What Do Toilets Have to Do With It? Health, the Environment, and the Working Poor in Rural South Texas Colonias

This paper develops and tests an environmental health ecological framework between the quality of infrastructure, utilities and resident’s practices to health problems reported in three Nueces County, Texas colonias. Populated by predominantly low-income, minority families, these peri-urban settlements are characterized by substandard housing, lacking traditional sewage systems, potable drinking water and pluvial drainage. It was hypothesized that those without indoor toilets, pluvial drainage and regular garbage collection would be more likely to report health problems. The study found that keeping trash for over a week was statistically related to gastrointestinal illness and eye infections. Having indoor toilets in conjunction with substandard septic tanks was statistically related to gastrointestinal illness, respiratory problems and skin infections. The lack of pluvial drainage was statistically significantly, while not related to a particular disease. The argument is made that flooding problems may have contributed to the sanitation problems. Specifically, drainage problems affect the septic tanks and cause backflow to the indoor toilets. Although a small sample, the findings show that people who live in colonias are at risk for disease because structural measures to improve sanitation are not available.


Introduction
As many as 400,000 rural Texans live in colonias (Powell 2008 1 ). Colonias are unincorporated communities that often lack the most basic living necessities, such as safe drinking water and sewer systems, electricity, paved roads and safe housing. Recently, the Texas State Office of Rural Community Affairs awarded $6.7 million to 16 rural communities. Four South Texas counties will receive infrastructure improvements such as first time water or sewer service. The predicament of these communities demonstrates what the Albrechts (2000 2 ) refer to as the extreme and extensive poverty occurring in non-metropolitan areas of the United States related to structural rather than cultural roots of poverty. It has been suggested that in the colonias and other similar areas in the United States poverty significantly impacts lifestyle choices and chances (Fauth et 11 ), and higher mortality rates (Antonovsky 1967 12 ;Williams 1990 13 ; Winkleby et al. 1992 14 ).
According to the Nueces County Highway Map, Rural Subdivision Map (Naismith Engineering 1998 15 ), approximately 176 housing subdivisions (colonias) exist in rural Nueces County. The Nueces County colonias share many of the traits found along the Texas-Mexico border, though not as severe. The high levels of E-coli and fecal coliform bacteria (water-borne vectors for gastrointestinal illnesses) found in stagnant flood in these areas have been the focus on recent interest.
Prior research has not been conducted in rural Nueces County. It appears that the residents of these colonias might share the same problems encountered by the border colonias, particularly in terms of a lack of infrastructure and the incidence of illness. Some of these health problems include: gastrointestinal illnesses, respiratory problems, skin and eye infections, cancer, birth defects, neural-tube disorders, and reproductive issues.
Using an Environmental Health Ecological Framework, the purpose of this research is to examine the linkages between incidence of disease and environmental pollution levels. The findings for this research are based on household level interviews in three Nueces County colonias. The research questions include: 1. To what extent is household members' access to adequate utilities, such as sanitation and other public services, related to disease incidence?
2. To what extents are household members' daily activities and periodic practices, that bring them in contact with pollutants, related to disease incidence?

Epidemiological Studies
Epidemiological studies have found a relationship between environmental pollution and health problems, particularly in residential areas adjacent to heavy concentrations of industry or agricultural production. Such studies have linked pesticides, herbicides, heavy metals, rubber, paint, industrial solvents, petroleum products, and industrial chemicals to cancers of the brain, liver, breasts, kidney, prostate, esophagus, skin, bone, marrow, and lymph nodes (Steingraber 1997  At the household-level, only a few studies have been conducted that focus on the impact of the environment on the border community health. In 1991, the Environmental Scoping Study investigated the potential links between local residents' health and environmental pollution in the Lower Rio Grande Valley. After examination of air, soil, and dust, for example, Akland et al. (1997 34 ) found higher levels of certain chemicals (specifically aluminum, calcium chlorine, bromine and silicon) than in other parts of the nation. Higher levels of some pesticides (malathion, permethrins, dieldrin and DDE) were found in the air within the study area than in non-agricultural areas. Water contamination in the well water included coliform bacteria, sulfates, chloride, manganese, and molybdenum, all unsafe for drinking, cooking, brushing teeth and washing dishes. The blood and urine testing of area household members indicated high level of PCBs, low levels of arsenic, small amounts of pesticides, and low levels of bromoform (Akland et al. 1997 35 ). Although the study's small sample did not lend itself to generalizable statistical conclusions, this research introduced a new model for community-based research that integrates public health concerns, exposure reduction, illness prevention, and intergovernmental regulatory activities. Rios and Valdez (2001 36 ) conducted a bi-national study in Brownsville (Cameron County) Texas and Matamoros (Tamaulipas) Mexico. This ecological, empirical, household level study found that the lack of sanitation facilities, conventional sewage and pluvial drainage were associated with gastrointestinal illnesses.

Conceptual Framework
This study adapts the Rios and Valdez (2001 37 ) framework on infrastructure and incidence of illness in border colonias, adding social and other indicators for the Nueces County colonias. This conceptual framework is depicted in Figure 1.

Social Indicators
In the present study, social indicators incorporate economic status, housing and ethnicity. Information also includes whether the head of household and spouse (if appropriate) worked for wages, was disabled or retired to establish the economic status of the householder. In addition, the respondent was asked to indicate whether the annual income was above or below $18,840.00, the poverty line. Each respondent was asked to self-report his/her ethnicity. Housing refers to the respondent's living arrangements, including the number of years lived in the current house, the number of rooms the house has, and the number of adults and children who live in the house.
As demonstrated in previous literature, these social indicators are associated with morbidity and mortality rates. It is anticipated that those with lower economic status are predisposed to live in poorer housing and would report higher incidences illness than those with greater economic status. Examination of the social indicators provides a context for understanding the life circumstances of colonias residents in South Texas.

Pollution Indicators
For environmental pollution, the daily activities and periodic practices of household members are used both as direct and indirect measures of contact with pollutants. It is anticipated that some of these practices have the potential for environmental contamination and could result in health problems.
Another research question investigates the availability and accessibility of sanitation, utilities and other public services. It is anticipated that the lack of adequate infrastructure has the potential to become an environmental problem, such as poor water quality, air quality (due to the water cycle), soil contamination or a vector for water-borne diseases.

Health Indicators
This study investigates the associations between the absence of traditional infrastructure, utilities, services and practices and gastrointestinal illnesses, respiratory, skin and eye infection.
Only those variables reflecting statistical significance and moderate levels of association are used.

Research Design
Geographic location was the sample selection criterion for potential interviewees. To obtain samples from numerous sections of Nueces County, we selected one colonia from eastern Nueces County and close to Corpus Christi, one in mid-rural Nueces County and in close proximity to Petronilla, and one in western Nueces County abutting Robstown.
It was anticipated that environmental pollution in these areas would be comprised of water and soil mediums and especially compromised water quality. Water pollution is defined in terms of biological agents (sewage) and organic and inorganic chemicals (toxins). Sewage is associated with drainage ditches, septic tanks, and filtration ponds. Toxins are located in landfills, waste sites, chemical waste sites and industrial plants. Secondly, the colonias is important as a convenient, accepted, and relatively homogeneous unit of analysis, containing families with common problems, needs, and political jurisdictions. These attributes are most relevant when making policy recommendations based on empirical research findings.
For the Nueces County colonias, the researchers anticipated that biological agents would be present due to the lack of infrastructure in these neighborhoods, and that the biological agents might be toxins present because of a lack of public services such as garbage collection and the use in the area of agricultural pesticides.

Site Selection
Based on the framework described above, the following activities were undertaken to select the most appropriate colonias.
1. County maps and the most recent engineering study (Naismith Engineering 1998 38 ) on the colonias were obtained.
2. The Nueces County Colonia Task Force provided both input as to the problems inherent in numerous colonias as well as the possible selection of specific colonias to be investigated.
3. The researchers visited and observed each of these colonias, recorded the number of houses, construction materials, services on the property, and visual evidence of pollution.
The colonias selected are presented in Table 1. Originally the researchers intended to conduct a census of the entire population residing within these colonias since U.S. Census data was not available. Time and resource limitations for the study prevented the implementation of a complete census. The sample from each colonia represented ten to fifteen percent of the targeted population, acceptable for field research (Babbie 2004 39  In addition, the majority (80 percent) had septic tanks with a few "holes" (an outdoor hole dug for use as a toilet) used as a means of sanitation. In this colonia, 60 percent of the residents did not have pluvial drainage and 40 percent did not have garbage collection services.
Tierra Grande is the most publicized colonia, often appearing on the local newscasts for major drainage problems (even though this colonia does not lie within a flood plain) and high levels of water-borne bacteria. This colonia is located at the northeast intersection of FM 665 and County Road 61 about 12 miles east of Driscoll and northwest of Petronilla. The researchers counted 229 dwellings and conducted 23 interviews, generating a 10 percent response rate. According to the respondents, 87 percent had running water in the house, 87 percent had indoor toilets connected to septic tanks (82.6 percent). In Tierra Grande, almost 96 percent lacked pluvial drainage and 56.5 percent did not have garbage collection services.
Rose Acres was not included in the Nueces County Comprehensive Colonia Planning Study (Naismith Engineering 1998 40 ). This neighborhood is located west of Corpus Christi off FM 665 and County Road 763 and west of the Corpus Christi Airport. With 59 dwellings in this colonia, the researchers interviewed 9 residents, generating a 15 percent response rate. The residents in this colonia reported living in the area between 40 to 90 years, and were noted by researchers as been generally older, more elderly than other colonias. The respondents indicated that the infrastructure and services lacking municipal sewage connections (all used septic tanks), trash collection (66.7 percent), and pluvial drainage (100%).

Household Interviews
Survey data was collected through face-to-face interviews at the homes of participants. Graduate students were enlisted as field interviewers. Prior to going in the field, the students were trained by lecture on how to establish rapport and maintain professionalism, via role playing and a video on how to avoid bias during the interview. The students were in pairs while in the field. The interviews were conducted in both English and Spanish. Data collection was conducted October 9 -16, 2004.

Survey Instrument
The questionnaire used was adapted from the empirical research project funded by the Environmental Protection Agency and conducted by Rios and Valdez (1996 41 ) on the Texas -Mexico border colonias. This instrument was used in a previous large study (n = 800) and, thus, provided the necessary validity and reliability for the present study. The changes made to the survey were made to ensure the survey reflected the population and problems specific to Nueces County. Four sections made up the seven-page questionnaire. The first section deal with the respondent household characteristics such as how many people lived in the house, where the adults worked, exposure to pesticides, and availability of utilities. The second section dealt with the proximity of the house to sources of potential contamination. It asked about the number of animals in the household, and practices concerning food and water storage, trash removal, and visits to the border. The next section focused on specific health problems and how they were remedied. The final section concerned recent deaths in the family, the most important problem in the colonia, and household income.

Potential Polluting Sources
The survey included colonias' infrastructure, utilities and practices as direct and indirect measures of potential polluting sources and related incidence of illness.

Infrastructure and Utilities
In the colonias, access to sanitation, utilities and other public services are used as both direct and indirect measures of contact with pollutants. The researchers anticipated that the lack of adequate infrastructure services would have the potential to become an environmental problem, such as poor water quality and contaminated soil. It also was expected that those families with adequate household facilities should be healthier than other families. The variables used in this study for biological agents include the presence or absence of indoor toilets and traditional sewage systems, alternative types of sewage systems such as septic tanks, outside pluvial drainage.

Practices
This study targeted some of the periodic practices or behaviors of the colonia residents that might be associated with environmental health issues. Some practices involved keeping trash on their property for extended periods or burning trash in response to the absence of trash collection services. These variables are classified as organic or inorganic agents or toxins, which can lead to numerous environmental health problems.

Health Indicators
For this study, the incidence of illnesses and disease are measured by the self-reported presence of gastrointestinal illness, such as diarrhea, hepatitis, worms or other parasites. The illnesses for respiratory infections included prolonged cold, bronchitis, flu, pneumonia, or tuberculosis. Skin infection included chicken pox, rashes, ringworm or scabies. In addition, eye infections reflected conjunctivitis or chronic eye allergies.

Statistical Analysis
Chi-square tests of significance are used to determine the relationships and associations between the infrastructure, utilities, and activities and gastrointestinal diseases, respiratory, skin and eye infections. Bivariate analyses are presented, which indicate the strength of the relationships between the variables. Only those variables indicating at least an acceptable level of association (.20) (Meier and Brudney 2002 42 ) are reported in the results.

Results
The results of 57 householder interviews are presented below. As a vulnerable and marginal population, many colonia residents were reluctant to participate in the interviews. Due to a lack of funding and time constraints, prior community awareness campaigns were limited. The Social Indicators for this population are presented in Table 2. Appropriate descriptive statistics are used for each variable. Table 3 depicts the variables for the Pollution Indicators while Table 4 describes the Health Indicators.

Social Indicators
In this study, 58.9 percent of the colonia households are inhabited by two adults with a mode of 3 children (  The findings reported in the following sections are limited to the aggregated data for the Tierra Verde and Tierra Grande colonias. Based on our observations and judgment, the Rose Acres colonia was categorically different from the other two colonias in the study. While Rose Acres exhibited some problems, primarily in shared water meters and lack of pluvial drainage, the housing units in the colonia appeared to be in much better condition. Notably, the small sample size surveyed in Rose Acres excluded that data from statistical analysis. In addition, the small sample size limited our ability to control for separate social Indicator variables.

Pollution Indicators
Surveyed residents were asked about the presence or absence of selected infrastructure, the sanitary practices and any potentially related health problems. The use of nominal level data (yes/no), limited statistical analysis to frequencies and Chi-square testing of those hypotheses necessary to determine if the variables are independent of each other and the contingency coefficient, necessary to determine the strength of association between the two variables (Norusis 2004 44 ). The findings are limited to those variables that generated a statistical significance of p<.05.

Infrastructure
The lack of adequate infrastructure, such as water, toilets, sewage, and so on, can be related to health problems. In this section the availability of certain types of utilities and public services are cross-tabulated with the health problems. It is expected that those respondents with infrastructure already in place reported they were healthier. According to Table 3, few are connected to the city sewage system (18.8 percent). The majority use a septic tank (81.3 percent) while 12.5 percent have an outhouse and 6.3 percent have a hole. Only about half of the respondents (52.1 percent) have regular trash collection. For the Health Indicators found in Table 4, the presence of gastrointestinal illnesses and eye infections were the predominant maladies (31.3 percent). The respondents also indicated the presence of respiratory illnesses (27.1 percent) and skin infections (29.2 percent).

Indoor Toilets
Of the various types of infrastructure investigated, the presence of indoor toilets was related to several illnesses. While it would be expected that having indoor toilets would provide a healthier environment, we must also consider that the vast majority of the colonia residents have inadequate septic tanks. These tanks may be compromised by the type of soil found in the Coastal Bend that allows a shifting of the amenity, resulting in open holes in the tanks and other damage. Another variable considered is that some septic tanks were found to be self-constructed and insufficient to meet the standard health and construction codes. Finally, the absence of pluvial drainage exacerbates the problem by flooding the septic tanks and backing up the indoor toilets.
The gastrointestinal illnesses included diarrhea, amoebas, worms or other parasites, salmonella, typhoid and hepatitis, with diarrhea being the most common type of illness. According to the Chi-square analysis (that includes all forms of gastrointestinal illnesses), 12 residents (27.3 percent) suffered from some type of gastrointestinal malady (  3.888; p = .049) associated to indoor toilet problems (27 percent). Respiratory infections included prolonged colds, bronchitis, flu, pneumonia, coughing with blood, Tuberculosis. No single type of respiratory infection dominated the results; however, it is noteworthy that almost 11 percent of the respondents had multiple respiratory afflictions. According to the Chi-square analysis, ten residents (about 28 percent) endured respiratory problems (  = 5.073; p = .024) associated with the indoor toilet problems (almost 31 percent).
Slightly more than 28 percent of the residents surveyed suffered from skin infections, including chicken pox, dermatitis, rashes, ringworm, fungus, and scabies. Of these residents, eleven (25 percent) were negatively affected by indoor toilets (  = 4.437; p = .035), indicating a moderate relationship (.291) as reflected by the contingency coefficient. In this category, the interviewers noted that skin infections were visible, but that the respondents often reported no infections.

Behavioral Patterns
To trace other possible sources of contamination for the colonia residents, we examined the relationships between the respondent's hygiene practices and health problems.

Garbage
Trash disposal practices are another source of potential environmental contamination. Half of the respondents (50 percent) indicated that they keep trash on their premises for more than a week.
The practice of keeping trash for more than one week is considered to be an organic/inorganic agent or source of environmental pollution that may lead to some environmental health problems. These practices are also a source of compromised air quality. More importantly, engaging in this practice is often associated with the lack of garbage collection in the colonias.
Keeping trash on the respondent's property was related to gastrointestinal illnesses and affected eight respondents (50 percent), (  = 3.927; p = .048) and moderately associated as evidenced by the contingency coefficient of .275. Also, the practice of keeping trash for at least a week was related to eye infections. Nine respondents (56.3 percent) experienced eye infections resulting in a strong statistical significance (  = 6.982; p = .008) and the strongest association level of .356.

Discussion
Numerous policy arenas relate to the peri-urban settlements, such as poverty, housing and infrastructure, and health. Some legislation has been enacted to address the issues in the colonias. However, some intractable problems remain. In Texas, water connections and sanitation facilities are traditionally provided by the private sector through the land developer. More importantly, the Texas Constitution bars the counties from providing infrastructure to settlements lying in county's political jurisdiction. In the case of the colonias, both on the border as well as in Nueces County, land was sold as undeveloped and lacked these utilities. For the colonias situated at the Texas-Mexico border, numerous state-level statutes were enacted beginning in 1995 to halt the sale of undeveloped land; to fund state-level programs for housing, water and drainage; and, to provide authority to county-level government to administer statelevel funds for environmental infrastructure.
The colonias legislation proved to be successful in the Texas-Mexico border region. Since the enactment of these policies, however, developers purchased nearby property, approximately 150 miles from the international border, and thus contributed to "colonia creep." The demographic data obtained by the researchers reflect a population popularly known as the "working poor." It appears that the lack of affordable housing elsewhere and the quest for the "American dream" were the main driving forces for the colonia resident's impulse to purchase this undeveloped land. In the absence of infrastructure, the colonia residents opted for septic tanks as an alternative means of sewage service. These septic tanks, however, tend to fail regulatory criteria for the type of soil found in this area.
Many comparisons can be drawn between the Texas border colonias and the Nueces county colonias. Senate Bill 425 was enacted in 2005, targeting counties located within 150 miles from the international border with populations of more than 250,000. The bill allows the affected county the power to regulate the approval of plats in unincorporated areas of the county. Other provisions of this bill include: "(1) to prevent future substandard housing from springing up; (2) to receive the assistance of a colonia ombudsman; and (3)  Numerous problems remain. The problematic drainage is at the core of many of the area's problems. For example, health conditions may tend to worsen over time if flooded and contaminated water remains on the surface in the area. Dwellings cannot be upgraded until adequate pluvial drainage is provided in the neighborhoods. The sanitation situation (septic tanks) has not yet been addressed. Again, environmental health problems may soon surface and may be as severe as those found in the Lower Rio Grande Valley (Rios and Valdez 2001 49 ).

Conclusion
This research examined the linkages between selected indirect measures of environmental pollution (pollution indicators) and incidence of illnesses (health indicators) in three Nueces County colonias: Tierra Verde, Tierra Grande and Rose Acres (which was excluded from the final study). The research questions investigated the daily activities and periodic practices of household members and the access and availability of utilities and other public services in the colonias as they related to incidence of disease. The site selection of a geographic location within Nueces County provided an appropriate "picture" of the possible problems for the residents of these neighborhoods throughout Nueces County. The researchers conducted the 57 interviews in October 2004; 48 were used in this study.
Within activities and practices, the practice of keeping trash for over a week on the respondent's property were statistically related to gastrointestinal illnesses and eye infections. These findings reflect organic or inorganic agents or toxins.
Within the infrastructure variables, having indoor toilets (in conjunction with substandard septic tanks) were statistically related to gastrointestinal illness, respiratory problems and skin infections. The lack of pluvial drainage was statistically significant, while not related to a particular disease. However, the researchers assert that the flooding problems may have contributed to the sanitation problems. Specifically, the drainage problems in these areas affect the septic tanks and cause backflow to the indoor toilets. These findings are associated with biological agents of environmental pollutants.
The small sample size did not allow us to fully investigate the social indicators. However, it appears that the problems in these colonias are related to poverty, especially a lack of affordable housing. People who live in colonias are at risk for disease because structural measures to improve sanitation are not available to them. Mirowsky, et al., concluded that "Improvements in status and resources produce the largest health payoff among relatively disadvantaged groups, for whom such improvements are least common" (2000 p.59 50 ). With this in mind, efforts to improve the living conditions of the poor serve not only those individuals, but also the community at large. This sample size for this research was relatively small due to a lack of funding, time constraints, and the lack of cooperation among colonia residents. More definitive conclusions could be made from a larger study that would include the social indicators and a census of the entire colonia population in Nueces County.