Dartmouth study examines well water testing promotion in pediatric primary care

October 26, 2020

Findings from a new study conducted by a team of researchers at Dartmouth's Geisel School of Medicine and published in the journal Preventive Medicine Reports, show that involving pediatric practices in the promotion of private well water testing can influence parental compliance.

More than 43 million people living in primarily rural areas of the U.S. rely on private unregulated wells for their drinking water--including northern New England, where 40 to 50 percent of the population depend on private wells. This puts families, and particularly vulnerable populations such as children, potentially at risk for ingesting harmful contaminants such as arsenic.

Inorganic arsenic, a tasteless and odorless metalloid, is known to contaminate 10 to 20 percent of bedrock wells in New Hampshire. This raises a significant public health concern given arsenic is associated with a myriad of health conditions, including bladder and other cancers, and growing evidence indicates impacts on children's health and development.

Yet, efforts to encourage well owners to periodically test their private wells, an activity that has fallen on the public health system (which lacks regulatory authority), have only seen limited success. Previous surveys in New Hampshire, for example, have reported that nearly 60 percent of residents hadn't tested their wells in at least three years and 15 percent had never had their wells tested. Lack of awareness among the physician community about the health risks of well water, parental confusion about which chemicals to test for, poor lab access, and the cost of testing have all been cited as reasons for poor compliance.

"We wanted to see if we could move the needle on testing by integrating it into the clinical environment as part of routine pediatric preventive care," explains Carolyn Murray, MD, MPH, director of the Community Outreach and Translation Core for the Dartmouth Children's Environmental Health and Disease Prevention Research Center and lead author on the study.

The research team conducted the study with 11 pediatric and family medicine clinics that are members of the Dartmouth CO-OP Primary Care Practice-based Research Network--a 250-member voluntary research organization of primary care practitioners located in New Hampshire, Vermont, and Maine. Parents of children under 12 months of age who use a private well were eligible, and a total of 240 kits were dispensed (at no cost).

To determine the most effective practice approaches to achieve successful well water testing, two interventions (with two study arms each) were assessed. The first compared differences in testing completion when water analysis results were provided only to the parents versus being provided to both the parents and clinic. The second tested the effectiveness of doing after-visit parental reminders to complete testing versus not doing follow-up reminders.

"I'd say we were very successful at getting all of the practices on board with asking parents, 'Where do you get your drinking water?' and raising clinician awareness of the prevalence of arsenic in private wells," says Murray, who is also an assistant professor of medicine, community and family medicine, and of The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine. "What we did learn was that there's a lot more complexity to people's testing behavior beyond just cost and beyond just the doctor saying, 'You should do this.'"

Well water testing completion rates ranged from 10 to 61 percent across the practices and study arms, with an average of 29 percent. The study arm with both parent and clinic access to results and a follow-up system of reminders for parents was more than twice as likely to achieve test completion than other study arms. But having clinicians (versus other staff) distribute the kits, irrespective of study arm, was the strongest predictor of testing completion overall.

"I think our main takeaway was that we can engage primary care practices in screening for drinking water source and promoting well water testing," says Murray. "But we need to get more creative in how we work with clinicians and care teams on this important health issue. There's definitely room for improvement, but we're off to a good start."

Margaret Karagas, PhD, director of the Dartmouth Children's Environmental Health and Disease Prevention Research Center and senior author on the study, agrees. "This was a great translational research opportunity, building on our close partnership with the Dartmouth CO-OP to test implementation strategies to reduce environmental threats to children's health and the health of their families."
-end-
Grant funding from the U.S. Environmental Protection Agency and the National Institute for Environmental Health Sciences supported this study.

Founded in 1797, the Geisel School of Medicine at Dartmouth strives to improve the lives of the communities it serves through excellence in learning, discovery, and healing. The Geisel School of Medicine is renowned for its leadership in medical education, healthcare policy and delivery science, biomedical research, global health, and in creating innovations that improve lives worldwide. As one of America's leading medical schools, Dartmouth's Geisel School of Medicine is committed to training new generations of diverse leaders who will help solve our most vexing challenges in healthcare.

The Geisel School of Medicine at Dartmouth

Related Health Articles from Brightsurf:

The mental health impact of pandemics for front line health care staff
New research shows the impact that pandemics have on the mental health of front-line health care staff.

Modifiable health risks linked to more than $730 billion in US health care costs
Modifiable health risks, such as obesity, high blood pressure, and smoking, were linked to over $730 billion in health care spending in the US in 2016, according to a study published in The Lancet Public Health.

New measure of social determinants of health may improve cardiovascular health assessment
The authors of this study developed a single risk score derived from multiple social determinants of health that predicts county-level cardiovascular disease mortality.

BU study: High deductible health plans are widening racial health gaps
The growing Black Lives Matter movement has brought more attention to the myriad structures that reinforce racial inequities, in everything from policing to hiring to maternal mortality.

Electronic health information exchange improves public health disease reporting
Disease tracking is an important area of focus for health departments in the midst of the COVID-19 pandemic.

E-health resource improves men's health behaviours with or without fitness facilities
Men who regularly used a free web resource made significantly more health changes than men who did not, finds a new study from the University of British Columbia and Intensions Consulting.

Mental health outcomes among health care workers during COVID-19 pandemic in Italy
Symptoms of posttraumatic stress disorder, depression, anxiety and insomnia among health care workers in Italy during the COVID-19 pandemic are reported in this observational study.

Mental health of health care workers in china in hospitals with patients with COVID-19
This survey study of almost 1,300 health care workers in China at 34 hospitals equipped with fever clinics or wards for patients with COVID-19 reports on their mental health outcomes, including symptoms of depression, anxiety, insomnia and distress.

Health records pin broad set of health risks on genetic premutation
Researchers from the University of Wisconsin-Madison and Marshfield Clinic have found that there may be a much broader health risk to carriers of the FMR1 premutation, with potentially dozens of clinical conditions that can be ascribed directly to carrying it.

Attitudes about health affect how older adults engage with negative health news
To get older adults to pay attention to important health information, preface it with the good news about their health.

Read More: Health News and Health Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.