Thesis (Ph.D.) University of Alaska Fairbanks, 2014.This dissertation addresses the need for a better understanding of how water and sanitation infrastructure and water use behaviors come together to influence health. The ultimate aim is to inform water infrastructure designs and behavior change programming for the prevention of acute respiratory infections (ARIs), skin infections, and diarrhea. All three diseases are of public health significance in Alaska, and all three can be prevented by proper access and use of water and sanitation services. I begin the dissertation by illustrating that some residents who have access to treated water continue to consume untreated river water and rain. In fact, 82% of respondents (n=172) reported that some of their drinking water came from an untreated source. Motives for drinking untreated water could be categorized into six themes: chemicals, taste, health, access, tradition, and cost. The next chapter describes the design and impact of a health promotion program to increase consumption of treated water. Self-reported data revealed that from pre- to post-intervention, the proportion of households drinking mostly treated water increased by 21% (39% to 60%), p < 0.0001. The third chapter reports changes in water use and health as reported by participants who recently received modern sanitation services. Most participants (n=101; 74%) reported improved community health. A prominent theme was that better access to treated water increased children’s ability to drink treated water and perform hand washing and bathing, practices known to prevent ARIs, skin infections and diarrhea. Based on the findings, I recommend: 1) providing inhouse piped water service where feasible, 2) development of an alternative water and sanitation system that provides adequate quantities of water for homes that may not be provided in-house piped water service, and 3) providing health promotion to encourage healthy water use, either in combination with provision of in-house water service, or as a stand-alone intervention.Chapter 1: Introduction -- Chapter 2: Consuming Untreated Water in Four Southwestern Alaska Native Communities: Reasons Revealed and Recommendations for Change -- Chapter 3: Alaska Native Consumers Show Increased Treated Drinking Water Consumption Following Project Meq-Egtaq -- Chapter 4: Alaska Native Consumers of Modern Sanitation Services Provide Insights to inform Infrastructure Designs and Health Promotion Planning -- Chapter 5: Conclusion
