Drinking-water contaminants pose a risk to public health. When confronted with elevated levels of contaminants, individuals can take actions to reduce exposure. Yet, few studies address averting behavior due to impaired water, particularly in high-income countries. This is a problem of national interest, given that 9 million to 45 million people have been affected by water quality violations in each of the past 34 years. No national analysis has focused on the extent to which communities reduce exposure to contaminated drinking water. Here, we present an assessment that sheds light on how communities across the United States respond to violations of the Safe Drinking Water Act, using consumer purchases of bottled water. This study provides insight into how averting behavior differs across violation types and community demographics. We estimate the change in sales due to water quality violations, using a panel dataset of weekly sales and violation records in 2,151 counties from 2006 to 2015. Critical findings show that violations which pose an immediate health risk are associated with a 14% increase in bottled water sales. Generally, greater averting action is taken against contaminants that might pose a greater perceived health risk and that require more immediate public notification. Rural, low-income communities do not take significant averting action for elevated levels of nitrate, yet experience a higher prevalence of nitrate violations. Findings can inform improvements in public notification and targeting of technical assistance from state regulators and public health agencies in order to reduce community exposure to contaminants.

Fourteen states and the District of Columbia allow unauthorized immigrants to obtain driver's licenses. Using variation in the timing and location of these policy changes, we show these Unauthorized Immigrant License Polices (UILPs) are associated with a 1% increase in both the number of licensed drivers and liability insurance coverage, although we do not document a statistically significant relationship with auto insurance claims. Nor do we detect a significant relationship between UILPs and the number of miles driven, vehicle registrations, air quality, or travel behaviors. Overall, our results are consistent with UILPs licensing unauthorized immigrants who were already driving.

Introduction: The past decade in the United States has been marked by an unprecedented expansion of unconventional oil and gas drilling, including hydraulic fracturing (i.e., fracking). Concerns have arisen regarding potential health and environmental risks associated with the use of the fracking process. The purpose of this exploratory study was to examine community perceptions, concerns, and knowledge of environmental health issues related to fracking in three Texas counties near one of the most active shale plays in South Texas, the Eagle Ford Shale. Methods: A convenience sample of 153 adults over the age of 18 years in three rural South Texas counties completed a 46-question survey. Demographic information, perceptions of environmental health risks, and knowledge of potential environmental health effects related to fracking were obtained. A validated health literacy measure was also used to assess participants' health literacy. Results: Participants were predominantly female (61%), white (75%), and Hispanic (62%). A majority owned land (53.6%) and had lived in their respective county for over 21 years (54%). Only 32% percent of participants had marginal or inadequate health literacy though a larger percentage of participants had limited knowledge of potential environmental health risks related to fracking.Conclusions: Approximately one third of participants had less than adequate health literacy as measured by the BRIEF. A high percentage of the population demonstrated limited knowledge regarding the potential environmental health impacts of fracking, suggesting limited environmental health literacy. Findings point to the need for environmental health specific assessments and focused environmental health promotion strategies.

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