Dissertations and Theses

Date of Degree

1-1-2018

Document Type

Dissertation

Degree Name

Doctor of Public Health (DPH)

Department

Community Health and Social Sciences

Advisor(s)

Nicholas Freudenberg

Committee Members

Sherry Baron

Yan Zheng

Subject Categories

Environmental Policy | Environmental Public Health | Public Health

Keywords

arsenic, drinking water, private well, New Jersey, water testing, regulation

Abstract

Over 45 million Americans drink from unregulated private well water of unknown quality. Arsenic is the most concerning groundwater contaminant for health because of its toxicity and widespread natural occurrence. Most residential wells in arsenic-affected areas have not been tested for arsenic; the success of community programs and efforts to motivate testing is limited by a range of psychological, situational, and socioeconomic barriers. However, testing only acts as screening and does not reduce exposure without effective and consistent actions to follow. Given the limitations in relying on individual well owners to be aware, willing, and capable of testing their water, state-wide regulations like New Jersey’s Private Well Testing Act (PWTA), which requires testing during real estate transactions, have the potential to make a significant contribution towards arsenic exposure reduction by acting as a screening intervention and allowing systematic collection of water test results. This dissertation describes the findings of three studies examining the PWTA: the circumstances of its origin, its impact on mitigation, and its potential to boost screening.

Chapter 2 is a comparative case study examining the context of the PWTA’s successful adoption into law, and failures to pass similar requirements in Maine. Viewed through Kingdon’s Multiple Streams framework, the PWTA was the result of problem, policy, and politics streams successfully aligned during a significant political window of opportunity. By contrast the failures in Maine highlight the considerable work remaining to facilitate or overcome the philosophical evolution required for further private well legislative action. In Chapter 3, a follow-up survey to owners of wells with > 5 µg/L arsenic identified through PWTA-required tests (n=486) reveals that most current homeowners have taken some mitigation action to reduce exposure; however, without a mandate for remediation or compliance, a significant portion (28%) of surveyed households have not. Those not acting have lower perceptions of susceptibility, severity, and benefits; perceive greater barriers; and express lower levels of self-efficacy and commitment to reduce exposure than those who are taking some mitigation action. Poor monitoring and maintenance behaviors among those with arsenic treatment installed threaten to undermine mitigation intentions. Chapter 4 reports on a mailed testing intervention targeting “neighbors” of wells exceeding 5 µg/L tested under the PWTA. Overall, 16% of those notified (n=1743) of arsenic in their neighborhood requested a free test kit and 13% submitted a water sample. Significant participation differences based on wording suggested that messages of comparatively high arsenic, relative to standards, may be more compelling than messages of general risk. The intervention prompted testing among 230 households largely unreached by previous awareness-raising activities and identified problems among a significant portion (25%), demonstrating the effectiveness of targeting outreach and messages to wells at high contamination risk.

Taken together, these studies demonstrate the utility and the potential, as well as the limitations, of the PWTA. The fact that 45 million Americans are excluded from the federal and state regulations that protect the right to safe drinking water in this country is an overlooked public health crisis. Practically, significant change may require many incremental, modest, and/or symbolic steps, by many local and state governments across the country; additional policy models must be tested and proven. Nevertheless, these studies demonstrate that legislation like the PWTA can make a significant contribution towards well screening and can be leveraged in many ways to reduce arsenic exposure in the private well population, beyond those directly affected by the law. It is a proven model that other states can now build on.

Available for download on Wednesday, December 18, 2019

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