Researchers at Dartmouth College are studying ways that doctors can encourage more homeowners to test their private water wells for toxins such as arsenic.
New Hampshire has lots of natural arsenic in its groundwater, and is working toward halving its limit on arsenic in public water systems – joining New Jersey as the only states to differ from the default federal standard.
But as much as half of New Hampshire and the rest of Northern New England relies on unregulated private wells for drinking water.
Arsenic is a carcinogen, and its prevalence here has been linked to the disproportionately high rates of bladder cancer in the region.
Dr. Carolyn Murray directs the Dartmouth Children’s Environmental Health and Disease Prevention Research Center. She wants family medicine doctors play a bigger role in encouraging private well testing and any necessary public health interventions.
"People’s doctors generally are really unaware of where you get your drinking water, is it regulated, whether you’ve ever tested it and what you tested it for,” Murray said.
Murray said the lead contamination crisis in the public water system of Flint, Michigan, was “a big wake-up call” that healthcare providers were wrong to assume people’s water was managed safely. For unregulated private wells, she said, the risk is even greater.
In her latest study, 11 clinics in mostly rural areas of New Hampshire and Vermont gave out prepaid water sampling kits, covering several contaminants and worth roughly $40 apiece, to 240 families with kids under a year old.
Murray said that age group was in focus because babies are highly vulnerable to water-related health problems, and because they have to see their doctors on a more routine basis than older kids.
The study tested out different approaches to distributing the kits, and found the most parents completed them when doctors handed them out in person and followed up with reminder calls. Overall, though, less than a third of participating parents returned their water samples to the state for analysis.
Murray said there was one unexpected challenge with mail in rural areas – the kits had to be returned in a pre-paid FedEx envelope within a day of being completed, and not all families could make that work.
But she said there may also be “behavioral science” issues behind the low return rate for the testing kits, and she wants to do more research on that.
“Why do people not do a lot of things that their doctor tells them to?” she said. “There’s a complacency – ‘My water tastes fine, it’s always tasted fine, maybe I don’t see the importance of this.’ Or a fear – like, if it is elevated, there’s a concern about, ‘Well, what would I need to do about that?’”
Among tests that were returned, the study found that about 14% had unsafe levels of arsenic – in line with how prevalent the contaminant is across the region. The authors note that participating in the study helped doctors themselves become more aware of this.
“While the overall well testing completion rate was lower than expected, all participating practices successfully implemented a system to identify private well users, which occurred infrequently prior to the intervention study and without consistent well testing recommendations,” the study says.
Next, Murray hopes to work with health systems on making drinking water sources a part of patients’ electronic health records – meaning doctors would ask on a routine basis about where a patient gets their water, and, for private wells, when they last tested it.
Learn more about resources to get your home's water tested at the Department of Environmental Services.