PHE 489 Module 5 Milestone Three Example

Four Steps to a Tested Well: Recommendations for Arsenic Testing and Treatment in Five New Hampshire Towns

[Student Name]

Southern New Hampshire University

PHE 489: Public Health Capstone Communication

Final Project Milestone Three

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Four Steps to a Tested Well: Recommendations for Arsenic Testing and Treatment in Five New Hampshire Towns

The literature review showed that well owners underrate their own arsenic risk, that knowing whom to call and seeing neighbors test predict testing, that voluntary outreach tends to reach better-off households first and that a testing requirement at home sale finds problems outreach misses but reaches homes slowly. This milestone translates those findings into recommendations for the regional public health network, the five towns and the state.

Options Considered

Five options were weighed against five criteria: strength of evidence, how many households each would reach, whether it would narrow or widen gaps between households, cost and feasibility within two years. Brownson et al. (2009) describe evidence-based policy as drawing on research about the problem, about which interventions work and about how to put them in place; the criteria were chosen to cover all three.

Table 1. Options scored from 1 (weak) to 3 (strong)

Note. Scores reflect the reviewed studies and local conditions.

No single option scores best on every criterion, which is why the recommendations combine several. The awareness campaign scores lowest on evidence and equity; information alone did not move owners in the reviewed studies, so it is not recommended as a stand-alone step.

Recommendation 1: Targeted Free Kits Through Local Messengers

The network should distribute 1,000 free arsenic test kits over two years, prioritizing households with children and the neighborhoods where the survey found the least testing. Kits should be handed out at town halls, libraries, school events and food pantries, and offered in person by town health officers and neighbors who have tested. Flanagan et al. (2015) found that knowing whom to contact and having neighbors who test were among the strongest predictors of testing, so the kit itself carries a phone number and a neighbor's name is part of every outreach event.

Recommendation 2: Results That Say What to Do Next

Every result should come back as a one-page letter in plain language: the arsenic level, whether it is above 10 micrograms per liter, and one recommended next step, such as using bottled water for drinking and cooking until treatment is installed. Results should also be stored by the network, with the owner's consent, so the owner can retrieve them later. Many owners in the reviewed surveys could not recall their results, and a test that is forgotten protects no one.

Recommendation 3: Help With Treatment and Follow-Up

Households with high arsenic and incomes below a set threshold should receive a rebate of up to $500 toward a point-of-use treatment unit, on the condition that they retest the treated water at six months, with the retest free. The network should send yearly reminders to replace filters and retest. Zheng and Flanagan (2017) showed that income shapes treatment as well as testing, so testing more wells without help to treat them would leave lower-income families knowing about a problem they cannot fix.

Recommendation 4: Support a State Testing Requirement at Home Sale

The network should ask state legislators to consider requiring an arsenic test when a home served by a private well is sold, with results given to the buyer and reported anonymously to the state. In New Jersey, buyers after such a law were far more likely to have found and treated high arsenic than earlier buyers (Flanagan et al., 2016). Because homes sell slowly, the requirement complements rather than replaces outreach. A requirement also brings in real estate agents and lenders as messengers.

Renters and Landlords

Renters on private wells depend on landlords to test and treat, and the reviewed studies said little about them. As a first step, town health officers should send landlords of well-served rentals a letter with a free kit and an offer to share results with tenants. The network should track how many landlords respond, which would give the region evidence that the literature currently lacks.

Who Does What

The regional public health network would lead the kits, results letters, rebates and evaluation. Town health officers would host distribution days and contact landlords. Libraries and food pantries would hand out kits. A state-certified laboratory would analyze samples at a negotiated price. Real estate agents would be invited to brief clients now, ahead of any law. The network's advisory board would review progress every six months.

Costs and Timeline

Recommendations 1 to 3 can begin within six months; the fourth depends on the legislative calendar.

Table 2. Two-year costs

Note. Funding would come from a state environmental grant and the network's budget.

Trade-Offs

Targeting kits means some owners who want a free test will be asked to pay or wait, which may cause complaints; the network should explain the priority openly. A testing requirement adds a small cost to home sales and may be opposed by some sellers and agents. Treatment rebates reach relatively few households. Each trade-off is accepted because the alternative, spreading resources evenly, would reproduce the gaps the review documented.

Measuring Success

Indicators include kits distributed and returned by neighborhood and household type, the share of returned tests above the federal limit, households with high results that install treatment within six months, retests confirming treatment works, and, if the law passes, tests reported at sale. A follow-up survey in two years, using the same questions as last year's, would show whether the share of owners who have ever tested has moved from 44%. Ayotte et al. (2017) suggest high arsenic is common across the region, so a rising number of identified wells should be read as success, not as a worsening problem.

Results would be reported to the towns each spring, and any step that falls short of its indicator after a year would be revised before more money is spent on it.

References

Ayotte, J. D., Medalie, L., Qi, S. L., Backer, L. C., & Nolan, B. T. (2017). Estimating the high-arsenic domestic-well population in the conterminous United States. Environmental Science & Technology, 51(21), 12443-12454. https://doi.org/10.1021/acs.est.7b02881

Brownson, R. C., Chriqui, J. F., & Stamatakis, K. A. (2009). Understanding evidence-based public health policy. American Journal of Public Health, 99(9), 1576-1583. https://doi.org/10.2105/AJPH.2008.156224

Flanagan, S. V., Marvinney, R. G., & Zheng, Y. (2015). Influences on domestic well water testing behavior in a Central Maine area with frequent groundwater arsenic occurrence. Science of the Total Environment, 505, 1274-1281. https://doi.org/10.1016/j.scitotenv.2014.05.017

Flanagan, S. V., Spayd, S. E., Procopio, N. A., Chillrud, S. N., Braman, S., & Zheng, Y. (2016). Arsenic in private well water part 1 of 3: Impact of the New Jersey Private Well Testing Act on household testing and mitigation behavior. Science of the Total Environment, 562, 999-1009. https://doi.org/10.1016/j.scitotenv.2016.03.196

Zheng, Y., & Flanagan, S. V. (2017). The case for universal screening of private well water quality in the U.S. and testing requirements to achieve it: Evidence from arsenic. Environmental Health Perspectives, 125(8), Article 085002. https://doi.org/10.1289/EHP629