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Abstract This study explores the outcomes and impacts of sanitary sewer overflows (SSOs) and basement backups in underserved communities in Baltimore, Maryland. The larger effort is an environmental and community-driven mixed-methods project, however, the research in this manuscript focuses on the household survey portion with residents who have experienced SSOs or sewage backups. Based on the snowball sampling method applied, the resulting residents engaged are predominantly African-American individuals, females, homeowners, and residents between the ages of 50 and 69. Strikingly, 70% of respondents reported that their frequency of SSOs is between moderate to frequent. The findings reveal that SSOs are a pervasive issue affecting residents’ physical and mental health and overall quality of life. Despite residents’ perceptions that their household infrastructure is in good condition, the recurring nature of SSOs highlights systemic problems within the city’s aging sewer systems, urging a deeper understanding of the social and structural vulnerabilities involved. This research calls attention to the importance of comprehensive interventions, including effective risk communication strategies and substantial investment in infrastructure rehabilitation, to mitigate the risks posed by SSOs and promote long-term resilience in urban environments. Additionally, it emphasizes the importance of community-driven research in addressing engineering, urban planning, and public health challenges with particular support for the most affected populations.
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This content will become publicly available on November 19, 2025
Sanitary sewer overflows, household sewage backups, and antibiotic-resistant bacteria: the new frontier of environmental health risks and disasters
Abstract Untreated sewage discharges leading to environmental contamination are increasingly common in communities across the globe. The cause of these discharges ranges from sewer lines in disrepair, blockages, and in the era of more extreme wet weather events, the infiltration of stormwater into the system during heavy downpours. Regardless of the driver of these events, the aftermath results in raw sewage spilling into local waterways, city streets, and commercial and residential structures. Historical research in public health has thoroughly documented the connection between exposure to untreated sewage and waterborne disease. Recent research has detected antibiotic-resistant bacteria at wastewater treatment facilities at a time when deaths by antibiotic-resistant infections are on the rise. However, no research has explored the exposure pathways of antibiotic-resistant bacteria during sanitary sewer overflows and household-level sewage backups. In this commentary, we aim to introduce this new frontier of environmental health risks and disasters. To do this, we describe the history of modern sanitation and sewer infrastructure with a particular focus on wastewater infrastructure in the U.S. We also explore emerging risks and current methods for identifying antibiotic-resistant bacteria in the environment. We end with future directions for interdisciplinary scholarship at the nexus of urban planning, engineering, and public health by introducing the Water Emergency Team (WET) Project. WET is a community-based multi-method effort to identify environmental risks in the aftermath of household backups through (1) residential surveys, (2) indoor visual inspections, (3) environmental sampling, and (4) laboratory processing and reporting. Our hope is that by introducing this comprehensive approach to environmental risks analysis, other scholars will join us in this effort and ultimately towards addressing this grand challenge of our time.
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- Award ID(s):
- 1828910
- PAR ID:
- 10601096
- Publisher / Repository:
- Environmental Research: Health
- Date Published:
- Journal Name:
- Environmental Research: Health
- Volume:
- 3
- Issue:
- 1
- ISSN:
- 2752-5309
- Page Range / eLocation ID:
- 013001
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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