Int. J. Environ. Res. Public Health 2011, 8 576 private or public system. Water resource quantity and income might also be driving forces for the differences. Further research is needed to better explain regional variations. 4. Conclusions Water is essential to human health and life. Access to safe water supplies and affordability are central concerns of public health and individual consumers. In this study we find that perceptions of ground water quality and local water supply safety are associated with decisions to purchase bottled water versus use public water systems for drinking water. When local water is not considered safe or of high quality U.S. consumers are more likely to use bottled water as a primary water source. Furthermore, negative perceptions of safety increase the likelihood of a consumer frequently purchasing bottled water regardless of whether their primary source of drinking water is a small water system or large municipal water supply system. Two key implications of our findings are that (1) public health officials and community leaders need to work to assure that public municipal drinking water supplies are safe; in addition, they should find effective ways to communicate to local residents the safety of their water supply; and (2) environmental leaders and activists need to campaign about the long lasting impacts of plastic water bottles. Further the public must be engaged in understanding the relationship of water quality to the capacity of local water systems to maintain safety and good taste standards. Consumer distrust of their groundwater quality should be leveraged to create community action to address legitimate concerns. Acknowledgements This research was partially funded by the National Institute of Food and Agriculture (NIFA), U.S. Department of Agriculture (USDA) under agreement 2008-51130-19526 also known as the Heartland Regional Water Coordination Initiative, the Iowa Agriculture and Home Economics Experiment Station, and USDA agreement 2008-51130-0474, also known as the Pacific Northwest Regional Water Resources Coordination Project. References and Notes 1. 2. 3. 4. 5. Gleick, P.H. The myth and reality of bottled water. In The World’s Water: The Biennial Report on Freshwater Resources 2004–2005; Island Press: Washington, DC, USA, 2004. Smaller Categories Still Saw Growth as the U.S. Liquid Refreshment Beverage Market Shrank by 2.0% in 2008; Beverage Marketing: New York, NY, USA, 31 August 2009. Available online: http://www.beveragemarketing.com/?section=news&newsID=111 (accessed on 26 September 2010). Lalumandier J.A.; Ayers, L.W. Fluoride and bacterial content of bottled water vs. tap water. Arch. Fam. Med. 2000, 9, 246-250. Raj, S.D. Bottled water: how safe is it? Water Environ. Res. 2005, 77, 3013-3018. Glennon, R.J. Water Follies: Groundwater Pumping and the Fate of America’s Fresh Waters; Island Press: Washington, DC, USA, 2002; pp. 1-3.