Self-reported household impacts of large-scale chemical contamination of the public water supply, Charleston, West Virginia, USA

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.

Evaluating water quality using social media and federal agency data

United States Environmental Protection Agency (USEPA) drinking water violation report is currently one of the most reliable measures of evaluating United States drinking water quality. While states continuously strive to comply with federal water quality standards making this documentation continuously relevant, consumers are likely to perceive water quality through sensory aesthetics or physical and virtual social networks. This research quantifies the relationship between consumer perceptions and government-reported drinking water quality to provide insights to state water managers and policymakers. We evaluated consumer perceptions of tap water using weekly social media data. The online search returned 898,709 mentions and 799,035 posts. Net sentiment, measured as the number of negative posts minus the number of positive posts divided by the number of posts expressing sentiment, was determined and ranged from -100 to 100. Net sentiment was uncorrelated with USEPA weekly water quality violations for most states. Net sentiment was correlated with violations related to arsenic standards (-0.223) and a total number of violations (-0.220) for Washington. For California, net sentiment was correlated with violations related to disinfectants and other organic compounds (-0.295). In many cases, water violations in one city became national news, which eclipsed local water issues circulating on social media.

Chronic environmental contamination: A systematic review of psychological health consequences

We sought to undertake a systematic review to assess the current research and to provide a platform for future research on the psychological health impact of chronic environmental contamination (CEC). CEC is the experience of living in an area where hazardous substances are known or perceived to be present in air, water, or soil at elevated levels for a prolonged and unknown period of time. We employed a systematic review approach to assess the psychological health impact of CEC in literature from 1995 to 2019, and conducted a meta-analysis of available findings (k = 60, N = 25,858) on the impact of CEC on anxiety, general stress, depression, and PTSD. We also present a narrative synthesis of findings that suggest risk factors for the experience of psychological health impacts in the wake of CEC. Likely factors increasing risk for elevated psychological health impact from CEC experience are institutional delegitimization of community concerns and the real or perceived presence of health effects from CEC. The meta-analyses observed small-to-medium effects of experiencing CEC on anxiety, general stress, depression, and PTSD. However, there was also evident risk of bias in the data. Our review suggests that psychological health in the context of CEC is an important potential public health burden and a key area for future improved research.

4-Methylcyclohexane methanol (MCHM) affects viability, development, and movement of Xenopus embryos

Following chemical spill disasters, it is important to estimate the effects of spilled chemicals on humans and the environment. Here we analyzed the toxicological effects of the coal cleaning chemical, 4-methylcyclohexane methanol (MCHM), which was spilled into the Elk River water supply in 2014. The viability of HEK293 T human cell line cultures and Xenopus tropicalis embryos was negatively affected, and the addition of the antioxidants alleviated toxicity with MCHM exposure. Additionally, X. tropicalis embryos suffered developmental defects as well as reversible non-responsiveness and melanization defects. The impact MCHM has on HEK293 T cells and X. tropicalis points to the importance of continued follow-up studies of this chemical.

Review of Modeling Methodologies for Managing Water Distribution Security

Water distribution systems are vulnerable to hazards that threaten water delivery, water quality, and physical and cybernetic infrastructure. Water utilities and managers are responsible for assessing and preparing for these hazards, and researchers have developed a range of computational frameworks to explore and identify strategies for what-if scenarios. This manuscript conducts a review of the literature to report on the state of the art in modeling methodologies that have been developed to support the security of water distribution systems. First, the major activities outlined in the emergency management framework are reviewed; the activities include risk assessment, mitigation, emergency preparedness, response, and recovery. Simulation approaches and prototype software tools are reviewed that have been developed by government agencies and researchers for assessing and mitigating four threat modes, including contamination events, physical destruction, interconnected infrastructure cascading failures, and cybernetic attacks. Modeling tools are mapped to emergency management activities, and an analysis of the research is conducted to group studies based on methodologies that are used and developed to support emergency management activities. Recommendations are made for research needs that will contribute to the enhancement of the security of water distribution systems.

Perceptions of Water-related Environmental Concerns in Northwest Ohio One Year after a Lake Erie Harmful Algal Bloom

Water is essential to human life around the world, but there are numerous threats to its quality both internationally and nationally. The purpose of this secondary data analysis was to examine public perceptions of water-related environmental concerns in northwest Ohio. In fall 2015, nine focus groups on environmental health conditions were conducted with Lucas County, Ohio residents. Each 90-min focus group was videotaped and professionally transcribed to maximize data capture and facilitate data analysis. Colaizzi's (1978) method of content analysis was applied to make sense of the participants' environmental concerns related to water. The majority of the 93 participants were white females between the ages of 40 and 59. A do-not-drink advisory related to a harmful algal bloom in the summer of 2014 and the possibility of a future bloom were still prominent in residents' minds that affected their perceptions and behaviors 1 year later. The emergent themes included: (1) avoiding the use of tap water due to concerns about water quality, (2) mourning the loss of a precious resource and their childhood recreational activities, (3) believing there are financial impacts associated with water problems, (4) distrusting the actions and decisions of persons in authority, (5) wanting to stop fighting about who is to blame and determine the problem's real cause, and (6) desiring actions and planning by authorities to prevent future problems. Understanding public perceptions of water-related environmental concerns can inform practitioners worldwide on successful approaches to restoring trust, educating about and communicating risk, and planning for future issues.

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.

Analysis of building plumbing system flushing practices and communications

Drinking water distribution system contamination incidents can prompt public agencies and drinking water utilities to issue do-not-drink and do-not-use advisories. After the contaminant is cleared from distribution mains, consumers are often directed to flush their plumbing. However, little validated guidance and few evaluated communications strategies are available on using flushing to decontaminate building water systems. Additionally, limited data support the effectiveness of current practices and recommendations. In this study, expert elicitation was used to assess existing flushing guidance and develop validated flushing guidance and communications for single-family residences. The resulting guidance recommends progressively opening all cold-water taps from the closest to point of entry to the furthest and allowing the water to run for at least 20 minutes. Hot-water taps should be opened progressively and run for at least 75 minutes. The guidance language and format conformed to grade-level and readability scores within recommended health communication ranges. The readability of eight other flushing guidance documents was also evaluated for contamination incidents from 2008-2015. Seven were written at a 10th-12th grade level, above the 6th-7th grade level recommended for health communications.

Potential and Actual Health Hazards in the Dense Urban Operational Environment: Critical Gaps and Solutions for Military Occupational Health

: This paper presents environmental health risks which are prevalent in dense urban environments.We review the current literature and recommendations proposed by environmental medicine experts in a 2-day symposium sponsored by the Department of Defense and supported by the Johns Hopkins University Applied Physics Laboratory.Key hazards in the dense urban operational environment include toxic industrial chemicals and materials, water pollution and sewage, and air pollution. Four critical gaps in environmental medicine were identified: prioritizing chemical and environmental concerns, developing mobile decision aids, personalized health assessments, and better real-time health biomonitoring.As populations continue to concentrate in cities, civilian and military leaders will need to meet emerging environmental health concerns by developing and delivering adequate technology and policy solutions.

The 2014 crude 4-methylcyclohexanemethanol chemical release and birth outcomes in West Virginia

Approximately 10,000 gallons of crude 4-methylcyclohexanemethanol and propylene glycol phenyl ether were accidentally released into the Elk River upstream from a water treatment facility in West Virginia. The objective of this study was to use logistic and Poisson regression analyses to determine the effect potential exposures had on adverse birth outcomes (birth weight, small for gestational age, and abnormal Apgar score). We adjusted for confounding factors and assessed prevalence of adverse birth outcomes by residential location and timing of the pregnancy. There were no statistically significant interactions between residential location and timing of the pregnancy (range of p values: .157-.806). Changes in the prevalence of birth outcomes were consistent before and after the spill regardless of residential location. There was no evidence of an association between adverse birth outcomes and potential exposure to the released chemicals.

Crude 4-methylcyclohexanemethanol (MCHM) did not cause skin irritation in humans in 48-h patch test

Crude 4-methylcyclohexanemethanol (MCHM) is an industrial chemical used to wash and clean coal. On January 9th, 2014 approximately 10,000 gallons of a mixture containing crude MCHM were released into the Elk River near Charleston, West Virginia, contaminating the local water supply. Following the spill, residents reported numerous health complaints, and sought medical attention for ailments including rashes and itching. The relationship between the complaints and the spill were unknown, as such symptoms are reported frequently in the background. In this study, the primary irritation potential of crude MCHM was evaluated in 206 individuals who underwent 48 hour semi-occluded patch testing. MCHM concentrations assessed in this study were 1, 5, 15, and 100 ppm. No appreciable skin reactions were observed in individuals at any concentration. Three of the five concentrations evaluated were above the highest measured concentration of MCHM in the tap water of residents in West Virginia (3.7 ppm). The results of this study suggest that crude MCHM would not be a dermal irritant for the vast majority, if not all, potentially exposed persons at the concentrations in the water reported after the spill.

Acute Health Effects After the Elk River Chemical Spill, West Virginia, January 2014

OBJECTIVES

On January 9, 2014, approximately 10 000 gallons of a mixture of 4-methylcyclohexanemethanol and propylene glycol phenyl ether spilled into West Virginia's Elk River, contaminating the potable water supply of about 300 000 West Virginia residents. This study sought to describe acute health effects after the chemical spill.

METHODS

We conducted a descriptive analysis using 3 complementary data sources: (1) medical records of patients who visited an emergency department during January 9-23, 2014, with illness potentially related to the spill; (2) West Virginia Poison Center caller records coded as "contaminated water" during January 9-23, 2014; and (3) answers to household surveys about health effects from a Community Assessment for Public Health Emergency Response (CASPER) questionnaire administered 3 months after the spill.

RESULTS

In the 2 weeks after the spill, 2000 people called the poison center reporting exposure to contaminated water, and 369 people visited emergency departments in the affected area with reports of exposure and symptoms potentially related to the spill. According to CASPER weighted cluster analyses, an estimated 25 623 households (21.7%; 95% confidence interval [CI], 14.4%-28.9%) had ≥1 person with symptoms who felt that they were related to the spill in the 3 months after it. Reported health effects across all 3 data sources included mild skin, respiratory, and gastrointestinal symptoms that resolved with no or minimal treatment.

CONCLUSIONS

Medical records, poison center data, and CASPER household surveys were inexact but useful data sources to describe overall community health effects after a large-scale chemical spill. Analyzing multiple data sources could inform epidemiologic investigations of similar events.

Oxidative remediation of 4-methylcyclohexanemethanol (MCHM) and propylene glycol phenyl ether (PPh). Evidence of contaminant repair reaction pathways

Rate constants and reaction efficiencies were determined for HO˙-mediated reactions for 4-methylcyclohexanemethanol and propylene glycol phenyl ether to simulate contaminant remediation in surface waters.

Sources of Information During the 2014 West Virginia Water Crisis: A Cross-Sectional Survey

Objective

On January 9, 2014, a faulty storage tank leaked 10,000 gallons of an industrial coal-processing liquid into the Elk River in West Virginia, contaminating the drinking water of 9 counties collectively known as the Kanawha Valley. In the context of this event, we explored the relationship between social determinants and (1) the timeliness with which residents learned about the crisis, (2) the source of information, (3) opinions on the source of information, (4) information-seeking behaviors, and (5) knowledge acquired.

Methods

Between February 7 and 26, 2014, we conducted a survey of 690 adult residents of West Virginia. Descriptive statistics and multivariable statistical models were performed.

Results

Information about water contamination spread quickly, with 88% of respondents from the affected counties hearing about the incident on the same day it occurred. Most people received the information from local television news (73%); social media users had 120% increased odds of knowing about the recommended behaviors. People who had a favorable opinion of the source of information demonstrated better knowledge of recommended behaviors.

Conclusions

The use of local television news during a crisis is important for timely dissemination of information. Information exposure across segments of the population differed on the basis of the population’s background characteristics. (Disaster Med Public Health Preparedness. 2017;11:196–206)

The toxicity of crude 4-methylcyclohexanemethanol (MCHM): review of experimental data and results of predictive models for its constituents and a putative metabolite

Crude 4-methylcyclohexanemethanol (MCHM) is an industrial solvent used to clean coal. Approximately 10 000 gallons of a liquid mixture containing crude MCHM were accidently released into the Elk River in West Virginia in January 2014. Because of the proximity to a water treatment facility, the contaminated water was distributed to approximately 300 000 residents. In this review, experimental data and computational predictions for the toxicity for crude MCHM, distilled MCHM, its other components and its putative metabolites are presented. Crude MCHM, its other constituents and its metabolites have low to moderate acute and subchronic oral toxicity. Crude MCHM has been shown not to be a skin sensitizer below certain doses, indicating that at plausible human exposures it does not cause an allergic response. Crude MCHM and its constituents cause slight to moderate skin and eye irritation in rodents at high concentrations. These chemicals are not mutagenic and are not predicted to be carcinogenic. Several of the constituents were predicted through modeling to be possible developmental toxicants; however, 1,4-cyclohexanedimethanol, 1,4-cyclohexanedicarboxylic acid and dimethyl 1,4-cyclohexanedicarboxylate did not demonstrate developmental toxicity in rat studies. Following the spill, the Centers for Disease Control and Prevention recommended a short-term health advisory level of 1 ppm for drinking water that it determined was unlikely to be associated with adverse health effects. Crude MCHM has an odor threshold lower than 10 ppb, indicating that it could be detected at concentrations at least 100-fold less than this risk criterion. Collectively, the findings and predictions indicate that crude MCHM poses no apparent toxicological risk to humans at 1 ppm in household water.

Subtleties of human exposure and response to chemical mixtures from spills

Worldwide, chemical spills degrade drinking water quality and threaten human health through ingestion and inhalation. Spills are often mixtures of chemicals; thus, understanding the interaction of chemical and biological properties of the major and minor components is critical to assessing human exposure. The crude (4-methylcyclohexyl)methanol (MCHM) spill provides an opportunity to assess such subtleties. This research determined the relative amounts, volatilization, and biological odor properties of minor components cis- and trans-methyl-4-methylcyclohexanecarboxylate (MMCHC) isomers and major components cis- and trans-4-MCHM, then compared properties and human exposure differences among them. (1)H nuclear magnetic resonance and chromatography revealed that the minor MMCHC isomers were about 1% of the major MCHM isomers. At typical showering temperature of 40 °C, Henry's law constants were 1.50 × 10(-2) and 2.23 × 10(-2) for cis- and trans-MMCHC, respectively, which is 20-50 fold higher than for 4-MCHM isomers. The odor thresholds were 1.83 and 0.02 ppb-v air for cis- and trans-MMCHC, which were both described as predominantly sweet. These data are compared to the higher 120 ppb-v air and 0.06 ppb-v odor thresholds for cis- and trans-4-MCHM, for which the trans-isomer had a dominant licorice descriptor. Application of a shower model demonstrated that while MMCHC isomers are only about 1% of the MCHM isomers, during showering, the MMCHC isomers are 13.8% by volume (16.3% by mass) because of their higher volatility. Trans-4-MCHM contributed about 82% of the odor because of higher volatility and lower odor threshold, trans-MMCHC, which represents 0.3% of the mass, contributed 18% of the odor. This study, with its unique human sensory component to assess exposure, reaffirmed that hazard assessment must not be based solely on relative concentration, but also consider the chemical fate, transport, and biological properties to determine the actual levels of exposure across different media.

Assessing clarity of message communication for mandated USEPA drinking water quality reports

The United States Environmental Protection Agency mandates that community water systems (CWSs), or drinking water utilities, provide annual consumer confidence reports (CCRs) reporting on water quality, compliance with regulations, source water, and consumer education. While certain report formats are prescribed, there are no criteria ensuring that consumers understand messages in these reports. To assess clarity of message, trained raters evaluated a national sample of 30 CCRs using the Centers for Disease Control Clear Communication Index (Index) indices: (1) Main Message/Call to Action; (2) Language; (3) Information Design; (4) State of the Science; (5) Behavioral Recommendations; (6) Numbers; and (7) Risk. Communication materials are considered qualifying if they achieve a 90% Index score. Overall mean score across CCRs was 50 ± 14% and none scored 90% or higher. CCRs did not differ significantly by water system size. State of the Science (3 ± 15%) and Behavioral Recommendations (77 ± 36%) indices were the lowest and highest, respectively. Only 63% of CCRs explicitly stated if the water was safe to drink according to federal and state standards and regulations. None of the CCRs had passing Index scores, signaling that CWSs are not effectively communicating with their consumers; thus, the Index can serve as an evaluation tool for CCR effectiveness and a guide to improve water quality communications.

Public response to the 2014 chemical spill in West Virginia: knowledge, opinions and behaviours

Background

On January 9^th 2014, a faulty storage tank leaked 10,000 gal of an industrial coal processing liquid into the Elk River in West Virginia (WV), contaminating the drinking water of the nine counties collectively known as the Kanawha Valley. The aim of this study was to 1) explore how and when people obtained information about the water contamination and 2) understand how individual and social factors such as socio-demographic characteristics, timing of information, trust in government, and risk perception influenced compliance with recommended behaviours and the public’s views on the need for environmental regulations.

Methods

Between February 7–26, 2014, a survey was conducted of adult residents of West Virginia including geographic areas affected and non-affected by the chemical spill. The total population-based sample size was 690 and the survey was administered online. Descriptive statistics and multivariate statistical models were created to determine what factors influenced compliance and public opinions.

Results

Findings from this study show that, during the 2014 West Virginia water crisis, information about water contamination spread quickly, as 73 % of survey respondents across the state and 89 % within the affected counties reported they heard about the incident the same day it occurred. Most people received the information promptly, understood what happened, and understood what to do to prevent exposure to the contaminant. The majority of respondents living in affected counties (70 %) followed the recommended behaviours. Among participants who voiced an opinion on the role of government in environmental regulations, the majority of respondents (54 %) reported there is “too little regulation.”

Conclusion

Data from this study show that a higher perception of risk and timely receipt of information are associated with compliance with recommended behaviours, underlying the importance of releasing information to the public as quickly as possible during a crisis. This study also highlights the importance of coordinating risk communication activities beyond the area of the incident to assure public understanding of what measures are recommended, which are not and where.