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Open Access
Assessing Knowledge and Awareness of Nitrate Contamination: A Survey of Healthcare Professionals
85% of the state’s population depends on groundwater for their drinking water sup- ply (Nebraska Department of Environment and Energy, 2024). Although the Safe Drinking Water Act maintains a regulatory maximum contami- nant level (MCL) of 10.0 mg/L for nitrate/ nitrite to reduce the risk of methemoglo- binemia, evidence suggests that a variety of other adverse health outcomes can result from nitrate in drinking water. Some studies show an increased risk with concentrations lower than the current regulatory MCL (U.S. Environmental Protection Agency, 2025). Statewide Domestic Water/ Wastewater Management, University of Nebraska–Lincoln, Nebraska Extension in Lancaster County School of Natural Resources, University of Nebraska–Lincoln Jesse E. Bell, PhD College of Public Health, University of Nebraska Medical Center School of Natural Resources, University of Nebraska–Lincoln Daugherty Water for Food Global Institute, University of Nebraska Krista A. Brown, MBA, MPH, PhD College of Public Health, University of Nebraska Medical Center Daugherty Water for Food Global Institute, University of Nebraska Summer Woolsey, MPH College of Public Health, University of Nebraska Medical Center Justin Baumert College of Medicine, University of Nebraska Medical Center Jessenia Hincapie, MPH Great Plains IDeA-CTR Network, University of Nebraska Medical Center Ruth Mencia, MPH College of Public Health, University of Nebraska Medical Center Laura Nagengast, MPH Great Plains IDeA-CTR Network, University of Nebraska Medical Center Anni Poetzl, MSc Nebraska Extension, Water and Cropping Systems, University of Nebraska–Lincoln Becky M. Schuerman
Abstract Our study assessed the knowledge, attitudes, and confidence of healthcare professionals (HCPs) about nitrate contamination of drinking water and adverse health outcomes. A cross-sectional survey was administered ( n = 689). Descriptive statistics, nonparametric tests, and linear regression were used to compare means in behavior and examine the effect of knowledge and attitudes on information-sharing practices with patients. Qualitative analysis of open-ended questions identified gaps in knowledge, current access to resources, and preferences for future training and resources. Participants reported a lack of knowledge about the detrimental health effects of nitrates and low confidence in advising their patients about drinking water quality. Participant attitude was a strong and significant predictor of information-sharing behaviors ( B = 0.624, p < .001). Participants also reported a need for additional knowledge and resources via educational videos, virtual training, and websites. Future research should develop targeted interventions to provide education and training for HCPs about nitrate contamination and its effect on adverse health outcomes. Keywords: nitrate, water quality, healthcare workers, drinking water, healthcare survey
Introduction In Nebraska, nearly 44 million acres—an estimated 90% of the state—are dedicated to farming and ranching. To sustain high lev- els of agricultural production, Nebraska and seven other states within the High Plains aqui- fer depend heavily on groundwater resources that support large-scale irrigation (Scanlon et al., 2012). As of 2023, more than 8.4 million acres of land in Nebraska are irrigated with groundwater, making it one of the most irri- gated states in the country (Nebraska Depart- ment of Agriculture, n.d.). In addition to a reliance on irrigation, Nebraska’s producers regularly apply fertil- izers in the forms of manufactured fertil- izer, manure, and biosolids to maximize
crop yields. Because nitrate is highly soluble, excess amounts can easily move with precipi- tation and irrigation runoff and leach away from the soil, ultimately accumulating in groundwater (Jayasekera et al., 2025; Wick et al., 2012). Being dependent on both irriga- tion and fertilizers places Nebraska’s ground- water at significant risk of nitrate contamina- tion (U.S. Geological Survey, 1999). Nitrate contamination in drinking water is a growing public health concern, as nitrate in fertilizers and animal waste can run off the land and contaminate local waterbodies. As a result, individuals living in rural areas are at higher risk of exposure to contami- nated drinking water than their urban coun- terparts (Skalaban et al., 2024). More than
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Volume 89 • Number 3
https://doi.org/10.70387/001c.171784
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