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A recent National Institute of Environmental Health Sciences’ (NIEHS) Environmental Health Chat podcast features an NIH-funded study that brings together multiple UK colleges and community partners to tackle real-world environmental health challenges.

For more than a decade, residents in Martin and Letcher Counties in Appalachian Eastern Kentucky frequently received notices in their water utility bills of exceedances in disinfection byproducts.

A common challenge for water systems worldwide, disinfection byproducts or – “DBPs” – form when chemicals that are used to kill pathogens that cause infectious diseases interact with organic matter and other precursors during the water treatment process. Long-term exposure to high levels of DBPs has been connected to increased risk of such health outcomes as bladder cancer and cardiac birth defects.

Worried about their health and seeking solutions, community members first reached out to UK scientists who study environmental health several years ago. Together, they have crafted a multi-level, systems-focused research project to identify and reduce DBP exposure.

Environmental Health Chat Podcast

In the Environmental Health Chat podcast episode, Anna G. Hoover, Ph.D., UK College of Public Health (CPH) assistant professor and interim vice chair for education in Epidemiology and Environmental Health, and Nina McCoy, community scientist and retired high school biology teacher, speak about the importance of partnerships, trust-building, and community-engaged research for reducing health risks related to potential environmental threats.

“Using chlorine to treat water before people consume it is critical to protecting public health,” said Hoover, who notes issues like cholera and typhoid. “There are all kinds of reasons we need to treat the water. We put the chlorine in to clean out those kinds of infectious diseases that might otherwise cause us serious problems.”

Hoover goes on to describe historical concerns about drinking water, including environmental disasters, and how past organizational and interpersonal communication have contributed to a lack of trust in the region. According to Hoover, “Once that kernel of distrust is sown, it can really sprout quite quickly and become very difficult to weed out.”

A pilot study funded by the UK Center for Appalachian Research in the Environmental Sciences (UK-CARES) was conducted by community members in partnership with College of Agriculture, Food and Environment (CAFE) Professor Jason Unrine, Ph.D.

The pilot found that more than 80% of the people who were surveyed in Martin County drink bottled water, and more than 40% will not even cook with water from their tap. These numbers, Hoover said, are “an indication of where trust is to some extent.”

In the podcast, McCoy, who leads the community group Martin County Concerned Citizens, describes why they reached out to UK. When she and others had requested information from officials about what was in their water, McCoy said, “I just never really got a good answer to that question.”

Initially, the community members primarily worried about arsenic and other contaminants from coal. Instead, the study found DBPs, specifically trihalomethanes and haloacetic acids, which are commonly found in chlorinated drinking water.

Building trust with the community

Hoover, who herself is from Appalachian Tennessee coal country, sees community-engaged research as a way to rebuild lost trust.

Hoover and Unrine co-lead the current project, which centers on engaging residents to conduct research and communicate findings. McCoy and other community co-investigators connect UK scientists with local residents, then train those residents to collect monthly water samples from their homes.

McCoy said, “This type of research is an excellent way of trying to build trust within a community. Because when the community is involved in this study, you're going to get more trust.” She continues, “These different citizen scientists are going to be involved in getting the work done, and I think they'll pay more attention to the results that we get.”

Data to empower people and reduce risk

The data will be helpful to Hoover and Unrine as they work with other UK scientists to model the changing levels and locations of disinfection byproducts in the public water systems of Martin and Letcher counties. The goal is to help water utilities reduce formation of DBPs during drinking water treatment and distribution. 

The study also will identify how characteristics of individual homes affect DBP exposure from drinking water and inhalation of DBPs volatilized from tap water during cooking, bathing and cleaning.

Hoover said that this study gives Eastern Kentucky the chance to be a leader in solving problems that are common around the world. It's also a chance to rebuild trust between the community, government agencies, utilities and scientists.

Hoover says an important role for university scientists is helping meet the needs of the Commonwealth’s communities by providing data and evidence to support decision-making.

“We have to give back to the communities. We have to respect their competing risks that they face and respect the values that they are trying to balance as they work to solve real environemental challenges.”

Research and community partners

UK co-investigators are Kelly Pennell and Lindell Ormsbee (UK College of Engineering), Jay Christian and Beverly May (UK College of Public Health) and Wayne Sanderson (UK College of Agriculture, Food and Environment).

Community co-investigators represent the Livelihoods Knowledge Exchange Network (LiKEN), Kentucky Headwaters, Martin County Concerned Citizens, and the Appalachian Citizens’ Law Center.

The project’s Stakeholder Consultation Core includes representation from water utilities, as well as state and local organizations. In addition, community scientists in the target counties are conducting in-home sampling. As of publication, the Martin County water system is in compliance with the U.S. Environmental Protection Agency’s DBP regulations.

Learn more about this study and its partners here.

Research reported in this publication was supported by the National Institute of Environmental Health Sciences of the National Institutes of Health under Award Number R01ES032396. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.