Where you drink water: An assessment of the Tennessee, USA public water supply.

Monitoring drinking water quality is essential to protect people's health and wellbeing. In the United States, the Safe Drinking Water Information System (SDWIS) database records the occurrence of a drinking water violation regulation in public water systems. A notable shortcoming of SDWIS is the lack of the contaminant concentration level about the allowable maximum contaminant threshold. In this study, we take advantage of both the SDWIS violation database and the contaminants sampling database at the state level to examine the drinking water quality of all kinds of drinking water systems in detail. We obtained sampling data (i.e., the concentration level of contaminants) of public water systems (PWSs) in Tennessee and explored the statistical distribution of contaminant concentration data in relation to the enforceable maximum regulatory contaminant level). We use both SDWIS violation records and actual concentrations of contaminants from the sampling data to study the factors that influence the drinking water quality of PWSs. We find that different types of violations were more frequent in (1) specific geological regions, (2) counties with PWSs that serve a larger population (10,000 to 100,000 people), and (3) places with abundant surface water, such as near a lake or major river. Additionally, the distribution of measured concentrations for many contaminants was not smooth but was punctuated by discontinuities at selected levels, such as at 50% of the maximum contaminant level. Such anomalies in the sampling data do not indicate violations, but more investigation is needed to determine the reasons behind the punctuated changes.

Drinking Water Violations and Environmental Justice in the United States, 2011-2015.

OBJECTIVES: To assess the extent to which drinking water violations in the United States differed on the basis of county race/ethnicity and socioeconomic status using the primary county served by the community water system (CWS) as the unit of analysis and to determine whether counties with higher proportions of underrepresented groups were disproportionately burdened with repeat violations. METHODS: We used multivariable logistic regression to calculate odds ratios of contextual environmental justice covariates associated with initial and repeat drinking water violations. We obtained violations from the federal Safe Drinking Water Information System. Results were nonstratified and stratified on the basis of population size served by the CWS. RESULTS: Stratified multivariable logistic regression results revealed previously unobservable patterns in nonstratified findings. Minorities face significant challenges, including exposure to poor water quality. The most notable differences in both initial and repeat violations that we observed were among CWSs that serve large populations. Our most consistent finding was the positive association of initial and repeat violations with the proportion of those who were uninsured, irrespective of stratification. CONCLUSIONS: Greater efforts are needed to ensure that counties with higher proportions of minorities, uninsured households, and low-income households have access to safe drinking water, irrespective of the size of population served by the CWS.

Health Service Accessibility and Risk in Cervical Cancer Prevention: Comparing Rural Versus Nonrural Residence in New Mexico.

PURPOSE: Multiple intrapersonal and structural barriers, including geography, may prevent women from engaging in cervical cancer preventive care such as screening, diagnostic colposcopy, and excisional precancer treatment procedures. Geographic accessibility, stratified by rural and nonrural areas, to necessary services across the cervical cancer continuum of preventive care is largely unknown. METHODS: Health care facility data for New Mexico (2010-2012) was provided by the New Mexico Human Papillomavirus Pap Registry (NMHPVPR), the first population-based statewide cervical cancer screening registry in the United States. Travel distance and time between the population-weighted census tract centroid to the nearest facility providing screening, diagnostic, and excisional treatment services were examined using proximity analysis by rural and nonrural census tracts. Mann-Whitney test (P < .05) was used to determine if differences were significant and Cohen's r to measure effect. FINDINGS: Across all cervical cancer preventive health care services and years, women who resided in rural areas had a significantly greater geographic accessibility burden when compared to nonrural areas (4.4 km vs 2.5 km and 4.9 minutes vs 3.0 minutes for screening; 9.9 km vs 4.2 km and 10.4 minutes vs 4.9 minutes for colposcopy; and 14.8 km vs 6.6 km and 14.4 minutes vs 7.4 minutes for precancer treatment services, all P < .001). CONCLUSION: Improvements in cervical cancer prevention should address the potential benefits of providing the full spectrum of screening, diagnostic and precancer treatment services within individual facilities. Accessibility, assessments distinguishing rural and nonrural areas are essential when monitoring and recommending changes to service infrastructures (eg, mobile versus brick and mortar).

A scalable climate health justice assessment model.

This paper introduces a scalable "climate health justice" model for assessing and projecting incidence, treatment costs, and sociospatial disparities for diseases with well-documented climate change linkages. The model is designed to employ low-cost secondary data, and it is rooted in a perspective that merges normative environmental justice concerns with theoretical grounding in health inequalities. Since the model employs International Classification of Diseases, Ninth Revision Clinical Modification (ICD-9-CM) disease codes, it is transferable to other contexts, appropriate for use across spatial scales, and suitable for comparative analyses. We demonstrate the utility of the model through analysis of 2008-2010 hospitalization discharge data at state and county levels in Texas (USA). We identified several disease categories (i.e., cardiovascular, gastrointestinal, heat-related, and respiratory) associated with climate change, and then selected corresponding ICD-9 codes with the highest hospitalization counts for further analyses. Selected diseases include ischemic heart disease, diarrhea, heat exhaustion/cramps/stroke/syncope, and asthma. Cardiovascular disease ranked first among the general categories of diseases for age-adjusted hospital admission rate (5286.37 per 100,000). In terms of specific selected diseases (per 100,000 population), asthma ranked first (517.51), followed by ischemic heart disease (195.20), diarrhea (75.35), and heat exhaustion/cramps/stroke/syncope (7.81). Charges associated with the selected diseases over the 3-year period amounted to US$5.6 billion. Blacks were disproportionately burdened by the selected diseases in comparison to non-Hispanic whites, while Hispanics were not. Spatial distributions of the selected disease rates revealed geographic zones of disproportionate risk. Based upon a downscaled regional climate-change projection model, we estimate a >5% increase in the incidence and treatment costs of asthma attributable to climate change between the baseline and 2040-2050 in Texas. Additionally, the inequalities described here will be accentuated, with blacks facing amplified health disparities in the future. These predicted trends raise both intergenerational and distributional climate health justice concerns.

Understanding environmental health inequalities through comparative intracategorical analysis: racial/ethnic disparities in cancer risks from air toxics in El Paso County, Texas.

This paper contributes to the environmental justice literature by analyzing contextually relevant and racial/ethnic group-specific variables in relation to air toxics cancer risks in a US-Mexico border metropolis at the census block group-level. Results indicate that Hispanics' ethnic status interacts with class, gender and age status to amplify disproportionate risk. In contrast, results indicate that non-Hispanic whiteness attenuates cancer risk disparities associated with class, gender and age status. Findings suggest that a system of white-Anglo privilege shapes the way in which race/ethnicity articulates with other dimensions of inequality to create unequal cancer risks from air toxics.