Health 2022, 19, 8610. https:// bottled water) from consenting households in a small rural community without utility-supplied water

Overview

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Key numbers

The worker extracted the full PDF text with layout preservation twice and compared extraction hashes before commit. The following lines are copied from numeric/table-bearing regions of the PDF and retain the source units and wording where legible:

the 69% (n = 9) of households that participated, all had piped well water, though 67% (n = 6) used
Received: 31 May 2022 from 44.4% (n = 4) of homes, E. coli in one home, and enteric pathogens (Aeromonas, Campylobacter,
MCL for nitrate, and 33% (n = 3) exceeded the EPA SMCL for iron. Among the 19 individuals residing
Publisher’s Note: MDPI stays neutral in study households, reported diarrhea was 25% more likely in homes with measured E. coli and/or
and Scott, ~10% of homes in this region of Central Appalachia lack complete plumbing
shallow (~3 m) depth to the water table and subject to frequent flooding (27).
ing the faucet with 70% isopropyl alcohol solution and flushing/running the water for
ples were also tested for nitrate (NO3 − ) and sulfate (SO4 2− ) using a Hach DR850 portable
with 2% trace metal grade nitric acid by volume and then analyzed for metals including
however, 27% (n = 4) declined to support the utility’s proposed water extension proposal,
community at the time of our visits (n = 13), 69% (n = 9) agreed to participate in our study.
used bottled water as their primary drinking water source. None of the 33% (n = 3) of
water (any method). Reported annual household incomes ranged from <$33,000 to no more
than $48, 000, w i t h 67$ 43,000/year (Table 1).
Table 1. Key Household Characteristics Overall and by Primary Source of Drinking Water.
Total a 3 100% 5 100% 8 100%
Male 2 67% 4 67% 6 67%
Female 1 33% 2 33% 3 33%
Total 3 100% 6 100% 9 100%
White/Caucasian 3 100% 6 100% 9 100%
Total 3 100% 6 100% 9 100%
Male 2 67% 4 67% 6 67%
Female 1 33% 2 33% 3 33%
Total 3 100% 6 100% 9 100%
(mean = 66.3, n = 3), though the difference was also not statistically significant (t-test with
We detected total coliforms in water samples from 44.4% (n = 4) of households, includ-
centration (mean of duplicate samples) was low (1.5 MPN/100 mL, standard deviation
Enterobacter in 22.2% (n = 3) of homes, and Aeromonas in 11.1% (n = 1); no other pathogens
Table 2. Water Sample Analysis Results by Water Source.
Total Coliforms (TC) Detected: % HHs (n) 16.7% (n = 1) 33.3% (n = 3) 33.3% (n = 3)
Aeromonas bacteria: % HHs (n) 11.1% (n = 1)
Arsenic (ppb) 0.038 0.072 0.181 0.029 0.022 0.061 0.021 0.017 0.056
Cadmium (ppb) 0.005 0.006 0.012 0.020 0.035 0.111 0.005 0.006 0.016
Chromium (ppm) 0.000 0.000 0.000 0.000 0.000 0.001 0.000 0.000 0.001
Lead (ppb) 0.022 0.053 0.130 0.500 0.758 2.197 0.067 0.171 0.520
Nitrate (NO3 − ) (ppm) 4.575 1.580 6.300 4.278 3.261 10.400 4.533 1.551 7.000
Selenium (ppm) 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000
Aluminum (ppm) 0.006 0.012 0.030 0.004 0.003 0.010 0.002 0.001 0.003
nitrate (10 ppm), and tap water samples from 33.3% (n = 3) of homes exceeded the SMCL
for iron (0.3 ppm) (38,39). Tap water samples from 44.4% (n = 4) of homes exceeded half
of the MCL for nitrate, and 55.5% (n = 5) exceeded half of the SMCL for iron. Half of the
bottled water samples we tested (50%, n = 3) exceeded half of the US EPA MCL for nitrate.

Methods (brief)

Virginia. Int. J. Environ. Res. Public health outcomes in Central Appalachia. We collected survey data and water samples (tap, source, and
doi.org/10.3390/ijerph19148610 in southwest Virginia. Water samples were analyzed for physicochemical parameters, total coliforms,
bottled water as their primary drinking water source. Total coliforms were detected in water samples
Accepted: 11 July 2022 Enterobacter) in 33% (n = 3) of homes. Tap water samples from 11% (n = 1) of homes exceeded the EPA
published maps and institutional affil- sample size was small, our findings suggest that a considerable number of lower-income residents
Appalachia are based on relatively small sample sizes.
For households that consented to water sampling and testing, we collected multiple
samples from two to three sources per home: tap water, source water (tap after steriliz-
2.3. Water Sample Analyses
Duplicate samples were tested for E. coli, an indicator of fecal contamination, and total
colorimeter (Hach Company, Loveland, CO, USA). Additionally, samples were processed
Electron iCAP-RQ ICP-MS at Virginia Tech (Standard Methods 3030D, 3125B) (31).
We detected total coliforms in water samples from 44.4% (n = 4) of households, includ-
ing one bottled water sample. E. coli (an indicator of fecal contamination) was detected
in tap and source water samples from one home; although the source water sample con-
centration (mean of duplicate samples) was low (1.5 MPN/100 mL, standard deviation
bacterial pathogens (using an RT-qPCR cutoff of Ct < 35) in source water samples from
Table 2. Water Sample Analysis Results by Water Source.

Implications

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Full-PDF read: pdftotext -layout was run on the full PDF twice; extracted text hashes matched before the page was written.
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Update history

The five most recent substantive edits to this page, classified major (evidence or structure moved), correction (a published value or statement was wrong and has been fixed), or minor (narrative rewritten without changing the underlying evidence). Each description is derived from what the edit did to this page; the linked commit is the authoritative record, routine regeneration passes are excluded, and the full version history lives in git. When DOI minting comes online (see schema docs), each entry below will also link to a version-pinned DataCite DOI.

Commit	Date	Change	Description
b01ec52c	2026-08-04	major	2 sections added
d49e450f	2026-08-03	major	5 sections added; narrative text revised