recommendations.

DISCUSSION

The project team developed 18 recommendations. The recommendations are organized by survey respondents' perceptions of potential public health impact. There are very few standard practices in Kansas that ensure safe water for nonpublic household water wells. Although not all of the 18 recommendations may be applicable to other communities and states, many likely would be useful for governmental agencies, academic institutions, nonprofit organizations, and others to consider. These recommendations offer more protections for nonpublic household water well users than any resource we have found. https://doi.org/10.1289/EHP5507.

Examining the factors related to bacteriological testing of private wells in Southern Ontario

The incidence of infectious waterborne disease in Canada continues to be a public health issue and can be associated with the source of drinking water. Millions of Canadians relying on unregulated private well water are at increased risk of disease. This study examined relationships between well and owner characteristics and the frequency of microbial testing of private wells in two southern-Ontario counties. Using multi-level logistic regression models, testing frequency (i.e., at least once per year vs. less) was modeled, as both self-reported and laboratory-validated, for associations with owner and well characteristics. For the self-reported outcome, a previous adverse test result significantly increased the odds of being classified as a frequent tester, and owners with a well-head more than 16 inches (40.6 cm) above the ground were at significantly higher odds of being classified as frequent testers compared to those with well-heads less than 16 inches above the ground and those below ground level. For the model based on the laboratory-validated outcome, the odds of an owner being a frequent tester significantly varied with the length of occupancy and the occurrence of a previous adverse result. The absence of associations between other well characteristics and testing frequency suggests that well safety education could benefit these communities.

Risk Communication and Factors Influencing Private Well Testing Behavior: A Systematic Scoping Review

Unregulated private wells may be at risk for certain types of contamination associated with adverse health effects. Well water testing is a primary method to identify such risks, although testing rates are generally low. Risk communication is used as an intervention to promote private well testing behavior; however, little is known about whether these efforts are effective as well as the mechanisms that influence effectiveness. A systematic scoping review was conducted to evaluate the current evidence base for risk communication effectiveness and factors that influence well testing behavior. The review was conducted with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) framework. Data were synthesized using a health behavior model (Health Belief Model) to identify areas amenable to intervention and factors to consider when designing risk communication interventions. We identified a significant shortage of studies examining the effectiveness of risk communication interventions targeted to well testing behavior, with only two quasi-experimental studies identified. The review also identified seventeen studies that examined or described factors relating to well testing behavior. The two empirical studies suggest risk communication methods can be successful in motivating private well owners to test their water, while the remaining studies present considerations for developing effective, community-specific content.

Well water testing in African-American communities without municipal infrastructure: Beliefs driving decisions

Some peri-urban African-American communities in North Carolina remain excluded from nearby municipal water service, forcing them to rely on unregulated private wells. Despite evidence of elevated drinking water contamination risks in these communities, water monitoring is rare. To identify factors influencing decisions to test private wells, we developed and administered a survey to residents of affected areas. A factor analysis identified three constructs significantly associated with a decreased likelihood of water testing: (1) the misconception that contaminants can be detected by sensory perception, (2) concerns about costs of testing and/or water treatment, and (3) not knowing how to get a water test or having time to do so. Increased knowledge about how to test and the importance of testing was significantly associated with a decreased concern about costs which, in turn, was significantly associated with an increased odds of testing. These results suggest the need for targeted risk communications that correct the misperception that contaminants can be tasted, smelled, or seen. The results also suggest the need for clear information about how to get a water test and for low-cost testing programs. Increased monitoring could empower residents to take protective actions and potentially mobilize political support for water service extensions.

Assessment of two behavioural models (HBM and RANAS) for predicting health behaviours in response to environmental threats: Surface water flooding as a source of groundwater contamination and subsequent waterborne infection in the Republic of Ireland

Extreme weather events (EWEs) are increasing in frequency, posing a greater risk of adverse human health effects. As such, developing sociological and psychological based interventions is paramount to empowering individuals and communities to actively protect their own health. Accordingly, this study compared the efficacy of two established social-cognitive models, namely the Health Beliefs Model (HBM) and Risks-Attitudes-Norms-Abilities-Self-regulation (RANAS) framework, in predicting health behaviours following EWEs. Surface water flooding was used as the exemplar EWE in the current study, due to the increasing incidence of these events in the Republic of Ireland over the past decade. Levels of prior experience with flooding were considered for analyses and comparative tools included a number of variables predicting health behaviours and intervention potential scores (i.e. measure of impact of targeting each model element). Results suggest that the RANAS model provides a robust foundation for designing interventions for any level of experience with an extreme weather event, however, use of the simpler HBM may be more cost-effective among participants unacquainted with an EWE and in relatively infrequent health threat scenarios. Results provide an evidence base for researchers and policymakers to appropriately engage with populations about such threats and successfully promote spatiotemporally appropriate health behaviours in a changing climate.

Risk Perceptions Toward Drinking Water Quality Among Private Well Owners in Ireland: The Illusion of Control

In rural areas where no public or group water schemes exist, groundwater is often the only source of drinking water and is extracted by drilling private wells. Typically, private well owners are responsible for the quality and testing of their own drinking water. Previous studies indicate that well owners tend to underestimate the risks of their well water being contaminated, yet little is known about why this is the case. We conducted a qualitative study by interviewing private well owners in Ireland to investigate their beliefs surrounding their water quality, which, in turn, inform their risk perceptions and their willingness to regularly test their water. Based on our findings we designed a theoretical model arguing that perceived control is central in the perceived contamination risks of well water. More specifically, we argue that well owners have the illusion of being in control over their water quality, which implies that people often perceive themselves to be more in control of a situation than they actually are. As a result, they tend to underestimate contamination risks, which subsequently impact negatively on water testing behaviors. Theoretical and practical implications are highlighted.

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.

State-Level Policies Concerning Private Wells in the United States

Currently, no federal policies exist in the United States regarding private wells; this authority is devolved to states. This study inventoried state-level policies governing private wells in the United States in order to identify the topics addressed by each state, division of responsibilities across state agencies, and geographic differences in policy comprehensiveness. From May to August 2016, two independent reviewers conducted an online search followed by directly contacting state agencies (98% response) to identify all state-level policies in the United States that directly reference private wells. The search, updated in April 2018, confirmed the existing water policy list and identified 23 additional policies. Policies were then coded according to nine not-mutually-exclusive classifications. The results indicate that all states had at least one policy addressing private well drilling or construction. Significant geographic differences exist in maintenance-related policies. In conclusion, although drilling and construction safety are addressed by each state, some policy domains are addressed inconsistently across states, and other policy domains are absent in most states.

Development and Validation of an Environmental Health Literacy Assessment Screening Tool for Domestic Well Owners: The Water Environmental Literacy Level Scale (WELLS)

In the U.S., privately owned wells are not subject to any regulatory testing requirements. Well owners must have sufficient environmental health literacy (EHL) to understand and interpret information that contain complex terms and labels to manage their water quality. The objective of this paper is to assess the performance and validity of a new EHL screening tool. The Water Environmental Literacy Level Scale (WELLS) is based on the Newest Vital Sign (NVS) and contains six questions on comprehension, calculations and application of information. Content validity was assessed from expert review. Criterion-related and construct validity were evaluated using an online, convenience sample of adults (n = 869). Percent of correct responses for items ranged from 53% to 96% for NVS and from 41% to 97% for WELLS. Completion time, mean scores, distributions, and internal consistency were equivalent between both scales. Higher scores suggest higher EHL. The scales were moderately correlated (ρ = 0.47, p < 0.001). Kappa agreement was 74%. Bland-Altman plots depicted little mean difference between the scales. Education and income level were positively associated with EHL. WELLS showed criterion-validity with NVS and construct validity with education and income. In practice or research, WELLS could quickly screen individuals for low EHL.

Exploring relevance, public perceptions, and business models for establishment of private well water quality monitoring service

Existing public policies mostly focus on public water systems, leaving aside the quality issues regarding private wells in small and rural locations. Establishment of affordable and accessible water quality monitoring services may ensure acceptable levels of all the parameters. This paper aims to explore (a) health risk because of chemical contaminants of private wells, (b) population perspective on well water quality and monitoring, and (c) to create a business model of a centralized water quality monitoring service. The results show potential problems with toxic levels of arsenic, barium, cadmium, chromium, lead, mercury, and selenium. About 5% of the province's population is at risk for potential exposure to contaminated private well water. The survey reinforces that the successful implementation of water testing laboratories for private wells is a shared responsibility between well owners and the government organizations, and almost three-fourths respondents were willing to share the cost up to certain limit. A business model including financial projections for a centralized water testing laboratory is presented. Drinking of unmonitored private well water is putting population health at risk. Either strong regulation with mandatory water testing or voluntary water testing with adequate government subsidy can ensure sustainable function of a centralized water testing laboratory.

Consumer water quality evaluation of private and public drinking water sources

Private water wells have no requirements to be tested or monitored to ensure safe drinking water quality, and yet those receiving their primary drinking water from private supplies are more frequently confident that their tap drinking water is safe. Using data from surveys administered in 2008 and 2014, this study assesses public attitudes and perceptions regarding drinking water. This study examines the results of a random sample survey of Texans to evaluate citizen awareness and attitudes on water issues. Most respondents reported that they believe their drinking water is of high quality, with 81.4% responding that they believe their tap water is safe to drink. An even larger number, 92.1%, of those receiving their water from private sources believe their tap water is safe. Conversely, only 57.0% of respondents who consume bottled water as their primary source of drinking water believe their tap water is safe to drink. Additionally, more than 65% of Texans receiving their primary drinking water from private supplies (usually their private water well) have never had their water supply tested. A large majority (81.3%) of those primarily receiving their drinking water from private supplies believed groundwater in their area to be of good or excellent quality.

Environmental Stewardship: A Conceptual Review and Analytical Framework

There has been increasing attention to and investment in local environmental stewardship in conservation and environmental management policies and programs globally. Yet environmental stewardship has not received adequate conceptual attention. Establishing a clear definition and comprehensive analytical framework could strengthen our ability to understand the factors that lead to the success or failure of environmental stewardship in different contexts and how to most effectively support and enable local efforts. Here we propose such a definition and framework. First, we define local environmental stewardship as the actions taken by individuals, groups or networks of actors, with various motivations and levels of capacity, to protect, care for or responsibly use the environment in pursuit of environmental and/or social outcomes in diverse social-ecological contexts. Next, drawing from a review of the environmental stewardship, management and governance literatures, we unpack the elements of this definition to develop an analytical framework that can facilitate research on local environmental stewardship. Finally, we discuss potential interventions and leverage points for promoting or supporting local stewardship and future applications of the framework to guide descriptive, evaluative, prescriptive or systematic analysis of environmental stewardship. Further application of this framework in diverse environmental and social contexts is recommended to refine the elements and develop insights that will guide and improve the outcomes of environmental stewardship initiatives and investments. Ultimately, our aim is to raise the profile of environmental stewardship as a valuable and holistic concept for guiding productive and sustained relationships with the environment.

Community Engaged Cumulative Risk Assessment of Exposure to Inorganic Well Water Contaminants, Crow Reservation, Montana

An estimated 11 million people in the US have home wells with unsafe levels of hazardous metals and nitrate. The national scope of the health risk from consuming this water has not been assessed as home wells are largely unregulated and data on well water treatment and consumption are lacking. Here, we assessed health risks from consumption of contaminated well water on the Crow Reservation by conducting a community-engaged, cumulative risk assessment. Well water testing, surveys and interviews were used to collect data on contaminant concentrations, water treatment methods, well water consumption, and well and septic system protection and maintenance practices. Additive Hazard Index calculations show that the water in more than 39% of wells is unsafe due to uranium, manganese, nitrate, zinc and/or arsenic. Most families' financial resources are limited, and 95% of participants do not employ water treatment technologies. Despite widespread high total dissolved solids, poor taste and odor, 80% of families consume their well water. Lack of environmental health literacy about well water safety, pre-existing health conditions and limited environmental enforcement also contribute to vulnerability. Ensuring access to safe drinking water and providing accompanying education are urgent public health priorities for Crow and other rural US families with low environmental health literacy and limited financial resources.

Private-well stewardship among a general population based sample of private well-owners

Private well stewardship, including on-going testing and treatment, can ensure private well users are able to maintain source-water quality and prevent exposures to potentially harmful constituents in primary drinking water supplies. Unlike municipal water supplies, private well users are largely responsible for their own testing and treatment and well stewardship is often minimal. The importance of factors influencing regular testing, and treatment behaviors, including knowledge, risk perception, convenience and social norms, can vary by geography and population characteristics. The primary goals of this study were to survey a general statewide population of private well users in Wisconsin in order to quantify testing and treatment patterns and gather data on motivations and barriers to well stewardship. The majority of respondents reported using and drinking well water daily but only about one half of respondents reported testing their wells in the last ten years and of these, only 10% reported testing in the last 12months. Bacteria and nitrates were contaminants most often tested; and, a private laboratory most often conducted testing. The most commonly reported water treatment was a water softener. Living in a particular geographic region and income were the most significant predictors of water testing and treatment. Iron and hardness, which influence water aesthetics but not always safety, were the most commonly reported water quality problems. Health concerns or perceived lack thereof were, respectively, motivators and barriers to testing and treatment. Limited knowledge of testing and treatment options were also identified as barriers. Results confirm previous findings that well stewardship practices are minimal and often context specific. Understanding the target population's perceptions of risk and knowledge are important elements to consider in identifying vulnerable populations and developing education and policy efforts to improve well stewardship.

Impact of the 2012 extreme drought conditions on private well owners in the United States, a qualitative analysis

BACKGROUND

Extreme hot and dry weather during summer 2012 resulted in some of the most devastating drought conditions in the last half-century in the United States (U.S.). While public drinking water systems have contingency plans and access to alternative resources to maintain supply for their customers during drought, little is known about the impacts of drought on private well owners, who are responsible for maintaining their own water supply. The purpose of this investigation was to explore the public health impacts of the 2012 drought on private well owners' water quality and quantity, identify their needs for planning and preparing for drought, and to explore their knowledge, attitudes, and well maintenance behaviors during drought.

METHODS

In the spring of 2013, we conducted six focus group discussions with private well owners in Arkansas, Indiana, and Oklahoma.

RESULTS

There were a total of 41 participants, two-thirds of whom were men aged 55 years or older. While participants agreed that 2012 was the worst drought in memory, few experienced direct impacts on their water quantity or quality. However, all groups had heard of areas or individuals whose wells had run dry. Participants conserved water by reducing their indoor and outdoor consumption, but they had few suggestions on additional ways to conserve, and they raised concerns about limiting water use too much. Participants wanted information on how to test their well and any water quality issues in their area.

CONCLUSIONS

This investigation identified information needs regarding drought preparedness and well management for well owners.

Methods of conducting effective outreach to private well owners - a literature review and model approach

Educational outreach programs have the potential to increase the occurrence of private well testing and maintenance behaviors, but are not always able to successfully engage the intended audience and overcome their barriers to change. We conducted a review of literature regarding behavior change and risk communication to identify common barriers to private well stewardship and motivational strategies to encourage change, as well as best practices for communicating with well owners. Results indicated that no specific strategy will be appropriate for all audiences, as different groups of well owners will have different barriers to change. For this reason, educators must develop an understanding of their audience so they are able to identify the most significant barriers to change and select motivational strategies that will directly reduce barriers. Implications for private well outreach programs are discussed.

Description of calls from private well owners to a national well water hotline, 2013

Water Systems Council (WSC) is a national, non-profit organization providing education and resources to private household well owners. Since 2003, WSC has provided wellcare®, a toll-free telephone hotline to answer questions from the public regarding well stewardship. In order to identify knowledge gaps regarding well stewardship among private well owners, we obtained data from WSC and reviewed calls made during 2013 to wellcare®. WSC records data from each wellcare® call-including caller information, primary reason for call, main use of well water, and if they were calling about a cistern, private well, shared well, or spring. We searched for calls with key words indicating specific contaminants of interest and reviewed primary reasons for calls. Calls classified as primarily testing-related were further categorized depending on whether the caller asked about how to test well water or how to interpret testing results. During 2013, wellcare® received 1100 calls from private well owners who were residents of 48 states. Among these calls, 87 (8%) mentioned radon, 83 (8%) coliforms, 51 (5%) chemicals related to fracking, 34 (3%) arsenic, and 32 (3%) nitrates key words. Only 38% of private well owners reported conducting any well maintenance activities, such as inspecting, cleaning, repairing the well, or testing well water, during the previous 12 months. The primary reason for calls were related to well water testing (n=403), general information relating to wells (n=249), contaminants (n=229), and well water treatment (n=97). Among calls related to testing, 319 had questions about how to test their well water, and 33 had questions about how to interpret testing results. Calls from private well owners to the wellcare® Hotline during 2013 identified key knowledge gaps regarding well stewardship; well owners are generally not testing or maintaining their wells, have questions about well water testing treatment, and concerns about well water contaminants.

Estimating the burden of acute gastrointestinal illness due to Giardia, Cryptosporidium, Campylobacter, E. coli O157 and norovirus associated with private wells and small water systems in Canada

Waterborne illness related to the consumption of contaminated or inadequately treated water is a global public health concern. Although the magnitude of drinking water-related illnesses in developed countries is lower than that observed in developing regions of the world, drinking water is still responsible for a proportion of all cases of acute gastrointestinal illness (AGI) in Canada. The estimated burden of endemic AGI in Canada is 20·5 million cases annually – this estimate accounts for under-reporting and under-diagnosis. About 4 million of these cases are domestically acquired and foodborne, yet the proportion of waterborne cases is unknown. There is evidence that individuals served by private systems and small community systems may be more at risk of waterborne illness than those served by municipal drinking water systems in Canada. However, little is known regarding the contribution of these systems to the overall drinking water-related AGI burden in Canada. Private water supplies serve an estimated 12% of the Canadian population, or ~4·1 million people. An estimated 1·4 million (4·1%) people in Canada are served by small groundwater (2·6%) and surface water (1·5%) supplies. The objective of this research is to estimate the number of AGI cases attributable to water consumption from these supplies in Canada using a quantitative microbial risk assessment (QMRA) approach. This provides a framework for others to develop burden of waterborne illness estimates for small water supplies. A multi-pathogen QMRA of Giardia, Cryptosporidium, Campylobacter, E. coli O157 and norovirus, chosen as index waterborne pathogens, for various source water and treatment combinations was performed. It is estimated that 103 230 AGI cases per year are due to the presence of these five pathogens in drinking water from private and small community water systems in Canada. In addition to providing a mechanism to assess the potential burden of AGI attributed to small systems and private well water in Canada, this research supports the use of QMRA as an effective source attribution tool when there is a lack of randomized controlled trial data to evaluate the public health risk of an exposure source. QMRA is also a powerful tool for identifying existing knowledge gaps on the national scale to inform future surveillance and research efforts.