Primary Drinking Water Source and Associated Acute Gastrointestinal Illness in New Mexico, USA 公开

Abstract

Background: Approximately 15% of Americans rely on private wells, which are not regulated under federal law, for their drinking water. Many well owners do not test or maintain their water quality even though the water source may be influenced by nearby surface waters and subject to fecal contamination. Consequently, many Americans may routinely drink water that increases their risk of illness.

Objectives: This study characterized the demographics of New Mexico residents according to their primary drinking water source and compared the incidence of self-reported AGI by primary drinking water sources.

Methods: This study analyzed data from the 2007 New Mexico Behavioral Risk Factor Surveillance System, using complex survey procedures to provide descriptive statistics and analyze associations. The primary outcome was self-reported acute gastrointestinal illness (AGI) in the previous 30 days, and the secondary outcome was AGI resulting in a health care visit. We evaluated the association between primary water source and AGI using logistic regression models, controlling for demographic characteristics and health status indicators.

Results: In total, 6,606 individuals were included in the study. Fifty-five percent of individuals used public water, 18% used private wells, and 27% used commercially bottled water; 42% reported filtering their water. Overall 30-day incidence of AGI was 15%, and did not vary significantly by primary water source or filtration. Drinking water sources varied age, marital status, education, employment, region, number of adults and children in the household, race/ethnicity, and rural/urban status. The final adjusted model suggested individuals using well water had a decreased odds of reporting AGI and seeking medical attention for AGI, however the differences were not significant (odds ratio (OR) = 0.83, 95% CI = 0.65, 1.06 and OR = 0.85, 95% CI = 0.41, 1.80).

Conclusion: Demographic characterization of respondents indicated that primary drinking water sources are not uniformly distributed throughout the population; this is useful information when determining how to target educational materials. Analyses did not reveal any significant associations between primary water source and AGI; however, the result of this cross-sectional survey does not exclude the possibility that some contaminated wells may pose a health risk in New Mexico.

Table of Contents

Background........................................................................................................................ 1

Drinking Water............................................................................................................. 1

Recommendations and Benchmarks........................................................................... 2

Well Types..................................................................................................................... 3

Private Well Water Quality Perceptions and Testing Behaviors............................ 4

Potential Waterborne Causes of Gastrointestinal Illness....................................... 6

Viruses......................................................................................................................... 6

Parasites....................................................................................................................... 7

Bacteria........................................................................................................................ 8

Contaminant Indicators............................................................................................... 8

Groundwater Outbreak Surveillance and Regulation............................................. 9

Well Water Contamination....................................................................................... 10

Introduction..................................................................................................................... 12

Study Area................................................................................................................... 12

Demographics............................................................................................................ 12

New Mexico Wells.................................................................................................... 12

Problem Statement..................................................................................................... 14

Hypothesis.................................................................................................................... 14

Specific Aims............................................................................................................... 15

Methods............................................................................................................................ 15

Study Design............................................................................................................... 15

Data Collection........................................................................................................... 16

Data Analysis............................................................................................................... 18

Created Variables and Groupings............................................................................. 20

Demographic and AGI Characteristics..................................................................... 22

Analytic Strategy........................................................................................................ 22

Results.............................................................................................................................. 24

General......................................................................................................................... 24

Water Source............................................................................................................... 25

Water Source by Health Indicators........................................................................... 27

Incidence of Acute Gastrointestinal Illness............................................................. 28

Incidence by Health Indicators.................................................................................. 28

Incidence by Water-related Behaviors....................................................................... 29

Modeling...................................................................................................................... 30

AGI............................................................................................................................ 30

Sought Medical Attention for AGI........................................................................... 31

Discussion........................................................................................................................ 32

Conclusions and Recommendations............................................................................. 41

References........................................................................................................................ 43

Tables and Figures.......................................................................................................... 49

Table 1: Response Percentages of Survey Questions................................................ 49

Table 2: Source of Drinking Water by Respondent Demographic Characteristics.... 50

Table 3: Source of Drinking Water by Health Indicators.......................................... 51

Table 4: Incidence of Acute Gastrointestinal Illness by Respondent Demographic Characterization 52

Table 5: AGI Incidence within the Past 30 Days by Health Indicators.................... 53

Table 6: AGI Incidence According to Water Consumption Habits........................... 54

Table 7: Adjusted Model Odds Ratio of Variables of AGI+ Compared to AGI-..... 55

Table 8: Adjusted Model Odds Ratio of Sought Medical Attention for AGI compared to Not Seeking Medical Attention 56

Appendix........................................................................................................................... 57

Appendix A: New Mexico Environment Department Well Test Form.................... 57

Appendix B: New Mexico Public Health Regions (2005-2012)............................... 59

Appendix C: New Mexico BRFSS Survey, 2007...................................................... 60

Appendix D: New Mexico Permission for Use of Information.............................. 146

Appendix E: Emory Institutional Review Board Study Exemption Notice............ 147

Appendix F: New Mexico Department of Health Guidelines for Race/Ethnicity Data 148

About this Master's Thesis

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School	Rollins School of Public Health
Department	Environmental Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Environmental Sciences Health Sciences, Epidemiology
关键词	AGI New Mexico Private Well Survey Data Drinking water Diarrhea BRFSS
Committee Chair / Thesis Advisor	Ryan, P Barry, Emory University
Committee Members	Gargano, Julia, Centers for Disease Control and Prevention
Partnering Agencies	State or local health department (not in Georgia) CDC

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