A variety of water quality issues potentially impact rural populations. Previous research conducted by our Center has identified 34,212 water point pollution discharge sources located in rural areas of the country. In addition, other discharge sources are located in urban areas but may have downstream impacts that spread to rural settings. Rural populations are more likely than urban counterparts to rely on untreated domestic wells that are unflouridated, and not all public water systems have adequate fluoridation, raising the possibility that rural populations are less likely to be protected against dental caries. Untreated or inadequately treated drinking water also raises the possibility of exposure to other types of contaminates from industrial or agricultural activity.

This study will investigate the availability of fluoridated water across urban-rural settings, and relate measures of fluoride availability to survey measures of dental health. The study will also investigate rural population exposure to chemical pollutants in surface water by measuring volumes and types of discharges from EPA-recognized water pollution sources, including sources located in rural areas and in upstream urban areas, and relating these measures to population health outcomes.

Data from the EPA Permit Compliance System will be used to measure the location, type, and quantity of water pollution discharges. Exposures will be refined by finding the percent of county populations that use water from various sources as measured from the Safe Water Drinking Information System (e.g. what percent relies on surface water near or downstream from pollution sites). Well water and fluoridation data will come from the CDC-s "My Water's Fluoride" database that includes information on location of water systems, size of population served, water source (surface or ground) and whether the water is adequately fluoridated. Health outcome data will come from the CDC mortality files, SEER cancer incidence data, or BRFSS survey data. Other variables will be measured from the US Census, the Area Resource File, and other sources.

Both spatial and statistical analyses will be undertaken. For example, spatial maps will show the distribution of exposure to chemical pollutant sources that include both localized and upstream sources that may exist in urban areas. Results of the study will help to inform policy decisions about improved water quality for rural populations, including the need for better access to public water that includes both adequate fluoridation and adequate protection from chemical pollutants. Results can also be used to inform other ongoing Center work regarding environmental competencies among rural healthcare providers by identifying possible environmental water quality issues that will impact patient health.

Publications

• Water Fluoridation and Dental Health Indicators in Rural and Urban Areas of the United States
  Policy Brief
  West Virginia Rural Health Research Center
  Date: 01/2012
  This policy brief investigates the availability of fluoridated water across urban and rural settings.
• Water Fluoridation and Dental Health Indicators in Rural and Urban Areas of the United States (Final Report)
  West Virginia Rural Health Research Center
  Date: 11/2011
  This study investigated the availability of fluoridated water across urban-rural settings and relates measures of fluoride availability to national survey measures of dental health in adults and children.