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Abstract Negative health impacts of water insecurity are often felt most in poor and rural communities and communities of color, who are more likely to be underserved by water infrastructure and disproportionately subject to socioeconomic stressors. Despite mandated efforts to allocate significant federal resources to infrastructure funding in ‘disadvantaged communities,’ communities with the most need risk systematic exclusion from access to resources, decision-making structures, and even benefits of research intended to address inequitable infrastructure services and health outcomes in their own communities. This project aims to describe groundwork and preliminary findings from community-engaged environmental research conducted within an ongoing community-based participatory research partnership in Robeson County, NC, a majority–minority county with the lowest median household income of NC’s 100 counties. Semi-structured interviews conducted with community members were analyzed to identify concerns about drinking water security (including safety, affordability, and reliability), perceptions of water quality, averting behaviors taken due to water insecurity, and ideas for improving water security. Findings suggest that there is a high level of mistrust in community water supplies, with perceptions of poor water quality driving a reliance on bottled water. Those relying on private wells expressed greater trust in their water and lower reliance on bottled water. Concerns about affordability were less prominent than those about water quality. Insufficient water reliability (low flow) was mentioned by many respondents, including those with community water service and those relying on private wells. Most supported increasing taxes to improve water security and also recommended increasing communications between water service providers and the public to improve trust. Overall, this work suggests the need for a comprehensive assessment of the quality and reliability of community water services in Robeson County, interventions to address problems identified, and much more engagement with the community about identifying and allocating funding to solve water security problems. 

Abstract The World Health Organization has declared antibiotic resistance “one of the biggest threats to global health.” Mounting evidence suggests that antibiotic use in industrial‐scale hog farming is contributing to the spread of antibiotic‐resistantStaphylococcus aureus. To capture available evidence on these risks, we searched peer‐reviewed studies published before June 2017 and conducted a meta‐analysis of these studies’ estimates of the prevalence of swine‐associated, antibiotic‐resistantS. aureusin animals, humans, and the environment. The 166 relevant studies revealed consistent evidence of livestock‐associated methicillin‐resistantS. aureus(MRSA) in hog herds (55.3%) raised with antibiotics. MRSA prevalence was also substantial in slaughterhouse pigs (30.4%), industrial hog operation workers (24.4%), and veterinarians (16.8%). The prevalence of swine‐associated, multidrug‐resistantS. aureus(MDRSA)—with resistance to three or more antibiotics—is not as well documented. Nonetheless, sufficient studies were available to estimate MDRSA pooled prevalence in conventional hog operation workers (15.0%), workers’ household members (13.0%), and community members (5.37%). Evidence also suggests that antibiotic‐resistantS. aureuscan be present in air, soil, water, and household surface samples gathered in or near high‐intensity hog operations. An important caveat is that prevalence estimates for humans reflect colonization, not active infection, and the health risks of colonization remain poorly understood. In addition, these pooled results may not represent risks in specific locations, due to wide geographic variation. Nonetheless, these results underscore the need for additional preventive action to stem the spread of antibiotic‐resistant pathogens from livestock operations and a streamlined reporting system to track this risk.