Drinking Water Sources, Quality, and Associated Health Outcomes in Appalachian Virginia: A Risk Characterization Study in Two Counties
On this page:
BACKGROUND: In the US, violations of drinking water regulations are highest in lower-income rural areas overall, and particularly in Central Appalachia. However, data on drinking water use, quality, and associated health outcomes in rural Appalachia are limited.
OBJECTIVES: We sought to assess public and private drinking water sources and associated risk factors and health outcomes for individuals living in rural regions of Appalachian Virginia.
METHODS: We administered surveys and collected tap water, bottled water, and saliva samples in lower-income households in two adjacent rural counties in southwest Virginia (bordering Kentucky and Tennessee). Water samples were tested for pH, temperature, conductivity, total coliforms, E. coli, free chlorine, nitrate, fluoride, heavy metals, and specific pathogen targets. Saliva samples were analyzed for antibody responses to potentially waterborne infections. We shared water analysis results with households.
RESULTS: We enrolled 33 households (83 individuals), 82% (n=27) with utility-supplied water and 18% with private wells (n=3) or springs (n=3). 58% (n=19) reported household incomes of <$20,000/year. Total coliforms were detected in water samples from 33% (n=11) of homes, E. coli in 12%, all with wells or springs (n=4), and Aeromonas, Campylobacter, and Enterobacter in 9%, all spring water (n=3). Diarrhea was reported for 10% of individuals (n=8), but was not associated with E. coli detection. 34% (n=15) of saliva samples had detectable antibody responses for Cryptosporidium spp., C. jejuni, and Hepatitis E. After controlling for covariates and clustering, individuals in households with septic systems and straight pipes had significantly higher likelihoods of antibody detection (risk ratios = 3.35, 95%CI = 1.04 – 10.77).
DISCUSSION: To our knowledge, this is the first study to analyze saliva samples, drinking water, and health outcomes from low-income households in Appalachian Virginia. Our findings indicate that utility-supplied water was generally safe, but individuals in low-income households without utility-supplied sewerage may have relatively higher exposures to water-related pathogens.