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Perfluorooctanoic acid (PFOA) and perfluorooctane sulfonic acid (PFOS) are receiving global attention due to their persistence in the environment through wastewater effluent discharges and past improper industrial waste disposal. They are resistant to biological degradation and if present in wastewater are discharged into the environment. The US Environmental Protection Agency (USEPA) issued drinking water Health Advisories for PFOA and PFOS at 70 ng/L each and for the sum of the two. The need for an enforceable primary drinking water regulation under the Safe Drinking Water Act (SDWA) is currently being assessed. The USEPA faces stringent legal constraints and technical barriers to develop a primary drinking water regulation for PFOA and PFOS. This review synthesizes current knowledge providing a publicly available, comprehensive point of reference for researchers, water utilities, industry, and regulatory agencies to better understand and address cross-cutting issues associated with regulation of PFOA and PFOS contamination of drinking water.

Many households in the United States face issues of incomplete plumbing and poor water quality. Prior scholarship on this issue has focused on one dimension of water hardship at a time, leaving the full picture incomplete. Here we begin to complete this picture by documenting incomplete plumbing and poor drinking water quality for the entire United States, as well as poor wastewater quality for the 39 states and territories where data is reliable. In doing so, we find evidence of a regionally-clustered, socially unequal household water crisis. Using data from the American Community Survey and the Environmental Protection Agency, we show there are 489,836 households lacking complete plumbing, 1,165 community water systems in Safe Drinking Water Act Serious Violation, and 9,457 Clean Water Act permittees in Significant Noncompliance. Further, elevated levels of water hardship are associated with rurality, poverty, indigeneity, education, and age—representing a nationwide environmental injustice. Proper water and sanitation access remains an issue for many in the United States. Here the authors estimate and map the full scope of water hardship, including both incomplete plumbing and water quality across the country.

Ensuring safe water supply for communities across the United States is a growing challenge in the face of aging infrastructure, impaired source water, and strained community finances. In the aftermath of the Flint lead crisis, there is an urgent need to assess the current state of US drinking water. However, no nationwide assessment has yet been conducted on trends in drinking water quality violations across several decades. Efforts to reduce violations are of national concern given that, in 2015, nearly 21 million people relied on community water systems that violated health-based quality standards. In this paper, we evaluate spatial and temporal patterns in health-related violations of the Safe Drinking Water Act using a panel dataset of 17,900 community water systems over the period 1982–2015. We also identify vulnerability factors of communities and water systems through probit regression. Increasing time trends and violation hot spots are detected in several states, particularly in the Southwest region. Repeat violations are prevalent in locations of violation hot spots, indicating that water systems in these regions struggle with recurring issues. In terms of vulnerability factors, we find that violation incidence in rural areas is substantially higher than in urbanized areas. Meanwhile, private ownership and purchased water source are associated with compliance. These findings indicate the types of underperforming systems that might benefit from assistance in achieving consistent compliance. We discuss why certain violations might be clustered in some regions and strategies for improving national drinking water quality.

Background Low-income and minority communities often face disproportionately high pollutant exposures. The lead crisis in Flint, Michigan, has sparked concern about broader socioeconomic disparities in exposures to drinking water contaminants. Nitrate is commonly found in drinking water, especially in agricultural regions, and epidemiological evidence suggests elevated risk of cancer and birth defects at levels below U.S. EPA’s drinking water standard (10 mg/L NO 3 -N). However, there have been no nationwide assessments of socioeconomic disparities in exposures to nitrate or other contaminants in U.S. drinking water. The goals of this study are to identify determinants of nitrate concentrations in U.S. community water systems (CWSs) and to evaluate disparities related to wealth or race/ethnicity. Methods We compiled nitrate data from 39,466 U.S. CWSs for 2010–2014. We used EPA’s Safe Drinking Water Information System (SDWIS) to compile CWS characteristics and linked this information with both city- and county-level demographic data gathered from the U.S. Census Bureau. After applying multiple imputation methods to address censored nitrate concentration data, we conducted mixed-effects multivariable regression analyses at national and regional scales. Results 5.6 million Americans are served by a CWS that had an average nitrate concentration ≥ 5 mg/L NO 3 -N between 2010 and 2014. Extent of agricultural land use and reliance on groundwater sources were significantly associated with nitrate. The percent of Hispanic residents served by each system was significantly associated with nitrate even after accounting for county-level cropland and livestock production, and CWSs in the top quartile of percent Hispanic residents exceeded 5 mg/L nearly three times as often as CWSs serving the lowest quartile. By contrast, the percent of residents living in poverty and percent African American residents were both inversely associated with nitrate. Conclusions Epidemiological evidence for health effects associated with drinking water above 5 mg/L NO 3 -N raises concerns about increased risk for the 5.6 million Americans served by public water supplies with average nitrate concentrations above this level. The associations we observed between nitrate concentrations and proportions of Hispanic residents support the need for improved efforts to assist vulnerable communities in addressing contamination and protecting source waters. Future studies can extend our methods to evaluate disparities in exposures to other contaminants and links to health effects.

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.

Growing recognition of water quality concerns, particularly in socially vulnerable communities in the United States, has prompted recent policies and investments to improve drinking water system performance. Current environmental justice tools limit measurement of drinking water quality issues to proximity to point-source contamination, such as superfund sites and social vulnerability to county level or zip code level data. We examined relationships between health-based (HB) drinking water quality violations and social vulnerability using a new database of community water system (CWS) service areas and a modified Social Vulnerability Index, which we specifically designed for drinking water quality. CWSs with HB violations disproportionately impact socially vulnerable communities, with ∼70% of such systems characterized by high social vulnerability. Increased risks of drinking water quality violations in high socially vulnerable communities are attributed in part to violations related to pervasive, naturally occurring contaminants (e.g. arsenic) requiring treatment and difficulties for small systems to implement and maintain treatment systems. Notably, recurrence of any HB violation is also related to social vulnerability ( R = 0.73). The relative importance of different social parameters, including socioeconomic status, race and language, and demographics and housing characteristics, varies with the type of violation. Further understanding linkages between drinking water quality violations and social vulnerability is essential for optimizing the deployment of, and motivating the next tranche of newly available drinking water infrastructure funding that is heavily prioritized toward disadvantaged communities.

The 1974 Safe Drinking Water Act (SDWA) regulates >170,000 public water systems to protect health, but not >13 million private wells. State and local government requirements for private well water testing are rare and inconsistent; the responsibility to ensure water safety remains with individual households. Over the last two decades, geogenic arsenic has emerged as a significant public health concern due to high prevalence in many rural American communities. We build the case for universal screening of private well water quality around arsenic, the most toxic and widespread of common private water contaminants. We argue that achieving universal screening will require policy intervention, and that testing should be made easy, accessible, and in many cases free to all private well households in the United States, considering the invisible, tasteless, odorless, and thus silent nature of arsenic. Our research has identified behavioral, situational and financial barriers to households managing their own well water safety, resulting in far from universal screening despite traditional public health outreach efforts. We observe significant socioeconomic disparities in arsenic testing and treatment when private water is unregulated. Testing requirements can be a partial answer to these challenges. Universal screening, achieved through local testing requirements complemented by greater community engagement targeting biologically and socioeconomically vulnerable groups, would reduce population arsenic exposure greater than any promotional efforts to date. Universal screening of private well water will identify the dangers hidden in America's drinking water supply and redirect attention to ensure safe water among affected households. https://doi.org/10.1289/EHP629.

According to the New York Times: Dr. Griscom commenced his lecture by observing that the importance of pure air was not so much studied as it ought to be, or it would be the care of persons generally to obtain as much purity in the atmosphere of their dwellings as possible. The City of New-York had spent fifteen million dollars in endeavoring to obtain pure water, but this was not more necessary to health and life than was pure air.2(p1) Griscom frequently compared the city's immense expenditures to secure safe drinking water (more than $600 million in today's currency) with its failure to invest in ventilation. Massachusetts passed laws preventing pollution and permitting experiments on water purification in the 1880s.6 In the early 20th century, as it became evident that filtration could remove bacteria, cities adopted filtration systems. Since the creation of the Environmental Protection Agency in 1974, the United States has had national standards that protect public drinking water and its sources.7 Economists have found that the Clean Water Act and the Safe Drinking Water Act have been effective in reducing water pollution.8 None of these standards has been promoted as challenges.

Drinking-water contaminants pose a risk to public health. When confronted with elevated levels of contaminants, individuals can take actions to reduce exposure. Yet, few studies address averting behavior due to impaired water, particularly in high-income countries. This is a problem of national interest, given that 9 million to 45 million people have been affected by water quality violations in each of the past 34 years. No national analysis has focused on the extent to which communities reduce exposure to contaminated drinking water. Here, we present an assessment that sheds light on how communities across the United States respond to violations of the Safe Drinking Water Act, using consumer purchases of bottled water. This study provides insight into how averting behavior differs across violation types and community demographics. We estimate the change in sales due to water quality violations, using a panel dataset of weekly sales and violation records in 2,151 counties from 2006 to 2015. Critical findings show that violations which pose an immediate health risk are associated with a 14% increase in bottled water sales. Generally, greater averting action is taken against contaminants that might pose a greater perceived health risk and that require more immediate public notification. Rural, low-income communities do not take significant averting action for elevated levels of nitrate, yet experience a higher prevalence of nitrate violations. Findings can inform improvements in public notification and targeting of technical assistance from state regulators and public health agencies in order to reduce community exposure to contaminants.

Background: Research on drinking water in the United States has rarely examined disproportionate exposures to contaminants faced by low-income and minority communities. This study analyzes the relationship between nitrate concentrations in community water systems (CWSs) and the racial/ethnic and socioeconomic characteristics of customers. Objectives: We hypothesized that CWSs in California's San Joaquin Valley that serve a higher proportion of minority or residents of lower socioeconomic status have higher nitrate levels and that these disparities are greater among smaller drinking water systems. Methods: We used water quality monitoring data sets (1999-2001) to estimate nitrate levels in CWSs, and source location and census block group data to estimate customer demographics. Our linear regression model included 327 CWSs and reported robust standard errors clustered at the CWS level. Our adjusted model controlled for demographics and water system characteristics and stratified by CWS size. Results: Percent Latino was associated with a 0.04-mg nitrate-ion (NO₃)/L increase in a CWS's estimated NO₃ concentration [95% confidence interval (CI), -0.08 to 0.16], and rate of home ownership was associated with a 0.16-mg NO₃/L decrease (95% CI, -0.32 to 0.002). Among smaller systems, the percentage of Latinos and of homeownership was associated with an estimated increase of 0.44 mg NO₃/L (95% CI, 0.03-0.84) and a decrease of 0.15 mg NO₃/L (95% CI, -0.64 to 0.33), respectively. Conclusions: Our findings suggest that in smaller water systems, CWSs serving larger percentages of Latinos and renters receive drinking water with higher nitrate levels. This suggests an environmental inequity in drinking water quality.