Assessing the defecation practices of unsheltered individuals and their contributions to microbial water quality in an arid, urban watershed.

Outdoor defecation by people experiencing homelessness is frequently perceived as a potentially large source of human fecal pollution and a significant source of health risk in urban waterbodies with recreational contact. The goal of this study was to count the number of people experiencing homelessness and quantifies their sanitation habits in an urban river corridor setting, then use this information for estimating human fecal pollutant loading on a watershed scale. Two types of census counts were conducted including periodic point-in-time counts over six years and weekly counts of encampments. While the population census varied from count-to-count, the range of population estimates in the river corridor varied from 109 to 349 individuals during the six-year span, which mirrored the weekly counts of encampments. A face-to-face survey of people experiencing homelessness assessed the sanitation habits of the unsheltered population (N = 63), including outdoor defecation frequency and containment practices. Overall, 95 % of survey respondents reported defecating outdoors; 36 % practiced outdoor defecation between 4 and 7 days/week and 27 % practiced outdoor defecation <1 day/week. Of those that did practice outdoor defecation, 75 % contained their feces in a bucket or bag, thereby limiting fecal material contributions to the river; 6.7 % reported defecating on low ground near the river that could wash off when flood waters rise during a storm event. Only a single survey respondent reported defecating directly into the river. Based on literature values for average HF183 output for an adult human, and the average rainfall in the urban watershed, the total watershed contribution of HF183 averaged 1.2 × 1010 gene copies per storm event (95 % CI: 0.9 × 1010-1.6 × 1010) along the 41 km stretch of river in this study. This human fecal loading estimate is at least two orders of magnitude less than cumulative HF183 loading from all human sources measured at the bottom of the watershed.

Scrutinizing surficial sediment along a 600-km-long urban coastal zone: Occurrence and risk assessment of fipronil and its three degradates.

Contamination in the coastal zone is closely linked to urbanization and has become a global issue. The coastal aquatic environment is the terminal sink for many chemicals; however, little is known about the occurrence and variation among habitats as well as integrative toxicity for pesticides, i.e., fipronil, and its three major degradates (-desulfinyl, -sulfide, and -sulfone, fiproles hereafter) in sediments in urban coastlines. In the present study, we report results of a random stratified survey for fiproles in surficial sediments in five embayment habitats (strata) along the Southern California Bight (SCB), USA coastline. Fiproles were present in a small areal extent (6.8%) of the SCB embayment, and detected in 14 out of 174 stations with a total concentration of the four analytes ranging from 0.50 to 17.5 µg/kg dry weight. The area-weighted mean concentrations were 3.16 ± 3.37, 0.584 ± 0.558, 0.071 ± 0.103, and 0.005 ± 0.009 µg/kg in brackish estuaries, estuaries, bays, and marinas, respectively, with the results below the detection limits in ports. Fipronil sulfone had the greatest detection frequency (8.05%) and highest mean concentration (3.24 ± 3.36 µg/kg) among the four compounds. A screening-level deterministic risk assessment for invertebrates found that, region-wide, fiproles generally posed an insignificant to low acute risk to the amphipod Eohaustorius estuarius in 7.36% of the SCB embayment area. In addition, high risk to the midge Chironomus dilutus was found in 77.5% of the fiproles-detectable area in the brackish estuary stratum that is a part of the Los Angeles River. Fipronil sulfone was identified as the major contributor of these effects. The results of this study establish a baseline of occurrence and toxicity potential for fiproles in coastal sediments of southern California.

Regional assessment of contaminant bioaccumulation in sport fish tissue in the Southern California Bight, USA.

Marine recreational fisheries in California are economically and culturally important; however, consumption of contaminated seafood may be a human health risk. The California Environmental Protection Agency Office of Environmental Health Hazard Assessment developed Advisory Tissue Levels (ATLs) to be used in developing consumption recommendations protecting the health of fish consumers. This study characterizes extent and magnitude of bioaccumulation of contaminants in sport fish in Southern California relative to ATLs. Most zones exceeded the ATL for mercury corresponding to consumption of not more than 3 servings per week in one or more target species. A third of zones exceeded the ATL for total polychlorinated biphenyls (PCBs) corresponding to consumption of not more than 7 servings per week. However, neither mercury nor total PCBs exceeded the most restrictive, "do not consume", thresholds in measured tissues. Contaminant concentrations in fish tissues have remained the same or decreased since a similar survey in 2009.

Benthic habitat condition of the continental shelf surrounding oil and gas platforms in the Santa Barbara Channel, Southern California.

The continental shelf of southern California is an important location for the extraction of petroleum and natural gas. Many platforms in the region have been operating for more than four decades and are being targeted for decommissioning. Information on the condition of surrounding habitats to the platforms will be important for regulators. The condition of sediments near (250 m-2 km) four active oil/gas platforms was evaluated with measures of macrobenthic infauna, toxicity, and chemical composition using standardized assessment indices and compared to that of equivalent locations across the region without platforms. Assessment scores indicated that the sediments surrounding the oil platforms were in a relatively good state, with reference-condition infauna, minimal levels of chemical exposure, and five instances (25% of samples) of low-level toxicity. Samples from around the oil platforms were in overall similar condition to the region, with slightly better condition infauna, nearly identical chemistry, and slightly worse toxicity.

Incidence and public health burden of sunburn among beachgoers in the United States.

The beach environment creates many barriers to effective sun protection, putting beachgoers at risk for sunburn, a well-established risk factor for skin cancer. Our objective was to estimate incidence of sunburn among beachgoers and evaluate the relationship between sunburn incidence and sun-protective behaviors. A secondary analysis, of prospective cohorts at 12 locations within the U.S. from 2003 to 2009 (n = 75,614), were pooled to evaluate sunburn incidence 10-12 days after the beach visit. Behavioral and environmental conditions were cross-tabulated with sunburn incidence. Multivariable logistic regression was used to estimate the association between new sunburn and sun-protective behaviors. Overall, 13.1% of beachgoers reported sunburn. Those aged 13-18 years (16.5%), whites (16.0%), and those at beach locations along the Eastern Seaboard (16.1%), had the highest incidence of sunburn. For those spending ≥5 h in the sun, the use of multiple types of sun protection reduced odds of sunburn by 55% relative to those who used no sun protection (Odds Ratio = 0.45 (95% Confidence Interval:0.27-0.77)) after adjusting for skin type, age, and race. Acute health effects of sunburn tend to be mild and self-limiting, but potential long-term health consequences are more serious and costly. Efforts to encourage and support proper sun-protective behaviors, and increase access to shade, protective clothing, and sunscreen, can help prevent sunburn and reduce skin cancer risk among beachgoers.

Quantification of pathogens and markers of fecal contamination during storm events along popular surfing beaches in San Diego, California.

Along southern California beaches, the concentrations of fecal indicator bacteria (FIB) used to quantify the potential presence of fecal contamination in coastal recreational waters have been previously documented to be higher during wet weather conditions (typically winter or spring) than those observed during summer dry weather conditions. FIB are used for management of recreational waters because measurement of the bacterial and viral pathogens that are the potential causes of illness in beachgoers exposed to stormwater can be expensive, time-consuming, and technically difficult. Here, we use droplet digital Polymerase Chain Reaction (digital PCR) and digital reverse transcriptase PCR (digital RT-PCR) assays for direct quantification of pathogenic viruses, pathogenic bacteria, and source-specific markers of fecal contamination in the stormwater discharges. We applied these assays across multiple storm events from two different watersheds that discharge to popular surfing beaches in San Diego, CA. Stormwater discharges had higher FIB concentrations as compared to proximal beaches, often by ten-fold or more during wet weather. Multiple lines of evidence indicated that the stormwater discharges contained human fecal contamination, despite the presence of separate storm sewer and sanitary sewer systems in both watersheds. Human fecal source markers (up to 100% of samples, 20-12440 HF183 copies per 100 ml) and human norovirus (up to 96% of samples, 25-495 NoV copies per 100 ml) were routinely detected in stormwater discharge samples. Potential bacterial pathogens were also detected and quantified: Campylobacter spp. (up to 100% of samples, 16-504 gene copies per 100 ml) and Salmonella (up to 25% of samples, 6-86 gene copies per 100 ml). Other viral human pathogens were also measured, but occurred at generally lower concentrations: adenovirus (detected in up to 22% of samples, 14-41 AdV copies per 100 ml); no enterovirus was detected in any stormwater discharge sample. Higher concentrations of avian source markers were noted in the stormwater discharge located immediately downstream of a large bird sanctuary along with increased Campylobacter concentrations and notably different Campylobacter species composition than the watershed that had no bird sanctuary. This study is one of the few to directly measure an array of important bacterial and viral pathogens in stormwater discharges to recreational beaches, and provides context for stormwater-based management of beaches during high risk wet-weather periods. Furthermore, the combination of culture-based and digital PCR-derived data is demonstrated to be valuable for assessing hydrographic relationships, considering delivery mechanisms, and providing foundational exposure information for risk assessment.

Child environmental exposures to water and sand at the beach: Findings from studies of over 68,000 subjects at 12 beaches.

Swimming and recreating in lakes, oceans, and rivers is common, yet the literature suggests children may be at greater risk of illness following such exposures. These effects might be due to differences in immunity or differing behavioral factors such as poorer hygiene, longer exposures to, and greater ingestion of potentially contaminated water and sand. We pooled data from 12 prospective cohorts (n=68,685) to examine exposures to potentially contaminated media such as beach water and sand among children compared with adults, and conducted a simulation using self-reported time spent in the water and volume of water swallowed per minute by age to estimate the total volume of water swallowed per swimming event by age category. Children aged 4-7 and 8-12 years had the highest exposures to water, sand, and algae compared with other age groups. Based on our simulation, we found that children (6-12 years) swallow a median of 36 ml (90th percentile=150 ml), whereas adults aged ≥35 years swallow 9 ml (90th percentile=64 ml) per swimming event, with male children swallowing a greater amount of water compared with females. These estimates may help to reduce uncertainty surrounding routes and durations of recreational exposures and can support the development of chemical and microbial risk assessments.

Seabirds as regional biomonitors of legacy toxicants on an urbanized coastline.

Seabirds are often cited as sentinels of the marine environment, but are rarely used in traditional ocean and coastal contaminant monitoring. Four classes of persistent organic pollutants (POPs, n=68) and three trace elements (mercury, selenium, and arsenic) were measured in the eggs of California least terns (Sterna antillarum browni), caspian terns (Hydroprogne caspia), double-crested cormorants (Phalacrocorax auritus), and western gulls (Larus occidentalis) that nest in the Southern California Bight. Building on a periodic five year regional monitoring program, we measured contaminant exposure and assessed the utility of seabirds as regional contaminant biomonitors. We found that the eggs of larger, more piscivorous species generally had the highest concentrations of POPs and trace elements while California least terns had the lowest concentrations, except for mercury which was higher in least terns. As expected, DDT concentrations were elevated near the Palos Verdes Superfund site. However, we also detected a previously unknown latitudinal pattern in PBDE concentrations in least terns. POP congener profiles also confirmed differences in contamination in urban least tern colonies closest to urban centers. Though toxicants were at detectable levels across species and sites, concentrations were below those known to cause adverse effects in avian taxa and are steady or declining compared to previous studies in this region. Our results suggest that regional seabird monitoring can inform site-specific remediation and support management and protection of regionally-threatened wildlife and coastal systems. Integration of seabird contaminant data with traditional sediment, water, bivalve and fish monitoring is needed to further our understanding of exposure pathways and food web contaminant transfer.

Incidence of gastrointestinal illness following wet weather recreational exposures: Harmonization of quantitative microbial risk assessment with an epidemiologic investigation of surfers.

We modeled the risk of gastrointestinal (GI) illness associated with recreational exposures to marine water following storm events in San Diego County, California. We estimated GI illness risks via quantitative microbial risk assessment (QMRA) techniques by consolidating site specific pathogen monitoring data of stormwater, site specific dilution estimates, literature-based water ingestion data, and literature based pathogen dose-response and morbidity information. Our water quality results indicated that human sources of contamination contribute viral and bacterial pathogens to streams draining an urban watershed during wet weather that then enter the ocean and affect nearshore water quality. We evaluated a series of approaches to account for uncertainty in the norovirus dose-response model selection and compared our model results to those from a concurrently conducted epidemiological study that provided empirical estimates for illness risk following ocean exposure. The preferred norovirus dose-response approach yielded median risk estimates for water recreation-associated illness (15 GI illnesses per 1000 recreation events) that closely matched the reported epidemiological results (12 excess GI illnesses per 1000 wet weather recreation events). The results are consistent with norovirus, or other pathogens associated with norovirus, as an important cause of gastrointestinal illness among surfers in this setting. This study demonstrates the applicability of QMRA for recreational water risk estimation, even under wet weather conditions and describes a process that might be useful in developing site-specific water quality criteria in this and other locations.

Coliphages and Gastrointestinal Illness in Recreational Waters: Pooled Analysis of Six Coastal Beach Cohorts.

BACKGROUND: Coliphages have been proposed as indicators of fecal contamination in recreational waters because they better mimic the persistence of pathogenic viruses in the environment and wastewater treatment than fecal indicator bacteria. We estimated the association between coliphages and gastrointestinal illness and compared it with the association with culturable enterococci. METHODS: We pooled data from six prospective cohort studies that enrolled coastal beachgoers in California, Alabama, and Rhode Island. Water samples were collected and gastrointestinal illness within 10 days of the beach visit was recorded. Samples were tested for enterococci and male-specific and somatic coliphages. We estimated cumulative incidence ratios (CIR) for the association between swimming in water with detectable coliphage and gastrointestinal illness when human fecal pollution was likely present, not likely present, and under all conditions combined. The reference group was unexposed swimmers. We defined continuous and threshold-based exposures (coliphage present/absent, enterococci >35 vs. ≤35 CFU/100 ml). RESULTS: Under all conditions combined, there was no association between gastrointestinal illness and swimming in water with detectable coliphage or enterococci. When human fecal pollution was likely present, coliphage and enterococci were associated with increased gastrointestinal illness, and there was an association between male-specific coliphage level and illness that was somewhat stronger than the association between enterococci and illness. There were no substantial differences between male-specific and somatic coliphage. CONCLUSIONS: Somatic coliphage and enterococci had similar associations with gastrointestinal illness; there was some evidence that male-specific coliphage had a stronger association with illness than enterococci in marine waters with human fecal contamination.

Acute Illness Among Surfers After Exposure to Seawater in Dry- and Wet-Weather Conditions.

Rainstorms increase levels of fecal indicator bacteria in urban coastal waters, but it is unknown whether exposure to seawater after rainstorms increases rates of acute illness. Our objective was to provide the first estimates of rates of acute illness after seawater exposure during both dry- and wet-weather periods and to determine the relationship between levels of indicator bacteria and illness among surfers, a population with a high potential for exposure after rain. We enrolled 654 surfers in San Diego, California, and followed them longitudinally during the 2013-2014 and 2014-2015 winters (33,377 days of observation, 10,081 surf sessions). We measured daily surf activities and illness symptoms (gastrointestinal illness, sinus infections, ear infections, infected wounds). Compared with no exposure, exposure to seawater during dry weather increased incidence rates of all outcomes (e.g., for earache or infection, adjusted incidence rate ratio (IRR) = 1.86, 95% confidence interval (CI): 1.27, 2.71; for infected wounds, IRR = 3.04, 95% CI: 1.54, 5.98); exposure during wet weather further increased rates (e.g., for earache or infection, IRR = 3.28, 95% CI: 1.95, 5.51; for infected wounds, IRR = 4.96, 95% CI: 2.18, 11.29). Fecal indicator bacteria measured in seawater (Enterococcus species, fecal coliforms, total coliforms) were strongly associated with incident illness only during wet weather. Urban coastal seawater exposure increases the incidence rates of many acute illnesses among surfers, with higher incidence rates after rainstorms.

Acute Gastroenteritis and Recreational Water: Highest Burden Among Young US Children.

OBJECTIVES: To provide summary estimates of gastroenteritis risks and illness burden associated with recreational water exposure and determine whether children have higher risks and burden. METHODS: We combined individual participant data from 13 prospective cohorts at marine and freshwater beaches throughout the United States (n = 84 411). We measured incident outcomes within 10 days of exposure: diarrhea, gastrointestinal illness, missed daily activity (work, school, vacation), and medical visits. We estimated the relationship between outcomes and 2 exposures: body immersion swimming and Enterococcus spp. fecal indicator bacteria levels in the water. We also estimated the population-attributable risk associated with these exposures. RESULTS: Water exposure accounted for 21% of diarrhea episodes and 9% of missed daily activities but was unassociated with gastroenteritis leading to medical consultation. Children aged 0 to 4 and 5 to 10 years had the most water exposure, exhibited stronger associations between levels of water quality and illness, and accounted for the largest attributable illness burden. CONCLUSIONS: The higher gastroenteritis risk and associated burden in young children presents important new information to inform future recreational water quality guidelines designed to protect public health.

Epidemiologic evaluation of multiple alternate microbial water quality monitoring indicators at three California beaches.

INTRODUCTION: Advances in molecular methods provide new opportunities for directly measuring pathogens or host-associated markers of fecal pollution instead of relying on fecal indicator bacteria (FIB) alone for beach water quality monitoring. Adoption of new indicators depends on identifying relationships between either the presence or concentration of the indicators and illness among swimmers. Here we present results from three epidemiologic studies in which a broad range of bacterial and viral indicators of fecal contamination were measured simultaneously by either culture or molecular methods along with Enterococcus to assess whether they provide better health risk prediction than current microbial indicators of recreational water quality. METHODS: We conducted prospective cohort studies at three California beaches -- Avalon Bay (Avalon), Doheny State Beach (Doheny), Surfrider State Beach (Malibu) -- during the summers of 2007, 2008 and 2009. The studies enrolled 10,785 swimmers across the beaches and recorded each swimmer's water exposure. Water and sand samples were collected several times per day at multiple locations at each beach and analyzed for up to 41 target indicators using 67 different methodologies. Interviewers contacted participants by phone 10-14 days later and recorded symptoms of gastrointestinal illness occurring after their beach visit. Regression models were used to evaluate the association between water quality indicators and gastrointestinal illness among swimmers at each beach. RESULTS: F+ coliphage (measured using EPA Method 1602) exhibited a stronger association with GI illness than did EPA Method 1600 at the two beaches where it was measured, while a molecular method, F+ RNA Coliphage Genotype II, was the only indicator significantly associated with GI illness at Malibu. MRSA, a known pathogen, had the strongest association with GI illness of any microbe measured at Avalon. There were two methods targeting human-associated fecal anaerobic bacteria that were more strongly associated with GI illness than EPA Method 1600, but only at Avalon. No indicator combinations consistently had a higher odds ratio than EPA Method 1600, but one composite indicator, based on the number of pathogens detected at a beach, was significantly associated with gastrointestinal illness at both Avalon and Doheny when freshwater flow was high. DISCUSSION: While EPA Method1600 performed adequately at two beaches based on its consistency of association with gastrointestinal illness and the precision of its estimated associations, F+ coliphage measured by EPA Method 1602 had a stronger association with GI illness under high risk conditions at the two beaches where it was measured. One indicator, F+ Coliphage Genotype II was the only indicator significantly associated with GI illness at Malibu. Several indicators, particularly those targeting human associated bacteria, exhibited relationships with GI illness that were equal to or greater than that of EPA Method 1600 at Avalon, which has a focused human fecal source. Our results suggest that site-specific conditions at each beach determine which indicator or indicators best predict GI illness.

Near-coastal water quality at reference sites following storm events.

Stormwater is a challenging source of coastal pollution to abate because stormwater also involves complex natural processes, and differentiating these processes from anthropogenic excesses is difficult. The goal of this study was to identify the natural concentrations of stormwater constituents along the 1377 km coastline of California, USA. Twenty-eight ocean reference sites, a priori defined by lack of human disturbance in its adjacent watershed, were collected following 78 site-events and measured for 57 constituents and toxicity. Results indicated a complete lack of toxicity and undetectable levels of anthropogenic constituents (i.e., pesticides). The range of concentrations in ocean receiving waters for naturally-occurring constituents (i.e., total suspended solids, nutrients, trace metals) typically ranged three orders of magnitude. Regional differences and storm characteristics did not explain much of the variations in concentration. The reference site information is now being used to establish targets for marine protected areas subject to runoff from developed watersheds.

Correspondence of biological condition models of California streams at statewide and regional scales.

We used boosted regression trees (BRT) to model stream biological condition as measured by benthic macroinvertebrate taxonomic completeness, the ratio of observed to expected (O/E) taxa. Models were developed with and without exclusion of rare taxa at a site. BRT models are robust, requiring few assumptions compared with traditional modeling techniques such as multiple linear regression. The BRT models were constructed to provide baseline support to stressor delineation by identifying natural physiographic and human land use gradients affecting stream biological condition statewide and for eight ecological regions within the state, as part of the development of numerical biological objectives for California's wadeable streams. Regions were defined on the basis of ecological, hydrologic, and jurisdictional factors and roughly corresponded with ecoregions. Physiographic and land use variables were derived from geographic information system coverages. The model for the entire state (n = 1,386) identified a composite measure of anthropogenic disturbance (the sum of urban, agricultural, and unmanaged roadside vegetation land cover) within the local watershed as the most important variable, explaining 56% of the variance in O/E values. Models for individual regions explained between 51 and 84% of the variance in O/E values. Measures of human disturbance were important in the three coastal regions. In the South Coast and Coastal Chaparral, local watershed measures of urbanization were the most important variables related to biological condition, while in the North Coast the composite measure of human disturbance at the watershed scale was most important. In the two mountain regions, natural gradients were most important, including slope, precipitation, and temperature. The remaining three regions had relatively small sample sizes (n ≤ 75 sites) and had models that gave mixed results. Understanding the spatial scale at which land use and land cover affect taxonomic completeness is imperative for sound management. Our results suggest that invertebrate taxonomic completeness is affected by human disturbance at the statewide and regional levels, with some differences among regions in the importance of natural gradients and types of human disturbance. The construction and application of models similar to the ones presented here could be useful in the planning and prioritization of actions for protection and conservation of biodiversity in California streams.

Impact of Stormwater Discharges on Water Quality in Coastal Marine Protected Areas.

Marine protected areas worldwide limit harvest to protect sensitive fisheries, but rarely do they address water quality goals that may have equally demonstrable impacts. California has over 500 coastal shoreline miles of marine protected areas designated as Areas of Special Biological Significance (ASBS), but receives untreated wet weather runoff discharges from over 1600 storm drain outfalls. The goal of this study was to assess the extent and magnitude of water quality impacts in ASBS following storm events. A stratified probabilistic design was used for sampling receiving water shorelines near (discharge) and far (non-discharge) from storm drain outfalls. In general, reasonably good water quality exists in California's ASBS following storm events. Many of the target analytes measured did not exceed water quality standards. The post-storm concentrations of most constituents in discharge and non-discharge strata of ASBS were similar. The three potentially problematic parameters identified were total PAH, chromium, and copper.

An assessment of the transport of southern California stormwater ocean discharges.

The dominant source of coastal pollution adversely affecting the regional coastal water quality is the seasonally variable urban runoff discharged via southern California's rivers. Here, we use a surface transport model of coastal circulation driven by current maps from high frequency radar to compute two-year hindcasts to assess the temporal and spatial statistics of 20 southern California stormwater discharges. These models provide a quantitative, statistical measure of the spatial extent of the discharge plumes in the coastal receiving waters, defined here as a discharge's "exposure". We use these exposure maps from this synthesis effort to (1) assess the probability of stormwater connectivity to nearby Marine Protected Areas, and (2) develop a methodology to estimate the mass transport of stormwater discharges. The results of the spatial and temporal analysis are found to be relevant to the hindcast assessment of coastal discharges and for use in forecasting transport of southern California discharges.

Effect of submarine groundwater discharge on bacterial indicators and swimmer health at Avalon Beach, CA, USA.

Use of fecal indicator bacteria (FIB) for monitoring beach water quality is based on their co-occurrence with human pathogens, a relationship that can be dramatically altered by fate and transport processes after leaving the human intestine. We conducted a prospective cohort study at Avalon Beach, California (USA), where the indicator relationship is potentially affected by the discharge of sewage-contaminated groundwater and by solar radiation levels at this shallow, relatively quiescent beach. The goals of this study were to determine: 1) if swimmers exposed to marine water were at higher risk of illness than non-swimmers; 2) if FIB measured in marine water were associated with swimmer illness, and; 3) if the associations between FIB and swimmer health were modified by either submarine groundwater discharge or solar radiation levels. There were 7317 individuals recruited during the summers of 2007-08, 6165 (84%) of whom completed follow-up within two weeks of the beach visit. A total of 703 water quality samples were collected across multiple sites and time periods during recruitment days and analyzed for FIB using both culture-based and molecular methods. Adjusted odds ratios (AOR) indicated that swimmers who swallowed water were more likely to experience Gastrointestinal Illness (GI Illness) within three days of their beach visit than non-swimmers, and that this risk was significantly elevated when either submarine groundwater discharge was high (AOR [95% CI]:2.18 [1.22-3.89]) or solar radiation was low (2.45 [1.25-4.79]). The risk of GI Illness was not significantly elevated for swimmers who swallowed water when groundwater discharge was low or solar radiation was high. Associations between GI Illness incidence and FIB levels (Enterococcus EPA Method 1600) among swimmers who swallowed water were not significant when we did not account for groundwater discharge, but were strongly associated when groundwater discharge was high (1.85 [1.06, 3.23]) compared to when it was low (0.77 [0.42, 1.42]; test of interaction: P = 0.03). These results demonstrate the need to account for local environmental conditions when monitoring for, and making decisions about, public health at recreational beaches. The views expressed in this article are those of the authors and do not necessarily reflect the views or policies of the U.S. Environmental Protection Agency.