This study will examine the effectiveness of an intervention to reduce household exposure to arsenic in private well water in American Indian communities. The study will be the first randomized controlled trial of an arsenic intervention in the US. Furthermore, the results of this research are of interest to the Indian Health Service as they are currently looking at ways to improve community outreach practice.
Arsenic is a highly toxic element found in drinking water, particularly in rural, private wells, including those in American Indian communities. Exposure to arsenic was associated with an increased risk of cardiovascular disease, diabetes, kidney disease, and cancer in American Indians from Arizona, Oklahoma, and North/South Dakota who participated in the Strong Heart Study (SHS). The SHS is the largest study of cardiovascular disease and its risk factors in American Indians, and has been working with these communities for more than 25 years. The SHS findings highlight the need to prevent arsenic exposure in these populations, especially in North and South Dakota, where naturally occurring arsenic in private well water is often above the current US Environmental Protection Agency (EPA) safety standard of 10 g/L.
Households within SHS communities in North and South Dakota that use private wells as their source of water for drinking and cooking, and whose arsenic levels are higher than the EPA safety standard, will have arsenic removal devices installed in their homes. Two methods of communicating the importance of reducing arsenic in water sources will be compared in randomly selected household to see which is most effective at reducing arsenic exposure. A single home visit at the time the arsenic removal device is installed with written maintenance instructions will be compared to multiple home visits by a community promoter to deliver an intensive educational health program. Final interventions will be selected by community members through Community Advisory Board Workshops.