Returning Individual Tap Water Testing Results to Research Study Participants after a Wildfire Disaster

Diagnostic screening of private well water using gas chromatography with high resolution mass spectrometry to support well water management

In the US, private well users are responsible for their own water quality testing, but local health officials are often uncertain what tests to recommend, particularly for regulated organic chemical contaminants. This study evaluated the utility of suspect and non-target screening (NTS) high resolution mass spectrometry (HRMS) as a tool to identify a wide range of organic chemicals of emerging concern in private well water and to inform well water management decisions. Qualitative NTS, which detects chemicals without providing concentrations, was used to analyze 25 private well water samples from Wake County, North Carolina. Using the NIST 20 mass spectral database (M1), NTS tentatively identified 106 unique organic chemicals across the 25 samples and an average of 11 organic chemicals per sample. At least one USEPA ToxCast chemical was identified in each private well water sample. Private well water users were interviewed prior to and after their sample's NTS results were reported back; four county groundwater managers were interviewed after aggregated results for all 25 water samples were reported back. All but one well user participant chose to participate in the reporting-back post-interview. The 24 private well users found NTS results useful and valued the contextualization of their results using NTS results for other well users and a local municipal water sample. Most private well users (67%) were surprised by their well water results, especially regarding the number of tentatively identified organic chemicals detected. All the groundwater managers believed the NTS results were useful and could help improve their testing recommendations to private well users. Even with qualitative limitations, NTS results can be an effective and valuable tool to inform the public and governance stakeholders in decisions around groundwater quality management.

Moving Forward with Reporting Back Individual Environmental Health Research Results

BACKGROUND

The practice of reporting back individual results to participants in environmental health research has evolved significantly over the past 20 years. Research findings support the potential of report-back to enhance the ethics, quality, and impact of environmental health research. Nonetheless, implementation of environmental health report-back practices is not yet routine.

OBJECTIVES

We propose a framework for institutionalizing appropriate report-back to participants of their individual results across the environmental health research enterprise. We provide a brief overview of the rationales for report-back, social science research on report-back experiences over the past two decades, and recent efforts to synthesize guidance in this field. We also describe barriers to be addressed in moving toward widespread implementation of report-back.

DISCUSSION

Report-back of individual results is increasingly recognized as an ethical responsibility and essential component of impactful environmental health research. Experience shows that when personal results are returned with appropriate contextual information, report-back can increase environmental health literacy, promote individual actions, and enhance engagement in policy change. Therefore, report-back can promote environmental justice and reduce disparities in access to science. Despite this evidence base, report-back is not widely implemented. We recommend the collaborative development of guidelines, training, and resources to build capacity for appropriate report-back to study participants across the environmental health research enterprise, and we identify research priorities to advance the field. Development of tools and shared infrastructure for report-back holds promise for reducing barriers while ensuring high-quality personalized reports. Disseminating successful case studies could also advance excellence. We recommend including diverse scientific disciplines, community partners, representatives of study populations, clinicians, institutional review boards (IRBs), legal experts, public health professionals, and government officials in further developing this critical aspect of environmental health research. https://doi.org/10.1289/EHP12463.

Integrating participant feedback and concerns to improve community and individual level chemical exposure assessment reports

BACKGROUND

As exposure assessment has shifted towards community-engaged research there has been an increasing trend towards reporting results to participants. Reports aim to increase environmental health literacy, but this can be challenging due to the many unknowns regarding chemical exposure and human health effects. This includes when reports encompass a wide-range of chemicals, limited reference or health standards exist for those chemicals, and/or incompatibility of data generated from exposure assessment tools with published reference values (e.g., comparing a wristband concentration to an oral reference dose).

METHODS

Houston Hurricane Harvey Health (Houston-3H) participants wore silicone wristbands that were analyzed for 1,530 organic compounds at two time-points surrounding Hurricane Harvey. Three focus groups were conducted in separate neighborhoods in the Houston metropolitan area to evaluate response to prototype community and individual level report-backs. Participants (n = 31) evaluated prototype drafts using Likert scales and discussion prompts. Focus groups were audio-recorded, and transcripts were analyzed using a qualitative data analysis program for common themes, and quantitative data (ranking, Likert scales) were statistically analyzed.

RESULTS

Four main themes emerged from analysis of the transcripts: (1) views on the report layout; (2) expression of concern over how chemicals might impact their individual or community health; (3) participants emotional response towards the researchers; and (4) participants ability to comprehend and evaluate environmental health information. Evaluation of the report and key concerns differed across the three focus groups. However, there was agreement amongst the focus groups about the desire to obtain personal exposure results despite the uncertainty of what the participant results meant.

CONCLUSIONS

The report-back of research results (RBRR) for community and individual level exposure assessment data should keep the following key principles in mind: materials should be accessible (language level, data visualization options, graph literacy), identify known information vs unknown (e.g., provide context for what exposure assessment data means, acknowledge lack of current health standards or guidelines), recognize and respect community knowledge and history, and set participant expectations for what they can expect from the report.