Change of water consumption and its potential influential factors in Shanghai: a cross-sectional study

Measurement of haloacetic acids in human urine samples from six megacities of China using a refined detection method

Haloacetic acids (HAAs) are common disinfection by-products in chlorine disinfected water. Humans are extensively exposed to them. However, nationwide biomonitoring data were not available for any country. This study developed a labor-efficient and sensitive method for the detection of urinary HAAs, including trichloroacetic acid (TCAA) and dichloroacetic acid (DCAA), and conducted an exposure assessment in a Chinese population. A total of 850 first-morning-void urine samples were collected from adults in six megacities in China: Wuhan (central), Lanzhou (northwest), Chengdu (southwest), Taiyuan (north), Shanghai (east), and Dalian (northeast). Each participant (n = 425) provided a pair of urine samples during the warm (September to October 2018) and cold (December 2018 to January 2019) seasons. The detection method achieved good retention of the target analytes using a Fluoro-Phenyl column and excellent selectivity using in-source fragmentation ions as precursor ions in multiple reaction monitoring. The detection rate of urinary TCAA in Chinese populations was high (78.5%) but varied among different regions (54.0% to 98.0%). DCAA was rarely detected (<10%). The overall median value of specific gravity adjusted TCAA concentrations was 5.70 μg/L in the warm season and 3.87 μg/L in the cold season, respectively. Higher urinary TCAA concentrations were more likely to occur in Wuhan (Yangtze River Basin), urban areas, and during the warm season. The upstream region of the Yangtze River Basin (Chengdu) typically has lower TCAA concentrations. TCAA formation in coastal cities such as Shanghai and Dalian may be impacted by seawater intrusion. Estimated daily intakes of TCAA were lower than its chronic reference dose of 20 μg/kg-bw/day. This detection method can be applied to future biomonitoring of urinary HAAs. More attention should be paid to the highly exposed subgroups when exploring the health effects of long-term TCAA exposure.

Water consumption prediction and influencing factor analysis based on PCA-BP neural network in karst regions: a case study of Guizhou Province

Water consumption prediction is an integral part of water resource planning and management. Constructing a highly precise water consumption prediction model is of great significance for promoting regional water resource planning and high-quality development of the socio-economy. This paper focuses on the case of the typical karst region in Guizhou Province in China. Based on data on water consumption and its influencing factors spanning 2000-2020, the principal component analysis method was applied to reduce the dimensionality of 16 influencing factors of water consumption in Guizhou; the principal components extracted were used as input samples of the BP neural network and a PCA-BP neural network water consumption prediction model was conducted to predict water consumption of Guizhou Province in the next 10 years. The results show that the mean absolute error and mean relative error of prediction based on the constructed PCA-BP neural network were 2.8% and 2.9%, respectively, with superior performance in terms of prediction error and trends compared with other models. This paper discusses the main influencing factors of water consumption and analyzes their influence on the water consumption forecasting model so that the parameters of the water consumption forecasting model can be selected more efficiently and provide a reference for regional water consumption analysis and water resource planning and management.

Drinking water behavior and willingness to use filters by middle-aged and elderly residents in rural areas: A cross-sectional study in Tengchong, China

Access to safe drinking water is critical to health and development issues, and residents' drinking behavior reflects their awareness of health and water hygiene. Random sampling and face-to-face questionnaires were used to investigate the drinking water behavior, sanitation and perceptions of drinking water among middle-aged and elderly residents in Tengchong, southwest Yunnan from July 1 to July 28, 2021. Differences between groups were assessed using the Chi-square test and t-test. Two binary logistic regression analyses were conducted to explore the influencing factors of drinking unboiled tap water and willingness to use filters. Results show that 35% of residents drink unboiled tap water, and 29.8% of respondents indicated a willingness to use filters. The model results showed a strong correlation between 60 and 79 years old (OR: 0.510, 95% CI: 0.303-0.858), 80 and above years old (OR: 0.118, 95% CI: 0.038-0.365), drinking water at a regular interval (OR: 0.397, 95% CI: 0.257-0.612), wanting to gain knowledge about drinking water (OR: 0.198, 95% CI: 0.099-0.395), Perceived health risks (PHR) (OR: 0.847, 95% CI: 0.771-0.929), having kidney stones (OR: 2.975, 95% CI: 1.708-5.253) and drinking unboiled tap water (p < 0.05). 60-79 years old (OR: 0.446, 95% CI: 0.244-0.815), 80 and above years old (OR: 0.228, 95% CI: 0.064-0.812), water storage (OR: 0.088, 95% CI: 0.026-0.300), middle school and above (OR: 2.238, 95% CI: 1.289-3.883), household water treatment (HWT) (OR: 33.704, 95% CI: 9.726-116.791), Perceived health risks (PHR) (OR:1.106, 95% CI: 1.009-1.213), water authority satisfaction (WAT) (OR:0.857, 95% CI: 0.769-0.956) and willingness to use filters were correlated (p < 0.05). Our findings suggested that a certain proportion of permanent middle-aged and elderly residents in rural areas still drink unboiled tap water, and residents are less willing to use filters. Residents' perception of drinking water can reflect residents' drinking water behavior and willingness to a certain extent. It is recommended that the government and Centers for Disease Control (CDC) should strengthen relevant measures such as knowledge popularization and health education, and regulate the water use behavior of middle-aged and elderly residents. Promote safe, economical and effective household water filtration facilities to ensure public health safety.

Do health risk perceptions motivate water - and health-related behaviour? A systematic literature review

Health-related risk perceptions are important determinants of health behaviours and components of behaviour change theories. What someone thinks or feels will motivate or hinder their intention or hesitancy to implement a certain behaviour. Thus, a perceived potential risk to our health and well-being can influence our health-promoting and/or health-seeking behaviour. We aimed to review and synthesize available peer-reviewed literature to better understand the links between water and health-related risk perceptions and behaviours. We conducted the first systematic review of peer-reviewed literature on risk perceptions and behaviours in the context of water and health, published between 2000 and 2021. A total of 187 publications met the inclusion criteria. We extracted data relating to study characteristics and categorized our results according to the major themes emerging from the literature, namely drinking water, sanitation, hygiene and wasterelated topics, health risk factors, diseases and mental health implications, and preventative measures. Our review shows that the literature has grown over the past twenty years, reporting information from different countries belonging to different income groups around the globe, conducted in various settings and contexts, among different target populations, from various disciplinary angles, using different methods, theories and approaches. Our review provides evidence of health risk perceptions determining behaviour particularly related to drinking water sources and water safety. Evidence on disease prevention, health seeking, variations and changes in perception and behaviour over space, geography, socioeconomic differences and time, and the relevance of cultural context is provided. Our review shows that risk perception studies are vital for WASH governance in terms of policy, raising awareness, education and behaviour change. In order to make risk perception and behaviour studies even more relevant to effective public health planning and health messaging, future research needs to increasingly focus on early culturally sensitive interventions and changes in perceptions and behaviours over time.

Biocide Use in the Beverage Industry: Consumers’ Knowledge and Label Preferences Relating to the Need and Usefulness of Biocides with Particular Reference to Dairy Beverage Products in New Zealand and China

Biocides, in the form of sanitisers and disinfectants, are used extensively to reduce the risk of microbial contamination to beverage products and to ensure the safety of potable water used in processing. To better understand consumers’ perceptions of biocide use and to explore messaging strategies regarding their importance to ensure product safety, eight focus groups were conducted in New Zealand (n = 4) and China (n = 4). Consumers generally did not understand why or how biocides were used. In both countries, their most trustworthy source of information on biocide use was government sources. New Zealand and Chinese participants did not like the word “biocide” mentioned on labels due to its perceived negative connotations. Interestingly, acceptance for the word was higher if the phrase “environmentally friendly” was simultaneously communicated. The findings from this study have provided the beverage industry with guidance on how best to initiate conversations with consumers on the use of biocides.

Perceptions of water as commodity or uniqueness? The role of water value, scarcity concern and moral obligation on conservation behavior

Water shortage will be an urgent worldwide concern in the coming decennia. This study examines individuals' perceptions of water's uniqueness in order to explore how these relate to (self-reported) conservation behaviors. The results of an online survey (n = 1013) in a Western European country showed that perceptions of water as a natural resource with unique assets positively influenced the value individuals attach to water and increased their concerns related to its scarcity. Both of these mediating variables (perceived water value and water scarcity concerns) strengthen individuals' moral obligations to conserve water, which appears to be an important mediating variable with regard to the positive impact perceived water uniqueness has on conservation behavior. People's perceptions of water's uniqueness are influenced by attributes focusing on its aesthetics and pureness, the hedonic (experiential) dimension of water, and, to a lesser extent, its naturalness. The utilitarian dimension of water does not predict the level of perceived uniqueness, and perceptions of water availability relate negatively to the perceived uniqueness of water. In particular, older females and respondents with a lower education level perceived the uniqueness of water to be high. The results of this study provide guidelines on how policy makers can promote water conservation by focusing on the meaning individuals attribute to water as a long-term behavioral change strategy. When individuals approach water as a commodity, the urge to conserve water is likely to stay low.

Non-communicable diseases are key to further narrow gender gap in life expectancy in Shanghai, China

Background

To address change in the gender gap of life expectancy (GGLE) in Shanghai from 1973 to 2018, and to identify the major causes of death and age groups associated with the change over time.

Methods

The temporal trend in GGLE was evaluated using retrospective demographic analysis with Joinpoint regression. Causes of death were coded in accordance with the International Classification of Diseases and mapped with the Global Burden of Disease (GBD) cause list. The life table technique and decomposition method were used to express changes in GGLE.

Results

The trend of GGLE in Shanghai experienced two phases, i.e., a decrease from 8.4 to 4.2 years in the descent phase (1973–1999) and a fluctuation between 4.0 and 4.9 years in the plateau phase (1999–2018). The reduced age-specific mortality rates tended to concentrate to a narrower age range, from age 0–9 and above 30 years in the descent phase to age above 55 years in the plateau phase. Gastroesophageal and liver cancer, communicable, chronic respiratory, and digestive diseases were once the major contributors to narrow GGLE in the descent phase. While, importance should be attached to a widening effect on GGLE by lung cancer, cardiovascular diseases, other neoplasms like colorectal and pancreatic cancer, and diabetes in the recent plateau phase.

Conclusions

Non-communicable diseases (NCDs) have made GGLE enter a plateau phase from a descent phase in Shanghai, China. Public efforts to reduce excess mortalities for male NCDs, cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes in particular and health policies focused on the middle-aged and elderly population might further narrow GGLE. This will also ensure improvements in health and health equity in Shanghai China.

Risk Perception and Human Health Risk in Rural Communities Consuming Unregulated Well Water in Saskatchewan, Canada

Rural communities dependent on unregulated drinking water are potentially at increased health risk from exposure to contaminants. Perception of drinking water safety influences water consumption, exposure, and health risk. A community-based participatory approach and probabilistic Bayesian methods were applied to integrate risk perception in a holistic human health risk assessment. Tap water arsenic concentrations and risk perception data were collected from two Saskatchewan communities. Drinking water health standards were exceeded in 67% (51/76) of households in Rural Municipality #184 (RM184) and 56% (25/45) in Beardy's and Okemasis First Nation (BOFN). There was no association between the presence of a health exceedance and risk perception. Households in RM184 or with an annual income >$50,000 were most likely to have in-house water treatment. The probability of consuming tap water perceived as safe (92%) or not safe (0%) suggested that households in RM184 were unlikely to drink water perceived as not safe. The probability of drinking tap water perceived as safe (77%) or as not safe (11%) suggested households in BOFN contradicted their perception and consumed water perceived as unsafe. Integration of risk perception lowered the adult incremental lifetime cancer risk by 3% to 1.3 × 10^-5 (95% CI 8.4 × 10^-8 to 9.0 × 10^-5 ) for RM184 and by 8.9 × 10^-6 (95% CI 2.2 × 10^-7 to 5.9 × 10^-5 ) for BOFN. Probability of exposure to arsenic concentrations >1:100,000, negligible cancer risk, was 23% for RM184 and 22% for BOFN.

Carcinogenic risk of N-Nitrosamines in Shanghai Drinking Water: Indications for the Use of Ozone Pretreatment

N-Nitrosamines are drinking water disinfection byproducts that pose a high carcinogenic risk. We hypothesized that raw water treatment processes influence the types and concentrations of nitrosamines in drinking water, thereby posing differential health risks. We compared the finished water of two water treatment plants (WTP-A, WTP-B) serving Shanghai, China. Both plants use the Qingcaosha reservoir as a water source to generate drinking water with conventional but distinct treatment processes, namely preoxidation with sodium hypochlorite (WTP-A) vs ozone (WTP-B). Average nitrosamine concentrations, especially that of the probable human carcinogen (2A) N-nitrosodimethylamine, were higher in finished (drinking) water from WTP-A (35.83 ng/L) than from WTP-B (5.07 ng/L). Other differences in mean nitrosamines in drinking water included N-nitrosodipropylamine (42.62 ng/L) and N-nitrosomethylethylamine (26.73 ng/L) in WTP-A in contrast to N-nitrosodiethylamine (7.26 ng/L) and N-nitrosopyrrolidine (59.12 ng/L) in WTP-B. The estimated adult cancer risk from exposure to mixed nitrosamines was 1.83 times higher from WTP-A than from WTP-B drinking water. Children exposed to nitrosamines had a significantly higher cancer risk than adults ( p < 0.05). Disease burden exceeded 10⁶ person-years. Taken together, these data suggest that use of ozone in the preoxidation step can reduce nitrosamine formation in drinking water and thereby lower the population cancer health risk.

Understanding the rapid increase in life expectancy in shanghai, China: a population-based retrospective analysis

Background

Life expectancy at birth (LE) is a comprehensive measure that accounts for age-specific death rates in a population. Shanghai has ranked first in LE in China mainland for decades. Understanding the reasons behind its sustained gain in LE provides a good reflection of many other cities in China. The aim of this study is intended to explore temporal trend in age- and cause-specific gains in LE in Shanghai and the probable reasons lay behind.

Methods

Joinpoint regression was applied to evaluate temporal trend in LE and the long time span was then divided accordingly. Contributions to change in LE (1973–2015) were decomposed by age and cause at corresponding periods.

Results

LE in Shanghai could be divided into four phases ie., descent (1973–1976), recovery (1976–1998), rapid rise (1998–2004) and slow rise (2004–2015). The growing LE was mainly attributed to reductions in mortality from the elderly populations and chronic diseases such as cerebrovascular disease, chronic lower respiratory disease, and gastrointestinal cancers (stomach, liver and esophageal cancer).

Conclusions

The four-decade sustained gain in LE in Shanghai is due to the reductions in mortality from the elderly and chronic diseases such as cerebrovascular disease, chronic lower respiratory disease, and gastrointestinal cancers. Further growth momentum still comes from the elderly population.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5112-7) contains supplementary material, which is available to authorized users.

Behavioural informatics for improving water hygiene practice based on IoT environment

The development of Internet of Things (IoT) and latest Information and Communication Technologies (ICT) have changed the nature of healthcare monitoring and health behaviour intervention in many applications. Water hygiene and water conservation behaviour intervention as important influence factors to human health are gaining much attentions for improving sustained sanitation practice. Based on face-to-face delivery, typical behaviour intervention method is costly and hardly to provide all day access to personalised intervention guidance and feedbacks. In this study, we presented a behavioural information system and water use behaviour model using IoT platform. Using Expanded Theory of Planned Behaviour (ETPB) and adopted structure equation model, this study offers a solution for understanding the behaviour intervention mechanism and methodology for developing empirical model. A case study of behaviour intervention model is presented by utilising residential water conservation behaviour data collected in China. Results suggested that cultural differences have significant influences on the understanding of intervention drivers, promoting projects and increasing awareness, which could improve the behaviour intervention efficiency and further facilitate the improvement of water hygiene practice. The performance evaluation of water saving dimension is discussed as well in the paper.

Effects of Boiling Drinking Water on Diarrhea and Pathogen-Specific Infections in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Globally, approximately 2 billion people lack microbiologically safe drinking water. Boiling is the most prevalent household water treatment method, yet evidence of its health impact is limited. To conduct this systematic review, we searched four online databases with no limitations on language or publication date. Studies were eligible if health outcomes were measured for participants who reported consuming boiled and untreated water. We used reported and calculated odds ratios (ORs) and random-effects meta-analysis to estimate pathogen-specific and pooled effects by organism group and nonspecific diarrhea. Heterogeneity and publication bias were assessed using I2, meta-regression, and funnel plots; study quality was also assessed. Of the 1,998 records identified, 27 met inclusion criteria and reported extractable data. We found evidence of a significant protective effect of boiling for Vibrio cholerae infections (OR = 0.31, 95% confidence interval [CI] = 0.13-0.79, N = 4 studies), Blastocystis (OR = 0.35, 95% CI = 0.17-0.69, N = 3), protozoal infections overall (pooled OR = 0.61, 95% CI = 0.43-0.86, N = 11), viral infections overall (pooled OR = 0.83, 95% CI = 0.7-0.98, N = 4), and nonspecific diarrheal outcomes (OR = 0.58, 95% CI = 0.45-0.77, N = 7). We found no evidence of a protective effect for helminthic infections. Although our study was limited by the use of self-reported boiling and non-experimental designs, the evidence suggests that boiling provides measureable health benefits for pathogens whose transmission routes are primarily water based. Consequently, we believe a randomized controlled trial of boiling adherence and health outcomes is needed.

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.

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.

Predictors of urinary trichloroacetic acid and baseline blood trihalomethanes concentrations among men in China

Urinary trichloroacetic acid (TCAA) and baseline blood trihalomethanes (THMs) have been measured as biomarkers of exposure to drinking water disinfection by-products (DBPs) that have been associated with increased risk of cancers and adverse reproductive outcomes. This study aimed to identify predictors of urinary TCAA and baseline blood THMs among men in China. Urine samples, blood samples, and information on socio-demographic factors and water-use activities were collected from 2216 men who participated in a cross-sectional study of exposure to drinking water DBPs and reproductive health during 2011 to 2012. Urinary TCAA and baseline blood THMs including chloroform (TCM), bromodichloromethane (BDCM), dibromochloromethane (DBCM), and bromoform (TBM) were analyzed. Multivariable linear regression was used to evaluate predictors of urinary TCAA and baseline blood THM concentrations. Tap water consumption was significantly associated with creatinine-adjusted urinary TCAA concentration (β = 0.23 μg/g creatinine per log10 unit; 95% CI: 0.12, 0.35). Men with surface water source had 0.13 (95% CI: 0.00, 0.27) higher mean creatinine-adjusted urinary TCAA concentrations than those with ground water source. Smoking was associated with lower concentration of creatinine-adjusted urinary TCAA. Age was significantly associated with baseline blood Br-THM (sum of BDCM, DBCM, and TBM) concentration (β = 0.01 ng/L per unit; 95% CI: 0.00, 0.02). Increased household income was associated with decreased concentrations of baseline blood BDCM and Br-THMs. Our results suggest that tap water consumption, water source, smoking, age, and household income as the primary determinants of exposure to drinking water DBPs should be considered in exposure assessment.