Monitoring, Managing, and Communicating Risk of Harmful Algal Blooms (HABs) in Recreational Resources across Canada.

Globally, harmful algal blooms (HABs) are on the rise, as is evidence of their toxicity. The impacts associated with blooms, however, vary across Nation states, as do the strategies and protocols to assess, monitor, and manage their occurrence. In Canada, water quality guidelines are standardized nationally, but the management strategies for HABs are not. Here, we explore current strategies to understand how to better communicate risks associated with HABs to the public. Our team conducted an environmental scan on provincial and territorial government agency protocols around HABs. Results suggest that there are variations in the monitoring, managing, and communicating of risk to the public: British Columbia, Manitoba, New Brunswick, and Quebec have well-established inter-agency protocols, and most provinces report following federal guidelines for water quality. Notably, 3 northern territories have no HABs monitoring or management protocols in place. More populous provinces use a variety of information venues (websites, social media, on site postings, and radio) to communicate risks associated with HABs, whereas others' communications are limited. To induce more collaboration on HABs monitoring and management and reduce the associated risks, creating a coherent system with consistent messaging and inter-agency communication is suggested.

Adsorption Studies of Waterborne Trihalomethanes Using Modified Polysaccharide Adsorbents.

The adsorptive removal of trihalomethanes (THMs) from spiked water samples was evaluated with a series of modified polysaccharide adsorbents that contain ß-cylodextrin or chitosan. The uptake properties of these biodegradable polymer adsorbents were evaluated with a mixture of THMs in aqueous solution. Gas chromatography employing a direct aqueous injection (DAI) method with electrolytic conductivity detection enabled quantification of THMs in water at 295 K and at pH 6.5. The adsorption isotherms for the polymer-THMs was evaluated using the Sips model, where the monolayer adsorption capacities ranged between 0.04 and 1.07 mmol THMs/g for respective component THMs. Unique adsorption characteristics were observed that vary according to the polymer structure, composition, and surface chemical properties. The modified polysaccharide adsorbents display variable molecular recognition and selectivity toward component THMs in the mixed systems according to the molecular size and polarizability of the adsorbates.

Risk Perception and Human Health Risk in Rural Communities Consuming Unregulated Well Water in Saskatchewan, Canada.

Rural communities dependent on unregulated drinking water are potentially at increased health risk from exposure to contaminants. Perception of drinking water safety influences water consumption, exposure, and health risk. A community-based participatory approach and probabilistic Bayesian methods were applied to integrate risk perception in a holistic human health risk assessment. Tap water arsenic concentrations and risk perception data were collected from two Saskatchewan communities. Drinking water health standards were exceeded in 67% (51/76) of households in Rural Municipality #184 (RM184) and 56% (25/45) in Beardy's and Okemasis First Nation (BOFN). There was no association between the presence of a health exceedance and risk perception. Households in RM184 or with an annual income >$50,000 were most likely to have in-house water treatment. The probability of consuming tap water perceived as safe (92%) or not safe (0%) suggested that households in RM184 were unlikely to drink water perceived as not safe. The probability of drinking tap water perceived as safe (77%) or as not safe (11%) suggested households in BOFN contradicted their perception and consumed water perceived as unsafe. Integration of risk perception lowered the adult incremental lifetime cancer risk by 3% to 1.3 × 10-5 (95% CI 8.4 × 10-8 to 9.0 × 10-5 ) for RM184 and by 8.9 × 10-6 (95% CI 2.2 × 10-7 to 5.9 × 10-5 ) for BOFN. Probability of exposure to arsenic concentrations >1:100,000, negligible cancer risk, was 23% for RM184 and 22% for BOFN.

Identifying transformational space for transdisciplinarity: using art to access the hidden third.

A challenge for transdisciplinary sustainability science is learning how to bridge diverse worldviews among collaborators in respectful ways. A temptation in transdisciplinary work is to focus on improving scientific practices rather than engage research partners in spaces that mutually respect how we learn from each other and set the stage for change. We used the concept of Nicolescu's "Hidden Third" to identify and operationalize this transformative space, because it focused on bridging "objective" and "subjective" worldviews through art. Between 2014 and 2017, we explored the engagement of indigenous peoples from three inland delta regions in Canada and as a team of interdisciplinary scholars and students who worked together to better understand long-term social-ecological change in those regions. In working together, we identified five characteristics associated with respectful, transformative transdisciplinary space. These included (1) establishing an unfiltered safe place where (2) subjective and objective experiences and (3) different world views could come together through (4) interactive and (5) multiple sensory experiences. On the whole, we were more effective in achieving characteristics 2-5-bringing together the subjective and objective experiences, where different worldviews could come together-than in achieving characteristic 1-creating a truly unfiltered and safe space for expression. The novelty of this work is in how we sought to change our own engagement practices to advance sustainability rather than improving scientific techniques. Recommendations for sustainability scientists working in similar contexts are provided.

Vanadium and thallium exhibit biodilution in a northern river food web.

Trophic transfer of contaminants dictates concentrations and potential toxic effects in top predators, yet biomagnification behaviour of many trace elements is poorly understood. We examined concentrations of vanadium and thallium, two globally-distributed and anthropogenically-enriched elements, in a food web of the Slave River, Northwest Territories, Canada. We found that tissue concentrations of both elements declined with increasing trophic position as measured by δ15N. Slopes of log [element] versus δ15N regressions were both negative, with a steeper slope for V (-0.369) compared with Tl (-0.099). These slopes correspond to declines of 94% with each step in the food chain for V and 54% with each step in the food chain for Tl. This biodilution behaviour for both elements meant that concentrations in fish were well below values considered to be of concern for the health of fish-eating consumers. Further study of these elements in food webs is needed to allow a fuller understanding of biomagnification patterns across a range of species and systems.

Bayesian Hierarchical Models as Tools to Evaluate the Association Between Groundwater Quality and the Occurrence of Type 2 Diabetes in Rural Saskatchewan, Canada.

There is growing interest in the role of environmental exposures in the development of diabetes. Previous studies in rural Saskatchewan have raised concerns over drinking water contaminants, including arsenic, which has been identified as a possible risk factor for diabetes. Using administrative health and water-quality surveillance data from rural Saskatchewan, an ecological study design was used to investigate associations between concentrations of arsenic, water health standards and aesthetic objectives, and the incidence and prevalence of diabetes. Mixtures of contaminants measured as health standards or as aesthetic objectives were summarized using principal component (PC) analysis. Associations were modeled using Bayesian hierarchical models incorporating both spatial and unstructured random effects, standardized for age and sex, and adjusted for socioeconomic factors and a surrogate measure for smoking rates. Arsenic was not associated with an increased risk of diabetes. For private wells, having groundwater arsenic concentrations in the highest quintile was associated with decreased cumulative diabetes incidence for 2010-2012 (risk ratio [RR] = 0.854, 95% credible interval [CrI] 0.761-0.958) compared with the lowest quintile, a result inconsistent with other studies. For public water supplies, having a first PC score for health standards (primarily summarized selenium, nitrate, and lead) in the third quintile (RR = 1.101, 95% CrI 1.019-1.188), fourth quintile (RR = 1.088, 95% CrI 1.003-1.180), or fifth quintile (RR = 1.115, 95% CrI 1.026-1.213) was associated with an increase in 2010 diabetes prevalence compared with the first quintile. An increase in the PC scores for the third aesthetic objective in private wells (characterized primarily by iron and manganese) was associated with decreased diabetes incidence, although a meaningful dose-response relationship was not evident. No other associations between PC scores for health standards or aesthetic objectives from public or private water supplies and diabetes were identified.

Ecological analysis of associations between groundwater quality and hypertension and cardiovascular disease in rural Saskatchewan, Canada using Bayesian hierarchical models and administrative health data.

Associations between groundwater quality and the prevalence of hypertension and ischemic heart disease were investigated in rural areas of the Canadian province of Saskatchewan. The partially ecological study was analyzed using Bayesian hierarchical models to account for spatial variability in risk. Exposure measures and health outcomes were estimated based on previously collected water quality surveillance data from public water supplies and private wells and administrative health data. Water quality exposures for each study region were estimated by applying geostatistical techniques to arsenic concentrations and principal component (PC) scores. The PC scores summarized groups of parameters measuring either health standards or aesthetic objectives described by the province. Generalized linear mixed models with a log link assessed associations between water quality and observed count of health outcomes relative to the expected value. The Bayesian models contained uncorrelated and spatially correlated random effects for each geographic region. Effect estimates were controlled for sex and age by stratification of case and expected case counts, for smoking by inclusion of sex- and age-specific prevalence of chronic obstructive pulmonary disease as a surrogate covariate, and for education and income by use of census data. There was no evidence for associations between groundwater arsenic concentrations in public or private water supplies and increased risk of hypertension or cardiovascular disease. An increase in the second aesthetic objectives PC score from public supplies was associated with a protective effect against ischemic heart disease. This PC value summarized hardness and magnesium Similarly, an increase in the second aesthetic objectives PC in private supplies was associated with decreased prevalence of hypertension. The results of this study are consistent with others demonstrating a relationship between elevated hardness and magnesium concentrations in drinking water and reduced risk of hypertension and cardiovascular disease. Further investigation is warranted with individual exposure history, particularly with respect to the potential beneficial effect of hard water on the prevalence of hypertension and cardiovascular disease.

Factors associated with drinking and being satisfied with tap water in Indigenous communities in Saskatchewan, Canada.

Previous studies have described concerns regarding tap water in Indigenous communities, yet there is little information on participants who report drinking their tap water and being satisfied with its quality. This study undertaken with members of 8 Indigenous communities in Saskatchewan, Canada, and identified factors associated with both the decision to drink tap water at home and being satisfied with its quality. We examined the importance of factors such as individual attributes, experiences, attitudes, household and community-based variables. Less than one-quarter of participants (23.4%) drank tap water and were satisfied with its quality. Individuals who did not boil tap water (odds ratio [OR] = 5.76, 95% confidence interval [CI] = 1.68-19.8), those who did not experience tap water odour (OR = 2.38, 95% CI = 1.26-4.50) and participants living in communities away from urban centres (OR = 2.74, 95% CI = 1.63-4.51) were more likely to drink and be satisfied with their tap water. Concerns about the environment had the most impact on community members aged 55+ years. Those not reporting concerns about environmental problems affecting water (OR = 11.4, 95% CI = 3.10-42.2) were much more likely to drink and be satisfied with their tap water. Programmes to improve water quality, reduce the need for boil water advisories and increase community confidence in the environment could improve tap water satisfaction and consumption.

Use of Principal Components Analysis and Kriging to Predict Groundwater-Sourced Rural Drinking Water Quality in Saskatchewan.

Groundwater drinking water supply surveillance data were accessed to summarize water quality delivered as public and private water supplies in southern Saskatchewan as part of an exposure assessment for epidemiologic analyses of associations between water quality and type 2 diabetes or cardiovascular disease. Arsenic in drinking water has been linked to a variety of chronic diseases and previous studies have identified multiple wells with arsenic above the drinking water standard of 0.01 mg/L; therefore, arsenic concentrations were of specific interest. Principal components analysis was applied to obtain principal component (PC) scores to summarize mixtures of correlated parameters identified as health standards and those identified as aesthetic objectives in the Saskatchewan Drinking Water Quality Standards and Objective. Ordinary, universal, and empirical Bayesian kriging were used to interpolate arsenic concentrations and PC scores in southern Saskatchewan, and the results were compared. Empirical Bayesian kriging performed best across all analyses, based on having the greatest number of variables for which the root mean square error was lowest. While all of the kriging methods appeared to underestimate high values of arsenic and PC scores, empirical Bayesian kriging was chosen to summarize large scale geographic trends in groundwater-sourced drinking water quality and assess exposure to mixtures of trace metals and ions.

Human Health Risk Assessment Applied to Rural Populations Dependent on Unregulated Drinking Water Sources: A Scoping Review.

Safe drinking water is a global challenge for rural populations dependent on unregulated water. A scoping review of research on human health risk assessments (HHRA) applied to this vulnerable population may be used to improve assessments applied by government and researchers. This review aims to summarize and describe the characteristics of HHRA methods, publications, and current literature gaps of HHRA studies on rural populations dependent on unregulated or unspecified drinking water. Peer-reviewed literature was systematically searched (January 2000 to May 2014) and identified at least one drinking water source as unregulated (21%) or unspecified (79%) in 100 studies. Only 7% of reviewed studies identified a rural community dependent on unregulated drinking water. Source water and hazards most frequently cited included groundwater (67%) and chemical water hazards (82%). Most HHRAs (86%) applied deterministic methods with 14% reporting probabilistic and stochastic methods. Publications increased over time with 57% set in Asia, and 47% of studies identified at least one literature gap in the areas of research, risk management, and community exposure. HHRAs applied to rural populations dependent on unregulated water are poorly represented in the literature even though almost half of the global population is rural.

Open-water and under-ice seasonal variations in trace element content and physicochemical associations in fluvial bed sediment.

Across the circumpolar world, intensive anthropogenic activities in the southern reaches of many large, northward-flowing rivers can cause sediment contamination in the downstream depositional environment. The influence of ice cover on concentrations of inorganic contaminants in bed sediment (i.e., sediment quality) is unknown in these rivers, where winter is the dominant season. A geomorphic response unit approach was used to select hydraulically diverse sampling sites across a northern test-case system, the Slave River and delta (Northwest Territories, Canada). Surface sediment samples (top 1 cm) were collected from 6 predefined geomorphic response units (12 sites) to assess the relationships between bed sediment physicochemistry (particle size distribution and total organic carbon content) and trace element content (mercury and 18 other trace elements) during open-water conditions. A subset of sites was resampled under-ice to assess the influence of season on these relationships and on total trace element content. Concentrations of the majority of trace elements were strongly correlated with percent fines and proxies for grain size (aluminum and iron), with similar trace element grain size/grain size proxy relationships between seasons. However, finer materials were deposited under ice with associated increases in sediment total organic carbon content and the concentrations of most trace elements investigated. The geomorphic response unit approach was effective at identifying diverse hydrological environments for sampling prior to field operations. Our data demonstrate the need for under-ice sampling to confirm year-round consistency in trace element-geochemical relationships in fluvial systems and to define the upper extremes of these relationships. Whether contaminated or not, under-ice bed sediment can represent a "worst-case" scenario in terms of trace element concentrations and exposure for sediment-associated organisms in northern fluvial systems. Environ Toxicol Chem 2017;36:2916-2924. © 2017 SETAC.

Self-reported Effects of Water on Health in First Nations Communities in Saskatchewan, Canada: Results From Community-Based Participatory Research.

Water-related health challenges on First Nations reserves in Canada have been previously documented. Our objective was to describe factors associated with self-reported health effects from tap water in 8 First Nations reserve communities in Saskatchewan, Canada. Community-based participatory approaches were used in designing and implementing cross-sectional household surveys. Individual, household, community, and contextual effects were considered in multilevel analysis. Negative health effects from tap water were reported by 28% of households (n = 579). Concerns about environmental factors affecting water quality (odds ratio [OR] = 3.4, 95% confidence interval [CI] = 1.8-6.7), rarely or never drinking tap water (OR = 2.9, 95% CI = 1.3-6.6), insufficient tap water (OR = 3.0, 95% CI = 1.4-6.3), paying for bottled water (OR = 3.2, 95% CI = 1.2-8.7), and dissatisfaction with tap water were associated with self-reported health effects (n = 393); however, the effect of dissatisfaction was modified by respondent age (P = .03). Quality and availability were associated with perceptions of health effects from drinking water, providing additional information on how ongoing concerns about drinking water influence self-reported health in some First Nations.

Bridging science and traditional knowledge to assess cumulative impacts of stressors on ecosystem health.

Cumulative environmental impacts driven by anthropogenic stressors lead to disproportionate effects on indigenous communities that are reliant on land and water resources. Understanding and counteracting these effects requires knowledge from multiple sources. Yet the combined use of Traditional Knowledge (TK) and Scientific Knowledge (SK) has both technical and philosophical hurdles to overcome, and suffers from inherently imbalanced power dynamics that can disfavour the very communities it intends to benefit. In this article, we present a 'two-eyed seeing' approach for co-producing and blending knowledge about ecosystem health by using an adapted Bayesian Belief Network for the Slave River and Delta region in Canada's Northwest Territories. We highlight how bridging TK and SK with a combination of field data, interview transcripts, existing models, and expert judgement can address key questions about ecosystem health when considerable uncertainty exists. SK indicators (e.g., bird counts, mercury in fish, water depth) were graded as moderate, whereas TK indicators (e.g., bird usage, fish aesthetics, changes to water flow) were graded as being poor in comparison to the past. SK indicators were predominantly spatial (i.e., comparing to other locations) while the TK indicators were predominantly temporal (i.e., comparing across time). After being populated by 16 experts (local harvesters, Elders, governmental representatives, and scientists) using both TK and SK, the model output reported low probabilities that the social-ecological system is healthy as it used to be. We argue that it is novel and important to bridge TK and SK to address the challenges of environmental change such as the cumulative impacts of multiple stressors on ecosystems and the services they provide. This study presents a critical social-ecological tool for widening the evidence-base to a more holistic understanding of the system dynamics of multiple environmental stressors in ecosystems and for developing more effective knowledge-inclusive partnerships between indigenous communities, researchers and policy decision-makers. This represents new transformational empirical insights into how wider knowledge discourses can contribute to more effective adaptive co-management governance practices and solutions for the resilience and sustainability of ecosystems in Northern Canada and other parts of the world with strong indigenous land tenure.

Stable sulfur isotopes identify habitat-specific foraging and mercury exposure in a highly mobile fish community.

Tracking the uptake and transfer of toxic chemicals, such as mercury (Hg), in aquatic systems is challenging when many top predators are highly mobile and may therefore be exposed to chemicals in areas other than their location of capture, confounding interpretation of bioaccumulation trends. Here we show how the application of a less commonly used ecological tracer, stable sulfur isotope ratios (34S/32S, or δ34S), in a large river-delta-lake complex in northern Canada allows differentiation of resident from migrant fishes, beyond what was possible with more conventional 13C/12C and 15N/14N measurements. Though all large fishes (n=105) were captured in the river, the majority (76%) had δ34S values that were indicative of the fish having been reared in the lake. These migrant fishes were connected to a food chain with greater Hg trophic magnification relative to the resident fish of the river and delta. Yet, despite a shallower overall trophic magnification slope, large river-resident fish had higher Hg concentrations owing to a greater biomagnification of Hg between small and large fishes. These findings reveal how S isotopes can trace fish feeding habitats in large freshwater systems and better account for fish movement in complex landscapes with differential exposure pathways and conditions.

Drinking water quality in Indigenous communities in Canada and health outcomes: a scoping review.

BACKGROUND: Many Indigenous communities in Canada live with high-risk drinking water systems and drinking water advisories and experience health status and water quality below that of the general population. A scoping review of research examining drinking water quality and its relationship to Indigenous health was conducted. OBJECTIVE: The study was undertaken to identify the extent of the literature, summarize current reports and identify research needs. DESIGN: A scoping review was designed to identify peer-reviewed literature that examined challenges related to drinking water and health in Indigenous communities in Canada. Key search terms were developed and mapped on five bibliographic databases (MEDLINE/PubMED, Web of Knowledge, SciVerse Scopus, Taylor and Francis online journal and Google Scholar). Online searches for grey literature using relevant government websites were completed. RESULTS: Sixteen articles (of 518; 156 bibliographic search engines, 362 grey literature) met criteria for inclusion (contained keywords; publication year 2000-2015; peer-reviewed and from Canada). Studies were quantitative (8), qualitative (5) or mixed (3) and included case, cohort, cross-sectional and participatory designs. In most articles, no definition of "health" was given (14/16), and the primary health issue described was gastrointestinal illness (12/16). Challenges to the study of health and well-being with respect to drinking water in Indigenous communities included irregular funding, remote locations, ethical approval processes, small sample sizes and missing data. CONCLUSIONS: Research on drinking water and health outcomes in Indigenous communities in Canada is limited and occurs on an opportunistic basis. There is a need for more research funding, and inquiry to inform policy decisions for improvements of water quality and health-related outcomes in Indigenous communities. A coordinated network looking at First Nations water and health outcomes, a database to store and create access to research findings, increased funding and time frames for funding, and more decolonizing and community-based participatory research aimed at understanding the relationship between drinking water quality and health outcomes in First Nations communities in Canada are needed.

Whiteboard animation for knowledge mobilization: a test case from the Slave River and Delta, Canada.

OBJECTIVE: To present the co-creation of a whiteboard animation video, an enhanced e-storytelling technique for relaying traditional knowledge interview results as narratives. DESIGN: We present a design for translating interview results into a script and accompanying series of figures, followed by technical steps to create a whiteboard animation product. METHOD: Our project used content analysis and researcher triangulation, followed by a collaborative process to develop an animated video to disseminate research findings. A 13-minute long whiteboard animation video was produced from a research study about changing environments in northern Canadian communities and was distributed to local people. Three challenging issues in the video creation process including communication issues, technical difficulties and contextual debate were resolved among the supporting agencies and researchers. CONCLUSIONS: Dissemination of findings is a crucial step in the research process. Whiteboard animation video products may be a viable and culturally-appropriate form of relaying research results back to Indigenous communities in a storytelling format.

Drinking water management: health risk perceptions and choices in First Nations and non-First Nations communities in Canada.

The relationship between tap water and health has been a topic of public concern and calls for better management in Canada since well-publicized contamination events in two provinces (Ontario and Saskatchewan) in 2000-2001. This study reports the perspectives on health risks from tap water and corresponding use of, and spending on, bottled water in a number of different communities in Canada. In 2009-2010, four First Nations communities (three from Ontario and one from Saskatchewan) and a geographically diverse sample of non-First Nations Canadians were surveyed about their beliefs concerning health risks from tap water and their spending practices for bottled water as a substitute. Responses to five identical questions were examined, revealing that survey respondents from Ontario First Nations communities were more likely than non-First Nations Canadians to believe bottled water is safer than tap water (OR 1.6); more likely to report someone became ill from tap water (OR 3.6); more likely to express water and health concerns related to tap water consumption (OR 2.4); and more likely to spend more on bottled water (OR 4.9). On the other hand, participants from one Saskatchewan First Nations community were less likely than non-First Nations Canadians to believe that someone had become ill from drinking tap water (OR 3.8), less likely to believe bottled water is safer than tap (OR 2.0), and less likely to have health concerns with tap water (OR 1.5). These differences, however, did not translate into differences in the likelihood of high bottled water expenditures or being a 100% bottled water consumer. The paper discusses how the differences observed may be related to water supply and regulation, trust, perceived control, cultural background, location, and past experience.

A framework for building research partnerships with first nations communities.

Solutions to complex health and environmental issues experienced by First Nations communities in Canada require the adoption of collaborative modes of research. The traditional "helicopter" approach to research applied in communities has led to disenchantment on the part of First Nations people and has impeded their willingness to participate in research. University researchers have tended to develop projects without community input and to adopt short term approaches to the entire process, perhaps a reflection of granting and publication cycles and other realities of academia. Researchers often enter communities, collect data without respect for local culture, and then exit, having had little or no community interaction or consideration of how results generated could benefit communities or lead to sustainable solutions. Community-based participatory research (CBPR) has emerged as an alternative to the helicopter approach and is promoted here as a method to research that will meet the objectives of both First Nations and research communities. CBPR is a collaborative approach that equitably involves all partners in the research process. Although the benefits of CBPR have been recognized by segments of the University research community, there exists a need for comprehensive changes in approaches to First Nations centered research, and additional guidance to researchers on how to establish respectful and productive partnerships with First Nations communities beyond a single funded research project. This article provides a brief overview of ethical guidelines developed for researchers planning studies involving Aboriginal people as well as the historical context and principles of CBPR. A framework for building research partnerships with First Nations communities that incorporates and builds upon the guidelines and principles of CBPR is then presented. The framework was based on 10 years' experience working with First Nations communities in Saskatchewan. The framework for research partnership is composed of five phases. They are categorized as the pre-research, community consultation, community entry, research and research dissemination phases. These phases are cyclical, non-linear and interconnected. Elements of, and opportunities for, exploration, discussion, engagement, consultation, relationship building, partnership development, community involvement, and information sharing are key components of the five phases within the framework. The phases and elements within this proposed framework have been utilized to build and implement sustainable collaborative environmental health research projects with Saskatchewan First Nations communities.

Risk factors associated with the choice to drink bottled water and tap water in rural Saskatchewan.

A cross-sectional study investigated risk factors associated with choices to drink bottled water and tap water in rural Saskatchewan. Of 7,500 anonymous postal questionnaires mailed out, 2,065 responses were analyzed using generalized linear mixed models. Those who reported a water advisory (p < 0.001) or living in the area for £10 years (p = 0.01) were more likely to choose bottled water. Those who reported tap water was not safe to drink were more likely to choose bottled water, an effect greater for those who had no aesthetic complaints (p ≤ 0.001), while those with aesthetic complaints were more likely to choose bottled water if they believed the water was safe (p < 0.001). Respondents who treated their water and did not use a community supply were more likely to choose bottled water (p < 0.001), while those who did not treat their water were more likely to choose bottled water regardless of whether a community supply was used (p < 0.001). A similar pattern of risk factors was associated with a decreased likelihood of consuming tap water daily; however, the use of a community water supply was not significant. Understanding the factors involved in drinking water choices could inform public health education efforts regarding water management in rural areas.