Since 2001 Upcountry Maui residents have been concerned that water additives may be linked to health problems in their community. A study using phone surveys was conducted to assess this issue. Most people suffered skin rashes, while others experienced eye irritations or respiratory problems. The surveys suggested that these symptoms might have been attributable to the water additives.D35HP16002/PHS HHS/United State

Geesey, Yvonne L

Iinuma, Gen

Jenkins, Kristine A

Pang, Lorrin W

Rohner, Amber L

Tavares, Damien K 3rd

eVols at University of Hawaii at Manoa

Effects of Upcountry Maui WaterAdditives on HealthAuthors:- Maui Department of Health andthe Quentin N. Burdick Interdisciplinary Training Rural HealthCommunity Capacity BuildingProgram (A.LR., LWP., G.l.,D.K,T., K.A.J., YLG,)Correspondence to:Amber L. Rohnerll25Young Street. #901.Honolulu. HI, 96814Phone: 1808l 870-1093Email: arohner@hawaii.eduAbstractSince 2001 Upcountry Maui residents have beenconcerned that water additives may be linked tohealth problems in their community A study using phone surveys was conducted to assess thisissue. Most people suffered skin rashes, while others experienced eye irritations or respiratory problems. The surveys suggested that these symptomsmight have been attributable to the water additives.IntroductionThe surface water that supplies parts of UpcountryMaui (including Kula, Pukalani. & Makawao) waspresumed to be corrosive and leaching lead from leadsolder and brass fittings found in several older homes.The Department ofWater Supply (DWS) tried to flushthe lines and attempted to adjust the pH level, but stillhad elevated levels of lead in many Upcountry homes.The Federal Safe Drinking Water Act & the Environmental ProtectionAgency2mandate local water utilitiesto ensure that water from a customer’s tap does notexceed 15 parts per billion of lead. Although the waterin the distribution system of concern in UpcountryMaui met this standard, the water coming from the tapof many Upcountry Maui homes did not. Because ofthese mandates the Calgon product C-9 (zinc orthophosphate) was added to the water supply on June 1.200lin an attempt to control the corrosion.3 C-9 isintended to help by creating a protective film in thewater pipes. preventing the leaching of the lead. Unfortunately. ninety-eight people subsequently’ reportedhealth problems to DWS. The use of C-9 was stoppedApril 10. 2003 and phosphoric acid was added instead.MethodsA study using two phone surveys was conducted toassess this issue. The first portion focused on developing a research tool and characterizing the signs andsymptoms believed to be associated with the Upcountrywater additives. For the second portion random phonenumbers from the Upcountry area and a control groupwere called to assess whether there was an appreciabledifference between the two groups. which would suggest that the water additives (C-9 and phosphoric acid)might have caused the health problems.For the first survey, the ninety-eight Upcountryhomes with complaints about symptoms from theadditives were contacted and asked specific questionsabout their symptoms. Phone calls were made from6/22/03 - 6/30/03 in the afternoon & evening times.The survey was designed to ensure anonymity. collectdemographics. and record the reported symptoms indetail. To minimize interviewer bias for both the firstand second surveys, a primary interviewer collectedthe demographic information for each participant.The participant was then transferred to a second interviewer. Before this transfer each participant wasinstructed not to tell the second interviewer wherehe or she lived. The second interviewer assessed themedical complaints when the participant indicated thatsymptoms were present. Information was collectedfor all household members, both symptomatic andasymptomatic.For the second sLirvey 200 random phone numbersfrom the Upcountry area (Kula, Pukalani, Makawaotowns) and 200 random numbers from the l)owntownarea (Kahului, Wailuku towns) were called. Phonecalls were made from 7/2/03 - 7/16/03 again in theafternoon & evening times. Participants were askedif they had experienced symptoms similar to thosereported in the first survey during the past 2 years, thetime period when C-9 and phosphoric acid were beingused to treat the water. The Downtown area was usedas a control group because the areahas a different watersupply with no C-9 or phosphoric acid treatment. Theteam used a modified version of the original surveyfbr the randomized, blinded, control group telephonesurvey, interviewers were again blinded to the locationof participants by using the two-interviewer method.ResultsTwenty-four households were willing to participate inthe first survey. Information was collected on sixty-twoindividuals residing in the twenty-four households.Every household had at least one symptomatic individual. In total there were thirty-two smptomaticindividuals. From this first survey it was determinedthat the primary complaints were skin rashes, eyeirritations, and respiratory problems. Twenty-sevenHAWAN MEDICAl JOuRNAL. VOL 63, SEPTEMHLR 2004264individuals reported a skin rash, thirteen reported eyeirritations, and four reported respiratory problems.fventy—two individuals reported having only onesymptom. v bile eight reported two symptoms. andt’vo reported all three symptoms. Residents stronglybelieved that their symptoms were related to use ofwater treated with C—9 or phosphoric acid.The results of the second randomized, blinded survey with a control group indicated that a statisticallysignificant (p=O.O2)number of LpcoLintry residentsexperienced similar symptoms over the past twoyears compared to Downtown residents. Thirty-sixhomes in the Upcountry group were contacted andinformation was gatheredon ninety-seven individuals.Fourteen of the ninety-seven reported symptoms; tenof them reported getting a skin rash. In the Downtowngroup, thirty homes were contacted and informationwas gathered on seventy-seven individuals. Onlythree reported symptoms, one reporting a skin rash.DiscussionThe surveys suggest that these symptoms may havebeen adverse reactions to the water additives, butmore research would be needed to confirm this. Acausal relationship cannot necessarily be inferred,however, the way in which the health problems manifested suggested that water use was a factor. In bothsurveys most symptomatic individuals Upcountryreported symptoms after showering or associatedtheir symptoms with some sort of water exposure,such as watering the lawn. Sonic also noted that ifthey showered Downtown or \vent on vacation thattheir symptoms would resolve, hut would return onceUpcountry water use was resumed. However, thethree symptomatic individuals from the Downtowngroup did not attribute their symptoms to water use.instead citing other causes, such as grass allergieswhen mowing the lawn causing eye irritation. Thefinding of symptomatic individuals in the Downtowngroup may simply account for the background rateof skin rashes, eye irritations, and respiratory problems present in the population for that given time.Again, while these results are suggestive that thereis an association between treated water & reports ofsymptoms. further studies would be needed to showa true correlation.There are several limitations to our study. Thesample size was small and there may have been anunintentional selection bias due to the times the callswere made. Also, those with unlisted phone numberswere not included in the study. adding to the bias.Additionally. reported symptoms could have been dueto confounding factors, such as allergies or illness,different soap use, or different ages or ethnic groupscontacted. However, despite the limitations a statistically significant difference was still shown betweenthe Upcountry group and the control group, suggestingthat the wateradditive could be the factorcontrihutingto the symptoms residents reported. Future studiesmay include a randomized. double blind. controlledcrossover study with participants bathing in treatedor untreated water. This may give more solid evidence about whether the water additives truly playa role in producing the symptoms of the residents.References1. http: waw.eoa.gov satewater sdwa sdwa.html The Sate Drinkrng Water Act2 http, www.eoa.gos ogwdw000 smalisys ndwac cooer.htrnI Fact Sheet: Leadand Copper Rule3. Hawa Revwed Statutes Chapter 340 F.4. Intellectual lmpairmentrn CNldrenwith Blood Lead Concentrationsbelow 10 pg perDecllrter, Canfield, R. L.. Henderson, C. R.Jr.. Cory-Slechta. D.A.. Cox. C.. JuskoT,A.. Lanphear, BR New England Journal of Medone,Vol.348. No.16. April 17.2003.AcknowledgmentsThis work was supported by the Maui Department of Health andthe Quentin N. Burdick Interdisciplinary Training Rural HealthCommunity Capacity Building Program. Through the Quentin N.Burdick Program, this project was supported by funds from theBureau of Health Professions, Health Resources and ServicesAdministration, and Department of Health and Human Servicesunder grant #D35HP1 6002. Mahalo to Dr. Lorrin Pang and Genlinuma fortheirguidance and mahalo to the terrific staff at the MauiDOH. Mahalo also to Jan Shoultz, Ron Matayoshi, and KentonKramer for their kokua with the Quentin N. Burdick Program andthis project.HAWAII MEDICAL JOURNAL, VOL 63, SEPTEMBER 231)4265

Effects of Upcountry Maui water additives on health.

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Effects of Upcountry Maui water additives on health.

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