Why Test Drinking Water for Nitrates: Client Education
This one-page handout makes the case for testing drinking water for nitrates and gives clients clear next steps. It covers:
The health problems linked to high nitrate levels.
How nitrate can pull other contaminants into groundwater.
A simple scale of the key levels.
What does and doesn't reduce nitrate.
Where to go with questions.
Use it with clients on private wells, families in farming areas, and households with a pregnant family member or an infant. It works well as a first conversation. For a closer look at what specific nitrate levels mean, pair it with the Nitrates in Drinking Water: Health Risks for Clients handout.
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Start Free TrialResource Inspiration
This handout came out of our course, "OT, Nitrates, and Cancer Prevention," with Jesse E. Bell, PhD, of the University of Nebraska Medical Center. A theme of the conversation was that awareness comes first: people can't reduce a risk they don't know about.
Dr. Bell also raised a common gap. Families are told to test their wells, then left without guidance when the result comes back high. This handout tries to close that gap by putting the reason to test, the fix, and the places to get help on one page.
Resource Utilization
Use this handout early, when a client hasn't tested their water or isn't sure why it matters. It fits naturally into a home health visit, a primary care referral for prevention education, or a caregiver conversation about an infant's formula.
The back half of the page is built for action. Walk through the "Reduce Nitrates Impact" section together, and help the client figure out who to contact first.
Supporting Evidence
The federal limit for nitrate in public drinking water is 10 mg/L. It was set to protect infants from blue baby syndrome (methemoglobinemia), a condition where the blood can't carry enough oxygen.
Newer studies have linked long-term exposure, including at levels below the federal limit, to certain cancers and birth outcomes. These are associations, not proof of cause. The Nitrates in Drinking Water: Health Risks for Clients page summarizes the key studies.
The "compounds problems" point is supported for uranium. A 2023 University of Nebraska–Lincoln study found that nitrate can release naturally occurring uranium into groundwater.
The action steps match public health guidance:
The CDC recommends that private well owners test for nitrates at least once a year.
The Minnesota Department of Health notes that boiling water makes nitrate more concentrated.
This handout is a starting point, not a final word. Research on nitrate and long-term health is still developing, and new studies may change what we know. We encourage you to read the linked studies, stay current with the literature, and use your clinical judgment when applying this information with clients. Clients with questions about their own water or health risks should talk with their physician or local health department.
Instructions and Tips
Lead with the fix. Clients may feel alarmed by the list of health conditions. Point out early that there's a clear next step: test, and treat the water if needed. Treat this as a conversation about lowering risk, not preventing disease.
Clear up common myths. Many people assume boiling or a pitcher filter makes water safe. Neither removes nitrate, and boiling actually concentrates it. This is often the most useful minute of the conversation.
Talk through reverse osmosis options:
Under-sink system. It treats the kitchen tap and costs in the hundreds of dollars.
Whole-house system. It costs in the thousands.
Upkeep. Either system needs regular filter changes. Retesting after installation confirms it's working.
Know your local resources. In Nebraska, the Department of Water, Energy, and Environment (DWEE) has offered free nitrate sample kits and a reverse osmosis rebate for private well owners. Some Natural Resources Districts run their own programs. These programs change, so check what's current before sharing.
Adapt it for your state. The "If You Have Questions" section links to a Nebraska resource. Outside Nebraska, point clients to your state or local health department instead.