Evaluation of Water Arsenic Filter Treatment in a Participatory Intervention to Reduce Arsenic Exposure in American Indian Communities: The Strong Heart Water Study

• Published in: The Science of the total environment Vol. 862; p. 160217
• Main Authors: Zacher, Tracy, Endres, Kelly, Richards, Francine, Rob, Lisa Bear, Powers, Martha, Yrachet, Joseph, Harvey, David, Best, Lyle G., Red Cloud, Reno, Black Bear, Annabelle, Ristau, Steve, Aurande, Dean, Skinner, Leslie, Cuny, Christa, Gross, Marie, Thomas, Elizabeth, Rule, Ana, Schwab, Kellogg J., O’Leary, Marcia, Moulton, Lawrence H., Navas-Acien, Ana, George, Christine Marie
• Format: Journal Article
• Language: English
• Published: 19-11-2022
• ISSN: 0048-9697; 1879-1026
• DOI: 10.1016/j.scitotenv.2022.160217

Many rural populations, including American Indian communities, using private wells from groundwater for their source of drinking and cooking water are disproportionately exposed to elevated levels of arsenic. However, programs aimed at reducing arsenic in American Indian communities are limited. The Strong Heart Water Study (SHWS) is a randomized controlled trial aimed at reducing arsenic exposure among private well users in American Indian Northern Great Plains communities. The community-led SHWS program installed point of use (POU) arsenic filters in the kitchen sink of households, and health promoters delivered an arsenic health communication program. In this study we evaluated the efficacy of these POU arsenic filters in removing arsenic during the two-year installation period. Participants were randomized into two arms. In the first arm households received a POU arsenic filter, and 3 calls promoting filter use (SHWS mobile health (mHealth) and filter only arm). The second arm received the same filter and phone calls, and 3 in-person home visits and 3 Facebook messages (SHWS intensive arm) for program delivery. Temporal variability in water arsenic concentrations from the main kitchen faucet was also evaluated. A total of 283 water samples were collected from 50 households with private wells from groundwater (139 filter and 144 kitchen faucet samples). Ninety-three percent of households followed after baseline had filter faucet water arsenic concentrations below the arsenic maximum contaminant level of 10 μg/L with no difference between study arms (98% in the intensive arm vs. 94% in the mHealth and filter only arm). No significant temporal variation in kitchen arsenic concentration was observed over the study period (intraclass correlation coefficient = 0.99). This study demonstrates that POU arsenic filters installed for the community participatory SHWS program were effective in reducing water arsenic concentration in study households in both arms, even with only delivery of the POU arsenic filter and mHealth program. Furthermore, we observed limited temporal variability of water arsenic concentrations from kitchen faucet samples collected over time from private wells in our study setting.