Effect of an Arsenic Mitigation Program on Arsenic Exposure in American Indian Communities: A Cluster Randomized Controlled Trial of the Community-Led Strong Heart Water Study Program

• Published in: Environmental health perspectives Vol. 132; no. 3; p. 37007
• Main Authors: George, Christine Marie, Zacher, Tracy, Endres, Kelly, Richards, Francine, Bear Robe, Lisa, Harvey, David, Best, Lyle G, Red Cloud, Reno, Black Bear, Annabelle, Skinner, Leslie, Cuny, Christa, Rule, Ana, Schwab, Kellogg J, Gittelsohn, Joel, Glabonjat, Ronald Alexander, Schilling, Kathrin, O'Leary, Marcia, Thomas, Elizabeth D, Umans, Jason, Zhu, Jianhui, Moulton, Lawrence H, Navas-Acien, Ana
• Format: Journal Article
• Language: English
• Published: United States National Institute of Environmental Health Sciences 01-03-2024; Environmental Health Perspectives
• Subjects: American Indian or Alaska Native; Arsenic; Arsenic - urine; Bangladesh; Cardiovascular diseases; Control; Creatinine; Drinking Water - chemistry; Environmental aspects; Environmental remediation; Health aspects; Humans; India; Methods; Mortality; Native Americans; Pancreatic cancer; Telemedicine; United States; Water; Water pollution; United States; Bangladesh; India
• ISSN: 0091-6765; 1552-9924
• DOI: 10.1289/EHP12548

Chronic arsenic exposure has been associated with an increased risk of cardiovascular disease; diabetes; cancers of the lung, pancreas and prostate; and all-cause mortality in American Indian communities in the Strong Heart Study.
The Strong Heart Water Study (SHWS) designed and evaluated a multilevel, community-led arsenic mitigation program to reduce arsenic exposure among private well users in partnership with Northern Great Plains American Indian Nations.
A cluster randomized controlled trial (cRCT) was conducted to evaluate the effectiveness of the SHWS arsenic mitigation program over a 2-y period on
) urinary arsenic, and
) reported use of arsenic-safe water for drinking and cooking. The cRCT compared the installation of a point-of-use arsenic filter and a mobile Health (mHealth) program (3 phone calls; SHWS mHealth and Filter arm) to a more intensive program, which included this same program plus three home visits (3 phone calls and 3 home visits; SHWS Intensive arm).
A 47% reduction in urinary arsenic [
creatinine] was observed from baseline to the final follow-up when both study arms were combined. By treatment arm, the reduction in urinary arsenic from baseline to the final follow-up visit was 55% in the mHealth and Filter arm (
creatinine) and 30% in the Intensive arm (
creatinine). There was no significant difference in urinary arsenic levels by treatment arm at the final follow-up visit comparing the Intensive vs. mHealth and Filter arms: GM ratio of 1.21 (95% confidence interval: 0.77, 1.90). In both arms combined, exclusive use of arsenic-safe water from baseline to the final follow-up visit significantly increased for water used for cooking (17% to 53%) and drinking (12% to 46%).
Delivery of the interventions for the community-led SHWS arsenic mitigation program, including the installation of a point-of-use arsenic filter and a mHealth program on the use of arsenic-safe water (calls only, no home visits), resulted in a significant reduction in urinary arsenic and increases in reported use of arsenic-safe water for drinking and cooking during the 2-y study period. These results demonstrate that the installation of an arsenic filter and phone calls from a mHealth program presents a promising approach to reduce water arsenic exposure among private well users. https://doi.org/10.1289/EHP12548.