title: Determinants of compliance with drinking water standards in rural Puerto Rico between 1996 and 2000: a multilevel approach.
abstract: BACKGROUND
  Two hundred and thirty nine (239) drinking water systems in Puerto Rico are not connected to the Puerto Rico Aqueducts and Sewers Authority (PRASA), and are thus known as Non-PRASA drinking water systems. Population served estimates by Non-PRASA systems are in the 100,000 to 300,000 range.
  
  
  OBJECTIVE
  To identify the determinants of compliance with drinking water standards by rural drinking water systems in Puerto Rico. To identify the best analytical methods for studying the problem of non-compliance with drinking water standards in Puerto Rico and its generalization to similar communities elsewhere.
  
  
  METHODS
  We reviewed capacity development and drinking water system evaluations performed by governmental and academic institutions between 1993 and 2004. Community and system variables were used to fit a multilevel model to predict compliance with drinking water standards. Data was obtained from the Environmental Protection Agency' Safe Drinking Water Information System and the Puerto Rico Health Department drinking water database for 231 systems, serving 90,000 persons.
  
  
  RESULTS
  There was an 11% increase in compliance (1996 = 4%; 2000=15%), a decrease of 13,634 people served by non-compliant systems (1996 = 86,169; 2000 = 72,535) and a 6% decrease in the number of non-compliant systems which had installed treatment equipment (1996 = 93%; 2000=87%). The prevalence of compliance among those systems that had installed treatment equipment was higher than among those systems that did not have treatment equipment, after adjusting by the time period (est. POR = 2.2, 95% CI, 1.40 - 3.44).
  
  
  CONCLUSIONS
  Our findings suggest alternative public health strategies are needed to ensure sustained safe water capacity in rural communities.
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, USA. rguerre3@jhmi.edu
authors.forename: Rafael
authors.initials: R
authors.lastname: Guerrero-Preston
authors.forename: José
authors.initials: J
authors.lastname: Norat
authors.forename: Mario
authors.initials: M
authors.lastname: Rodríguez
authors.forename: Lydia
authors.initials: L
authors.lastname: Santiago
authors.forename: Erick
authors.initials: E
authors.lastname: Suárez
mesh_terms: D019983:Guideline Adherence / Q000706:statistics & numerical data*; D011647:Puerto Rico; D012423:Rural Health; D014881:Water Supply / Q000592:standards*