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Research 11 s
<br />Land Application of Treated Sewage Sludge: Community Health and
<br />Environmental Justice
<br />Amy Lowman,' Mary Anne McDonald,' Steve Wing,' and Naeema Muhammad3
<br />'Department of Epidemiology, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA; 'Department of Community
<br />and Family Medicine, Duke University, Durham, North Carolina, USA; 'Concerned Citizens of Tillery, Tillery, North Carolina, USA
<br />BACKGROUND: In the United States, most of the treated sewage sludge (biosolids) is applied to
<br />farmland as a soil amendment. Critics suggest that rules regulating sewage sludge treatment and
<br />land application may be insufficient to protect public health and the environment. Neighbors of
<br />land application sites report illness following land application events.
<br />OB1ECTrvES: We used qualitative research methods to evaluate health and quality of life near land
<br />application sites.
<br />METHODS: We conducted in -depth interviews with neighbors of land application sites and used
<br />qualitative analytic software and team -based methods to analyze interview transcripts and identify
<br />themes.
<br />RESULTS: Thirty -four people in North Carolina, South Carolina, and Virginia responded to
<br />interviews. Key themes were health impacts, environmental impacts, and environmental justice.
<br />Over half of the respondents attributed physical symptoms to application events. Most noted
<br />offensive sludge odors that interfere with daily activities and opportunities to socialize with family
<br />and friends. Several questioned the fairness of disposing of urban waste in rural neighborhoods.
<br />Although a few respondents were satisfied with the responsiveness of public officials regarding
<br />sludge, many reported a lack of public notification about land application in their neighborhoods,
<br />as well as difficulty reporting concerns to public officials and influencing decisions about how the
<br />practice is conducted where they live.
<br />CONCLUSIONS: Community members are key witnesses of land application events and their poten-
<br />tial impacts on health, quality of life, and the environment. Meaningful involvement of community
<br />members in decision making about land application of sewage sludge will strengthen environmental
<br />health protections.
<br />KEY WORDS: biosolids, environmental health, environmental justice, land application, qualitative
<br />research, sewage sludge. Environ Health Perspect 121:537 -542 (2013). http: / /dx.doi.org /10.1289/
<br />ehp.1205470 [Online 11 March 20131
<br />In the United States, municipal wastewater
<br />must be treated before it is returned to the
<br />environment. Sewage sludge is the solid by-
<br />product of wastewater treatment. Most of the
<br />sludge created by municipal wastewater treat-
<br />ment plants in the United States undergoes
<br />biological, chemical, or thermal treatment and
<br />is then applied to farmland as a soil amend-
<br />ment [National Research Council (NRC)
<br />2002]. Treated sewage sludge, also called bio-
<br />solids, contains nutrients useful as fertilizers as
<br />well as heavy metals, toxicants, and pathogens.
<br />U.S. Environmental Protection Agency (EPA)
<br />regulations require periodic monitoring of
<br />certain heavy metals and indicator bacteria in
<br />treated sludge, but there is no routine moni-
<br />toring of other toxicants (NRC 2002; U.S.
<br />EPA 1994). Most treated sludge is labeled
<br />Class B, which has less stringent requirements
<br />for pathogen reduction than Class A sludge;
<br />the two classes are the same with respect to
<br />other contaminants (NRC 2002). Treated
<br />sludge is usually applied to land as a liquid
<br />spray or solid cake, creating aerosols and dust
<br />particles that can drift downwind from the
<br />application sites (Baertsch et al. 2007; Paez-
<br />Rubio et al. 2007).
<br />Some scientists suggest the rules regulat-
<br />ing sludge treatment and land application are
<br />based on outdated science and may be insuffi-
<br />cient to protect public health and the environ-
<br />ment (Gattie and Lewis 2004; Harrison and
<br />McBride 2008; Harrison et al. 1999, 2006;
<br />Lewis and Gattie 2002; Lewis et al. 2002;
<br />Mathney 2011; Snyder 2008). Monitoring
<br />land application, enforcing regulatory rules,
<br />and systematic tracking and investigation of
<br />public concerns are often limited by staffing
<br />shortages and budget constraints at federal,
<br />state, and local levels (Harrison and Eaton
<br />2001; Lowman et al. 2011; U.S. EPA 2000,
<br />2002). The U.S. EPA's Inspector General
<br />(U.S. EPA 2000) found that,
<br />while EPA promotes land application, EPA can-
<br />not assure the public that current land application
<br />practices are protective of human health and the
<br />environment.
<br />Some residents living near land applica-
<br />tion sites associate physical symptoms such as
<br />mucous membrane irritation, respiratory and
<br />gastrointestinal distress, headaches, and skin
<br />rashes with land application of sewage sludge
<br />(Harrison and Oakes 2002; Lewis et al. 2002;
<br />Lowman et al. 2011; Shields 2002). Residents
<br />also report foul odors and interference with
<br />their quality of life and beneficial use of their
<br />property (Lowman et al. 2011; Shields 2002).
<br />Although in 2002 the NRC's Committee on
<br />Toxicants and Pathogens in Biosolids Applied
<br />to Land recommended studying human expo-
<br />sure and illness, little research into the experi-
<br />ences of persons living near such sites has
<br />been conducted since then (NRC 2002).
<br />This article reports the results of analyses of
<br />qualitative interviews conducted with neigh-
<br />bors of sites where sewage sludge is applied to
<br />land. Qualitative research is of increasing inter-
<br />est in environmental health science, and has
<br />been promoted as a useful tool that can com-
<br />plement traditional exposure assessment and
<br />epidemiologic studies (Brown 2003; Moffatt
<br />and Pless- Mulloli 2003; Scammell 2010).
<br />Little quantitative research has been con-
<br />ducted on the impacts of the land application
<br />of treated sewage sludge on neighbors' health
<br />because of a lack of systems for surveillance
<br />of reported illness (Keil et al. 2011; Lowman
<br />et al. 2011), the episodic nature of most appli-
<br />cations, and low population density in rural
<br />areas. We use qualitative methods to provide
<br />detailed information about people's percep-
<br />tions of health and quality of life, including
<br />temporal sequences of events that may be dif-
<br />ficult to ascertain in traditional cross - sectional
<br />epidemiologic research. Furthermore, we use
<br />qualitative research to understand local and
<br />individual factors that may modify a person's
<br />experience with the land application of sewage
<br />sludge and to place these experiences into a
<br />broader context of environmental injustice.
<br />Address correspondence to A. Lowman, Department of
<br />Epidemiology, University of North Carolina, Campus
<br />Box # 8050, Chapel Hill, NC 27599 USA. Telephone:
<br />(919) 966 -1306. E-mail: amy—lowman @unc.edu
<br />We thank the study participants for their
<br />generous contribution of time and thoughtfulness
<br />to this research. We also thank the members of the
<br />community-based organizations who brought this
<br />research topic to our attention and contributed to the
<br />development of the research questions.
<br />This research was funded by the National
<br />Institute of Environmental Health Sciences (grant
<br />5ROlES015469 -02).
<br />S.W. provided pro bona testimony in legal proceed-
<br />ings related to landfills and provided advice on radia-
<br />tion and health for a law firm that made a gift to the
<br />University of North Carolina, Chapel Hill. S.W. and
<br />A.L. participated in research in 2006 -2007 funded
<br />by the Water and Environment Research Foundation
<br />(WERE) to develop a protocol for tracking and
<br />investigating symptoms reported near sewage sludge
<br />land application sites. N.M. is an employee of the
<br />Concerned Citizens of Tillery. M.A.M. declares she
<br />has no actual or potential competing financial interests.
<br />Received 15 May 2012; accepted 28 February 2013.
<br />Environmental Health Perspectives • VOLUME 121 1 NUMBER 5 1 May 2013 537
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