Public Perceptions of Wastewater Use for Community Health Monitoring in the United States


a new plus one The journal article by researchers at the University of Louisville highlighted public perceptions of sewer monitoring and safety issues associated with sewage monitoring that could be changed through educational programs. These findings will provide vital information to refine policy, enforcement, and regulatory measures related to wastewater-based epidemiology and improve public acceptance.

Study: Nationwide Public Perceptions Regarding Acceptance of Wastewater Use for Community Health Monitoring in the United States. Image Credit: Daniel Jedzura / Shutterstock


Sewer monitoring has emerged as a potentially novel and cost-effective component of public health surveillance. Wastewater monitoring involves the collection of pooled samples from sewage systems at the community or institutional level. The sewers serve as an aggregation for human waste at the community level and a template for community policing.

Sewer monitoring can provide valuable information about which pathogenic viruses, bacteria, and protozoa are prevalent in a community. With respect to public health, wastewater monitoring programs uncover infections and diseases that may have escaped or are not reported by standard surveillance systems and could fuel outbreaks.

For example, wastewater monitoring has been used to detect and track outbreaks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). During the early phases of the coronavirus disease 2019 (COVID-19) pandemic, alterations to social restrictions were implemented based on community infection levels. There were concerns about whether wastewater monitoring data could be used as evidence to change social behavior and isolation protocols.

The study

This study explored whether public perceptions of wastewater monitoring can be used as a public health surveillance tool, through a survey administered to a sample of people in the United States.

The study aimed to assess knowledge, awareness, acceptability, confidentiality, and variables that affect an individual’s knowledge of the sewer monitoring agreement.

The findings provided insights into the acceptance of sewer monitoring and may guide policy making on the expansion of sewer monitoring applications at the national and local levels.

Participants were recruited online through Qualtrics XM, a national research panel provider randomly invited to participate in the survey. This survey consisted of three components: questions about sewer monitoring knowledge and acceptance; demographic questions, such as age, gender identity, geography, race, ethnicity, education level, and income; and a privacy attitude questionnaire (PAQ) to assess general privacy limits.

Location of respondentsLocation of respondents

The results

Overall, 3,083 participants answered questionnaires about sewer monitoring as a public health surveillance tool that assessed their knowledge, perceptions, and concerns about privacy.

About half of those surveyed had no idea if COVID-19 could be detected in wastewater. In general, people in the United States (US) were less aware of sewer monitoring than of other types of public health surveillance.

Respondents, as measured by the PAQ, showed moderate levels of concern about privacy, with higher levels of concern related to personal information and lower levels for financial information.

Most respondents supported sewer monitoring, particularly to identify toxins, disease, and terrorist threats, with a decreasing level of preference in the given sequence. While support seemed to deteriorate for assessing population health behaviors and states, such as lifestyle, diet, and mental illness.

There were no significant privacy issues associated with sewer monitoring across the country. In particular, city-scale sampling garnered greater support than narrower-scale sampling.

Sewer monitoring is an emerging technology, so in areas where public health surveillance is relatively unknown, educational programs can be advantageous in changing public perceptions. Findings from this survey show that while knowledge and awareness related to sewer monitoring is low, the US population is specific about what is and is not appropriate for monitoring; public opinion must be considered.

The study had some caveats: the fact that the participants were self-selected and the nature of the survey was hidden until the participants met the inclusion requirements. Also, the survey researchers may have had a self-selection bias; respondents were older, wealthier, better educated, and from the suburbs; Residents of rural areas were excluded and the research was limited to the US.

More research is required to assess public attitudes toward the use of sewers for community health monitoring around the world.


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