Community Water Systems Research Articles

Predictors of Water Lead Levels in Drinking Water of Homes With Domestic Wells in 3 Illinois Counties.

Millions of US homes receive water from private wells, which are not required to be tested for lead (Pb). An approach to prioritizing high-risk homes for water lead level (WLL) testing may help focus outreach and screening efforts, while reducing the testing of homes at low risk. To (1) characterize distribution of WLLs and corrosivity in tap water of homes with private residential wells, and (2) develop and evaluate a screening strategy for predicting Pb detection within a home. Cross-sectional. Three Illinois counties: Kane (northern), Peoria (central), and Jackson (southern). 151 private well users from 3 Illinois counties. Water samples were analyzed for WLL and corrosivity. (1) WLL and corrosivity, and (2) the sensitivity, specificity, and predictive value of a strategy for prioritizing homes for WLL testing. Pb was detected (>0.76 ppb) in tap water of 48.3% homes, and 3.3% exceeded 15 ppb, the US Environmental Protection Agency action level for community water systems. Compared with homes built in/after 1987 with relatively low corrosivity, older homes with more corrosive water were far more likely to contain measurable Pb (odds ratio = 11.07; 95% confidence interval, 3.47-35.31). The strategy for screening homes with private wells for WLL had a sensitivity of 88%, specificity of 42%, positive predictive value of 58%, and negative predictive value of 80%. Pb in residential well water is widespread. The screening strategy for prioritizing homes with private wells for WLL testing is greater than 85% sensitive.

Using Chemical Inventory Data to Prepare Against Source Water Contamination

Key TakeawaysIf community water systems can easily access information about hazardous chemical storage in their source water protection area (SWPA) and know how to make full use of the data, they stand a better chance of sufficiently preparing for source water emergencies.Required under the Emergency Planning and Community Right‐to‐Know Act, annual Tier II reports contain valuable information about specific hazardous chemicals that are stored or used in SWPAs.Provisions in America's Water Infrastructure Act of 2018 give community water systems a legal right to Tier II hazardous chemical inventory data for facilities in their SWPA, which can be used to promote comprehensive source water protection planning.

The Next One

Even as we continue to battle the scourge of COVID-19, there's a lot of hope that things eventually will return to normal. Moving forward, though, will there ever be a time when we aren't at the outset of another global pandemic, and should planning efforts more often consider strategies to address a pandemic on top of another disaster? COVID-19 has revealed many of the water industry's strengths and some areas that need improvement, but thankfully water professionals are used to planning for uncertainty. Accommodating the natural cycle of water moving through the environment with seasonal impacts, leaders and decision makers must also account for any significant negative events in their forecasts and plans. For example, utilities and the communities they serve must also address drought leading to wildfires, torrential rains producing floods, and deep freezes causing pipes to burst. Climate change increases the likelihood of those extremes, but even when facing a flood after a fire during a pandemic, water services must always continue. While most of us are focused on the COVID-19 pandemic, some of those in the trenches are already preparing for the next catastrophe—be it another pandemic or some other global disturbance. Regardless of challenges and their combinations, water experts are creating the policies, plans, and bases of design to account for whatever comes next. It's up to water professionals to know their systems, build in and expand resiliency, and guide a community's valuable assets through one event, then another, or sometimes two or more at the same time. However, the challenges that seem daunting today will catalyze understanding and innovation, leaving the industry better prepared for the future. We can't allow any natural or man-made force to overwhelm a community's water systems under normal conditions but especially not in times of crisis. In preparing for and dealing with large-scale threats, it's great to have relationships in place so responses and resources can be coordinated quickly. At the local level, teams must be properly equipped and prepared, and AWWA is ready and able to connect those who need help with the industry guidance and expertise they need. Responding to COVID-19, the water industry so far hasn't missed a beat, and those systems that faced wildfires or floods on top of this pandemic are learning lessons that will serve as future models for responding to compounding calamities. In preparing for the next one, the water industry will need to optimize available resources to ensure water systems and the professionals behind them can effectively face the next contagion combined with a natural disaster occurring alongside a man-made challenge, while always looking ahead for the next one. This month's Journal AWWA features articles on source water protection, water loss control, lead and copper control, and using inclusive language. If you are interested in submitting an article, contact me at journaleditor@awwa.org.

Myth and reality of community ownership and control of community-managed piped water systems in Ghana

Abstract Water supply has remained centralised and governments advanced several reasons (health benefits and increase in rural productivity) for the state-led water services delivery. This approach had budgetary and sustainability challenges. This led to a community-based management approach in which communities were required to contribute towards water supply and own the water supply. This paper explores households’ perception of who owns and controls community water systems that were provided under the ambit of community-based management regimes. The study was conducted in four communities in the Upper West Region of Ghana. Data were collected using two main sources: (i) a household survey, using questionnaires; and (ii) a platform, comprising 14 participants. The study found that there is a relationship between community contribution and ownership of the water systems. Community level actors argue that communities own the water systems, because they contributed towards capital cost and are responsible for operations and maintenance. Community level actors have control over the decisions of the water systems. Legal ownership resides in the government and communities manage the water systems and appropriate the returns, thus creating a sense of ownership of the water systems. As such, there is a dualistic ownership of the water systems.

Arsenic in US correctional facility drinking water, 2006-2011

Background: Very little is known about the quality of drinking water in US correctional facilities (e.g. detention centers, prisons, jails, etc.), which disproportionately detain people of color. The current Environmental Protection Agency’s maximum contaminant level (MCL) for arsenic in public drinking water is 10 µg/L. We estimated drinking water arsenic concentrations in US correctional facilities to determine if incarcerated persons remain at risk for chronic, elevated water arsenic exposure relative to the non-incarcerated US population.Methods: We obtained 230,158 arsenic monitoring records for 37,098 community water systems (CWSs) from the Environmental Protection Agency’s Third Six Year Review of Contaminant Occurrence dataset (covering 2006-2011). We compared six-year average arsenic concentrations in all CWSs versus CWSs exclusively serving correctional facilities. We separately evaluated the Southwestern US (where groundwater arsenic concentrations are relatively high) versus non-Southwestern US.Results: Average six-year water arsenic concentrations were higher for CWSs exclusively serving correctional facilities in the Southwest (6.41 µg/L, 95% CI 3.48, 9.34) compared to all other Southwestern CWSs (3.11 µg/L, 95% CI 2.97, 3.24) and to other CWSs across the rest of the US (1.39 µg/L, 95% CI 1.35, 1.42). Compared to other US CWSs and to other Southwestern CWSs, correctional facility CWSs in the Southwest were more likely to report six-year arsenic averages exceeding 10 µg/L (1.6%, 5.8%, and 26.1% of systems, respectively).Conclusions: CWSs exclusively serving correctional facilities in the Southwestern US reported average water arsenic concentrations twice as high as those reported by all other CWSs in the Southwest, and more than a quarter reported six-year averages exceeding the EPA’s regulatory MCL. Strict enforcement of the EPA’s drinking water regulations and a comprehensive review of other drinking water contaminants in CWSs serving correctional facilities is necessary to protect the health and human rights of all incarcerated persons in the US.

Data-driven approaches to advance California’s Human Right to Water Law: Characterizing inequities in drinking water quality among domestic well communities and public drinking water systems

In 2012, California became the first state to recognize the Human Right to Water. However, roughly 10% of California’s public drinking water systems are currently out of compliance with federal and state drinking water quality standards, and an estimated 6 million Californians are served by systems that have been in violation at some point since 2012. A disproportionate number of water quality violations occur in smaller drinking water systems that serve rural, low income communities color, where a lack of resources make it challenging to treat contaminated water and meet regulatory standards. Additionally, significant data gaps exist regarding the location and water quality of unregulated water sources, such as private domestic wells.The UC Berkeley Water Equity Science Shop sought to characterize demographic differences in water quality for communities reliant upon domestic wells and community water systems. We integrated data from the Department of Water Resources; Tracking California’s Drinking Water Systems Geographic Reporting Tool; and the US Census to identify the location of likely domestic well communities across California. Using water quality data from CalEnviroscreen 3.0 and the Groundwater Risk Index Tool, and demographic data from the American Community Survey, we estimate sociodemographic differences in water quality using multivariate analysis.Results indicate that over 1.3 million Californians rely on private wells for drinking water. We estimate 49,000 and 102,000 people live in domestic well areas where drinking water is likely to exceed regulatory standards for nitrates and arsenic, respectively. Average contaminant concentrations of arsenic and nitrate are over 1.5 times higher in areas served by domestic wells than in community water systems. Multivariate statistical models indicate that area-level measures of race/ethnicity and poverty are associated with increases in drinking water contaminant concentrations in domestic well areas.

The Contribution of Groundwater Arsenic to Public Water Arsenic Concentrations in the United States, 2006-2011

Background: Although many aquifers in the US contain elevated concentrations of naturally occurring arsenic and groundwater is a major water source for many community water systems (CWSs), the contribution of groundwater to CWS arsenic concentrations has not been systematically studied. We evaluated the contribution of domestic well arsenic concentrations to CWS arsenic concentrations over time and by region for conterminous US at the county-level from 2006-2011. We hypothesized domestic well arsenic would be more strongly associated with CWS arsenic concentrations in the Southwestern US and during 2006-2008 versus 2009-2011, reflecting the 2006 implementation of EPA’s 10μg/L MCL. Methods: County-level 90th percentile probability of domestic well water arsenic exceeding 10μg/L was estimated by US Geological Survey (USGS) using boosted regression tree models. County-level CWS arsenic was estimated using EPA’s 2006-2011 Six Year Review of Contaminant Occurrence Database. We used linear regression to assess associations between domestic well arsenic, a proxy for groundwater arsenic, and CWS arsenic, stratified by CWS monitoring period (2006-2008 vs. 2009-2011) and region for 2,231 counties across conterminous U.S. Results: From 2006-2011 nationwide, the relationship between the 90th percentile probability of domestic well arsenic exceeding 10μg/L and CWS arsenic decreased by 1.14 (95% CI: -1.54, -0.73)μg/L between 2006-2008 and 2009-2011. A declining relationship was observed in all regions, except the Central Midwest and Pacific Northwest. Discussion: The probability of high arsenic in domestic well water, a proxy for groundwater, is relevant contributor to CWS arsenic nationwide. This contribution was weaker in 2009-2011, possibly reflecting implementation of the 2006 MCL and uncertainty in modeled probability estimates. Declines in contribution of domestic well arsenic to CWS arsenic varied regionally, suggesting that interventions to implement the MCL were more successful in some regions (Southeast, Southwest) than others (Central Midwest, Pacific Northwest), or that aquifers used for domestic wells and CWSs differ regionally. Keywords: Water, water quality, biomarkers, arsenic, environmental epidemiology

Health and economic impact of nitrate pollution in drinking water: a Wisconsin case study.

Nitrate contamination of drinking water, common in agricultural areas, increases the risk of certain cancers and impacts fetal development during pregnancy. Building on previously published methodology, this study evaluates nitrate-attributable disease cases and adverse birth outcomes as well as their economic costs for Wisconsin, USA. Nitrate is the most common contaminant in groundwater in Wisconsin. Two-thirds of the state's residents use groundwater as the primary source of drinking water. Here, we analyze nitrate exposure from drinking water in Wisconsin based on nitrate test results for community water systems for the period of 2010-2017 and a novel methodology for estimating nitrate exposure for the 28% of state's residents who use private wells. We estimate that annually, 111-298 combined cases of colorectal, ovarian, thyroid, bladder, and kidney cancer in Wisconsin may be due to nitrate contamination of drinking water. Each year, up to 137-149 cases of very low birth weight, 72-79 cases of very preterm birth, and two cases of neural tube defects could be due to nitrate exposure from drinking water. The direct medical cost estimates for all nitrate-attributable adverse health outcomes range between $23 and $80 million annually. Simulating targeted reductions in the counties with the highest current drinking water nitrate concentrations resulted in similar reductions in adverse health outcomes as statewide reduction efforts, up to nitrate reductions of 20%. Time trend analysis suggests that groundwater nitrate concentrations are overall increasing. Thus, nitrate contamination of water supplies in Wisconsin is a public health problem that needs to be addressed.

Detection of Shiga toxin-encoding genes in small community water supplies.

Shiga toxin (Stx), one of the most potent bacterial toxins known, can cause bloody diarrhea, hemolytic uremic syndrome, kidney failure and death. The aim of this pilot was to investigate the occurrence of Shiga toxin-encoding genes, stx (stx1 and stx2) from total coliform (TC) and E. coli positive samples from small community water systems. After aliquots for TC and E. coli analyses were removed, the remnant volume of the samples was enriched, following a protocol developed for this study. Fifty-two per cent of the samples tested by multiplex PCR were positive for the presence of the stx genes; this percentage was higher in raw water samples. The stx2 gene was more abundant. Testing larger volumes of the samples increase the sensitivity of our assay, providing an alternative protocol for the detection of Shiga toxin-producing E. coli (STEC) that might be missed by the TC assay. This study confirms the presence of Stx encoding genes in source and distributed water for all systems sampled and suggests STEC as a potential health risk in small systems.

The Effects of Agricultural and Urban Land Use on Drinking Water Treatment Costs: An Analysis of United States Community Water Systems

For community water providers, safeguarding source waters from contamination offers an additional barrier of protection and a potential means of avoiding in-plant treatment costs. Whether source water protection efforts are cost-effective relative to in-plant treatment requires hydrologic, geologic, and climatologic knowledge of source watersheds, as well as an understanding of how changes in source water quality affect treatment costs. Quantitative evidence on the latter relationship is limited. This study estimates separate hedonic cost functions for water systems that primarily use surface water sources and those that primarily use groundwater sources using a database of United States (US) Community Water Systems. Cost functions relate annual variable treatment cost to production, factor input prices, capital stock, and source water quality, as proxied by land use within various ex-ante defined contributing areas (i.e., surrounding land areas affecting source water quality). For surface water systems, a 1% increase in urban land relative to forestland is correlated with a 0.13% increase in annual variable treatment costs. In this analysis, the relationship between costs and agricultural land is not statistically significant. Conversely, for groundwater systems, a 1% increase in agricultural land relative to forestland is correlated with a 0.24% increase in costs, whereas in this analysis the relationship between costs and urban land is not statistically significant. The cost-effectiveness of forestland preservation, based on sample means, varies considerably with the size of the contributing area, with no clear indication as to whether preservation is more likely to be cost-effective for surface water or groundwater systems.

Digitizing a Statewide Map of Community Water System Service Areas

Key TakeawaysA digital map of all North Carolina water system service‐area boundaries allows for improved planning at all levels of government.The process for digitizing maps is time‐consuming and requires nuance, especially because the input from different systems varies.Creating an individual map of their service area can be challenging for low‐capacity systems; for this reason, providing assistance to these systems is essential.Acquiring individual maps from system managers and maintaining the data over time require close partnerships.

Exploring Water Management Practices and Sustainability Implications in the Bamenda Metropolis of Cameroon

City governments, the world over, are grappling with the problem of sustaining water supply to their rapidly growing population. The need to meet up with this exigency has been emphasized in Sustainable Development Goal (SDG) 6 (Ensure availability and sustainable management of water and sanitation for all) and SDG 11 (Make cities and human settlements inclusive, safe, resilient, and sustainable). While a series of demand and supply-side approaches to water management have been employed, the extent to which water management practices could guarantee (un)sustainability still require clarity, especially in the context of cities in Sub-Saharan Africa (SSA). Taking the case of the Bamenda Metropolis of Cameroon, we contribute to address this lacunae, by identifying household level water management practices in Bamenda, and discussing the implications it has for sustainable water supply (availability, affordability). To obtain relevant data for this study, a random sample of 120 households, within 8 neighborhoods of Bamenda, was conducted. Furthermore, we employed descriptive and inferential statistical methods to test the relationship between household socio-economic characteristics and water management (consumption, rationing, preservation). The results reveal the following: In terms of regularity, approximately 63% of the households have irregular water supply, and consume less than 50 litres of water per day. The key water source is pipe borne water (65%), supplied by CAMWATER and Community Water Systems. One of the main water management practice at household level is rainwater harvesting (41.7%), while sustainability is compromised by the weak management systems from supply side, and limited knowledge and resources at the demand side (household level). There is a need for policy (re)orientation to regulate household water distribution, consumption and affordability. Further studies are required to ground this assertion.

Inorganic contaminants in Canadian First Nation community water systems.

While previous Canadian studies have examined microbiological water quality in First Nations, there is little published information on inorganic contaminants. In Atlantic Canada, the lead, manganese, and arsenic content of First Nations' drinking water has been measured for more than a decade, but the data have not been analyzed comprehensively. These contaminants are linked with health problems, and high levels in drinking water are a cause for concern. We examined 12 years of data from 47 First Nation community water systems to identify systems experiencing difficulties meeting sampling frequency or regulatory guidelines. While most contaminant concentrations were below guideline values, we identified elevated concentrations and issues with sampling frequency. No system met both sampling frequency requirements - a minimum of one sample per year per analyte - and regulatory guidelines. Exceedance rates for lead, manganese, and arsenic were high in some systems. Moreover, current sampling procedures for lead specify that taps be flushed prior to sampling, which is known to underestimate lead exposure. We find that a switch to random daytime sampling would at least sometimes yield higher estimates of lead at the tap. Our analysis demonstrates the need for increased monitoring and updated sampling procedures to better characterize inorganic contaminant occurrence in First Nations.

Techno-Economic Analysis of a Solar Thermal Plant for Large-Scale Water Pasteurization

Water pasteurization has the potential to overcome some of the drawbacks of more conventional disinfection techniques such as chlorination, ozonation and ultraviolet radiation treatment. However, the high throughput of community water systems requires energy-intensive processes, and renewable energy sources have the potential to improve the sustainability of water pasteurization plants. In case of water pasteurization by solar thermal treatment, the continuity of operation is limited by the intermittent availability of the solar irradiance. Here we show that this problem can be addressed by a proper design of the plant layout, which includes a thermal energy storage system and an auxiliary gas boiler. Based on a target pasteurization protocol validated by experiments, a complete lumped-component model of the plant is developed and used to determine the operating parameters and size of the components for a given delivery flow rate. Finally, we report an economic analysis of the proposed plant layout, which allows its optimization for different scenarios based on two design variables, namely the solar multiple and the duration of the thermal energy storage. Based on the analyzed cases, it is found that the proposed plant layouts may yield a unit cost of water treatment ranging from ≈32 EUR-cents m−3 to ≈25 EUR-cents m−3.

Children drinking private well water have higher blood lead than those with city water

Although the Flint, Michigan, water crisis renewed concerns about lead (Pb) in city drinking water, little attention has been paid to Pb in private wells, which provide drinking water for 13% of the US population. This study evaluates the risk of Pb exposure in children in households relying on private wells. It is based on a curated dataset of blood Pb records from 59,483 North Carolina children matched with household water source information. We analyze the dataset for statistical associations between children's blood Pb and household drinking water source. The analysis shows that children in homes relying on private wells have 25% increased odds (95% CI 6.2 to 48%, P < 0.01) of elevated blood Pb, compared with children in houses served by a community water system that is regulated under the Safe Drinking Water Act. This increased Pb exposure is likely a result of corrosion of household plumbing and well components, because homes relying on private wells rarely treat their water to prevent corrosion. In contrast, corrosion control is required in regulated community water systems. These findings highlight the need for targeted outreach to prevent Pb exposure for the 42.5 million Americans depending on private wells for their drinking water.

Abstract A05: Cumulative risk, key characteristics of carcinogens, and hallmarks of cancer analysis for carcinogenic drinking water contaminants

Abstract Classic toxicologic and carcinogenic evaluations involve exposure to a single agent, an approach that misses the health impacts of co-occurring exposures to carcinogenic chemicals. To understand the molecular processes that underpin cancer development in people and the carcinogenic impact of environmental pollutants, it is critical to assess the potential health impacts of co-occurring contaminants that are found in common media such as air, water, food products, and consumer products. If environmentally relevant mixtures of chemicals are causing or substantially contributing to cancer, the public health consequences would be profound. A cumulative cancer risk assessment can help in the development of approaches to minimize the burden of cancer due to carcinogenic contaminants in the environment. Here we present an analysis for drinking water in which we identify common combinations of co-occurring carcinogenic contaminants in drinking water. We utilize a risk-based cancer metric as well as a mode of action analysis based on the Hallmarks of Cancer and Key Characteristics of Carcinogens frameworks. Applying this method to drinking water contaminant occurrence data between 2010 and 2017 for the United States reveals that 269,957,711 people served by 43,142 community water systems may be exposed to a mixture of carcinogenic contaminants at levels above the de minimis risk. Based on an assessment of 22 carcinogenic water contaminants, we estimated that 98,657 lifetime cancer cases could be due to contaminated tap water. Almost half of the estimated cancer cases are due to arsenic, while the rest of the risk is due to the presence of disinfection byproducts, radiologic contaminants, and hexavalent chromium. The risk is unevenly distributed across community water systems with approximately 1/3 of the expected cancer cases found in systems serving 10,000-100,000 people and another 1/3 of expected cases in systems serving 100,000-1 million people. In contrast, water systems serving communities smaller than 10,000 people, while contributing less than a fifth of attributable cancer cases, often represent highest individual risks in terms of contaminant exposure for residents served by those systems. A temporal analysis of accumulated cancer risk indicates that for some exposure scenarios, reaching and exceeding the one-in-one-million risk level can occur early in life during sensitive windows of development. In conclusion, real-life exposure information can be helpful for probing the pathways leading to environmental carcinogenesis and also for integrating information from multiple risk assessment frameworks. Citation Format: Sydney S. Evans, Alexis Temkin, Chris Campbell, Olga V. Naidenko. Cumulative risk, key characteristics of carcinogens, and hallmarks of cancer analysis for carcinogenic drinking water contaminants [abstract]. In: Proceedings of the AACR Special Conference on Environmental Carcinogenesis: Potential Pathway to Cancer Prevention; 2019 Jun 22-24; Charlotte, NC. Philadelphia (PA): AACR; Can Prev Res 2020;13(7 Suppl): Abstract nr A05.

Disparities in community water system compliance with the Safe Drinking Water Act

Understanding potential disparities in community compliance with the Safe Drinking Water Act (SDWA) will help managers effectively and fairly allocate funding for improving drinking water systems. Environmental justice is experienced at the scale of the individual, the household, the neighborhood, or the water service provider and is too fine-grained a scale for spatial analysis with most available state datasets. This research represents an effort to ascertain which spatial analysis method selected to estimate the demographics of water service areas best supports environmental justice analysis at the state scale. To understand whether there are disparities in compliance with the SDWA, this study specifically investigated the relationship between socioeconomic status and race as well as other water system variables, and violations to the SDWA of community water system (CWS) in the state of Pennsylvania. The sociodemographic characteristics of the water systems were estimated using three different CWS-level spatial analysis methods (areal weighting, dasymetric mapping, areal interpolation) and a county-level spatial analysis method. Negative binomial regression was used to evaluate whether these sociodemographic characteristics, and other water system variables, including size of the water system, ownership, and water source, are associated with SDWA violations. This research demonstrates that the spatial analysis method selected for an environmental justice study can affect the results and conclusions of the research. Evidence that SDWA violations were associated with race or socioeconomic status was not found; however, this study did determine that small CWSs (<200 connections) and CWSs serving rural areas are less likely to be compliant with the SDWA.

Arsenic in US correctional facility drinking water, 2006–2011

BackgroundLittle is known about the quality of drinking water in US correctional facilities (e.g. detention centers, prisons, jails, etc.). Our objective was to determine if incarcerated persons are at risk for chronic, elevated arsenic exposure relative to the non-incarcerated US population, particularly in the Southwestern US where public water and groundwater arsenic concentrations are high compared to the rest of the US. MethodsWe analyzed 230,158 arsenic monitoring records from 37,086 community water systems (CWSs) from the Environmental Protection Agency's (EPA) Third Six Year Review of Contaminant Occurrence dataset (covering 2006–2011). We compared six-year average arsenic concentrations and the odds of exceeding the EPA's 10 μg/L maximum contaminant level (MCL) for CWSs exclusively serving correctional facilities versus all other CWSs in the Southwestern US, where groundwater arsenic concentrations are high. ResultsAverage six-year water arsenic concentrations were higher for Southwestern correctional facility CWSs (6.41 μg/L, 95% CI 3.48, 9.34) compared to all other Southwestern CWSs (3.11 μg/L, 95% CI 2.97, 3.24) and to other CWSs across the rest of the US (1.39 μg/L, 95% CI 1.35, 1.42). In the Southwest, 26.1% (N = 6) of correctional facility CWSs versus 5.8% (509) of other CWSs reported six-year arsenic averages exceeding 10 μg/L, corresponding to an odds ratio of 5.70 (95% confidence interval 2.24, 14.52). Correctional facility CWSs in the Southwest were also more likely to report six-year averages exceeding 5 μg/L (the MCL for New Jersey and New Hampshire, N = 8, odds ratio 2.77, 95% CI 1.17, 6.54). DiscussionPersons incarcerated in the Southwestern US were at disproportionate risk of elevated drinking water arsenic exposure and related disease from 2006 to 2011. Strict enforcement of EPA regulations and additional technical and financial support for CWSs serving correctional facilities in the Southwest is necessary to protect the health and human rights of incarcerated persons.

Community water fluoridation perceptions and practice in the United States: challenges in governance and implementation

AbstractThe primary objective of this research is to reveal potential challenges in achieving the finalized water fluoridation recommendation made by the Federal Water Fluoridation Panel in the United States (U.S.) with data extracted from consumer confidence reports. A secondary objective is to understand community water system manager's perceptions of and ability to meet this new standard using a survey instrument. Mean fluoridation levels are above the recommended level. The confidence interval does not capture the nationally recommended 0.7 mg/L. The t-test revealed two statistically significant results: that the sample mean is not equal to 0.7 mg/L and that the sample mean is higher than 0.7 mg/L. Respondents felt engaged in the policy process, but preferred state over federal policymaking. There is evidence that the optimal fluoridation level may not have been reached by water systems and that some water systems are under-fluoridating, while others are over-fluoridating. Several large water systems and pockets across the U.S. are not practicing artificial water fluoridation which reduces the effectiveness of this policy. Regular engagement by states with water system managers and feedback from water management professionals could be encouraged to better understand local constraints in meeting the federal recommendation.

The effects of drinking water service fragmentation on drought-related water security.

Drought is a critical stressor that contributes to water insecurity. In the United States, an important pathway by which drought affects households' access to clean, reliable drinking water for basic needs is through the organization and activities of community water systems. Research on the local political economy of drinking water provision reveals the constraints on community water systems that affect their performance when confronting drought hazards. Fragmentation in responsibility for drinking water contributes to disparities in drought vulnerability, preparation, and response across households and across communities. The nature and extent of these disparities require further investigation to identify strategies for expanding water security in the face of drought and other water hazards.