Abstract In the study described in this article, the authors

Christopher Heaney, PhD Sacoby Wilson, PhD Omega Wilson, MA John Cooper, PhD Natasha Bumpass Marilyn Snipes

Introduction

Low-income communities of color strad-dling rural-urban unincorporated boundaries of municipalities across the U.S. often fall within extraterritorial jurisdiction, joint-planning agreement, or industrial zoning designations that tend to concentrate locally unwanted land uses and psychosocial stress-ors and limit access to health-promoting infrastructure (Maantay, 2001, 2002; Wilson, 2009; Wilson, Hutson, & Mujahid, 2009). Residents of these communities are often disproportionately and adversely burdened by co-occurring environmental justice issues such as landfills, wastewater treatment plants, Superfund sites, brownfields, toxic release inventory facilities, hazardous waste sites, heavily trafficked highways, and concentrated

animal feeding operations (Bullard, 1990, 1994; Bullard, Mohai, Saha, & Wright, 2007; Maantay, 2002; Norton et al., 2007; Wilson, Bumpass, Wilson, & Snipes, 2008; Wilson, Cooper, Heaney, & Wilson, 2008; Wilson et al., 2009; Wilson, Wilson, Heaney, & Cooper, 2008; Wing, Cole, & Grant, 2000; Wing & Wolf, 2000). Residents of these communities tend to rely on a complex mixture of unreg-ulated private wells and septic systems and inadequate public drinking water and sewer services (Bullard, 1990, 1994; Bullard et al., 2007; Wilson, Cooper et al., 2008; Wilson, Wilson et al., 2008; Wing et al., 2000).

National media attention focused on this issue during the case of Jerry R. Kennedy et al. v. City of Zanesville, Ohio (Johnson, 2008; Smyth, 2008). Residents of Coal Run, Ohio,

a predominately black community built on top of abandoned coal mines located just outside the Zanesville incorporated city limit, were awarded a settlement of nearly $11 million after repeated requests for public water service were denied by local officials for more than five decades (Johnson, 2008; Smyth, 2008).

Because a complex mixture of private and regulated public drinking water services often exists in these marginalized communities, the benefits of routine federal monitoring of community water systems and required public notification and reporting under the Safe Drinking Water Act amendments of 1996 are not shared by all (Francis et al., 1984; U.S. Environmental Protection Agency [U.S. EPA], 1996). State and local regulations of private wells and septic systems, where they exist, typically require a minimum amount of testing and monitoring (usually once at the time of construction and installation).

Given the limited extent of testing and monitoring performed on drinking water and sewer services in these low-income communities of color, knowledge of the magnitude of water quality problems and public drinking water and sewer service disparities is limited. Recent research by Uhlmann and co-authors (2009) exam-ined differences in risks of sporadic enteric disease by drinking water source (ground-water vs. surface (ground-water) and type (regulated, public vs. private) (Uhlmann et al., 2009). The authors’ findings of an increased risk of enteric disease among individuals living on land parcels serviced by private wells under-score the importance of improving our knowledge of the vulnerability of drinking water and sewer services in such

marginal-A b s t r a c t

Use of Community-Owned and -Managed

Research to Assess the Vulnerability

of Water and Sewer Services

in Marginalized and Underserved

Environmental Justice Communities

A d v A n c E m E n t o f t H E sCIENCE

ized communities straddling rural-urban boundaries (Uhlmann et al., 2009).

Community-based participatory research (CBPR) has advanced popular movements for environmental justice (Arcury, Quandt, & Dearry, 2001; Avery, Wing, Marshall, & Schiff-man, 2004; Corburn, 2002a, 2002b; Israel et al., 2001; Israel et al., 2005; Israel et al., 2006; Minkler, Vasquez, Tajik, & Petersen, 2006; O’Fallon & Dearry, 2002; Parker et al., 2003; Wing & Wolf, 2000). The denial of basic amenities, which include regulated public drinking water service, regulated public sewer service, storm water drainage, paved roads, sidewalks, community lighting, curbside solid waste collection, and emergency medical, fire, and police protection services, is being identified by community-based organiza-tions (CBOs) as an emerging environmental justice issue (Heaney, Wilson, & Wilson, 2007; Wilson, Bumpass et al., 2008; Wilson, Cooper et al., 2008; Wilson, Heaney, Wilson, & Cooper, 2007; Wilson, Wilson et al., 2008). The denial of basic amenities is often tied to historical and ongoing institutional racism (Johnson, 2008; Smyth, 2008; Wilson, Bumpass et al., 2008; Wilson, Cooper et al., 2008; Wilson, 2009) and CBOs face singu-lar challenges for data collection. Residents facing this environmental justice issue often harbor deeply rooted mistrust of elected officials, state environmental protection agen-cies, local health departments, and academic researchers investigating household drink-ing water and sewer infrastructure problems (Wilson, Bumpass et al., 2008). Residents often fear condemnation of property if viola-tions are discovered, presenting barriers to data collection to investigate drinking water and sewer service disparities in these marginalized and underserved communities (Wilson, Bumpass et al., 2008).

A novel community-driven research approach that builds on the principles of CBPR stresses community ownership and manage-ment at each stage of the research process, promoting CBOs with demonstrated orga-nizational capacity to the role of principal investigator and project manager (Heaney et al., 2007; Wilson, Bumpass et al., 2008). Principles of community-owned and –managed research (COMR), described previously (Heaney et al., 2007; Wilson, Bumpass et al., 2008), go beyond traditional CBPR and other forms of university-managed research with communities

by emphasizing the credibility and capacity of CBOs to maintain ownership and community trust. COMR was developed by the West End Revitalization Association (WERA) through its organizing efforts to preserve three low-income African-American communities in Mebane, North Carolina, a semiurban town of 7,284 people (78% white, 18% black per the 2000 U.S. Census). WERA represents the communities of West End, White Level, and Buckhorn/Perry Hill, comprised of approximately 500 house-holds, 10 churches, and one Masonic Lodge. WERA worked with residents to stop plans to build a 27-mile interstate highway corridor from I-85/40 in Mebane to Danville, Virginia, whose path would have leveled historic homes and churches in the West End and White Level communities (U.S. Census Bureau [USCB], 2011). The three WERA communities are 85% to 95% African-American, and many residents, descendants of slaves, inherited land passed down across multiple generations (Wilson, Cooper et al., 2008).

WERA formed a COMR partnership with researchers at the University of North Carolina School of Public Health (UNC) to perform a cross-sectional household drinking water and sewer service survey and measure fecal pollution levels in drinking water and surface water supplies in the communities, which is reported in this article.

Materials and Methods

Study Area

WERA communities are located inside the Mebane city limits and on the border of Alamance and Orange counties, North Carolina. Households in these communities use a combination of 1) private individual and community water wells; 2) regulated public drinking water service (public drink-ing water); 3) private on-site septic tank soil absorption systems (septic systems); and 4) regulated public sewer service (public sewer). Partnerships with residents of these commu-nities were fostered by WERA through its community organizing efforts described in detail elsewhere (Heaney et al., 2007; Wilson, Bumpass et al., 2008; Wilson, Cooper et al., 2008; Wilson, Wilson et al., 2008).

Household Recruitment

WERA staff coordinated the process of household recruitment, which involved

COMR methods to contact local households (Heaney et al., 2007; Wilson et al., 2007; Wilson, Wilson et al., 2008). WERA board and staff and UNC partners trained volunteer residents from the WERA neighborhoods to become community monitors (CMs) (Heaney et al., 2007; Wilson et al., 2007; Wilson, Wilson et al., 2008). Teams of WERA CMs who lived in each study neighborhood recruited households from their neighbor-hood to participate in the study. For example, CMs who lived in West End recruited house-holds in West End to participate. WERA staff also telephoned residents, coordinated CM visits to households, and distributed infor-mation about the study to residents attending large WERA community meetings of up to 100 residents and smaller training sessions of 10 to 20 residents.

The UNC Public Health-Nursing insti-tutional review board (IRB) approved the study and its materials after WERA’s President Omega Wilson completed the National Institute of Health’s (NIH’s) online human subjects certification course. WERA, in partnership with UNC and with tech-nical assistance from U.S. EPA’s Office of Environmental Justice and Tetra Tech, Inc., developed U.S. EPA–approved quality assur-ance and quality control guidelines for alphanumeric survey coding, survey data collection, chain-of-custody, secure data storage, and data analysis as part of WERA’s U.S. EPA–funded collaborative problem-solving project grant (Heaney et al., 2007; Wilson et al., 2007; Wilson, Wilson et al., 2008). CMs visited households in WERA neighborhoods, distributed drinking water and sewer service surveys, and also requested permission to collect water samples at house-holds (Heaney et al., 2007). Recruitment was designed to reflect the demographics of the neighborhoods. Community monitors’ grass-roots knowledge of the communities formed the basis of WERA’s effort to improve trust and interest in participating in the study (Heaney et al., 2007). WERA CMs recruited households using individual and commu-nity drinking water wells (target group) and households using public drinking water service (referent group). Recruitment for surface water sampling focused on house-holds using septic systems (target group) and those using public sewer service (referent group), regardless of drinking water type.

Household Drinking Water and Sewer Service Survey

WERA’s board and staff developed a household survey prior to its work with U.S. EPA and its partnership with UNC. This community-designed survey was later revised for WERA’s U.S. EPA environmental justice small grant study in 2002 with input from a collaborative workgroup of WERA’s board members and staff, CMs, UNC researchers, and U.S. EPA technical advisors (Wilson, Wilson et al., 2008). WERA based the survey on input from affected resi-dents and World Health Organization (WHO) guidelines, the North Carolina Department of Environment and Natural Resources (DENR), and Orange County, North Carolina, Depart-ment of EnvironDepart-mental Health (DEH). The survey covered 1) basic demographic informa-tion (e.g., age, sex, race/ethnicity, household income); and 2) information about household infrastructure (e.g., age of home, type of water and sewer service, well characteristics, history of septic system problems). The survey was designed to identify three common metrics of septic system failure defined as 1) soggy soil over septic drainfield during nonrainfall periods; 2) smell of raw sewage near septic drainfield; and 3) sewage backup into the home (Hoover, 1994, 1997; Konsler, 2003; World Health Organization [WHO], 1994). We also considered an additional sign of septic system operation problems if the household reported of a pumping frequency of at least once a year (Hoover, 1994, 1997; T. Konsler, personal communication, 2003; WHO, 1994). WERA’s telephone number and address were included on surveys. WERA staff assigned an alphanu-meric code to each household survey response to protect confidentiality.

Drinking Water and Surface Water Analysis

Sample Collection

Teams of WERA community monitors were trained in the aseptic method of water sample collection as described in the 20th edition of the Standard Methods for the Examination of Water and Wastewater (American Public Health Association [APHA], 1998). WERA CMs collected drinking water samples from households that permitted sample collection. Drinking water samples were drawn from an indoor faucet or outdoor spigot after running the water for three minutes. Drinking water

samples were collected at households using individual and community private wells (target group) and those using public drink-ing water (referent group). Perennial and intermittent streams bordering households in WERA neighborhoods were also sampled. Surface water samples were collected at house-holds using private septic systems (target group) and at households using public sewer service (referent group). WERA CMs assigned a unique alphanumeric code to each house-hold drinking water and surface water sample. Physical and Microbiological Measurements of Fecal Pollution

We examined turbidity in nephelometric turbidity units (NTU) using the Hach 2100N turbidimeter (detection range 0 to 4,000 NTU). Fecal coliforms and E. coli were measured using the Colilert IDEXX Quanti-Tray most probable number (MPN) assay and membrane filtra-tion method (U.S. EPA, 2006a). Enterococcus was enumerated using the Enterolert IDEXX Quanti-Tray MPN assay and membrane filtra-tion method (U.S. EPA, 2002). Standard U.S. EPA protocols were followed for membrane filtration methods (U.S. EPA, 2002, 2006a).

Drinking water (2 L) and surface (1 L) water samples were assayed for coliphage by the two-step enrichment method (U.S. EPA, 2001). E. coli C3000, CN13, and F-amp were used as bacterial hosts for coliphage enrichment. Coliphage concentrations were reported as an MPN of plaque forming units (PFU) per 100 mL of water sample based upon presence/absence in three replicate dilutions of 3mL, 30mL, and 300mL and 1mL, 10mL, and 100mL for drinking water and surface water samples, respectively (with a lower detection limit of <0.2 MPN/100mL).

Statistical Analysis

Differences in turbidity (NTU) and fecal microbial indicator concentrations at target and referent sites in WERA neighborhoods (MPN/100mL) were evaluated. For the drink-ing water analysis, we compared differences between households with private wells (target group) and those with public drinking water (referent group). For the surface water analy-sis, we compared differences between streams proximal to households using private septic systems (target group) and streams proximal to households using public sewer (referent group). Fecal indicator concentrations below

the lower detection limit were assigned a value of one-half the lower detection limit. Unpaired, nonparametrical two-sided t-tests (Mann-Whitney tests) were used to evaluate differences in mean (turbidity) and median (fecal microbial indicator) concentrations. All analyses were completed using SAS version 9.

Results

Characteristics of Participants, Households, and Communities

WERA CMs approached 250 out of the approx-imately 500 households in West End, White Level, and Buckhorn/Perry Hill (Table 1). Of the 250 households approached, 120 (48%) agreed to participate and completed the house-hold drinking water and sewer service survey. An adult household member ≥18 years of age completed the survey, answering questions on behalf of other household members. Informa-tion on 370 individuals was collected from the 120 households. Ninety-one percent of study participants were African-American, over 50% earned less than $20,000 per year, and 13% reported living with a disability (Table 1).

Household Drinking Water and On-Site Septic System Survey

Vulnerability of Household Drinking Water Service and Water Use

Seventy percent of surveyed households used Alamance/Orange public drinking water, 28% of households used private individual or community wells, and 3% used Mebane city public drinking water (Table 1). Eighty-eight percent of the wells surveyed were at least 18 years old and 15% were dug wells of inad-equate construction quality (Table 1). The majority of household wells delivered drink-ing water via an electric pump (Table 1).

Forty-eight percent of households reported that their drinking water had one of the following characteristics: 1) tastes bad; 2) smells bad; 3) has a color; or 4) looks cloudy; and 14% of households reported these characteristics on a daily basis (Table 1). Participants reported a range of household water uses including the following: drinking (93%), bathing (97%), and washing clothes (84%) (Table 1). Participating households reported the presence of 34 abandoned wells including three (9%) that were still open, providing a direct route for contamination

A d v A n c E m E n t o f t H E sCIENCE

Characteristics of Participants, Households, and Water and sewer systems in WERA Communities

# (%) # (%) # (%)

Household Demographics Water Service continued Sewer Service continued

Race/ethnicity (N = 370) Well water access (n = 33) Septic tank size (N = 120)

White 28 (8) Electric pump 30 (91) 1000 gallons 10 (8)

African-American 335 (91) Don’t know 3 (9) 1500 gallons 4 (3)

Native-American 5 (<1) Number of abandoned wells 34 (100) Don’t know 94 (78)

Other 2 (<1) Status of abandoned wells (n = 34) Missing 12 (10)

Persons with disability (N = 370) 47 (13) Sealed 10 (29) Construction material of septic tank (N = 120)

County of residence (N = 120) Filled 11 (32) Concrete 69 (59)

Orange 74 (62) Capped 9 (27) Cinder block 5 (4)

Alamance 46 (38) Still open 3 (9) Metal 2 (2)

Age of home (N = 120) Don’t know 1 (3) Don’t know 38 (32)

≤20 years 26 (22) Distance between operating and abandoned wells (n = 34) Missing 6 (5) 21–40 years 51 (43) ≤100 feet 11 (32) Three Metrics of Septic System Failure

41–60 years 29 (24) >100 feet 19 (56) Metric 1

>60 years 5 (5) Don’t know 4 (12) Septic system drainage field smells bad (N = 120)

Don’t know 9 (8) Water characteristic (N = 120) Yes 13 (11)

Annual household income (N = 120) Tastes bad 19 (16) No 102 (85)

≤$19,999 61 (51) Smells bad 12 (10) Don’t know 5 (4)

$20,000–$29,999 26 (22) Has a color 10 (8) Metric 2

$30,000–$39,999 8 (7) Looks cloudy 17 (14) Septic system drainage field makes yard wet (N = 120) $40,000–$49,999 10 (8) Water characteristic observed (N = 120) Yes 15 (13)

≥$50,000 7 (6) Daily 17 (14) Daily 2 (13)

Water Service Weekly 8 (7) Weekly 4 (27)

Type of drinking water service (N = 121)a _{Monthly 15 (13) Monthly 8 (53)}

Private household well 33 (28) Household water use (N = 120) Spring 7 (47)

Mebane city water 4 (3) Drinking 112 (93) Summer 8 (53)

Alamance/Orange water 84 (70) Bathing 116 (97) Fall 7 (47)

Well lining material (n = 33) Washing clothes 101 (84) Winter 10 (67)

Rocks/stones 3 (9) Other 40 (33) No 103 (86)

Concrete pipe 15 (46) Sewer Service Don’t know 2 (2)

Plastic 2 (6) Type of sewer service (N = 120) Metric 3

Don’t know 9 (27) Private septic system 120 (100) Septic backup into home (N = 120)

Missing 4 (12) Age of septic system (N = 120) Yes 22 (18)

Year of well construction (n = 33) ≤10 years 15 (13) No 94 (78)

1930–1949 10 (30) 11–20 years 15 (13) Don’t know 4 (3)

1950–1969 12 (36) 21–30 years 32 (29) Frequency of septic system pumping (N = 120)

1970–1989 7 (21) 31–40 years 25 (21) Every 6 months 7 (6)

1990–2000 0 (0) >40 years 14 (12) Every year 12 (10)

Don’t know 4 (12) Don’t know 18 (15) Every 2 years 13 (11)

Well construction method (n = 33) Missing 1 (<1) Every 3 years 21 (18)

Dug 5 (15) Every 5 years 49 (41)

Drilled 21 (64) Don’t know 18 (15)

Don’t know 7 (21)

a _{Total N = 121 because some households reported having a private well in addition to a connection to regulated public drinking water service.}

TABLE

1

of groundwater via surface water intrusion. Thirty-two percent of abandoned wells were <100 ft. from the household’s operating well (Table 1). Eighteen percent of operating wells were <50 ft. from septic tank or drain-age lines, which is less than the minimum setback distance of 100 ft. required by the Orange County Board of Health (Orange County Health Department, 2008) (Table 1). Household Septic System Failure

All households responding to the survey used private septic systems (N = 120) (Table 1). Twenty-eight percent of households using septic systems also relied on private wells (Table 1). At least 75% of the participat-ing households were usparticipat-ing septic systems more than 10 years old (Table 1). Sixty-three percent of household septic systems had tanks constructed of concrete or cinder block materials (Table 1). Septic system failure proportions were 13%, 11%, and 18%, according to the three common metrics defined as the following: drainage field makes the yard wet, drainage field smells bad, and septic backs up into the home, respectively (Table 1). Sixteen percent of septic systems needed to be pumped at least annually, which is a further indication of septic system opera-tional problems (Table 1).

Fecal Pollution of Water Supplies

Drinking Water Turbidity

A subset of 58 of the 94 drinking water samples collected from households in WERA communities during a U.S. EPA environ-mental justice small grant study in 2002 was analyzed for turbidity. Fifteen private well water samples (target group) and 43 public drinking water samples (referent group) were analyzed (Table 2). Mean turbidity of private well water samples (mean = 0.72 NTU; SE = 0.24) was higher than the mean turbidity observed in public drinking water samples (mean = 0.25 NTU; SE = 0.23) (t-value = 6.85; df = 56) (Table 2).

Fecal Microbial Pollution of Drinking Water Ninety-four household drinking water samples were analyzed for fecal coliforms, E. coli, Entero-coccus, and coliphage (F+_{, somatic, and total).}

Forty-four private well water (target group) samples and 50 public drinking water (referent group) samples were collected. Analyses revealed

Drinking Water Turbidity (NTU) at Target and Referent Households in WERA Communities Turbidity (NTU) Target Referent No. samples 15 43 Mean 0.72* 0.25* Standard error 0.24 0.23 Median 0.76 0.20 Minimum 0.26 0.08 Maximum 1.28 1.24

Note. NTU = nephelometric turbidity units; target = private well water; referent = public drinking water. * t-value = 6.85; df = 56.

Drinking Water Fecal Indicator Concentrations (MPN/100 mL) at Target and Referent Households in WERA Communities

Target

Fecal

coliformsa _{E. coli}a _coccusEntero-a _coliphageTotal b F +

coliphagec _coliphageSomatic c

MPN/100 mL MPN/100 mL No. samples 44 44 44 15 29 29 No. pos. samples 6 6 5 0 1 0 Mean pos. samples 54 46 427 – – – Standard error pos. samples 38 38 390 – – – Minimum 0.5 0.5 0.5 – 0 – Maximum 236 236 1986 – 0.2 – Referent Fecal

coliformsa _{E. coli}a _coccusEntero-a _coliphageTotal b F +

coliphagec _coliphageSomatic c

MPN/100 mL MPN/100 mL No. samples 50 50 50 43 7 7 No. pos. samples 1 0 0 1 0 0 Mean pos. samples – – – – – – Standard error pos. samples – – – – – – Minimum 0.5 – – 0 – – Maximum 5.2 – – 0.36 – –

Note. MPN = most probable number; target = private well water; referent = public drinking water.

a _{Samples below detection assigned one half the lower detection limit of <1 MPN/100 mL.} b _{Total coliphage assay performed on subset of samples.}

c _F+ _{and somatic coliphage assay performed on subset of samples.}

TABLE

2

A d v A n c E m E n t o f t H E sCIENCE

a low number of positive samples for all fecal indicators; however, a higher number of posi-tive samples was observed in private well water compared to public drinking water (Table 3). In well water (target group), six samples were positive for fecal coliforms and E. coli and five were positive for Enterococcus. Among positive samples in the target group, the mean concentra-tion of fecal coliforms, E. coli, and Enterococcus was 54 MPN/100mL, 46 MPN/100mL, and 427 MPN/100mL, respectively (Table 3). One target group sample was positive for F+ _{coliphage, at}

a concentration of 0.2 MPN/100 mL (Table 3). One referent group sample was positive for fecal coliforms at a concentration of 5.2 MPN/100mL and another was positive for total coliphage at a concentration of 0.36 MPN/100mL (Table 3). The highest single sample maximum fecal indi-cator concentrations were observed in private wells (Table 3).

Fecal Microbial Pollution of Surface Water Fifty-five (1-liter) surface water samples (16 target samples and 39 referent samples) were analyzed for fecal coliforms, E. coli, Enterococcus, and F+_{, somatic, and total}

coli-phage (Table 4). Little statistical evidence was shown of a difference in mean fecal indicator concentrations between target and referent groups. Overall, 55% of samples exceeded U.S. EPA fecal coliforms single sample maximum contaminant limit (MCL) (200 MPN/100mL) in WERA community surface water streams. Twenty-four percent and 56% of samples exceeded U.S. EPA recreational freshwater guideline values of 126 MPN/100mL for E. coli and 33 MPN/100mL for Enterococcus, respectively. The highest single sample maximum fecal indicator concentrations were observed at target sites (Table 4).

Discussion

More than 43 million Americans rely on more than 15 million privately owned domes-tic wells and an undetermined number of community drinking water wells (DeSimone, Hamilton, & Gilliom, 2009). Approximately 25% of all U.S. households lack regulated public sewer service and instead rely on private onsite septic systems, outhouses, or privies (USCB, 1990). Behind Michigan and Pennsylvania, North Carolina has the third greatest number of households relying on private wells (912,113) (National Ground Water Association, 2009). North Carolina ranks third behind Maine (54.6%) and New Hampshire (50.4%) with 50.2% of house-holds relying on private unregulated sewage disposal systems (USCB, 1990). The U.S. Census Bureau’s American housing survey, conducted in 1997, estimated that 23% of U.S. households rely on on-site septic systems or cesspools and that 2% of these systems reported failures in the three months prior to the survey (USCB, 1997). Most monitoring and testing programs administered by local health departments are passive and often reflect only a small proportion of well vulner-ability and septic system failure conditions. At the federal, state, and local level, limited requirements exist for routine inspection of private unregulated wells and septic systems after initial construction and installation.

Results of the household survey revealed a higher proportion of septic system failure (18%) in WERA communities compared to data from 1980 in Orange County, North Carolina, showing an 11% failure (Grayson, Olive, & Steinbeck, 1982). After reporting survey results to local officials, it became apparent that the failures WERA docu-mented represented the tip of the iceberg. To qualify for a community development block grant (CDBG), city of Mebane and Alamance County Environmental Health Department officials hired a third-party contractor to assess on-site septic system failures along two streets in West End. The final CDBG applica-tion submitted by the city of Mebane revealed a 50% septic system failure prevalence along one street and 100% along a second street (at a total of 40 houses) (City of Mebane, 2004a, 2004b). This prevalence of on-site septic system failure represents a human exposure potential to fecal contamination and untreated sewage in these communities,

A d v A n c E m E n t o f t H E sCIENCE

surface Water Fecal Indicator Concentrations (MPN/100 mL) at Target and Referent sites in WERA Communities

Target

Fecal

coliformsa _{E. coli}a _coccusEntero-a _coliphageTotal b F +

coliphagec _coliphageSomatic c

MPN/100 mL MPN/100 mL No. samples 39 39 39 3 22 22 Mean 3863 2031 1784 19 8.7 26 Standard error 1641 915 869 14 8.1 16 Median 345 96 52 9.3 0.2 1.1 Minimum 0.5 0.5 0.5 1.5 0.1 0.2 Maximum 57,940 28,510 29,090 46 179 279 Referent Fecal

coliformsb _{E. coli}b _coccusEntero-b _coliphageTotal c F +

coliphagec _coliphageSomatic c

MPN/100 mL MPN/100 mL No. samples 16 16 16 2 7 8 Mean 1502 729 1684 1.5 6.3 5.1 Standard error 931 429 1059 0 5.5 4.6 Median 247 100 92 1.5 0.2 0.6 Minimum 0.5 0.5 0.5 1.5 0.1 0.1 Maximum 15,150 6760 17,230 1.5 39 38

Note. MPN = most probable number; target = streams proximal to households with septic systems; referent = streams proximal to households with public sewer service.

a _{4 samples below the lower detection limit of <1 MPN/100 mL.} b _{3 samples below the lower detection limit of <1 MPN/100 mL.}

c _{Coliphage quantification performed only after initial presence/absence positive test.}

TABLE

4

including West End where the city of Mebane constructed its sewage treatment plant in the 1920s. The first African-American house-holds were not tapped on to the municipal sewage treatment facility until 1979 with funding from a CDBG managed by Alamance County (Wilson, Wilson et al., 2008). These infrastructure disparities could have been reduced by connecting low-income African-American households to public drinking water and public sewer decades ago. Over 400 households in WERA studies commu-nities have yet to be connected to Mebane’s municipal sewage treatment facility.

Accompanying septic system failures was evidence of fecal pollution of private house-hold wells and public drinking water supplies. Although turbidity was higher in private wells, public drinking water supplies also exceeded U.S. EPA primary standards for turbidity (<1.0 NTU) for drinking water (U.S. EPA, 2006b). Previous studies have demonstrated that increases in turbidity similar to levels observed in our study (0.5 NTU or less) have been associated with waterborne disease outbreaks (Egorov et al., 2002; Egorov, Naumova, Tere-schenko, Kislitsin, & Ford, 2003; Morris, Naumova, Levin, & Munasinghe, 1996; Schwartz & Levin, 1999; Schwartz, Levin, & Goldstein, 2000; Schwartz, Levin, & Hodge, 1997; Vreeburg & Boxall, 2007). WERA’s data collection revealed the presence of fecal coli-forms, E. coli, Enterococcus, and coliphages in private wells and suggests fecal contamination of household drinking water supplies and the need for precautionary measures to protect residents’ public health.

The presence of fecal coliforms and coli-phages in public drinking water supplies suggests the need for an investigation of the microbial quality of the public drink-ing water distribution system over a longer period of time. Fecal contamination of the distribution system could potentially lead to community-wide exposures to pathogenic microorganisms. The results of our drink-ing water testdrink-ing suggest a need to improve deteriorating and out-of-compliance or unregulated drinking water infrastructure (both private and public drinking water) serving residents in these communities.

Evidence of fecal pollution, up to 290 times U.S. EPA Clean Water Act MCL value (200 CFU/100mL) in community streams, warrants efforts to educate residents about

potential health risks of children playing in yards, pets drinking surface water, and adult family members mowing grass in areas saturated with effluent from overflow-ing on-site septic systems. Concentrations of the fecal indicator bacteria observed at stream sites in these communities exceeded single sample maximum values for E. coli (576 CFU/100mL) and Enterococcus (151 CFU/100mL) by a factor of 50 and 193, respectively (Dufour, 1984; North Carolina DENR, 2007; U.S. EPA, 1986).

Response rates may be considered low, but given residents’ deeply rooted fears of property condemnation and the history of racism, discrimination, and intimida-tion (Wilson, Bumpass et al., 2008), the COMR recruitment effort can be viewed as a success. WERA’s primary goal in design-ing and implementdesign-ing COMR was to collect data to investigate public health risks and leverage corrective action in these margin-alized and underserved communities. The strengths of this research include the use of COMR methods to train CMs, recruit partic-ipants, and collect data from a population that is difficult to track using traditional university- or public health agency-managed data collection methods. WERA and its UNC partners trained 10 CMs, received participation by 120 households and 370 residents, and collected water samples from 94 households and 55 stream sites in three low-income African-American communi-ties, demonstrating that COMR can be used as a model for data collection in comparable marginalized and underserved communities in North Carolina and other states.

Conclusion

The partnership between grassroots WERA community members and academic research-ers to implement WERA’s COMR model reduced residents’ mistrust of the research process, led to participation by a population not often trusting of scientific research, made operational an innovative community-driven approach to collect data in communities lacking basic amenities, revealed a discon-nect between neighborhood water and sewer system conditions and local public health compliance, enforcement, and assurance actions, and ushered in national policy discus-sions with WERA about use of COMR and community-facilitated strategies by U.S.

EPA and the National Environmental Justice Advisory Council (NEJAC) (Heaney et al., 2007; NEJAC, 2009; U.S. EPA, 2010; Wilson, Bumpass et al., 2008; Wilson et al., 2007). The results of this COMR partnership high-light an understudied and emerging national environmental justice issue: the denial of the right to basic amenities (Wilson, Bumpass et al., 2008). Effective interventions at the historical roots of the public health move-ment exist (improving water and sanitation services) (Cutler & Miller, 2005; Kjellstrom et al., 2007; Ringen, 1979); however, power-ful institutional barriers to extending service improvements endure at the local level and have been characterized by some as envi-ronmental racism (Johnson, 2008; Smyth, 2008; Wilson, Bumpass et al., 2008) due to inequities in local planning and zoning prac-tices (Maantay, 2001, 2002; Wilson, Cooper et al., 2008; Wilson et al., 2009). Replica-tion of WERA’s COMR approach in similarly marginalized and underserved low-income communities of color would help advance a national popular environmental justice move-ment for the right to basic amenities.

Acknowledgements: Funding for this study was provided by the Office of Environmental Justice Region 4 of U.S. Environmental Protec-tion Agency, NaProtec-tional Office of Environmental Justice of U.S. EPA, and the University of North Carolina-Chapel Hill and Shaw University-Raleigh, North Carolina Partnership for the Elimination of Health Disparities Project EXPORT. Dr. Heaney received support through the National Institute of Environmental Health Sciences environmental epidemiology training grant (T32 ES007018) and the U.S. Environmental Protection Agency cooperative training agreement in environmental sciences research (CR83323601) at the University of North Carolina Department of Biostatistics and Department of Environmental Sciences and Engineering. We thank Mark Sobsey, Jan Vinjé, and Douglas Wait for their overall guid-ance and technical support of this work.

Corresponding Author: Christopher Heaney, W.K. Kellogg Health Scholar, CB# 7435, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7435. E-mail: [email protected].

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