In the United States, municipal wastewater must be treated before it is returned to the environment. Sewage sludge is the solid by-product of wastewater treatment. Most of the sludge created by municipal wastewater treatment plants in the United States undergoes biological, chemical, or thermal treatment and is then applied to farmland as a soil amendment [National Research Council (NRC) 2002]. Treated sewage sludge, also called biosolids, contains nutrients useful as fertilizers as well as heavy metals, toxicants, and pathogens. U.S. Environmental Protection Agency (EPA) regulations require periodic monitoring of certain heavy metals and indicator bacteria in treated sludge, but there is no routine monitoring of other toxicants (NRC 2002; U.S. EPA 1994). Most treated sludge is labeled Class B, which has less stringent requirements for pathogen reduction than Class A sludge; the two classes are the same with respect to other contaminants (NRC 2002). Treated sludge is usually applied to land as a liquid spray or solid cake, creating aerosols and dust particles that can drift downwind from the application sites (Baertsch et al. 2007; Paez-Rubio et al. 2007).
Some scientists suggest the rules regulating sludge treatment and land application are based on outdated science and may be insufficient to protect public health and the environment (Gattie and Lewis 2004; Harrison and McBride 2008; Harrison et al. 1999, 2006; Lewis and Gattie 2002; Lewis et al. 2002; Mathney 2011; Snyder 2008). Monitoring land application, enforcing regulatory rules, and systematic tracking and investigation of public concerns are often limited by staffing shortages and budget constraints at federal, state, and local levels (Harrison and Eaton 2001; Lowman et al. 2011; U.S. EPA 2000, 2002). The U.S. EPA's Inspector General (U.S. EPA 2000) found that,
while EPA promotes land application, EPA cannot assure the public that current land application practices are protective of human health and the environment.
Some residents living near land application sites associate physical symptoms such as mucous membrane irritation, respiratory and gastrointestinal distress, headaches, and skin rashes with land application of sewage sludge (Harrison and Oakes 2002; Lewis et al. 2002; Lowman et al. 2011; Shields 2002). Residents also report foul odors and interference with their quality of life and beneficial use of their property (Lowman et al. 2011; Shields 2002). Although in 2002 the NRC's Committee on Toxicants and Pathogens in Biosolids Applied to Land recommended studying human exposure and illness, little research into the experiences of persons living near such sites has been conducted since then (NRC 2002).
This article reports the results of analyses of qualitative interviews conducted with neighbors of sites where sewage sludge is applied to land. Qualitative research is of increasing interest in environmental health science, and has been promoted as a useful tool that can complement traditional exposure assessment and epidemiologic studies (Brown 2003; Moffatt and Pless-Mulloli 2003; Scammell 2010). Little quantitative research has been conducted on the impacts of the land application of treated sewage sludge on neighbors' health because of a lack of systems for surveillance of reported illness (Keil et al. 2011; Lowman et al. 2011), the episodic nature of most applications, and low population density in rural areas. We use qualitative methods to provide detailed information about people's perceptions of health and quality of life, including temporal sequences of events that may be difficult to ascertain in traditional cross-sectional epidemiologic research. Furthermore, we use qualitative research to understand local and individual factors that may modify a person's experience with the land application of sewage sludge and to place these experiences into a broader context of environmental injustice.