Academic journal article Environmental Health Perspectives

Health Risks of Limited-Contact Water Recreation

Academic journal article Environmental Health Perspectives

Health Risks of Limited-Contact Water Recreation

Article excerpt

BACKGROUND: Wastewater-impacted waters that do not support swimming are often used for boating, canoeing, fishing, kayaking, and rowing. Little is known about the health risks of these limited-contact water recreation activities.

OBJECTIVES: We evaluated the incidence of illness, severity of illness, associations between water exposure and illness, and risk of illness attributable to limited-contact water recreation on waters dominated by wastewater effluent and on waters approved for general use recreation (such as swiming).

METHODS: The Chicago Health, Environmental Exposure, and Recreation Study was a prospective cohort study that evaluated five health outcomes among three groups of people: those who engaged in limited-contact water recreation on effluent-dominated waters, those who engaged in limited-contact recreation on general-use waters, and those who engaged in non--water recreation. Data analysis included survival analysis, logistic regression, and estimates of risk for counterfactual exposure scenarios using G-computation.

RESULTS: Telephone follow-up data were available for 11,297 participants. With non--water recreation as the reference group, we found that limited-contact water recreation was associated with the development of acute gastrointestinal illness in the first 3 days after water recreation at both effluent-dominated waters (adjusted odds ratio (AOR) 1.46; 95% confidence interval (CI): 1.08, 1.96] and general-use waters (1.50; 95% CI: 1.09, 2.07). For every 1,000 recreators, 13.7 (95% CI: 3.1, 24.9) and 15.1 (95% Cl: 2.6, 25.7) cases of gastrointestinal illness were attributable to limited-contact recreation at effluent-dominated waters and general-use waters, respectively. Eye symptoms were associated with use of effluent-dominated waters only (AOR 1.50; 95% CI: 1.10, 2.06). Among water recreators, our results indicate that illness was associated with the amount of water exposure.

CONCLUSIONS: Limited-contact recreation, both on effluent-dominated waters and on waters designated for general use, was associated with an elevated risk of gastrointestinal illness.

KEY WORDS: environmental microbiology, epidemiology, gastrointestinal illness, wastewater, water pollution, water recreation. Environ Health Perspect 120:192-197 (2012). http://dx.doi.org/10.1289/ehp.1 103934 [Online 26 October 2011]

Limited-contact water recreation activities are popular in the United States. An estimated 71 million people participate in fishing, 52 million in motor boating, 20.7 million in canoeing, 9.4 million in rowing1 and 6.4 million in kayaking (Cordell et al. 2004). Some waters that have not attained the goal of the Clean Water Act (1972) to support "recreation in and on the water are used for limited-contact recreation (e.g., fishing and boating) hut not full-contact recreation (e.g., swimming and water skiing). Recently, site-specific standards for limited (or secondary) contact recreation have been explored in several U.S. states for waters that do not support full-contact recreation, generally because of high concentrations of bacteria [Illinois Pollution Control Board 2010; Missouri Department of Natural Resources 2011; Texas Commission on Environmental Quality 2009; u.s. Environmental Protection Agency (EPA) 2003; Utah Department of Environmental Quality 2008]. Large cohort studies (Colford et al. 2007; Wade et a1. 2008, 2010) have evaluated the health risks of full-contact recreation, but little is known about the health risks of limited-contact recreation. The Chicago Health, Environmental Exposure, and Recreation Study (CHEERS), a prospective cohort study, was designed to estimate the risk of illness attributable to limited-contact water recreation. Additionally, we assessed the severity of illness reported by study participants.

Materials and Methods

Overview. The design and methods for the study presented here were adapted from those of the U. …

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