AbstractHealth disparities that cannot be fully explained by socio-behavioral factors persist in the Central Appalachian region of the United States. A review of available studies of environmental impacts on Appalachian health and analysis of recent public data indicates that while disparities exist, most studies of local environmental quality focus on the preservation of nonhuman biodiversity rather than on effects on human health. The limited public health studies available focus primarily on the impacts of coal mining and do not measure personal exposure, constraining the ability to identify causal relationships between environmental conditions and public health. Future efforts must engage community members in examining all potential sources of environmental health disparities to identify effective potential interventions.

Over 1.7 million Virginians rely on private water systems to supply household water. The heaviest reliance on these systems occurs in rural areas, which are often underserved in terms of financial resources and access to environmental health education. As the Safe Drinking Water Act (SDWA) does not regulate private water systems, it is the sole responsibility of the homeowner to maintain and monitor these systems.Previous limited studies indicate that microbial contamination of drinking water from private wells and springs is far from uncommon, ranging from 10% to 68%, depending on type of organism and geological region. With the exception of one thirtyyear old government study on rural water supplies, there have been no documented investigations of links between private system water contamination and household demographic characteristics, making the design of effective public health interventions, very difficult.The goal of the present study is to identify potential associations between concentrations of fecal indicator bacteria (e.g. coliforms, E. coli) in 831 samples collected at the point-of-use in homes with private water supply systems and homeowner-provided demographic data (e.g. homeowner age, household income, education, water quality perception). Household income and the education of the perceived head of household were determined to have an association with bacteria concentrations. However, when a model was developed to evaluate strong associations between total coliform presence and potential predictors, no demographic parameters were deemed significant enough to be included in the final model. Of the 831 samples tested, 349 (42%) of samples tested positive for total coliform and 55 (6.6%) tested positive for E. coli contamination. Chemical and microbial source tracking efforts using fluorometry and qPCR suggested possible E. coli contamination from human septage in 21 cases. The findings of this research can ultimately aid in determining effective strategies for public health intervention and gain a better understanding of interactions between demographic data and private system water quality.iii ACKNOWLEDGMENTS

Historically, the importance of public health has often been recognized during or as a result of major tragedy. The attacks that occurred in the United States in 2001 are no exception. These events have raised awareness of our vulnerability and the need for emergency preparedness, the need for a flexible and sustainable public health infrastructure, and the importance of linkages between environmental exposures and health outcomes. The authors encourage the public health community, along with policymakers, to develop a national environmental health tracking system that can improve our overall public health capacity and prepare us to investigate the critical issues of the day, whether they be emerging infectious diseases, terrorist attacks, or chronic illnesses.

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