The influence of an educational fact sheet on small system water supplier attitudes toward the lead and copper rule.

In May 1991, the EPA established the lead and copper rule (1). The purpose of this new environmental regulation is to reduce lead and copper in drinking water and to inhibit corrosion of water distribution pipes. This new rule requirement is due to the findings of several studies regarding the widespread and adverse health impact that ingested lead and copper can have on children and adults.

Lead is widely used in drinking water distribution systems and in household plumbing systems. Nationally, there are approximately 4 million lead service line pipes in use (2) and Detroit has approximately 100,000 lead service lines in use which constitutes one-third of the service lines (3). Lead pipes were used because they are very corrosion resistant due to the lead carbonate film that forms on pipe surfaces. Unfortunately, the water used can result in increased solubility of the lead carbonate and increased leaching (extraction and dissolution) of lead into the water via corrosion. Lead alloys were also widely used, until 1986, as solder because of their low melting point.

The sources and causes of lead in drinking water are varied. The primary sources of lead in the drinking water system are the source water treated by the drinking water plant, the lead service lines throughout the distribution system, and the lead solder used to weld pipe joints and make repairs. It is the lead solder that is primarily responsible for the high lead levels in drinking water (4). Lead leaching into drinking water results from corrosive water flowing through the system and/or galvanic reactions (5). Corrosive water is water that has an acidic pH and a low calcium concentration. Corrosive water prevents a film deposition of the chemical calcium carbonate from forming on the piping surface. This chemical inhibits chemical reactions that cause lead to be released into the drinking water. The galvanic reaction, on the other hand, results from a chemical reaction between the copper and lead connection due to their different chemical properties.

The 1986 amendments to the Safe Drinking Water Act prohibited the use of lead solder constituting more than 0.2 percent lead and the use of piping constituting greater than 8 percent lead in public water systems and household plumbing (5). The lead and copper rule initiates a program to reduce lead levels in drinking water by removing it from source water, requiring conditions to reduce corrosion, educating consumers, and removing lead service lines if necessary (1). It requires water companies to use consumer's first draw tap water samples as an indicator of the lead concentration in drinking water. If the level of lead is above 15 ppb in more than 10 percent of consumer tap water samples, then the water company is required to implement a strategy to bring levels below this amount.

The objectives of this study were to determine whether the receipt of factual information about 1) lead poisoning and 2) the EPA's lead and copper rule would influence the attitudes of State of Michigan small system water suppliers toward the rule. Small water supply systems constitute 24 percent of the community systems (systems that serve residents who use the water almost every day over a long period of time) (6). These community systems constitute 29 percent of the approximately 200,000 public water supply systems in the United States and serve 90 percent of the population. Of this population, 19.3 million people (8.5 percent) are served by small water supply systems.

Methodology

This study mail surveyed all small community supply systems, e.g. townships, villages, and cities, and about 2 percent of the small non-transient non-community supply systems which included schools, hospitals, and prisons in the State of Michigan resulting in a sample size of 802 water suppliers. The community supply systems are the primary focus in this study because their customers use the water every day over an extended period of time.

The survey consisted of a fact sheet and a pre-test and post-test questionnaire. Respondents were requested to complete side A of the questionnaire. Next, open the fact sheet and read it. Then, turn to side B of the questionnaire and answer the questions while taking into consideration the information in the fact sheet. The time required to complete the questionnaire would be from 5 to 10 minutes. They were provided with a pre-addressed stamped envelope to return the questionnaire within a two week time period. The statements that appeared on the questionnaire were chosen based upon the findings of a pilot study carried out by this investigator and telephone conversations with several State of Michigan small system water suppliers. There were 11 statements (attitudinal measures) on the questionnaire that assessed the respondent's level of agreement or satisfaction with the statement as written. Seven of these measures were repeated with exact wording on the post-test. An agreement scale of five levels ranging from strongly agree to strongly disagree was provided. The attitudinal measures were worded on the questionnaire as shown in Table 1.

Repeated measures A1 to A6 and A9 are also identified as "positive statements" since they are written in a context that favors the lead and copper rule.

The fact sheet provided information on several topics that influenced regulatory decision makers to establish the lead and copper rule. The fact sheet neither gave nor discussed details about the rule requirements. The fact sheet contained the information given in Table 2.

Data collection and analysis

Responses were coded as numerical values based upon a pre-defined coding scheme. The data were stored on a Microsoft Excel 3.0 spreadsheet and translated for statistical analysis using SPSS/PC+. The statistical analysis for the results consisted of a paired t-test for repeated attitudinal items and cross tabulations between repeated attitudinal items, and test-retest correlations. The McNemar Chi-Square for correlated proportions was calculated to determine whether the proportion of respondents who changed their response toward the direction of disagreement differed significantly from the proportion of respondents who changed their responses toward the direction of agreement.

Results and Discussion

The survey return rate was 26 percent from a total of 802 surveys that were mailed. Survey results showed that 77.9 percent of the respondents said they were personally responsible for implementing the rule, 76.0 percent said they were non-profit water suppliers, 43.8 percent made comments on the survey, and 18.3 percent gave either their name or address. Thirty-four percent of the surveys arrived at or were sent to a drinking water treatment plant.

The respondents were asked to identify the resources they used to obtain information about the lead and copper rule. The largest percentage of respondents (54.8 percent) used the EPA guidance manual or consulted a water works organization to obtain information about the lead and copper rule. About 51 percent of the respondents indicated other resources used that were not listed on the survey. Of these, the Michigan Department of Public Health was mentioned most often. The EPA telephone hotline and Federal Register or other legal document was used by 3.9 percent and 11.1 percent of the respondents respectively. Respondents were also asked about their level of satisfaction with the resources used. Of the 86.5 percent who responded to this item, most respondents (70.5 percent) were either satisfied or very satisfied with the resources used.

With exception to the measure on environmental extremism, the medians for the measures either shifted to a higher agreement level or remained unchanged on the post-test. The percentage increase in combined agreement and strong agreement ranged from 13 percent to 20.2 percent in favor of measures concerning the rule requirements to reduce corrosion, consideration of small system resource limitations, and benefits versus costs. In contrast, there was a 4.9 percent decline in the combined agreement categories concerning the perception of the rule as an example of environmental extremism.

The opinions of respondents with regard to their level of understanding of the new rule or their view of lead in drinking water as an important issue remained at an high agreement level after exposure to the fact sheet. At least 80 percent agreed or strongly agreed that they understood the rule and that lead in drinking water is an important issue that should be addressed.

The difference between each mean was statistically significant at the 0.001 level of significance for the measures concerning a) the requirements for reducing lead, copper, and corrosion, b) small system resource limitations, c) costs versus benefits, and d) understanding of the rule. The test-retest correlations were significant at the 0.001 level for all attitudinal measures. This indicated significance is due mainly to the large sample size and the strong correlation between pre- and post-test responses. The strong correlation indicates that respondents tended to give the same response or respond in the same direction of agreement on the post-test after reading the fact sheet. The difference between the means for an attitudinal measure ranged from 0.04 to 0.52. The smallest mean difference occurred for measure A6 which stated, "Lead in drinking water is an important issue that should be addressed." The largest mean difference occurred for measure A3 which stated, "The lead and copper rule requirements have taken into consideration the resource limitations of small water systems."

The McNemar Chi Square was statistically significant at the 0.01 level for all attitudinal measures except A6. A significantly greater percentage of respondents changed toward the direction of agreement with the measures about the lead rule after reading the fact sheet than did respondents who changed in the other direction. The range for the increase in agreement among measures A1 through A6 was 12.2 percent to 35.8 percent. The attitudinal measure that received the largest percent increase in agreement was A4 which stated, "Overall, the benefits derived from implementing the lead and copper rule requirements outweigh the costs involved." The range for percent decrease in agreement was 3.64 percent to 7.78 percent among measures A1 to A6. The measure receiving the largest percent decrease in agreement was A6 which stated, "Lead in drinking water is an important issue that should be addressed."

Summary and suggestions for future research

Many respondents who disagreed on the pre-test statements either disagreed less, changed to neutral, or agreed more on the post-test measures after reading the fact sheet. From 12 to 36 percent of the respondents changed their responses in the direction toward more agreement with the statements that favored the lead and copper rule; whereas, from 3 to 8 percent changed in the direction toward disagreement with these statements. For each of the measures, the corresponding directional percentage changes were statistically significant. In addition, there was a 5 percent decline among the respondents who either agreed or strongly agreed with the view that "the lead and copper rule is an example of environmental extremism."

The opinions of respondents with regard to their level of understanding of the new rule or their view of lead in drinking water as an important issue remained at a high agreement level after exposure to the fact sheet. At least 80 percent agreed or strongly agreed that they understood the rule and that lead in drinking water is an important issue that should be addressed.

The null hypothesis stating that the difference between the pre-test and post-test means for each repeated attitudinal measure is zero was rejected at the two-tailed significance level of 0.001 for repeated measures A1 to A5 and for A7 at the two-tailed significance level of 0.01. This indicated significance is due mainly to the large sample size and the strong correlation between pre and post-test responses. The test-retest correlations were significant at the 0.001 level for all attitudinal measures. This indicated that the responses on the post-test either remained the same or moved in the direction of more agreement compared to the pre-test responses for all measures except A7. For A7, the correlation indicated that the responses either remained the same or changed in the direction of lesser agreement with that statement.

It appears that educating water suppliers on the purpose and benefits of implementing the lead and copper rule can be beneficial not only by informing them but also by promoting a positive view toward this regulatory requirement. Moreover, much could be learned by performing a study that compared small system water supplier attitudes on the basis of compliance with regulatory requirements. In addition, a study of the steps a small system water supplier takes to work toward complying with regulatory requirements should be studied as a function of their attitude toward the regulation. Such a study would give insight into the behavioral and problem solving patterns of those with differing attitudes.

Table 1. Pre- and Post-Test Attitudinal Measures

Attitudinal Measures

A1. The lead and copper rule requirements are good example of the method needed to reduce lead and copper in drinking water

A2. The lead and copper rile requirements are a good example of the method needed to reduce corrosion in the piping system

A3. The lead and copper rule requirements have taken into consideration the resource limitations of small water systems

A4. Overall, the benefits derived from implementing the lead and copper rule requirements outweigh the costs involved

A5. I understand the purpose of the lead and copper rule

A6. Lead in drinking water is an important issue that should be addressed

A7. The lead and copper rule is an example of environmental extremism

A8. I understand the lead and copper rule requirements for small systems

A9. The compliance time schedule for small water systems takes into consideration the limited resources of small systems

B8. The fact sheet was helpful

Table 2. Fact Sheet Contents

FACTS YOU SHOULD KNOW(+)

* "According to public health findings, drinking water accounts for 10 to 20 percent of children's total exposure to lead." (1)

* Studies have shown that current lead levels in drinking water can adversely affect a child's health. Thus, the new lead and copper rule serves to reduce this risk to children as well as the risk to adults. (2)

* There are three main phases of the lead and copper rule. (3)

1. Treat drinking water to reduce levels and inhibit corrosion

2. Replace lead service lines if treatment efforts are unsuccessful

3. Educate customer on measure to take to reduce their lead intake

* Lead poisoning can cause hearing loss, stunted growth, and reduced IQ levels in children as well as severe mental retardation or death. In adults, lead poisoning can cause cardiovascular problems, high blood pressure, and kidney disorders. (4)

* According to the EPA, if implemented as planned, the lead and copper rule will "significantly reduce lead exposures to 130 million American within a period of six years and will bring the blood lead levels of and additional 560,000 children below 10 micrograms per deciliter of blood, which is the level of concern--the safety line." (1)

* Implementation of the lead and copper rule will result in significant health care savings. In terms of comparing water company costs to health care cost savings, the ratio is 1 t 7. (5)

* With regard to compliance, "Exemptions are allowed if the water system is unable to comply because of compelling factors (including economic ones), the exemption will not cause an unreasonable risk to health... Variances and exemptions will include a compliance schedule and state-specified requirements to ensure that an unreasonable risk to health does not exist." (6)

* Environmental Protection Agency drinking water hotline-lead rule questions call 1-800-426-4791.

References

(1) ... (1991), "Agency sets new standards for lead in drinking water," EPA Journal, 17:54.

(2) Boffardi, B.P. (1990), "Minimization of lead corrosion in drinking water," Materials Performance, 29:45-9.

(3) Frey, M.M., et al. (1991), "Complying with the lead and copper rule," Water/Engineering and Management, 138:22-7.

(4) Lin, S.D. (1989), "Proposed lead rules add chores, costs to utility burden," Water/Engineering and Management 136:36+.

(5) ... "Saving lives and money by cutting lead," Environment, 28(10):21-2.

(6) Pontius, F.W. (1991), "The new lead and copper rule," American Water Works Association Journal, 83:12+.

+ Note: print is smaller than actual print on fact sheet

TABULAR DATA OMITTED

TABULAR DATA OMITTED

TABULAR DATA OMITTED

Issue      Featured topic      Deadline

Jan/       Mgmt/Admin          11/24/93
Feb

March      Water               01/21/94

April      Injury/             02/18/94
           Occup. Health

May        International       03/18/94
           Env. Health

June       Vector Control      04/15/94

July/      Food                05/20/94
Aug

Sept       Education/          07/22/94
           Training

Oct        Hazardous           08/19/94
           Substances

Nov        Solid Waste/        09/16/94
           Recycling

Dec        Air/Indoor Air      10/21/94
           Quality

References

1. U.S. Environmental Protection Agency (June 7, 1991), Drinking water regulation, Federal Register 56(110):26460-26546.

2. ... (1991), Implementing the lead rule, Am. Water Works Assoc. 83:26-28.

3. ... (1988), Lead in drinking water, Detroit News, May 9, p. 1B.

4. Lin, S.D. (1989), Proposed lead rules add chores, costs to utility burden, Water/Engineering and Manage. 136:35-36.

5. Boffardi, B.P., (1990), Minimization of lead corrosion in drinking water, Materials Performance 29:45-49.

6. Goodrich, J.A. et al. (1992), Safe drinking water from small systems: Treatment options, Am. Water Works Assoc. 84:49.

Bibliography 

American Water Works Association, (January 1992), "Small systems shortcomings seen as performance barrier," American Water Works Association Journal 84:104.

American Water Works Association, (May 1992), "Supporting small systems," American Water Works Association Journal 84:24+.

(See the May 1992 issue of the American Water Works Association Journal)

Cosgrove, E., M.J. Brown, P. Madizan, et al., (July/August 1989), "Childhood lead Poisoning: Case study traces source to drinking water," Journal of Environmental Health 52(1):345-9.

Environment, (Dec. 1986), "Saving lives and money by cutting lead," Environment 28(10):21-2.

Frey, M.M., L.L. Harms, and H.A. Susla (August 1991), "Complying with the lead and copper rule," Water/Engineering and Management 138:22-3+.

Rowland, J., (Sept/Oct 1989), "Lead in drinking water," Journal of Environmental Health 52(2):126.

Schwartz, J. and R. Levin, (April 1987), "Dealing with the dangers of lead," EPA Journal 13:6-8.

Science News, (May 18, 1991), "New lead rules for water," Science News 139:308.

Truitt, R., (Nov. 1988), "EPA's proposal for getting the lead out sparks lively debate," Water/Engineering and Management 135:18-19.