Browsing by Author "Patton, Hannah"

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    Microbiological and chemical drinking water contaminants and associated health outcomes in rural Appalachia, USA: A systematic review and meta-analysis
    Darling, Amanda; Patton, Hannah; Rasheduzzaman, Md; Guevara, Rachel; McCray, Joshua; Krometis, Leigh-Anne H.; Cohen, Alasdair (Elsevier, 2023-09)
    In rural areas of the United States, an estimated ~1.8 million people lack reliable access to safe drinking water. Considering the relative dearth of information on water contamination and health outcomes in Appalachia, we conducted a systematic review of studies of microbiological and chemical drinking water contamination and associated health outcomes in rural Appalachia. We pre-registered our protocols, limiting eligibility to primary data studies published from 2000 to 2019, and searched four databases (PubMed, EMBASE, Web of Science, and the Cochrane Library). We used qualitative syntheses, meta-analyses, risk of bias analysis, and meta-regression to assess reported findings, with reference to US EPA drinking water standards. Of the 3452 records identified for screening, 85 met our eligibility criteria. 93 % of eligible studies (n = 79) used cross-sectional designs. Most studies were conducted in Northern (32 %, n = 27) and North Central (24 %, n = 20) Appalachia, and only 6 % (n = 5) were conducted exclusively in Central Appalachia. Across studies, E. coli were detected in 10.6 % of samples (sample-size-weighted mean percentage from 4671 samples, 14 publications). Among chemical contaminants, sample-size-weighted mean concentrations for arsenic were 0.010 mg/L (n = 21,262 samples, 6 publications), and 0.009 mg/L for lead (n = 23,259, 5 publications). 32 % (n = 27) of studies assessed health outcomes, but only 4.7 % (n = 4) used case-control or cohort designs (all others were cross-sectional). The most commonly reported outcomes were detection of PFAS in blood serum (n = 13), gastrointestinal illness (n = 5), and cardiovascular-related outcomes (n = 4). Of the 27 studies that assessed health outcomes, 62.9 % (n = 17) appeared to be associated with water contamination events that had received national media attention. Overall, based on the number and quality of eligible studies identified, we could not reach clear conclusions about the state of water quality, or its impacts on health, in any of Appalachia's subregions. More epidemiologic research is needed to understand contaminated water sources, exposures, and potentially associated health outcomes in Appalachia.
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    Springing for Safe Water: Drinking Water Quality and Source Selection in Central Appalachian Communities
    Patton, Hannah; Krometis, Leigh-Anne H.; Sarver, Emily A. (MDPI, 2020-03-21)
    Issues surrounding water infrastructure, access, and quality are well documented in the Central Appalachian region of the United States. Even in cases where residents have in-home piped point-of-use (POU) water, some rely on alternative drinking water sources for daily needs—including water collection from roadside springs. This effort aims to better understand and document spring usage in this region by identifying the factors that influence drinking water source selection and comparing household and spring water quality to Safe Drinking Water Act (SDWA) health-based and aesthetic contaminant recommendations. Households were recruited from communities surrounding known springs in three states (Kentucky, Virginia, and West Virginia). First- and second-draw, in-home POU tap water samples were collected from participating households and compared to samples collected from local springs on the same day. Samples were analyzed for fecal indicator bacteria and inorganic ions. Study participants completed surveys to document perceptions of household drinking water and typical usage. The majority of survey participants (82.6%) did not trust their home tap water due to aesthetic issues. Water quality results suggested that fecal indicator bacteria were more common in spring water, while several metallic ions were recovered in higher concentrations from household samples. These observations highlight that health risks and perceptions may be different between sources.