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frustration was expressed in other interviews. For example, a respondent from Virginia said the Dillon Rule, a judicial doctrine that limits local government authority in Virginia, North Carolina, and other states (Clay 1989), pre- vents her local government from establishing rules and regulations governing land applica- tion where she lives. She felt that it was unfair to favor one land owner who wants to use sludge when the majority of the community is opposed to it. She added, The industry has all the control. Because they can pull up application, or they can lay it down. And they don't care. As long as they've got permission to do it, they're going to do it. In spite of perceived barriers to influenc- ing land application decisions, over half of the interviewees (19/34) described changes they would like the industry to make to improve public notification and enhance public and environmental protections. First, several respondents suggested public officials should directly notify residents within 1 mile of sludge fields before the first and subsequent land application events. A few said residents should be given the opportunity before land applica- tion events to inform public officials of house- hold members with health conditions, such as a respiratory illness or weakened immune system, so that an injection method of land application can be used to better safeguard their health, or so application at the site can be suspended. Some respondents who reported poorly visible signs near sludge fields or who reported seeing no signs at all suggested that land appli- ers post large visible signs 2 weeks before application and for the duration of the event. Respondents said this would allow them to prepare for the event and take necessary safety precautions for their family and animals. Also related to public notifications, some respon- dents said they would like to receive the results of sludge testing from the wastewater treat- ment plants that apply waste near their homes in order to monitor concentrations of harmful constituents and possible concerns. Respondents concerned about well water contamination said the city should provide water to residents in land application areas or offer free periodic testing of their private well water to evaluate its safety. A few respondents said application in a critical watershed and land application before forecasted rain events should be prohibited. If the latter should occur, respondents said the sludge should be tilled under immediately following application to prevent runoff. Some respondents also felt that land application should not occur under windy conditions because of the increased likelihood of exposing neighbors to migrating pollut- ants. Generally speaking, respondents who were aware of land application rules and who reported violations said that better enforcement Sewage sludge, health, and environmental justice of existing rules is needed to protect human and environmental health. Respondents who felt there were conflicts of interest in land application governance and practice that undermine human health and the environment said these should be mini- mized by contracting with independent sci- entists to perform and report soil and sludge batch testing; funding independent, formal research about health and environmental impacts of sludge application; prohibiting state and local health departments and the U.S. EPA from promoting land application; and making government employees respon- sible for telling residents the truth about land application. Finally, a few respondents said they would like the land application industry to improve and maintain roads damaged by the frequent travel of heavy sludge trucks. Overall, eight respondents said they would like land application to stop, either indefinitely or until independent research can "prove it's safe" for human health and the environment. Discussion We used qualitative research methods to enhance understanding of the impacts of land - applied sewage sludge on the health and qual- ity of life of nearby populations. Respondents reported symptoms consistent with findings from earlier studies that report neighbors of land application sites experience physical reac- tions to land- applied sludge (Gattie and Lewis 2004; Lewis et al. 2002). Confined animal feeding operations (CAFOs) also apply liquid wastes and sludge to farmland. CAFO neigh- bors describe health impacts similar to those reported by neighbors of land - applied sew- age sludge (Butlers 2005; Horton et al. 2009; Radon et al. 2007; Schiffman 1998; Schiffman et al. 2000; Schinasi et al. 2011; Tajik et al. 2008; Thu 2002; Thu et al. 1997; Wing and Wolf 2000; Wing et al. 2008). The overlap of hazardous agents in CAFO waste and treated sewage sludge, including odorant compounds, endotoxins, and other allergens and irritants, suggests that similar community health impacts are plausible (Lewis et al. 2002). Respondents also reported adverse impacts on their mental and social well-being and on the surrounding natural environment. Some said they observed sludge spillage on public roadways and private property, grazing cattle on land - applied pasture soon after applica- tion, and sludge runoff into surface waters. These and other land application activities that respondents said they witnessed are vio- lations of land application standards in one or more of the three states represented in this study (Harrison and Eaton 2001; North Carolina Department of Environment and Natural Resources 2006; South Carolina Department of Health and Environmental Control 2009; Virginia Department of Environmental Quality 2011), highlighting the need for stricter enforcement of standards. Respondents also described environmental injustices related to land application of sewage sludge, including barriers to participating in decisions about how the practice is conducted in their neighborhood. Land application of sewage sludge is part of a larger context of envi- ronmental injustice that characterizes relation- ships between urban areas that create wastes and nearby rural areas that receive the wastes. In addition to sewage sludge, urban wastes disposed in rural and semirural communities include municipal solid wastes, construction and demolition debris, and industrial wastes (Norton et al. 2007). Jones (2011) describes the urban —rural dimension of environmental injustice this way: For the majority of Americans who live in metro- politan areas, rural dumping becomes a logical choice: undeveloped land is inexpensive and avail- able, fewer residents will be harmed should con- tainment measures fail, and, most importantly, nuisances and dangers are removed from their own neighborhoods. This report does not include everything respondents said about living near sludge appli- cation sites; rather it represents the dominant themes that we identified in the open -ended interviews. There were few positive remarks about sludge and the response of industry and government officials to residents' concerns, possibly because of our method of recruiting participants. We asked community contacts to help us identify people who could pro- vide information on the subject of living near sludge application sites. Although we did not ask for referrals to people who had problems with sludge, people with negative opinions of the practice may share local social networks, which could lead to their perspectives being overrepresented. Alternatively, some rural resi- dents who have been negatively affected by land application of sludge may be unwilling to speak out or participate in research because they fear retribution from influential land owners or government officials who benefit from sludge application and control rental property, access to resources, or jobs. In addition, we are unable to report the numbers of respondents who had similar or opposing views or experiences for all interview topics because we obtained the information through open -ended interviews that did not probe the participants to respond to a list of standardized questions. Our study was not designed to quantify the prevalence or incidence of reported symptoms, health impacts and other concerns in populations near land application sites. Our study does demonstrate that people of diverse backgrounds who live in three dif- ferent states raised health and environmental concerns about land application. Similarities Environmental Health Perspectives • VOLUME 121 1 NUMBER 51 May 2013 541 IIIIIIIIIIII