Implementing wastewater monitoring on American Indian reservations to assess community health indicators

Healthcare access and health-related information for American Indian/Alaska Native (AIAN) communities is often limited. A potential solution to acquire additional population level health data is through wastewater-derived measurements, a method termed wastewater-based epidemiology (WBE), however, due to often remote locations with rudimentary wastewater infrastructure, the feasibility of implementing WBE on an AIAN reservation is unclear. In this study, we i) performed a preliminary assessment of percent connectivity of the top 10 most populous tribal reservations using available wastewater treatment facility information from the Environmental Protection Agency Enforcement and Compliance History Online database and satellite imagery, and ii) performed a sampling campaign on a select tribal reservation to measure common WBE indicators of health and behavior. Results indicate that, on average, approximately 81 ± 23% of tribal residents are connected to some form of aggregated wastewater collection system. On the sampled reservation, 6 communities comprising 7500 people were sampled across 160 km of reservation land using active samplers successfully deployed within the sewer network upstream of terminal lagoon systems. Results showed detectable levels of 7 opioids, 1 opioid maintenance medication, 5 stimulants, 1 hallucinogen, and chemical indicators of alcohol, nicotine, caffeine, and an over-the-counter cough suppressant. These results illustrated the feasibility in implementing WBE in rural and remote communities where information on community health may be lacking.