Racial Disparities in Access to Municipal Drinking Water: Lead Exposure Risk and a Risk Communication Intervention

Abstract

A growing body of research has documented millions of Americans living in peri-urban areas lacking access to municipal water service. Many affected communities are majority-minority and were historically zoned out of municipal boundaries through a process known as “racial underbounding.” Residents rely on unregulated private wells, even though their communities are typically encircled by municipal water lines. Little is known about chemical contaminants, such as lead, in drinking water in these communities, in part due to a lack of water quality monitoring. The overall hypotheses of this thesis are that the risk of exposure to lead in drinking water in underbounded communities is higher than in areas with public water service; that risk awareness is low; and that awareness can be increased through evidence-based risk communication. These hypotheses are explored through a field study to characterize water quality in underbounded areas of Wake County, NC; a population survey of these communities; and a randomized-controlled trial of a risk communication intervention. This research is the first to study lead in kitchen tap water in underbounded communities. In addition, it is the first to examine risk awareness and factors driving decisions to test water quality. Finally, it is the first randomized-controlled trial of a health risk communication in these communities and one of the first targeted at private well owners in any context. This dissertation provides evidence to support the three hypotheses. The average lead concentrations in the study households was nearly three times as high as in households served by the Raleigh municipal water supply, and lead in water exceeded the Environmental Protection Agency’s water-lead action level in 24% of households. Risk awareness was low: only 5.5% of study participants answered “yes” to “My well water may be contaminated with lead.” More than half of respondents had not tested their water for at least five years. Participants who recalled seeing the risk communication developed in this dissertation had significantly increased odds of testing their water (OR = 258, p = 0.001). Overall, these results suggest the need for interventions to raise risk awareness and improve water quality in underbounded communities.Doctor of Public Healt