Tracking national opinion about wastewater monitoring as a standard complement of public health tools in the United States

National opinion on a wide variety of public health topics can change over time or have highly contextual nuisances. As the COVID-19 pandemic has progressed, we aimed to see how public perceptions have changed regarding the acceptance of using wastewater for community health monitoring in the metropolitan United States. This study is an annual update of prior inquiry into knowledge of wastewater-based epidemiology, privacy concerns surrounding the collection of wastewater samples and the use of data acquired along with privacy awareness from an online survey administered in the winter of 2023. We found public support for monitoring of toxins (90.8%), disease (90.6%), terror (86.8%), illicit drugs (70.5%), prescription medications (68.6%), and gun residue (59.8%) remained high. Most respondents supported monitoring of the entire city (77.6%). This longitudinal research has shown year-upon-year only slight increases in public support of wastewater monitoring for public health protection and continues to show an absence of significant nationwide privacy concerns as long as catchment population sizes ensure fully anonymous households. This support is conditional and is probably best understood through the lens of the COVID-19 pandemic where the value proposition of public protection was popularized. The survey also consistently showed the public would support expansion of wastewater monitoring as a standard complement of public health tools into other areas of public health protection. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by grants from the James Graham Brown Foundation and the Owsley Brown II Family Foundation. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The University of Louisville Institutional Review Board approved this project as Human Subjects Research (IRB number: 21.0877). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors.