Gastric Cancer Mortality and Drinking Water Qualities in Taiwan

The possible association between the risk of gastric cancer and nitrate and hardness in drinking water from municipal supplies was investigated in a matched case-control study in Taiwan. Data on gastric cancer deaths among eligible residents in Taiwan from 1987 through 1991 (6,766 cases) were obtained from the Bureau of Vital Statistics of the Taiwan Provincial Department of Health. Controls were deaths from other causes (6,766 controls) and were matched individually to the cases by sex, year of birth, and year of death. Data on nitrate–nitrogen (NO₃–N) and hardness levels in drinking water throughout Taiwan were collected from the Taiwan Water Supply Corporation (TWSC). The municipality of residence for cases and controls was assumed to be the source of the subject's nitrate and hardness exposure via drinking water. There was no difference in gastric cancer rates between the groups with different levels of nitrate. The odds ratios (95% confidence interval) for death from gastric cancer was 0.95 (0.87–1.03) for the group with water nitrate levels between 0.23 and 0.44 mg/L, and 1.02 (0.93–1.11) for the group with nitrate levels greater than 0.45 mg/L. However, the results show a significant negative relationship between drinking water hardness and gastric cancer mortality. Odds ratios were 1.16 (1.07–1.26) and 1.65 (1.52–1.79), respectively, for exposure to moderately hard water and soft water compared with the use of hard water. This is an important finding for the Taiwan water industry and human health risk. Received: 27 November 1996/Accepted: 16 April 1997     

Water nitrates and CNS birth defects: a population-based case-control study

The relation between maternal exposure to nitrates in drinking water and risk of delivering an infant with a central nervous system (CNS) malformation was examined by means of a case-control study in New Brunswick, Canada. All cases of CNS defects for a "high" and a "low" prevalence area of New Brunswick, for the years 1973-1983, were included in the study. Controls were selected randomly from the livebirth files for the province, matched on county of maternal residence and date of birth. One hundred and thirty (130) cases were identified and individually matched with two controls each. Individual water samples were collected from the case and control mother's address given on the birth or stillbirth records. The study revealed that the effect of nitrate exposure in water was modified by whether the source of the drinking water was a private well or a public municipal distribution system. Compared to a baseline nitrate level of 0.1 ppm, exposure to nitrate levels of 26 ppm from private well water sources was associated with a moderate, but not statistically significant, increase in risk (risk odds ratio = 2.30; 95% confidence interval = 0.73-7.29). If the source of drinking water was a municipal distribution system or a private spring, an increase in nitrate exposure was associated with a decrease in risk of delivering a CNS-malformed infant; however, these effect estimates were not statistically significant. The positive increase in risk with nitrate exposure from well water sources requires further study using a larger case series and a larger proportion of exposures to nitrate levels exceeding 5 ppm.     

Does calcium in drinking water modify the association between nitrate in drinking water and risk of death from colon cancer?

The objective of this study was to explore whether calcium (Ca) levels in drinking water modified the effects of nitrate on colon cancer risk. A matched case–control study was used to investigate the relationship between the risk of death from colon cancer and exposure to nitrate in drinking water in Taiwan. All colon cancer deaths of Taiwan residents from 2003 through 2007 were obtained from the Bureau of Vital Statistics of the Taiwan Provincial Department of Health. Controls were deaths from other causes and were pair-matched to the cases by gender, year of birth and year of death. Information on the levels of nitrate-nitrogen (NO₃-N) and Ca in drinking water have been collected from Taiwan Water Supply Corporation (TWSC). The municipality of residence for cases and controls was assumed to be the source of the subject's NO₃-N and Ca exposure via drinking water. We observed evidence of an interaction between drinking water NO₃-N and Ca intake via drinking water. This is the first study to report effect modification by Ca intake from drinking water on the association between NO₃-N exposure and risk of colon cancer mortality.     

Adenocarcinoma of the stomach and esophagus and drinking water and dietary sources of nitrate and nitrite

We conducted a population-based case-control study of adenocarcinoma of the stomach and esophagus in Nebraska, U.S.A. Nitrate concentrations in public drinking water supplies were linked to residential water source histories. Among those using private wells at the time of the interview, we measured nitrate levels in water samples from wells. Dietary nitrate and nitrite were estimated from a food-frequency questionnaire. Among those who primarily used public water supplies (79 distal stomach, 84 esophagus, 321 controls), average nitrate levels were not associated with risk (highest versus lowest quartile: stomach OR=1.2, 95% CI [0.5-2.7]; esophagus OR=1.3, 95% CI [0.6-3.1]). We observed the highest ORs for distal stomach cancer among those with higher water nitrate ingestion and higher intake of processed meat compared with low intakes of both; however, the test for positive interaction was not significant (p=0.213). We did not observe this pattern for esophagus cancer. Increasing intake of nitrate and nitrite from animal sources was associated with elevated ORs for stomach cancer and with a significant positive trend in risk of esophagus cancer (P-trend=0.325 and 0.015, respectively). Larger studies with higher exposures to drinking water sources of nitrate are warranted to further evaluate N-nitroso compound precursors as risk factors for these cancers.     

Rectal cancer mortality and total hardness levels in Taiwan's drinking water.

The possible association between the risk of rectal cancer and hardness levels in drinking water from municipal supplies was investigated in a matched case-control study in Taiwan. All eligible rectal cancer deaths (986 cases) of Taiwan residents from 1990 through 1994 were compared with deaths from other causes (986 controls), and the hardness levels of the drinking water used by these residents were determined. Data on water hardness throughout Taiwan were collected from Taiwan Water Supply Corporation (TWSC). The control group consisted of people who died from other causes and the controls were pair matched to the cases by sex, year of birth, and year of death. The results show a significant negative relationship between drinking water hardness and rectal cancer mortality. Odds ratio and 95% confidence intervals were 1.24 (1.01-1. 55) and 1.38 (1.10-1.73), respectively, for exposure to moderately hard water and soft water compared with the use of hard water. Trend analyses showed an increasing odds ratio for rectal cancer with decreasing levels of hardness in drinking water. This is an important finding for the Taiwan water industry and human health.     

Nitrate in public water supplies and risk of bladder cancer

BACKGROUND: Nitrate is a precursor compound in the formation of N-nitroso compounds, most of which are potent animal carcinogens. N-nitroso compounds and their precursors have not been extensively evaluated as bladder cancer risk factors. METHODS: We conducted a population-based case-control study of bladder cancer in Iowa. Cases were men and women newly diagnosed with bladder cancer in 1986-1989. Nitrate data for Iowa public water supplies were sparse before the 1960s. To reduce misclassification by unknown nitrate levels, we included only those who used public supplies with nitrate data for 70% or more of their person-years since 1960 (808 cases, 1259 controls). RESULTS: Among controls, the median average nitrate level for their Iowa residences with public water supplies was 1.3 mg/liter nitrate-nitrogen (interquartile range = 0.6-3.0). After adjustment for confounders, we found no increased risk of bladder cancer with increasing average nitrate levels in drinking water; the highest quartile odds ratio for women was 0.8 (95% confidence interval = 0.4-0.8), and for men 0.5 (0.4-0.8). We observed no association among those with high water nitrate exposure (>median) and low (相似文献   

Colon Cancer Mortality and Total Hardness Levels in Taiwan's Drinking Water

The possible association between the risk of colon cancer and hardness levels in drinking water from municipal supplies was investigated in a matched case-control study in Taiwan. All eligible colon cancer deaths (1,714 cases) of Taiwan residents from 1989 through 1993 were compared with deaths from other causes (1,714 controls) and the hardness levels of the drinking water used by these residents were determined. Data on water hardness throughout Taiwan have been collected from Taiwan Water Supply Corporation (TWSC). The control group consisted of people who died from other causes and the controls were pair matched to the cases by sex, year of birth, and year of death. The results show a significant negative relationship between drinking water hardness and colon cancer mortality. Odds ratio and 95% confidence intervals were 1.22 (1.04–1.43) and 1.46 (1.22–1.75), respectively, for exposure to moderately hard water and soft water compared with the use of hard water. Trend analyses showed an increasing odds ratio for colon cancer with decreasing levels of hardness in drinking water. This is an important finding for the Taiwan water industry and human health. Received: 8 July 1997/Accepted: 29 November 1997     

Nitrate and nitrite exposure in Italian populations with different gastric cancer rates

Exposure to nitrate and nitrite from dietary sources was estimated by questionnaire and measurement of salivary levels of the ions in residents of four regions of Italy with longstanding, contrasting, gastric cancer mortality rates. Whether using salivary levels or dietary questionnaire estimations no association was found between nitrate and nitrite exposure and gastric cancer mortality rates. For salivary nitrate and nitrite, the intra-provincial variation was greater than any inter-province difference. However, for dietary nitrate and nitrite intakes, there were significant differences between the regional groups (but not related to gastric cancer risk). Despite the limitations of the methods used, there was a weak positive association between salivary concentrations of nitrate and questionnaire assessment. Dietary factors are likely to play key roles at different stages of the gastric carcinogenic process. Nitrate may play a part but is unlikely to be a rate-limiting factor in all individuals or populations.     

Effect modification of the association between trihalomethanes and pancreatic cancer by drinking water hardness: Evidence from an ecological study

The objective of this study was to examine the relationship between total trihalomethanes (TTHM) levels in public water supplies and risk of pancreatic cancer and to determine whether calcium (Ca) and magnesium (Mg) levels in drinking water modify the effects of TTHM on risk to develop pancreatic cancer. A matched case-control study was used to investigate the relationship between the risk of death attributed to pancreatic cancer and exposure to TTHM in drinking water in 53 municipalities in Taiwan. All pancreatic cancer deaths in the 53 municipalities from 1998 through 2007 were obtained from the Bureau of Vital Statistics of the Taiwan Provincial Department of Health. Controls were deaths from other causes and were pair matched to the cancer cases by gender, year of birth, and year of death. Each matched control was selected randomly from the set of possible controls for each cancer case. Data on TTHM levels in drinking water were collected from Taiwan Environmental Protection Administration. Information on the levels of Ca and Mg in drinking water was obtained from the Taiwan Water Supply Corporation. The municipality of residence for cancer cases and controls was presumed to be the source of the subject's TTHM, Ca, and Mg exposure via drinking water. Relative to individuals whose TTHM exposure level<4.9 ppb, the adjusted OR (95% CI) for pancreatic cancer was 1.01 (0.85-1.21) for individuals who resided in municipalities served by drinking water with a TTHM exposure>4.9 ppb. There was no evidence of an interaction of drinking water TTHM levels with low Ca intake via drinking water. However, we observed evidence of an interaction between drinking water TTHM concentrations and Mg intake via drinking water. Our findings showed that the correlation between TTHM exposure and risk of pancreatic cancer is influenced by Mg in drinking water. Increased knowledge of the interaction between Mg and TTHM in reducing pancreatic cancer risk will aid in public policy making and standard setting.     

Municipal drinking water nitrate level and cancer risk in older women: the Iowa Women's Health Study

Nitrate contamination of drinking water may increase cancer risk, because nitrate is endogenously reduced to nitrite and subsequent nitrosation reactions give rise to N-nitroso compounds; these compounds are highly carcinogenic and can act systemically. We analyzed cancer incidence in a cohort of 21,977 Iowa women who were 55-69 years of age at baseline in 1986 and had used the same water supply more than 10 years (87% > 20 years); 16,541 of these women were on a municipal supply, and the remainder used a private well. We assessed nitrate exposure from 1955 through 1988 using public databases for municipal water supplies in Iowa (quartile cutpoints: 0.36, 1.01, and 2.46 mg per liter nitrate-nitrogen). As no individual water consumption data were available, we assigned each woman an average level of exposure calculated on a community basis; no nitrate data were available for women using private wells. Cancer incidence (N = 3,150 cases) from 1986 through 1998 was determined by linkage to the Iowa Cancer Registry. For all cancers, there was no association with increasing nitrate in drinking water, nor were there clear and consistent associations for non-Hodgkin lymphoma; leukemia; melanoma; or cancers of the colon, breast, lung, pancreas, or kidney. There were positive associations for bladder cancer [relative risks (RRs) across nitrate quartiles = 1, 1.69, 1.10, and 2.83] and ovarian cancer (RR = 1, 1.52, 1.81, and 1.84), and inverse associations for uterine cancer (RR = 1, 0.86, 0.86, and 0.55) and rectal cancer (RR = 1, 0.72, 0.95, and 0.47) after adjustment for a variety of cancer risk/protective factors, agents that affect nitrosation (smoking, vitamin C, and vitamin E intake), dietary nitrate, and water source. Similar results were obtained when analyses were restricted to nitrate level in drinking water from 1955 through 1964. The positive association for bladder cancer is consistent with some previous data; the associations for ovarian, uterine, and rectal cancer were unexpected.     

Risk of non-Hodgkin lymphoma and nitrate and nitrite from drinking water and diet

INTRODUCTION: Nitrate and nitrite are precursors in the in vivo formation of N-nitroso compounds, potent animal carcinogens. METHODS: We conducted a population-based case-control study of non-Hodgkin lymphoma (NHL) in 1998 to 2000 in Iowa, Detroit, Seattle, and Los Angeles. Because nitrate levels were elevated in many drinking water supplies in Iowa, but not in the other study centers, we evaluated water nitrate levels and risk of NHL in Iowa only. Monitoring data for public supplies were linked to water source histories from 1960 onward. Nitrate was measured at interview homes with private wells. We limited most analyses to those with nitrate estimates for > 70% of their person-years since 1960 (181 cases, 142 controls). For those in the diet arm of the study (458 cases, 383 controls from 4 centers) and for Iowa participants in both the diet and drinking water analyses, we estimated dietary nitrate and nitrite intake using a 117-item food-frequency questionnaire that included foods high in nitrate and nitrite. Odds ratios and 95% confidence intervals were calculated using logistic regression, adjusting for the study matching factors, education, and caloric intake (diet analyses only). RESULTS: We found no overall association with the highest quartile of average drinking water nitrate (> 2.90 mg/L nitrate-N: odds ratios = 1.2; 95% confidence interval = 0.6-2.2) or with years > or = 5 mg/L (10+ years: 1.4; 0.7-2.9). We observed no evidence of an interaction between drinking water nitrate exposure and either vitamin C or red meat intake, an inhibitor and precursor, respectively, of N-nitroso compound formation. Among those in the diet arm, dietary nitrate was inversely associated with risk of NHL (highest quartile: 0.54; 0.34-0.86). Dietary nitrite intake was associated with increasing risk (highest quartile: 3.1; 1.7-5.5) largely due to intakes of bread and cereal sources of nitrite. CONCLUSION: Average drinking water nitrate levels below 3 mg/L were not associated with NHL risk. Our study had limited power to evaluate higher levels that deserve further study.     

Esophageal cancer mortality and total hardness levels in Taiwan's drinking water

The possible association between the risk of esophageal cancer and hardness levels in drinking water from municipal supplies was investigated in a matched case-control study in Taiwan. All eligible esophageal cancer deaths (2084 cases) of Taiwan residents from 1987 through 1996 were compared with deaths from other causes (2084 controls), and the hardness levels of the drinking water used by these residents were determined. Data on water hardness throughout Taiwan have been collected from the Taiwan Water Supply Corporation (TWSC). The control group consisted of people who died from other causes and the controls were pair-matched to the cases by sex, year of birth, and year of death. The results show that there is a 42% excess risk of mortality from esophageal cancer in relation to the use of soft water (adjusted odds ratio and 95% confidence intervals was 1.42 (1.22-1.66). This is an important finding for the Taiwan water industry and human health.     

A review of nitrates in drinking water: maternal exposure and adverse reproductive and developmental outcomes

In this review we present an update on maternal exposure to nitrates in drinking water in relation to possible adverse reproductive and developmental effects, and also discuss nitrates in drinking water in the United States. The current standard for nitrates in drinking water is based on retrospective studies and approximates a level that protects infants from methemoglobinemia, but no safety factor is built into the standard. The current standard applies only to public water systems. Drinking water source was related to nitrate exposure (i.e., private systems water was more likely than community system water to have nitrate levels above the maximum contaminant limit). Animal studies have found adverse reproductive effects resulting from higher doses of nitrate or nitrite. The epidemiologic evidence of a direct exposure-response relationship between drinking water nitrate level and adverse reproductive effect is still not clear. However, some reports have suggested an association between exposure to nitrates in drinking water and spontaneous abortions, intrauterine growth restriction, and various birth defects. Uncertainties in epidemiologic studies include the lack of individual exposure assessment that would rule out confounding of the exposure with some other cause. Nitrates may be just one of the contaminants in drinking water contributing to adverse outcomes. We conclude that the current literature does not provide sufficient evidence of a causal relationship between exposure to nitrates in drinking water and adverse reproductive effects. Future studies incorporating individual exposure assessment about users of private wells--the population most at risk--should be considered.     

Nitrate in public water supplies and the risk of colon and rectum cancers

BACKGROUND: Nitrate is a widespread contaminant of drinking water, but its potential health effects are unclear. In the body, nitrate is reduced to nitrite, which can react with amines and amides by nitrosation to form N-nitroso compounds, known animal carcinogens. N-nitroso compound formation is inhibited by certain nutrients, such as vitamin C, and increased by meat intake. METHODS: We investigated the association of nitrate in public water supplies with incident colon and rectum cancers in a case-control study conducted in Iowa from 1986 to 1989. Nitrate levels in Iowa towns were linked to the participants' water source histories. We focused our analyses on the period from 1960 onward, during which nitrate measurements were more frequent, and we restricted analyses to those persons with public water supplies that had nitrate data (actual or imputed) for greater than 70% of this time period (376 colon cancer cases, 338 rectum cancer cases, and 1244 controls). RESULTS: There were negligible overall associations of colon or rectum cancers with measures of nitrate in public water supplies, including average nitrate and the number of years with elevated average nitrate levels. For more than 10 years with average nitrate greater than 5 mg/L, the odds ratio (OR) for colon cancer was 1.2 (95% confidence interval [CI] = 0.9-1.6) and for rectum the OR was 1.1 (CI = 0.7-1.5). However, nitrate exposure (>10 years with average nitrate >5 mg/L) was associated with increased colon cancer risk among subgroups with low vitamin C intake (OR = 2.0; CI = 1.2-3.3) and high meat intake (OR = 2.2; CI = 1.4-3.6). These patterns were not observed for rectum cancer. CONCLUSIONS: Our analyses suggest that any increased risk of colon cancer associated with nitrate in public water supplies might occur only among susceptible subpopulations.     

Calcium and magnesium in drinking water and risk of death from acute myocardial infarction in Taiwan

Many studies have examined the association between cardiovascular disease mortality and water hardness. However, the results have not been consistent. This report examines whether calcium and magnesium in drinking water are protective against acute myocardial infarction (AMI). All eligible AMI deaths (10,094 cases) of Taiwan residents from 1994 to 2003 were compared with deaths from other causes (10,094 controls), and the levels of calcium and magnesium in drinking water of these residents were determined. Data on calcium and magnesium levels in drinking water throughout Taiwan have been obtained from the Taiwan Water Supply Corporation. The control group consisted of people who died from other causes and the controls were pair matched to the cases by sex, year of birth, and year of death. The adjusted odd ratios (95% confidence interval) were 0.79 (0.73-0.86) for the group with water calcium levels between 25.1 and 42.4 mg/L and 0.71 (0.65-0.77) for the group with calcium levels of 42.6 mg/L or more. After adjustment for calcium levels in drinking water, there was no difference between the groups with different levels of magnesium. The results of the present study show that there is a significant protective effect of calcium intake from drinking water on the risk of death from AMI.     

Nitrate contamination of drinking water: relationship with HPRT variant frequency in lymphocyte DNA and urinary excretion of N-nitrosamines.

We studied peripheral lymphocyte HPRT variant frequency and endogenous nitrosation in human populations exposed to various nitrate levels in their drinking water. Four test populations of women volunteers were compared. Low and medium tap water nitrate exposure groups (14 and 21 subjects) were using public water supplies with nitrate levels of 0.02 and 17.5 mg/l, respectively. Medium and high well water nitrate exposure groups (6 and 9 subjects) were using private water wells with mean nitrate levels of 25 and 135 mg/l, respectively. Higher nitrate intake by drinking water consumption resulted in a dose-dependent increase in 24-hr urinary nitrate excretion and in increased salivary nitrate and nitrite levels. The mean log variant frequency of peripheral lymphocytes was significantly higher in the medium well water exposure group than in the low and medium tap water exposure groups. An inverse correlation between peripheral lymphocyte labeling index and nitrate concentration of drinking water was observed. Analysis of N-nitrosamine in the urine of 22 subjects by gas chromatography-mass spectrometry revealed the presence of N-nitrosopyrrolidine in 18 subjects. Analysis of the mutagenicity of well water samples showed that a small number of the well water samples were mutagenic in the Ames Salmonella typhimurium test after concentration over XAD-2 resin. In conclusion, consumption of drinking water, especially well water, with high nitrate levels can imply a genotoxic risk for humans as indicated by increased HPRT variant frequencies and by endogenous formation of carcinogenic N-nitroso compounds from nitrate-derived nitrite.     

Impact of nitrates in drinking water on cancer mortality in Valencia,Spain

The concentrations of nitrates in public drinking water in the Mediterranean coastal province of Valencia are not only the highest in Spain but also in the whole of Europe. Intensive agricultural practices involve a traditional and growing use of nitrogen fertilizers. This and the terrain — poorly consolidated and porous in areas — favors the accumulation of nitrates in underground aquifers, thereby perhaps accounting for this contamination. The possible conversion of nitrates to nitrites under certain conditions of gastric achlorhydria, followed by their transformation to nitrosamines — substances known to be carcinogenic in experimental models — has led to a number of epidemiological studies of the possible relationship between high nitrate levels in public drinking water and mortality due to different cancers. The aim of the present study was to analyze the relationship between different levels of exposure to nitrates in the drinking water of the 258 municipalities in the province of Valencia and mortality due to cancer of the stomach, bladder, prostate and colon in this population. The cancer mortality rate was found to rise with increasing exposure to nitrates in the case of gastric cancer in both sexes, and in prostate cancer. These same results were obtained on calculating relative risk for the different age groups associated with the consumption of drinking water containing different levels of nitrates. Thus, in populations with nitrate concentrations in excess of 50 mg/1, relative risk for gastric cancer in the 55–75 years age group was 1.91 and 1.81 for males and females, respectively (p<0.05). In the case of prostate cancer elevated relative risks were also encountered: 1.86 and 1.80 for the 55–75 and over 75 years age groups, respectively.     

环境污染对居民细胞遗传物质损伤的调查研究

流行病学资料调查表明，大同市南郊区北村乡近年来恶性肿瘤死亡呈明显的上升趋势，为了探讨癌高发的原因，本文对该地区大气、地面水及居民饮水、蔬菜和人群血清的污染情况进行相关因素的分析调查。结果表明，大气中的苯并（a）芘（Bap）、悬浮颗粒物（TSP）及饮食中硝酸盐、亚硝酸盐均高于非污染区，地面水污染严重。同时该地区居民外周血淋巴细胞微核、畸变核及人群血清铜含量、铜／锌比值均明显高于对照区，差异均非常显著（P＜0．01），并与该地区大气中Bap和TSP、饮食中的硝酸盐和亚硝酸盐成正相关。结果还表明，该地区居民外周血淋巴细胞的非程序DNA合成（UDS）试验的cpm值明显低于对照组，差异非常显著（P＜0.001），并与大气、水源的污染因素成负相关。认为大同市北村乡地区近年来大气、水源的严重污染可能是该地区居民细胞遗传物质损伤及癌发病率增高的重要因素。     

Pancreatic cancer and drinking water and dietary sources of nitrate and nitrite

N-Nitroso compounds, known animal carcinogens, are formed endogenously from drinking water and dietary sources of nitrate and nitrite. The authors conducted a population-based case-control study of pancreatic cancer in Iowa to determine whether increased consumption of nitrate and nitrite from drinking water and dietary sources was associated with risk. They linked detailed water source histories to nitrate measurements for Iowa community water supplies. After exclusions for insufficient data, 1,244 controls and 189 pancreatic cancer cases were available for analysis. Among controls, the median average nitrate level (1960-1987) was 1.27 (interquartile range, 0.6-2.8) mg of nitrate nitrogen per liter of water. No association was observed between pancreatic cancer risk and increasing quartiles of the community water supplies' nitrate level. Increasing intake of dietary nitrite from animal sources was associated with an elevated risk of pancreatic cancer among men and women (highest quartile odds ratios = 2.3, 95% confidence interval: 1.1, 5.1, for men and 3.2, 95% confidence interval: 1.6, 6.4, for women). In contrast, dietary nitrate intake showed an inverse association with risk among women and no association among men. This study suggests that long-term exposure to drinking water nitrate at levels below the maximum contaminant level of nitrate nitrogen (10 mg/liter) is not associated with pancreatic cancer; however, the consumption of dietary nitrite from animal products may increase risk.     

Nitrate contamination of domestic potable water supplies: a social problem?

Nitrate contamination of potable water supplies is a recognized health hazard. Potentially, the contamination of private drinking water supplies could be a problem in the rural Palouse area of Idaho and Washington. Studies have shown that 12 percent of the rural population of Whitman County, Washington, may be drinking water containing nitrates in excess of the national standard. Yet there is no organized concern about this potential health hazard among local citizens. After reviewing the literature on nitrate contamination of ground water and discussing nitrate contamination of private potable water supplies in the Palouse, we use a social movement theory of social problems to explain why this situation has not been defined as a public health problem.