During June 19–23, 2024, Porter Novelli Public Services conducted a 9-question, nationwide survey among US adults (Appendix). The survey aimed to assess participants’ knowledge and attitudes regarding WS, referred to as wastewater monitoring in the survey (Appendix). In this qualitative analysis, we reviewed and categorized 2,024 free text responses to the open-ended question, “Do you have any concerns about wastewater monitoring in your community? Why or why not?”

Three analysts independently coded survey responses and subsequently reached consensus on themes. Each response was classified into the most relevant theme on the basis of its content. We calculated summary statistics to provide an overview of the findings. This activity was reviewed by members of the Information Collections and Human Studies Team in CDC’s National Center for Emerging and Zoonotic Infectious Diseases and was determined to be nonresearch in accordance with 45 CFR 46.102(l) on April 11, 2023. The survey was conducted in a manner consistent with applicable federal law and CDC policy.

Of 2,024 write-in responses, a total of 1,342 (66.3%) participants reported no concerns with WS, 285 (14.1%) expressed concerns, 248 (12.3%) were uncertain or did not understand the question, 110 (5.4%) were unaware of WS initiatives, and 39 (1.9%) relied on private wastewater systems only. From 1,181 responses, we identified the following 4 themes: trust in government and authorities, effectiveness and accuracy of monitoring, public health implications, education and communication (Table). Many respondents expressed multiple themes. For example, among 1,342 participants who expressed no concerns, 49% expressed no concerns at all, 43% supported the initiative with conditional trust in government agencies, and 6% expressed no concerns due to their unfamiliarity with the subject.

In this June 2024 nationwide survey, most respondents did not have concerns about WS for infectious diseases. However, some expressed limited or no awareness of WS and a desire for additional information and improved communication about findings from the initiatives.

Because large-scale use of WS is relatively new, few studies examining public perceptions of these initiatives are available. Results of several national surveys found that about half of respondents reported previous awareness of wastewater monitoring, but most were generally supportive of this public health strategy (3–5). Another survey found that 65% of participants (n = 516) knew little or nothing about WS and suggested the need for communication about how WS works, how findings are used, and protections against misuse (6). Those findings align closely with the results from our analysis and suggest a consistent pattern of support for WS while highlighting the opportunity for continued public education and communication about those efforts.

The findings from this survey highlight the trust that communities have in state and local public health and suggest that communities trust WS when they trust the institutions conducting it. They also suggest that, to further build and maintain trust, WS activities should remain transparent and focused on informing public health action and preventing community harm. The findings also highlight the opportunity for additional efforts to educate the public on why WS is used and how wastewater data are protected.

To engage community members, public health entities can share messages around individual health choices through trusted messengers like healthcare providers, community health workers, and local leaders. Public health entities should also build strong relationships with community and faith-based organizations to better reach local audiences and align communication strategies with the needs and preferences of the populations they serve (7–9).

The first limitation of this study is that it relied on a convenience sample and an internet-based, English-only survey; persons with limited internet access, less familiarity with online technology, or limited English proficiency might have been excluded. Therefore, the results are not representative of the entire population. In addition, because open-ended questions were optional, responses might not reflect the full range of perspectives on WS.

In conclusion, the survey’s findings highlighted opportunities for public health to use WS to build trust. Engaging communities through trusted messengers and organizations can enhance understanding and acceptance, and continued education and transparent communication could increase public awareness and strengthen confidence in public health initiatives. Together, those strategies can support effective individual and community responses to infectious disease threats.