PHE 489 Module 7 Final Project Example

Know Your Well: A Public Health Proposal to Raise Arsenic Testing and Treatment in Five Southern New Hampshire Towns

[Student Name]

Southern New Hampshire University

PHE 489: Public Health Capstone Communication

Final Project

[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.

Know Your Well: A Public Health Proposal to Raise Arsenic Testing and Treatment in Five Southern New Hampshire Towns

Executive Summary

Nearly every household in our five towns drinks from a private well, and fewer than half have ever tested for arsenic. At last year's free testing day, about one sample in six exceeded the federal limit. Arsenic cannot be seen, smelled or tasted, and long-term exposure raises the risk of several cancers and chronic diseases. This proposal asks the board to fund Know Your Well, a two-year, $105,000 program that would put free test kits in the hands of the households least likely to test, return results with a clear next step, help lower-income families pay for treatment and support a state law requiring a test when a home is sold. Its main target is to raise the share of well owners who have ever tested from 44% to 60%.

The Problem

The arsenic in local groundwater comes from bedrock and varies from one well to the next, so a household learns its own risk only by sampling its own tap. Federal drinking water standards apply to public systems, not to private wells, and no state or town rule in our area requires owners to test. Our survey of 612 well households found that 44% had ever tested for arsenic, fewer than one in five had done so in the past five years, about half of those who tested could not recall the result and fewer than one in twelve had a treatment system. More than a third of households include children, who are especially vulnerable.

What the Evidence Shows

Chronic exposure to arsenic in drinking water causes cancers of the skin, lung and bladder and is linked to heart disease, diabetes and harm to children's development (Naujokas et al., 2013). Nationally, about 2.1 million people drink from household wells above the federal limit, and the national model flags New England as a high-risk region (Ayotte et al., 2017). Research in Maine found that owners accept arsenic as dangerous but see their own wells as safer than their neighbors', and that owners who know where to get a test, and whose neighbors have tested, are the ones who do it (Flanagan et al., 2015). Voluntary efforts tend to reach better-educated, higher-income households first (Zheng & Flanagan, 2017). New Jersey's requirement to test at home sale sharply increased the share of buyers who found and treated high arsenic, though it reaches homes only as they change hands (Flanagan et al., 2016).

What the Program Aims For

Know Your Well exists to cut long-term arsenic exposure for households on private wells across the five towns. Four objectives measure progress.

Table 1. Objectives

Note. Priority households are those with children or in the lowest-testing areas.

Interventions

Know Your Well has four parts. First, 1,000 free kits will be handed out over two years at town halls, libraries, food pantries and school events, with priority for families with children and for the parts of town with the lowest survey testing rates. Neighbors who have tested will help at every event. Second, results will come back as a one-page letter showing the level, whether it is above the limit and one next step, with a copy kept by the network for owners who want it. Third, households with high arsenic and limited income can receive up to $500 toward a treatment unit, with a free retest at six months and yearly reminders. Fourth, the network will brief legislators on a bill requiring an arsenic test at home sale, bringing local families whose wells were high.

A smaller fifth step addresses renters: town health officers will send landlords of rentals on wells a free kit and a form for sharing results with tenants.

Timeline

The program runs over two years.

Table 2. Timeline

Note. Legislative work follows the state's filing calendar.

Budget

The two-year budget totals $105,000.

Table 3. Two-year budget

Note. A state environmental grant would cover about two thirds; the network the rest.

Communication

Messages are tailored to four audiences. Owners receive a postcard and in-person invitations that make the risk personal and the action easy. Landlords hear from health officers. Select boards see their own town's numbers and are asked to host kit days. Legislators receive a two-page brief and visits from constituents. All materials are tested with residents before use and written in plain language.

Evaluation

The evaluation tracks both delivery and results.

Table 4. Evaluation measures

Note. The survey repeats last year's questions so results can be compared.

Ethics and Equity

Results belong to the owner and will not be shared without consent. Kits are free so cost does not decide who learns their risk, and priority goes to households the research shows are usually missed. Materials avoid alarm by noting that bottled water can bridge the gap until treatment is in place, and that treatment is effective. The proposal recognizes that targeting means some owners will wait for a free kit; the reason will be explained openly.

Sustaining the Work

Two years will not reach every well. To keep the program going, the network will ask the five towns to add a small line for kits to their health budgets, build the results records into its permanent systems and train town health officers to run kit days without network staff. If the state testing law passes, it will carry part of the work forward on its own, as homes change hands.

Limitations

The proposal rests on research from other states and on local data with modest response rates. Its success depends on volunteers and partners whose time is not paid. A testing law may not pass within two years. And the program cannot measure arsenic in residents' bodies, only in their water, so health benefits will be inferred rather than observed. Brownson et al. (2009) note that evidence for policy is often incomplete; the evaluation is designed to add local evidence as the program runs.

Conclusion and Request

The danger in our towns' wells is silent, but it is measurable and treatable. Know Your Well uses what research says works, aims first at the households most often missed and checks its own results. The board is asked to approve the program and its $105,000 budget and to authorize the director to apply for the state grant this spring.

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

Naujokas, M. F., Anderson, B., Ahsan, H., Aposhian, H. V., Graziano, J. H., Thompson, C., & Suk, W. A. (2013). The broad scope of health effects from chronic arsenic exposure: Update on a worldwide public health problem. Environmental Health Perspectives, 121(3), 295-302. https://doi.org/10.1289/ehp.1205875

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