Chronic arsenic exposure is associated with adverse health outcomes, and early life exposure is particularly damaging. Households with pregnant people and young children drinking from unregulated wells in arsenic-prevalent regions are therefore a public health priority for outreach and intervention. A partnership between Columbia University, New Jersey government partners, and Hunterdon Healthcare has informed Hunterdon County residents of the risks faced from drinking arsenic-contaminated water and offered free well testing through a practice-based water test kit distribution and an online patient portal outreach. Encouraged by those successes, Hunterdon Healthcare incorporated questions about drinking water source and arsenic testing history into the electronic medical record (EMR) template used by most primary care practices in Hunterdon County. The new EMR fields allow for additional targeting of risk-based outreach and water test kit distribution, offering promising new opportunities for public health and environmental medicine outreach, surveillance, and research.

The Newark Basin comprises Late Triassic and Early Jurassic fluvio-lacustrine rocks (Stockton, Lockatong, Passaic, Feltville, Towaco, and Boonton Formations) and Early Jurassic diabase intrusions and basalt lava flows. Boron concentrations in private well water samples range up to 18,000 μg/L, exceeding the U.S. Environmental Protection Agency Health Advisory of 2000 μg/L for children and 5000 μg/L for adults. Boron was analyzed in minerals, rocks, and water samples using FUS-ICPMS, LA-ICP-MS, and MC ICP-MS, respectively. Boron concentrations reach up to 121 ppm in sandstone of the Passaic Formation, 42 ppm in black shale of the Lockatong Formation, 31.2 ppm in sandstone of the Stockton Formation, and 36 ppm in diabase. The δ11B isotopic values of groundwater range from 16.7 to 32.7‰, which fall within those of the diabase intrusion (25 to 31‰). Geostatistical analysis using Principal Component Analysis (PCA) reveals that boron is associated with clay minerals in black shales and with Na-bearing minerals (possibly feldspar and evaporite minerals) in sandstones. The PCA also shows that boron is not associated with any major phases in diabase intrusion, and is likely remobilized from the surrounding rocks by the intrusion-related late hydrothermal fluids and subsequently incorporated into diabase. Calcite veins found within the Triassic rock formations exhibit relatively elevated concentrations ranging from 6.3 to 97.3 ppm and may contain micro-inclusions rich in boron. Based on the available data, it is suggested that the primary sources of boron contaminating groundwater in the area are clay minerals in black shales, Na-bearing minerals in sandstone, diabase intrusion-related hydrothermal fluids, and a contribution from calcite veins.

Observation of arsenic water treatment adsorption media in the treated water of several homes with high arsenic private wells led to the hypothesis that treatment media was escaping the treatment systems and entering the plumbing and drinking water. Our research at 62 homes identified that microparticles of arsenic water treatment media and/or water softener resin had escaped the treatment system in 71% of the homes. This is a potential health hazard as ingesting arsenic treatment media or water softener resin may lead to an elevated ingestion exposure to arsenic and other contaminants. Potential causes of media escape from the treatment systems include media observed to be smaller in size than specifications and media breaking into smaller pieces. One interim solution to media escape is installation of a post-treatment sediment filter. New developments in media durability or treatment system design and maintenance may be needed to prevent media escaping into drinking water.Practitioner Points Arsenic in private wells is often treated with point-of-entry whole house adsorption systems. Arsenic adsorption treatment media and/or water softener resin was observed in treated water at 44 of 62 homes inspected. Water treatment media escaping into treated water is a potential hazardous exposure pathway. Potential causes and solutions are discussed. Investigation at 62 homes with high arsenic private wells identified that microparticles of arsenic water treatment media and/or water softener resin had escaped the treatment system and entered drinking water in 71% of the homes. Ingestion of these microparticles may lead to an elevated exposure to arsenic and other contaminants. image

Context: When the New Jersey Private Well Testing Act (PWTA) became effective in 2002, the maximum contaminant level (MCL) for arsenic in the United States was 50 μg/L. In 2006, the federal and New Jersey MCLs were lowered to 10 μg/L and 5 μg/L, respectively. Objective: To notify and provide free arsenic water testing for homeowners who had a PWTA arsenic result that passed for the MCL in 2006 or earlier but would exceed under the more health protective MCL enacted in 2006, which is still in effect as of this publication date. Design: About 1200 homeowners with PWTA arsenic results between 5 μg/L and 50 μg/L were offered free arsenic water testing. More than 400 homeowners requested tests and 292 returned samples. Setting: New Jersey, United States. Participants: Homeowners with a passing PWTA arsenic result before 2006 that would have failed under the New Jersey arsenic MCL enacted in 2006. Main Outcome Measures: Return rate of testing kits; number of tests exceeding arsenic MCL; and participant survey results. Results: Untreated well water samples (n = 279) were collected and 62.4% exceeded the New Jersey MCL. Treated well water samples (n = 102) were collected and 11.8% exceeded the current New Jersey MCL. In all, about 40% of drinking water samples from the tap, including those with or with no arsenic treatment, exceeded the New Jersey MCL. A survey of participants (n = 69) found that although many (67%) respondents reported that they at least had some idea that wells in their area are vulnerable to naturally occurring contaminants, such as arsenic, many (68%) reported that they had little or no idea that the New Jersey arsenic MCL had been lowered from 50 μg/L to 5 μg/L in 2006. Conclusions: This effort further illuminates the necessity and significance of public health outreach for private well water users, especially after drinking water standards change.

Gross alpha, a measurement of radioactivity in drinking water, is the most frequent laboratory test to exceed primary drinking water standards among wells tested under the New Jersey Private Well Testing Act (NJ PWTA). Certain geological factors prevalent in New Jersey (NJ) are primarily responsible for the presence of radioactivity in private well drinking water and thus, many of the estimated one million private well users in NJ may be at-risk of water contamination from naturally occurring radionuclides. Neighbor-based private well outreach methodology was utilized to identify high risk wells in both northern and southern NJ regions and offer free private well testing for radionuclides. Previously tested wells with gross alpha exceeding or equal to 3.7 becquerels per liter (Bq L-1; 100 pCi/L) were selected (n = 49) to identify neighbors (n = 406) within 152.4 m (500 feet). Invitation letters were mailed to selected neighbors and some of the previously tested high wells (n = 12) offering free water sampling for the following parameters: gross alpha (48-hour rapid test), combined radium-226 and radium-228 (Ra-226 + Ra-228), uranium-238 (U-238), radon-222 (Rn-222) and iron. Overall, 70 neighbors and 5 high PWTA wells participated in this free water testing opportunity. For neighboring wells, gross alpha results revealed 47 (67.1%) wells exceeding the gross alpha MCL of 0.555 Bq L-1 (15 pCi/L) mainly due to radium activity in the raw/untreated water. Of those with water treatment (n = 62), 12 (19.4%) treated water samples exceeded the gross alpha MCL. Targeting neighbors of known highly radioactive wells for private well testing is an effective public health outreach method and can also provide useful insight of regional contaminant variations.

Over 1 million people in New Jersey (NJ) are estimated to receive drinking water from private wells. The most commonly detected contaminants in NJ private well water are naturally occurring arsenic and gross alpha (8.3 and 10.9%, respectively). Between 2015 and 2018, three free and voluntary private well testing events tested a total of 571 at-risk wells and 226 (40%) were identified as having one or more contaminants exceeding drinking water standards. Participants were invited to complete a survey to evaluate household characteristics, participant experience, and private well stewardship behavior patterns. Of 529 delivered surveys, 211 (40%) participants completed surveys. Among respondents, 63% reported plans to test their private wells in the future. Among failed wells, 45% of households reported performing mitigative action in response to the event, either through the installation of water treatment system or switching to bottled water. The survey evaluation identified previous knowledge of well contamination risks and discussing test results with a third party as important factors for promoting self-reported stewardship behavior. The evaluation provides guidance for outreach organizers to develop effective testing events and further considers the private well owners' experience of the outreach events to identify information for ‘best practices’ and improvements of future programs.

Arsenic, a known human carcinogen, can be removed from drinking water through various processes including adsorption, ion exchange, and membrane technologies. Based on observation of water treatment media in the tap water of several homes, it was hypothesized that treatment media may be escaping the treatment systems and entering the plumbing and water system of homes. In a sample of 62 homes, media breakthrough was observed in 44 (71%). This is a potential health hazard as ingesting arsenic and other treatment media may lead to an elevated ingestion exposure to arsenic and other contaminants. This is the first study to document this occurrence. A short-term potential solution to media breakthrough is to install a 5-micron post-treatment sediment filter, but it is imperative that further research be conducted to ensure this solution completely mitigates the problem. Over the long-term, new developments in both media durability and treatment system design should be sought to prevent media escaping into drinking water.

Arsenic and boron can naturally occur in well water and chronic exposure to both is associated with a wide variety of health effects. In 2016, two New Jersey townships were targeted for a school-based outreach and testing event because the population relies on private well water for potable use, the aquifer is known to be at risk for arsenic and boron contamination, and young children are particularly vulnerable. Within 1 week, 376 homes submitted water samples. The results showed 94 homes (25%) exceeded the New Jersey arsenic maximum contaminant level and 18 homes (5%) exceeded the U.S. Environmental Protection Agency boron health advisory for children. A short survey attached to sample bottles provided information about reasons for testing and asked if a treatment method was installed. School-based recruitment for private well testing was an efficient public health outreach method to quickly obtain many private well samples and is a promising model for future private well outreach.

Households with pregnancies and young children are a priority group for outreach on private well water screening due to the widespread occurrence and toxicity of common groundwater contaminants such as arsenic. Given the trusted role of health care providers as communicators of health risk, Columbia University investigators and New Jersey government partners collaborated with Hunterdon Healthcare to offer free well testing to residents of Hunterdon County, a hot spot for naturally occurring arsenic in New Jersey. Through practice-based test kit distribution and online patient portal messages, supported by a public multimedia campaign, we tested 433 private wells and alerted 50 families about elevated arsenic found in their drinking water. These health care-facilitated outreach strategies allowed for targeting based on geographic and demographic risk and suggested opportunities to better leverage communication channels, such as incorporating questions on home water source into the electronic medical record.

Research into precautionary action suggests outreach with personally-relevant risk information may help overcome optimistic biases, which have been shown to impede voluntary testing for arsenic by at-risk private well households. Since 2002, New Jersey's Private Well Testing Act (PWTA) has required testing for arsenic during real estate transactions. The PWTA database of over 35,000 geocoded well arsenic tests offers a unique opportunity to evaluate the efficacy of targeted outreach to neighbors living in proximity to a known high arsenic well with variable risk messaging to motivate testing. In this study, residents of properties (n = 1743) located within 500 ft and between 500 and 1000 ft of a known high arsenic well (>5 μg/L, New Jersey's drinking water arsenic standard) were mailed a notice of the high arsenic result in their neighborhood and offered a free water test. Overall 274 households (16%) requested a test kit and 230 (13%) ultimately submitted a water sample; with significantly higher participation rates among those told their neighborhood well had an arsenic concentration "over 5 times higher" than the standard, compared to those told the concentration was "above." Overall, 25% of wells tested (n = 230), and 47% (n = 66) of non-treated wells located within 500 ft of a well with >25 μg/L arsenic, exceeded the standard for arsenic. Both the arsenic concentration and distance to the neighboring well were significant predictors of exceedance. Given the high proportion of previously untested wells (70%) and their owners' lack of awareness of arsenic in their area (80%), this targeting approach succeeded not only in identifying a much higher proportion of at risk wells than blanket testing by town or county, but also in motivating testing among households unreached by prior awareness-raising activities. In conclusion, geographically and personally-relevant risk targeted messaging and outreach are both efficient and effective.

Over 2 million mostly rural Americans are at risk of drinking water from private wells that contain arsenic (As) exceeding the U.S. Environmental Protection Agency (USEPA) Maximum Contaminant Level (MCL) of 10 micrograms per liter (μg/L). How well existing treatment technologies perform in real world situations, and to what extent they reduce health risks, are not well understood. This study evaluates the effectiveness of household As treatment systems in southern-central Maine (ME, n = 156) and northern New Jersey (NJ, n = 94) and ascertains how untreated well water chemistry and other factors influence As removal. Untreated and treated water samples, as well as a treatment questionnaire, were collected. Most ME households had point-of-use reverse-osmosis systems (POU RO), while in NJ, dual-tank point-of-entry (POE) whole house systems were popular. Arsenic treatment systems reduced well water arsenic concentrations ([As]) by up to two orders of magnitude, i.e. from a median of 71.7 to 0.8 μg/L and from a mean of 105 to 14.3 μg/L in ME, and from a median of 8.6 to 0.2 μg/L and a mean of 15.8 to 2.1 μg/L in NJ. More than half (53%) of the systems in ME reduced water [As] to below 1 μg/L, compared to 69% in NJ. The treatment system failure rates were 19% in ME (>USEPA MCL of 10 μg/L) and 16% in NJ (>NJ MCL of 5 μg/L). In both states, the higher the untreated well water [As] and the As(III)/As ratio, the higher the rate of treatment failure. POE systems failed less than POU systems, as did the treatment systems installed and maintained by vendors than those by homeowners. The 7-fold reduction of [As] in the treated water reduced skin cancer risk alone from 3765 to 514 in 1 million in ME, and from 568 to 75 in 1 million in NJ.

Exposure to naturally occurring arsenic in groundwater is a public health concern, particularly for households served by unregulated private wells. At present, one of the greatest barriers to exposure reduction is a lack of private well testing due to difficulties in motivating individual private well owners to take protective actions. Policy and regulations requiring testing could make a significant contribution towards universal screening of private well water and arsenic exposure reduction. New Jersey's Private Well Testing Act (PWTA) requires tests for arsenic during real estate transactions; however, the regulations do not require remedial action when maximum contaminant levels (MCLs) are exceeded. A follow-up survey sent to residents of homes where arsenic was measured above the state MCL in PWTA-required tests reveals a range of mitigation behavior among respondents (n = 486), from taking no action to reduce exposure (28%), to reporting both treatment use and appropriate maintenance and monitoring behavior (15%). Although 86% of respondents recall their well was tested during their real estate transaction, only 60% report their test showed an arsenic problem. Treatment systems are used by 63% of households, although half were installed by a previous owner. Among those treating their water (n = 308), 57% report that maintenance is being performed as recommended, although only 31% have tested the treated water within the past year. Perceived susceptibility and perceived barriers are strong predictors of mitigation action. Among those treating for arsenic, perceived severity is associated with recent monitoring, and level of commitment is associated with proper maintenance. Mention of a treatment service agreement is a strong predictor of appropriate monitoring and maintenance behavior, while treatment installed by a previous owner is less likely to be maintained. Though the PWTA requires that wells be tested, this study finds that not all current well owners are aware the test occurred or understood the implications of their arsenic results. Among those that have treatment installed to remove arsenic, poor monitoring and maintenance behaviors threaten to undermine intentions to reduce exposure. Findings suggest that additional effort, resources, and support to ensure home buyers pay attention to, understand, and act on test results at the time they are performed may help improve management of arsenic water problems over the long term and thus the PWTA's public health impact.

Arsenic, a known human carcinogen, occurs naturally in groundwater in New Jersey and many other states and countries. A number of municipalities in the Piedmont, Highlands, and Valley and Ridge Physiographic Provinces of New Jersey have a high proportion of wells that exceed the New Jersey maximum contaminant level (MCL) of 5 µg/L. Hopewell Township, located in Mercer County and the Piedmont Province, has a progressive local ordinance which requires the installation of dual-tank, point-of-entry treatment systems on affected wells.Thisprovided a unique study opportunity. Of the 55 homes with dual-tank POE treatment systems recruited into this study, 51 homes (93%) had arsenic levels under the MCL at the kitchen sink, regardless of years in service and/or maintenance schedule adherence. Based on the study participants' water consumption and arsenic concentrations, we estimate that Hopewell's arsenic water treatment ordinance, requiring POE dual-tank arsenic treatment, reduced the incidence of excess lifetime (70-year) bladder and lung cancers from 121 (1.7 cancer cases/year) to 16 (0.2 cancer cases/year) preventing 105 lifetime cancer cases (1.5 cases/year). Because the high risk of cancer from arsenic can be mitigated with effective arsenic water treatment systems, this ordinance should be considered a model for other municipalities.

Arsenic, a toxic element naturally found in groundwater, is a public health concern for households drinking from wells. Private well water is not regulated to meet the federal drinking water arsenic Maximum Contaminant Level (MCL) of 10μg/L, or the more protective 5μg/L New Jersey (NJ) state MCL. In the absence of consistent private well regulation, public health efforts have relied on promoting testing in affected communities to various degrees of success. Few interventions publish results, and more often focus on the outcome of tested wells rather than who completed a test, and more importantly, who did not. Through our survey of randomly selected addresses (n=670) in 17 NJ towns we find higher rates of arsenic testing in areas with a history of testing promotion. However, we also see a stronger correlation of testing behavior with income and education in high promotion areas, suggesting that community engagement activities may be exacerbating socioeconomic status (SES) testing disparities. Well owners with a bachelor's degree had ten times greater odds of participating in our direct mail testing intervention than those with less education when tests cost $40. After all households (n=255) were offered free tests to overcome many of the usual testing barriers - awareness, convenience, and cost - only 47% participated and those who chose to return water samples were of higher income and education than those who did not. Our findings highlight that while efforts to promote and provide arsenic testing succeed in testing more wells, community testing interventions risk increasing SES disparities if those with more education and resources are more likely to take advantage of testing programs. Therefore, testing interventions can benefit by better targeting socially vulnerable populations in an effort to overcome SES-patterned self-selection when individuals are left alone with the responsibility of managing their drinking water quality.

Arsenic is a naturally occurring toxic element often concentrated in groundwater at levels unsafe for human consumption. Private well water in the United States is mostly unregulated by federal and state drinking water standards. It is the responsibility of the over 13 million U.S. households regularly depending on private wells for their water to ensure it is safe for drinking. There is a consistent graded association with health outcomes at all levels of socioeconomic status (SES) in the U.S. Differential exposure to environmental risk may be contributing to this persistent SES-health gradient. Environmental justice advocates cite overwhelming evidence that income and other SES measures are consistently inversely correlated with exposure to suboptimal environmental conditions including pollutants, toxins, and their impacts. Here we use private well household surveys from two states to investigate the association between SES and risks for arsenic exposure, examining the potentially cumulative effects of residential location, testing and treatment behavior, and psychological factors influencing behavior. We find that the distribution of natural arsenic hazard in the environment is socioeconomically random. There is no evidence that higher SES households are avoiding areas with arsenic or that lower SES groups are disproportionately residing in areas with arsenic. Instead, disparities in exposure arise from differing rates of protective action, primarily testing well water for arsenic, and secondly treating or avoiding contaminated water. We observe these SES disparities in behavior as well as in the psychological factors that are most favorable to these behaviors. Assessment of risk should not be limited to the spatial occurrence of arsenic alone. It is important that social vulnerability factors are incorporated into risk modeling and identifying priority areas for intervention, which should include strategies that specifically target socioeconomically vulnerable groups as well as all the conditions which cause these disparities in testing and treatment behavior.

Regularly ingesting water with elevated arsenic increases adverse health risks. Since September 2002, the NJ Private Well Testing Act (PWTA) has required testing untreated well water for arsenic during real estate transactions in 12 counties. Its implementation provides an opportunity to investigate the effects of policy intervention on well testing and treatment behavior. Here we analyze results of a survey mailed to 1943 random addresses (37% response), including responses from 502 private well households who purchased their homes prior to PWTA commencement and 168 who purchased after. We find the PWTA has significantly increased arsenic testing rates in an area where 21% of wells contain arsenic above the 5μg/L NJ drinking water standard. The PWTA has allowed identification of more wells with arsenic (20% of post-PWTA vs. 4% of pre-PWTA households) and more treatment for arsenic (19% of post-PWTA vs. 3% of pre-PWTA households). Such an Act is a partial answer to significant socioeconomic disparities in testing observed among households for whom it is not required. Additionally residents purchasing homes since 2002 are younger and disproportionately more likely to have children in their household (60% vs. 32%), a priority group given their particular vulnerability to effects of arsenic. Despite more wells tested under the PWTA, post-PWTA well owners forget or misremember arsenic test results more often, are more likely to report not knowing what kind of treatment they are using, and are not reporting better maintenance or monitoring of their treatment systems than pre-PWTA households. This suggests serious challenges to reducing arsenic exposure remain even when testing is a requirement. Furthermore, only a fraction of wells have been tested under the PWTA due to the slow pace of housing turnover. We recommend more public resources be made available to support private well testing among socially and biologically vulnerable groups.

A comparison of the effectiveness of whole house (point-of-entry) and point-of-use arsenic water treatment systems in reducing arsenic exposure from well water was conducted. The non-randomized observational study recruited 49 subjects having elevated arsenic in their residential home well water in New Jersey. The subjects obtained either point-of-entry or point-of-use arsenic water treatment. Prior ingestion exposure to arsenic in well water was calculated by measuring arsenic concentrations in the well water and obtaining water-use histories for each subject, including years of residence with the current well and amount of water consumed from the well per day. A series of urine samples was collected from the subjects, some starting before water treatment was installed and continuing for at least nine months after treatment had begun. Urine samples were analyzed and speciated for inorganic-related arsenic concentrations. A two-phase clearance of inorganic-related arsenic from urine and the likelihood of a significant body burden from chronic exposure to arsenic in drinking water were identified. After nine months of water treatment the adjusted mean of the urinary inorganic-related arsenic concentrations was significantly lower (p < 0.0005) in the point-of-entry treatment group (2.5 μg/g creatinine) than in the point-of-use treatment group (7.2 μg/g creatinine). The results suggest that whole house arsenic water treatment systems provide a more effective reduction of arsenic exposure from well water than that obtained by point-of-use treatment.

Total arsenic in urine is often the principal means for assessing chronic exposure to arsenic-contaminated drinking water. This approach ignores many components of the human diet, especially fish and seafood that contain arsenic at significant concentrations. The toxicity differences between the inorganic forms and the dietary forms suggest both should be evaluated when attempting to assess risk from arsenic exposure. Urine biomonitoring for 53 participants was used to confirm reduction in arsenic exposure resulting from well water remediation removing inorganic arsenic from drinking water. Initially, only total arsenic urine assays were performed, but spikes in total arsenic urine concentrations were determined to be diet related and demonstrated the need for analytical methods that differentiate the arsenic species. A secondary analysis was added that quantified inorganic-related arsenic in urine and the dietary forms related to fish and seafood by subtraction from total arsenic. Significant differences were found between the inorganic arsenic component and the total arsenic measured in their urine. On average, approximately 76% of total arsenic in urine was attributed to fish and other organo-arsenic dietary sources, implying a potential significant overestimate of exposure, and demonstrating the need for differentiation of the inorganic-related arsenic from dietary arsenic.

Concentrations of arsenic have been measured in soils, streambed sediments, ground water, surface water, and drinking water in New Jersey over the past few decades as part of several U.S. Geological Survey (USGS) and other agency investigations with various objectives. Results of these studies indicate that arsenic concentrations vary spatially in all the sampled media and that both natural and human sources of arsenic in the environment may affect drinking-water quality. Arsenic concentrations in ground water, surface water, and drinking water rarely exceeded the previous Federal and State Maximum Contaminant Level (MCL) of 50 µg/L (micrograms per liter); however, the new Federal MCL of 10 µg/L will be exceeded in several public and many domestic drinking-water-supply wells in New Jersey. Arsenicconcentration data for environmental samples in some parts of New Jersey are scarce. Additional data as well as process-related studies will help to determine which human populations are most likely to be exposed to arsenic.