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

Trial Summary

What is the purpose of this trial?

Appalachian Kentuckians in Martin and Letcher Counties are grappling with a health-threatening drinking water crisis arising from exposures to disinfection by-products (DBPs). DBPs include trihalomethanes (THMs), haloacetic acids (HAAs), chlorate, and other compounds that have been associated with a variety of adverse health effects, including increased risk of bladder cancer and cardiovascular birth defects. This study implements a multi-stakeholder, multi-method approach to improve understanding of, characterize spatial and temporal variations in, and reduce exposure to DBPs in these Appalachian Kentucky counties.

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 data supports the effectiveness of the treatment Citizen Scientist Training Program, Stakeholder Consultation Core Program, GAC, Activated Carbon, Granular Activated Carbon Filter for reducing cancer risk from disinfection by-products?

The research indicates that chlorination of drinking water is associated with an increased risk of bladder cancer, while alternative methods like chloramination may have fewer carcinogenic by-products. This suggests that treatments like Granular Activated Carbon (GAC) filters, which can reduce disinfection by-products, might help lower cancer risk. ^{1 2 3 4 5}

How does the community education program for reducing cancer risk from disinfection by-products differ from other treatments?

This treatment is unique because it focuses on educating communities in Appalachia about reducing cancer risk from disinfection by-products in drinking water, rather than using a medical or chemical intervention. It aims to raise awareness and promote safer water practices, which is different from traditional treatments that might involve medication or direct medical procedures. ^{1 2 3 6 7}

Research Team

Anna Hoover, PhD

Principal Investigator

University of Kentucky

Eligibility Criteria

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

I am 18 years old or older.

Located in Martin or Letcher County water districts

Exclusion Criteria

Located outside of Martin or Letcher County water districts

Timeline

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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 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 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]

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]

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 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]

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]

References

1. United States pubmed.ncbi.nlm.nih.gov

Type of disinfectant in drinking water and patterns of mortality in Massachusetts. [2018]

2. United States pubmed.ncbi.nlm.nih.gov

Bladder cancer in Massachusetts related to chlorinated and chloraminated drinking water: a case-control study. [2016]

3. Switzerland pubmed.ncbi.nlm.nih.gov

Analysis of Cumulative Cancer Risk Associated with Disinfection Byproducts in United States Drinking Water. [2023]

4. England pubmed.ncbi.nlm.nih.gov

Case control study of the geographic variability of exposure to disinfectant byproducts and risk for rectal cancer. [2018]

5. United States pubmed.ncbi.nlm.nih.gov

Case-control study of bladder cancer and water disinfection methods in Colorado. [2019]

6. Netherlands 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. [2013]

7. England pubmed.ncbi.nlm.nih.gov

Evaluating Evidence for Association of Human Bladder Cancer with Drinking-Water Chlorination Disinfection By-Products. [2023]