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

Improving Private Well Testing Programs: Experimental Evidence from Iowa

Approximately 23 million U.S. households rely on private wells for drinking water. This study first summarizes drinking water behaviors and perceptions from a large-scale survey of households that rely on private wells in Iowa. Few households test as frequently as recommended by public health experts. Around 40% of households do not regularly test, treat, or avoid their drinking water, suggesting pollution exposure may be widespread among this population. Next, we utilize a randomized control trial to study how nitrate test strips and information about a free, comprehensive water quality testing program influence households' behaviors and perceptions. The intervention significantly increased testing, including high-quality follow-up testing, but had limited statistically detectable impacts on other behaviors and perceptions. Households' willingness to pay for nitrate test kits and testing information exceeds program costs, suggesting that the intervention was welfare-enhancing.

Prioritizing water availability study settings to address geogenic contaminants and related societal factors

Water availability for human and ecological uses depends on both water quantity and water quality. The U.S. Geological Survey (USGS) is developing strategies for prioritizing regional-scale and watershed basin-scale studies of water availability across the nation. Previous USGS ranking processes for basin-scale studies incorporated primarily water quantity factors but are now considering additional water quality factors. This study presents a ranking based on the potential impacts of geogenic constituents on water quality and consideration of societal factors related to water quality. High-concentration geogenic constituents, including trace elements and radionuclides, are among the most prevalent contaminants limiting water availability in the USA and globally. Geogenic constituents commonly occur in groundwater because of subsurface water-rock interactions, and their distributions are controlled by complex geochemical processes. Geogenic constituent mobility can also be affected by human activities (e.g., mining, energy production, irrigation, and pumping). Societal factors and relations to drinking water sources and water quality information are often overlooked when evaluating research priorities. Sociodemographic characteristics, data gaps resulting from historical data-collection disparities, and infrastructure condition/age are examples of factors to consider regarding environmental justice. This paper presents approaches for ranking and prioritizing potential basin-scale study areas across the contiguous USA by considering a suite of conventional physical and geochemical variables related to geogenic constituents, with and without considering variables related to societal factors. Simultaneous consideration of societal and conventional factors could provide decision makers with more diverse, interdisciplinary tools to increase equity and reduce bias in prioritizing focused research areas and future water availability studies.

Behavioral pathways to private well risk mitigation: A structural equation modeling approach

Complex, multihazard risks such as private groundwater contamination necessitate multiannual risk reduction actions including seasonal, weather-based hazard evaluations. In the Republic of Ireland (ROI), high rural reliance on unregulated private wells renders behavior promotion a vital instrument toward safeguarding household health from waterborne infection. However, to date, pathways between behavioral predictors remain unknown while latent constructs such as extreme weather event (EWE) risk perception and self-efficacy (perceived behavioral competency) have yet to be sufficiently explored. Accordingly, a nationwide survey of 560 Irish private well owners was conducted, with structural equation modeling (SEM) employed to identify underlying relationships determining key supply management behaviors. The pathway analysis (SEM) approach was used to model three binary outcomes: information seeking, post-EWE action, and well testing behavior. Upon development of optimal models, perceived self-efficacy emerged as a significant direct and/or indirect driver of all three behavior types-demonstrating the greatest indirect effect (β = -0.057) on adoption of post-EWE actions and greatest direct (β = 0.222) and total effect (β = 0.245) on supply testing. Perceived self-efficacy inversely influenced EWE risk perception in all three models but positively influenced supply awareness (where present). Notably, the presence of a vulnerable (infant and/or elderly) household member negatively influenced adoption of post-EWE actions (β = -0.131, p = 0.016). Results suggest that residential and age-related factors constitute key demographic variables influencing risk mitigation and are strongly mediated by cognitive variables-particularly self-efficacy. Study findings may help contextualize predictors of private water supply management, providing a basis for future risk-based water interventions.

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.

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.

Meeting the Water and Sanitation Challenges of Underbounded Communities in the U.S

Water and sanitation (wastewater) infrastructure in the United States is aging and deteriorating, with massive underinvestment over the past several decades. For many years, lack of attention to water and sanitation infrastructure has combined with racial segregation and discrimination to produce uneven access to water and wastewater services resulting in growing threats to human and environmental health. In many metropolitan areas in the U.S., those that often suffer disproportionately are residents of low-income, minority communities located in urban disadvantaged unincorporated areas on the margins of major cities. Through the process of underbounding (the selective expansion of city boundaries to exclude certain neighborhoods often based on racial demographics or economics), residents of these communities are disallowed municipal citizenship and live without piped water, sewage lines, and adequate drainage or flood control. This Perspective identifies the range of water and sanitation challenges faced by residents in these communities. We argue that future investment in water and sanitation should prioritize these communities and that interventions need to be culturally context sensitive. As such, approaches to address these problems must not only be technical but also social and give attention to the unique geographic and political setting of local infrastructures.

Water Quality from the Sources of Non-Centralized Water Supply within the Rural Settlements of Zhytomyr Region

The research was conducted within the territories of rural settlements of Zhytomyr region. A total of 72 sources of non-centralized water supply were surveyed. Water quality was assessed by physical and chemical (pH, iron total, total water hardness) and toxicological (nitrites, nitrates, and ammonium) indicators, the content of which was compared with the norms given in the State Sanitary Regulations and Standards 2.2.4-171-10 “Hygienic Requirements for Drinking Water Intended for Human Consumption.” The assessment of drinking water quality was carried out in accordance with DSTU (National Standards of Ukraine) 4808:2007 and with the water quality index (WQI). It was found that the largest deviations from the norm among toxicological indicators were observed for nitrates – 63.9%. In terms of water quality classes according to DSTU 4808:2007, drinking water from sources of non-centralized water supply of villages showed the following distribution: 2.8% of the samples belonged to class 1 (excellent water quality), 72.2% to class 2, and 25% to class 3. According to WQI, 16.7% of the examined sources of non-centralized water supply had excellent water, 63.9% had good water, and 19.4% had poor water. Despite the fact that the water from the investigated sources of non-centralized water supply was of acceptable quality, it is impotable due to the excessive nitrate content. The results obtained show that there is a need for monitoring of drinking water quality from the sources of non-centralized water supply, especially in rural settlements that are not provided with centralized water supply.

Impacts of COVID-19 lockdown on private domestic groundwater sample numbers, E. coli presence and E. coli concentration across Ontario, January 2020-March 2021: An interrupted time-series analysis

Approximately 1.5 million individuals in Ontario are supplied by private water wells (private groundwater supplies). Unlike municipal supplies, private well water quality remains unregulated, with owners responsible for testing, treating, and maintaining their own water supplies. The COVID-19 global pandemic and associated non-pharmaceutical interventions (NPIs) have impacted many environmental (e.g., surface water and air quality) and human (e.g., healthcare, transportation) systems over the past 15-months (January 2020 to March 2021). To date, the impact of these interventions on private groundwater systems remains largely unknown. Accordingly, the current study aimed to investigate the impact of a province-wide COVID-19 lockdown (late-March 2020) on health behaviours (i.e., private domestic groundwater sampling) and groundwater quality (via Escherichia coli (E. coli) detection and concentration) in private well water in Ontario, using time-series analyses (seasonal decomposition, interrupted time-series) of a large-spatio-temporal dataset (January 2016 to March 2021; N = 743,200 samples). Findings indicate that lockdown concurred with an immediate (p = 0.015) and sustained (p < 0.001) decrease in sampling rates, equating to approximately 2200 fewer samples received per week post-interruption. Likewise, a slightly decreased E. coli detection rate was observed approximately one month after lockdowns began (p = 0.003), while the proportion of "highly contaminated" samples (i.e., E. coli > 10 CFU/100 mL) was shown to increase within one month (p = 0.02), followed by a sustained decrease for the remainder of the year (May 2020-December 2020). Analyses strongly suggest that COVID-19 interventions resulted in discernible impacts on both well user behaviours and hydrogeological mechanisms. Findings may be used as an evidence-base for assisting policy makers, public health practitioners and private well owners in developing recommendations and mitigation strategies to manage public health risks during extreme and/or unprecedented future events.

Predicting factors of public awareness and perception about the quality, safety of drinking water, and pollution incidents

Public perception of drinking water quality and safety results from the interaction of multiple factors, including the public engagement, which requires sufficient knowledge and awareness. This issue has yet to be addressed in Algeria. This study investigated the residents' perception and awareness about the drinking water quality, safety, and water pollution events. A survey-based cross-sectional study was conducted amongst citizens living in the province of Biskra. Multinomial regression analysis was used to identify the predicted public perception factors about drinking water-related issues. Regardless of the degree of public trust in the drinking water sources, the main drinking water source reported by the participants was tank water (43.3%) followed by tap water (32%). Water quality standards are a measure of the condition of water relative to the contaminants. Water consumption profiles gave priority attention to taste (48.7%), odour (35%), appearance (34.7%), and colour (32%), reflecting a low level of knowledge about the water quality standards. Most of the residents (55.7%) reported a deficient communication about the preventive measures to protect public health. The higher level of education showed a statistically significant impact in discriminating between those who felt very satisfied and dissatisfied participants with the drinking water quality and those who felt between satisfied and dissatisfied (P = 0.023, P = 0.034, respectively). Additionally, education level had a statistically significant role in differentiating trust levels in drinking water quality between two groups, those belonging to either confident or relatively confident and the group of extremely worried respondents, with P = 0.000 and P = 0.000, respectively. Interviewed respondents with certain education levels showed higher trust in the safety of drinking water when compared to those with lower education levels. Gender had a significant role in differentiating the group of respondents who were relatively confident from those who were extremely worried (P = 0.016). The public knowledge about the standards of water quality, safety, and the pollution-related issues remains relatively low. This study is of interest to policy makers and public health authorities who implement actions for water contamination prevention and public health protection. These findings could have national implications and are also applicable, in general context, particularly in low and middle-income countries.

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.

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.

Private groundwater contamination and extreme weather events: The role of demographics, experience and cognitive factors on risk perceptions of Irish private well users

Extreme weather events (EWEs) may significantly increase pathogenic contamination of private (unregulated) groundwater supplies. However, due to the paucity of protective guidance, private well users may be ill-equipped to undertake adaptive actions. With rising instances of waterborne illness documented in groundwater-dependent, developed regions such as the Republic of Ireland, a better understanding of well user risk perceptions pertaining to EWEs is required to establish appropriate educational interventions. To this end, the current study employed an online and physical questionnaire to identify current risk perceptions and correspondent predictors among Irish private well users concerning extreme weather. Respondents were elicited via purposive sampling, with 515 private well users elucidating perceived supply contamination risk in the wake of five EWEs between the years 2013-2018 including drought and pluvial flooding. A novel scoring protocol was devised to quantify overall risk perception (i.e. perceived likelihood, severity and consequences) of extreme weather impacts. Overall risk perception of EWEs was found to demonstrate a significant relationship with gender (p = 0.017) and event experience (p < 0.001), with female respondents and those reporting prior event experience exhibiting higher median risk perception scores. Risk perception was additionally mediated by perceived self-efficacy in undertaking supply maintenance (p = 0.001), as well users citing confidence in ability scored significantly lower than those citing no confidence. Two-step cluster analysis identified three distinct respondent subsets based on risk perception of EWEs (high, moderate and low perception), with female respondents and those with a third-level education significantly more likely to fall within the high perception cluster. Study findings affirm that certain demographic, experiential and cognitive factors exert a significant influence on private well user risk perceptions of EWE impacts and highlight potential focal points for future educational interventions seeking to reduce the risk of human infection associated with groundwater and extreme weather.

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.

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.