The Community Engagement Core (CEC) aims to reduce health risks of residents in Maine who rely on domestic wells for water supply and who are exposed to arsenic, and to raise awareness of other contaminants (Rn, U and Mn). The population relying on domestic wells in New England is subject to lifetime risks for lung and bladder cancers at a staggering 125 in 1 million, ranked second only to that of western states at 152 in 1 million (Kumar et al., 2010). This risk is likely an underestimate because newer and more data from Maine and New Hampshire have found both higher As concentrations and a higher percentage of wells tested exceeding the maximum contaminant level (MCL) for As at 10 ug/L. In 17 towns of central Maine, the Columbia team has found that the percentage of domestic wells exceeding EPA MCL levels for As, Rn, U and Mn are 31%, 29%, 4% and 4%, respectively. Eight percent of well waters have As and Rn both exceeding MCLs. Arsenic testing and treatment will be promoted in this central Maine community before up scaling in the state of Maine. Our goal is to establish a community engagement working model applicable for risk reduction of domestic well users in New England region, with the following specific aims:
- Identify and engage community stakeholders. In year one, a community advisory committee will be formed to guide implementation.
- Determine and reduce barriers for testing. By year five, the percentage of residents with private wells in 17 towns in central Maine who have their well water tested for arsenic will double compared to baseline.
- Determine whether dissemination of well water As test results has influenced the homeowner’s decision to treat for As and determine and reduce barriers for treatment. By year five, the percentage of residents with private wells in central Maine who treat their well water for arsenic will double.
- Raise awareness in the communities of other hazards in their well water: Rn, U and Mn.
Whereas treatment and testing costs may be barriers in behavior change, we hypothesize that attitudes, social norms and self-regulatory factors are likely to be far more influential than risk perception alone (Abraham and Michie, 2008). These factors have proven more influential in other settings related to water use behavior: attitudes (e.g. beliefs regarding benefits and costs of using safe water options, taste, etc.), social norms (e.g. what other people are doing, what people think they are expected to do, etc.), self-regulatory factors (e.g. when maintenance of treatment unit is not well integrated into people's routines) (Mosler, 2012). We are developing innovative community participatory tools to target these key behavioral factors such that the behavior of residents of Maine (and beyond) at risk from arsenic exposure can be understood and changed to improve health.
The first meeting of the Maine Arsenic Reduction for Community Health (MARCH) Advisory Committee was held in Readfield, Maine on May 9, 2013. The MARCH partnership grew out of our ongoing community engagement core (CEC) activities. The committee brings together residents of the CEC’s project area in Central Maine that also represent local government, Maine CDC, education, USGS, and the well drilling and treatment field. MARCH aims, through direct engagement with community to enable vulnerable households including those with children, to regularly test their well water for arsenic and other water quality parameters, to have access to information of water quality test results and treatment options, and to take actions to mitigate arsenic in most effective and economic ways. MARCH works with all its partners and members of the community towards eliminating the exposure to arsenic and other contaminants in domestic well water to improve community health. This is a goal adopted by the MARCH advisory committee on behalf of the rural community affected by arsenic and other water contaminants in Maine.
During the first meeting participants reviewed the current knowledge on the arsenic problem in central Maine and the findings of the CEC’s community well testing and treatment surveys implemented in January 2013. Discussion included reasons households decide to test and treat their well water and strategies to engage the community to promote these practices. Plans were made for an NIH Public Environmental Health Partnership (PEHP) Research to Action grant proposal to develop and implement a public health action plan for arsenic mitigation. Committee members gave advice on proposed activities like a longitudinal cohort study on treatment efficacy and a No Arsenic Well Left Behind testing campaign. MARCH Advisory Committee participants included Cheryl Marvinney, Maranacook Community High School; Ike Goodwin, Goodwin Well Drilling; Joanne Joy, Healthy Communities of the Capital Area; and Martha Nielsen, Manchester Select Board and USGS, as well as Columbia CEC scientists Yan Zheng and Sara Flanagan.
Abraham, C., Michie, S., 2008. A taxonomy of behavior change techniques used in interventions. Health Psychology 27, 379-387.
Kumar, A., Adak, P., Gurian, P.L., Lockwood, J.R., 2010. Arsenic exposure in US public and domestic drinking water supplies: A comparative risk assessment. J. Expo. Anal. Environ. Epidemiol. 20, 245-254.
Mosler, H.-J., 2012. A systematic approach to behavior change interventions for the water and sanitation sector in developing countries: a conceptual model, a review, and a guideline. International Journal of Environmental Health Research.