NIH-Funded Study to Improve Safe Water Access in Rural Appalachia

East Tennessee State University and Virginia Tech are partnering on a $3.7 million NIH-funded trial to evaluate whether low-cost countertop filters can reduce waterborne illnesses among rural Appalachian households that rely on unregulated private wells and springs.

• By Stasia DeMarco
• November 19, 2025

East Tennessee State University (ETSU) is partnering with Virginia Tech on a major National Institutes of Health (NIH)–funded study that aims to improve access to safe drinking water and reduce waterborne illnesses across rural Appalachian communities. The project, backed by a $3.7 million NIH grant, focuses on 10 counties in Northeast Tennessee and Southwest Virginia—areas where many families rely on private wells and springs that are unregulated, unmonitored, and often vulnerable to contamination.

The initiative will evaluate whether simple, affordable countertop water filters can meaningfully reduce gastrointestinal and other water-related illnesses. Many lower-income households in the region face higher risks from bacteria, viruses, and other contaminants present in private water sources, highlighting a longstanding public health gap in Appalachia.

Multidisciplinary Collaboration Across Institutions

ETSU researchers will work closely with Virginia Tech investigators to support field operations, deepen regional community engagement, and contribute to the study’s scientific design and data analysis.
Key ETSU partners include:

• Dr. Beth O’Connell, Department of Community and Behavioral Health; Department of Environment and Occupational Health and Safety Sciences; Center for Rural Health and Research
• Dr. Phillip Scheuerman, Department of Environmental and Occupational Health and Safety Sciences; Environmental Health Sciences Laboratory
• Dr. Md Rasheduzzaman, Department of Environmental and Occupational Health and Safety Sciences

“We are excited to continue this collaborative work to address the basic need for safe drinking water and serve the people of our region,” O’Connell said.

A Major Trial With National Implications

The randomized controlled trial—“Expanding Safe Water Access to Improve Health Outcomes in Appalachia: The Rural Water Filtration and Health (RWELL) Trial”—will enroll approximately 480 households and more than 1,500 participants. Half of the homes will receive water filters immediately, while the other half will receive them after 12 months. This staggered approach will allow researchers to compare health indicators between the groups over time.
The team will track self-reported illnesses, analyze water samples for pathogens, and conduct extensive water quality testing. The results will help determine whether low-cost filters can help reduce illness and improve the health of families who lack access to treated municipal water systems.
Nearly 40 million Americans rely on private wells for drinking water, yet most states do not require routine testing—leaving millions vulnerable to hidden microbial and chemical hazards. Findings from the RWELL Trial could influence future policy, funding, and public-health strategies, helping expand safe water access in rural communities nationwide.

A Broad, Multidisciplinary Research Team

The study is led by Dr. Alasdair Cohen of Virginia Tech and supported by collaborators across several institutions. Virginia Tech researchers include Dr. Leigh-Anne Krometis, Erin Ling, and Dr. Marc Edwards. The broader research team features Dr. Joe Brown of the University of North Carolina at Chapel Hill, and Dr. Alan Hubbard and Dr. Isha Ray of the University of California, Berkeley.
The project builds on earlier pilot work conducted alongside scientists at the U.S. Environmental Protection Agency, including Dr. Tim Wade, Dr. Andrey Egorov, and Shannon Griffin.

Improving Water Access for Appalachian Families

For ETSU, the collaboration provides an opportunity to deliver new tools, resources, and evidence-based solutions to Appalachian families who have long lacked reliable access to treated water. With community trust and regional engagement at the center of the effort, the study seeks to deliver both scientific insight and practical impact—improving health outcomes while informing national conversations about rural water safety.