Study To Examine If Water Filters Can Improve Health For Households In Rural Appalachia

A team led by Virginia Tech’s Alasdair Cohen is launching the first major U.S. study to test whether simple countertop water filters can reduce illness in households that rely on private wells and springs for drinking water.

The study, supported by a $3.7M National Institutes of Health (NIH) grant, includes faculty members from four universities and will focus on rural Appalachia in Southwest Virginia and northeast Tennessee. Findings from Cohen and colleagues’ prior studies indicate that lower-income families in that region face higher risks of waterborne diseases because of contaminated private water sources that are not monitored and regulated like public water systems.

Cohen, assistant professor of environmental epidemiology in the Department of Population Health Sciences, part of the Virginia-Maryland College of Veterinary Medicine, is the principal investigator for the study. Titled “Expanding Safe Water Access to Improve Health Outcomes in Appalachia: The Rural Water Filtration and Health (RWELL) Trial,” the study will continue through 2030.

The research team plans to enroll approximately 480 households and more than 1,500 people across 10 counties in Southwest Virginia and northeast Tennessee. All households will be provided countertop water filters in a randomized fashion, half receiving them initially and half receiving them after a 12-month period. Scientists will track rates of reported illnesses, test saliva and stool samples for waterborne germs, and comprehensively analyze water quality in both groups over the study period.

Preliminary research has shown that some households with private wells or springs have harmful bacteria, viruses, and other contaminants in their water supply.

The study's goal is to determine whether affordable point-of-use filters can significantly reduce gastrointestinal and other water-related illness in rural communities without access to treated municipal water.

"We share the water testing results back with the households,” Cohen said. “We also provide gift cards as a token of thanks for people’s time and participation.”

As many as 40 million Americans get their drinking water from private wells that are not monitored by health officials, according to the Environmental Protection Agency. This creates a significant data gap about water quality and health risks, especially in rural areas where many families cannot afford expensive water treatment systems.

If successful, the study could provide evidence for policies and programs to expand safe drinking water access in underserved rural areas throughout Appalachia and similar rural regions nationwide.

“This could be very promising as a kind of stopgap, semi-permanent option for households that for a variety of reasons don't have better options, or can't afford to have wells repaired or regularly tested,” Cohen said.

Cohen is hopeful the results will spur public officials to take action.

“If we find that yes, the filters are used, that people like them, and that filter use is associated with improved health outcomes, then at that point I’d hope state or local governments, federal agencies, or nonprofits, would take what we’ve done and scale it up,” Cohen said. “That’s also why it’s so important that the intervention provision is relatively straightforward and that the filters are relatively affordable, easy to use, and hopefully even improve the taste of well and spring water for many households.”

Co-investigators from Virginia Tech on the project include Leigh-Anne Krometis, professor of biological systems engineering in the College of Agriculture and Life Sciences; Erin Ling, coordinator of the Virginia Household Water Quality Program and senior Extension specialist in biological systems engineering; and Marc Edwards, University Distinguished Professor of Civil and Environmental Engineering within the College of Engineering.

East Tennessee State University is a key partner in the study, with collaboration from Beth O’Connell, associate professor in the Department of Community and Behavioral Health; Phillip Scheuerman, professor in the Department of Environmental and Occupational Health and Safety Sciences; and Md Rasheduzzaman, formerly a postdoctoral associate working with Cohen at Virginia Tech but now assistant professor in the Department of Environmental and Occupational Health and Safety Sciences.

“We are excited to continue this collaborative work to address the basic need for safe drinking water and serve the people of our region,” O’Connell said.

Also collaborating on the project are Joe Brown, professor and engineering programs director in the Department of Environmental Sciences and Engineering, and interim director of the UNC Water Institute at the University of North Carolina; Professor Alan Hubbard, biostatistician and co-director of the Center for Targeted Machine Learning at the University of California, Berkeley; and Professor Isha Ray in the Energy and Resources Group at the University of California, Berkeley.

The two pilot studies Cohen led to inform the design of this study were conducted in collaboration with Tim Wade, Andrey Egorov, Shannon Griffin, and other scientists at the U.S. Environmental Protection Agency, and Cohen hopes to continue working with them for this study.

For Cohen, this study is a capstone of much prior research into Appalachian water quality issues.

"This is the culmination of years of work since coming to Virginia Tech,” Cohen said. “It’s rewarding to see all that collaboration, fieldwork, long days collecting samples, working with students in the lab, and analyzing data come together — to now have the opportunity, and funding support, to take things to the next level and hopefully help to further expand safe water access and improve health outcomes for people and communities in this region and beyond."