| 1. |
- Bondelind, Mia, 1980, et al.
(author)
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Building trust: the importance of democratic legitimacy in the formation of consumer attitudes toward drinking water
- 2019
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In: Water Policy. - : IWA Publishing. - 1366-7017 .- 1996-9759. ; 21:1, s. 1-18
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Journal article (peer-reviewed)abstract
- This study aimed to explore the role of democratic decision legitimacy in the formation of consumer attitudes toward drinking water. Using consumer-level data on the decision to change the drinking water sources in two Swedish cities, three core sets of variables were constructed: (1) the overall democratic decision legitimacy, defined as the citizens' support for the decision; (2) the input, throughput and output dimensions of decision legitimacy, representing the citizens' perceived opportunity to provide input, their ability to oversee, as well as their level of satisfaction with the outcome of the decision-making process; and (3) consumer attitudes toward drinking water, comprising trust, risk perception and acceptance. The results of the study provide support for the proposed mechanism that consumers that perceive a decision-making process more positively also tend to support the ultimate decision more, which in turn helps to establish more positive consumer attitudes towards their drinking water. Consequently, democratic legitimacy is an important precursor for building trust. This is particularly important if a waterborne outbreak has negatively impacted consumers' trust in their water, and when political and engineering decisions must be made.
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| 2. |
- Bondelind, Mia, 1980, et al.
(author)
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Kommunikationsstrategier och konsumentperspektiv vid händelser på distributionsnätet
- 2017
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Reports (other academic/artistic)abstract
- Inom VA-verksamheten är de nöjda konsumenterna oftast tysta eftersom de har begränsade möjligheter att göra aktiva val när det gäller dricksvattnet. Ibland uppstår det kriser i dricksvattenförsörjningen, och studier har visat att det är bra med goda relationer mellan beslutsfattare och allmänhet före en kris. Det gör att krisen hanteras på ett bättre sätt, och att förtroendet mellan allmänhet och beslutsfattare påverkas mindre av krisen. Ett snabbt informationsflöde är ett effektivt och viktigt sätt för vattenleverantören att minska de negativa sociala konsekvenserna av ett sjukdomsutbrott, förutsatt att man har allmänhetens förtroende.Kvaliteten på den information som kommuniceras är avgörande för konsumenternas förtroende. Tidigare studier av krishantering har genomförts efter större händelser, som vattenburna sjukdomsutbrott. En studie i Lilla Edet efter norovirusutbrottet år 2008 visade att de som upplevde att informationen var av hög kvalitet också var de som upplevde lägre risk att dricka vattnet. Det kan ibland vara svårt att tolka resultaten från studierna eftersom det ofta är extrema engångsföreteelser som har inträffat. Sådana extrema händelser är svåra för VA-ansvariga att förutse, och de är händelser som kanske de flesta svenskar aldrig råkar ut för.Syftet med den aktuella studien var att undersöka hur informations- och kommunikationsstrategier genomförs i ett antal kommuner, samt hur kedjan händelse–beslut–kommunikation fungerar. Konsumenternas nöjdhet med informationen har undersökts vid normala driftstörningar på ledningsnätet. Projektet har genomförts av forskare vid Chalmers tekniska högskola och Livsmedelsverket. Medfinansiärer är Myndigheten för samhällsskydd och beredskap och Svenskt Vatten Utveckling. Författarna lämnar följande rekommendationer till kommuner och dricksvattenproducenter.Rutiner. Följ regelbundet upp dokumenterade rutiner för hur kommunikation ska ske internt och externt vid olika typer av händelser. Följ också regelbundet upp nöjdhet hos konsumenterna och utvärdera resultatet, och följ upp tillfällen med ökat antal inkommande samtal till kundtjänst. Det är svårare att nå ut med information under kvällar och helger samt till områden där ägarna inte bor permanent.Målgrupper. Målgruppen är nästan alltid heterogen. Informationen kan anpassas för exempelvis olika geografiska områden, åldersgrupper, för oroliga och missnöjda konsumenter, samt för konsumenter med annat modersmål än svenska. För att undvika att information försvinner på vägen är det viktigt att i största möjliga mån rikta sig direkt till konsumenterna och undvika mellanhänder.Kommunikationskanaler. Webbplatsen är stommen i kommunikationen, och konsumenter söker självmant information på internet och hittar till webbplatsen. Den bör därför hållas uppdaterad och ha information som är anpassad till målgrupperna. Direkt kommunikation, till exempel via sms, är ett effektivt sätt att nå ut till berörda konsumenter, men träffbilden för olika kommunikationskanaler kan variera mellan olika kommuner.
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| 3. |
- Heibati, Masoumeh, 1986, et al.
(author)
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Assessment of drinking water quality at the tap using fluorescence spectroscopy.
- 2017
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In: Water research. - : Elsevier BV. - 1879-2448 .- 0043-1354. ; 125, s. 1-10
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Journal article (peer-reviewed)abstract
- Treated drinking water may become contaminated while travelling in the distribution system on the way to consumers. Elevated dissolved organic matter (DOM) at the tap relative to the water leaving the treatment plant is a potential indicator of contamination, and can be measured sensitively, inexpensively and potentially on-line via fluorescence and absorbance spectroscopy. Detecting elevated DOM requires potential contamination events to be distinguished from natural fluctuations in the system, but how much natural variation to expect in a stable distribution system is unknown. In this study, relationships between DOM optical properties, microbial indicator organisms and trace elements were investigated for households connected to a biologically-stable drinking water distribution system. Across the network, humic-like fluorescence intensities showed limited variation (RSD = 3.5-4.4%), with half of measured variation explained by interactions with copper. After accounting for quenching by copper, fluorescence provided a very stable background signal (RSD
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| 4. |
- Helte, Emilie, et al.
(author)
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Calcium and magnesium in drinking water and risk of myocardial infarction and stroke-a population-based cohort study
- 2022
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In: American Journal of Clinical Nutrition. - : Oxford University Press. - 0002-9165 .- 1938-3207. ; 116:4, s. 1091-1100
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Journal article (peer-reviewed)abstract
- BACKGROUND: The implication of calcium and magnesium in drinking water for cardiovascular disease is unclear.OBJECTIVES: To assess the association of the concentration of calcium and magnesium in drinking water with incidence of myocardial infarction and stroke, accounting for dietary mineral intake.METHODS: We linked drinking water monitoring data to residential information of 26,733 women from the population-based Swedish Mammography Cohort, who completed a 96-item FFQ at baseline. Drinking water was categorized into low (magnesium <10 mg/L and calcium <50 mg/L) or high (magnesium ≥10 mg/L or calcium ≥50 mg/L) mineral concentration. Incident cases of myocardial infarction and stroke types were ascertained 1998-2019 using the National Patient Register.RESULTS: The mean ± SD concentration of calcium and magnesium in drinking water was 29 ± 7 mg/L and 5 ± 1 mg/L in the low-exposed area and 52 ± 20 mg/L and 10 ± 3 mg/L in the high-exposed area, respectively. During 16 years of follow-up, we ascertained 2023, 2279, and 452 cases of myocardial infarction, ischemic stroke, and hemorrhagic stroke, respectively. High drinking water calcium and magnesium was associated with lower risk of ischemic and hemorrhagic stroke HRs of 0.87 (95% CI: 0.80, 0.95) and 0.78 (95% CI: 0.65, 0.95), whereas the HR for myocardial infarction was 0.93 (95% CI: 0.85, 1.02). In separate analyses, only drinking water magnesium, not calcium, remained associated with ischemic stroke (HR: 0.69; 95% CI: 0.54, 0.88).CONCLUSIONS: Drinking water with a high concentration of calcium and magnesium, particularly magnesium, may lower the risk of stroke in postmenopausal women.
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| 5. |
- Helte, Emilie, et al.
(author)
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Chlorination by-products in drinking water and risk of bladder cancer : A population-based cohort study
- 2022
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In: Water Research. - : Elsevier. - 0043-1354 .- 1879-2448. ; 214
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Journal article (peer-reviewed)abstract
- Chlorination by-products have been consistently associated with risk of bladder cancer in case-control studies, but confirmation from large-scale cohort studies is lacking. We assessed the association of drinking water trihalomethanes (THM), a proxy for chlorination by-products, with risk of bladder cancer in 58,672 men and women. Data came from two population-based cohorts, parts of the Swedish Infrastructure for Medical Population-Based Life-Course and Environmental Research (SIMPLER). Individual exposure to THM was assessed by combining residential information with tap water monitoring data. Participants were categorized into non-exposed, low (<15 µg/L) or high (≥15 µg/L) THM exposure. Incident cases were ascertained from 1998 through 2019 via register linkage. During 16 years of follow-up (965,590 person-years), 831 bladder cancer cases were ascertained. We observed no overall association of THM with risk of bladder cancer, hazard ratio for the highest exposed compared to the non-exposed 0.90 (95% confidence interval: 0.73 - 1.11). The null association remained after restricting the analysis to long-term residents and across strata of smoking status and cancer stage. Our results indicate that chlorination by-product exposure at THM concentrations representative of chlorinated drinking waters in most European countries, is not associated with an increased risk of bladder cancer.
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| 6. |
- Helte, Emilie, et al.
(author)
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Disinfection by-products in drinking water and risk of colorectal cancer : a population-based cohort study.
- 2023
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In: Journal of the National Cancer Institute. - 0027-8874 .- 1460-2105.
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Journal article (peer-reviewed)abstract
- BACKGROUND: Colorectal cancer is the third most common malignancy worldwide, and it is strongly linked to lifestyle and environmental risk factors. While several drinking water disinfection by-products are confirmed rodent carcinogens, there is still inconclusive evidence for human carcinogenicity, including colorectal cancer.METHODS: We assessed the association of long-term exposure to Trihalomethanes (THMs, the most prevalent disinfection by-products in chlorinated drinking water) with incidence of colorectal cancer in 58,672 men and women in two population-based cohorts. Exposure was assessed by combining long-term information of residential history with drinking water monitoring data. Participants were categorized according to no exposure, low exposure (<15µg/L) and high exposure (≥15µg/L). Incident cases of colorectal cancer were ascertained using the Swedish National Cancer Register.RESULTS: During an average follow-up of 16.8 years (988,144 person-years), 1,913 cases of colorectal cancer were ascertained (1,176 and 746 men and women, respectively). High drinking water THM concentrations (≥15 µg/L) was associated with increased risk of colorectal cancer in men (hazard ratio, HR: 1.26, 95% confidence interval, CI: 1.05 to 1.51) compared to no exposure. When assessing subsites, the association was significant for proximal colon cancer (HR: 1.59, 95% CI: 1.11 to 2.27) but not distal colon cancer or rectal cancer. In women, we observed overall no association of THMs with colorectal cancer.CONCLUSION: These results add further support to that disinfection by-products in drinking water may be a possible risk factor for proximal colon cancer in men. This observation was made at THM concentrations lower than in most previous studies.
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| 7. |
- Säve-Söderbergh, Melle, et al.
(author)
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Gastrointestinal illness linked to incidents in drinking water distribution networks in Sweden
- 2017
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In: Water Research. - : Elsevier BV. - 0043-1354 .- 1879-2448. ; 122, s. 503-511
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Journal article (peer-reviewed)abstract
- During recent years, knowledge gaps on drinking water-related gastrointestinal illness have been identified, especially for non-epidemic cases. Pathogen contamination of drinking water during distribution has been suggested to contribute to these cases, but the risk factors are not yet fully understood. During 2014–2015, we conducted an epidemiological study in five municipalities in Sweden, to assess whether incidents in the drinking water distribution system influence the risk of gastrointestinal illness. Telephone interviews were conducted in the affected areas and in reference areas 7–14 days after a reported incident. Symptoms of gastrointestinal illness occurring during the period were documented for each household member. The results showed a significantly elevated risk of vomiting and acute gastrointestinal illness (AGI) in the affected areas, compared to the reference areas (ORvom. = 2.0, 95% CI: 1.2–3.3; ORAGI = 1.9, 95% CI: 1.2–3.0). Certain conditions, or risk factors, during the incidents, such as sewage and drinking water pipelines at the same level in the trench, were associated with an elevated risk of AGI and vomiting. Safety measures taken during repair work, like flushing, were also associated with an elevated risk of AGI and vomiting. These results show that incidents in the drinking water distribution network contribute to endemic gastrointestinal illness, especially AGI and vomiting, and that external pathogen contamination of the drinking water is a likely cause of these cases of gastrointestinal illness. The results also indicate that safety measures used today may not be sufficient for eliminating the risk of gastrointestinal illness.
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| 8. |
- Säve-Söderbergh, Melle
(author)
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Risks and benefits of drinking water treatment : focusing on child health and prenatal development
- 2021
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Doctoral thesis (other academic/artistic)abstract
- Drinking water is our most important food item and its access is indispensable for a wellfunctioning society. Recent Swedish water-borne outbreaks have demonstrated a system vulnerability and a clear need for improved knowledge on how variations in drinking water quality affects our health. This thesis explores this topic and consists of two large-scale epidemiological studies. The specific objectives were to i) obtain data on drinking water consumption patterns among adults, ii) assess whether changes in drinking water treatment and/or raw water source–aiming to increase pathogen reduction–affected the risk of gastrointestinal illness (GII) and iii–iv) assess if gestational exposure to by-products from drinking water chlorination war associated with the risk of adverse reproductive outcomes. In a longitudinal cohort, we collected repeated information on tap water consumption and GII episodes via a monthly SMS among 5,200 participants during several periods in 2012-2016. The study was conducted in two parts of Sweden, in populations of neighbouring municipalities. In Paper I, we found that 99.8% of adults were consumers of cold tap water, while the consumption of bottled water was low. This lends support to the use of large register-based studies to assess the associations between drinking water exposures and health. In Paper II, we assessed if changes in municipal drinking water production and/or of raw water source affected the risk of GII. These changes encompassed either switching ground water treatment plant, changing from a surface to a ground water treatment plant or switching the surface water treatment plant and raw water source, all resulting in increased pathogen reduction in the drinking water. We observed no differences in the risk of GII among adults, however, among children, a 24% relative risk reduction in GII was observed after switching surface water treatment plant and raw water source. The indications that children are the most sensitive population to drinking water related GII are in line with previous findings. In a nationwide register-based study, we assessed whether gestational exposure to chlorination by-products, trihalomethanes (TTHM), was associated with small for gestational age (SGA), preterm delivery or congenital malformations. We included more than 620,000 children born during 2005–2015 of mothers residing in Swedish localities (≥10 000 inhabitants) and where information on trimester specific TTHM exposure was available. The exposure was categorized into no chlorination, <5, 5–15, and >15 μg TTHM/L and stratified by treatment (hypochlorite and chloramine). In Paper III, we found indications of a dosedependent multivariable-adjusted association of TTHM with risk of SGA in areas using hypochlorite, odds ratio (OR) 1.20 (95% confidence interval [CI]: 1.08-1.33) when comparing the highest exposed population to the unexposed. In Paper IV, TTHM was dosedependently associated with malformations, but only in areas using chloramine. Comparing the population with highest exposure to the unexposed, ORs of 1.82 (95% CI: 1.07–3.12), 2.06 (95% CI: 1.53–2.78), 1.77 (95% CI: 1.38–2.26) and 1.34 (95% CI: 1.10–1.64) were seen for malformations of the nervous system, urinary system, genitals and limbs, respectively. The findings indicate that chlorination by-products may be associated with several adverse reproductive outcomes. Congenital malformations linked to chlorination by-product from chloramine use has not previously been highlighted and needs further attention.
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| 9. |
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| 10. |
- Tornevi, Andreas, et al.
(author)
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Efficacy of water treatment processes and endemic gastrointestinal illness : A multi-city study in Sweden
- 2016
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In: Water Research. - : Elsevier BV. - 0043-1354 .- 1879-2448. ; 102, s. 263-270
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Journal article (peer-reviewed)abstract
- Outbreaks of acute gastrointestinal illnesses (AGI) have been linked to insufficient drinking water treatment on numerous occasions in the industrialized world, but it is largely unknown to what extent public drinking water influences the endemic level of AGI. This paper aimed to examine endemic AGI and the relationship with pathogen elimination efficacy in public drinking water treatment processes. For this reason, time series data of all telephone calls to the Swedish National Healthcare Guide between November 2007 and February 2014 from twenty Swedish cities were obtained. Calls concerning vomiting, diarrhea or abdominal pain (AGI calls) were separated from other concerns (non-AGI calls). Information on which type of microbial barriers each drinking water treatment plant in these cities have been used were obtained, together with the barriers' theoretical pathogen log reduction efficacy. The total log reduction in the drinking water plants varied between 0.0 and 6.1 units for viruses, 0.0-14.6 units for bacteria and 0.0-7.3 units regarding protozoans. To achieve one general efficacy parameter for each plant, a weighted mean value of the log reductions (WLR) was calculated, with the weights based on how commonly these pathogen groups cause AGI. The WLR in the plants varied between 0.0 and 6.4 units. The effect of different pathogen elimination efficacy on levels of AGI calls relative non-AGI calls was evaluated in regression models, controlling for long term trends, population size, age distribution, and climatological area. Populations receiving drinking water produced with higher total log reduction was associated with a lower relative number of AGI calls. In overall, AGI calls decreased by 4% (OR = 0.96, CI: 0.96-0.97) for each unit increase in the WLR. The findings apply to both groundwater and surface water study sites, but are particularly evident among surface water sites during seasons when viruses are the main cause of AGI. This study proposes that the endemic level of gastroenteritis can indeed be reduced with more advanced treatment processes at many municipal drinking water treatment plants.
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