Community Education Programs for Reducing Cancer Risk from Disinfection By-products in Appalachia

Overseen By Jason Unrine, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Anna Hoover

Disqualifiers: Outside Martin or Letcher

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

200 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to address drinking water issues in Martin and Letcher Counties, Kentucky, by studying harmful chemicals called disinfection by-products (DBPs). These DBPs can increase the risk of bladder cancer and other health problems. Participants will join either a Citizen Scientist Training Program, where they learn to sample water at home, or a Stakeholder Consultation Program (also known as the Stakeholder Consultation Core Program), which involves community meetings. The trial seeks individuals who live in Martin or Letcher County water districts and can read and speak English.

As an unphased trial, this study offers participants the chance to contribute to important community health research and gain valuable knowledge about water safety.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that these programs are safe?

Research shows that participants generally find the Citizen Scientist Training Program easy to handle. Studies have found that similar programs lead to positive outcomes, such as higher completion rates. Participants typically finish these programs without major issues.

For the Stakeholder Consultation Core Program, specific safety data is limited. However, since this program involves meetings and discussions, it is unlikely to cause health issues. Participants in these activities usually do not report negative effects.

Overall, both programs emphasize education and community involvement. They do not involve medical treatments, suggesting they are safe for participants. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it's exploring innovative ways to reduce cancer risk from disinfection by-products, a concern in Appalachia. Unlike traditional methods, which might focus solely on water treatment or regulation, this trial involves community-driven approaches. The Citizen Scientist Training Program empowers locals to actively participate in monitoring and sampling their environment, fostering a sense of ownership and awareness. Meanwhile, the Stakeholder Consultation Core Program engages community members in ongoing discussions and decision-making processes, ensuring that solutions are tailored to the specific needs and concerns of the community. These strategies could offer a more sustainable and effective way to manage environmental cancer risks.

What evidence suggests that this trial's programs could be effective in reducing cancer risk from disinfection by-products?

Research has shown that educational programs like the Citizen Scientist Training Program, one of the study arms in this trial, can lead to important benefits. These include helping participants complete necessary training and increasing their understanding of disinfection by-products (DBPs) in their water. Participants in this arm will collect and test water samples, raising awareness and encouraging action. Meanwhile, the Stakeholder Consultation Core Program, another arm of this trial, brings people together to discuss and find ways to reduce DBPs. Although these programs don't directly lower DBP levels, they empower communities to understand and address the risks associated with DBP exposure. ^{1 3 6 7 8}

Who Is on the Research Team?

Anna Hoover, PhD

Principal Investigator

University of Kentucky

Are You a Good Fit for This Trial?

This trial is for adults over 18 who live in Martin or Letcher County water districts in Appalachia, can read and speak English, and are concerned about the health risks from disinfection by-products (DBPs) in their drinking water.

Inclusion Criteria

Able to read/speak in English

Located in Martin or Letcher County water districts

Exclusion Criteria

Located outside of Martin or Letcher County water districts

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Stakeholder Consultation

Participants engage in quarterly meetings and deliberative activities as part of the Stakeholder Consultation Core

5 years

Quarterly meetings

Citizen Science Training

Participants receive training and conduct in-home sampling for disinfection by-products

5 years

Follow-up

Participants are monitored for changes in network centrality, density, reciprocity, and environmental health literacy

5 years

What Are the Treatments Tested in This Trial?

Interventions

• Citizen Scientist Training Program
• Stakeholder Consultation Core Program

Trial Overview The study tests a community-based approach to reduce exposure to harmful DBPs. Participants will join either a Citizen Scientist Training Program or Stakeholder Consultation Core Program to learn and help address the water crisis.

How Is the Trial Designed?

Group I: Stakeholder Consultation Core Membership Experimental Treatment 1 Intervention

Study participants in this condition will participate in quarterly meetings and deliberative activities of the project's Stakeholder Consultation Core.

Group II: Citizen Science Training Experimental Treatment 1 Intervention

Study participants in this condition will participate in training and in-home sampling for disinfection by-products.

Who Is Running the Clinical Trial?

Anna Hoover

Lead Sponsor

Trials

1

Recruited

200+

National Institute of Environmental Health Sciences (NIEHS)

Collaborator

Trials

294

Recruited

1,233,000+

Published Research Related to This Trial

A case-control study involving 614 bladder cancer patients and 1,074 controls found that individuals consuming chlorinated drinking water had a 60% higher risk of bladder cancer compared to those using chloramine-treated water.

When comparing only to individuals who died of lymphoma, the risk of bladder cancer increased significantly, with a mortality odds ratio of 2.7, suggesting a strong association between chlorinated water and bladder cancer risk.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Bladder cancer in Massachusetts related to chlorinated and chloraminated drinking water: a case-control study. Zierler, S., Feingold, L., Danley, RA., et al.[2016]

A review of 30 years of research identified 85 disinfection by-products (DBPs) from drinking water, with 11 currently regulated and 74 emerging DBPs that may pose health risks due to their genotoxic and carcinogenic properties.

Brominated and iodinated DBPs are found to be more genotoxic than chlorinated compounds, with emerging evidence suggesting that dermal and inhalation exposure to these DBPs, particularly trihalomethanes (THMs), may significantly increase the risk of bladder cancer.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Occurrence, genotoxicity, and carcinogenicity of regulated and emerging disinfection by-products in drinking water: a review and roadmap for research. Richardson, SD., Plewa, MJ., Wagner, ED., et al.[2013]

A study conducted in Colorado found that long-term exposure (over 30 years) to chlorinated surface water is significantly associated with an increased risk of bladder cancer, with an odds ratio of 1.8 compared to those with no exposure.

The increased risk of bladder cancer was consistent across genders and smoking statuses, but levels of trihalomethanes, nitrates, and residual chlorine did not show a direct association with bladder cancer risk after adjusting for exposure duration.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Case-control study of bladder cancer and water disinfection methods in Colorado. McGeehin, MA., Reif, JS., Becher, JC., et al.[2019]

A study of mortality patterns in Massachusetts from 1969 to 1983 found a moderate association between chlorinated drinking water and increased bladder cancer risk, with a mortality odds ratio of 1.7.

Residents in communities using chloraminated water showed a slight increase in deaths from pneumonia and influenza compared to those using chlorinated water, suggesting potential health implications of different water disinfection methods.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Type of disinfectant in drinking water and patterns of mortality in Massachusetts. Zierler, S., Danley, RA., Feingold, L.[2018]

A comprehensive analysis of disinfection byproducts in drinking water revealed that brominated haloacetic acids pose a higher cancer risk than trihalomethanes, with significant implications for public health.

Lifetime cancer risk estimates for U.S. community water systems indicate a risk of approximately 3 cases per thousand people, emphasizing the importance of monitoring and regulating these contaminants to protect public health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Analysis of Cumulative Cancer Risk Associated with Disinfection Byproducts in United States Drinking Water. Evans, S., Campbell, C., Naidenko, OV.[2023]

Epidemiological studies have consistently linked exposure to chlorination disinfection by-products (CxDBPs) in drinking water with an increased risk of urinary bladder cancer, highlighting a significant public health concern.

Challenges in accurately measuring CxDBP levels in these studies complicate the translation of hazard identification into effective risk management and regulatory policies, indicating a need for further research to clarify exposure-response relationships.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluating Evidence for Association of Human Bladder Cancer with Drinking-Water Chlorination Disinfection By-Products. Hrudey, SE., Backer, LC., Humpage, AR., et al.[2023]

In a case-control study of 128 rectal cancer cases and 253 controls in Monroe County, New York, higher levels of the trihalomethane byproduct bromoform in drinking water were associated with an increased risk of rectal cancer, with an odds ratio of 1.85 for increased exposure.

The study found that the highest quartiles of bromoform consumption (1.69-15.43 ug/day) significantly raised the odds of rectal cancer to 2.32, indicating a potential geographic link between water quality and cancer risk.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Case control study of the geographic variability of exposure to disinfectant byproducts and risk for rectal cancer. Bove, GE., Rogerson, PA., Vena, JE.[2018]

Citations

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a Design and Development Case Study | TechTrends The purpose of this design and development case study is to provide an in-depth account of the needs analysis (through surveys and interviews), design, ...

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A Mixed Methods Approach to Understanding the Public ... All teachers in the program engage their students as citizen scientists in collecting well water samples from their homes and work with scientist partners who ...

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Preliminary Evaluation of a Citizen Scientist Educational ... Results suggest the educational program has the potential to improve key outcomes including completion of regulatory training and increased ...

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Biomedical Citizen Science at the National Institutes of ... We describe unique examples of successful biomedical citizen science and community-engaged research projects that are hosted by NIH or that have received NIH ...

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Preliminary Evaluation of a Citizen Scientist Educational ... Results suggest the educational program has the potential to improve key outcomes including completion of regulatory training and increased ...

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Citizen Science Approach to Home Radon Testing ... This longitudinal, mixed-methods study using a citizen science approach recruited and trained a convenience sample of 60 non-scientist homeowners from four ...

8. sciencedirect.com sciencedirect.com/science/article/pii/S0013935124008181

Citizen science in environmental health research Public interest for citizen science (CS) in environmental health is growing. The goals of environmental health research projects are diverse ...