NEHA July/August 2022 Journal of Environmental Health

JOURNAL OF f i f t e e n d o l l a r s Environmental Health Published by the National Environmental Health Association Dedicated to the advancement of the environmental health professional Volume 85, No. 1 July/August 2022

July/August 2022 • Journal of Environmental Health 3 ADVANCEMENT OF THE SCIENCE Occurrence of Nitrate and Indicators of Agricultural and Septic System Contamination in a West Central Wisconsin Sand Aquifer ................................................................................. 8 International Perspectives: Effectiveness of London’s Ultra Low Emission Zone in Reducing Air Pollution: A Pre- and Post-Comparison of NO2 and PM10 Levels ............................................. 16 ADVANCEMENT OF THE PRACTICE Competencies for Environmental Health Professionals Who Detect, Investigate, and Respond to Foodborne Illness Outbreaks .......................................................................... 24 Direct From CDC/Environmental Health Services: Resources and Tools for Emergencies .......... 34 Direct From ecoAmerica: Climate Changes Mental Health ........................................................ 38 ADVANCEMENT OF THE PRACTITIONER JEH Quiz #1............................................................................................................................... 15 EH Calendar .............................................................................................................................. 40 People on the Move................................................................................................................... 41 Resource Corner........................................................................................................................ 42 JEH Corresponding Author and Subject Index: Volume 84...................................................... 44 YOUR ASSOCIATION President’s Message: Help Spread the Word—Environmental Health Is Public Health.............................6 Special Listing ........................................................................................................................... 48 NEHA News .............................................................................................................................. 50 NEHA 2023 AEC....................................................................................................................... 56 DirecTalk: Summer in Iowa ........................................................................................................ 58 Environmental health professionals are essential to foodborne illness outbreak investigations, although many do not receive formal training in this area. This month’s cover article, “Competencies for Environmental Health Professionals Who Detect, Investigate, and Respond to Foodborne Illness Outbreaks,” presents a competency framework that reflects the comprehensive set of skills desired for environmental health professionals at state and local health agencies. The study describes the findings of a web-based survey that assessed these competencies and identified training priorities among practicing environmental health professionals, as well as an environmental health competency training road map. See page 24. Cover image © iStockphoto: jittawit.21 A B O U T T H E C O V E R A D V E R T I S E R S I N D E X American Public Health Association...................... 5 HealthSpace Is Now HS GovTech......................... 60 Inspect2GO Environmental Health Software ......... 2 Micro Essential Laboratory, Inc............................ 37 NEHA-FDA Retail Flexible Funding Model Grant Program .......................................... 59 Ozark River Manufacturing Co. ........................... 33 Rural Community Assistance Partnership, Inc. ... 33 JOURNAL OF Environmental Health Dedicated to the advancement of the environmental health professional Volume 85, No. 1 July/August 2022

4 Volume 85 • Number 1 Of f i c i a l Pub l i ca t i on Journal of Environmental Health (ISSN 0022-0892) Kristen Ruby-Cisneros, Managing Editor Ellen Kuwana, MS, Copy Editor Hughes design|communications, Design/Production Cognition Studio, Cover Artwork Soni Fink, Advertising For advertising call (303) 802-2139 Technical Editors William A. Adler, MPH, RS Retired (Minnesota Department of Health), Rochester, MN Gary Erbeck, MPH Retired (County of San Diego Department of Environmental Health), San Diego, CA Thomas H. Hatfield, DrPH, REHS, DAAS California State University, Northridge, CA Dhitinut Ratnapradipa, PhD, MCHES Creighton University, Omaha, NE Published monthly (except bimonthly in January/February and July/ August) by the National Environmental Health Association, 720 S. Colorado Blvd., Suite 105A, Denver, CO 80246-1910. Phone: (303) 7569090; Fax: (303) 691-9490; Internet: E-mail: kruby@ Volume 85, Number 1. Yearly subscription rates in U.S.: $150 (electronic), $160 (print), and $185 (electronic and print). Yearly international subscription rates: $150 (electronic), $200 (print), and $225 (electronic and print). Single copies: $15, if available. Reprint and advertising rates available at CPM Sales Agreement Number 40045946. Claims must be filed within 30 days domestic, 90 days foreign, © Copyright 2022, National Environmental Health Association (no refunds). All rights reserved. Contents may be reproduced only with permission of the managing editor. Opinions and conclusions expressed in articles, columns, and other contributions are those of the authors only and do not reflect the policies or views of NEHA. NEHA and the Journal of Environmental Health are not liable or responsible for the accuracy of, or actions taken on the basis of, any information stated herein. NEHA and theJournal of Environmental Health reserve the right to reject any advertising copy. Advertisers and their agencies will assume liability for the content of all advertisements printed and also assume responsibility for any claims arising therefrom against the publisher. Full text of this journal is available from ProQuest Information and Learning, (800) 521-0600, ext. 3781; (734) 973-7007; or www.proquest. com. TheJournal of Environmental Health is indexed by Current Awareness in Biological Sciences, EBSCO, and Applied Science & Technology Index. It is abstracted by Wilson Applied Science & Technology Abstracts and EMBASE/Excerpta Medica. All technical manuscripts submitted for publication are subject to peer review. Contact the managing editor for Instructions for Authors, or visit To submit a manuscript, visit Direct all questions to Kristen Ruby-Cisneros, managing editor, Periodicals postage paid at Denver, Colorado, and additional mailing offices. POSTMASTER: Send address changes to Journal of Environmental Health, 720 S. Colorado Blvd., Suite 105A, Denver, CO 80246-1910. Printed on recycled paper. in the next Journal of Environmental Health h Long-Term Trends of Fine Particulate Matter in the Dallas– Fort Worth Metropolitan Area h Operational Insights Into Mosquito Control Disaster Response in Coastal North Carolina: Experiences With the Federal Emergency Management Agency After Hurricane Florence h Survival of Listeria monocytogenes in Commercially Available ColdBrewed and Refrigerated Coffee don’t miss

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6 (:7@80 • !@8-0= YOUR ASSOCIATION D. Gary Brown, DrPH, CIH, RS, DAAS Help Spread the Word— Environmental Health Is Public Health  PRES IDENT ’ S MESSAGE I want to thank all the environmental health professionals who were the unsung heroes of the COVID-19 pandemic. Environmental health professionals stepped up to the plate and performed a variety of tasks that provided their peers and the public with important insight into the value of our profession. I would be remiss to not thank all of the National Environmental Health Association (NEHA) staff for their hard work. NEHA is lucky to have such a passionate, dedicated, and hardworking staff. I grew up in Lackawanna, New York, a steel town located in a suburb of Buffalo. At its height of operation, the Bethlehem Steel Plant, known locally as Daddy Bethlehem, was the world’s largest steel factory that employed over 20,000 workers. Growing up in a steel town was a wonderful experience with people from all over the world having a shared sense of community. As I got older, I realized I grew up in a polluted town. I remember as a kid my grandmothers taking clothes off the line so the clothes would not get covered in coal dust when the coke ovens would have their shake out. As a child I would walk along the appropriately named Smokes Creek and helped clean debris out to the creek as a Boy Scout. I learned firsthand the danger of heavy manufacturing. When I was little, my father received third degree burns on his lower leg. Two of my friends, Michael “Mugsy” Francis Catuzza and Kenneth Pirowski, lost their lives in occupational accidents, which taught me that the true value of environmental and occupational health and safety (EOHS) can never be measured in dollars. My father was a third-generation steel worker and if Bethlehem Steel did not close down in the 1980s, I probably would have been the fourth generation. Later in his career, my father was the union representative who assisted with health and safety at Bethlehem Steel, which helped guide my career. I went to the University of Buffalo, studying premed with the hopes of becoming a veterinarian. Unfortunately, I am allergic to animals and needed to make a career switch. I switched to environmental studies under the assumption I would spend most of my time in nature counting deer. Instead, I was conducting sewer monitoring watching the feces (aka brown trout) float by. My first job after graduation was in a laboratory, which I did not enjoy. No one informed me that the professions in the environmental field making money were engineering or EOHS, a lesson I learned the hard way. My father told me to look into health and safety. In his infinite wisdom, he stated that people will pay more to save themselves than whales. The only EOHS program in New York at the time was at Hunter College in New York City. I called the EOHS Department at Hunter College to learn more. I ended up speaking with Dr. David Kotelchuck, program director, who spent over one hour enlightening me about this amazing field. Majoring in EOHS was wonderful—I loved my classes that were taught by professors who had practiced in the field for years before coming into academia. My professors at Hunter College are my inspiration through their love teaching and their genuine concern for the success of their students. I did an internship at an EOHS consulting firm in Buffalo and realized that I had found a home. After graduating, I worked for consulting firms and in the chemical industry. The work was fulfilling but my passion was teaching. Something my grandfather Eli Evanovich, who only finished third grade in Macedonia, resonated with me: “Education is something that can never be taken away from you.” In order to teach EOHS, I knew I had to go back to school to obtain a terminal degree, which led me to the University of Alabama at Birmingham. I have many people to thank who helped me complete my doctor of public health (DrPH) that afforded me a wonderful, fulfilling career, including Dr. Mitchell Zavon and Dr. R. Kent Oestenstad (aka Dr O). There are not enough words to thank my wife Deby, who has been a stalwart in support of my career, dreams, and aspirations, as well as our eventual move to Kentucky. I started a consulting firm in Buffalo while completing my doctoral research. It was there that I began my journey as a Hawaiian shirt, sneaker wearing fashionista. I hit the lottery when I became a faculty member of the Environmental Health Science Program at Eastern Kentucky University, being mentored by Dr. Our communities need us as environmental health leaders to be bold.

July/August 2022 • Journal of Environmental Health 7 Peter (aka “Yoda the Industrial Hygiene Master) Creighton, Dr. Carolyn Harvey, Professor Worley Johnson, Professor Joe Beck, and the other faculty. I started as the baby of the program but after 21 years, I am now the old man. Funny how that happens. I have found a home in Jamaica teaching with Dr. Norbert Campbell and Dr. Henroy Scarlett in the Occupational and Environmental Safety and Health Department at the University of the West Indies at Mona, Jamaica, along with being a member of the Jamaica Association of Public Health Inspectors for the past 17 years. When not teaching, I consult for government and private entities. Environmental health is a hidden treasure, providing a world of opportunity that touches all aspects of daily life. In my opinion, one of the greatest challenges we face is a lack of knowledge by the public of our profession. I will be working with NEHA members and staff to increase the visibility of the environmental health profession. Along with the general public, we need to diligently educate the numerous professionals we work with that environmental health is public health. This increased awareness will also help to reverse the trend of fewer students pursuing a formal education in environmental health. Students are the future of environmental health; therefore, we need to not only increase the number of the younger generation but also get them more involved in NEHA. As a profession, we all need to work together to spread the word far and wide about this exciting, fulfilling, and meaningful career. I believe an increased awareness will also lead to increased diversity in our field, an area that needs improvement. As the world is reopening from the COVID19 pandemic, environmental health needs to seize the opportunity to educate the public, policy makers, and key stakeholders of the technical, scientific expertise required to become a Registered Environmental Health Specialist/Registered Sanitarian (REHS/RS). The REHS/RS credential is under appreciated by many, something I will work diligently to rectify. Another priority for myself and the NEHA Board of Directors and staff is to make NEHA more beneficial to our affiliates. I have a passion for assisting people all over the world to have clean air, food, and water, along with a healthy and safe place to live, work, and play. I believe NEHA can help increase international participation and in turn, we can all learn from each other to help improve environmental health and the overall quality of life on a global scale. We are a cure to many of the world’s ills. Environmental health professionals realize this fact but we need everyone else to know it. We are making progress as an association and I hope to help us make even more progress. This moment is our time to help spread the word—environmental health is public health. Our communities, here and worldwide, need us as environmental health leaders to be bold. Join the only community of people as dedicated as you are about protecting human health and the environment. Begin connecting today through NEHA membership. ENVIRONMENTAL HEALTH It’s a tough job. That’s why you love it. C M Y CM MY CY CMY K

8 (:7@80 • !@8-0= A D VANC EME N T O F T H E SCIENCE Introduction Nitrate is a widespread, highly mobile contaminant of groundwater that is especially common in dense agricultural areas (Spalding & Exner, 1993). Potential sources of nitrate contamination include agricultural or lawn fertilizer application, septic systems, animal feedlots and barnyards, and septage or sludge disposal. The burden of nitrate contamination in groundwater in the Upper Midwest has been widely studied (Bundy et al., 1996; Chern et al., 1999; LeMasters & Baldock, 1997; Shaw, 1994), partly because of the human health effects associated with nitrate exposure. Though nitrate is a naturally occurring compound, it is often found in groundwater at levels that greatly exceed the U.S. Environmental Protection Agency (U.S. EPA) preventive action limit (2 mg/L) or maximum contaminant level (MCL, 10 mg/L) in agricultural and dense unsewered residential areas. The health-based standards for nitrate were established from the risk of methemoglobinemia, a condition in which the blood’s ability to transport oxygen is compromised. Individuals who are pregnant and infants are at greatest risk. Some studies also suggest livestock that drink water with elevated nitrate have poorer pregnancy outcomes (AlQudah et al., 2009). The Wisconsin Department of Natural Resources (WI DNR) has estimated that 90% of nitrate in Wisconsin groundwater is from agricultural activities, approximately 9% is from septic systems, and <1% is attributable to lawn fertilizer or other sources (Shaw, 1994). In addition to the health risks from nitrate, there could be additional risks to private well owners where co-contaminants associated with agriculture and septic systems exceed preventative action limits. Elevated nitrate often is correlated with pesticides, herbicides, viruses, pharmaceuticals, or other constituents of agrichemicals or human wastewater (Burow et al., 1998; Istok et al., 1993; Seiler et al., 1999). One study estimated that 42% of private drinking water wells in Wisconsin contained a detectable level of an herbicide or herbicide metabolite (Wisconsin Department of Agriculture, Trade, and Consumer Protection [WI DATCP], 2017). In Eau Claire County located in West Central Wisconsin, over 25,000 people (approximately 1 in 4) rely on private wells as their primary source of drinking water. The quality of private well water is of public health concern because private water supplies are not regularly tested or regulated. Over 4,500 nitrate tests have been analyzed at the Eau Claire City–County Health Department (ECC–CHD) since 2005. Approximately 4,500 wells remain untested in Eau Claire County for nitrate. Approximately -> ? = ,. ? Fertilizers, manure, and septic effluent are potential sources of nitrate in groundwater. Nitrate can be harmful if ingested above the U.S. Environmental Protection Agency maximum contaminant level of 10 mg/L. In Eau Claire County, located inWest Central Wisconsin, approximately one quarter of households rely on private wells. Sources of nitrate in private wells in Eau Claire County have not been researched previously. A total of 110 private wells in Eau Claire County were tested for seven agricultural and three septic indicators to identify sources of nitrate contamination. Nitrate contamination risk factor data (e.g., well depth, casing depth) were also collected. Average nitrate concentrations were significantly higher in wells with agricultural indicators, suggesting agriculture is a source of nitrate. Wastewater indicators were identified, but septic systems were not a significant source of nitrate. Well casing depth was the only risk factor associated with elevated nitrate. Funds should be allocated to the Eau Claire City–County Health Department to promote and subsidize point-of-use drinking water treatment in homes with nitrate levels ≥10 mg/L. Further, new well casing depths should be >12 m (40 ft) to avoid infiltration of nitrate and other contaminants. Occurrence of Nitrate and Indicators of Agricultural and Septic System Contamination in a West Central Wisconsin Sand Aquifer Laura Suppes, MPH, PhD, REHS University of Wisconsin–Eau Claire Ted Johnson Eau Claire City–County Health Department (Retired) Shane Sanderson, MS, JD, REHS Linn County Department of Health Services Sarah Vitale, PhD University of Wisconsin–Eau Claire Audrey Boerner, MS Eau Claire City–County Health Department

July/August 2022 • :@=9,7 :1 9A4=:9809?,7 0,7?3 9 1 in 2 wells sampled in Eau Claire County have nitrate that exceeds naturally occurring concentrations (generally presumed to be ≤2 mg/L). Nearly 1 in 20 sampled wells exceed the health-based standard for nitrate. Until our study, almost no wells had been tested for common nitrate co-contaminants such as pharmaceuticals or agricultural chemicals in Eau Claire County, though other areas of the state have been investigated as early as the 1980s (Rothschild et al., 1982). Aims of our study were to determine nitrate trends and identify nitrate contamination risk factors of private wells in Eau Claire County. Methods Site Selection This study took place from July 2016 through June 2018 and was approved by the University of Wisconsin–Eau Claire Institutional Review Board in 2016. Private well owners with a septic system and past water test containing nitrate levels ≥5 mg/L in the ECC–CHD Certified Public Health Laboratory water quality database were invited to participate. This level was used because it provided a robust number of potential participants (399) and at ≥5 mg/L, the nitrate present was likely from an anthropogenic source (U.S. Geological Survey, 1999). Well owners were mailed a letter describing the study that contained instructions to contact ECC–CHD to participate in the study. Questionnaire We developed the questionnaire used in our study in consultation with researchers from a similar study in Hastings, Minnesota, to create an exhaustive list of potential risk factors of nitrate contamination of well water (Dakota County Environmental Management, 2003). Property owners were issued a questionnaire on-site that gathered well contamination risk factor data such as site history and proximity to potential nitrate sources (e.g., septic systems, distance to and type of agricultural fields, fertilizer storage, abandoned wells). Using the questionnaire, researchers also recorded approximate distances from the wellhead to potential sources of nitrate such as animal feedlots, privies, and fertilizer storage. For each well, we gathered construction data—including well depth, construction date, casing depth, and well type—prior to sampling wells that had records available from WI DNR. Sample Collection and Analysis We collected samples for nitrate as well as seven agricultural indicators (i.e., atrazine, desethyl atrazine, desisopropyl atrazine, acetochlor, alachlor, metolachlor, and cyanazine) and three septic system indicators (i.e., caffeine, carbamazepine, and carisoprodol). We collected water samples for nitrate in clear, sterilized 250-ml polyethylene bottles. We collected agricultural and septic system indicator samples in 1-L amber glass bottles. Samples were collected from an outside tap or pressure tank tap (before in-line water treatment systems where present) and after running the source for approximately 2 min. If no water treatment system was present, we also collected water samples from the indoor tap. Samples were transported on ice to the ECC–CHD laboratory, stored at <6 °C, and processed within 24 hr of collection. Nitrate samples were analyzed using Standard Method 4500D-NO3. Nitrate standards were prepared from pure potassium nitrate (Fisher Scientific). Nitrate standards and samples were treated with an interference suppressor and then analyzed with a calibrated ion-selective electrode. Target chemicals for agricultural and septic system indicators were obtained as neat standards and prepared as diluted solutions in ethyl acetate (ChemService). Samples were analyzed using modified U.S. EPA (1995) Method 507. Control spikes were prepared by addition of standard solutions to 1 L of reagent water. Method blanks consisted of 1 L reagent water. To aid in recovery, 50 g of sodium chloride was dissolved in the samples, and 1,2-dimethyl-3-nitrobenzene was added as a surrogate spike. A sample size of 1 L was drawn through a Empore C18 and an SPD-RPD extraction disk (3M). The disks were eluted first with 8 ml ethyl acetate and then with 8 ml methylene chloride. The eluant was dried with sodium sulfate powder then reduced to 5 ml volume by evaporation of the solvent over a hot plate at 100 °C until the volume was reduced to 5 ml. The extract was injected into a calibrated Trace 1300 gas chromatograph with a nitrogen–phosphorus detector to determine the sample concentration (Thermo Fisher Scientific). Both the control spikes and method blanks (one of each per batch) were processed in the same manner as the samples. Hydrocodone, acetaminophen, flumetsulam, mesotrione, saccharin, and sulfamethoxazole were evaluated as potential indicator compounds—but were not amenable to the method. Statistical Analysis A student’s t-test at the 95% confidence level was performed on dichotomous questionnaire responses to determine if the average nitrate concentration differed among sites with agricultural or septic system indicators and risk factors identified on the questionnaire. For example, the average nitrate concentration was compared at sites positive and negative for agricultural indicators to determine if herbicides and pesticides are indicators of nitrate contamination in private wells. Pearson’s correlation coefficient was used to explore associations between numerical data collected on the questionnaire. Correlation coefficients (r) > .3 and < .5 indicate a moderate correlation and r > .5 indicates a strong correlation. STATA data analysis and statistical software version 13.1 was used to perform the statistical analysis. Results Sample Demographics There were 399 eligible participants for our study. Of these, 130 households indicated interest (33% response rate) and 110 fully participated by completing the questionnaire and submitting water samples (28% response rate). A total of 108 samples were above the nitrate, agricultural, or septic system indicator detection limits; thus, we included these 108 samples in statistical analysis. Samples were collected from 10 different townships in Eau Claire County, with an additional 3 county townships having no participants. Positive samples of agricultural and septic systems were limited to 3 townships (Table 1). No agricultural or human waste indicators were found in samples from the other 7 townships. Agricultural and Septic System Indicators Agricultural indicators were identified in 15% of samples; septic system indicators were found in 5%of samples. Agricultural indicators detected were desethyl atrazine, desisopropyl atrazine, atrazine, and alachlor. Detected

10 (:7@80 • !@8-0= A D VANC EME N T O F T H E SCIENCE septic system indicators included caffeine and carbamazepine (Table 2). The most frequent agricultural indicator was desethyl atrazine (13% of samples), followed by atrazine (10% of samples). Of the 108 samples, 16 samples (15%) were positive for atrazine and/or an atrazine metabolite and 1 sample was positive for alachlor. Caffeine was the most frequent septic system indicator (4%). The four sites with caffeine detections were independent from the two sites with carbamazepine detects (the only other detected human waste indicator). Of the sites with atrazine detects, only two did not have atrazine metabolite detects. The four sites with atrazine metabolite detects did not have atrazine present in groundwater at detectable levels. Nitrate The nitrate MCL was exceeded in 24 of 108 samples (22%). The maximum detected nitrate concentration was more than double the MCL at 22 mg/L. The average nitrate concentrations in each township are shown in Figure 1. None of the agricultural or septic system indicators was above available enforcement standards. The average nitrate concentration in wells with agricultural indicators present was 10.7 mg/L, which is significantly higher at the 95% confidence level than the average nitrate concentration in wells without agricultural indicators present (6.8 mg/L; p < .0026). The median nitrate concentration was 6.7 mg/L. When comparing the average nitrate concentration in wells positive for atrazine (but no other agricultural indicators) with wells without atrazine, nitrate concentrations were significantly higher in atrazine wells (p < .0025). No statistically significant relationship was found between wells with high nitrate concentrations and presence of the septic system indicators analyzed. Nitrate Contamination Risk Factors Contrary to our hypothesis, there were weak correlations between nitrate concentration and well age (r = .08) and well depth (r = .17). Other analyzed variables with weak correlations to nitrate concentration were drillhole depth (r = .21), static water level (r = .22), and well screen length (r = .05). Well construction information was available for 39% of sampled sites. Among these sites, wells with a casing depth <12 m (40 ft) had significantly more nitrate at the 95% confidence level (p < .032). A total of 73% of households (52 households) that reported a crop within 91 m (300 ft) of the well stated the crop was corn. Discussion Agricultural and Septic System Indicators Atrazine and desethyl atrazine (an atrazine metabolite) were the most frequent agricultural indicators detected. The frequency of detection was similar to Wisconsin’s state average. Throughout Wisconsin, atrazine and atrazine metabolites are present in approximately 23% of private wells compared with 15% in our study (WI DATCP, 2017). The infrequent detection of the other agriculture and septic system indicators could be due to a variety of reasons. Atrazine is a broadleaf herbicide for agriculture, and weed control is responsible for the overwhelming majority of atrazine in the environment. Because atrazine is classified as a restricted-use pesticide, only certified applicators are permitted to purchase or apply it. Atrazine is not very persistent in surface soils after application due to biodegradation. The half-life of atrazine in soil has been reported within a range of 14–109 days. Slow or no biodegradation occurs once atrazine is in groundwater (Agency for Toxic Substances and Disease Registry, 2011). The low number of atrazine detects in groundwater for our study is likely a result of its biodegradation prior to entering the water column. Caffeine and carbamazepine were the only septic system indicators detected. Caffeine can serve as an effective indicator of groundwater contamination from septic systems because of its widespread use (Seiler et al., 1999). Caffeine might be present in wastewater as unmetabolized caffeine consumed in beverages or via disposal of unconsumed coffee, soft drinks, or tea. Of the sampled wells, four contained caffeine at detectable levels; the maximum concentration of caffeine was 0.36 µg/L, which is slightly higher than other similar studies. For example, Seiler et al. (1999) detected 0.23 µg/L of caffeine below an unsewered Nevada subdivision. Considering 100% of sampled sites in our study have septic systems, a higher number of detectable concentrations of caffeine or other wastewater indicators was expected. Caffeine Number of Samples Collected and Percentage of Samples Positive for Agricultural and Septic System Indicators, Eau Claire County Townships, Wisconsin Township Sample Size Population # of Permitted Septic and Holding Tanks Samples Positive for Agricultural Indicators # (%) Samples Positive for Septic System Indicators # (%) Bridge Creek 3 1,902 699 0 0 Brunswick 16 1,713 700 0 0 Clear Creek 1 817 331 0 0 Drammen 2 745 330 0 0 Lincoln 3 1,186 444 0 0 Ludington 1 1,096 479 0 0 Pleasant Valley 27 3,181 1,355 6 (22) 3 (11) Seymour 8 3,276 1,299 0 0 Union 14 2,736 1,071 10 (71) 1 (7) Washington 29 7,379 2,278 1 (3) 2 (7) Note. Population numbers were calculated from 2013–2017 U.S. Census Bureau estimates. TABLE 1

July/August 2022 • Journal of Environmental Health 11 is highly biodegradable in soils with strong microbiological communities, however, and is known to sorb to sandy loam and silt loam soils, which are present in Eau Claire County (Karnjanapiboonwong et al., 2010; Knee et al., 2010) and might reduce the presence of caffeine in groundwater. Conversely, carbamazepine does not degrade or sorb and can survive intact in groundwater for >8 years (Clara et al., 2004; Drewes et al., 2003). These properties make carbamazepine a good option for a wastewater tracer. Carbamazepine, however, is much less ubiquitous in septic systems compared to caffeine due to its overall lower rate of consumption. Seiler et al. (1999) found 1 positive sample for carbamazepine in 16 samples from unsewered subdivisions. Out of 38 groundwater sampling locations in western Montana, 11 locations contained detectable carbamazepine with a maximum concentration of 0.42 µg/L (Miller & Meek, 2006) in comparison with a maximum 0.85 µg/L found in our study. The relatively low detection rates of caffeine and pharmaceuticals do not confirm that a well has not been impacted by septic effluent, though, especially given the transMaximum Concentrations, Frequency, and Detection Limits for the Analysis of Agricultural and Septic System Indicators and Nitrate, Eau Claire County, Wisconsin Indicator Chemical Chemical Purpose Detection Limit (μg/L) Maximum Concentration Detected (μg/L) MCL (μg/L) # of Detects Agricultural Desethyl atrazine Atrazine metabolite 0.2 0.49 NA 14 Desisopropyl atrazine Atrazine metabolite 0.2 0.42 NA 3 Atrazine Herbicide 0.1 0.49 3 11 Acetochlor Herbicide 0.2 ND NA 0 Alachlor Herbicide 0.2 0.28 2 1 Metolachlor Herbicide 0.2 ND NA 0 Cyanazine Herbicide 0.1 ND NA 0 Septic system Caffeine Stimulant 0.2 0.36 NA 4 Carbamazepine Anticonvulsant 0.3 0.85 NA 2 Carisoprodol Muscle relaxant 0.3 ND NA 0 Nitrate Fertilizer, waste product 0.41 mg/L 22 mg/L 10 mg/L 108 Note. MCL = maximum contaminant level; NA = not applicable; ND = not detected. TABLE 2 Average Nitrate Concentrations in Private Wells, Eau Claire County Townships, Wisconsin Note. No township’s average nitrate concentration in private wells exceeded the U.S. Environmental Protection Agency (U.S. EPA) maximum contaminant level (MCL) for nitrate of 10 mg/L. 6.1 6.7 4.0 7.6 7.1 9.3 9.8 5.1 8.4 5.5 0 2.0 4.0 6.0 8.0 10.0 12.0 Bridge Creek Brunsw ick Clear Creek D rammen L incoln L udington P leasant V alley Seymour Union W ashington A v erage N it rat e C oncent rat ion (mg/L ) T ow ns hip U . S. EPA N it rat e MC L (10. 0 mg/L ) FIGURE 1

12 (:7@80 • !@8-0= A D VANC EME N T O F T H E SCIENCE port barriers of caffeine and potential sporadic use of the pharmaceuticals. In future studies, better indicators of septic system impacts might be a) other chemicals that are less biodegradable and ubiquitous or b) pharmaceutical metabolites. Nitrate Across Wisconsin as a whole, 10–11% of private wells on average are above the nitrate MCL (LeMasters & Baldock, 1997; WI DATCP, 2017). Even though the sample population in our study contained wells known to have at least ≥5 mg/L nitrate, the percentage of samples above the U.S. EPA nitrate MCL for drinking water (10 mg/L) that we found (22%) is similar to what other regional studies found. In areas with abundant agriculture in Wisconsin, much like Eau Claire County, 17–26% of private wells contain nitrate above the U.S. EPA MCL (LeMasters & Baldock, 1997). In nearby Hastings, Minnesota, researchers found 25% of private and public drinking water wells had nitrate concentrations above the U.S. EPA MCL (Hastings is 140 km west of Eau Claire County) and deemed these findings as a water quality “problem” for the area (Dakota County Environmental Management, 2003). For existing private wells in Eau Claire County with nitrate tests >10 mg/L, homeowners are notified and point-of-use or whole-house system installation is recommended by ECC–CHD. Nitrate testing of private wells in Eau Claire County, however, is not required, and there is no funding to help homeowners purchase point-of-use treatment systems. Results from a statewide study found that 70% of Wisconsin homeowners did not take action to reduce nitrate drinking water exposures (Knobeloch et al., 1997). Among the homeowners who did take action in our study population, the most common solutions were purchasing bottled water and installing a point-of-use nitrate treatment system. The average cost of purchasing bottled water or installing a point-of-use treatment system at the time of the Knobeloch et al. (1997) study was $200/year and $850/year, respectively. Present-day estimates for bottled water (1 gallon/day) are approximately $475/person/ year. Reverse osmosis systems are available currently for a one-time cost of at least $200 plus the cost of installation and replacement filters (additional annual cost estimate of $50– $120, depending on usage), for a total cost of $250–$320. The cost of these mitigation options could be prohibitive for some county residents. To make access to safe, clean drinking water more equitable, affordable nitrate mitigation resources should be made available and advertised to households in areas with nitrate well water levels ≥10 mg/L. Considering the time, effort, and environmental impact of purchasing bottled water, the cost of installing and maintaining a point-of-use treatment system is the preferable option for households. The efficacy of a private well nitrate remediation program that would offer and aggressively advertise nitrate remediation options to homeowners with well water at or above the U.S. EPA nitrate MCL should be tested in an area that is experiencing nitrate contamination issues (like Eau Claire County). There is also a need for prioritizing education and outreach about the importance of monitoring nitrate levels in at-risk private wells (i.e., 5–9 mg/L nitrate). Nitrate Contamination Risk Factors The significantly higher average nitrate concentration in wells with agricultural indicators suggests agriculture is a source of nitrate contamination in private wells in Eau Claire County. Although studies have demonstrated that nitrate from septic system effluent is a contributor to poor well water quality (Shaw, 1994), our findings do not suggest septic systems are a significant source of nitrate in Eau Claire County. Other studies have also indicated that agriculture is the primary source of nitrate contamination compared with septic systems (Chern et al., 1999). Casing depth was the only risk factor associated with elevated nitrate. Previous research indicates wells with casings less than 12.2 m (40 ft) have significantly more nitrate (Bundy et al., 1996), which is consistent with our study. Well age and depth had been previously identified as nitrate contamination risk factors but did not correlate with nitrate contamination in our study (Dakota County Environmental Management, 2003). The sandy soil, heavy agriculture, and thick sandstone aquifers allow for rapid and deep infiltration of water and water-soluble contaminants. This process and the increased likelihood of denitrification or lower nitrate concentrations in older groundwater at depth (Böttcher et al., 1990; Kraft et al., 2004) are the most likely explanation for higher concentrations of nitrate in wells with shallow casing. Many of the wells for which records were available (n = 43) are constructed as open boreholes, with highly variable distances between the bottom of the borehole and bottom of the casing (0 up to 48.2 m [158 ft]) borehole depth below casing, median of 5.1 m (17 ft). This finding could explain the lack of correlation between nitrate concentration and well borehole depth in our study. Conclusion The frequency of samples with nitrate concentrations above the drinking water MCL in our study is similar to other regional studies where water quality was declared problematic. Agriculture appears to be the primary source of nitrate contamination of private wells in Eau Claire County. Solutions presented to resolve the nitrate problem in Wisconsin have traditionally focused on reducing nitrate fertilizer overuse on crops. Although this strategy is an important part of the solution, direct action is needed to protect homeowners from the adverse health effects associated with consuming water with nitrate ≥10 mg/L. As most Wisconsin homeowners (70%) do not take action to reduce nitrate exposures from drinking contaminated well water (Knobeloch et al., 1997), local public health authorities must develop and implement interventions. Funds should be allocated to public health authorities in Eau Claire County or other areas experiencing similar nitrate contamination issues to promote and subsidize point-of-use drinking water treatment systems in homes with nitrate levels ≥10 mg/L. The efficacy of this approach could be studied as a pilot for other areas experiencing a similar rate of nitrate contamination in private well water. As casing depth was the only risk factor to have an association with nitrate contamination, private wells should be constructed with a casing depth greater than 12 m (40 ft) where possible to avoid infiltration of nitrate and other contaminants. Acknowledgements: Funding for this work was provided by the State of Wisconsin Groundwater Research fund and was administered by WI DNR. We thank the following individuals for their contributions to

July/August 2022 • :@=9,7 :1 9A4=:9809?,7 0,7?3 13 the project: Matt Steinbach and Greg Leonard (administrative support and advisors); Jenna Ouradnik, Breanna Rheinschmidt, and Dexter Zebro (student interns and technicians); Megan Ballweg, Danielle Bredehoeft, Olivia Feider, Rachel Kennedy, Jacob Kentnich, Mitchell Vandenmeerendonk, Victoria Vouk, Tyler Wendt, and Ka Yang (sampling assistants); and Jill V. Trescott, groundwater protection supervisor with Dakota County Environmental Resources Department and coauthor of the Hastings Area Nitrate Study. Corresponding Author: Laura M. Suppes, Associate Professor, Environmental Public Health, University of Wisconsin–Eau Claire, 105 Garfield Avenue, Eau Claire, WI 54702. Email: Agency for Toxic Substances and Disease Registry. (2011). Toxicological profile for atrazine. ToxProfiles.aspx?id=338&tid=59 Al-Qudah, K.M., Rousan, L.M., & Ereifej, K.I. (2009). Nitrate/ nitrite poisoning in dairy cattle associated with consumption of forages irrigated with municipally treated wastewater. Toxicological and Environmental Chemistry, 91(1), 163–170. https://doi. org/10.1080/02772240802051205 Böttcher, J., Strebel, O., Voerkelius, S., & Schmidt, H.-L. (1990). Using isotope fractionation of nitrate-nitrogen and nitrateoxygen for evaluation of microbial denitrification in a sandy aquifer. Journal of Hydrology, 114(3–4), 413–424. https://doi. org/10.1016/0022-1694(90)90068-9 Bundy, L.G., Knobeloch, L., Webendorfer, B., Jackson, G.W., & Shaw, B.H. (1996). Nitrate in Wisconsin groundwater: Sources and concerns (Publication no. G3054). https://adams.extension.wisc. edu/files/2015/09/Nitrates-Sources-and-Concerns.pdf Burow, K.R., Shelton, J.L., & Dubrovsky, N.M. (1998). Occurrence of nitrate and pesticides in ground water beneath three agricultural land-use settings in the eastern San Joaquin Valley, California, 1993– 1995 (Water-Resources Investigations Report 97-4284). U.S. Geological Survey. Chern, L., Kraft, G., & Postle, J. (1999). Nitrate in groundwater—A continuing issue for Wisconsin citizens. Nutrient Management Subcommittee of the Nonpoint Source Pollution Abatement Program Redesign. Clara, M., Strenn, B., & Kreuzinger, N. (2004). Carbamazepine as a possible anthropogenic marker in the aquatic environment: Investigations on the behaviour of Carbamazepine in wastewater treatment and during groundwater infiltration. Water Research, 38(4), 947–954. Dakota County Environmental Management. (2003). Hastings Area Nitrate Study: Final report. ment/WaterResources/WellsDrinkingWater/Documents/Hastings AreaNitrateStudy.pdf Drewes, J.E., Heberer, T., Rauch, T., & Reddersen, K. (2003). Fate of pharmaceuticals during ground water recharge. Groundwater Monitoring & Remediation, 23(3), 64–72. https://doi. org/10.1111/j.1745-6592.2003.tb00684.x Istok, J.D., Smyth, J.D., &Flint, A.L. (1993). Multivariate geostatistical analysis of ground-water contamination: A case history. Groundwater, 31(1), 63–74. tb00829.x Karnjanapiboonwong, A., Morse, A.N., Maul, J.D., & Anderson, T.A. (2010). Sorption of estrogens, triclosan, and caffeine in a sandy loam and silt loam soil. Journal of Soils and Sediments, 10(7), 1300–1307. Knee, K.L., Gossett, R., Boehm, A.B., & Paytan, A. (2010). Caffeine and agricultural pesticide concentrations in surface water and groundwater on the north shore of Kauai (Hawaii, USA). Marine Pollution Bulletin, 60(8), 1376–1382. marpolbul.2010.04.019 Knobeloch, L., Anderson, H., Warzecha, C., Kanarek, M., & Schubert, C. (1997). Nitrate-contaminated drinking water followback study (DNR Project #131). Wisconsin Department of Natural Resources. marydnr131.pdf Kraft, G.J., Browne, B.A., DeVita, W.M., & Mechenich, D.J. (2004). Nitrate andpesticide residue penetration intoaWisconsinCentral Sand Plain aquifer. College of Natural Resources, University of Wisconsin–Stevens Point. uments/penetration_sandplain.pdf LeMasters, G., & Baldock, J. (1997). A survey of atrazine in Wisconsin groundwater (Publication no. 26a). Wisconsin Department of Agriculture, Trade, and Consumer Protection—Agricultural Resource Management Division. Miller, K.J., & Meek, J. (2006). Helena Valley ground water: Pharmaceuticals, personal care products, endocrine disruptors (PPCPs), and microbial indicators of fecal contamination (Montana Bureau of Mines and Geology Open-File Report 532). Montana Department of Environmental Quality. pdf-open-files/mbmg532-helenavalley.pdf Rothschild, E.R., Manser, R.J., & Anderson, M.P. (1982). Investigation of aldicarb in ground water in selected areas of the Central Sand Plain of Wisconsin. Groundwater, 20(4), 437–445. https:// Seiler, R.L., Zaugg, S.D., Thomas, J.M., & Howcroft, D.L. (1999). Caffeine and pharmaceuticals as indicators of waste water contamination in wells. Groundwater, 37(3), 405–410. https://doi. org/10.1111/j.1745-6584.1999.tb01118.x Shaw, B. (1994). Nitrogen contamination sources: A look at relative contributions. In Conference proceedings—Nitrate in Wisconsin’s groundwater: Strategies and challenges (pp. 19–24). University of Wisconsin–Stevens Point. shed/Documents/nitrogen_conferenceproceedings.pdf References continued on page 14

14 (:7@80 • !@8-0= ( ! ! & " & SCIENCE Spalding, R.F.,&Exner,M.E. (1993). Occurrence of nitrate in groundwater—A review. Journal of Environmental Quality, 22(3), 392– 402. U.S. Environmental Protection Agency. (1995). Method 507: Determination of nitrogen- and phosphorus-containing pesticides in water by gas chromatography with a nitrogen-phosphorus detector (Revision 2.1). U.S. Geological Survey. (1999). The quality of our nation’s waters— Nutrients and pesticides (USGS Circular 1225). https://pubs.usgs. gov/circ/circ1225/pdf/front.pdf Wisconsin Department of Agriculture, Trade, and Consumer Protection. (2017). Wisconsin groundwater quality: Agricultural chemicals in Wisconsin groundwater. GroundwaterReport2017.pdf References continued from page 13 The NEHA Endowment Foundation was established to enable NEHA to do more for the environmental health profession than its annual budget might allow. Special projects and programs supported by the foundation will be carried out for the sole purpose of advancing the profession and its practitioners. Individuals who have contributed to the foundation are listed below by club category. These listings are based on what people have actually donated to the foundation—not what they have pledged. Names will be published under the appropriate category for 1 year; additional contributions will move individuals to a different category in the following year(s). For each of the categories, there are a number of ways NEHA recognizes and thanks contributors to the foundation. If you are interested in contributing to the Endowment Foundation, please call NEHA at (303) 756-9090. You can also donate online at Thank you. %'##"$& DELEGATE CLUB ($1–$99) Name in the Journal for 1 year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–$499) Letter from the NEHA president and name in the Journal for 1 year. 0990?3 ,9407>:9 4.3070 4 ,224: 9, --0=? 990??0 >307-D ,=:7D9 =,D 4.3,07 ,76: :99, 0=,9 D,6, @-: ,@ #3474; 020= %,9/=, :92 ,80> ,.6 $:-0=? ,2740A,E :39 ,=.077: )09/077 ::=0 (4.?:=4, @==,D %@>,9 ( #,==4> ,==D $,8/49 :9,?3,9 # $@-4923 :>0;3 ) $@>>077 4.3H70 %,8,=D, &488 (4.640 %.370@9492 ,=4: %0849,=, :>3@, $ %6022> :=:?3D %:=,99: ,.<@07490 &,D7:= 49/, (,9 :@?09 &:8 (D70> 4>, )34?7:.6 21st CENTURY CLUB ($500–$999) Name submitted in drawing for a free 1-year NEHA membership and name in the Journal for 1 year. & %?0;309 :90> !0/ &30=409 0:9 (49.4 SUSTAINING MEMBERS CLUB ($1,000–$2,499) Name submitted in drawing for a free 2-year NEHA membership and name in the Journal for 1 year. ,80> ,7>,8: = =4,9 :7749> 0:=20 :==4> #0?0= %,9>:90 #0?0= %.384?? ,80> %;0.63,=? AFFILIATES CLUB ($2,500–$4,999) Name submitted in drawing for a free AEC registration and name in the Journal for 1 year. $:-0=? ) @>?,=/ &48:?3D ! ,?.3 )071:=/ $:-0=?> EXECUTIVE CLUB AND ABOVE (>$5,000) Special invitation to the AEC President’s Reception and name in the Journal for 1 year. (49.09? $,/60 THE NEHA ! ") !& "'! & "!