Abstract

Public perception of drinking water quality reflects thoughts, trust, and beliefs about whether drinking water poses a risk to health and well-being. This perception is often shaped by sensory qualities such as appearance, taste, color, and odor. We conducted a systematic review of peer-reviewed articles published between 1990 and 2023 to (a) assess public perceptions of drinking water quality and (b) identify the factors influencing these perceptions in the United States. A systematic search of eight databases yielded 19,225 publications, of which 64 articles met the inclusion criteria for analysis. Most of these studies were published between 2006 and 2023. Of the 64 articles reviewed, 24 (37.5%) reported tap water as safe for drinking, while 19 (29.6%) cited bottled water as safe. Additionally, 1 (1.6%) identified well water, 2 (3.1%) filtered water, and 1 (1.6%) spring water as safe. Over the past five years, a decline in the number of studies affirming tap water's safety was observed, alongside an increase in studies favoring bottled water. Factors influencing public perceptions included the organoleptic properties of water (taste, smell, and color), socio-demographic characteristics, health risk concerns, past negative experiences with water utilities, trust in water systems, and media influence and public awareness. Although many respondents express trust in tap water quality, ongoing challenges with public water systems are eroding this trust, leading to increased reliance on bottled water. Addressing these issues through infrastructure improvements, public education, and community engagement is crucial to restoring long-term confidence in drinking water quality. Systematic review registration: The systematic review protocol was registered (CRD42024545308) and is published on PROSPERO.

1. Introduction

Safe drinking water is sourced from public water systems, private wells, and bottled water ¹. Public perception of water quality is primarily influenced by sensory attributes such as taste, appearance, odor, and color ². However, these perceptions are often shifting and may not always align with scientific assessments ³. In recent years, incidents like the 2014-2015 Flint water crisis ⁴ and water quality challenges in Jacksonville, Florida ⁵, and Jackson, Mississippi ⁶ have heightened public awareness and concern over drinking water safety. These events have exposed the vulnerabilities in the nation’s water infrastructure, driving concerns about emerging contaminants, aging systems, and environmental degradation ⁷.

Public perception of water quality plays a pivotal role in shaping water management, policy development, and public health interventions ⁸. Trust in government agencies such as the Environmental Protection Agency (EPA), water providers, and other stakeholders is essential for maintaining public confidence in drinking water systems. The Environmental Protection Agency enforces the Safe Drinking Water Act, which mandates several initiatives such as annual consumer confidence reports, source water assessments, and state compliance reports to enhance public understanding of drinking water quality. Water utilities are also required to notify consumers promptly in the event of any violations of health standards ⁹. Clear communication, effective regulation, and accountability are crucial for building and sustaining this trust ¹⁰. When trust erodes, individuals often seek alternatives such as bottled water or private wells, which result in health, economic, and environmental consequences ¹¹. The global surge in bottled water consumption, with over a million bottles purchased every minute, exacerbates environmental challenges as only 20% of these bottles are recycled, while the remainder contribute to landfills, pollution, and greenhouse gas emissions ¹².

Public perception drives water consumption behaviors, hygiene practices, and environmental stewardship ¹³. Also, concerns over water quality drive many consumers to install filtration systems or avoid tap water altogether ¹⁴. Studies show that distrust in tap water is more common among non-white populations, particularly Latinx and Black communities, who often turn to bottled water and, in some cases, sugary beverages as alternatives ¹⁵. Indigenous communities similarly demonstrate lower levels of trust in municipal water systems, resulting in higher avoidance of tap water ^{16, 17}. These disparities highlight the influence of public perception on consumers.

Additional factors that shape public perception include sensory attributes of water, perceived risks, trust in suppliers, past water quality issues, and information disseminated through media and social networks ¹⁸. A comprehensive national study using data from the 2013 American Housing Survey found that perceptions of water quality were closely linked to socioeconomic factors such as education, income, minority status, and foreign-born nativity, with Latin American immigrants showing particularly low levels of trust in tap water ¹⁹.

Understanding public perception of drinking water quality and the factors influencing it is critical for policymakers, water providers, and other stakeholders. With this knowledge, targeted interventions, policies, and communication strategies can be developed to build public trust, address challenges, and ensure equitable access to safe drinking water for all communities. By prioritizing transparency, stringent regulation, and active public engagement, a more resilient and sustainable drinking water infrastructure that meets the needs of current and future generations can be developed.

The objective of this systematic review is to identify, appraise and synthesize available literature on the public perception of drinking water quality in the United States. Through this review, we aim to provide evidence-based and actionable insights into the public's perception of drinking water quality in the United States. It is our anticipation that the findings will offer valuable guidance in the development of policies and programs aimed at enhancing the public perception of drinking water quality.

Review questions

1.What are the public perceptions of drinking water quality in the United States?

2.What are the factors influencing public perception of drinking water quality?

2. Materials and Methods

This review followed the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Protocols 2015 (PRISMA-P- Table 2) ²¹ and guidance for dissemination of results ²². The study protocol was registered in the International Prospective Register of Systematic Reviews Database (PROSPERO) (available at https:// www.crd. york.ac.uk/prospero) in May 2024 with registration number CRD42024545308

This study systematically reviewed all published works in the United States on public perception of drinking water quality from 1990-2023. The search used concepts of drinking water, perception, quality, and the United States. The following terms were included for the drinking water concept: drink* water, potable water, bottled water, tap water, well water, filter* water, pipe* water, spring water, rainwater collection, water kiosk, sachet water, community water, water supply, lake water, faucet, private water, domestic water, and household water. The perception concept included the following terms: perception, insight, discernment, knowledge, awareness, attitude, trust, confidence, view, satisfaction, perspective, transparency, belief, and influence. The third concept of quality included the following terms: quality, purification, safety, pollut*, contamin*, microbiology, water chemistry, toxicity, constitution, condition, risk, treatment, and testing. For the United States concept, the University of Alabama at Birmingham’s Research Guide on PubMed via LHL: Hedges (2024) United States search hedge that is currently in progress was consulted. Terms were selected for all the 50 states in the United States, and the territories of American Samoa, Guam, Micronesia, Northern Mariana Islands, Puerto Rico, and the United States Virgin Islands.

This search string was constructed and run by an academic librarian adhering to PRISMA-S in consultation with the principal investigators. One limit was applied to the search, the year limiter of 1990-2023. Databases used for the search were: ABI INFORM (ProQuest), APA PsycINFO (Ebsco), Agricultural and Environmental Science Collection (ProQuest), CINAHL Complete (Ebsco), Cochrane Library (Reviews), COMPENDEX (Engineering Village), PubMed, Web of Science, and Google Scholar. Databases were searched from January 1, 1990, to December 31, 2023. For the full PubMed strategy, see Table 2. Results were uploaded and deduplicated in Covidence.

Inclusion criteria: The following criteria were used to select articles from the databases

1. Peer reviewed primary study published in English language from the United States

2. Investigation time: 1990-2023

3. Study that reported the public perceptions of drinking water quality and factors influencing it.

Exclusion criteria

1. Study not related to or not focused on public perception of drinking water quality.

2. Studies that are not based on empirical or primary research.

3. Study not published within the years 1990-2023

Retrieved articles were imported into Rayyan where irrelevant articles were removed. The remaining papers were downloaded for eligibility assessment and data extraction.

Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) ²³. Disagreements were resolved through discussions between the reviewers or with a third reviewer

The following information were extracted using a data extraction form based on ‘JBI-MAStARI collection form for intervention reviews. Data extracted covered the following points (JBI-MAStARI.

• Study details: title, author, publication details, location

• Study design: type of study, duration, outcomes measured.

• Participant demographics: setting, inclusion and exclusion criteria, population size and demographics.

• Intervention characteristics: duration, type, and mode of intervention.

• Outcomes: measure of outcome used; any other outcomes analyzed.

• Results: raw data

• Conclusions: author and reviewer conclusions.

Each article selected for the final review was independently assessed by KO and JI for its relevance to the study. Any differences in judgment were resolved through discussion with SK. We utilized a PRISMA flow diagram, Figure 1, to refine the selection process. The screening process involved four stages: (1) examining article titles generated by keyword searches, (2) evaluating abstracts, (3) reviewing the full text of the articles, and (4) determining their relevance to the review. Additionally, a table was created to document the study design, population demographics, interventions assessed, and key outcomes relevant to the review. The second reviewer (JI) independently cross-checked the extracted data and tabulated results for accuracy. All articles deemed appropriate for inclusion were independently rated for relevance by both reviewers. Over the course of two months, both authors held regular meetings to review progress and resolve any issues.

Descriptive data on study type, author, project year, study design, countries of focus, country of publication, and methods were entered into a Microsoft Excel database. The main outcomes from studies were extracted and summarized.

Quality of study

To assess the quality of the studies, each article was evaluated based on whether it was published in a peer-reviewed journal, under the assumption that peer-reviewed articles have undergone thorough scrutiny by independent reviewers prior to publication.

3. Results

A total of 19,225 publications were identified from nine databases, out of which 6,036 were duplicates and 12,907 were excluded based on title and abstract. Ninety-six articles were selected for full text review. The most common reasons for exclusion were that the study was not focused on perception of drinking water quality (n=21), was repeated (n=5), used secondary data (n=4) and news article (n=2). Finally, 64 publications were included in this systematic review. The results of this review are organized into characteristics of literature included, respondents’ perceptions of drinking water quality and the factors influencing the perception of drinking water quality. Figure 1 shows the PRISMA 2020 flow diagram for the systematic reviews which included searches of databases, registers and included articles.

The articles reviewed in this study span 33 years (1990-2023) and provide insights into public perception of drinking water quality across the United States. Tables 4 and 5 below respectively summarized the characteristics of the 64 articles.

The majority (71.9%) were published prior to 2020. The included articles reported public perception of drinking water quality in the Northeast (9.4%), Midwest (6.3%), West (20.3%), South (37.5%) regions of the United States, multiple states (15.6%) and online (10.9%). In this review, the state with the highest number of publications was Texas 7(10.9%), followed by Florida 5(7.8%) , California 5(7.8%), West Virginia 5(7.8%) while 15.6% of the articles surveyed respondents across multiple states. The setting reported most by the authors was urban and rural (46.9%), followed by urban (39.1%), and rural (14.1%). The study design used by most of the authors was quantitative (87.5%), followed by mixed methods (7.8%) and qualitative (4.7%). Figure 2 is a graph showing the number of articles published per year. Similarly, Figure 3 presents a bar chart of the number of studies included per state and Figure 4 shows the map of the United States showing number of articles included per state

Age: Across studies, younger populations, such as university students and young adults, often exhibited different drinking water behaviors compared to older adults. For example, university students preferred bottled water due to concerns about taste and safety, while older adults generally relied more on tap water and water filtration systems.

Gender: Gender played a significant role in drinking water choices. Women tended to prefer bottled water over tap water more than men, often citing concerns about safety and taste. Men, on the other hand, were more likely to rate the quality of tap water as favorable.

Education: Higher levels of education were associated with a greater likelihood of using water filters and bottled water. Educated individuals often expressed more concern about contaminants and were more informed about water quality issues. However, they were also more likely to engage in practices such as water filtration over bottled water consumption.

Socioeconomic Status: Socioeconomic status significantly influenced water preferences. Lower-income individuals were less likely to buy bottled water due to its cost, but they were also more skeptical about the safety of tap water. Higher-income individuals were more likely to afford bottled water, and they reported greater satisfaction with tap water.

Perception of Safety: Perceptions of safety strongly impacted water choices. Those who believed their tap water was unsafe were more likely to consume bottled water. This belief was particularly common among minority groups and lower-income communities, who reported greater distrust in their local water supplies.

Perception of Taste: Taste was frequently cited as a reason for choosing bottled water over tap water. Bottled water was preferred when individuals found tap water’s taste or smell to be unpleasant, which was often linked to a perception of poor water quality

Location: Geographic location influenced water perceptions. Urban residents generally had more confidence in their tap water compared to those living in rural areas, who often relied on private wells and expressed greater concerns about contaminants. In regions with known water quality issues, such as areas affected by fracking, residents

Age: Younger adults and students tended to have more negative perceptions of tap water, often preferring bottled water due to concerns about safety, taste, and quality. Older adults and residents in rural areas, such as well users, showed more trust in their local water sources but often engaged in additional practices like filtration.

Gender: Women and younger adults, particularly in lower-income groups, were more likely to mistrust tap water and rely on bottled water. Additionally, women were shown to experience higher levels of water insecurity, which influenced their drinking water choices.

Education: Higher levels of education were associated with more awareness of water quality and the use of filtration systems. Educated individuals were more likely to engage in water-related stewardship practices. However, education also played a role in shaping negative perceptions among some groups, particularly when individuals were more aware of contaminants and environmental risks.

Socioeconomic Status: Lower-income households consistently exhibited greater mistrust of tap water, relying more on bottled water despite the financial burden of purchasing it. Socioeconomic disparities significantly influenced drinking water perceptions, with those in poorer neighborhoods reporting dissatisfaction with tap water taste and quality.

Perception of Safety: A significant number of participants expressed concerns about the safety of their tap water, often citing chemical or microbial contamination as a primary reason for choosing bottled water. Perceptions of safety were influenced by income, past water-related issues, and access to information about water treatment

Perception of Taste: Taste played a critical role in drinking water preferences, with many individuals citing unpleasant taste, odor, and appearance as reasons for avoiding tap water. Bottled water was often preferred for its perceived superior taste.

Location: Geographic location strongly influenced water perceptions. Residents in rural areas, such as those in Central Appalachia or shrinking cities like Flint and Detroit, were more likely to distrust their tap water. Urban residents, particularly those in lower socioeconomic neighborhoods, reported dissatisfaction with water quality, leading to higher bottled water consumption.

Forty-one articles reported respondents’ perceptions of tap water quality. Twenty-four reported tap waters to be safe for drinking while seventeen reported tap waters as unsafe. Nineteen articles surveyed respondents about perceptions of bottled water quality and reported bottled water as safe. Similarly, one article reported well water, two filtered water and one spring water were all perceived to be safe for drinking by respondents. Table 5 below shows the number of studies where respondents reported drinking water as safe or unsafe and Figure 5 shows a graph of the number of articles per year that reported bottled water and tap water as safe or unsafe for drinking.

The studies included in this review identified several key factors influencing respondents' perceptions of drinking water quality. These factors include organoleptic properties (taste, smell, and color), socio-demographic characteristics, health risk perceptions, prior negative experiences with water utilities, trust in water systems and management, and media influence and public awareness.

Organoleptic properties: Fifteen studies highlighted the sensory characteristics of water such as taste, smell, and color as major determinants of drinking water quality perception. Negative sensory experiences, such as a bad taste, unpleasant odor, or discoloration, significantly undermined trust in tap water, often prompting individuals to seek alternative sources such as bottled or filtered water. These organoleptic properties are frequently associated with safety concerns and are a primary reason consumers avoid tap water in favor of what they perceive to be safer options.

Socio-demographic characteristics: Twenty-six studies emphasized the significant role of socio-demographic factors in shaping perceptions of drinking water quality. Variables such as income, education, race/ethnicity, gender, household size, and geographic location were found to influence water source preferences. For instance, low-income and minority communities were more likely to mistrust tap water and choose bottled water as a safer alternative. Reviewed studies indicated that Hispanics and African Americans were approximately 20% more likely to select bottled water compared to their white counterparts, reflecting a deeper mistrust rooted in socio-economic and historical contexts.

Perceived health risks: Twelve studies reported that concerns about health risks and fear of illness heavily influenced respondents’ drinking water choices. Concerns about contaminants such as arsenic, lead, or industrial chemicals frequently led individuals to question the safety of tap water. These health-related fears were significant drivers of bottled water consumption, particularly in communities where public awareness of waterborne diseases and contamination risks was heightened.

Previous negative experiences with water utilities: Three studies highlighted past negative experiences with water systems, such as exposure to lead contamination or substandard water quality, had lasting effects on public perceptions. Individuals who had encountered poor service or contamination were more likely to avoid tap water, even if improvements had since been made, opting instead for alternatives like bottled water or home filtration systems.

Trust in water systems and managementNine studies underscored the importance of trust in local water utilities, government agencies, and regulatory bodies, such as the Environmental Protection Agency (EPA), in shaping perceptions of water safety. Lower levels of trust often corresponded with higher reliance on bottled water, reflecting a broader lack of confidence in public water systems. Transparency, communication, and regulatory oversight were identified as key factors in building or eroding this trust.

Media influence and public awareness: Five studies discussed the role of media coverage and public awareness in influencing perceptions of water quality. High-profile events such as the Flint and Michigan water crisis, amplified by media outlets, contributed to widespread mistrust of tap water in affected areas and beyond. Public health campaigns and media reports also played a role in shaping public opinion, either by raising awareness of potential risks or reinforcing negative perceptions.

4. Discussion

The studies reviewed in this systematic review span 33 years (1990-2023) and provide insights into public perception of drinking water quality across the United States. The review includes a variety of research designs, ranging from quantitative surveys to mixed methods and qualitative studies, often focusing on specific populations such as low-income communities, minorities, and residents in areas with known water quality issues. These studies were conducted in diverse geographical locations, including border regions, rural areas, urban centers, and states like Florida, Texas, Michigan, and Arizona. Sample sizes varied greatly across studies, ranging from smaller, localized samples to larger, nationally representative datasets. The studies captured respondents’ perceptions of their drinking water quality along with factors influencing the perceptions such as socio-demographics, trust in local water systems, and the role of infrastructure.

The perception of tap water quality emerged as a dominant theme across many of the reviewed studies. Negative perceptions often stem from concerns about safety, taste, smell, and appearance. For example, Araya et al. (2023) found that in Texas colonias, 32% of households reported issues with their tap water's smell, color, or taste ²⁴. Similarly, studies in Michigan ²⁵ and Phoenix ²⁶ revealed that concerns about contamination, taste, and organoleptic properties played a major role in driving mistrust of tap water. Public trust in water systems was another recurring factor, with studies like that ¹⁹ highlighting that individual demographic factors, such as race and immigrant status, strongly influenced perceptions of water safety. In many cases, perceptions of poor tap water quality led individuals to seek alternatives, such as bottled water, filtering systems, or even spring water ²⁷.

Many studies documented a preference for bottled water over tap water, often tied to perceptions of greater safety and better taste. For example, Huerta-Saenz et al. (2012) found that both adolescents and caretakers in urban minority populations rated bottled water higher in taste, clarity, and safety than tap water ²⁸. Other studies, such as those by Levêque & Burns (2018), indicated that individuals frequently opted for bottled water due to perceived health risks associated with tap water, despite evidence showing that bottled water may not always be of superior quality ²⁹. Bottled water consumption is often linked to socio-demographic factors, such as ethnicity, income, and education levels. Minority populations, particularly Latinx and African American communities, have been shown to favor bottled water due to mistrust of tap water, as reported by [30, 31] ^{30, 31}. This mistrust is rooted in historical inequities, such as discriminatory housing policies that confined minority populations to areas with substandard infrastructure. Additionally, socio-economic barriers, including limited access to affordable filtration systems, reinforce reliance on bottled water despite the economic burden. Cultural practices, such as the preference for traditional water sources in Indigenous communities, further highlight the need for inclusive and culturally sensitive public health interventions

Additionally, economic concerns sometimes exacerbate bottled water consumption, especially in communities where tap water is perceived as unsafe or inadequate. Studies like those of Chatterjee et al. (2022) and Mahler (2021) emphasized the role of risk perception and trust in shaping water consumption behaviors ^{5, 32}. Trust in local water providers and government agencies was often a significant determinant of perception. Studies showed that mistrust, particularly in minority and low-income communities, contributed to a preference for bottled water over tap water. Media coverage and environmental factors, such as the Flint water crisis, also heightened public awareness and skepticism regarding tap water quality. Tap water quality perceptions were closely linked to infrastructure issues, such as old or deteriorating pipes, contamination risks, and inadequate treatment processes. In some studies, like those conducted in West Virginia ³³ and Texas ³⁴, respondents reported issues such as high levels of contaminants and poor water pressure, leading to greater reliance on alternative sources of water.

Studies that focused on private well water highlighted unique challenges and perceptions. For example, Benson et al. (2006) reported that in rural Nevada, 75% of respondents relied on tap water sourced from wells, with concerns about contaminants like arsenic ³⁵. Similarly, Gitter et al. (2023) found that even after experiencing events like Hurricane Harvey, many well users in Texas still believed their water was safe, despite having been exposed to microbial contamination risks ³⁶. Perceptions of well water quality were frequently tied to the lack of infrastructure and regulatory oversight. In areas where well water was the primary drinking source, concerns about contamination and inadequate testing were prevalent, as seen in ^{37, 38}.

Bottled water quality was generally perceived as superior to tap water, although this was not always the case. Factors influencing bottled water quality perceptions included its convenience, accessibility, and marketing by bottled water companies. In some instances, environmental concerns about plastic waste and cost were raised, but the overall perception remained that bottled water was a safer and more reliable option than tap water, as discussed by Viscusi et al. (2015) ³⁹.

The differences between the results reported in studies published from 1990-2019 and those published from 2020-2023 on drinking water perceptions and preferences reflect shifts in public awareness, socio-political factors, and technological advances. In the more recently published studies, younger adults continued to express mistrust of tap water, but this was compounded by increased awareness of environmental concerns such as microplastics in bottled water. There was also a noticeable increase in younger adults advocating for water safety. In the more recently published studies, women remained more likely to consume bottled water than men, but the focus also expanded to include issues related to water insecurity and the burden of ensuring safe drinking water, particularly in lower income households. Higher education still correlated with awareness in the more recently published studies, but there was a stronger focus on environmental stewardship, such as reducing bottled water consumption due to sustainability concerns. Educated individuals were also more vocal about water safety concerns, especially related to water treatment failures. Socioeconomic disparities became even more pronounced, with low-income households reporting higher levels of water insecurity and dissatisfaction with water services. In some areas, such as Flint, Michigan, bottled water became a necessity due to systemic water safety failures.

State-specific trends in water distrust, such as in Texas and Michigan, are shaped by a combination of socio-economic and environmental factors. In Texas, the presence of colonias—unincorporated communities with limited access to safe drinking water—exacerbates mistrust due to inadequate infrastructure and historical neglect. Similarly, Michigan’s water crises, including the highly publicized Flint incident, have led to a long-term erosion of trust in public water systems. These incidents underscore the role of historical events and systemic challenges in shaping public perceptions, particularly in communities disproportionately affected by environmental injustice and economic disparities.

Concerns about tap water safety persisted in the more recently published studies, but there was also growing scrutiny of bottled water due to environmental concerns like plastic pollution. Additionally, public perception shifted more toward distrust in water governance, with events such as the Flint water crisis reinforcing fears. Taste remained a factor, but there was an increased focus on water safety and the long-term environmental impact of bottled water consumption. As a result, more individuals in the 2020-2023 period opted for home water filtration systems to improve the taste of tap water without contributing to plastic waste. Geographic differences in water perception became even more evident in the later period, particularly in regions affected by public water crises, such as Flint and Detroit. Urban and rural areas alike faced challenges, but rural residents were more likely to distrust centralized water systems and prefer local or private wells. Between 2020-2023, there was a noticeable increase in environmental awareness, with more individuals concerned about the environmental impact of bottled water consumption (e.g., plastic pollution and microplastics), which was less prominent in the 1990-2019 period. In the more recent period, there has been a stronger narrative around distrust in public water governance and infrastructure, especially in the wake of highly publicized water safety failures. This was not as widely prevalent in the earlier period, where the focus was more on individual health risks rather than systemic failures. While concerns about safety and taste remain consistent across both periods, the 2020-2023 articles reveal heightened environmental awareness, growing mistrust in water systems, and increased socioeconomic disparities, all of which influence modern perceptions of water quality and behavior.

Emerging issues such as climate change, water scarcity, and advancements in water treatment technology are likely to influence future perceptions of drinking water quality. Climate change is expected to increase the frequency of droughts and extreme weather events, exacerbating water insecurity. Technological advancements, such as decentralized water treatment systems and smart monitoring technologies, hold promise for rebuilding public trust. However, these innovations must be accompanied by transparent communication to ensure equitable access and adoption across socio-economic groups.

Comparing the U.S. findings with public perceptions in countries like Canada and South Africa highlights unique challenges. In Canada, public trust in water systems remains relatively high due to stringent water quality regulations and proactive communication strategies. Conversely, in South Africa, water perceptions are heavily influenced by historical inequalities and inconsistent service delivery, like patterns observed in some U.S. minority communities. These comparisons emphasize the importance of addressing systemic inequities to improve public confidence in water systems globally.

Strengths and Limitations

There are some limitations to this systematic review. The included studies predominantly focus on specific regions within the United States, which may limit the generalizability of the findings to other geographic areas. As with any systematic review, there is the potential for publication bias, where studies reporting significant findings are more likely to be published than those with non-significant results. This could lead to an overestimation of the impact of certain factors influencing drinking water perceptions and skew the review’s conclusions. Many of the studies included in the review are cross-sectional, capturing respondents' perceptions at a single point in time. Longitudinal studies tracking changes in public perception over time are limited, making it difficult to understand how perceptions evolve in response to policy changes, environmental events, or improvements in water infrastructure. Most of the studies included in the review rely on self-reported data from respondents. Self-reported perceptions may be influenced by recall bias, social desirability bias, or a lack of knowledge about actual water quality, potentially limiting the accuracy of the findings. Addressing these limitations in future research could enhance our understanding of public perceptions of drinking water quality and contribute to more targeted and effective policy interventions

Implications for practice and policy

Based on the findings from this systematic review, several recommendations can be made to improve public perception of drinking water quality in the United States. Successful policy interventions offer valuable lessons for improving trust in water systems. For instance, the implementation of community-based water quality monitoring programs in California has empowered residents to participate actively in ensuring safe drinking water. Similarly, Philadelphia’s Water Revenue Assistance Program (WRAP) has addressed affordability concerns by providing financial assistance to low-income households. These examples illustrate the importance of integrating community engagement and economic support into water governance strategies to rebuild trust.

1.Enhance public communication and transparency: There is a need for more transparent communication from water utilities and regulatory bodies. Providing regular, clear, and accessible updates on water quality, treatment processes, and potential risks can help rebuild trust in public water systems, particularly in communities where trust has been eroded.

2. Invest in infrastructure improvements: Addressing the aging and deteriorating water infrastructure should be a priority. Improvements in water treatment processes, as well as the replacement of outdated pipes and plumbing systems, can reduce contamination risks and improve the organoleptic properties (taste, smell, color) of tap water, leading to improved public perceptions.

3. Targeted public health campaigns: Tailored public health campaigns are essential to educate populations about the actual safety of tap water versus the perceived safety of bottled water. These campaigns should focus on communities with heightened mistrust, such as minority populations and low-income areas, and should address concerns surrounding contaminants and health risks.

4. Community engagement and involvement: Engaging communities in water quality monitoring and decision-making processes can empower residents and enhance their trust in the system. Water utilities should prioritize community partnerships and allow for greater public participation in ensuring safe drinking water.

5. Support for vulnerable populations: Policies should be developed to ensure equitable access to safe drinking water, especially for vulnerable populations relying on private well water or those living in rural or low-income urban areas. This may include subsidies for filtration systems, expanded water testing programs, and interventions to address specific health risks related to contaminated water sources.

Conclusion

This systematic review highlights the complexities surrounding public perception of drinking water quality in the United States over the past 33 years. The findings suggest that perceptions are influenced by multiple factors, including organoleptic properties (taste, smell, and color), socio-demographic characteristics, health risk perceptions, prior negative experiences with water utilities, trust in water systems and management, and media influence and public awareness. Negative perceptions of tap water often drive individuals to turn to alternatives such as bottled water, which carries its own economic and environmental costs.

To improve public confidence in drinking water, policymakers and water utilities must focus on addressing infrastructure challenges, enhancing transparency, and fostering community trust. Effective public health interventions that promote education about water safety and ensure equitable access to clean drinking water are critical in reshaping perceptions. By prioritizing these efforts, the United States can work toward building a more resilient and trusted public water system that meets the needs of all its citizens.

Conflicts of Interest

The authors declare no conflicts of interest exist.

Authors Contributions

KO conceived and designed the study under the supervision of SK. MY is a University Librarian who designed the search strategy and extracted the articles from the databases. KO and JI independently screened and assessed the articles for eligibility. KO and JI extracted the results from the excel sheet. KO drafted the manuscript. All authors critically reviewed the manuscript and approved the final version.

ACKNOWLEDGEMENTS

The authors would like to thank everyone who contributed to this review. We are grateful to you all.

References