A University-Community Partnership to Reduce Exposure to Disinfection Byproducts in Appalachia

Grants and Contracts Details


Rural Americans are confronting a drinking water crisis driven by the nation’s aging infrastructure. In Appalachia, water infrastructure challenges have been exacerbated by decreasing tax revenues related to the decline of coal mining and accompanying population loss. For decades, Appalachian communities have struggled with inadequate water resources stretched between the coal mining industry and community residents. To address these tensions, Kentucky passed legislation that expanded public drinking water systems throughout the entire state, resulting in 97% of Kentucky’s total population – one-fifth of which resides in Appalachia - relying on public drinking water systems. Due to mountainous topography and technical challenges, severely-degraded public water systems in Appalachian Kentucky pose important health risks. For example, Appalachian Kentucky’s Martin County recently was characterized as having the “worst drinking water district…in the state.” This system loses as much as 70% of its treated water through pipe breaks and leaks, decreasing system pressures and leading to a loss of sustainable flows. Low pressures can result in the incursion of contaminants into the system, thereby requiring increased disinfection to kill emergent bacteria. Disinfection by-products (DBPs) are formed as a result and are among the most frequent sources of U.S. Environmental Protection Agency [USEPA} drinking water violations, affecting as many as 11 million people nationwide. With epidemiological studies consistently linking DBP exposure to urinary tract cancers and adverse birth outcomes, DBP exposure represents a looming threat to public health. Through a pilot community-engaged study, we have begun to characterize and address these issues. Martin County, the original launching point for Lyndon Johnson’s War on Poverty in 1964, finds 40% of its residents living below the federal poverty level, and many cannot afford to pay for water. The research team has found extensive in-home drinking water contamination, including coliform bacteria, while DBP concentrations at taps have routinely exceeded the EPA maximum contaminant levels, in contrast with routine regulatory sampling at two points (per EPA protocols). We also have observed strong seasonal variation in contamination levels, which likely relates to changes in source water chemistry, the amount and composition of natural organic matter in source water, and the lack of local resources to adapt to changing water quality conditions. These factors have contributed to decreased community trust in both the local water utility’s and state agencies’ ability to insure the availability of safe and affordable drinking water. Unfortunately, these systemic, multisectoral issues extend beyond Martin County and across Appalachian communities that grapple with similar exposure risks. We propose to build on pilot study findings by deploying a multi-pronged, multi-stakeholder approach to raise awareness of, characterize spatial and temporal variations in, and reduce exposure to DBP in central Appalachia. Expanding our pilot study to a regional scale, we will add citizen science, public health communication, and systems intervention components to new analyses of seasonal changes in source water chemistry and explore implications for multi-route exposure risks. Specific Aim 1: Utilize existing academic-community partnerships to strengthen regional capacity for citizen science, building DBP-related environmental health literacy [EHL] and training residents to conduct in-home DBP sampling to evaluate spatial and temporal patterns of DBP multi-route (e.g. ingestion, inhalation, and dermal) exposure risks. Specific Aim 2: Apply emerging knowledge of source water chemistry and system operating conditions to develop, validate, and disseminate predictive models that can support small drinking water utilities in reducing formation of disinfection by-products. Specific Aim 3: Strengthen multidirectional communication about drinking water quality, affordability, and availability in Appalachian Kentucky, collaboratively building partnerships among community groups, public officials, and university researchers. Accomplishing these aims will increase scientific understanding of the causes of DBP formation in aging rural drinking water systems, a need that was brought forward by community groups and has been the subject of existing collaborations in ongoing, community-engaged research. Further, the project-derived models and technical assistance offers a systems-level intervention to decrease multi-route exposure risks to DBPs. Processes for strengthening multi-stakeholder, as well as the technical products, will be transferrable to other rural regions that face similar drinking water infrastructure challenges, ultimately helping reduce exposure to environmental health threats.
Effective start/end date11/1/2310/31/24


  • National Institute of Environmental Health Sciences


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