Public Awareness and Acceptance of Wastewater Surveillance in the United States, June 2024

Wastewater surveillance (WWS) is a valuable public health tool for monitoring infectious diseases. Recent studies suggest its potential for monitoring opioids or other drugs. We evaluated WWS awareness and public acceptance of WWS for respiratory and vector-borne diseases and opioids in the US population.

We conducted a nationwide cross-sectional survey in June 2024 among US adults aged ≥18 years. We used quantitative analysis (N = 2024) to assess associations between participants' awareness of and attitudes toward WWS, including how those data should be used. We performed qualitative analysis to identify themes among participants who provided comments about opioids or other illicit drugs (n = 67).

Overall, more than half of participants expressed comfort with WWS for respiratory diseases (54.1%), mosquito-borne diseases (57.3%), and opioids or other drugs (51.1%). These percentages were significantly higher (P < .001) among people with awareness of WWS than among those who were unaware of WWS: 70.6% were comfortable with WWS for respiratory diseases and 71.6% were comfortable with WWS for mosquito-borne diseases, while slightly fewer participants were comfortable with WWS for opioids or other drugs (64.8%). Among those unaware of WWS, about half were comfortable with WWS for respiratory diseases (50.8%), mosquito-borne diseases (55.5%), or opioids or other drugs (49.2%). Qualitative analysis highlighted concerns about privacy, changes in law enforcement activity with opioid monitoring, and the possibility of negative community effects.

Comfort with WWS activities was higher among those who were aware of WWS than among those who were not. Future efforts could focus on improving public awareness and knowledge of how wastewater data are collected and used to benefit public health.