TITLE: Water Quality and Impact on Health in Nogales...

TITLE: Water Quality and Impact on Health in Nogales, Mexico

SITE: US Geological Survey and Udall Center for Public Policy

STUDENT NAME: Felipe Caldeira

COMPLETION DATE: May 2011

I do do not give permission for this report to be made available for review.

Student Signature:_________________________________________________________

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DATE:

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STATEMENT BY AUTHOR

This internship report has been submitted in partial fulfillment of requirements for an advanced degree at The University of Arizona and is deposited in the Office of Student Services and Alumni Affairs at the Mel and Enid Zuckerman College of Public Health to be made available to borrowers under the rule of the College.

In submitting this report, I do give permission for this report to be read by others.

Brief quotations of this internship report are allowable without special permission, provided that accurate acknowledgment of source is made. Requests for permission of extended quotation from or reproduction of this manuscript in whole or in part may be granted by the author.

STUDENT NAME: Felipe Caldeira

STUDENT SIGNATURE: _________________________________________

C a l d e i r a : I n t e r n s h i p R e p o r t

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Acknowledgements

This project would not have been possible without the altruistic help of the research

volunteers Perry Gast, Sofia Grigera, and Luis Lozano from the Mel and Enid Zuckerman

College of Public Health, Ashley Rigas from the US Geological Survey, and Alejandro

Araiza from Instituto Municipal de Investigacion y Planeacion. My advisors Jill de

Zapien, Mary Kay O’Rourke, and Cecilia Rosales played an integral role to help guide

the research in the right direction. Generous funding, support, and supervision came from

Laura Norman, Floyd Gray, and James Callegary at the US Geological Survey. I must

also thank all the binational institutions that provided helpful input throughout the entire

project including the Border Environmental Health Initiative with the US Geological

Survey; numerous faculty members at the Mel and Enid Zuckerman College of Public

Health including Dr. Kelly Reynolds; Claudia Gil at Instituto Municipal de Investigacion

y Planeacion for approving this project and introducing me to Alejandro Araiza;

Francisco Gastelum, Veronica Meranza, and Selma Valenzuela at the Organismo

Operador Municipal de Agua Potable Alcantarillado y Saneamiento de Nogales, Sonora

for their hard work and patience; all the members of the Binational Health Council

(COBINAS) as part of the Arizona Department of Health Services for their constructive

and supportive criticism; and Drs. Robert Varady and Laura Lopez Hoffman for their

unparallel wisdom. And of course, my partner Casey Cassidy for nodding his head every

time I talked about my work. Thank you.


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Dedication

This project, and its accompanying reports and findings, is dedicated to all the

anonymous residents of Nogales, Sonora, Mexico that took the selfless time to allow us

into their home for several weekends and conduct the investigation with no compensation

and no tangible reward.


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Table of Contents

List of Illustrations ...................................................................................................................... 6

Abstract ....................................................................................................................................... 7

Introduction and Background ...................................................................................................... 8

Methods ..................................................................................................................................... 22

Results ....................................................................................................................................... 29

Discussion ................................................................................................................................. 44

Conclusion ................................................................................................................................ 56

Work Cited ................................................................................................................................ 58


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List of Illustrations

Table 1. Learning objectives and internship activities .................................................................. 18 Table 2. Demographic profile ....................................................................................................... 29 Table 3. Quality of life .................................................................................................................. 30 Table 4. Rate of diarrhea from summer surveys ........................................................................... 31 Table 5. Water use ......................................................................................................................... 33 Table 6. Water quality perceptions ................................................................................................ 35 Table 7. E.coli and total fecal coliforms in households ................................................................. 38 Table 8. 2x2 table of E.coli and reported episode of diarrhea ....................................................... 41 Table 9. Metal and ion concentrations from samples on 8/21/11 .................................................. 42 Table 10. Mean, median, and standard deviation of metal concentrations from 21 homes ........... 43 Table 11. 10 public health essential services and how addressed in internship ............................. 53

Figure 1. A typical view of a colonia marginal in Nogales, Mexico ............................................. 10 Figure 2. A pipla in Nogales, Mexico ........................................................................................... 14 Figure 3. Methodology .................................................................................................................. 22 Figure 4. Environmental vulnerability of colonias of Ambos Nogales ......................................... 24 Figure 5 Household recruitment .................................................................................................... 27 Figure 6. Logging of water samples .............................................................................................. 27 Figure 7. Survey being conducted ................................................................................................. 27 Figure 8 Collection of water sample from point of use (tinaco) .................................................... 27 Figure 9. Percent of houses with E.coli and total fecal coliforms during summer ........................ 39 Figure 10. Average contaminant load and rate of diarrhea by neighborhood and season ............. 40


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Abstract

Introduction: In Nogales, Mexico, some neighborhoods, or colonias, have intermittent

delivery of water through pipes while other areas lack piped water and rely on water

delivered by truck or pipas. What impact is access to piped water versus non-piped water

having on health in different colonias in Nogales? Methodology: Water samples were

collected at point of use and a survey was implemented to examine quality of life, water

consumption, and impacts on human health in two areas of Nogales; one area with

comparatively high socio-environmental conditions and therefore access to piped water

(Colonia Lomas de Fatima) and another area with low socio-environmental conditions

and therefore no access to piped water but a reliance on pipas (Colonia Luis Donaldo

Colosio). A total of 21 households were recruited for the study (14 in Colosio and 7 in

Lomas), which was composed of 84 individuals (63 from Colosio and 21 from Lomas).

Findings: Respondents identified diarrhea as an issue for 50% of participating

households. In fact, 11 people were hospitalized due to diarrhea; more than half from

Colosio. A 2 x 2 table suggests greater frequency of no diarrhea reported when E.coli was

not present. E.coli was well above the EPA’s limit in Colosio with the average number of

colonies per 100mL at 26.7 but not Fatima with the average being 0. Total fecal

colifroms were present in over 50% of households in both colonias. Microbial

contamination was significantly higher in the summer than in the winter in both colonias.

Metal concentrations for arsenic, lead, and mercury (median in mg/L: 0.00305, 0.000455,

<0.0002) were well below the EPA’s limit in both colonias. Chloride was found to be

significantly higher in Colosio (median 29.2mg/L). Conclusion: Residents in colonias

without piped water are at a greater risk of gastrointestinal illness from consumption of

contaminated water. Ongoing binational collaboration will assist in disseminating

information for helping improve water quality in poorer colonias of Nogales.


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Introduction and Background

Literature Review

People, businesses, industry and society thrive only with a dependable source of high

quality water as water is essential for the maintenance of human life. Water plays a role

in digestion, absorption, circulation, and excretion, and maintains body temperature.

Water facilitates growth and repair in the body, and it is part of all body tissues and fluids

(Mack & Varady, 1995).

Water holds a number of significant implications for public health. “Inadequate

consumption of water is detrimental to human health and contributes to mortality in

developing societies” (Mack and Varady, 1995; Udall Center, 1994). Numerous studies

(Mack & Varady, 1995; Esrey et al., 1990; Ezzati, 2005) indicate that dehydration will

kill faster than starvation. Clearly, water should be provided to all populations but

especially to the most vulnerable: infants and those who are ill (Aldous, 2003). Chronic

water shortages seriously compromise household sanitation and personal hygiene leading

to a variety of health problems, most notably gastrointestinal diseases and parasitic

infections (US-EPA, 1999). Water shortages indirectly affect health since users

sometimes seek delivery alternatives. Distraught water users may fill compromised

storage or transfer containers contaminated by chemicals or exposed to microorganisms

(Mack & Varady, 1995; US-EPA, 1999).

The US-Mexico border zone stretches 3,000km from the Pacific Ocean to the Gulf of

Mexico and 100km north and south of the line as defined by the La Paz Agreement (US-


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Mexico Border Health Commission, 2003). Over the past 20 years, a unique dynamic of

commerce and trade affected the region in part due to the North American Free Trade

Agreement (NAFTA) (Lara-Valencia et al., 2008). In Mexico, people have moved to the

border region as industrial factories, or maquiladoras, provide financial incentives to both

migrant workers and corporations in both countries for their cheap labor and proximity to

major cities for transport.

The mountain ranges surrounding Nogales are described as "impermeable tertiary

volcanic materials" that cannot store groundwater (Mack & Varady, 1995). The city is

built on quaternary alluvial units that yield moderate amounts of water at relatively

shallow depths (Mack & Varady, 1995). However, the demands of urbanization and

industrialization have altered the regional water balance. The growing demand is rapidly

depleting stores of subsurface water, the only stable water source. Given pressures of

population and development, "…natural recharge from mountain-front and stream-

channel recharge processes cannot adequately replenish the supply of groundwater”

(Mack & Varady, 1995).

This influx of people places a significant strain on local resources of border communities.

Public services and systems are heavily burdened by an increased demand that can not be

met by the strained, unimproved infrastructure (Mack & Varady, 1995). This lack of

access to services and resources results in the development of squatter communities

called colonias marginales or marginalized neighborhoods (Norman et. al., 2006).


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Colonias marginales are colonias that lack basic infrastructure such as paved roads,

electricity, and even piped water (Norman et al., 2006; Lara-Valencia et al., 2008;

Sanchez, 1995; Sadalla et al., 1999). They are characterized by very low socioeconomic

status (SES) and associated impacts on health. Colonias marginales are established as a

result of mobile workers from throughout Mexico seeking jobs in northern Mexico in the

maquiladoras and other industries and unable to afford housing once they arrive

(Sanchez, 1995; Tolan, 1990). Individuals would build their homes out of whatever left

over construction material they could find around the city or what they could afford and

build their homes in uninhabited regions. These uninhabited regions sprouted make shift

homes so quickly that the city of Nogales is unable to construct paved roads or piped

water. Often times these uninhabited regions that become massive colonias marginales

are not recognized by the city or lack governance as development of homes were done

without legal permits.

Figure 1. A typical view of a colonia marginal in Nogales, Mexico


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Sadalla et al. (1999) conducted a survey to describe and quantify the environmental

pollution produced by residential behavior in marginalized colonias of Nogales, Sonora.

Sadalla et al. (1999) states that an

“…analyses of the environmental impact of the maquila on the US-Mexican border region has to date focused primarily on the contribution of industrial practices. Considerably less is known of the environmental degradation engendered by substandard living conditions in the communities populated by the workforce of the maquiladoras.”

Activities such as burning garbage for heating and cooking, inappropriate waste disposal

and the absence of sewers combined with substandard latrine construction will eventually

contaminate local aquifers according to Sadalla et al. (1999).

Sadalla et al. (1999) administered a Residential Behavior Survey to 400 dwellings in 3

different regions in Nogales, Sonora consisting of 16 colonias. Sadalla et al.’s (1999)

survey focused on behavior relevant to air quality, water quality, and waste disposal.

With respect to water quality, residents were asked questions related to source of water

used for drinking, cooking, and bathing; water sterilization practices if any; water storage

practices; and water disposal practices. Sadalla et al.’s (1999) last set of questions

“assessed residents’ beliefs and knowledge about the health risks that are produced by

their residential environment and by their behavioral practices.” Sadalla et al. (1999)

reasons that “it is possible that colonia residents may not be concerned about factors that

greatly influence their health, but at the same time remain quite concerned about factors

that have minimal health impact.”Sadalla et al. (1999) makes assumptions from the data

he collected that residents’ actions are causing health hazards however he does not

investigate what health hazards are present because of those actions.


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According to Collins et al. (2010), “quality of life issues can serve to bring about

reallocation of resources to improve life. There are only so many funds/resources to

invest in communities and understanding the limitations and areas that need

improvement can provide insight for better budget allocations.” Quality of life questions

can include rating personal satisfaction with government resources, public infrastructure,

living conditions, and the environment. Collins et al. (2010) implemented a survey along

several US-Mexico border towns including San Diego/Tijuana, El Paso/Ciudad Juarez,

and Somerton-San Luis/San Luis-Rio Colorado. Contrary to what most people would

believe about life in Mexico, residents’ are relatively satisfied with their quality of life

according to Collins et al. (2010). Yet certain aspects of satisfaction are ranked much

lower on a 9 point Likert scale. For instance, in Somerton-San Luis/San Luis Rio

Colorado, satisfaction associated with the quality of piped water provided by the city,

residents on the US side (Somerton-San Luis) gave an average score of 3.3 out of 9

whereas residents on the Mexico side (San Luis-Rio Colorado) responded with an

average score of 6.2. When residents were asked to rate their concern about the impacts

of the water quality on health, residents on the US side averaged a score of 6.8 while

residents of Mexico responded with a score of 4.1 or greater satisfaction. The same trend

of increased concern or dissatisfaction on the US and greater satisfaction in Mexico was

consistent in the other towns surveyed by Collins et al. (2010).

With a major influx of people migrating to the city of Nogales, Mexico, resources must

be rationed. For instance, water delivery in the city is sparse. Established colonias that

have piped water receive water from the municipal water system at certain times in the


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day and then shut off briefly for a few hours at different times depending on the colonia

(Mack and Varady, 1995). Residents use various systems in order to compensate for

these water shut off hours. In colonias where piped water is available, most homes have

an aljibe system. An aljibe is a cement storage tank normally located underground at

each home that pumps water to the house. When water is available from the city, it fills

the aljibe. During household use, water is pumped from the aljibe to the house. Since

there is intermittent water delivery, residents with the aljibe have a constant source of

water. The aljibe is underground with the lid at ground level and because of this

household water is subject to contamination from run-off on the city streets. Little

information on the water quality of aljibes is available and research is needed.

In colonias without out piped water, most notably colonias marginales, water is delivered

by water truck or pipas into plastic storage containers called tinacos or metal storage

containers called tambos. Tinacos are containers normally sold at home improvement

stores and placed on top of homes. A hose is attached to the tinaco and delivers water to

the user by simple use of gravity. Tambos on the other hand are placed at ground level

and are usually scavenged rather than bought. Normally, these containers were left over

from maquiladoras and little if any information is known by the user what the tambo

used to contain.

Pipas can be operated by the municipal water company, OOMAPAS, or by private

owners. Private pipa operators normally own wells on their property and distribute water

from their wells using their own pipas. Pipas operated by OOMAPAS are regulated by


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their water quality standards whereas private pipas are not. Limited research is known

about the water quality from pipas and which neighborhoods they service.

Figure 2. A pipla in Nogales, Mexico

The exponential growth experienced in Nogales in recent years is also causing a strain on

local infrastructure which is exacerbated by the climate (Norman et al., 2010). Rushing

floodwaters caused by the region's heavy rain falls during the summer "monsoons" cause

sewer-line breaks and lead to run off throughout the city. During these periods of extreme

flooding, health hazards increase from both exposure to raw sewage and post-flood

surface sewerage accumulations that create a breeding ground for infectious disease

agents (Norman et al., 2010).

Nogales residents experience many of the health problems associated with inadequate

sewerage and the ensuing water contamination, primarily gastrointestinal diseases and

hepatitis (Mack and Varady, 1995). A study conducted by the Ambos Nogales Water

Project revealed that diarrheal diseases, along with acute respiratory infections, were the


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principal causes of morbidity among children from birth to four years of age (ADHS,

1993). The same study also found that gastroenteritis and other infectious diseases were

the seventh leading cause of mortality within the general population in the region. The

same study found an incidence rate for Hepatitis A of 27 cases per 10,000 people in

Nogales, Arizona, and 18.67 cases per 10,000 people in Santa Cruz County. These

incidence rates were considerably higher than those for other Arizona border counties

(Yuma and Cochise County). It is important to note that Hepatitis A is a virus transmitted

through water and food by fecal contamination.

This growing concern prompted the U.S. Environmental Protection Agency (EPA) to

commission a report (1999) which states "wastewater collection and treatment is the most

pressing infrastructural problems facing the urbanized portions of the U.S.-Mexico

border." But recognizing waste water is not just an infrastructural problem, the report

goes on to state that "its solution would resolve many associated environmental and

health problems in the large and small population centers of the region."

The Ambos Nogales Water Project (ADHS, 1993) examined water quality in the region.

The report notes that wells and wastewater lines in Nogales, Sonora, were generally

contaminated by bacteria. The water project also found elevated nitrate and detectable

concentrations of volatile organic compounds (VOC's) in the shallow aquifer. The

Arizona Department of Environmental Quality (ADEQ) and the Arizona Department of

Health Services (ADHS, 1993) monitored ground water in the region and discovered

measureable amounts of the carcinogen tetrachloroethylene or TCE in excess of the


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Arizona Based Guidance Levels (HBGL) and maximum containment level (MCL)

(ADHS, 1993). Fecal coliforms have also been continuously found in excess of both

national standards by various studies’ investigations (Mack and Varady, 1995; Sanchez,

1995; Udall, 1994). It is important to note that fecal coliforms are not a health hazard per

se but their presence is a good indicator of other bacteria causing potential health

problems, such as gastroenteritis and hepatitis (Colford et al., 2006).

Mack and Varady surveyed and characterized the shared physical water resources of the

Nogales area in 1995. They evaluated water use patterns and management approaches in

a semiarid and urban environment and suggested ways water-related decisions and

policies could be made responsive to local needs and desires. They provide an in depth

assessment of water availability in the marginalized colonias, water shortages throughout

the region, infrastructure problems, and flooding. Detectable concentrations in each

category were found in majority of the wells Mack and Varady (1995) sampled for. Mack

and Varady (1995) conclude that contaminated water or poor water quality as a root

cause of prevalent gastrointestinal disease in Nogales.

Sanchez (1995) published an article similar to Mack and Varady (1995) where he

investigated water quality in Nogales, Sonora. Sanchez (1995) discusses water

availability in the marginalized colonias, water shortages throughout the region,

infrastructure problems, and flooding (Sanchez, 1995). However his primary focus

addresses on hazardous waste from industries as a major contributor to poor water

quality.


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”Official sources estimate that the annual generation of hazardous wastes in Mexico could be close to 14 million tons but only a minimal part of them are legally disposed of… Evidence of this mismanagement is the discovery of illegal dump sites of hazardous waste within and outside the urban areas.”

Sanchez (1995) states that “Two major water quality problems in Nogales, Sonora are

bacteriological pollution associated with deficiencies in the municipal sewerage system

and the potential pollution of wells used to supply water to low income neighborhoods of

the city.” Sanchez (1995) collected water samples from the municipal drinking water

system in Nogales, Sonora and from wells in five different colonias. Sanchez (1995)

found no significant levels of bacteriological contamination from the municipal drinking

water system but did find significant trace amounts of bacteriologic contamination in the

wells he sampled. Three of the wells are used to supply water by truck or pipas to low

income neighborhoods. Sanchez (1995) goes on to state that “although our results did not

detect pollution in the municipal water system, more than 20% of the population relies on

other sources of water.” The complex water delivery system of Nogales means there are

many points of contaminant entry.

There is sufficient evidence to suggest that health impacts from water quality will be

found in Nogales, Sonora. Researchers agree that the incidence of acute gastrointestinal

disease or diarrhea can not be measured but rather, estimated (Colford et al., 2006). It is

well understood that Mexico has long had a problem with increased rates of acute

gastrointestinal disease when compared to the United States (Border Health Commission,

2003; Centro de Salud Urbano, 2010; Sanchez, 1995; Udall, 1994). Some have attributed


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this spike in prevalence across the border to inadequate infrastructure while others blame

contaminated sources such as rivers and ground water.

Goal

The goal of this internship is to understand the US-Mexico border issues as it pertains to

water by working in a federal agency among numerous binational partners to provide

community leaders and policymakers in the area with an assessment of the current water

quality issues and its impact on community health in order to make better informed

decisions for the future.

Objectives

Table 1. Learning objectives and internship activities Learning Objectives Activities

Develop relationships with health officials

and community partners.

• Attend binational meetings and

conferences

• Contact potential collaborators by

previous associations

• Network with community

members

• Provide updated progress on

internship

• Distribute results of the internship

• Seek feedback

Establish relationship with promotoras • Volunteer at events

Develop skills in conducting a literature

review

• Use library resources

• Search within databases


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• Keep track of literature

• Ask for recommended articles to

read

Develop skills in forming survey

questionnaires based on published studies

• Conduct literature search

• Write questions

Be able to improve a survey questionnaire

using focus groups

• Gain input from committee

members

• Gain input from locals

• Gain input from health officials

Be able to administrate a survey

questionnaire in Nogales, Sonora

• 20 households from 2 areas in

Nogales for a total of 40

households.

• Help from promotoras in

administering the survey due to

cultural competency.

Gain knowledge on the strengths and

limitations of using a survey questionnaire

for collecting health information.

• Analyze questionnaire data

• Review study process

• Compare results with published

studies

• Identify strengths and limitations

of the survey

Be able to collect water samples

• Establish a standard procedure for

collecting water samples without

contamination

• Educate promotoras on procedures

• Have samples be analyzed.

Gain knowledge on strengths and

limitations of water collection techniques

• Analyze water quality data

• Review study process


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• Compare results with published

studies

• Indentify strengths and limitations

of water sampling.

Be able to formulate a policy

recommendation

• Gather all results collected and

analyze for significance.

• Work with officials to gain input

on their ideas and experiences on

effective policy

• Conduct a literature search

• Formulate a policy

recommendation based on results

• Receive feedback on formulated

policy recommendation.

Gain knowledge and skills in presenting

the results of the project

• Attend and present at related

conferences and meetings

• Submit for publication

• Distribute results to all

collaborators and any other

requests.

Opportunities for Public Health Experience

Working with the USGS and the Udall Center will provide for several opportunities for

public health experience. Both agencies heavily deal with research and policy

implications related to that research. This internship will allow me to work hands on in

the communities of Nogales, Sonora and interact with not only community members but

leaders, professionals, and policy makers of the region. All aspects of the public health


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field will be practiced with this internship. Epidemiology and biostatistics skills will be

used to design the study and analyze results; socio-cultural aspect skills will be used to

understand the complex ecological models that make up the current border health issues;

policy and management skills will be used to formulate recommendations for community

leaders; environmental health skills will be used to investigate how current environmental

health concerns affect water quality and in turn affect people’s health.

Function of Site

The internship site is a joint collaboration between the United States Geological Survey

(USGS) and the Udall Center for Studies in Public Policy. Part of the USGS’s mission is

to “…manage water, biological, energy, and mineral resources; and enhance and protect

our quality of life.” The Udall Center “sponsors policy-relevant, interdisciplinary

research and forums that link scholarship and education with decision-making.” One of

its primary focus areas is in environmental policy. The college of Public Health’s mission

is “…dedicated to promoting health of individuals and communities with a special

emphasis on diverse populations of the Southwest.” This project seeks to investigate the

current water quality and water availability situation in colonias of Nogales, Sonora,

Mexico with impacts on respective communities’ health to initiate a cost effective

binational policy recommendation for sustainable water delivery. The USGS will provide

the objective data for the project meanwhile the Udall Center will provide its knowledge

and experience in environmental policy.


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Methods In order to reach internship goals and objectives, the following methodology was

employed. Figure 1 illustrates the methodology for this project in a diagram form.

Figure 3. Methodology

Development

It was important from the beginning for this project to be truly binational. Input, insight,

suggestions, and feedback were to be taken into consideration for every aspect of this

project. Therefore, binational collaboration was the driving force for this project. First,

border issues as they pertained to water quality in Nogales had to be understood. A

literature review was conducted on current information available about water quality and

health in Nogales, Sonora. Some of this literature review is available in the Introduction

section of this report.

Second, key informant interviews were conducted to further understand water quality

issues from those with experience and knowledge about Nogales. Focus groups consisted


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of meetings with faculty members, federal agencies, Mexican health professionals and

authorities, and community members. Attending meetings with the Binational Health

Council or COBINAS provided the most opportunity for feedback and networking.

After becoming familiar with border water issues from an extensive literature review and

meeting with professionals and community members through numerous key informant

interviews, a survey was designed and drafted. The survey was derived from questions of

similar projects focusing on the quality of life in Tijuana, Mexico (Collins, 2010) and

environmental quality in Nogales, Mexico (Sanchez, 1999). Quality of life questions

were asked to mimic work done by Collins et al. (2010), in terms of personal satisfaction

with government resources, public infrastructure, living conditions, and the environment

on a scale from 1 to 5 in order to investigate trends in ratings of quality of life among

different income levels in Nogales, Sonora as well as to illustrate communities’

perceptions of priority for resources. Questions about how water is obtained, stored, and

purified as well as rate of consumption were asked as per Sadalla’s (1999) research.

Questions pertaining to the prevalence of diarrhea in the household, sources of water, and

open ended questions related to community involvement were created by the authors.

After the survey was complete, it was revised based on feedback from stakeholders

meetings. The Spanish version of the survey was translated by the authors then sent to the

Ayuntamiento de Nogales Sonora for a formal Spanish revision and cultural competency.

After a final draft was completed, the survey along with accompanying consent materials

was sent for approval to the University of Arizona’s Office for the Responsible Conduct


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of Research or Internal Review Board (IRB). Approval was received on July 14, 2010

and a copy is available in the Appendix.

While the survey was being designed and drafted, the overall study design was being

discussed as well. With the assistance of researchers from the USGS and faculty from

MEZCOPH it was proposed to recruit 40 households from two colonias in Nogales,

Sonora and to collect three trials of water samples over the summer and three trials of

samples over the winter from each household to test for seasonal variability. In order to

correlate health impacts and water quality, water samples collected from each home

would be analyzed for microbes

E.coli and total fecal coliforms

and metals such as arsenic, lead,

and mercury to name a few. It

was decided that the two colonias

would be Colosio and Lomas de

Fatima. Colosio was identified as

a marginalized and highly socio-

environmentally vulnerable

colonia and Fatima was identified

as a more affluent and less socio-

environmentally vulnerable

colonia. Figure 2 illustrates

Figure 4. Environmental vulnerability of colonias of Ambos Nogales


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where the colonias are in relation to each other and level of environmental vulnerability

according to research done by Lara-Valencia (2008). All neighborhoods were considered

but Colonia Colosio and Colonia Lomas de Fatima were chosen due to accessibility,

safety, personal contacts, location, and information on access to piped water.

Implementation

The project goal was collection of a survey and water samples from 20 households in

each of two neighborhoods (Colosio and Fatima). Student volunteers from the University

of Arizona’s Mel and Enid Zuckerman College of Public Health and the College of

Science’s Geosciences Department were recruited and trained on the study’s protocols

based on their bilingual ability, Human Subjects Training Certification, and willingness

to help. A representative from the Ayuntamiento de Nogales Sonora was also trained and

acted as our main liaison while out in the field. Households were chosen at random in

each of the colonias. Interviewers then asked to speak with the head of the household

who was 18 years or older and then asked if they would be willing to participate in the

study. If the respondent accepted, a consent form was signed and the survey interview

began. If they refused, the interviewer would move on to another randomly selected

household. Refusals were not accounted for therefore a refusal rate was not calculated. In

order to save time and increase participation, the respondents reported conditions for all

members of the household via one household representative. The full lengthn surveys

were conducted on Saturday, August 20, 2010 with a short follow up survey conducted in

the winter (Saturday January 15, 2011) to test for any seasonal variability in rate of


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diarrhea. The average amount of time taken to complete the 30 question survey was about

35-40 minutes. Consent forms and copies of the survey as well as recruiting materials, all

approved by the IRB are available in the Appendix.

During the study design phase, a lab agreement was arranged with OOMAPAS to analyze

water samples for microbial contamination. Because microbial analysis of water samples

is time sensitive and to help strengthen binational collaboration between agencies, it was

agreed that the USGS would pay OOMAPAS for microbial analysis of samples collected.

Analysis of metal concentrations would be done by another lab and also paid for by the

USGS. Water samples analyzed for microbial contamination were analyzed using the

Colilert-Blue and microfiltration technique. Water samples analyzed for metal

concentrations were analyzed using ion chromatography.

Due to heavy rain during the first day of investigation, only 21 households were recruited

into the study; 14 from Colosio and 7 from Lomas de Fatima. Due to US federal budget

and funding issues, only three trials of water samples were collected from each home

during the summer and only one trial was collected in the winter. Water samples were

collected on Saturday August 21, August 28, and September 4, 2010 and Saturday

January 15, 2011. Metal analysis was only analyzed for samples collected on the first day

of investigation (August 21, 2010) due to the expensive cost of analysis and limited

research indicating a significant change of metal concentration in water over time.


P a g e | 27

Figure 8 Collection of water sample from point of use (tinaco)

Figure 5 Household recruitment

Figure 6. Logging of water samples

Figure 7. Survey being conducted


P a g e | 28

Follow Up

As part of IRB protocol and a form of indirect compensation for participating in the

study, households were told the results of their water quality analysis and contact

information was provided for a health professional with the Centro de Salud Publico de

Nogales, Sonora for assistance with proper disinfection practices on water storage

containers.

Preliminary results were shared with all stakeholders involved with the study design by

way of meetings, fact sheets, brief and formal presentations, and executive summaries.

Publishing the investigation and results were also a method of follow up and transparency

so that future researchers could be aware of developments of water quality issues in

Nogales since most articles are dated 15 years ago. Preliminary results were presented at

a conference at the University of California at Berkeley for the Journal of Health,

Wellness and Society with expenses paid for by the USGS and the University of

Arizona’s Graduate Professional Student Council. Due to human subjects and federal

investigation protocols, two publishable reports were drafted; one focuses on the results

of the survey and another focuses on the results of just the water quality investigation.

Draft copies of these reports are available in the Appendix.

Ongoing dissemination of results is forthcoming and researchers with the USGS have

plans to incorporate results into a binational study symposium, the Border Environmental

Health Initiative or BEHI. Copies of posters and presentations are available in the

Appendix.


P a g e | 29

Colosio Fatiman=14 n=7

18 to 24 3 025 to 34 6 335 to 44 2 045 to 54 2 055 to 64 0 065 or over 1 4

0 -‐ 1 0 01 -‐ 5 3 05 -‐ 10 3 010 -‐ 20 6 0

More than 20 2 71 0 12 0 23 4 14 0 25 5 16 3 07 1 08 0 09 0 0

more than 9 0 0Yes 11 5No 3 2Rent 0 0Own 14 7Other 0 00 8 01 5 32 1 33 0 14 0 0

more than 4 0 0

3. How many

people live in your

household?

4. Do you have pets?5. Do you rent or own your house?

6. How many cars does the household have?

Question Answers

1. What is your age range?

2. H ow long have you lived in Nogales , S ono ra (in years )?

Results Survey

Table 2 demonstrates the demographic profile of a

single respondent representing each household. A

majority of respondents in Colosio were between the

ages of 25-34 where as in Fatima, the majority were 65

or over. Respondents in Colosio were fairly new to the

neighborhood when compared to Fatima where

respondents said they have lived there for over 20 years

or all their life. Residents in Colosio frequently have

several family members living in one home with

majority of respondents indicating five people living in

a single home. In Fatima however, family members live

much more comfortably with majority indicating that

less than five family members live in the home.

Because of these numbers of occupancy, a total of 84

people are represented in this research with 63 coming

from Colosio and 21 coming from Fatima. All respondents said they own their home and

property rather than rent. The majority of residents in Colosio do not own a car, whereas

the majority in Fatima said they have at least one car per household.

Table 3 demonstrates a respondent’s level of satisfaction with certain quality of life

indicators. When it came to satisfaction with current housing or neighborhood, more than

Table 2. Demographic profile


P a g e | 30

half of the residents in Colosio said they were very satisfied. All the respondents in

Fatima indicated they were more than satisfied with their current living situation. When it

came to people’s satisfaction with the responsiveness of local government, in Colosio

responses were varied. Four out of 14 were very satisfied where as another four were not

satisfied at all with government responsiveness. In Fatima responses were not as varied

and all respondents said they are very satisfied with local government responsiveness.

Respondents rated their personal quality of life, as they personally defined it, and the

majority of respondents in Colosio said they were very satisfied where as the rest varied

among all levels of satisfaction. In Fatima however, only half said they were very

satisfied whereas the rest were mixed. The majority of respondents in Colosio said they

were very happy with their life in Nogales with a few (3 out of 14) indicating they were

not at all happy with their life. Almost all of the respondents in Fatima indicated that they

were happy with their life. Similar to their satisfaction with local government

responsiveness, majority of respondents in Colosio rated their access to medical treatment

in the area fairly high while other responses varied. In Fatima, all respondents rated their

access to medical treatment at a level of satisfactory or higher.

Table 3. Quality of life

Question

Answers (1-‐low; 5-‐high) 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5

Colosio (n=14) 2 1 3 1 7 4 3 1 2 4 2 2 2 0 8 3 0 1 1 9 1 2 3 2 6

Fatima (n=7) 0 0 0 1 6 0 0 0 1 6 1 1 0 1 4 1 0 0 0 6 0 0 2 2 3

8. Satisfaction with the responsiveness of your local government to your needs?

9. Satisfaction with your personal quality of life in Nogales?

10. In general, how happy are you with your life?

11. How would you rate how you can get medical treatment in your community?

7. Satisfaction with your current housing (house and colonia)?


P a g e | 31

Table 4. Rate of diarrhea from summer surveys

Table 4 demonstrates the rate of diarrhea in the household as well as respondents’

perceptions of water quality and how it impacts their health. Of the 21 households

recruited for this study, ten households reported a case of diarrhea within the past four

weeks of the survey. Of those ten households, six were from Colosio and four were from

Lomas de Fatima which means the rate of diarrhea in both colonias is almost at 50%.

Only four cases were self reported whereas the rest were reported by a relative. Two

households involved children under the age of 18. These cases of children were in

Colosio only. One household of these two said that three of their children reported an

episode of diarrhea. Since having multiple loose stools with excess water is not

necessarily an indicator of gastrointestinal disease in Mexico due to high fiber diets and

endemic pathogens, diarrhea may not be seen as a problem to some. However, a majority

of respondents in both colonias indicate that diarrhea is a problem and not just a natural

occurrence. Of interest is that of the three households that said diarrhea is a natural

occurrence, two of them had an episode of diarrhea recently. In Lomas, of the two that

said diarrhea was a natural occurrence, one had experienced diarrhea recently. In all, 12

people out of the 84 individuals in the sample reported a case of diarrhea within the past

four weeks; eight individuals were from Colosio and four were from Lomas de Fatima.

Question

Answer Yes No Yes No Yes No Yes No Yes No Yes NoColosio (n=14) 6 9 2 5 1 13 3 11 9 5 11 3Fatima (n=7) 4 3 2 5 0 7 3 7 5 2 5 2

S e e s d ia rrhe a a s a p ro b lem ra the r tha n na tura l o c c urre nc e

Episode of diarrhea in the past 4 weeks

Hospitalized due to diarrhea

Missed work or school

Claim water as the cause

Claim water can make them sick


P a g e | 32

Of the ten households with cases of diarrhea reported within the past four weeks, four

required a household member to be hospitalized. In all, 11 people were hospitalized due

to their case of diarrhea; eight were from Colosio while three were from Lomas de

Fatima. Therefore, the rate of requiring specialized treatment for diarrhea is higher in

Colosio than in Lomas de Fatima. Although some respondents said they were

hospitalized because of their diarrhea, only one household said they or a family member

missed work or school and another household said they weren’t sure. When asked what

they believe caused their episode of diarrhea, no household blamed the consumption of

water. Although none of the households that reported a case of diarrhea blamed water as

the cause, a majority of respondents do believe however that the water available to them

could potentially make them sick. Of those households that reported diarrhea, four

households in Colosio believe the water could make them sick where as the sentiment

was felt in three households in Lomas de Fatima. Some households reported that they

were already sick to begin with, or they believe they ate something that made them ill, or

it was a change in medication, or some simply didn’t know what the cause was.

Interestingly, some households claimed it was the heat and climate that caused their

episode of diarrhea. Whether this means they consumed more water because of

dehydration is unknown and should be investigated further. No household in either

colonia reported an episode of diarrhea within one week from when the follow up survey

was implemented during the winter. Therefore, the rate of diarrhea is low during the

winter months.


P a g e | 33


None 0 1OTC Tx 6 1

Prescription Tx 6 1Tea 0 1

Other herbal 0 0Juice 1 0Water 3 1Other 5 4

Potable water 0 3Bottled water 12 7

Private Water Truck 6 1Municipal Water Truck 0 0

Other 0 0

Yes 0 7

No 14 0

No 2 0Cistern 0 0

Tank on top of house (tinaco) 9 4Water tank or portable conainer 0 0

Underground tank (aljibe) 0 4Plastic gallon or bucket 4 0

Dishes 1 0Other 4 0Clear 8 5

Yellowish 0 1With dirt particles 6 1With other particles 0 0

No 10 3Chlorine 3 3Filter 0 0Boil 0 0Other 0 2

Yes 12 7

No 2 0

1 -‐ 2 0 02 -‐ 4 1 24 -‐ 6 4 26 -‐ 8 2 0

More than 8 7 3Piped in 0 7Bottled 1 0


Other 0 0Less than 100 pesos 1 0

100 -‐ 300 5 4301 -‐ 500 6 3501 -‐ 700 1 0701 -‐ 900 0 0901 -‐ 1300 1 01301 -‐ 1500 0 0

More than 1500 0 0*Mark all that apply

29. How do you obtain water for use other than drinking?*

30. How much money (in pesos) do you spend on water per month?

AnswerQuestion

19. How is diarrhea treated in the household?*

21. How do you get your drinking water?*

2 2 . Is the ho us e c o nne c te d to the c ity wa te r s ys tem v ia p ipe s ?

24. Do you store your water?*

25. How does the water that reaches your house look?26. Do you clean your water before using it to drink or cook?*

2 7 . Wo u ld yo u be wil l ing to tre a t yo u r wa te r a ny fu rthe r?

28. How many glasses of water (237ml) do you and your family drink a day?

Table 5 demonstrates how residents

normally treat episodes of diarrhea, how

they obtain their water, and whether they

disinfect the water in any way. Almost all

respondents indicated they treat their

episode of diarrhea in some way. The

majority of respondents said they treat

diarrhea with some sort of medication

whether prescription or otherwise. Others

use rehydration therapy by consuming

more water. Some respondents in both

colonias indicated using “suero” as a form

of treatment. Suero is Spanish for a saline

solution. A majority of respondents in both

colonias indicated they obtain their

drinking water from bottled water. Half of

respondents in Colosio rely on the water

trucks or pipas for their drinking water or

in conjunction with their bottled water. In

Fatima however, majority rely on the water

that is piped in from the city for drinking

Table 5. Water use


P a g e | 34

water if not in conjunction to their bottled water.

As predicted and expected, none of the respondents in Colosio have water piped into their

house and all respondents in Fatima have piped water. Most respondents said they store

their water in some way. A majority of respondents in Colosio said they store their water

either in a tank on top of their house, known as a tinaco, and or in plastic or metal

industrial container known as a tambo. In Fatima, all respondents store their water in

tinacos and or in the underground tanks also known as aljibes.

A majority of respondents in Colosio said that the water reaching the home is clear with

the rest expressing that it sometimes contained dirt particles. In Fatima, the

overwhelming majority said their water arrives clear while others said they noticed dirt

particles or discoloration. Almost none of respondents in Colosio treat their water before

using it to drink or cook. Some indicated they treat water with a bit of chlorine. In

Fatima, half disinfect their water using chlorine or some other method. An overwhelming

majority if not all of respondents in both colonias indicated they would not be willing to

treat their water any further than whatever practice they currently use.

When asked about their daily consumption of water, half of households in Colosio said

they drink more than eight glasses a day while the other half drank anywhere from four to

six a day. In Fatima, most drank anywhere from two to six glasses of water a day while

the rest of respondents drank more than eight. Other than drinking, respondents were

asked how they obtained their water for things other than drinking such as cleaning,

bathing, washing, etc. As expected, almost all of respondents in Colosio said they use the


P a g e | 35

water provided in pipas and therefore stored in their tinacos and tambos. In Fatima,

almost all respondents used the water that was piped in for uses other than drinking. The

majority of respondents in Colosio said they paid anywhere from 100-500 Mexican pesos

a month for water expenses whereas in Fatima almost all paid anywhere within that

range. One hundred to five hundred Mexican pesos amounts to about 10-50 US dollars.

Table 6. Water quality perceptions

Table 6 reflects respondents’ perceptions of their water and asked to rate different aspects

of their water. Half of respondents in Colosio said they were uncertain or gave an

indifferent rating for the overall purity of potable water in Nogales. This is most likely

because the respondents in Colosio do not have potable water available to them. All

respondents in Fatima rated the purity of water at some level above average. When it

came to the purity of piped water in the home, a majority of Fatima respondents rated it at

some level above average. When it came to satisfaction with their water service, almost

half of respondents in Colosio said they were overly satisfied with their current situation

where as majority of the other half said they were not at all satisfied with it. Meanwhile

all residents in Fatima said they were more than satisfied with their water service. When

asked about their concern over the purity of potable water in their community or colonia,

a majority of respondents in Colosio said they were uncertain or indifferent while others

Question

Answers (1-‐low; 5-‐high) 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5

Colosio (n=14) 0 2 7 2 2 3 0 4 2 1 4 0 2 0 7 3 1 5 1 3 6 1 1 2 4

Fatima (n=7) 0 0 3 3 1 0 0 0 2 3 0 0 0 1 6 2 0 2 0 3 4 0 0 2 1

31. The overall purity of potable water in Nogales?

32. The purity of piped water in your household, if piped?

33. Satisfaction with your water service?

34. Your concern over the purity of potable water in your community?

35. Concern with flooding and drought in the region?


P a g e | 36

equally indicated they were not at all concerned or very concerned. In Fatima, this

polarized distribution was also present. In terms of climatic challenges that affect water

resources such as flooding and drought, almost half of respondents in Colosio said they

are not concerned at all while other answers varied among different levels of concern. In

Fatima about half said they had no concern.

A series of open ended questions were also asked that were categorized as policy

implication questions as their responses could help shape local legislation on how to

handle current water inequity, cleaner potable water, and expanding water delivery.

When asked how much more per month they would be willing to pay for better potable

water, a majority of respondents said they would not be willing to pay more than they

already pay. Some said they didn’t know while others said they wouldn’t because they

already paid enough. Some were willing to pay between 100-500 pesos more a month or

in other words, double what they pay now. Responses in Fatima however indicated they

would be willing to pay more when compared with the residents in Colosio. When asked

what they would recommend so that potable water is improved a majority of respondents

believe that in order to improve potable water the system should be expanded so that

those that don’t have water get it. Others indicated that the water should be better treated

such as with chlorination, filtration, or purification. Some said to be aware of the

environment such as illegal dumping and better maintenance of wells and the watershed.

Residents in Colosio focused more on expansion and treatment of water whereas in

Fatima, residents focused more on the environment and water treatment. When asked

what the citizens of Nogales and OOMAPAS (the local water company) could do to


P a g e | 37

improve potable water, no clear answer was provided but a majority of respondents said

that delivery should be improved by OOMAPAS.

As for what citizens could do, it seems that there was mention that people should do their

part in paying for the water they receive and not waste or pollute the water they already

have. However, a majority of respondents were unsure of what could be done. When

asked whether or not they pay taxes if they would be willing to pay more in taxes for

better potable water majority of respondents said they didn’t know or don’t pay taxes or

would not be willing to pay any more in taxes for improved water. Responses indicated

that the amount that people would be willing to pay more in taxes is lower than what they

would be willing to pay for their water bills. This could be due to mistrust that their

money would be appropriately spent on water.

Finally, respondents were asked what they could do to improve potable water for the city.

Responses were varied but majority of respondents understood the role of preservation of

the environment for better water. For instance, some mentioned properly disposing waste

and not polluting or contaminating local water sources. Some also understood that they

should clean and maintain their water storage systems.

Water Quality

Table 7 demonstrates the number of colonies of E.coli and total fecal coliforms for each

household in a 100 mL sample. Households with numbers 1-14 were in the

environmentally vulnerable colonia, Colosio, whereas households with numbers 16-22

were in the more affluent neighborhood, Lomas de Fatima. Blank cells indicate that a


P a g e | 38

representative from the household was not present during the water collection or the

household did not have water to sample from. The households in red indicate that a

member of the household reported an episode of diarrhea within the past four weeks from

the start of the investigation (8/21/2010) and winter follow up (1/15/2011).

Table 7. E.coli and total fecal coliforms in households

To better represent Table 7, Figure 9 illustrates the percent of homes in the study that

tested positive for E.coli and total fecal coliforms during the investigation. A household

was defined as having E.coli or colifroms if detected on any visit. Almost 80% of homes

in the marginalized and highly environmentally vulnerable colonia, Colosio, had E.coli

present whereas none of the homes in the more affluent neighborhood, Lomas de Fatima,

had any E.coli present. 100% of the homes in Colosio tested positive for total fecal


P a g e | 39

coliforms during the length of the study whereas less than 60% of homes in Lomas de

Fatima were contaminated with total fecal coliforms. A high percent of total fecal

colifroms in Lomas de Fatima is alarming as these homes are receiving piped water.

Fecal contamination in these homes is an indicator that there is an environmental

exposure with these homes water delivery systems such as with their aljibes or tinacos or

even cracks in pipes within the home.

Figure 9. Percent of houses with E.coli and total fecal coliforms during summer

Figure 10 illustrates the average number of colonies per 100mL sample of E.coli and total

fecal coliforms by neighborhood and season as well as the rate of diarrhea. The percent of

households that reported diarrhea in Colosio is approximately 42.9% whereas in Fatima it

is almost 60%. Figure 4 demonstrates that although E.coli and total fecal coliforms values

are greater in Colosio, the percent of households that reported diarrhea is lower than

Fatima. This suggests that the rate of diarrhea is independent of water quality alone and

*

* No E.coli detected


P a g e | 40

therefore other confounders such as insufficient seasonal chlorination, food, food

preparation, climate, medication, illness and hygiene could play a role.

Figure 10. Average contaminant load and rate of diarrhea by neighborhood and season

A 2x2 table suggests a mild increase in diarrhea associated with E.coli and less diarrhea

in the absence of E.coli. Therefore, the 2x2 table indicates that the trend is in the right

direction (See Table 8). Again, other factors (insufficient seasonal chlorination, food,

food preparation, climate, medication, illness and hygiene) may be at play.


P a g e | 41

Table 8. 2x2 table of E.coli and reported episode of diarrhea

For seasonal variability, the percent of households that tested positive for E.coli in

Colosio is lower in the winter at almost 40% of households versus 80% in the summer

and in Fatima it remained 0% during the summer and winter (See Figure 9). The average

E.coli count in Colosio also dropped from 26.7 to 3.7 colonies per 100mL (See Figure

10). Total fecal colifroms were also reduced in the winter in Colosio at almost 60% of

households in the winter versus 100% in the summer with the average colony count per

100mL dropping from 79.4 to 65.8. The trend was seen in Lomas de Fatima with less

than 20% of households testing positive for total fecal colifroms in the winter versus

almost 60% in the summer. The average total fecal coliform colony count in Fatima

dropped from 22.3 to 1.1 per 100mL.

The metal analysis of the water samples showed that all median concentrations of metals

such as arsenic (0.00305mg/L), lead (0.000455mg/L), mercury (<0.0002mg/L), cadmium

(0.000060mg/L), copper (0.0100mg/L), to name a few were well below the EPA’s

maximum contaminant level (MCL) in both colonias. The median concentrations of

molybdenum (0.00165mg/L), lead (0.001050mg/L), antimony (0.000330mg/L), selenium

(0.00170mg/L), arsenic (0.00368mg/L), copper (0.0259mg/L), tin (0.0134mg/L), and

zinc (0.0464mg/L) were higher in Lomas de Fatima. These elevated concentrations are

most likely due to homes in Lomas de Fatima receiving piped water from metal pipes.

Yes No TotalsReported Episode of Diarrhea

E.coli

Present 5 4 9Not Present 5 7 12

Totals 10 11 21E.coli


P a g e | 42

Colosio had higher median concentrations of cadmium (0.000065mg/L) as well as

chloride (29.2mg/L) and sulfate (45.9mg/L). Colosio had significantly higher levels of

chloride than Lomas de Fatima where the median concentration was 29.2mg/L versus

7.7mg/L. Chloride in water is an indicator of naturally present salt in the environment

which can be attributed to exposure to inorganic fertilizers, landfill leachates, septic tank

effluents, animal feeds, industrial effulents, irrigation drainage and chlorine treatment

(WHO, 2003). Because residents in Colosio have their water storage containers exposed

to the environment and have reported treating with chlorine elevated levels of chloride is

expected. Table 9 shows the concentrations for all metals and ions sampled for and Table

10 shows the mean, standard deviation, and median of each metal concentration sampled.

Table 9. Metal and ion concentrations from samples on 8/21/11

Arsenic (As) mg/L

Cadmium (Cd) mg/L

Chloride (Cl) mg/L

Copper (Cu) mg/L

Mercury (Hg) mg/L

Manganese (Mn) mg/L

Molyebdenum (Mo) mg/L

Lead (Pb) mg/L

Antimony (Sb) mg/L

Selenium (Se) mg/L

Tin (Sn) mg/L

Sulfate (SO4) mg/L

Zinc (Zn) mg/L

EPA: 0.010 mg/L

EPA: 0.005 mg/L

EPA: 250 mg/L

EPA: 1.3 mg/L

EPA: 0.002 mg/L

EPA: 0.05 mg/L

EPA: 0.015 mg/L

EPA: 0.006 mg/L

EPA: 0.05 mg/L

EPA: 250 mg/L

EPA: 5 mg/L

Colosio 1 0.000670 0.000070 29.2 0.0372 < 0.0002 0.0025 0.0009 0.00038 0.00011 0.0001 0.0243 45.2 0.0522Colosio 2 0.000430 0.000040 30.9 0.0035 < 0.0002 0.0022 0.0010 0.00008 0.00007 0.0001 0.0104 48.1 0.0091Colosio 3 0.000560 0.000070 29.2 0.0114 < 0.0002 0.0045 0.0011 0.00023 0.00039 0.0002 0.0282 47.8 0.0341Colosio 4 0.000530 0.000060 42.6 0.0032 < 0.0002 0.0011 0.0011 0.00054 0.00008 0.0004 0.0024 74.6 0.0187Colosio 5 0.003040 0.000020 8.27 0.1380 < 0.0002 0.0009 0.0003 0.00108 0.00008 0.0007 0.0058 4.49 0.0110Colosio 5 -‐Replicate 0.003050 0.000060 8.29 0.1400 < 0.0002 0.0019 0.0004 0.00114 0.00009 0.0008 0.021 4.52 0.0260Colosio 6 0.000520 0.000050 31.3 0.0059 < 0.0002 0.0037 0.0010 0.00005 0.00013 0.0003 0.0196 48.3 0.0168Colosio 7 0.000880 0.000090 31.1 0.0060 < 0.0002 0.0055 0.0016 0.00275 0.00016 0.0004 0.0261 46.5 0.0276Colosio 8 0.003380 0.000060 7.51 0.0013 < 0.0002 0.0005 0.0004 0.00003 0.00011 0.0007 0.004 2.49 0.0121Colosio 9 0.003140 0.000070 9.97 0.0116 < 0.0002 0.0040 0.0005 0.00034 0.00020 0.0006 0.0337 7.41 0.0265Colosio 10 0.000410 0.001040 22.8 0.0039 < 0.0002 0.0038 0.0007 0.00036 0.00016 0.0003 0.0156 37.3 0.1700Colosio 10-‐Replicate 0.000380 0.001020 22.8 0.0013 < 0.0002 0.0029 0.0007 0.00029 0.00016 0.0004 0.0006 37.6 0.1690Colosio 11 0.001080 0.000020 37.8 0.0013 < 0.0002 0.0009 0.0008 0.00015 0.00010 0.0005 0.0158 56.4 0.0091Colosio 12 0.000600 0.000040 41.4 0.0023 < 0.0002 0.0012 0.0011 0.00004 0.00008 0.0006 0.0016 72.1 0.0097Colosio 13 0.000610 0.000150 34.8 0.0132 < 0.0002 0.0099 0.0010 0.00081 0.00020 0.0006 0.067 51.6 0.0607Colosio 14 0.004180 0.000100 5.79 0.0049 < 0.0002 0.0028 0.0006 0.00041 0.00008 0.0004 0.0234 3.54 0.0476Lomas 16 0.008640 0.000040 9.95 0.0334 < 0.0002 0.0013 0.0005 0.00136 0.00012 0.0005 0.0278 8.93 0.0410Lomas 16-‐Replicate 0.007960 0.000080 9.96 0.0412 < 0.0002 0.0056 0.0007 0.00102 0.00025 0.0007 0.0523 8.93 0.0591Lomas 17 0.013600 0.000050 18.3 0.0085 < 0.0002 0.0010 0.0030 0.00050 0.00015 0.0007 0.005 17.4 0.0534Lomas 18 0.002760 0.000030 7.86 0.21000 < 0.0002 0.0009 0.0016 0.00060 0.00031 0.0017 0.0011 35.1 0.0414Lomas 19 0.003790 0.000060 7.74 0.1610 < 0.0002 0.0029 0.0017 0.00132 0.00041 0.0017 0.0223 36.5 0.0559Lomas 19-‐Replicate 0.003750 0.000080 7.6 0.1620 < 0.0002 0.0025 0.0018 0.00149 0.00036 0.0017 0.0179 36.8 0.0298Lomas 20 0.003370 0.000030 7.41 0.0048 < 0.0002 0.0005 0.0016 0.00015 0.00035 0.0017 0.004 36.3 0.0343Lomas 20-‐Replicate 0.003320 0.000170 7.46 0.0183 < 0.0002 0.0058 0.0017 0.00124 0.00042 0.0017 0.0669 36.5 0.0833Lomas 21 0.003610 0.000150 7.24 0.0061 < 0.0002 0.0012 0.0018 0.00108 0.00031 0.0016 0.0044 34.7 0.0514Lomas 22 0.003260 0.000040 7.45 0.0149 < 0.0002 0.0005 0.0016 0.00021 0.00035 0.0018 0.0088 36.2 0.0248

Colonia House #


P a g e | 43

Table 10. Mean, median, and standard deviation of metal concentrations from 21 homes

Mean Median Std Dev Mean Median Std Dev Mean Median Std Dev Mean Median Std DevColosio 0.00143 0.00064 0.00135 0.000185 0.000065 0.000331 24.6 29.2 12.8 0.0241 0.0054 0.0457Lomas 0.00541 0.00368 0.00354 0.000073 0.000055 0.000049 9.1 7.7 3.4 0.0660 0.0259 0.0790Both 0.00298 0.00305 0.00307 0.000142 0.000060 0.000264 18.6 10.0 12.7 0.0402 0.0100 0.0627



Selenium (Se) mg/L Tin (Sn) mg/L Sulfate (SO4) mg/L Zinc (Zn) mg/L

Arsenic (As) mg/L Cadmium (Cd) mg/L Chloride (Cl) mg/L Copper (Cu) mg/L

Manganese (Mn) mg/L Molyebdenum (Mo) mg/L Lead (Pb) mg/L Antimony (Sb) mg/L


P a g e | 44

Discussion

Findings

With the data obtained we have made a number of observations. First, data exists within

the municipality to characterize access to water for each colonia. As Collins et al. (2010)

explains, there is a common misconception by outsiders that quality of life in Mexico is

low. Table 3 indicates that life satisfaction is quite high. For instance, for the five

questions in the survey inquiring about quality of life, majority of respondents in both

colonias rated quality of life factors with a three or greater on a 5 point scale.

Respondents in the higher SES colonia, Lomas de Fatima, were quite pleased with life,

although the number of respondents was only 7.

Sadalla et al. (1999) states, “it is possible that colonia residents may not be concerned

about factors that greatly influence their health, but at the same time remain quite

concerned about factors that have minimal health impact.” These statements were not

reflected in this survey; again the respondent number is low. Residents mistrust the water

quality, that is they believe it could make them sick, however they are taking their own

precautions against it. Ninety percent of residents in both colonias indicated that they

obtain their drinking water from a bottled water source. Therefore, in this study, colonia

residents can identify a risk to their health and take necessary precautions. It is important

to note that even though residents are protecting themselves by purchasing drinking

water, they continue to use the water delivered to them to wash clothes, clean dishes, and


P a g e | 45

bathe. None of these activities require direct ingestion of water, yet people may be

exposed through secondary means.

Second, microbial contamination is high, particularly in the marginalized colonia Colosio

that does not have access to piped water. Observations are similar to others (ADHS,

1993; Mack and Varady, 1995; Sanchez, 1995; Williams, 1987; Udall Center, 1994)

however their samples were obtained from wells whereas for this project they were

obtained from the household’s reported point of use such as tinacos, tambos, and aljibes.

Sanchez (1995) stated that no microbial contamination was observed from water sampled

from the municipal water system however there is no mention as to where in the

municipal water system they were obtained i.e. point of use, pipas, distribution site,

treatment plant, city pipes, etc. Because we found microbial contamination in excess of

the EPA’s (2011) recommended MCL of 0 for majority of the households, water is

contaminated by the time it reaches the user.

Third, because half the households report an episode of diarrhea within the past four

weeks, the rate of diarrhea is high. It is understandable that residents do not blame the

water for their episode of diarrhea since almost all said they drink bottled water.

However, residents fail to realize that they are still exposed to potentially contaminated

water from cleaning, cooking, and bathing and therefore have not taken this exposure into

consideration. Given that most residents, especially in Colosio, are not drinking water

delivered to them and are taking basic precautions by personally disinfecting their potable


P a g e | 46

water, most residents did not favor an increase in taxes or water bills or adding on any

new disinfection practices for better potable water.

Fourth, even though the rate of diarrhea is high it seems that it is independent of water

quality. This is because the colonia that was expected to have the lowest rate of diarrhea

because they received piped water, Fatima, had an incidence of diarrhea of almost 60%

versus 40% in Colosio. When a 2x2 table is constructed, households that reported no

diarrhea and tested negative for E.coli had the highest frequency, demonstrating a trend

in the right direction. These results indicate that the high rate of diarrhea in the colonias is

attributed to other risk factors such as food, food preparation, hygiene, illness,

prescription side effects, climate, etc and perhaps even indirect exposure from delivered

water such as bathing and washing dishes and clothes.

Fifth, microbial contamination is higher in the summer during the rainy monsoon season.

Households that tested positive for E.coli dropped from approximately 80% to 40% and

total fecal coliforms dropped from 100% to almost 60% in Colosio. The increase in

microbial contamination during the rainy summer season is most likely attributed to

heavy runoff (Curreiro, et al. 2001). The relatively high concentration of chloride found

in Colosio samples is evidence of environmental exposure from runoff (WHO, 2003). In

Colosio, as residents use latrines to relieve themselves, runoff from heavy rainfall can

carry waste and excrement throughout the city, and therefore contaminating improperly

sealed aljibes, as well as form dust as it dries and landing inside of tinacos and tambos.


P a g e | 47

These series of events most likely cause the elevated levels of microbes during the

summer season in Nogales, Mexico.

Lastly, metal concentrations analyzed for were well below the EPA’s (2011) MCL.

Although researchers (ADHS, 1993; Mack and Varady, 1995; Sanchez, 1995; Williams,

1987; Udall Center, 1994) found elevated levels of TCE and VOCs, Sanchez (1995)

stated that VOCs found in well water were traced to industries in the area. Arsenic,

cadmium, mercury, antimony and selenium are metals commonly associated with

industrial waste and by products (EPA, 2011). Because these concentrations were low in

this study, it’s possible that Nogales has been enforcing its environmental protection laws

since previous studies’ findings.

Recommendations

Regardless of residents’ perceived risks there is a health issue. One way to align

perceived risks with actual risk and effective preventive action is through education and

awareness. Most residents indicated that the only disinfection practice they partake in is

chlorine treatment. No household mentioned scrubbing, cleaning and rinsing their storage

containers when empty. Research volunteers also observed numerous containers without

lids leading to environmental exposure as evidenced by the high concentration of chloride

in Colosio samples. Failure to apply various procedures and only relying on basic

chlorine treatment can lead to chlorine resistant bacteria.

During the follow-up survey, research volunteers were required to inform residents of

water quality and provide basic instructions on how to better disinfect their water storage


P a g e | 48

containers as well as provide contact information for the local public health department.

Residents mentioned they would be willing to take on new practices if properly

instructed. The city of Nogales, Sonora currently does not have a health education

program addressing disinfection of water containers. Such a program could be easily

implemented with the help of promotores. Promotores, or promoters of health in Spanish,

are Spanish speaking community health workers that reside and work in the community.

They are normally not specialized in the health field but rather have shown an interest in

community health issues and help disseminate information from a trained health

professional. Their approachability and simplified dissemination of health education has

been shown to be highly effective in the prevention of health issues (Meister, 1992). The

promotores could be involved in instructing how to properly disinfect tinacos, tambos,

and aljibes and perhaps how to use flocculent.

Flocculent is a disinfectant powder that is added to drinking water to remove

microorganisms, organic matter and heavy metals (Chiller et al., 2006). The flocculent

disinfectant includes many chemicals used in commercial water treatment but has been

specially formulated to work quickly on small volumes of water. All ingredients in the

flocculent disinfection are used in commercial water treatment or in food products and

are generally recognized as safe. The flocculent disinfectant combines precipitation,

coagulation and flocculation with chlorination. Four sachets of flocculent are enough for

a week's worth of water consumption and each sachet costs $0.035. A recent World

Health Organization study (Chiller et al., 2006) found that in total, there was a 40%


P a g e | 49

reduction in the longitudinal prevalence of diarrhea among people using the flocculent

that did not have access to a potable water system.

A comprehensive review of 100 studies evaluating the health impact of improvements in

water supplies and sanitation in developing countries found that improvements in water

supply alone were associated with a median reduction of 25% in diarrheal morbidity

(Esrey, 1990). The same study also revealed that, in these same areas, improvements in

both water and sanitation have an even greater impact on mortality than on illness, with a

median reduction of 60% in deaths from diarrheal diseases. Just a slight improvement in

water quality can play a major role in improving a community's health and quality of life.

Impact

The results of this project will benefit the local center of the USGS and Mexican agencies

involved in the project. The USGS is not known to deal with human health issues

involved with environmental health and instead focuses on the physical and chemical

aspects of the environment and how they change as a result of human involvement and

natural processes. This project, its design and its results, can assist the USGS in tying its

extensive research of the southwest to public health such as water quality control,

watershed management, and even ecosystems modeling to name a few. The Mexican

agencies involved in this project have expressed immense gratitude for this project as

information on water quality and health specifically to the colonias in Nogales, Sonora

are limited or nonexistent. Mexican officials have mentioned that talks are underway to


P a g e | 50

possibly request a more in depth version of this project and to begin designing a citywide

tinaco disinfection and education program.

Strengths and Weaknesses

The literature related to health on the border specifically Nogales, Sonora, Mexico is

limited. Most of the research available concerning water and health in Nogales is over ten

years old. Available research pertains to water quality and does not investigate its direct

effects on health but makes assumptions. This study investigates health as it pertains to

gastrointestinal disease by using qualitative and quantitative methods in two

neighborhoods in Nogales. By implementing a survey that inquires about quality of life,

water delivery, rate of diarrhea, and disinfection practices as well as analyzing water

quality, this study is multifactorial. Most importantly, this project was a true binational

effort. Not only researchers were involved from both sides of the border but also

policymakers and government officials in an effort to help disseminate relevant

information quicker and to use results as a major reference for policy and systems change

in the area.

As with any study there are limitations to its success and this study was no exception.

The observations would be more credible with a greater sample size and representation of

more colonias. The information gathered from the survey might be improved if every

person in a household was interviewed rather than a single respondent representing the

views of the entire household. This approach might yield “autocorrelated” responses and

would require a greater consenting process, but views might be more diverse that


P a g e | 51

presented. The survey could also have been improved if prospective: each household and

each member could keep a journal of personal water consumption and episodes of

diarrhea for a designated time period rather than relying on recall. A comparison of the

neighborhoods in Nogales, Arizona with the neighborhoods in Nogales, Sonora might

have been beneficial. In addition, more collection of samples over time would have

improved observations of seasonal variability. An investigation of VOCs in water

samples would have supplemented conclusions. Results could be improved if water

samples were collected from every point of distribution ie well, treatment facility, pipa,

city pipe line, tinaco/tambo/aljibe. Due to time constraints and limited resources, the

methodology for the study was reduced from the original study design. Although the

study is limited, we strongly believe it provides researchers and stakeholders with a status

report regarding potential concerns and issues.

By working closely in the development of this study with Mexican officials, some of

whom included local epidemiologists, directors of public health agencies (CSP), directors

of zoning and planning (IMIP), and the local water company (OOMAPAS), we believe

the information provided will be applied to good use.

Relation to Public Health

The three core functions of Public Health are:

“1) assessment and monitoring of the health of communities and populations at risk to identify health problems and priorities; 2) formulating public policies, in collaboration with community and government leaders, designed to solve identified local and national health problems and priorities; 3) assuring that all populations have access to appropriate and cost-effective care, including health


P a g e | 52

promotion and disease prevention services, and evaluation of the effectiveness of that care.”

The first core was addressed by analyzing and assessing water quality in Nogales, Sonora

and its connection to the prevalence of gastrointestinal disease by administering a

questionnaire. Health was monitored by asking participating households if an episode of

diarrhea had occurred within the past four weeks both in the summer and in the winter.

Water quality was also assessed and monitored seasonally for changes in microbial

contamination and possible change in metal concentration.

The second core was addressed by collaborating with local and binational leaders,

stakeholders, professionals, and policy makers in addressing the issue of water quality

and potentially formulating public policies to improve the water in Nogales, Sonora and

ultimately its citizens’ health. All processes of the study have been transparent from the

beginning and results, both preliminary and solid, have been disseminated to all parties

involved including participating households. It is believed that with constant and direct

communication with all parties as well as expressing recommendations and providing

scientific proof of current issues will assist binational leaders in discussing, strategizing,

and possibly implementing cost effective interventions for improving water quality and

health in the area.

The third core was addressed by providing participating households with the results of

the water quality investigation and linking them with appropriate local care such as a

local contact person with the Centro de Salud Urbano that would not only address any

concerns they had about the episode of diarrhea they reported but also suggestions of how


P a g e | 53

they could properly disinfect they water storage containers. A representative from the

Ayuntamiento de Nogales also shadowed all visitations and provided even more

networking for participating households.

Table 11 lists the 10 Essential Public Health Services and how they were addressed by

this internship.

Table 11. 10 public health essential services and how addressed in internship

Essential Services How Addressed

1 Monitor health status to identify

community health problems

Health status will be monitored by

implementing a questionnaire that

investigates the prevalence of

gastrointestinal disease such as

diarrhea and if its cause is connected

with the local water supply.

2

Diagnose and investigate health problems

and health hazards in

the community

Health hazards will be investigated

by analyzing the water for hazards

such as pathogens and metals and

frequency during seasonal

variability.

3 Inform, educate, and empower people

about health issues

The results of this internship will be

made public and distributed to local

officials that collaborated or

provided input on the project. The

promotoras, or local community

health workers, will help administer

the questionnaire will also


P a g e | 54

disseminate information to their

communities.

4 Mobilize community partnerships to

identify and solve health problems

Community partnerships will be

established by working with local

health officials, community health

workers, and attending meetings and

conferences.

5 Develop policies and plans that support

individual and community health efforts

A cost effective policy

recommendation will be made based

on the results of the internship as

well as from all collaborators

involved.

6 Enforce laws and regulations that protect

health and ensure safety

The results of this internship could

potentially help further enforce

environmental laws and water

quality.

7

Link people to needed personal health

services and assure the provision of health

care when otherwise unavailable

Contact information was provided to

a local health official with the

Centro de Salud Urbano to report

their concerns over their episode of

diarrhea as well as education on

suggestions for proper disinfection

practices for water storage

containers.

8 Assure a competent public health and

personal health care workforce The Asociacion de Promotoras who

will be working on this project are a


P a g e | 55

competent public health workforce

with community ties due to their

commitment to community health.

9

Evaluate effectiveness, accessibility, and

quality of personal and population based

health services

Health services in particular will not

be addressed however the

questionnaire contains questions

about quality of life such as access

to such services and overall

satisfaction with them.

10 Research for new insights and innovative

solutions to health problems

The results from this internship will

hopefully provide new insights on

the current water quality issue in

Nogales, Sonora as well as provide

innovative policy solutions to those

problems. The internship will

hopefully be used as a pilot for a

larger more comprehensive study

later on.


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Conclusion

Summary

As evidenced by the greater levels of microbial contamination from Colosio when

compared to Fatima, there is a possibility of greater vulnerability to gastrointestinal

illness when there is no access to piped water. Yet, actual reported disease was 43% in

Colosio and 57% in Fatima. This investigation did not find water quality to be the reason

behind the high rate of diarrhea. Microbial contamination was found to be significantly

greater during the summer monsoon season. Both neighborhoods report more diarrhea

during the summer season. Summer contamination has serious public health implications

as the region will experience increased extreme weather and warming due to climate

change. The city of Nogales, Mexico needs to have an at-home water treatment education

program, to promote clean water delivery and decrease water inequities.

Evaluation of Experience

The experience gained from this internship was absolutely invaluable. Working with the

USGS and the Udall Center has provided me with immense opportunities from traveling

to conferences, to publishing, to having enough funding to implement such an

investigation. Although working with so many agencies and institutions and all the

feedback and shared interests they provided was extremely challenging and at times

frustrating, without their voice this project would not have been successful. As I prepare

to leave the college, the USGS, and the Udall Center, I hope that all agencies involved,


P a g e | 57

on both sides of the border, use this project with all its strengths and limitations to

provide for a better and healthier border.


P a g e | 58

Work Cited

Aldous, P. (2003). The world’s forgotten crisis. Nature. 422:251. Arizona Dept. of Health Services. (1993). Health risk assessment at Nogales Wash. Prevention Bulletin 7(1): 2-3. Callegary, J., Gray, F., Paretti, N., Norman,L., Withers, K., Vandervoet, P., McAndrew, R., Scott, C., Van Riper, C., Megdal, S., & Prichard, A. (2010). Physical and biological science to study interactions among water, environmental, and human health in the transboundary upper santa cruz basin. In Proceedings of Santa Cruz River Researcher’s Day. March 29. Tucson, Arizona. (http://www.southwestlearning.org/getinvolved/outreach/workshops/scr) Centro de Salud Urbano de Nogales, Gobierno del Estado de Sonora, Secretaria de Salud Publica. Internal Document. (2010). Chiller, T. M., & Mendoza, C. E., & Lopez, M. B., et. al. (2006). Reducing diarrhea in Guatemalan children: randomized controlled trail of flocculent-disinfectant for drinking water. Bulletin of the World Health Organization. 84 (1) 28-35. Colford, J. M., & Roy, S., & Beach, M. J., et. al. (2006). A review of household drinking water intervention trials and an approach to the estimation of endemic waterborne gastroenteritis in the United States. Journal of Water and Health. 4 (2) 71-88. Collins, K., & Subhrajit, G., & Sadalla, E., et. al. (2010). A longitudinal assessment of quality of life in the US-Mexico border region. Southwest Consortium for Environmental Research & Policy. Project Number: EIR 06-2/3. Curriero, F., Patz, J. A., Rose, J. B., Lele, S. (2001). The association between extreme precipitation and waterborne disease outbreaks in the United States, 1948-1994. The American Journal of Public Health, 91(8), 1194-1199. Esrey, S., et al. (1990). Health benefits from improvements in water supply and sanitation: survey and analysis of the literature of selected diseases. United States Agency for International Development, Water and Sanitation for Health (WASH) Technical Report 66, Washington, D.C.: Agency for International Development. Ezzati, M. (2005). Environmental risks in the developing world: exposure indicators for interventions, programs & policies. Journal of Epidemiology 59:15-22. Lara-Valencia, F., Declet-Barreto, J., & Keys, E. (2008). Spatial equity and transportation hazard along cross-border trade corridors: the case of ambos Nogales. Journal of Borderland Studies, 23(2), 1-16.


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Lara-Valencia, F., Brazel, A. J., Mahoney, E., et. al. (2010). The response of US-Mexico border cities to climate change: current practices and urgent needs. DRAFT. Mack, M. D., & Varady, R. (1995). Transboundary water resources and public health in the US-Mexico border region. Journal of Environmental Health. Meister, J., Warrick, L. de Zapien, J., & Wood, A. (1992). Using lay health workers: case study of a community-based prenatal intervention. Journal of Community Health, 17 (1), 37-51. Morehouse, B., Carter, R. H., & Sprouse, T. W. (2000). The implications of sustained drought for transboundry water management in Nogales, Arizona, and Nogales, Sonora. Natural Resources Journal, 40, 783-817. Norman, L., & Austin, D. (2004). Unifying US-Mexico sister cities with colonias GIS as a framework [abs.]: Arizona Geographic Information Council (AGIC) 2004 GIS Education and Training Symposium. October 27-29. Prescott, Arizona. Norman, L. M., Donelson, A., Pfeifer, E., and Lam, A. H., (2006). Colonia development and land use change in ambos Nogales, United States-Mexican border: U.S. Geological Survey Open File Report: 2006-1112. http://pubs.usgs.gov/of/2006/1112. Norman, L., Huth, H., Levick, L., Shea Burns, I., Phillip Guertin, D., Lara-Valencia, F., & Semmens, D. (2010). Flood hazard awareness and hydrologic modeling at Ambos Nogales, United States-Mexico border. Journal of Flood Risk Management. (3) pp 151–165. Paretti, N., Callegary, J., Gray, F., Beisner, K., Norman, L., & Van Riper, Charles. (2010). Occurrence, fate, and bioaccumulation of organic and inorganic contaminants from multiple sources in the upper Santa Cruz watershed, [abs.], Arizona Hydrological Society, Sept 1-4. Tucson, Arizona.

Sadalla, E., & Swanson, T., & Velasco, J. (1999). Residential behavior and environmental hazards in Arizona-Sonora colonias: A continuation project. Southwest Consortium for Environmental Research & Policy. Project Number: EH99-2. Sanchez, R. A. (1995). Water quality problems in Nogales, Sonora. Environmental Health Perspectives. 103 (1) 93-97. Tolan, S. (1990). The border boom. Hope and heartbreak. The New York Times Magazine; July 1, 1990. Udall Center for Studies in Public Policy. (1994). The Ambos Nogales water resources


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project: Summary of project outputs, Tucson, Arizona. Udall Center US Environmental Protection Agency. (2011). Drinking water contaminants. Drinking Water. Accessed on March 3, 2011 at http://water.epa.gov/drink/contaminants/ US Environmental Protection Agency Region IX. (1999). Environmental assessment for water system improvements for city of Nogales, Sonora, Mexico. US-Mexico Border 2012 Program. Accessed on April 12, 2010 from http://www.epa.gov/usmexicoborder/infrastructure/nogales/water.html US Environmental Protection Agency. (2011). Drinking water contaminants. Drinking Water. Accessed on March 3, 2011 at http://water.epa.gov/drink/contaminants/ US - Mexico Border Health Commission. (2003). Healthy Border 2010 - An Agenda for Improving Health on the United States-Mexico Border. Retrieved on April 10, 2010 from http://www.borderhealth.org Williams, JD. (1987). Groundwater sampling plan for Nogales Wash. Arizona Department of Health Services. Phoenix, Arizona. World Health Organization. (2003). Chloride in drinking water. WHO Guidelines for Drinking Water Quality. Accessed on March 16, 2011 from http://www.who.int/water_sanitation_health/dwq/chloride.pdf

TO: M. en C. Francisco Octavio Gastelum Ceballos, Director General, OOMAPAS FROM: Felipe Caldeira, Graduate Research Assistant DATE: June 2, 2010 SUBJECT: Authorization to Collect Water Samples from Residences Receiving Water Treated by OOMAPAS

As a Master’s student with the College of Public Health at the University of Arizona as well as a graduate research assistant with the Udall Center for Public Policy, I would like to collect and analyze, with the permission of OOMAPAS, water samples from homes in Nogales, Sonora, Mexico in order to investigate the water quality at point of use and its potential impact on a person’s health. People, businesses, industry and society thrive when there is a dependable source of high quality water. Rapid development in the US-Mexico border region, fueled by international commerce and industrialization, places pressure on resources, particularly potable water, and challenges communities providing these resources. The purpose of this investigation is to compare the water quality of two very different colonias in Nogales, Sonora in terms of their socioeconomic vulnerability and access to potable water; Lomos de Fatima and the area containing Marguerita Maza de Juarez Colonia Luis Donaldo Colosio. Water samples collected will be analyzed for metals such as arsenic, lead, and mercury and pathogens such as E.coli, enterococci and others. Water will be collected during the summer season as well as the winter season to test for seasonal variability. The results of the water samples will be coupled with a survey administered to each household that investigates the household’s prevalence of gastrointestinal disease such as diarrhea. A copy of the survey being implemented as well as an abstract and consent form are attached. The results of this investigation will be of great significance to the city of Nogales, Sonora. Although the city of Nogales regularly treats its water with the support of OOMAPAS however, in neighborhoods that are not connected to the city’s water system and thus have to rely on water delivery by water trucks and eventually store them in containers, the water quality could potentially be decreased as several sources of contamination would have been presented. The results of this investigation will help the city of Nogales, Sonora evaluate its water at the point in which it is being ingested and how it is impacting its citizens’ health. This investigation could be used as a tool for Nogales to justify expanding its water system or other less costly recommendations such as educating the public on water treatment practices in the household or even providing safe disinfectants for households to use. Any of the discussed interventions and others applied as a result of this investigation will ultimately help the city of Nogales, Sonora lower its prevalence of gastrointestinal disease and be an exemplary community that takes pride in its clean water and its citizens’ health. With the official authorization from OOMAPAS to collect water samples, the results of this study will be shared with OOMAPAS before they are published. Any material published from this investigation will not be used against OOMAPAS or the city of Nogales, Sonora, Mexico. If you have any questions, please feel free to contact me at [email protected]

Enc. Consent Form, Abstract, Survey

PARA: M. en C. Francisco Octavio Gastelum Ceballos, Director General, OOMAPAS DE: Felipe Caldeira, Graduate Research Assistant FECHA: June 2, 2010 TEMA: Autorización para recoger muestras de agua de las residencias que reciben agua tratada por el OOMAPAS Como estudiante de maestría en el Colegio de Salud Pública de la Universidad de Arizona, así como asistente de investigación con el Centro Udall de Políticas Públicas, me gustaría recoger y analizar, con el permiso del OOMAPAS, muestras de agua en residencias en Nogales , Sonora, México, a fin de investigar la calidad del agua en el punto de uso y su impacto sobre la salud de una persona. Personas, empresas, industria y la sociedad prosperan cuando existe una fuente confiable de agua de alta calidad. Rápido desarrollo en la región fronteriza de México-Estados Unidos, impulsado por el comercio internacional y la industrialización, pone una presión sobre los recursos, especialmente del agua potable, y existe un desafío entre estos recursos. El propósito de esta investigación es comparar la calidad del agua de dos colonias muy diferentes en Nogales, Sonora, en términos de su vulnerabilidad socioeconómica y el acceso al agua potable; Lomos de Fátima y el área que contiene Marguerita Maza de Juárez y Colonia Luis Donaldo Colosio. Las muestras de agua recogidas se analizarán para metales como el arsénico, plomo y mercurio y patógenos tales como E.coli, enterococos y otros. El agua será recogida durante la temporada de verano, así como la temporada de invierno para probar la variabilidad estacional. Los resultados de las muestras de agua serán utilizados con los resultados de una encuesta administrada a cada hogar que investiga la prevalencia de enfermedades gastrointestinales como diarrea. Una copia de la encuesta esta adjuntada así como el resumen y el formulario de consentimiento. Los resultados de esta investigación serán de gran importancia para la ciudad de Nogales, Sonora. Aunque la ciudad de Nogales regularmente trata sus aguas con el apoyo de OOMAPAS sin embargo, en los barrios que no están conectadas al sistema de agua y por lo tanto tienen que recurrir a la entrega de agua por pipas y, finalmente, almacenarlos en tinacos, la calidad del agua podría se disminuyó a medida que varias fuentes de contaminación que se han presentado. Los resultados de esta investigación ayudarán a la ciudad de Nogales, Sonora evaluar su agua en el punto en el que se ingieren y cómo está afectando la salud de sus ciudadanos. Esta investigación podría ser utilizado como una herramienta para Nogales justificar la expansión de su sistema de agua o también otras recomendaciones menos costosas, como educar el público sobre las prácticas de tratamiento de agua en el hogar, o incluso distribuir desinfectantes adecuados para los hogares. Cualquiera de las intervenciones analizadas, y otras aplicadas como consecuencia de esta investigación, ayudará a la ciudad de Nogales, Sonora reducir su prevalencia de enfermedades gastrointestinales y ser una comunidad ejemplar que se enorgullece de su agua limpia y la salud de sus ciudadanos. Con la autorización oficial de OOMAPAS para recoger muestras de agua, los resultados de este estudio serán compartidos con OOMAPAS antes de su publicación. Cualquier material publicado en esta investigación no serán utilizadas contra OOMAPAS o la ciudad de Nogales, Sonora, México. Si tiene alguna pregunta, por favor no dude en ponerse en contacto conmigo, [email protected] Adjunto: Formulario de Consentimiento, Resumen, Cuestionario

THE UNIVERSITY OF ARIZONA HUMAN SUBJECTS PROTECTION PROGRAM

PROJECT APPROVAL FORM – SOCIAL/BEHAVIORAL

1

Project Title: Water Quality and Health Analysis in Two Different Colonias of Nogales, Sonora, Mexico

Title on consenting documents (if different from project title): ________________________________________

IDENTIFICATION OF PI(S)

Principal Investigator(s): Degree(s): Status/rank: Department: College:

Robert G. Varady Ph.D Deputy Director Udall Center for

Studies in Public

Policy

The University

of Arizona

______________________________ ______ ______________ ________________ ____________

Faculty Advisor (if PI is a student):

______________________________ ______ ______________ ________________ ____________

PI CONTACT INFORMATION

Contact phone: 520-626-4393 Fax: ______________________________

Email: [email protected] Campus Mailing

address

(PO Box/VA

Mailstop):

803 E First St, Tucson, AZ 85719

ADVISOR/ALTERNATE CONTACT INFORMATION

Contact phone: 520-626-7083 Fax: ______________________________

Email:

[email protected] Campus Mailing

address:

Jill de Zapien

1295 N Martin

PO Box 245163

Tucson, AZ 85724

PROJECT START DATE: _________________________ PROJECT END DATE: _________________________

SUPPORT

Is this research project supported by intra- or extramural funding? Yes No

If “yes”, sponsoring agency/ies: _____________________________________________________________

Amount of funding:

_____________________________________________________________

NOTE: The full grant application must be submitted if the research described in your PAF is in conjunction

with a grant proposal.

Please provide answers to all of the following questions. All projects submitted for review must be typed (no

handwritten proposals accepted). After review by the Department Review Committee, please forward their

opinions and comments along with the signatures on the Project Review Form to the Human Subjects Protection

Program Office, University of Arizona, PO BOX 245137, Tucson, Arizona 85724-5137. Only one copy is

required and will be retained for the Human Subjects Protection Program files and eventually archived for a

permanent record.

mailto:[email protected]

Form version date: 2/3/10 Page 2 of 11 modified by: dg

Verification of Human Subjects Training (VOTF)

All individuals conducting research involving human subjects (with or without financial support of any sponsoring

organization or agency) must complete Human Subjects training. Those individuals include principal investigators, co-

investigators and all other individuals involved in the conduct of research. Students and their advisors must meet the same

standard as faculty and staff.

Please list all individuals involved in the above-cited research study

Name Research Role

(PI, Co-PI,

Collaborator,

Sub-I, Data Mgr,

Research Asst,

etc.)

Affiliation

UA/VA/

Other

Will this

person be

involved in

the

consenting

process? *

YES or NO

Training

Title

Indicate type

of training:

Biomed,

SBS, and/or

CITI-

Biomed,

CITI-SBS (see

definitions

below)**

Completion

Date(s)

for each

Human

Subjects

training

listed

(mm/dd/yy)

Felipe Caldeira Graduate

Research

Assistant

UA

USGS

Yes CITI – SBS 02/27/09

*Consent forms are to be signed and dated by the subject (or their legal representative) and by the Principal Investigator or Co-Principal Investigator

(no other study personnel may sign as Investigator without prior approval of the IRB). Other study personnel involved in the consenting process may sign as Presenter, but not as Investigator.

**CITI-Biomed, CITI-SBS: Collaborative Institutional Training Initiative – www.citiprogram.org

Author: University of Miami

http://www.citiprogram.org/


ASSURANCES ________________________________________________________________________________________

If appropriate, after review by the Departmental Review Committee, please forward their opinions and comments along with the

signatures on the Project Review Form to the Human Subjects Protection Program, University of Arizona, PO BOX 245137, Tucson,

Arizona 85724-5137. Only one copy is required and will be retained for the Human Subjects Protection Program files and eventually

microfilmed for a permanent record. Please provide responses to all of the following items.

1. PRINCIPAL INVESTIGATOR By signing below, I, the Principal Investigator, assure that all other investigators (co- investigators, collaborating investigators,

involved statisticians, consultants, or advisors) are fully aware of, and concur with, the project submission and that all Human Subjects

training verification information provided in this form is accurate. I ensure that I have identified all units that need to be prepared for

their involvement in the research project (e.g., schools, counseling services) and written authorizations for each area will be provided

prior to study initiation. I agree that no procedural changes relating to the research will take place without prior review by the IRB.

The following statement refers to concerns regarding Conflict of Interest, such as financial, administrative, or authoritative matters

that may influence any aspect of your research for which the IRB Committee should be aware:

Reporting Potential Conflicts of Interest:

A “Report of Outside Interests Related to Research” (ROI) must be submitted to the Conflict of Interest Office in accordance with the

UA’s Conflict of Interest and Conflict of Commitment policy (see http://orcr.vpr.arizona.edu/conflict-of-interest). The form is

available online http://orcr.vpr.arizona.edu/COI-forms.

PI Certification:

The Principal Investigator hereby affirms that ALL appropriate Covered Individuals (as defined by the policy posted on the

above-referenced website) have submitted an ROI to the Conflict of Interest Office and no outside interests related to this project

have been disclosed by any individual.

The Principal Investigator hereby affirms that ALL appropriate Covered Individuals (as defined by the policy posted on the

above-referenced website) have submitted an ROI to the Conflict of Interest Office and outside interests have been disclosed by

one or more individuals that must be reviewed by the Institutional Review Committee (IRC) to determine whether a conflict

exists related to this project.

Principal Investigator (Print) Signature Date Department

Advisor (Print) Signature Date Department

2. DEPARTMENTAL REVIEW COMMITTEE We/I have examined the proposal cited above, and find that the information contained therein is complete and that the scientific or

scholarly validity of the project has been assessed and found to be appropriate. If applicable, attach corresponding scientific review

letter.

______________________________ ____________________ __________ _____________________________

Chair of Departmental Signature Date Department

Review Committee (Print)

If this project recruits participants at the SAVAHCS or conducts any research activity at the SAVAHCS, the following must be

completed prior to submission:

The undersigned certifies that all VA staff listed as researchers on this project have met all VA training requirements.

______________________________ ____________________ __________ _____________________________

Chair of R & D Committee Signature Date Department

SAVAHCS (Print)

http://orcr.vpr.arizona.edu/conflict-of-interest


3. SUPERVISING OFFICIAL

I certify that (1) the resources necessary to protect human participants are available. Such resources include but are not limited to;

staffing and personnel (in terms of availability, number, expertise, and experience); psychological, social, or medical services (e.g.,

counseling or social support services required due to research participation); psychological, social, or medical monitoring, ancillary

care, equipment needed to protect participants, and resources for participant communication (e.g., language translation services)

(2) I assume the responsibility for ensuring the competence, integrity, and ethical conduct of the investigator(s); (3) no procedural

changes relating to the human subjects involved will be allowed without prior review by the Human Subjects Committee; (4) I am

satisfied that the procedures to be used for obtaining informed consent comply with the spirit and intent of DHHS and FDA

regulations; (5) I certify that the investigator(s) is fully competent to accomplish the goals and techniques stated in the attached

proposal

I certify that signed consent forms will be filed in ____________ (administrative room/building) and retained for a period of 6 years.

_______________________________ ____________________________ _________ _________________________

Name of Department Head, Dean of Signature Date Title

the College, Section Chief or

comparable authority (Print)


PROJECT ABSTRACT

In the space below, provide an abstract of the project. Include information about (a) the background and

rationale for the study; (b) the purpose and objectives; (c) methods to be employed and (d) significance of the

study. (a) the background and rationale for the study;

Water, air, and land suffer a disproportionate amount of environmental degradation on the border than the rest of the natural resources

of each nation.1 Several factors attribute to the border's current environmental condition, for one, rapid population growth over the past

decades has caused a great demand for resources which local governments have not been able to keep up with. This unbalanced

system has led to poorly planned development patterns in the colonias. Along with a growing population comes increased traffic

congestion, and waste generation. Overburdened and sometimes nonexistent waste treatments and disposal facilities often leads to

illegal dumping. Additionally, an inadequate water supply has been identified in the region. Agricultural drainage and airborne dust

from unpaved roads and pesticide exposure contribute to the pollution and harmful environmental exposures. All these factors

combined amount to an "abysmal air and water quality"1 in the border region.

(b) the purpose and objectives;

This project seeks to identify and evaluate environmental indicators and measures that are predictors of disease with regards

to water. We will examine the relationships between water availability, quality, and health indicators.

Similar studies about environmental quality and its effect on health have been conducted and published by the Pan American

Health Organization2 and Arizona State University

3. Related research projects including the USGS’s Border Environmental Health

Initiative and the Santa Cruz Watershed Ecosystem Portfolio Model as well as the Border 2012 task forces and initiatives are ongoing.

The goal of this project is to correlate investigation os the current water quality and water availability situation in colonias of

Nogales, Sonora, Mexico with impacts on respective communities’ health to initiate a cost effective binational policy

recommendation for sustainable water delivery.

Part of the USGS’s mission is to “…manage water, biological, energy, and mineral resources; and enhance and protect our

quality of life.” The college of Public Health’s mission is “…dedicated to promoting health of individuals and communities with a

special emphasis on diverse populations of the Southwest.” The goal of this project directly corresponds with the missions of the

USGS and the College of Public Health at the University of Arizona because of its relevance to water management, quality of life and

emphasis on promoting the health of a Southwest population.

(c) methods to be employed

The project will consist of 5 research areas:

1) Is to predict 2 areas or neighborhoods in Nogales Sonora that are opposites of one another in terms of their water quality.

This will be determined using existing databases for previous incidences of environmental health indicators such as

gastrointestinal disease, parasitic disease, pregnancy outcomes and diarrhea.

2) After those 2 areas are selected, 40 families (20 from each area) will be asked to participate in the study by answering a series

of questions about their water such as quality, access and their health in addition to quality of life. The same families will be

interviewed twice, once in the summer and once in the winter to assess seasonal variability on water quality.

3) Three water samples from each household will be taken twice a year, 3 times in the summer and 3 times in the winter, to test

for seasonal variability and then analyzed for microbes (E.coli) and metals (Arsenic, Lead, and Mercury). New analysis of

water quality will be done by James Callegary and the analysis of metals in water will be done by Floyd Gray, both with the

USGS.

4) Based on the water sample results and interviews, the two areas will be geocoded and mapped to predict areas with potential

water issues as well as provide a spatial analysis of disease data and quality of life. Geocoding will be conducted by Laura

Norman with the USGS.

5) Based on families’ responses about how they obtain their water and how and if they disinfect, a literature review will be

conducted to provide a relevant cost effective way for the city of Nogales, Sonora to deliver its water to residents that have

been shown to be affected by poor water quality due to poor infrastructure.

(d) significance of the study.

People, businesses, industry and society thrive when there is a dependable source of high quality water. Overuse of limited

aquifers and recent drought threaten water availability and quality throughout Northern Sonora and Southern Arizona. The work of

this project is important because it will provide the city of Nogales, Sonora with a tool to observe the potential disproportionate water

quality in its neighborhoods and its effects on its people’s health as well as a new paradigm to investigate in a sustainable water

delivery system.


1. POPULATION

a. Number of persons to be recruited for participation in the study: Approximately 40.

b. Describe the population to be recruited and rationale for their participation (indicate age range, gender,

and ethnicity). Note any special efforts to encourage the recruitment of women and/or representatives

from racial or ethnic minority groups.

The population to be recruited for this study will be individuals living in Nogales, Sonora, Mexico in two

socioeconomically different neighborhoods. Participants will be head of households, over the age of 18,

with a focus on women since cultural norms indicate they are more willing to answer questions about their

families and provide information.

c. Does your study actively target vulnerable populations such as children, pregnant women, prisoners, or

cognitively impaired subjects? If yes, describe additional safeguards planned to protect the rights and

welfare of these vulnerable populations.

No.

i. If a subject transitions into one of the vulnerable populations (pregnant women or cognitively

impaired), will the study procedures place them at any additional risk?

No.

ii. If a subject becomes incarcerated (including awaiting sentencing, court-mandated treatment, or

in prison), will study procedures be conducted with that subject during their incarceration?

No.

d. What are the inclusion and exclusion criteria for study participation?

Inclusion: Residence in one of the study areas or colonias, willing to participate, head of household, over

the age of 18, preferably women.

Exclusion: Any criteria not matching the inclusion.

2. RECRUITMENT AND CONSENT PROCEDURES. For each response in this section, note whether

the activity will be done orally, in writing, or both. List points to be covered in an oral or written

presentation here. Place consent documents in Appendix A. Include copies of any visual material

(advertisements, flyers, web announcements, etc.) in Appendix B for approval.

a. Describe how potential participants will be identified and how you will respect and protect their privacy

during recruitment.

Potential participants will be indentified by visiting one of the 2 areas or neighborhoods in Nogales,

Sonora, Mexico and going door to door to households and verbally asking if they would be willing to

participate in the study. Their privacy will be protected and respected because their identifying

information such as name and address will not be published or made public. Results will be kept stored

in a federal storage room within the USGS.

b. Describe how you will contact individuals who may become participants in the study (e.g., web site,

email, flyers, phone calls, advertisements).

Individuals will be recruited via door to door verbal and written consent. Phone calls and letters may be

used for recruitment to remind participants of sampling dates and times if they were unavailable at a


previous time.

c. Describe how the project will be explained to individuals when you recruit them for participation

(include the text of advertisements, phone solicitations, etc). Include any pre-screening questions or

surveys that may be used.

During the in house visit or door to door solicitation, surveyors will say something like this in Spanish:

“Hello, my name is ________. The University of Arizona is interested in conducting a study on water

quality and health in your neighborhood and also to determine what you think about your life in Nogales.

We were wondering if you would be willing to participate in this study. No one will be told what you tell us.

We will combine everyone’s answers and only report the combined answer from all surveys.

There is about 40 questions altogether and it should take no more than 25 minutes for you to answer them

all. We would also like to collect water samples from your home; 3 times within the next couple of weeks

and 3 times in the winter around January. Collecting water should take no more than 5 minutes. Would you

be willing to participate?”

d. Describe how informed consent will be obtained. If the participants are minors or of another vulnerable

population, explain how assent or legal consent will be secured. Include if appropriate, the steps you

will take to allow sufficient time for the participant to think about their participation or time to review

the consent form with family or friends, prior to consenting. If an informed consent document is

inappropriate for your project, explain why and how you will ensure informed consent.

Informed consent will be obtained by introducing the project, handing the consent form, asking if they need

it to be read and reading it if necessary, and acquiring a signature on the consent form.

i. Into what languages will the consent be translated? (if applicable) (The language must be one that is

understood by the participant or the participant’s legally authorized representative. NOTE: translated

consent documents must be reviewed and approved by the Institutional Review Board prior to use.)

Because the study is being conducted in Nogales, Sonora, Mexico, the consent form will be available in

Spanish.

e. How will you make it clear to the recruits that their participation is voluntary and that they may

withdraw at any time?

There will be a statement of their voluntary participation and withdrawal in the consent form.

f. Describe the additional safeguards you will use to protect participants from coercion or undue influence,

during recruitment and throughout the study (e.g. if the participants are students and the investigator is

their teacher).

There will be a statement in the consent form about how their information will not be used against them or

made identifiable. The consent form will also state that this is a voluntary study and that they are not

required to participate nor receive any direct incentive.

3. METHODOLOGY AND DATA COLLECTION PROCEDURES

a. Is your project evaluating an active intervention or treatment procedure (to determine whether an

intervention/treatment is effective for the people undergoing it)?

o Yes No If yes, in lay terms provide a summary of the intervention and/or treatment


methods

o Describe the procedures being performed already for diagnostic or treatment purposes

b. What type of data collection and recording will be employed? Check all that apply and provide an

explanation. (If Administrative Records are to be used, include a letter of authorization from the

appropriate agencies in Appendix C. Include samples of all data collection instruments in Appendix D.)

Questionnaires/Surveys Interviews/Focus Groups

Observations Records Review (medical, educational, etc.)

Videotaping Audiotaping

Photography Other (define): Water samples

Participant observation

c. In lay terms, provide a description of the research methods (including deception) and procedures for data

collection that will be employed.

Water samples will be collected in each of the 40 households 3 times during the summer and 3 times during

the winter. Water samples will be collected by the researcher from where the participant indicates their

point-of-use in terms of drinking water ie tap, water tank, bucket, etc. 1 Liter of water will be collected

from each home. The participant must be home at the time of collection and must give their verbal

approval to recollect water samples. Samples will be analyzed for E.coli and other microbes and metals

such as Arsenic, Lead, and Mercury. An in-depth survey asking questions about quality of life, water

quality, access and delivery, and health will be asked in the summer. A follow up, shorter, survey will be

asked in the winter. The data collected will be geocoded to show spatial analysis as well as graphed to

show distribution of responses and results of samples.

d. Describe the procedures you will use to respect and protect the research participant’s privacy

(physically, behaviorally, or intellectually) during the data collection process (e.g. during the interview

the participant will meet with the researcher in a location away from his/her place of employment).

No other identifying information will be collected from participants such as federal assigned numbers besides

their name and address. Participant’s names and addresses will also not be used for publication or public

access.

e. Describe when appropriate, how the research plan makes adequate provision for monitoring of data

when participant safety is a concern, or identification of or support for distressed participants to ensure

their safety (e.g. Participants who may self-identify for depression will be provided with referral

information so they may seek professional help.)

When participant safety is of concern such as they have been ill from the water numerous times or have had

several hospital visits because of drinking the water, they will be referred to their local promotora or

community health worker as well as local health official.

i. Indicate the plan for reporting unanticipated problems involving risks to participants or others and how

you will manage that information.

Problems involving risks to participants will be reported to participant’s first then local health officials. The

University of Arizona’s IRB office will also be notified if there are unanticipated risks to participants or

others. If participants indicated a high level of concern for their health because of their water, they will

be referred to promotoras and local free clinics and doctors on a case by case basis.


f. Where will the project be conducted? If study is to be conducted anywhere outside your department

(e.g., in another department, at an off-campus agency or organizational location), include a letter of

authorization in Appendix C, or state when it will be provided to the Human Subjects Protection Office.

The project, in terms of developing data collection methods, sample testing, and analysis, will be conducted

within the department. The collecting of data for the project such as water sampling and responses to

surveys will be conducted and the participants’ household.

g. Are you the lead investigator of a multicenter study?

No.

i. If yes, describe the plan for communicating the following information (relevant to the protection of

research participants) among the sites involved in this study:

o Unexpected problems

o Protocol modifications

o Interim results

h. Does your study include plans to conduct research at external sites that are “engaged” in the research?

(For more information about “engagement” you can go to

http://www.hhs.gov/ohrp/policy/index.html#engagement)

Yes. The USGS will provide work space and laboratory space to conduct the research for analysis.

i. If yes, does the site have an IRB and if so, will the site’s IRB approve the research or will it rely upon

the University of Arizona’s IRB

ii. If no, provide written site authorization for use of the site

The USGS does NOT have an IRB however it will rely upon the University of Arizona’s IRB.

4. CONFIDENTIALITY OF PERSONAL IDENTIFYING INFORMATION

a. What procedures will be followed to ensure that the information obtained about them will be stored in a

secure manner? (Specify how the confidentiality of data will be maintained throughout the research.)

After data is collected from participants, the data will be stored and transported securely back to the

United States where it will then be stored securely in a locked storage room within the USGS federal

building in Tucson. The USGS is located in the DeConcini / Environmental and Natural Resources

Building on the University of Arizona campus on 520 North Park Ave, Tucson, AZ, 85719.

b. What are the plans for retention and/or destruction of linkages between study data and personal

identifying information? (Specify when and how personal identifying information will be destroyed.)

After the data is collected, analyzed, and published, all study data will be destroyed 20 years after the

Graduate Research Assistant has graduated or the research has ended (May 2011) as per University of

Arizona research policy.

c. If these linkages will not be destroyed, explain how you will maintain confidentiality of the personally

identifying information.

Not applicable. Data will be destroyed.


d. In the event that personally identifying information will not be kept confidential, explain why not and

explain how you will ensure that the subjects are consenting to your sharing this information.

Not applicable. Information will be confidential.

e. Will a Certificate of Confidentiality (through DHHS or another Federal agency) be utilized?

No.

5. BENEFITS, COSTS, COMPENSATION & RISKS

a. Benefits:

i. What are the potential benefits directly to the participants, if any?

No direct benefits will be awarded to participants.

ii. What are the potential broader benefits of the study?

Potential policy implications that will allow the city of Nogales to improve its water quality and

delivery that will ultimately improve the health and well being of its residents.

b. Costs: What are the costs to the participants (monetary, time, etc)?

There should be no monetary costs to the participants. The only foreseeable cost to participants

is time. The time to take the survey twice a year may rake up to 45 minutes total.

c. Compensation: Will monetary or other compensations be offered to the subjects? (If so, identify the

amount of compensation and method of payment.)

There will be no monetary compensation.

d. Risks:

i. What risks to the participants could be encountered through participation in this project (physical,

psychological, sociological, financial, economic, etc)?

There are no foreseeable risks to participants associated with the project. Because the study will

be collecting water samples from participants’ homes and not implementing an intervention,

there is minimal risk associated with the project. Also, answers to the survey will be kept

confidential with no addresses or names collected.

ii. Describe the approaches you will take to minimize these risks and/or to minimize their impact.

6. APPENDICES

Attach the following appendices to the PRF, in the order specified, labeled as indicated, and with a table

of contents identifying all appendix materials. Use titles that are consistent with those used in the text of

the PRF.

A.1 Subject Informed Consent Form/Parental Informed Consent Form


A.2 Minor Assent Form

B. Recruitment Materials

C. Site Authorization Letter (for study conduct and/or access to administrative records)

D. Data Collection Instruments

E. Grant Applications

F. HIPAA documentation.

Laura M. Norman, PhD

U.S. Geological Survey, Western Geographic Science Center

520 N. Park Avenue, Suite #102K, Tucson, AZ 85719-5035

Phone: (520) 670-5510; Fax: (520) 670-5113; [email protected]

June 23, 2010

Danielle Gartner

IRB Associate

The University of Arizona, Human Subjects Protection Program

PO Box 245137

Phone: 626-5859

[email protected]

http://orcr.vpr.arizona.edu/irb

RE: Authorization Letter from USGS describing role in "Water Quality and Health Analysis in

Two Different Colonias of Nogales, Sonora, Mexico" study.

To Whom It May Concern,

The USGS U.S.-Mexico Border Environmental Health Initiative (BEHI) have developed

transboundary datasets, standards, and web mapping services

(http://borderhealth.cr.usgs.gov/IMS.html) in close collaboration with the Mexican Geography

and Census Bureau (INEGI) and the International Boundary and Water Commission (IBWC).

I am part of a multidisciplinary team of scientists leading the next four years of the BEHI

research and monitoring program within the Upper Santa Cruz Watershed, located at the Arizona

and Sonora, Mexico border. The objective of this program is to understand and document the

complex movement of natural and anthropogenic contaminants through the Upper Santa Cruz

River Watershed (http://borderhealth.cr.usgs.gov/PDFs/WR-website.pdf).

The study to collect and analyze water samples from homes in Nogales, Sonora, Mexico

in order to investigate the water quality at point of use and its potential impact on a person’s

health is complimentary to this effort. USGS will help process the water samples, mentor

student researchers, plot out potential sources of contamination via maps and facilitate

publication of results for this study.

Sincerely,

Laura M. Norman

Research Physical Scientist

CC: Felipe Caldeira, Laura Lopez-Hoffman, and Robert Varady

FORM: Verification of Human Subjects Training Form (VOTF)

NUMBER DATE PAGE

F107 10/01/2010 1 of 1

HSPP USE ONLY Date received: Received by:

Use to list all current Key Personnel

IRB Project No.: 10-0384-00

Protocol Name: Water Quality and Health Analysis in Two Different Colonias in

Nogales, Sonora, Mexico

Investigator: Felipe Caldeira

Investigator’s Contact

Information: [email protected]

Alternate Contact: Robert Varady

Alternate Contact’s


PI Attestation: (SAVAHCS Studies only)

I confirm that the below staff members are qualified and have been properly trained

to perform consenting procedures under my supervision in this study.

PI Signature: Date:

Name Research Role Department &

Institution Consenter

Training

Date

Alejandro Araiza Research Assistant UA – Udall Center No

Yes 8/10/10

Luis Lozano Research Assistant UA – College of

Public Health

No

Yes 5/18/10

Sofia Grigera Research Assistant UA – College of

Public Health

No

Yes 2/8/10

Perry Gast Research Assistant UA – College of

Public Health

No

Yes 9/18/09

Ashley Rigas Research Assistant UA – GeoSciences No

Yes 8/16/10

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

Water Quality and Health Analysis in Two Different Colonias of Nogales, Sonora, Mexico

Ask to see the male or female head of household over 18.

Introduce the project by saying something like:

“Hello, my name is ________. The University of Arizona is interested in conducting a study on

water quality and health in your neighborhood and also to determine what you think about your

life in Nogales. We were wondering if you would be willing to participate in this study. No one

will be told what you tell us. We will combine everyone’s answers and only report the combined

answer from all surveys.

There is about 40 questions altogether and it should take no more than 25 minutes for you to

answer them all. We would also like to collect water samples from your home; 3 times within the

next couple of weeks and 3 times in the winter around January. Would you be willing to

participate?”

1) If no, thank them for their time and move on.

2) If yes, thank them for participating, hand them the consent form for them to sign allowing

them time to read it.

3) Meanwhile fill out the starter questions.

4) Give them a copy of the survey to follow along and ask if they have any questions.

5) Read all questions exactly as worded so that each respondent is asked the same

questions. Instructions to interviewers are in italics and should not be read to the

respondents.

Date : _______________________________________________

Start Time : __________________________________________

End time: ___________________________________________

Participant Household Data

GPS____________________

Street address: __________________________________________

Nearest Cross street __________________________________________

Participant Name_______________________________________

Gender: Male Female

Please circle the appropriate answers.

General Questions

First, I would like to ask questions about yourself.


a. 18 to 24 b. 25 to 34 c. 35 to 44 d. 45 to 54 e. 55 to 64 f. 65 or over

2. How long have you lived in Nogales, Sonora (in years)?

a. 0- 1 year b. 1-5 years c. 5-10 years d. 10-20 years e. all your life

3. How many people live in your household?

a. 1 b. 2 c. 3 d. 4 e. 5 f. 6 g. 7 h. 8 i. 9 j. more than 9

4. Do you have pets?

a. Yes b. No

5. Do you rent or own your house?

a. Rent

b. Own

c. Other: _____________________


a. 0 b. 1 c. 2 d. 3 e. 4 f. more than 4

Residential

Now I would like to ask you questions about living in Nogales. On a scale from 1-5 with 1 being

the lowest value and 5 being the highest value, how would you rate the following:

7. Satisfaction with your current housing (your house and this colonia)?





Health Questions

Now I would like to ask you questions about you and your family’s health. Everyone gets

episodes of diarrhea. Some have episodes more than others. Diarrhea can be defined as soft,

watery, bowel movement that is sometimes difficult to control and may occur more than once a

day. Tell me:

12. Do you see diarrhea as a problem or a natural occurrence?

a. Problem

b. Natural occurrence

13. Did you or anyone in the household have episodes of diarrhea recently?

a. Yes (Go to #14 below)

b. No (Go to #18 below)

Relationship

Spouse,

Mother,

Father, Son,

Daughter,

etc

Age

Range: 1) Under 18

2) 18-65

3) 65 and

over

14. Episode of

diarrhea in

the past

week:

Yes, No,

Don’t Know

15. Episode of

diarrhea in

the past

month:

Yes, No,

Don’t Know

16. Hospitalized

from

episode of

diarrhea:

Yes, No,

Don’t Know

If Y, then #

of times in

last month.

17. Missed work

or school

because of

episode of

diarrhea:

Yes, No,

Don’t Know

If Y, then #

of times in

last month.

Person 1 Self

Person 2

Person 3

Person 4

Person 5

Person 6

Person 7

Person 8

18. What would you say was the cause of the episode(s) of diarrhea experienced by you or

the household?

a. Water

b. Food

c. Illness

d. Not sure

e. Other: _____________________________

19. When someone in the house gets diarrhea, how is it normally treated? Mark all that

apply.

a. None

b. Pepto-Bismol

c. Other over the counter medication:________________

d. Prescription medication:____________________

e. Tea:____________________

f. Herbal remedies besides tea:____________________

g. Juice

h. Water

i. Other:___________________

20. Do you think the water makes you sick?

a. Yes b. No

Water Use Questions

Now I would like to ask you questions relating to how you get your water and how you use it.

Please answer the following:

21. How do you get your DRINKING water?

a. Potable water

b. Bottled water

c. Private water truck

b. City water truck

c. Other (specify) _____________________________________

22. Is this house connected to the city’s water system through pipes?

a. Yes. b. No

23. If you receive water from the system, during what times is what delivered to you?

24. Do you store your water?

a. No

b. Yes. If yes,:

1. Cistern

2. Tank on top of the house

3. Water tank or portable container

4. Underground tank

5. Plastic gallon or plastic bucket

6. Dishes (pots, etc.)

7. Others (specify)______________________________________

25. How does the water that reaches your house look?

a. Clear

b. Yellowish

c. With sand or dirt or particles

d. Other particles

26. Do you clean your water before using it to drink or cook?

a. No

b. Yes. If yes, which treatment:

1. Chlorine

2. Filter

3. Boil

4. Other (specify)______________________________________

27. Would you be willing to treat your water any further than what you already do?

a. Yes b. No

28. How many glasses of water (~237mL) do and your family drink a day?

a. 1-2 b. 2-4 c. 4-6 d. 6-8 e. more than 8

29. How do you obtain water for use other than drinking (baths, washing, etc.)?

a. Piped in/Potable water (water faucet)

b. Bottled water

c. Private water truck

d. City water truck

e. Other (specify) _____________________________________

30. How much money do you spend on water per month (water bill, supplies, etc.?)

a. Less than 100 pesos b. 100-300 pesos c. 300-500 pesos d. 500-700 pesos

e. 700-900 pesos f. 1000-1300 pesos g. 1300-1500 pesos f. More than 1500

Water Quality Questions

Now I would like to ask you questions relating to water and the environment in Nogales. On a

scale from 1-5 with 1 being the lowest value and 5 being the highest value, how would you rate

the following:

31. The overall purity of potable water in Nogales?

32. The purity of piped water in your household, if it’s piped?




Policy Implication Questions

Now I would like to ask you questions about what you would like to see change and how you

think that can be achieved. These questions are your opinions and are not predetermined

answers. Tell me briefly:

34. How much more per month would you be willing to pay for better potable water?

35. What would you recommend so that potable water is improved?

36. What could the citizens of Nogales and OOMAPAS do to improve potable water?

37. If you pay taxes, how much more would you be willing to pay for better potable water?

38. What could you do to improve potable water for the city?

Water Quality and Health Analysis in Two Different Colonias of Nogales, Sonora, Mexico Winter Survey

Ask to see the female head of household over the age of 18.

Reintroduce yourself and remind them of the study and the interview they did by saying:

"Hello, my name is ________. We were here during the summer to collect water samples and ask

questions about water quality and health in your neighborhood and also to determine what you

think about life here in Nogales. We were wondering if we could finish the interview and collect

3, final, water samples during the next three weekends. Remember that no one will know what

you tell us. We will combine everyone’s answers and only report on the combined answers from

the survey.

This time there are only 4 questions total and it should take no more than 5 minutes to respond.

Can we get started?"

If no, thank them for their time and ask if there’s a better time to finish the survey and collect

water samples. If yes, thank them for participating and begin the survey.

Read all questions exactly as worded so that each respondent is asked the same questions.

Instructions to interviewers are in italics and should not be read to the respondents.

Date : _______________________________________________

Start Time : __________________________________________

End time: ___________________________________________

Best time for collecting water samples :____________________

Everyone gets episodes of diarrhea. Some have episodes more than others. Diarrhea can be

defined as soft, watery, bowel movement that is sometimes difficult to control and may occur

more than once a day. Tell me:

Relationship

Spouse,

Mother,

Father, Son,

Daughter,

etc

Age

Range: 1) Under 18

2) 18-65

3) 65 and

over

1. Episode of

diarrhea in

the past

week:

Yes, No,

Don’t Know

2. Episode of

diarrhea in

the past

month:

Yes, No,

Don’t Know

3. Hospitalized

from

episode of

diarrhea:

Yes, No,

Don’t Know

If Y, then #

of times in

last month.

4. Missed work

or school

because of

episode of

diarrhea:

Yes, No,

Don’t Know

If Y, then #

of times in

last month.

Person 1 Self

Person 2

Person 3

Person 4

Person 5

Person 6

Person 7

Person 8

Análisis sobre la Calidad del Agua y la Salud en Nogales, Sonora, México. * La encuesta debe ser atendida por persona mayor de 18 años.

** Invitación a ser encuestado:

"Hola, mi nombre es ________. La Universidad de Arizona está interesada en la realización de

un estudio sobre la calidad del agua y la salud en su colonia y también para determinar lo que

usted piensa acerca de su vida en Nogales. Queremos saber si estaría dispuesto a participar en

este estudio. Toda la información que proporcione será confidencial y solo será utilizado para

fines estadísticos. Vamos a combinar las respuestas de todos y sólo informan de la respuesta

combinada de todas las encuestas. Queremos saber si estaría dispuesto a participar en este

estudio.

El total de preguntas a responder son cuarenta, el tiempo de respuesta se estima en veinticinco

minutos como máximo. Para complementar el estudio, le estamos solicitando que nos permita

tomar muestras de agua de su casa; para nosotros es necesario hacer las tomas en tiempos

diferentes, que no tardará más de cinco minutos, por lo que le pedimos autorización para

recabarlas durante los próximos tres fines de semana y la misma cantidad de muestras en época

de invierno, antes del mes de enero. ¿Estaría dispuesto a participar?"

1).- En caso de negativa, agradecer tiempo brindado.

2.- En caso afirmativo, darles las gracias por participar, dan a ellos la autorización para que

firmen y le dan tiempo para leerlo.

3).- Mientras tanto, llene las preguntas primarias en la caja.

4).- Déles una copia de la encuesta y póngase a sus órdenes en caso de que tengan duda sobre

alguna de las preguntas.

5).- Lea todas las preguntas exactamente como está redactada de manera que cada encuestado

se le pide las mismas preguntas.

Fecha: _____________________________________________

Hora de inicio: _______________________________________

Hora de finalización: ___________________________________

Datos de la casa:

GPS_________________________________________________

Dirección: ____________________________________________

Intersección más cerca___________________________________

Nombre: ______________________________________________

Género: Femenino Masculino

Favor de encerrar las respuestas apropiadas.

Preguntas generales:

En primer lugar, me gustaría hacer preguntas acerca de usted.

1. ¿Cuál es su edad?

a. 18 a 24 b. 25 a 34 c. 35 a 44 d. 45 a 54 e. 55 a 64 f. 65 o más

2. ¿Cuánto tiempo ha vivido en Nogales, Sonora (en años)?

a. 0 - 1 año b. 1 – 5 años c. 5 – 10 años d. 10 – 20 años e. Toda su vida

3. ¿Cuántas personas viven en su casa?

a. 1 b. 2 c. 3 d. 4 e. 5

f. 6 g. 7 h. 8 i. 9 j. más de 9

4. ¿Tiene mascotas?

a. Si b. No

5. ¿Usted renta o es dueño de su casa?

a. Alquila

b. Dueño

c. Otro: ____________________________________

6. ¿Cuántos vehículos tiene la familia?

a. 0 b. 1 c. 2 d. 3 e. 4 f. más de 4

Residencial

Ahora me gustaría hacerle unas preguntas sobre su vida en Nogales. En una escala de 1 a 5, con

1 el valor más bajo y 5 el valor más alto, ¿cómo calificaría los siguientes?:

7. ¿Satisfacción con su residencia (su casa y esta colonia)?___

8. ¿Satisfacción con la capacidad de respuesta del gobierno municipal a sus

necesidades? ___

9. ¿Satisfacción con su calidad de vida personal en Nogales? ___

10. ¿En general, nivel de felicidad que tiene con su vida? ___

11. ¿Cómo califica el modo en que tiene acceso a cualquier tratamiento médico, en su

comunidad? _______

Preguntas sobre la salud.

Ahora me gustaría hacerle algunas preguntas sobre su salud y la de su familia. Todo el mundo

tiene episodios de diarrea. Algunos tienen episodios con más frecuencia que otros. La diarrea se

puede definir como evacuaciones íiquidas del intestino que a veces es difícil de controlar y que

ocurren más que una vezs en un mismo día. Dígame:

12. ¿Considera a la diarrea como un problema o un evento natural?

a. Problema

b. Ocurrencia natural

13. ¿Usted o alguien en su casa tuvo un episodio de diarrea recientemente?

a. Sí (Siga a 14 abajo)

b. No (Siga a 18 abajo)

Relación

Esposo,

madre,

padre, hijo,

hija, etc

Edades: 1) Menores

de 18 años

2) 18-65

3) 65 o más

14. Episodio de

diarrea en la

última

semana:

Sí, No, No

sabe

15. Episodio de

diarrea en el

último mes:

Sí, No, No

sabe

16. Hospitaliza

do por causa

del episodio

de diarrea:

Sí, No, No

sabe. Si

afirmativo, #

en el último

mes.

17. Perdió días

en el trabajo

o en la

escuela por

causa del

episodio de

diarrea:

Sí, No, No

sabe. Si

afirmativo, #

en el último

mes.

Persona 1 Yo mismo

Persona 2

Persona 3

Persona 4

Persona 5

Persona 6

Persona 7

Persona 8

18. ¿Cuál diría que fue la causa del episodio(s) de diarrea experimentada por usted y/o

algún miembro de su familia?

a. Agua

b. Comida

c. Enfermedad

d. No está seguro

e. Otro: _____________________________

19. ¿Cuando alguien en casa tiene diarrea, normalmente, cual tratamiento utilizan para

combatirla? Marque todas las opciones que apliquen.

a. Ninguno

b. Pepto-Bismol

c. Otro medicamento commercial sin receta:________________

d. Medicamento con receta:____________________

e. Té:____________________

f. Remedios herbarios además de té:____________________

g. Jugo

h. Agua

i. Otros:___________________

20. ¿Cree usted que el agua hace que usted o alguien de su familia se enferme?

a. Sí b. No

Preguntas sobre el uso del agua

Ahora me gustaría hacerle unas preguntas relativas a cómo obtiene el agua y cómo la usa. Por

favor responda las siguientes:

21. ¿De dónde obtiene el agua para beber?

a. Agua potable.

b. Agua embotellada

c. Camión de agua privada

d. Camión de agua del municipio

e. Otros (especificar) _____________________________________

22. ¿Esta casa tiene drenaje (alcantarillado) conectado a las tuberías de la calle?

a. Sí b. No

23. ¿Si recibe agua del grifo, durante que horas recibe de la red? _____________________

24. ¿Almacena agua?

a. No

b. Sí. ¿en qué recipiente lo almacena?

1. Cisterna.

2. Tinaco.

3. Depósito de agua o contenedores portátiles.

4. Aljibe.

5. Galón de plástico o cubeta.

6. Olla u otro utensilio de cocina.

7. Otros ______________________.

25. ¿Cómo es la apariencia del agua que llega a su casa?

a. Transparente.

b. De color amarillento.

c. Con arena o tierra.

d. Otras partículas.

26. ¿Aplica algún tratamiento para limpiar o purificar el agua antes de usarla para beber o

cocinar?

a. No

b. Sí. ¿qué tratamiento utiliza?

1. Uso de cloro.

2. Filtro.

3. Hervir.

4. Otros (especificar)______________________________________

27. ¿Estaría dispuesto a tratar o limpiar su agua, más de lo que ya lo hace?

a. Sí b. No

28. ¿Cuántos vasos de agua (~237mL) bebe usted y su familia cada día?

a. 1-2 b. 2-4 c. 4-6 d. 6-8 e. Más de 8.

29. ¿Cómo obtiene agua para otros usos, que no sea beber?

a. Agua potable.

b. Agua embotellada.

c. Camión de agua privada

d. Camión de agua del municipio

f. Otros (especificar) _____________________________________

30. ¿Cuánto dinero gastas en agua por mes (factura de agua, suministros, etc.)?

a. Menos de 100 pesos b. 100-300 pesos c. 300-500 pesos d. 500-700 pesos

e. 700-900 pesos f. 1000-1300 pesos g. 1300-1500 pesos f. Más que 1500 pesos

Preguntas sobre la Calidad del Agua

Ahora me gustaría hacerle unas preguntas relacionadas con el agua y el medio ambiente en

Nogales. En una escala de 1 a 5, con 1 el valor más bajo y 5 el valor más alto, ¿cómo calificaría

lo siguientes:

31. ¿Qué tan pura considera el agua potable en Nogales? ____

32. ¿La pureza de agua potable entubada en su hogar, si la llevan? ____

33. ¿Satisfacción con su servicio de agua? ____

34. ¿Tiene preocupación por la pureza del agua potable en su comunidad? ____

35. ¿Preocupación por inundaciones y/o la sequía en la localidad? _____

Cuestiones Sobre Implicación Política

Ahora me gustaría hacerle unas preguntas acerca de lo que le gustaría ver cambiar y cómo cree

que se puede lograr. Estas preguntas son sus opiniones y las respuestas no están

predeterminadas. Dime brevemente:

34. ¿Qué cantidad mensual estaría dispuesto a pagar por recibir el servicio de agua más

potable?

35. ¿Que recomendaría para que el agua sea más potable?

36. ¿Qué podrían hacer los nogalenses y el Organismo Operador de Agua en Nogales para

mejorar el agua potable?

37. ¿Si usted paga impuestos, cuanto más estaría dispuesto a pagar por que le brinden el

servicio de agua más potable en el municipio?

38. ¿Qué podría hacer usted para que el agua sea más potable para el resto de la ciudad?

Calidad del Agua y Análisis de Salud en dos colonias diferentes de Nogales, Sonora, México Encuesta de Invierno

Pida ver la jefa de la familia mayor de 18 años.

Presentarte nuevamente ante quien atienda la encuesta y recordarle de su entrevista anterior

diciendo:

"Hola, me llamo ________. Estuvimos aquí en el verano para recoger muestras de agua y hacer

preguntas acerca de la calidad del agua y la salud en su vecindario y también para determinar

lo que usted piensa acerca de su vida en Nogales. Queremos saber si podríamos terminar la

entrevista y recoger otra, final, tres muestras en los próximos tres fines de semana. Recuerda

que nadie se le dirá lo que nos dicen. Vamos a combinar las respuestas de todos y sólo informan

de la respuesta combinada de todas las encuestas.

Esta vez solamente se trata de 4 preguntas en total, y debe llevar no más de 5 minutos para que

usted pueda responder. ¿Podemos empezar? "

Si no, les agradezcan por su tiempo y preguntarle que si algún otro momento puede resultar

mejor para realizarle la entrevista y las horas para colectar agua. En caso afirmativo, darles las

gracias por participar y comenzar la encuesta.

Lea todas las preguntas exactamente como está redactada de manera que a cada encuestado se

le hagan las mismas preguntas. Instrucciones a los entrevistadores están en cursiva y no debe

ser leído a los encuestados.

Fecha: _____________________________________________

Hora de inicio: _______________________________________

Hora de finalización: ___________________________________

La mejor hora para la recogida de agua :____________________

Todo el mundo tiene episodios de diarrea. Algunos tienen episodios más que otros. La diarrea se

puede definir como evacuaciones liquidas del intestino que a veces es difícil de controlar y

ocurre más que es normal para un día. Dime:

Relación

Esposo,

madre,

padre, hijo,

hija, etc

Edades: 1) Menores

de 18 años

2) 18-65

3) 65 o más

1. Episodio de

diarrea en la

última

semana:

Sí, No, No

sabe

2. Episodio de

diarrea en el

último mes:

Sí, No, No

sabe

3. Hospitalizad

o por causa

del episodio

de diarrea:

Sí, No, No

sabe. Si

afirmativo, #

en el último

mes.

4. Perdió días

en el trabajo

o en la

escuela por

causa del

episodio de

diarrea:

Sí, No, No

sabe. Si

afirmativo, #

en el último

mes.

Persona 1 Yomismo

Persona 2

Persona 3

Persona 4

Persona 5

Persona 6

Persona 7

Persona 8

¡Gracias por participar en nuestro estudio! Su participación ayudará a mejorar la ciudad de Nogales, Sonora. Esto es un recuerdo de que regresaremos de nuevo en enero de 2011 durante los sabados para hacer una breve encuesta de cinco preguntas y recoger más muestras de agua. Este proceso sólo durará unos 10 minutos. Si tiene preguntas, póngase en contacto con el coordinador del estudio, Felipe Caldeira, 520-921-0388 o con Alejandro Araiza del Hyuntamiento de Nogales 631-130-5991. ¡Muchisimas gracias!



Felipe Caldeira Quarterly Report

January 1, 2011 – March 31, 2011 Publications:

Felipe Caldeira, Mary Kay O’Rourke, Claudia Gil, “Water and Wellness in Nogales, Sonora, Mexico,” The International Journal of Health, Wellness and Society, (Submitted).

Presentations:

Caldeira, Felipe. 2011. “Water and Wellness in Nogales, Sonora, Mexico.” The International Conference on Health, Wellness and Society. January 20, 2011. University of California at Berkeley.

Caldeira, Felipe. 2011. “Water Inequity in a Border Colonia.” The University of Arizona’s Institute of the Environment Environmental Grad Research Blitz. February 1, 2011. University of Arizona, Tucson, AZ.

“Student Research in the College of Public Health: Water and Health in Nogales, Mexico.” The Mel and Enid Zuckerman College of Public Health Student Spotlight. Spring 2011. University of Arizona, Tucson, AZ.

Caldeira, Felipe. 2011. “Nogales, Sonora, Mexico: What’s in the Water?” The Sonoran Institute’s Santa Cruz River Research Day. March 29, 2011. Tucson, AZ

Proposals:

Felipe Caldeira submitted “Water and Wellness in Nogales, Mexico” to the International Journal on Health Wellness and Society – pending.

Felipe Caldeira submitted “Water Inequity in a Border Colonia” to the Institute of the Environment’s Environmental Research Grad Blitz – accepted.

Felipe Caldeira submitted “Nogales, Sonora, Mexico: What’s in the Water?” to the Sonoran Institute’s Santa Cruz River Research Day – accepted.

Felipe Caldeira submitted “Water Quality and Impact on Health in Nogales, Mexico” to the Mel and Enid Zuckerman College of Public Health – pending.

Research Projects

US Federal Grant Number 10HQPA0037: Investigation of Water Quality and Quality of Life in a Border Colonia (Felipe Caldeira): Felipe Caldeira is finishing his research on water quality and quality of life in Nogales, Sonora, Mexico and how it impacts health. The last batch of samples have been collected and analyzed for. Caldeira is currently working on publishing his findings and presenting them at conferences and poster sessions as well as meeting with Mexican partners and stakeholders about what the results mean and how to move forward.

Felipe Caldeira Quarterly Report

October 1, 2010 – December 31, 2010 Presentations:

Caldeira, Felipe. 2010. Water Quality and Health Analysis in Two Different Colonias in Nogales, Sonora, Mexico. US-‐Mexico Border Environmental Health Initiative (BEHI) showcase “Investigations of the Santa Cruz Watershed.” October 12, 2010. Tucson, Arizona.

Awards:

The Mel and Enid Zuckerman College of Public Health Student Researcher of the Year Award. Announced December 2010.

Workshops:

USGS volunteer and Udall Center for Public Policy Graduate Research Assistant, Felipe Caldeira attended a showcase co hosted by USGS Interdisciplinary scientists, Laura Norman, Charles Van Riper, James Callegary, and Floyd Gray about the US-‐Mexico Border Environmental Health Initiative titled “Investigations of the Santa Cruz Watershed,” on October 12, 2010 at the USGS in Tucson, Arizona.

Proposals:

Felipe Caldeira submitted “Water and Wellness in Nogales, Mexico” to the International Conference on Health Wellness and Society – accepted.

Felipe Caldeira submitted “Water and Wellness in Nogales, Mexico” to the International Journal on Health Wellness and Society – pending.

Felipe Caldeira submitted “Water Inequity in a Border Colonia” to the Institute of the Environment’s Environmental Research Grad Blitz – accepted.

Research Projects

US Federal Grant Number 10HQPA0037: Investigation of Water Quality and Quality of Life in a Border Colonia (Felipe Caldeira): Felipe Caldeira is finishing his research on water quality and quality of life in Nogales, Sonora, Mexico and how it impacts health. The last batch of samples have been collected and analyzed for. Caldeira is currently working on publishing his findings and presenting them at conferences and poster sessions as well as meeting with Mexican partners and stakeholders about what the results mean and how to move forward.

Water and Wellness in Nogales, Sonora, Mexico

Caldeira, F.1,2, O’Rourke, M. K.2 ,and Gil, C.3

Abstract:

Rapid development in the US-Mexico border region, fueled by international commerce and industrialization, places pressure on resources, particularly potable water, and challenges communities providing these resources. In Nogales, Sonora, Mexico, some neighborhoods have intermittent delivery of water through pipes other areas lack piped water and relied on water delivered by truck. People receiving delivered water often get sick through multiple sources such as contaminated water storage containers, contaminated delivery trucks tanks, and potentially contaminated water loaded into the trucks. Based on the literature, the people in Nogales are not receiving contaminated water supplies but instead perceive a risk of contamination, especially for those living in poorer communities. Little information is available on human health relationships with water quality in this area. We developed a survey to examine quality of life, water consumption, and impacts on human health in two areas of Nogales, Sonora, Mexico; one area with comparatively high socio-environmental conditions (Colonia Lomas de Fàtima) and another area with low socio-environmental conditions (Colonia Luis Donaldo Colosio). Questions describing the household's water source, delivery, personal disinfection practices, and gastrointestinal disease frequency were asked at each participating residence to investigate the relationship between water quality and quality of life. A total of 21 households were recruited for the study (14 in Colosio and 7 in Lomas de Fatima). Respondents identified diarrhea as an issue for 50% of participating households. In fact, 11 people were hospitalized due to diarrhea; more than half from Colosio. The majority of respondents seemed satisfied with their overall quality of life, but they felt helpless in tackling community water issues. People, businesses, industry and society thrive when there is a dependable source of high quality water. Further research and investigation of water quality is needed for links between prevalence and source of diarrhea.

1 The Udall Center for Public Policy, The University of Arizona, Tucson, AZ.

2 The Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ.

3 Instituto Municipal de Investigación y Planeación, Nogales, Sonora, Mexico

5/7/11 1:35 PMGmail - Health and Wellness Conference 2011- Proposal W11P0265

Page 1 of 1file:///Volumes/Cruzer/Internship/Internship%20Report/Appendix/Gm…%20and%20Wellness%20Conference%202011-%20Proposal%20W11P0265.htm

Felipe Caldeira <[email protected]>

Health and Wellness Conference 2011- Proposal W11P0265Health and Wellness Conference 2011<[email protected]>

Thu, Dec 23, 2010 at 11:26AM

To: [email protected]

Dear Felipe Caldeira,

We are pleased to inform you that your presentation "Water and Wellness inNogales, Sonora, Mexico" has now been scheduled in the program forInternational Conference on Health, Wellness and Society.

Your session details are:

When: 4:55 PM on Thursday 20 JanuaryWhere: Room 4.Session Type: 30 minute Paper PresentationEquipment Requirements: We will provide data projectors in all of oursession rooms. We do ask that delegates bring their own laptops. If yo area Mac user, please be sure to bring the correct Mac VGA adapter. There areno overhead projectors for transparencies.

This schedule may be subject to change of time, although it is mostunlikely that there will be a change of day. We will send you anotification if there is any change.

We request all presenters pick up their badges at least half an hour before the commencement of the days program on the day their presentation hasbeen scheduled. If your badge has not been picked up by then, we willassume you have not been able to attend the conference and we will cancelyour session. This is in order to avoid the possibility of participantsattending a session where the presenter does not appear, and to give otherparticipants adequate warning that the session will not go ahead.

If you have any queries then please contact me through the above address.

Please quote proposal ID W11P0265 in any correspondence.

Kind regards,Bill PercivalConference Producer

1/19/11

1

S

Water and Wellness in Nogales, Sonora, Mexico

By: Felipe Caldeira, Mary Kay O’Rourke, Claudia Gil

Felipe Caldeira Graduate Research Assistant

Udall Center for Public Policy The University of Arizona

www.u.arizona.edu/~felipec

2011 International Conference on Health, Wellness and Society

Acknowledgement

S  Generous funding was provided by the US Geological Survey (USGS)

1/19/11

2

Background

S Commerce and NAFTA S Influx of migrant workers to the border.

S Maquiladoras S Cheap labor

S Loose Regulation

S Environmental and Safety

S Colonias S Colonias vs Colonias Marginales

S Socioeconomic status / Socio-Environmental Vulnerability

Background

Lara-Valencia, F., Declet-Barreto, J., & Keys, E. (2008). Spatial equity and transportation hazard along cross-border trade corridors: the case of ambos Nogales. Journal of Borderland Studies, 23(2), 1-16.

1/19/11

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Background

1/19/11

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Background

S  Access to Water

S  Full

S  Part Time

S  None

S  Alternatives

S  Water Trucks / Pipas

S  Bottled Water

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Background

Water from the system

Tinaco

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Background

Background

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Background

Aljibe

Water from the system

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Background

S  Environmental Exposure

S  Dirt Roads

S  Flooding

S  Health Effects

Hypothesis

S  Because colonias marginales lack acess to basic amenities, we believe reported quality of life will be low in colonias with low socio economic status.

S  Because colonias marginales lack access to potable water and therefore are exposed to various sites of contamination, we believe the rate of diarrhea will be higher in colonias with low socio economic status.

S  Because rainfall increases over the summer and rainfall increases the number of contaminants, we believe water quality will be lower during the summer.

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S  Binational Health Council/Consejo Binacional de Salud (COBINAS)

S  Organismo Operador Municipal de Agua Potable, Alcantarillado Y Saneamiento de Nogales, Sonora (OOMAPAS)

S  Instituto Municipal de Investigacion Y Planeacion del Gobierno Municipal de Nogales

S  Centro de Salud Urbano de Nogales

S  The University of Arizona

S  College of Public Health

S  Udall Center for Public Policy

S  The United States Geological Survey

Methods: Binational Collaboration

Methods

S  Academic Participation

S  Literature Review

S  Study Design

S  Binational Health Professional Participation (COBINAS)

S  Survey Review, Revision, Translation S  AZDHS, COPH, Focus

Groups, Gobierno de Nogales

S  Mexican Authorization (OOMAPAS)

S  IRB Approval

S  Community Members Input and Collaboration

S  Lab Agreement with OOMAPAS

S  Volunteer Coordination

S  Follow up

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Methods

S  40 households (proposed) S  20 from colonia marginal (Colosio) S  20 from colonia Lomos de Fatima

S  Sample for microbes S  E.coli S  Total Fecal Coliforms S  Conduct replicates and blanks

S  Sample for metals S  Arsenic, Mercury, Lead

S  Survey S  Quality of Life S  Prevalence of diarrhea S  Perceptions of Problems and Solutions

Methods: Water Quality

S  E.coli and Total Fecal Coliforms S  Animal Contamination S  Agricultural Runoff S  Sewage S  Strain on the system S  Increased exposure

S  Arsenic, Lead, Mercury S  Industrial Contamination S  Carcinogens

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Methods: Seasonal Variability

S  3 trials in each household in the summer

S  3 trials in each household in the winter

S  What happens during monsoon season vs. dry winter season?

S  Climate change implications

Survey: Sample Questions

S  Quality of life (social) S  Satisfaction with government?

S  Economic status S  Do you rent or own?

S  Water access S  How do you get drinking

water? S  Do you treat your water? S  How much water do you

drink? S  Where does your water come

from?

S  Perceived problems S  Prevalence of diarrhea S  Level of concern? S  Is diarrhea a problem? S  Episodes in last week? S  Episodes in the last month? S  Does someone have it more

than others? S  How is diarrhea treated?

S  Solutions to problems S  What would you recommend? S  How much more would you

pay? S  What could the city do? S  What could you do?

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Background

Lomas de Fatima

Colosio


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Field Work

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Results - Survey The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.

S  Access to water confirmed

S  Quality of Life higher than expected

Question

Answers (1-‐low; 5-‐high) 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5

Colosio (n=14) 2 1 3 1 7 4 3 1 2 4 2 2 2 0 8 3 0 1 1 9 1 2 3 2 6

Fatima (n=7) 0 0 0 1 6 0 0 0 1 6 1 1 0 1 4 1 0 0 0 6 0 0 2 2 3





Table 2. Quality of Life7. Satisfaction with your current housing (house and colonia)?


19.0%

23.8%

0.0%

9.5%

47.6%

What would you say was the cause of the episode(s) of diarrhea experienced by you

or the household?

a. Water

b. Food

c. Illness

d. Not sure

e. Other (please specify)

S  Rate of diarrhea high

S  Treatment Expensive

S  Water quality perceptions high

S  Minimal interest in disinfecting further

Question



Table 3. Diarrhea and Water PerceptionsEpisode of diarrhea in the past 4 weeks





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S  Equal responsibility between government and individuals

S  Role in the environment misunderstood

S  Awareness of environmental implications higher than expected.

S  No diarrhea reported during winter season.

Results – Water Quality

S  No direct relationship between rate of diarrhea and water quality

S  Contaminants higher in summer (confirmed)

S  Contamination in storage tanks higher (confirmed)

S  Contamination in pipes low

S  Less access to water = higher vulnerability

S  No contamination found in blanks (household bottled water)

HHID D1 E.coli? D1 Coliformes? D2 E.coli? D2 Coliformes? D3 E.coli? D3 Coliformes? W E.Coli? W Coliformes?

1 0 10 0 12 0 8 0 0 2 6 TMTC 13 TMTC 4 TMTC 0 0 3 0 TMTC 18 TMTC 30 TMTC 2 TMTC 4 TMTC TMTC TMTC TMTC TMTC TMTC NA NA 5 0 1 0 0 0 0 NA NA 6 0 0 0 0 0 TMTC 0 61 7 8 TMTC 5 TMTC 23 TMTC 15 TMTC 8 TMTC TMTC TMTC TMTC 0 TMTC NA NA 9 0 TMTC TMTC TMTC 34 TMTC 1 TMTC 10 5 94 NA NA 0 TMTC 0 55 11 3 76 3 60 1 TMTC 12 TMTC 12 2 TMTC TMTC TMTC 37 TMTC NA NA 13 4 TMTC TMTC TMTC 0 TMTC 3 TMTC 14 55 TMTC 24 TMTC 5 TMTC 4 42 16 0 64 0 0 0 1 0 0 17 0 0 0 4 0 0 0 0 18 0 0 0 0 0 0 0 0 19 0 0 0 TMTC 0 4 0 8 20 0 0 NA NA NA NA 0 0 21 0 68 0 80 0 TMTC 0 0 22 0 0 0 0 0 0 0 0

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Future Considerations

Implications

S  Climate change S  Local awareness and impact S  Extended monsoons S  Flooding S  Strain on the system S  Increased exposure

Suggestions for Management

S  Water Delivery S  Should delivery be extended? S  Should regulation be more enforced

for pipas? S  Costs?

S  Sanitation Practices S  Health education S  Promotora model S  Regular maintenance of tinacos? S  Flocculent Use?

S

Thank you!

Felipe Caldeira


Graduate Research Assistant Udall Center for Public Policy

Masters Candidate in Public Health

at the University of Arizona

[email protected]

Water and Wellness in Two Colonias of Nogales, Sonora, Mexico

Caldeira, F.1,2, O’Rourke, M. K.2, and Gil, C.3

Keywords:

Water quality, water inequity, water delivery, quality of life, human health, public health, community health, environmental health, diarrhea, gastrointestinal disease, perceived risk, US-‐Mexico border, binational, colonias, survey, seasonal variability, socio-‐economic status, water disinfection, promotoras, flocculent.

Acknowledgements:

A significant portion of this research was underwritten by the United States Geological Survey (USGS) and supervised by Dr. Laura Norman. Additional support was obtained from Udall Center for Public Policy. Binational collaboration between the USGS, the Mel and Enid Zuckerman College of Public Health (MEZCOPH), the Arizona Department of Health Services (ADHS), Arizona Department of Environmental Quality (ADEQ), Centro de Salud Urbano en Nogales (CSU), Instituto Municipal de Investigación y Planeación (IMIP), Ayuntamiento de Nogales Sonora, Asociación de Promotoras de Nogales, and Organismo Operador Municipal de Agua Potable, Alcantarillado y Saneamiento de Nogales, Sonora (OOMAPAS) was essential to the completion of this project.

Introduction:

People, businesses, industry and society thrive only with a dependable source of high quality water as water is essential for the maintenance of human life. Water plays a role in digestion, absorption, circulation, and excretion, and maintains body temperature. Water facilitates growth and repair in the body, and it is part of all body tissues and fluids (Mack & Varady, 1995).

Water holds a number of significant implications for public health. “Inadequate consumption of water is detrimental to human health and contributes to mortality in developing societies” (Mack and Varady, 1995; Udall Center, 1994). Numerous studies (Mack & Varady, 1995; Esrey et al., 1990; Ezzati, 2005) indicate that dehydration will kill faster than starvation. Clearly, water should be provided to all populations but especially to the most vulnerable: infants and those who are ill (Aldous, 2003). Chronic water shortages seriously compromise household sanitation and personal hygiene leading to a variety of health problems, most notably gastrointestinal diseases and parasitic infections (US-‐EPA, 1999). Water shortages indirectly affect health since users sometimes seek delivery alternatives. Distraught water users may fill compromised storage or transfer containers contaminated by chemicals or exposed to microorganisms (Mack & Varady, 1995; US-‐EPA, 1999).

The US-‐Mexico border zone stretches 3,000km from the Pacific Ocean to the Gulf of Mexico and 100km north and south of the line as defined by the La Paz Agreement (US-‐Mexico Border Health Commission,

1 The Udall Center for Public Policy, The University of Arizona, Tucson, AZ. 2 The Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ. 3 Instituto Municipal de Investigación y Planeación, Nogales, Sonora, Mexico

2003). Over the past 20 years, a unique dynamic of commerce and trade affected the region in part due to the North American Free Trade Agreement (NAFTA) (Lara-‐Valencia et al., 2008). In Mexico, people have moved to the border region as industrial factories, or maquiladoras, provide financial incentives to both migrant workers and corporations in both countries for their cheap labor and proximity to major cities for transport.

This influx of people places a significant strain on local resources of border communities. Public services and systems are heavily burdened by an increased demand that cannot be met by the strained, unimproved infrastructure (Mack & Varady, 1995). This lack of access to services and resources results in the development of squatter communities called colonias marginales or marginalized neighborhoods (Norman et al., 2006). Colonias marginales are characterized by very low socioeconomic status (SES) and associated impacts on health. Generally, these neighborhoods lack access to water, plumbing, roads and other infrastructure.

Potable Water in Nogales, Sonora:

The mountain ranges surrounding Nogales are described as "impermeable Tertiary volcanic materials" that cannot store groundwater (Mack & Varady, 1995). The city is built on Quaternary alluvial units that yield moderate amounts of water at relatively shallow depths (Mack & Varady, 1995). However, the demands of urbanization and industrialization have altered the regional water balance. The growing demand is rapidly depleting stores of subsurface water, the only stable water source. Given pressures of population and development, "…natural recharge from mountain-‐front and stream-‐channel recharge processes cannot adequately replenish the supply of groundwater” (Mack & Varady, 1995). In order to compensate for this, the city of Nogales (Sonora) regularly shuts off the water supply to certain neighborhoods on a rotating schedule throughout the week. Such shortages prompt discussion of whether the water system should be expanded.

Water from approximately 41 wells is filtered before entering the domestic water supply and delivered by pipe through the older portions of the city. Most Nogales residents purchase bottled water for drinking due to fear of the local water quality (Mack & Varady, 1995). Parts of the city experience water delivered by “stand pipes” where resident bring containers and fill them. In other areas, trucks may deliver water to residential or public tanks. Trucks that deliver water to residents are normally referred to as pipas. Pipas may get their water from the municipal water system or from owners with private wells with lax regulation and standard enforcement. Some residents may obtain water from the homes of friends or relatives. Water is typically stored in plastic containers called tinacos or metal industrial storage containers called tambos.

Residential units connected to the city’s water system often have an aljibe. An aljibe is a cement storage tank normally located underground at each home that pumps water to the house. When water is available from the city, it fills the aljibe. During household use, water is pumped from the aljibe to the house. Since there is intermittent water delivery, residents with the aljibe have a constant source of water. However, because the aljibe is underground with the lid at ground level, household water is

subject to contamination from run-‐off. Little information on the health impacts of aljibes are available and research is needed.

Further, there is a concern for Nogales's local water delivery system. Mack and Varady (1995) state that the sewers beneath the streets of Nogales, Sonora, are aging and poorly maintained. Therefore, not only are entire zones and neighborhoods unserved or underserved, but sewerage is problematic because of breaks and leaks. These breaches are exacerbated regularly by rushing floodwaters from the region's heavy rain falls, during the summer "monsoons" (Curriero et al., 2001, Morehouse et al., 2000, Norman et al., 2010). As a result, during such episodes sewer-‐line breaks are common and leaks find their way to the aquifer, threatening groundwater quality. During these periods of extreme flooding, health hazards increase from both exposure to raw sewage and post-‐flood surface sewerage accumulations that promote infectious disease agents (Mack and Varady, 1995).

Water Quality and Human Health:

“Nogales residents experience many of the health problems associated with inadequate sewerage and the ensuing water contamination, primarily gastrointestinal diseases and hepatitis” (Mack and Varady, 1995). A study conducted by the Ambos Nogales Water Project reveals that diarrheal diseases, along with acute respiratory infections, are the principal causes of morbidity among children from birth to four years of age (ADHS, 1993). The same study finds that gastroenteritis and other infectious diseases were the seventh leading cause of mortality within the general population in the region and Hepatitis A has an incidence rate of 27 cases per 10,000 people in Nogales, Arizona, and 18.67 cases per 10,000 people in Santa Cruz County. These incidence rates are considerably higher than those for other Arizona border counties (Yuma and Cochise County). It is important to note that Hepatitis A is a virus transmitted through water and food by fecal contamination.

This growing concern prompted the U.S. Environmental Protection Agency (EPA) to commission a report (1999) which states "…wastewater collection and treatment is the most pressing infrastructural problems facing the urbanized portions of the U.S.-‐Mexico border." The report recognizes that waste water is more than an infrastructure problem, and states that "…its solution would resolve many associated environmental and health problems in the large and small population centers of the region."

There is sufficient evidence to suggest that health impacts from water quality will be found in Nogales, Sonora. Researchers agree that the incidence of acute gastrointestinal disease or diarrhea cannot be measured but rather, estimated (Colford et al., 2006). It is well understood that Mexico has long had a problem with increased rates of acute gastrointestinal disease when compared to the United States (US-‐Mexico Border Health Commission, 2003; Centro de Salud Urbano, 2010; Sanchez, 1995). Some attribute this spike in prevalence across the border to inadequate infrastructure while others blame contaminated sources such as rivers and ground water.

Literature Review:

Mack and Varady (1995) evaluate water use patterns and management approaches in a semiarid and urban environment and suggest ways water-‐related decisions and policies could be made responsive to

local needs and desires. They provide an in depth assessment of water availability in the marginalized colonias, water shortages throughout the region, infrastructure problems, and flooding. Detectable concentrations of contaminant in each category were found in a majority of the wells sampled (Mack and Varady, 1995). They conclude that contaminated water or poor water quality is a root cause of prevalent gastrointestinal disease in Nogales. Because of this conclusion, rate of gastrointestinal disease will become an indicator and the basis for this study.

Sanchez (1995) published an article similar to Mack and Varady (1995) where he investigated water quality in Nogales, Sonora. Sanchez (1995) discusses water availability in the marginalized colonias, water shortages throughout the region, infrastructure problems, and flooding (Sanchez, 1995). However his primary focus addresses hazardous waste from industries as a major contributor to poor water quality. ”Official sources estimate that the annual generation of hazardous wastes in Mexico could be close to 14 million tons but only a minimal part of them are legally disposed of… Evidence of this mismanagement is the discovery of illegal dump sites of hazardous waste within and outside the urban areas.”-‐-‐Sanchez (1995). He further states that “Two major water quality problems in Nogales, Sonora are bacteriological pollution associated with deficiencies in the municipal sewerage system and the potential pollution of wells used to supply water to low income neighborhoods of the city.” Sanchez (1995) collected water samples from the municipal drinking water system in Nogales, Sonora and from wells in 5 different colonias. He found no significant levels of bacteriological contamination from the municipal drinking water system, but did find significant trace amounts of bacteriologic contamination in the wells he sampled. Three of the wells are used to supply water by truck or pipas to low-‐income neighborhoods. Sanchez (1995) goes on to state that “although our results did not detect pollution in the municipal water system, more than 20% of the population relies on other sources of water.” The complex water delivery system of Nogales means there are many points of contaminant entry. The survey developed for this project will investigate how rates of gastrointestinal disease vary among water delivery systems and if there is any relationship with SES.

Sadalla et al. (1999) describe and quantify the environmental pollution produced by residential behavior in marginalized colonias of Nogales, Sonora. They state that an “…analyses of the environmental impact of the maquila on the US-‐Mexican border region has to date focused primarily on the contribution of industrial practices. Considerably less is known of the environmental degradation engendered by substandard living conditions in the communities populated by the workforce of the maquiladoras.” Activities such as burning garbage for heating and cooking, inappropriate waste disposal and the absence of sewers combined with substandard latrine construction will eventually contaminate local aquifers according to Sadalla et al. (1999). Sadalla et al. (1999) administered a Residential Behavior Survey to residents of 400 dwellings in 3 different regions in Nogales, Sonora consisting of 16 colonias. The survey focuses on behavior relevant to air quality, water quality, and waste disposal. With respect to water quality, residents were asked questions related to source of water used for drinking, cooking, and bathing; water sterilization practices if any; water storage practices; and water disposal practices. Their last set of questions “…assessed residents’ beliefs and knowledge about the health risks that are produced by their residential environment and by their behavioral practices.” Sadalla et al. (1999) reason “...it is possible that colonia residents may not be concerned about factors that greatly influence their

health, but at the same time remain quite concerned about factors that have minimal health impact.” Because of this concept of perceived risk and its affect on behavior, questions were devised to assess whether residents were concerned about local water quality, whether they take any precautions to alleviate risks from poor water quality, and to correlate these findings with the household’s rate of diarrhea. Sadalla et al. (1999) did not ask questions related to health, rather they infer from the collected data that residents’ actions are causing health hazards.

According to Collins et al. (2010), “…quality of life issues can serve to bring about reallocation of resources to improve life. There are only so many funds/resources to invest in communities and understanding the limitations and areas that need improvement can provide insight for better budget allocations.” Quality of life questions can include rating personal satisfaction with government resources, public infrastructure, living conditions, and the environment. Collins et al. (2010) implemented a survey along several US-‐Mexico border towns including San Diego/Tijuana, El Paso/Ciudad Juarez, and Somerton-‐San Luis/San Luis-‐Rio Colorado. Contrary to what most people would believe about life in Mexico, residents are relatively satisfied according to Collins et al. (2010). Yet certain aspects of satisfaction are ranked much lower on a 9 point Likert scale (1 highly satisfied -‐9 unsatisfied). For instance, in the Somerton-‐San Luis/San Luis Rio Colorado region, he evaluated the satisfaction associated with the quality of piped water provided by the city. Residents on the US side (Somerton-‐San Luis) gave an average score of 3.3 out of 9 whereas residents on the Mexico side (San Luis Rio Colorado) responded with an average score of 6.2. When residents were asked to rate their concern about the impacts of the water quality on health, residents on the US side averaged a score of 6.8 while residents of Mexico responded with a score of 4.1 or greater satisfaction. The same trend of increased concern or dissatisfaction on the US and greater satisfaction in Mexico was consistent in the other towns surveyed by Collins et al. (2010).

Using the concepts of perceived risks and affects on behavior described by Sadalla et al. (1999) and the identification of ways to improve life formulated by Collins et al. (2010), we examined the current quality of life in two colonias. The study examines health hazards related to water quality and uses the presence or absence of diarrhea as the outcome variable.

Methods:

Community outreach: Stakeholder meetings were conducted with MEZCOPH, OOMAPAS, Centro de Salud Urbano en Nogales, Instituto Municipal de Investigación y Planeación, and the Ayuntamiento de Nogales Sonora to discuss issues of study design, implementation, cultural competency, relevancy, shared interests, and desired outcomes. Additional contact occurred through quarterly binational meeting called COBINAS which involved ADHS, ADEQ, Centro de Salud Urbano en Nogales, and Asociación de Promotoras de Nogales among others. Additional insight and direction of project development occurred through these interactions.

Study Design: Pilot data were collected from two colonias to determine the impact of economic status, water delivery system, perceived health risk associated with water quality and personal behavior on the prevalence of diarrhea. Neighborhoods were selected based on their SES as determined by Lara-‐

Valancia (2008). Lara-‐Valencia (2008) provides a map of each of the colonias in Nogales, Mexico and the degree of environmental vulnerability (Figure 1). According to Lara-‐Valencia (2008), the higher the environmental vulnerability the lower the economic status. Therefore in Figure 1, the darker shades outlining certain neighborhoods represent colonias with a lower SES and vice versa. All neighborhoods were considered but Colonia Colosio and Colonia Lomas de Fatima were chosen due to accessibility, safety, personal contacts, location, and information on access to piped water. Figure 1 indicates the location of these colonias within Nogales.

Twenty households were randomly selected in each of the two colonia reflecting SES extremes and water delivery system (piped chlorinated water vs. trucked water delivery). A survey derived from questions asked by Collins et al. (2010) in Tijuana, Sanchez (1999) in Nogales and Sadalla et al. (1999) from multiple border cities was collected at each home. Questions addressed: personal satisfaction with government resource use, public infrastructure, living conditions, and the environment; prevalence of diarrhea in the household, sources of water, and open ended questions related to community involvement. After the survey was complete, it was revised based on feedback from stakeholders meetings. The Spanish version of the survey was translated by the authors then sent to the Ayuntamiento de Nogales Sonora for a formal Spanish revision and to address cultural competency. After a final draft was completed, the survey along with accompanying consent materials was sent for approval to the University of Arizona’s Office for the Responsible Conduct of Research or Internal Review Board (IRB). Approval was received on July 14, 2010. A short, 5 question, follow up survey was also approved by the IRB and implemented on the same participating households during the winter of 2011 (January 15, 2011) in order to test for any seasonal variability on the prevalence of diarrhea. Water samples were collected from each participating household to test for microbes such as Total Fecal Coliform and E.coli and metals such as arsenic, lead, and mercury. The results of the water samples are to be published in a separate report. Implementation: In order to recruit multiple households from different colonias, student volunteers from the University of Arizona’s Mel and Enid Zuckerman College of Public Health and the College of Science’s Geosciences Department were recruited and trained on the study’s protocols based on their bilingual ability, Human Subjects Training Certification, and willingness to help. A representative from the Ayuntamiento de Nogales Sonora was also trained and acted as our liaison while in the field. Households were randomly selected in each of the colonias. Interviewers asked to speak with the head of the household who was 18 years or older and then asked if they would be willing to participate in the study. If the respondent accepted, a consent form was signed and the survey interview began. If they refused, the interviewer would move on to another randomly selected household. In order to save time and increase participation, the respondents reported conditions for all members of the household. The surveys were conducted on Saturday, August 20, 2010. The average amount of time taken to complete the 30 question survey was about 35-‐40 minutes.

Data Evaluation: The goal was to characterize and compare survey results from two colonias in terms of water delivery, satisfaction and gastrointestinal health determined by diarrhea frequency among household residents. Low response rates preclude statistical analyses (even categorical analyses given only 7 homes in the high SES neighborhood), so data are presented in tables and discussed qualitatively.


18 to 24 3 025 to 34 6 335 to 44 2 045 to 54 2 055 to 64 0 065 or over 1 4

0 -‐ 1 0 01 -‐ 5 3 05 -‐ 10 3 010 -‐ 20 6 0

More than 20 2 71 0 12 0 23 4 14 0 25 5 16 3 07 1 08 0 09 0 0

more than 9 0 0Yes 11 5No 3 2Rent 0 0Own 14 7Other 0 00 8 01 5 32 1 33 0 14 0 0

more than 4 0 0

3. How many

people live in your

household?

4. Do you have pets?5. Do you rent or own your house?


Table 1. Demographic ProfileQuestion Answers


2. H ow long have you lived in Nogales , S ono ra (in years )?

Question

Answers (1-‐low; 5-‐high) 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5

Colosio (n=14) 2 1 3 1 7 4 3 1 2 4 2 2 2 0 8 3 0 1 1 9 1 2 3 2 6

Fatima (n=7) 0 0 0 1 6 0 0 0 1 6 1 1 0 1 4 1 0 0 0 6 0 0 2 2 3





Table 2. Quality of Life7. Satisfaction with your current housing (house and colonia)?

Results: In all, 21 households were surveyed: 14 from the lower SES colonia (Colosio) and 7 from the higher SES colonia (Lomas de Fatima.

Table 1 summarizes the demographic profile for each colonia based on responses from a single respondent representing each household. A majority of respondents in Colosio were between the ages of 25-‐34 where as in Fatima, the majority were 65 or over. Respondents in Colosio were fairly new to the neighborhood when compared to Fatima where respondents said they lived for over 20 years or all their life. Residents in Colosio frequently have several family members living in one home with majority of respondents indicating five people living in a single home. In Fatima however, family members live much more comfortably with majority indicating that less than five family members live in the home. Because of these numbers of occupancy, a total of 84 people are represented in this research with 63 coming from Colosio and 21 coming from Fatima. All respondents said they own their home and property rather than rent. The majority of residents in Colosio do not own a car as opposed to residents of Fatima.

Table 2 demonstrates a respondent’s level of satisfaction with certain quality of life indicators. When it came to satisfaction with current housing or neighborhood, more than half of the residents in Colosio said they were very satisfied. All the respondents in Fatima indicated they were more than satisfied with their current living

situation. When it came to people’s satisfaction with the responsiveness of local government, in Colosio responses were varied. Four out of 14 were very satisfied where as another four were not satisfied at all with government responsiveness. In Fatima responses were not as varied and all respondents said they are very satisfied with local government responsiveness. Respondents rated their personal quality of life, as they personally defined it, and the majority of respondents in Colosio said they were very satisfied where as the rest varied among all levels of satisfaction.

Question



Table 3. Diarrhea and Water PerceptionsEpisode of diarrhea in the past 4 weeks





In Fatima however, only half said they were very satisfied whereas the rest were mixed. The majority of respondents in Colosio said they were very happy with their life in Nogales with a few (3 out of 14) indicating they were not at all happy with their life. Almost all of the respondents in Fatima indicated that they were happy with their life. Similar to their satisfaction with local government responsiveness, majority of respondents in Colosio rated their access to medical treatment in the area fairly high while other responses varied. In Fatima, all respondents rated their access to medical treatment at a level of satisfactory or higher.

Table 3 demonstrates the rate of diarrhea in the household as well as respondents’ perceptions of water quality and how it impacts their health. Of the 21 households recruited for this study, ten households reported a case of diarrhea within the past four weeks of the survey. Of those ten households, six were from Colosio and four were from Lomas de Fatima which means the rate of diarrhea in both colonias is almost at 50%. Only four cases were self reported whereas the rest were reported by a relative. Two households involved children under the age of 18. These cases of children were in Colosio only. One household of these two said that three of their children reported an episode of diarrhea. Since having multiple loose stools with excess water is not necessarily an indicator of gastrointestinal disease in Mexico due to high fiber diets and endemic pathogens, diarrhea may not be seen as a problem to some.

However, a majority of respondents in both colonias indicate that diarrhea is a problem and not just a natural occurrence. Of interest is that of the three households that

said diarrhea is a natural occurrence, two of them had an episode of diarrhea recently. In Lomas, of the two that said diarrhea was a natural occurrence, one had experienced diarrhea recently. In all, 12 people out of the 84 individuals in the sample reported a case of diarrhea within the past four weeks; eight individuals were from Colosio and four were from Lomas de Fatima.

Of the ten households with cases of diarrhea reported within the past four weeks, four required a household member to be hospitalized. In all, 11 people were hospitalized due to their case of diarrhea; eight were from Colosio while three were from Lomas de Fatima. Therefore, the rate of requiring specialized treatment for diarrhea is higher in Colosio than in Lomas de Fatima. Although some respondents said they were hospitalized because of their diarrhea, only one household said they or a family member missed work or school and another household said they weren’t sure. When asked what they believe caused their episode of diarrhea, no household blamed the consumption of water. Although none of the households that reported a case of diarrhea blamed water as the cause, a majority of respondents do believe however that the water available to them could potentially make them sick. Of those households that reported diarrhea, four households in Colosio believe the water could make them sick where as the sentiment was felt in three households in Lomas de Fatima. Some households reported that they were already sick to begin with, or they believe they ate something that made them ill, or it was a change in medication, or some simply didn’t know what the cause were. Interestingly, some households claimed it was the heat and climate that caused their episode of diarrhea. Whether

this means they consumed more water because of dehydration is unknown and should be investigated further. No household in either colonia reported an episode of diarrhea within one week from when the follow up survey was implemented during the winter. Therefore, the rate of diarrhea is low during the winter months.

Table 4 demonstrates how residents normally treat episodes of diarrhea, how they obtain their water, and whether they disinfect the water in any way. Almost all respondents indicated they treat their episode of diarrhea in some way. The majority of respondents said they treat diarrhea with some sort of medication whether prescription or otherwise. Others use rehydration therapy by consuming more water. Some respondents in both colonias indicated using “suero” as a form of treatment. Suero is Spanish for a saline solution. A majority of respondents in both colonias indicated they obtain their drinking water from bottled water. Half of respondents in Colosio rely on the water trucks or pipas for their drinking water or in conjunction with their bottled water. In Fatima however, majority rely on the water that is piped in from the city for drinking water if not in conjunction to their bottled water.

As predicted and expected, none of the respondents in Colosio have water piped into their house and all respondents in Fatima have piped water. Most respondents said they store their water in some way. A majority of respondents in Colosio said they store their water either in a tank on top of their house, known as a


None 0 1OTC Tx 6 1

Prescription Tx 6 1Tea 0 1

Other herbal 0 0Juice 1 0Water 3 1Other 5 4

Potable water 0 3Bottled water 12 7


Other 0 0

Yes 0 7

No 14 0

No 2 0Cistern 0 0

Tank on top of house (tinaco) 9 4Water tank or portable conainer 0 0

Underground tank (aljibe) 0 4Plastic gallon or bucket 4 0

Dishes 1 0Other 4 0Clear 8 5

Yellowish 0 1With dirt particles 6 1With other particles 0 0

No 10 3Chlorine 3 3Filter 0 0Boil 0 0Other 0 2

Yes 12 7

No 2 0

1 -‐ 2 0 02 -‐ 4 1 24 -‐ 6 4 26 -‐ 8 2 0

More than 8 7 3Piped in 0 7Bottled 1 0


Other 0 0Less than 100 pesos 1 0

100 -‐ 300 5 4301 -‐ 500 6 3501 -‐ 700 1 0701 -‐ 900 0 0901 -‐ 1300 1 01301 -‐ 1500 0 0

More than 1500 0 0*Mark all that apply

29. How do you obtain water for use other than drinking?*

30. How much money (in pesos) do you spend on water per month?

AnswerQuestion

19. How is diarrhea treated in the household?*

21. How do you get your drinking water?*

2 2 . Is the ho us e c o nne c te d to the c ity wa te r s ys tem v ia p ipe s ?

24. Do you store your water?*

Table 4. Water Use

25. How does the water that reaches your house look?26. Do you clean your water before using it to drink or cook?*

2 7 . Wo u ld yo u be wil l in g to tre a t yo u r wa te r a ny fu rthe r?

28. How many glasses of water (237ml) do you and your family drink a day?

tinaco, and or in plastic or metal industrial container known as a tambo. In Fatima, all respondents store their water in tinacos and or in the underground tanks also known as aljibes.

A majority of respondents in Colosio said that the water reaching the home is clear with the rest expressing that it sometimes contained dirt particles. In Fatima, the overwhelming majority said their water arrives clear while others said they noticed dirt particles or discoloration. Almost none of respondents in Colosio treat their water before using it to drink or cook. Some indicated they treat water with a bit of chlorine. In Fatima, half disinfect their water using chlorine or some other method. An overwhelming majority if not all of respondents in both colonias indicated they would not be willing to treat their water any further than whatever practice they currently use.

When asked about their daily consumption of water, half of households in Colosio said they drink more than eight glasses a day while the other half drank anywhere from four to six a day. In Fatima, most drank anywhere from two to six glasses of water a day while the rest of respondents drank more than eight. Other than drinking, respondents were asked how they obtained their water for things other than drinking such as cleaning, bathing, washing, etc. As expected, almost all of respondents in Colosio said they use the water provided in pipas and therefore stored in their tinacos and tambos. In Fatima, almost all respondents used the water that was piped in for uses other than drinking. The majority of respondents in Colosio said they paid anywhere from 100-‐500 Mexican pesos a month for water expenses whereas in Fatima almost all paid anywhere within that range. One hundred to five hundred Mexican pesos amounts to about 10-‐50 US dollars.

Table 5 reflects respondents’ perceptions of their water and asked to rate different aspects of their water. Half of respondents in Colosio said they were uncertain or gave an indifferent rating for the overall purity of potable water in Nogales. This is most likely because the respondents in Colosio do not have potable water available to them. All respondents in Fatima rated the purity of water at some level above average. When it came to the purity of piped water in the home, a majority of Fatima respondents rated it at some level above average. When it came to satisfaction with their water service, almost half of respondents in Colosio said they were overly satisfied with their current situation where as majority of the other half said they were not at all satisfied with it. Meanwhile all residents in Fatima said they were more than satisfied with their water service. When asked about their concern over the purity of potable water in their community or colonia, a majority of respondents in Colosio said they were uncertain or indifferent while others equally indicated they were not at all concerned or very concerned. In Fatima, this polarized distribution was also present. In terms of climatic challenges that

Question

Answers (1-‐low; 5-‐high) 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5

Colosio (n=14) 0 2 7 2 2 3 0 4 2 1 4 0 2 0 7 3 1 5 1 3 6 1 1 2 4

Fatima (n=7) 0 0 3 3 1 0 0 0 2 3 0 0 0 1 6 2 0 2 0 3 4 0 0 2 1

Table 5. Water Quality Perceptions31. The overall purity of potable water in Nogales?

32. The purity of piped water in your household, if piped?




affect water resources such as flooding and drought, almost half of respondents in Colosio said they are not concerned at all while other answers varied among different levels of concern. In Fatima about half said they had no concern.

A series of open ended questions were also asked that were categorized as policy implication questions as their responses could help shape local legislation on how to handle current water inequity, cleaner potable water, and expanding water delivery. When asked how much more per month they would be willing to pay for better potable water, a majority of respondents said they would not be willing to pay more than they already pay. Some said they didn’t know while others said they wouldn’t because they already paid enough. Some were willing to pay between 100-‐500 pesos more a month or in other words, double what they pay now. Responses in Fatima however indicated they would be willing to pay more when compared with the residents in Colosio. When asked what they would recommend so that potable water is improved a majority of respondents believe that in order to improve potable water the system should be expanded so that those that don’t have water get it. Others indicated that the water should be better treated such as with chlorination, filtration, or purification. Some said to be aware of the environment such as illegal dumping and better maintenance of wells and the watershed. Residents in Colosio focused more on expansion and treatment of water whereas in Fatima, residents focused more on the environment and water treatment. When asked what the citizens of Nogales and OOMAPAS (the local water company) could do to improve potable water, no clear answer was provided but a majority of respondents said that delivery should be improved by OOMAPAS. As for what citizens could do, it seems that there was mention that people should do their part in paying for the water they receive and not waste or pollute the water they already have. However, a majority of respondents were unsure of what could be done. When asked whether or not they pay taxes if they would be willing to pay more in taxes for better potable water majority of respondents said they didn’t know or don’t pay taxes or would not be willing to pay any more in taxes for improved water. Responses indicated that the amount that people would be willing to pay more in taxes is lower than what they would be willing to pay for their water bills. This could be due to mistrust that their money would be appropriately spent on water. Finally, respondents were asked what they could do to improve potable water for the city. Responses were varied but majority of respondents understood the role of preservation of the environment for better water. For instance, some mentioned properly disposing waste and not polluting or contaminating local water sources. Some also understood that they should clean and maintain their water storage systems.

Discussion:

The literature related to health on the border specifically Nogales, Sonora, Mexico is limited. Most of the research available concerning water and health in Nogales is over ten years old. Available research pertains to water quality and does not investigate its direct effects on health but makes assumptions. This study investigates health as it pertains to gastrointestinal disease by using qualitative and methods in two neighborhoods in Nogales. By implementing a survey that inquires about quality of life, water delivery, rate of diarrhea, and disinfection practices, this study is multifactorial. Most importantly, this project was a true binational effort. Not only were researchers involved from both sides of the border, but policymakers and government officials interacted in an effort to help disseminate relevant

information more quickly and to use results as a major reference for policy and systems change in the area.

As with any study there are limitations to its success and this study was no exception. The observations would be more credible with a greater sample size and representation of more colonias. The information gathered from the survey might be improved if every person in a household was interviewed rather than a single respondent representing the views of the entire household. This approach might yield “autocorrelated” responses and would require a greater consenting process, but views might be more diverse that presented. The survey could also have been improved if prospective: each household and each member could keep a journal of personal water consumption and episodes of diarrhea for a designated time period rather than relying on recall. A comparison of the neighborhoods in Nogales, Arizona with the neighborhoods in Nogales, Sonora might have been beneficial. Due to time constraints and limited resources, the methodology for the study was reduced from a more expansive study design. Although the study is limited, we strongly believe it provides researchers and stakeholders with a status report regarding potential concerns and issues.

With the data obtained we have made a number of observations. First, data exists within the municipality to characterize access to water for each colonia. As Collins et al. (2010) explain, there is a common misconception by outsiders that quality of life in Mexico is low. Table 2 indicates that life satisfaction is quite high. For instance, for the five questions in the survey inquiring about quality of life, majority of respondents in both colonias rated quality of life factors with a three or greater on a 5 point scale. Respondents in the higher SES colonia, Lomas de Fatima, were quite pleased with life, although the number of respondents was only 7.

Sadalla et al. (1999) state, “…it is possible that colonia residents may not be concerned about factors that greatly influence their health, but at the same time remain quite concerned about factors that have minimal health impact.” This statement was not reflected in this survey; again the respondent number is low. Residents mistrust the water quality, that is they believe it could make them sick, however they are taking their own precautions against it. Ninety percent of residents in both colonias indicated that they obtain their drinking water from a bottled water source. Therefore, in this study, colonia residents can identify a risk to their health and take necessary precautions. It is important to note that even though residents are protecting themselves by purchasing drinking water, they continue to use the water delivered to them to wash clothes, clean dishes, and bathe. None of these activities require direct ingestion of water, yet people may be exposed through secondary means.

Since half the households report an episode of diarrhea within the past four weeks, the rate of diarrhea is high. It is understandable that residents do not blame the water for their episode of diarrhea since almost all said they drink bottled water (a source untested in this project). However, residents fail to realize that they are still exposed to potentially contaminated water from cleaning, cooking, and bathing and therefore have not taken this exposure into consideration. Given that most residents, especially in Colosio, are not drinking water delivered to them and are taking basic precautions by personally disinfecting their tap water, most residents did not favor an increase in taxes or water bills or adding on

any new disinfection practices for better potable water. Future analyses of water quality and episodes of diarrhea will shed light on these beliefs.

Regardless of residents’ perceived risks there is a health issue. One way to align perceived risks with actual risk and effective preventive action is through education and awareness. Most residents indicated that the only disinfection practice they partake in is chlorine treatment. No household mentioned scrubbing, cleaning and rinsing their storage containers when empty. Research volunteers also observed numerous containers without lids leading to potential environmental exposure. Failure to apply various procedures and only relying on basic chlorine treatment (WHO, 2003) can lead to chlorine resistant bacteria.

During the follow-‐up survey, research volunteers were required to inform residents of water quality and provide basic instructions on how to better disinfect their water storage containers. Residents mentioned they would be willing to take on new practices if properly instructed. The city of Nogales, Sonora currently does not have a health education program addressing disinfection of water containers. Such a program could be easily implemented with the help of promotoras. Promotoras, or promoters of health in Spanish, are Spanish speaking community health workers that reside and work in the community. They are normally not specialized in the health field but rather have shown an interest in community health issues and help disseminate information from a trained health professional. Their approachability and simplified dissemination of health education is highly effective in the prevention of health issues (Meister et al., 1992). The promotoras could be involved in instructing how to properly disinfect tinacos, tambos, and aljibes and perhaps how to use flocculent.

Flocculent is a disinfectant powder that is added to drinking water to remove microorganisms, organic matter and heavy metals (Chiller et al., 2006). The flocculent disinfectant includes many chemicals used in commercial water treatment but has been specially formulated to work quickly on small volumes of water. All ingredients in the flocculent disinfection are used in commercial water treatment or in food products and are generally recognized as safe. The flocculent disinfectant combines precipitation, coagulation and flocculation with chlorination. Four sachets of flocculent are enough for a week's worth of water consumption and each sachet costs $0.035. A recent World Health Organization study (Chiller et al., 2006) reports a 40% reduction in the longitudinal prevalence of diarrhea among people using the flocculent that did not have access to a potable water system.

In summary, we found that people living in these two colonias of Nogales, Mexico, particularly those in the high SES section of the city, were satisfied with life. People were concerned about water quality and took personal steps to protect their health including the purchase of bottled water and personal disinfection of water by addition of chlorine bleach. Future training efforts of residents promoting increased system maintenance of water tanks and containers might improve water quality and health as would use of flocculent. By working closely in the development of this study with Mexican officials, some of whom included local epidemiologists, directors of public health agencies (CSP), directors of zoning and planning (IMIP), and the local water company (OOMAPAS), we believe the information provided will enhance future water system development and policy.

Work Cited

Aldous, P. (2003). The world’s forgotten crisis. Nature. 422:251. ADHS (Arizona Dept. of Health Services). (1993). Health risk assessment at Nogales Wash. Prevention Bulletin 7(1): 2-‐3. Centro de Salud Urbano de Nogales, Gobierno del Estado de Sonora, Secretaria de Salud Publica. Internal Document. (2010). Chiller, T. M., & Mendoza, C. E., & Lopez, M. B., et. al. (2006). Reducing diarrhea in Guatemalan children: randomized controlled trail of flocculent-‐disinfectant for drinking water. Bulletin of the World Health Organization. 84 (1) 28-‐35. Colford, J. M., & Roy, S., & Beach, M. J., et. al. (2006). A review of household drinking water intervention trials and an approach to the estimation of endemic waterborne gastroenteritis in the United States. Journal of Water and Health. 4 (2) 71-‐88.

Collins, K., & Subhrajit, G., & Sadalla, E., et. al. (2010). A longitudinal assessment of quality of life in the US-‐Mexico border region. Southwest Consortium for Environmental Research & Policy. Project Number: EIR 06-‐2/3.

Curriero, F., Patz, J. A., Rose, J. B., Lele, S. (2001). The association between extreme precipitation and waterborne disease outbreaks in the United States, 1948-‐1994. The American Journal of Public Health, 91(8), 1194-‐1199. Esrey, S., et al. (1990). Health benefits from improvements in water supply and sanitation: survey and analysis of the literature of selected diseases. United States Agency for International Development, Water and Sanitation for Health (WASH) Technical Report 66, Washington, D.C.: Agency for International Development. Ezzati, M. (2005). Environmental risks in the developing world: exposure indicators for interventions, programs & policies. Journal of Epidemiology 59:15-‐22. Lara-‐Valencia, F., Declet-‐Barreto, J., & Keys, E. (2008). Spatial equity and transportation hazard along cross-‐border trade corridors: the case of ambos Nogales. Journal of Borderland Studies, 23(2), 1-‐16. Mack, M. D., & Varady, R. (1995). Transboundary water resources and public health in the US-‐Mexico border region. Journal of Environmental Health, 57 (8). Meister, J., Warrick, L. de Zapien, J., & Wood, A. (1992). Using lay health workers: case study of a community-‐based prenatal intervention. Journal of Community Health, 17 (1), 37-‐51. Morehouse, B., Carter, R. H., & Sprouse, T. W. (2000). The implications of sustained drought for transboundry water management in Nogales, Arizona, and Nogales, Sonora. Natural Resources Journal, 40, 783-‐817. Norman, L. M., Donelson, A., Pfeifer, E., and Lam, A. H., (2006). Colonia development and land use change in ambos Nogales, United States-‐Mexican border: U.S. Geological Survey Open File Report: 2006-‐1112. http://pubs.usgs.gov/of/2006/1112. Norman, L., Huth, H., Levick, L., Shea Burns, I., Phillip Guertin, D., Lara-‐Valencia, F., & Semmens, D. (2010). Flood hazard awareness and hydrologic modeling at Ambos Nogales, United States-‐Mexico border. Journal of Flood Risk Management. (3) pp 151–165.

Sadalla, E., & Swanson, T., & Velasco, J. (1999). Residential behavior and environmental hazards in Arizona-‐Sonora colonias: A continuation project. Southwest Consortium for Environmental Research & Policy. Project Number: EH99-‐2. Sanchez, R. A. (1995). Water quality problems in Nogales, Sonora. Environmental Health Perspectives. 103 (1) 93-‐97. Udall Center for Studies in Public Policy. (1994). The Ambos Nogales water resources project: Summary of project outputs, Tucson, Arizona. Udall Center US Environmental Protection Agency Region IX. (1999). Environmental assessment for water system improvements for city of Nogales, Sonora, Mexico. US-‐Mexico Border 2012 Program. Accessed on April 12, 2010 from http://www.epa.gov/usmexicoborder/infrastructure/nogales/water.html US Environmental Protection Agency. (2011). Drinking water contaminants. Drinking Water. Accessed on March 3, 2011 at http://water.epa.gov/drink/contaminants/ US -‐ Mexico Border Health Commission. (2003). Healthy Border 2010 -‐ An Agenda for Improving Health on the United States-‐Mexico Border. Retrieved on April 10, 2010 from http://www.borderhealth.org World Health Organization. (2003). Chloride in drinking water. WHO Guidelines for Drinking Water Quality. Accessed on March 16, 2011 from http://www.who.int/water_sanitation_health/dwq/chloride.pdf

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can also be easily found by going to www.santacruzriver.org , which is redirected to the Southwest Learning Center’s Santa Cruz page. Along with Watershed Management Group and the University of Arizona's Water Resources Research Center (WRRC), Sonoran Institute is launching the nation’s first pilot program testing an innovative idea that links personal water conservation and local river restoration. The idea, developed by the WRRC and known as Conserve to Enhance, proposes that dollars saved through water conservation can purchase water for the environment. Currently 60 residents are signed up in Tucson’s Conserve to Enhance pilot, installing water harvesting features at their homes and donating savings to local river restoration projects. Revenues generated by the program will be used to purchase water and deliver it to local environmental enhancement projects as selected by the program’s Advisory Board. This year’s first project is the Atturbury Wash Restoration Site. Results from the pilot will inform an effort to bring the program to other communities.

Nogales, Sonora, Mexico: Is There Something in the Water?

CALDEIRA , FELIPE, Udall Center for Public Policy; Mel and Enid Zuckerman College of Public Health, University of Arizona Laura M. Norman, US Geological Survey, Border Environmental Health Initiative (BEHI), Tucson, AZ James Callegary, US Geological Survey, Border Environmental Health Initiative (BEHI), Tucson, AZ Floyd Gray, US Geological Survey, Border Environmental Health Initiative (BEHI), Tucson, AZ In Nogales, Sonora, Mexico, some neighborhoods have intermittent delivery of water through pipes while other areas lack piped water and rely on water delivered by truck. Multiple sources could potentially contaminate the quality of this water at point of use including contact with water storage containers and delivery trucks tanks, in addition to the preexisting conditions of the water loaded into the trucks. Little information is available on water quality and its impact on human health in this area. Adding complexity to the problem are monsoonal rains that increase surface runoff in the city during the summer months that could both dilute some contaminants and/or contribute to others. We collected 21 water samples from point of use in households both in August (rainy season) and in January (dry season) to analyze potential contaminants including microbes, metals, and anions. Fourteen households in Colonia Luis Donaldo Colosio, a neighborhood recognized as marginalized and highly vulnerable, were sampled and 7 households in Colonia Lomas de Fatima, a more affluent neighborhood recognized for having low vulnerability, were sampled. This presentation will report on the quantities found of total fecal coliforms, E.coli, arsenic, lead, mercury, chlorine and sulfate in both neighborhoods and discuss potential cause and effects.

http://www.santacruzriver.org/�

Water Quality Analysis, Perceptions and Risk in Nogales, Sonora, Mexico

Caldeira, F.1,2, Norman, L.3, Callegary, J.3, Gray, F.3, and Meranza, V.4

Keywords:

Water quality, microbial analysis, metal analysis, water inequity, water delivery, quality of life, human health, public health, community health, environmental health, diarrhea, gastrointestinal disease, US-‐Mexico border, binational, colonias, survey, seasonal variability, socio-‐economic status, water disinfection, promotoras, flocculent.

Abstract:

Introduction: In Nogales, Mexico, some neighborhoods, or colonias, have intermittent delivery of water through pipes while other areas lack piped water and rely on water delivered by truck or pipas. How does water quality differ seasonally from a colonia with access to piped water versus one that does not and does it have any health implications? Methodology: Water samples were collected at point of use in two areas of Nogales; one area with comparatively high socio-‐environmental conditions and therefore access to piped water (Colonia Lomas de Fatima) and another area with low socio-‐environmental conditions and therefore no access to piped water but a reliance on pipas (Colonia Luis Donaldo Colosio). A total of 21 households were recruited for the study (14 in Colosio and 7 in Lomas). Findings: E.coli was well above the EPA’s limit in Colosio but not Fatima. Total fecal colifroms were present in over 50% of households in both colonias. Microbial contamination was significantly higher in the summer than in the winter in both colonias. Metal concentrations for arsenic, lead, and mercury (median in mg/L: 0.00305, 0.000455, <0.0002) were well below the EPA’s limit in both colonias. Chloride was found to be significantly higher in Colosio (median 29.2mg/L). Conclusion: Residents in colonias without piped water are at a greater risk of gastrointestinal illness from consumption of contaminated water. Ongoing binational collaboration will assist in disseminating information for helping improve water quality in poorer colonias of Nogales.

Acknowledgements:

This research was developed and supported by the United States Geological Survey (USGS) and the Border Environmental Health Initiative (BEHI). Binational collaborators include the Mel and Enid Zuckerman College of Public Health (MEZCOPH), Instituto Municipal de Investigación y Planeación (IMIP), Ayuntamiento de Nogales Sonora, Organismo Operador Municipal de Agua Potable, Alcantarillado y Saneamiento de Nogales, Sonora (OOMAPAS), Centro de Salud Urbano en Nogales (CSU), Asociación de Promotoras de Nogales, Udall Center for Public Policy at the University of Arizona and the Arizona Department of Health Services (ADHS).

Introduction:

1 The Udall Center for Public Policy, The University of Arizona, Tucson, AZ. 2 The Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ. 3 Organismo Operador Municipal de Agua Potable de Nogales Sonora.

The US-‐Mexico border zone stretches 3,000km from the Pacific Ocean to the Gulf of Mexico and 100km north and south of the line as defined by the La Paz Agreement. Over the past 20 years, a unique dynamic of commerce and trade affected the region in part due ratification of the North American Free Trade Agreement (Lara-‐Valencia et. al., 2008). Promise of employment and opportunity on the border brought on by assembly plants or maquiladoras has provoked a major influx of people to Nogales, Mexico that the city has not been able to keep up with in terms of providing resources and adequate infrastructure.

Because of this disparity of local resources and infrastructure within the border city of Nogales, Mexico, there is development of neighborhoods or colonias and colonias marginales or marginalized neighborhoods (Norman et. al., 2006). Colonias marginales are colonias that lack basic infrastructure such as paved roads, electricity, and even piped water (Norman et. al., 2006; Lara-‐Valencia et. al., 2008; Sanchez, 1995; Sadalla et. al., 1999). Colonias marginales are established as a result of mobile workers from throughout Mexico seeking jobs in northern Mexico in the maquiladoras and other industries and unable to afford housing once they arrive (Sanchez, 1995; Tolan, 1990). Individuals would build their homes out of whatever left over construction material they could find around the city or what they could afford and build their homes in uninhabited regions. These uninhabited regions sprouted make shift homes so quickly that the city of Nogales is unable to construct paved roads or piped water. Often times these uninhabited regions that become massive colonias marginales are not recognized by the city or lack governance as development of homes were done without legal permits.

With a major influx of people migrating to the city of Nogales, Mexico, resources must be rationed. For instance, water delivery in the city is sparse. Established colonias that have piped water receive water from the municipal water system at certain times in the day and then shut off briefly for a few hours at different times depending on the colonia (Mack and Varady, 1995). Residents use various systems in order to compensate for these water shut off hours. In colonias where piped water is available, most homes have an aljibe system. An aljibe is a cement storage tank normally located underground at each home that pumps water to the house. When water is available from the city, it fills the aljibe. During household use, water is pumped from the aljibe to the house. Since there is intermittent water delivery, residents with the aljibe have a constant source of water. The aljibe is underground with the lid at ground level and because of this household water is subject to contamination from run-‐off on the city streets. Little information on the water quality of aljibes are available and research is needed. In colonias without out piped water, most notably colonias marginales, water is delivered by water truck or pipas into plastic storage containers called tinacos or metal storage containers called tambos. Tinacos are containers normally sold at home improvement stores and placed on top of homes. A hose is attached to the tinaco and delivers water to the user by simple use of gravity. Tambos on the other hand are placed at ground level and are usually scavenged rather than bought. Normally, these containers were left over from maquiladoras and little if any information is known by the user what the tambo used to contain. Pipas can be operated by the municipal water company, OOMAPAS, or by private owners. Private pipa operators normally own wells on their property and distribute water from their wells using their own pipas. Pipas operated by OOMAPAS are regulated by their water quality standards whereas private pipas

are not. Limited research is known about the water quality from pipas and which neighborhoods they service. The exponential growth experienced in Nogales in recent years is also causing a strain on local infrastructure which is exacerbated by the climate (Norman et. al., 2010). Rushing floodwaters caused by the region's heavy rain falls during the summer "monsoons" cause sewer-‐line breaks and lead to run off throughout the city. During these periods of extreme flooding, health hazards increase from both exposure to raw sewage and post-‐flood surface sewerage accumulations that create a breeding ground for infectious disease agents (Norman et. al., 2010).

Water quality data available specifically for Nogales, Mexico is limited and usually dated. However, research conducted by several authors has provided essential information about water quality in Nogales, Mexico. Researchers in the 1990s discovered bacterial contamination as well as measureable amounts of the carcinogen tetrachloroethylene (TCE) and volatile organic compounds (VOCs) in excess of the Arizona Based Guidance Levels (HBGL) and maximum containment level (MCL) in wells and wastewater lines in Nogales, Mexico (ADHS, 1993; Mack and Varady, 1995; Sanchez, 1995; Williams, 1987; Udall Center, 1994). Specific metal concentrations were not reported. Researchers (Mack and Varady, 1995; Sanchez, 1995) discovered that some of the wells they sampled from were being used by pipas to distribute and deliver water to colonias. Interestingly, when water from the municipal water system was sampled, researchers found no bacterial contamination or trace amounts of metals and other inorganic compounds (Sanchez, 1995).

More recently, water sampling was conducted at five points of the Santa Cruz River from its reference site (Lochiel, AZ) to its integrator site (Tumacacori National Park). The Santa Cruz River, which runs through Nogales, Mexico begins in Lochiel, AZ, runs south into Mexico and back north into the US. Preliminary results showed that organic and inorganic compound levels were increased after the reference site in Lochiel, AZ especially after the Santa Cruz River passed Nogales (Paretti et. al., 2010). However, inorganic concentrations were below limits. As mentioned, there is a gap between information available on water quality in wells and at point of use as well as how water quality differs from those that have infrastructure and those that do not. This study seeks to investigate how water quality differs seasonally at point of use from a colonia with piped water versus a colonia marginal with no access to piped water.

Methods:

Stakeholder meetings were conducted with MEZCOPH, USGS, OOMAPAS, Centro de Salud Urbano en Nogales, Instituto Municipal de Investigación y Planeación, and the Ayuntamiento de Nogales Sonora at the onset of study to discuss design, implementation, cultural competency, relevancy, shared interests, and desired outcomes. A quarterly binational meeting called COBINAS which involved ADHS, Centro de Salud Urbano en Nogales, and Asociación de Promotoras de Nogales among many others was attended for additional insight on project development.

A representative from the Ayuntamiento de Nogales Sonora acted as the main liaison while out in the field. Households were chosen at random in each of the colonias. Interviewers then asked to speak with

the head of the household who was 18 years or older and then asked if they would be willing to participate in the study. Water samples were conducted on Saturday, August 21, August 28, and September 4, 2010 and once over the winter (January 15, 2011) to test for seasonal variability. Water samples were collected from each participating household to test for microbes such as total fecal coliforms and E.coli and metals such as arsenic, lead, and mercury to name a few. Blank samples and replicates of one third of the samples were also collected in accordance with USGS policy for quality assurance.

In all, 21 households were represented; 14 from a marginalized and highly socio-‐environmentally vulnerable colonia (Colosio) and 7 from a more affluent and less socio-‐environmentally vulnerable colonia (Lomas de Fatima). All neighborhoods were considered but Colonia Colosio and Colonia Lomas de Fatima were chosen due to accessibility, safety, personal contacts, location, and information on access to piped water. Figure 1 indicates the location of these colonias within Nogales.

Results:

Graph 1 illustrates the percent of homes in the study that tested positive for E.coli and total fecal coliforms during the investigation. Almost 80% of homes in the marginalized and highly environmentally vulnerable colonia, Colosio, had E.coli present whereas none of the homes in the more affluent neighborhood, Lomas de Fatima, had any E.coli present. 100% of the homes in Colosio tested positive for total fecal coliforms during the length of the study whereas less than 60% of homes in Lomas de Fatima were contaminated with total fecal coliforms. A high percent of total fecal colifroms in Lomas de Fatima is alarming as these homes are receiving piped water. Fecal contamination in these homes is an indicator that there is an environmental exposure with these homes water delivery systems such as aljibes or tinacos or even cracks in pipes within the home.

As water samples were obtained, a survey about people’s perceptions of the water and relationship to health, more specifically incidence of diarrhea, was administered (Caldeira et. al., 2011). Graph 2

illustrates the percent of households with E.coli and diarrhea. The percent of households that reported diarrhea in Colosio is approximately 40% whereas in Fatima it is almost 60%. Graph 2 demonstrates that even though E.coli and total fecal coliforms are higher in Colosio, the percent of households that reported diarrhea is lower than Fatima. This suggests that the rate of diarrhea is independent of water quality alone and therefore other cofounders such as food, food preparation, climate, medication, illness, hygiene, etc. play a role as well.

A 2x2 table shows however that the trend is in the right direction because the number of households with no E.coli present and no diarrhea reported is higher than any other category or group (See Table 1).

Graph 3 illustrates the seasonal variability of E.coli and total fecal coliforms. The percent of households that tested positive for E.coli in Colosio is lower in the winter at almost 40% of households versus 80% in the summer and in Fatima it remained 0% during the summer and winter. Total fecal colifroms were also reduced in the winter in Colosio at almost 60% of households in the winter versus 100% in the summer. The trend was seen in Lomas de Fatima with less than 20% of households testing positive for total fecal colifroms in the winter versus almost 60% in the summer.

The metal analysis of the water samples showed that all median concentrations of metals such as arsenic (0.00305mg/L), lead (0.000455mg/L), mercury (<0.0002mg/L), cadmium (0.000060mg/L), copper (0.0100mg/L), etc were well below the EPA’s maximum contaminant level (MCL) in both colonias. The median concentrations of molybdenum (0.00165mg/L), lead (0.001050mg/L), antimony (0.000330mg/L), selenium (0.00170mg/L), arsenic (0.00368mg/L), copper (0.0259mg/L), tin (0.0134mg/L), and zinc (0.0464mg/L) were higher in Lomas de Fatima. These elevated concentrations are most likely due to homes in Lomas de Fatima receiving piped water from metal pipes. Colosio had higher median concentrations of cadmium (0.000065mg/L) as well as chloride (29.2mg/L) and sulfate (45.9mg/L). Colosio had significantly higher levels of chloride than Lomas de Fatima where the median concentration was 29.2mg/L versus 7.7mg/L. Chloride in water is an indicator of naturally present salt in the environment which can be attributed to exposure to inorganic fertilizers, landfill leachates, septic tank effluents, animal feeds, industrial effulents, irrigation drainage and chlorine treatment (WHO, 2003). Because residents in Colosio have their water storage containers exposed to the environment and have reported treating with chlorine (Caldeira et. al., 2011), elevated levels of chloride is expected.

Discussion:

With the data obtained, we have made a number of observations. First, microbial contamination is high, particularly in the marginalized colonia Colosio that does not have access to piped water. Observations are similar to others (ADHS, 1993; Mack and Varady, 1995; Sanchez, 1995; Williams, 1987; Udall Center, 1994) however their samples were obtained from wells whereas for this project they were obtained from the household’s reported point of use such as tinacos, tambos, and aljibes. Sanchez (1995) stated that no microbial contamination was observed from water sampled from the municipal water system however there is no mention as to where in the municipal water system they were obtained i.e. point of use, pipas, distribution site, treatment plant, city pipes, etc. Because we found microbial contamination in excess of the EPA’s recommended MCL of 0 for majority of the households, water is contaminated by the time it reaches the user.

Second, the rate of diarrhea is high however it is independent of water quality. This is because the colonia that was expected to have the lowest rate of diarrhea because they received piped water, Fatima, had an incidence of diarrhea of almost 60% versus 40% in Colosio. Individuals also reported only drinking bottled water and not water delivered to them (Caldeira et. al., 2011). When a 2x2 table is constructed, households that reported no diarrhea and tested negative for E.coli had the highest frequency, demonstrating a trend in the right direction. These results indicate that the high rate of diarrhea in the colonias is attributed to other risk factors such as food, food preparation, hygiene, illness, prescription side effects, climate, etc and perhaps indirect exposure from delivered water such as bathing and washing dishes and clothes.

Third, microbial contamination is higher in the summer during the rainy monsoon season. Households that tested positive for E.coli dropped from approximately 80% to 40% and total fecal coliforms dropped from 100% to almost 60% in Colosio. In addition, no diarrhea was reported during the winter sampling (Caldeira et. al., 2011). The increase in microbial contamination during the rainy summer season is most likely attributed to heavy runoff (Curreiro, et. al. 2001). The relatively high concentration of chloride found in Colosio samples is evidence of environmental exposure from runoff (WHO, 2003). In Colosio, as residents use latrines to relieve themselves, runoff from heavy rainfall can carry waste and excrement throughout the city, and therefore contaminating improperly sealed aljibes, as well as form dust as it dries and landing inside of tinacos and tambos. These series of events most likely cause the elevated levels of microbes during the summer season in Nogales, Mexico.

Lastly, metal concentrations analyzed for were well below the EPA’s MCL. Although researchers (ADHS, 1993; Mack and Varady, 1995; Sanchez, 1995; Williams, 1987; Udall Center, 1994) found elevated levels of TCE and VOCs, Sanchez (1995) stated that VOCs found in well water were traced to industries in the area. Arsenic, cadmium, mercury, antimony and selenium are metals commonly associated with industrial waste. Because these concentrations were low in this study, it’s possible that Nogales has been enforcing its environmental protection laws since previous studies’ findings.

While metal concentrations are below a safe limit, microbial concentrations are not, especially in colonias without access to piped water. Expanding the municipal water system to all neighborhoods in Nogales is incredibly expensive and ongoing debate in the area for decades. Increased awareness of vulnerability and proper disinfection practices could alleviate some of the burden associated with increasing the municipal water system in the mean time.

In Caldeira and others’ (2011) study, residents mentioned they would be willing to take on new practices if properly instructed. The city of Nogales, Sonora currently does not have a health education program addressing disinfection of water containers. Such a program could be easily implemented with the help of promotoras. Promotoras, or promoters of health in Spanish, are Spanish speaking community health workers that reside and work in the community. They are normally not specialized in the health field but rather have shown an interest in community health issues and help disseminate information from a trained health professional. Their approachability and simplified dissemination of health education has been shown to be highly effective in the prevention of health issues (Meister, 1992). The promotoras

could be involved in instructing how to properly disinfect tinacos, tambos, and aljibes and perhaps how to use flocculent.

Flocculent is a disinfectant powder that is added to drinking water to remove microorganisms, organic matter and heavy metals (Chiller, 2006). The flocculent disinfectant includes many chemicals used in commercial water treatment but has been specially formulated to work quickly on small volumes of water. The flocculent disinfectant combines precipitation, coagulation and flocculation with chlorination. Four sachets of flocculent are enough for a week's worth of water consumption and each sachet costs approximately $0.035. A recent World Health Organization study (Chiller, 2006) found that in total, there was a 40% reduction in the longitudinal prevalence of diarrhea among people using the flocculent that did not have access to a potable water system.

Conclusion:

As evidenced by the increased levels of microbial contamination in Colosio, there is a higher vulnerability to gastrointestinal illness when there is no access to piped water. Numerous reports have illustrated that the greater the barrier to clean piped water, the greater the chances of illness and mortality (Aldous, 2003; Colford, 2006; Chiller et. al., 2006; Esrey et. al., 1990; Ezzati, 2005; USMBHC, 2003). Although this investigation did not find water quality to be the sole reason behind the high rate of diarrhea, it is obvious that contaminated water with fecal microbes can cause illness. Microbial contamination was also found to be significantly higher during the summer monsoon season. This information has serious public health implications as the region has been experiencing increased extreme weather recently due to climate change (Lara-‐Valencia et. al., 2010; Morehouse et. al., 1990; Norman et. al., 2010). As the city of Nogales, Mexico does not currently have an at-‐home water treatment education program, such a grass-‐roots program, which has been shown to effective in this region (Meister et. al., 1992), could be implemented to help alleviate some of the burden on local infrastructure development for clean water delivery and decrease water inequities. The literature related to health on the border specifically Nogales, Sonora, Mexico is limited. Most of the research available concerning water and health in Nogales is over ten years old. Although most of the research available pertains to water quality it does not investigate its direct effects on health but rather makes assumptions. Data pertaining to water quality on the border is regularly sampled from wells rather than from point of use. Using results from Caldeira et. al. (2011) this study investigates water quality and human health by using qualitative and quantitative methods in two neighborhoods in Nogales. By incorporating data from a survey that inquires about quality of life, water delivery, rate of diarrhea, and disinfection practices as well as an analysis of water quality, this study is multi-‐factorial. Most importantly, this project was a true binational effort. Not only researchers were involved from both sides of the border but also policymakers and government officials in an effort to help disseminate relevant information quicker and to use results as a major reference for policy and systems change in the area.

As with any study there are limitations to its success and this study was no exception. The observations would be more credible with a greater sample size and representation of more colonias. More collection

of samples over time would have improved observations of seasonal variability. An investigation of VOCs in water samples would have supplemented conclusions. Results could be improved if water samples were collected from every point of distribution ie well, treatment facility, pipa, city pipe line, tinaco/tambo/aljibe. A comparison of the neighborhoods in Nogales, Arizona with the neighborhoods in Nogales, Sonora might have been beneficial. Due to time constraints and limited resources, the methodology for the study was reduced from the original study design. Although the study is limited, we strongly believe it provides researchers and stakeholders with a status report regarding potential concerns and issues.

By working closely in the development of this study with Mexican officials, some of whom included local epidemiologists, directors of public health agencies (CSP), directors of zoning and planning (IMIP), and the local water company (OOMAPAS), we believe the information provided will be applied to good use.

Work Cited

Aldous, P. (2003). The world’s forgotten crisis. Nature. 422:251. Arizona Dept. of Health Services. (1993). Health risk assessment at Nogales Wash. Prevention Bulletin 7(1): 2-‐3. Caldeira, F., & O’Rourke, M. K., & Gil, C. (2011). Water and wellness in two colonias of Nogales, Sonora, Mexico. Journal of Health, Wellness, and Society. (forthcoming) Callegary, J., Gray, F., Paretti, N., Norman,L., Withers, K., Vandervoet, P., McAndrew, R., Scott, C., Van Riper, C., Megdal, S., & Prichard, A. (2010). Physical and biological science to study interactions among water, environmental, and human health in the transboundary upper santa cruz basin. In Proceedings of Santa Cruz River Researcher’s Day. March 29. Tucson, Arizona. (http://www.southwestlearning.org/getinvolved/outreach/workshops/scr) Centro de Salud Urbano de Nogales, Gobierno del Estado de Sonora, Secretaria de Salud Publica. Internal Document. (2010). Chiller, T. M., & Mendoza, C. E., & Lopez, M. B., et. al. (2006). Reducing diarrhea in Guatemalan children: randomized controlled trail of flocculent-‐disinfectant for drinking water. Bulletin of the World Health Organization. 84 (1) 28-‐35. Colford, J. M., & Roy, S., & Beach, M. J., et. al. (2006). A review of household drinking water intervention trials and an approach to the estimation of endemic waterborne gastroenteritis in the United States. Journal of Water and Health. 4 (2) 71-‐88. Curriero, F., Patz, J. A., Rose, J. B., Lele, S. (2001). The association between extreme precipitation and waterborne disease outbreaks in the United States, 1948-‐1994. The American Journal of Public Health, 91(8), 1194-‐1199. Esrey, S., et al. (1990). Health benefits from improvements in water supply and sanitation: survey and analysis of the literature of selected diseases. United States Agency for International Development, Water and Sanitation for Health (WASH) Technical Report 66, Washington, D.C.: Agency for International Development. Ezzati, M. (2005). Environmental risks in the developing world: exposure indicators for interventions, programs & policies. Journal of Epidemiology 59:15-‐22. Lara-‐Valencia, F., Declet-‐Barreto, J., & Keys, E. (2008). Spatial equity and transportation hazard along cross-‐border trade corridors: the case of ambos Nogales. Journal of Borderland Studies, 23(2), 1-‐16. Lara-‐Valencia, F., Brazel, A. J., Mahoney, E., et. al. (2010). The response of US-‐Mexico border cities to climate change: current practices and urgent needs. DRAFT. Mack, M. D., & Varady, R. (1995). Transboundary water resources and public health in the US-‐Mexico border region. Journal of Environmental Health. Meister, J., Warrick, L. de Zapien, J., & Wood, A. (1992). Using lay health workers: case study of a community-‐based prenatal intervention. Journal of Community Health, 17 (1), 37-‐51. Morehouse, B., Carter, R. H., & Sprouse, T. W. (2000). The implications of sustained drought for transboundry water management in Nogales, Arizona, and Nogales, Sonora. Natural Resources Journal, 40, 783-‐817.

Norman, L., & Austin, D. (2004). Unifying US-‐Mexico sister cities with colonias GIS as a framework [abs.]: Arizona Geographic Information Council (AGIC) 2004 GIS Education and Training Symposium. October 27-‐29. Prescott, Arizona. Norman, L. M., Donelson, A., Pfeifer, E., and Lam, A. H., (2006). Colonia development and land use change in ambos Nogales, United States-‐Mexican border: U.S. Geological Survey Open File Report: 2006-‐1112. http://pubs.usgs.gov/of/2006/1112. Norman, L., Huth, H., Levick, L., Shea Burns, I., Phillip Guertin, D., Lara-‐Valencia, F., & Semmens, D. (2010). Flood hazard awareness and hydrologic modeling at Ambos Nogales, United States-‐Mexico border. Journal of Flood Risk Management. (3) pp 151–165. Paretti, N., Callegary, J., Gray, F., Beisner, K., Norman, L., & Van Riper, Charles. (2010). Occurrence, fate, and bioaccumulation of organic and inorganic contaminants from multiple sources in the upper Santa Cruz watershed, [abs.], Arizona Hydrological Society, Sept 1-‐4. Tucson, Arizona.

Sadalla, E., & Swanson, T., & Velasco, J. (1999). Residential behavior and environmental hazards in Arizona-‐Sonora colonias: A continuation project. Southwest Consortium for Environmental Research & Policy. Project Number: EH99-‐2. Sanchez, R. A. (1995). Water quality problems in Nogales, Sonora. Environmental Health Perspectives. 103 (1) 93-‐97. Tolan, S. (1990). The border boom. Hope and heartbreak. The New York Times Magazine; July 1, 1990. Udall Center for Studies in Public Policy. (1994). The Ambos Nogales water resources project: Summary of project outputs, Tucson, Arizona. Udall Center US Environmental Protection Agency. (2011). Drinking water contaminants. Drinking Water. Accessed on March 3, 2011 at http://water.epa.gov/drink/contaminants/ US Environmental Protection Agency Region IX. (1999). Environmental assessment for water system improvements for city of Nogales, Sonora, Mexico. US-‐Mexico Border 2012 Program. Accessed on April 12, 2010 from http://www.epa.gov/usmexicoborder/infrastructure/nogales/water.html US -‐ Mexico Border Health Commission. (2003). Healthy Border 2010 -‐ An Agenda for Improving Health on the United States-‐Mexico Border. Retrieved on April 10, 2010 from http://www.borderhealth.org Williams, JD. (1987). Groundwater sampling plan for Nogales Wash. Arizona Department of Health Services. Phoenix, Arizona. World Health Organization. (2003). Chloride in drinking water. WHO Guidelines for Drinking Water Quality. Accessed on March 16, 2011 from http://www.who.int/water_sanitation_health/dwq/chloride.pdf

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S

Water Quality and Impact on Health in Two Colonias of Nogales, Mexico

Felipe Caldeira Public Health Policy and Management


MEZCOPH Spring 2011 Internship Conference

Background S Commerce and NAFTA

S Influx of workers to the border.

S Maquiladoras S Cheap labor

S Loose Regulation

S Environmental and Safety

S Colonias S Colonias vs Colonias Marginales

S Socioeconomic status / Socio-Environmental Vulnerability

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Question

S  How does water differ from those with access to piped water versus those that do not?

S  What effect is the water having on people’s health?

S  How does water quality change seasonally?

Methods

Development •  Literature Review •  Focus Groups •  Survey •  Approval

Implementation •  Field Work •  Lab Work •  Volunteers

Follow Up •  Results •  Analysis •  Recommendations

Binational Collaboration

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Methods

S  40 households (proposed)

S  Sample for microbes

S  Sample for metals

S  Survey

S  Seasonal

Rainfall trend in Southwest

Rainfall trend in temperate

Background

Lomas de Fatima

Colosio


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Field Work

How does water differ from those with access to

piped water versus those that do not?

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What effect is the water having on people’s health?

What effect is the water having on people’s health?

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How does water quality change seasonally?

Summary

How Water Quality Differs: S  E.coli and total fecal coliforms higher in colonia without access to piped water

S  Metal concentrations higher in colonia with piped water but are below standards

S  Chloride higher in colonia with no piped water.

How Water Quality Impacts Health: S  Occurrence of diarrhea independent

S  Trend in the right direction S  Other risk factors for diarrhea occurrence:

S  Food, Hygiene, Illness

How Water Quality Changes Seasonally: S  Higher concentrations of microbes in the summer

S  No diarrhea reported in the winter

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Conclusion

S  Higher vulnerability living in a colonia with no piped water.

S  Water delivered not a direct cause of diarrhea.

S  Climate affects microbial concentration.

S

Thank you!

Volunteers: MEZCOPH: Luis Lozano, Perry Gast, Sofia Grigera,

USGS: Ashley Rigas, IMIP: Alejandro Araiza

Advisors: Jill de Zapien, Mary Kay O’Rourke, Cecilia Rosales

Collaborators: BEHI (USGS), MEZCOPH,

IMIP, OOMAPAS, Centro de Salud Urbano de Nogales,

Binational Health Council/COBINAS (ADHS) Udall Center for Public Policy,

Funding: USGS | BEHI | Udall Center

5/7/11 1:34 PMGmail - Continuing Review Report to Conclude Project (# 10-0384-00)

Page 1 of 2file:///Volumes/Cruzer/Internship/Internship%20Report/Appendix/Gma…eview%20Report%20to%20Conclude%20Project%20(%23%2010-0384-00).htm

Felipe Caldeira <[email protected]>

Continuing Review Report to Conclude Project (# 10-0384-00)3 messages

Felipe Caldeira <[email protected]> Tue, Apr 26, 2011 at 11:32 AMReply-To: [email protected]: Bonnie Miranda <[email protected]>

Hi Bonnie

I am about to graduate and the the project titled "Water Quality and Health Analysis in Two Different Colonias ofNogales, Sonora, Mexico" has therefore concluded. I know that we must hand deliver the form to the IRB office butI wanted to send you the form to review first so that I'm filling it in correctly.

Let me know if you have any questions, comments, or concerns.

I appreciate your help.

Thank you!

Felipe--

www.u.arizona.edu/~felipec------------------------------------------Felipe Caldeiram: 520-921-0388w: 520-670-6671*395

2 attachments

F212-CONTINUINGREVIEWProgressReporteffective10-01-10_editedforCOPH.doc223K

Summary Explanation.docx12K

Miranda, Bonnie L - (bmiranda) <[email protected]> Tue, Apr 26, 2011 at 11:48 AMTo: "Caldeira, Felipe - (felipec)" <[email protected]>

Hi Felipe –

Actually because there was no risk in your project it was determined at the time of approval that it isexempt from regulatory determination, so it does not have an expiration date and you do not need tosubmit a Continuing Review to conclude the project. Thanks for checking and making sure it didn’tAdministratively Close! One less thing to worry about before graduation!

http://www.u.arizona.edu/%7Efelipec

tel:520-921-0388

tel:520-670-6671

https://mail.google.com/mail/?ui=2&ik=f983c8798a&view=att&th=12f93151b8a6e317&attid=0.1&disp=attd&realattid=f_gmz69of90&zw

https://mail.google.com/mail/?ui=2&ik=f983c8798a&view=att&th=12f93151b8a6e317&attid=0.2&disp=attd&realattid=f_gmz69ofe1&zw

FORM: Continuing Review Progress Report

NUMBER DATE PAGE F212 10/01/2010 1 of 3

HSPP USE ONLY Date received: Received by:

©2009 Huron Consulting Services, LLC. Huron Consulting Group Use and distribution subject to End User License Agreement at Experience. Redefined.™ http://www.huronconsultinggroup.com/SOP [email protected]

Use for both continuing review and as a final report to close a study. If modifications are being requested, submit a separate request for a modification.

IRB Project No.: 10-0384-00

Expiration Date: 07/13/10 – no expiration

Protocol Name: Water Quality and Health Analysis in Two Different Colonias of Nogales, Sonora, Mexico

Investigator: Felipe Caldeira Investigator’s Contact


Alternate Contact: Robert Varady, PhD Alternate Contact’s


Enrollment Status Number of subjects enrolled:

Since activation Since last approval Male Female Other, Unknown

Total locally:

Total all sites: 21 0 NA NA Number of subjects enrolled locally since activation of the study:

Caucasian Black Hispanic Asian Pacific Islander

American Indian/ Alaska Native Other, Unknown

Total number of subjects considered members of vulnerable populations:

Children Prisoners Fetuses Pregnant Students Employees

Cognitively Impaired Other

0 0 0 0 0 0 0 Financial Interest Declaration

The Principal Investigator hereby affirms that ALL appropriate project personnel employed by the UA have submitted an ROI to the Conflict of Interest Office and no outside interests related to this project have been disclosed by any individual.

The Principal Investigator hereby affirms that ALL appropriate project personnel employed by the UA have submitted an ROI to the Conflict of Interest Office and outside interests have been disclosed by one or more individuals that must be reviewed by the Institutional Review Committee (IRC) to determine whether a conflict exists related to this project.




Yes* No The following questions refer to all sites involved in the research:

Since the last IRB review, have subjects experienced any harms (expected or unexpected)?

Since the last IRB review, have subjects experienced any benefits?

Since the last IRB review, have there been any unanticipated problems involving risks to subjects or others since the last IRB review?

Since the last IRB review, have any subjects withdrawn from the research?

Since the last IRB review, have any subjects or others complained about the research?

Since the last IRB review, have there been any publications in the literature relevant to the risks or potential benefits research?

Since the last IRB review, have there been any interim findings?

Since the last IRB review, have there been any multi-center trial reports?

Since the last IRB review, have there been any data safety monitoring board reports?

Since the last IRB review, has there been any other relevant information regarding this research, especially information about risks associated with the research?

In the opinion of the principal investigator, have the risks or potential benefits of this research changed?

Since the last IRB review, have there been any modifications to the research?

Are there any problems that required prompt reporting that have NOT been submitted as required?

Have all serious adverse events and unanticipated adverse events in Veterans Administration (VA) research been reported as required? Check N/A if this is not Veterans Administration (VA) research.

*Attach a summary explanation or description for each question whose answer is “Yes.”

Current Protocol Status Check all that are true or not applicable

The research is permanently closed to enrollment. All subjects have completed all research-related interventions. Collection of private identifiable information is completed. Analysis of private identifiable information is completed.

If all items are checked, the research may be concluded Otherwise, the Human Research must undergo continuing review by the IRB.

Project Number and Title: 10-‐0384-‐00 Water Quality and Health Analysis in Two Different Colonias of Nogales, Sonora, Mexico

Summary of Explanation:

“Since the last IRB review, have there been any interim findings?” Yes.

Since the last IRB review (11/8/10) there have been interim findings as the investigation has collected data from IRB approved questionnaires and analyzed them. Results are available in the following abstract from the research:

Introduction: In Nogales, Mexico, some neighborhoods, or colonias, have intermittent delivery of water through pipes while other areas lack piped water and rely on water delivered by truck or pipas. What impact is access to piped water versus non-piped water having on health in different colonias in Nogales? Methodology: Water samples were collected at point of use and a survey was implemented to examine quality of life, water consumption, and impacts on human health in two areas of Nogales; one area with comparatively high socio-environmental conditions and therefore access to piped water (Colonia Lomas de Fatima) and another area with low socio-environmental conditions and therefore no access to piped water but a reliance on pipas (Colonia Luis Donaldo Colosio). A total of 21 households were recruited for the study (14 in Colosio and 7 in Lomas), which was composed of 84 individuals (63 from Colosio and 21 from Lomas). Findings: Respondents identified diarrhea as an issue for 50% of participating households. In fact, 11 people were hospitalized due to diarrhea; more than half from Colosio. A 2 x 2 table suggests greater frequency of no diarrhea reported when E.coli was not present. E.coli was well above the EPA’s limit in Colosio at 80% of households but not Fatima with 0% of households. Total fecal colifroms were present in over 50% of households in both colonias. Microbial contamination was significantly higher in the summer than in the winter in both colonias. Metal concentrations for arsenic, lead, and mercury (median in mg/L: 0.00305, 0.000455, <0.0002) were well below the EPA’s limit in both colonias. Chloride was found to be significantly higher in Colosio (median 29.2mg/L). Conclusion: Residents in colonias without piped water are at a greater risk of gastrointestinal illness from consumption of contaminated water. Ongoing binational collaboration will assist in disseminating information for helping improve water quality in poorer colonias of Nogales.




Provide 1 copy of the consent documents to be used in the next approval period (See Investigator Manual for additional instructions related to these documents). If consent will not be documented in writing, a script of information to be provided orally to subjects. This may be omitted if the research is permanently closed to enrollment.

Department Chair or Supervisor Approval I have reviewed this application and determined that all departmental requirements are met and that the investigator has adequate resources to conduct the Human Research in terms of time, facilities, staff, access to a subject population, and resources for care than subjects may need.

Departmental Chair or Supervisor Signature Date

Investigator Acknowledgement

I agree to conduct this Human Research in accordance with applicable regulations and the University of Arizona’s policies and processes.

Investigator signature Date

5/7/11 1:34 PMGmail - Continuing Review Report to Conclude Project (# 10-0384-00)

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Bonnie

From: [email protected] [mailto:[email protected]] On Behalf Of Felipe CaldeiraSent: Tuesday, April 26, 2011 11:32 AMTo: Miranda, Bonnie L - (bmiranda)Subject: Continuing Review Report to Conclude Project (# 10-0384-00)

[Quoted text hidden]

Felipe Caldeira <[email protected]> Tue, Apr 26, 2011 at 11:56 AMReply-To: [email protected]: "Miranda, Bonnie L - (bmiranda)" <[email protected]>

Thank you so much Bonnie![Quoted text hidden]



Water Quality and Impact on Health in Nogales Mexico

Executive Summary

Objective: Water quality concerns

in Nogales, Sonora, Mexico have been a

major public health problem for decades.

However, research in the area is limited.

Most of the research available about water

quality is restricted to wells and washes in

the area. Minimal information is available

about water quality at point of use and how

it impacts health. This study investigates

water quality at point of use, how it

impacts health based on a reported rate of

diarrhea, and if water quality changes

seasonally in two economically different

neighborhoods.

Methods: Water samples and a

survey were collected from two

neighborhoods in Nogales, Mexico. One

neighborhood lacks basic infrastructure

such as paved roads, electricity, and piped

water (Colosio) and another is a more

affluent neighborhood with basic

infrastructure (Lomas de Fatima). Water

samples were collected to test for microbes

E.coli and total fecal coliforms, which are

indicators of fecal matter and therefore

contamination in water, as well as analysis

of metals such as arsenic, lead, and

mercury, which can cause chronic health

problems with continued exposure. A

survey was also implemented to inquire

about quality of life, rate of diarrhea, and

other factors.

Results: 21 households (14 from

Colosio and 7 from Fatima) were recruited

representing 84 individuals (63 from

Colosio and 21 from Fatima).

80% of houses in Colosio tested positive

for E.coli and 100% of houses tested

positive for total fecal coliforms. In Fatima,

no houses tested positive for E.coli but

60% of houses tested positive for total fecal

coliforms during the summer.

Reported cases of diarrhea were

high with 50% of houses reporting an

episode of diarrhea within four weeks from

the day of investigation (8/21/11). 12 out of

the 84 individuals reported an episode of

diarrhea with 8 coming from Colosio. 3

were children under the age of 18 and 11

people were hospitalized. 40% of houses in

Colosio reported an episode of diarrhea

whereas 60% of houses in Fatima reported

a case of diarrhea.

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It is expected that the houses with

more contamination (Colosio) would have

more cases of diarrhea but that is not

observed in this study. Therefore, water

quality is independent of the rate of

diarrhea. There are other factors such as

hygiene, food preparation, illness, etc

contributing to the high rate of diarrhea.

During the winter (1/15/11), water

quality improved as the percent of houses

in Colosio positive for E.coli dropped to

40% and total fecal coliforms dropped to

60%. No E.coli was present in Fatima

during the winter and total fecal coliforms

dropped to 16%. No diarrhea was reported

during the winter.

All metal concentrations were

well below federal levels. Chloride, which

is an indicator of environmental exposure

from dust, was high in Colosio.

Recommendations: Nogales,

Mexico does not currently have a water

storage disinfection education program.

Such a program could help educate people

how to properly and regularly disinfect

their containers and lower the amount of

contaminated water and in turn improve

health.

Felipe Caldeira

The University of Arizona

[email protected]

Calidad de agua y impacto sobre la salud en Nogales, Mexico

Resumen Ejecutivo

Objetivo: La calidad del agua en

Nogales, Sonora, México ha sido un

problema para la salud pública a décadas.

Sin embargo, la investigación en el área es

limitada. La mayoría de las investigaciones

disponibles sobre la calidad del agua se

limita a los pozos. Existe información

mínima sobre la calidad del agua durante

punto de uso y su impacto en la salud. Este

estudio investiga la calidad del agua

durante punto de uso, cómo afecta a la

salud basado en una tasa de notificación de

diarrea, y si los cambios de la calidad del

agua estacionalmente en dos barrios

económicamente diferentes.

Métodos: Las muestras de agua y

una encuesta se obtuvieron de dos barrios

en Nogales, México. Un bario falta

infraestructura básica como caminos

pavimentados, electricidad y agua por

tubería (Colosio) y el otro es un barrio más

alfuente con infraestructura básica (Lomas

de Fátima). Tomaron muestras de agua

para detectar los microbios E.coli y

coliformes fecales, que son indicadores de

la materia fecal y por lo tanto la

contaminación en el agua, así como el

análisis de metales como el arsénico, el

plomo y el mercurio, que puede causar

problemas crónicos de salud con la

exposición continua. Una encuesta se llevó

a cabo también para preguntar acerca de la

calidad de vida, tasa de diarrea, y otros

factores.

Resultados: 21 hogares (14 de

Colosio y 7 de Fátima) fueron reclutados

en representación de 84 personas (63 de

Colosio y 21 de Fátima). 80% de las casas

de Colosio, fueron positivos por E.coli y

100% de las viviendas fueron positivas

para coliformes fecales. En Fátima, no

hube casas positivas por E.coli, pero 60%

de las viviendas resultaron positivos para

coliformes fecales durante el verano.

Los casos de diarrea fue alta con

50% de las casas con un episodio de diarrea

durante cuatro semanas a partir del día de

la investigación (8/21/11). 12 de los 84

individuos informó un episodio de diarrea

con 8 de Colosio. 3 eran niños menores de

18 y 11 personas fueron hospitalizadas.

40% de las casas de Colosio, informó un

episodio de diarrea mientras que el 60% de

las viviendas en Fátima reportó un caso de

diarrea.

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Se espera que las casas con más

contaminación (Colosio) habría más casos

de diarrea, pero no se observa en este

estudio. Por lo tanto, la calidad del agua es

independiente de la tasa de diarrea. Hay

otros factores como la higiene, preparación

de alimentos, enfermedades, etc que

contribuyen a la alta tasa de diarrea.

Durante el invierno (1/15/11), el

porcentaje de casas positivo para E.coli en

Colosio bajó para 40% y coliformes fecales

se redujo para 60%. E.coli no estaba

presente en Fátima durante el invierno y

coliformes fecales se redujo para 16%.

Ninguien se informó de diarrea durante el

invierno.

Todas las concentraciones de

metales fueron debajo de los niveles

federales. Cloruro, que es un indicador de

la exposición al polvo del medio ambiente,

fue alta en Colosio.

Recomendaciones: No hay un

programa de educación de desinfección de

contenedores de agua en Nogales, México.

Un programa podría ayudar a educar sobre

la manera correcta y con regularidad de

como desinfectar contenedores y reducir la

cantidad de agua contaminada y al retorno

mejorar la salud.

Felipe Caldeira

The University of Arizona

[email protected]

TITLE: Water Quality and Impact on Health in Nogales...

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