Evaluation of a water arsenic filter in a participatory intervention to reduce arsenic exposure in American Indian communities: The Strong Heart Water Study

Zacher, Tracy; Endres, Kelly; Richards, Francine Red Willow; Robe, Lisa Bear; Powers, Martha; Yracheta, Joseph; Harvey, David; Best, Lyle G.; Cloud, Reno Red; Bear, Annabelle Black; Ristau, Steve; Aurand, Dean; Skinner, Leslie; Cuny, Christa; Gross, M.; Thomas, Elizabeth; Rule, Ana M.; Schwab, Kellogg J.; O’Leary, Marcia; Moulton, Lawrence H.; Navas‐Acien, Ana; George, Christine Marie

doi:10.1016/j.scitotenv.2022.160217

Cited by 6 publications

(6 citation statements)

References 40 publications

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“…This finding was corroborated by recipients, who described that the plumbers had told them that the filter change would be "easy" but in practice it was more complex and difficult than they had expected. This is supported by the quantitative findings from the RCT, which found that only 46% of households changed their filter during the two-year study period [35].…”

Section: Intervention Characteristicsmentioning

confidence: 54%

“…Filter selection was driven by community preferences on the aesthetic quality of water and by local hydrogeology and the technical ability of the filter to efficiently remove target contaminants [11]. Quantitative results from the SHWS RCT indicated that the POU arsenic filters met and exceeded expectations, with 93% of filter-proceeding water below the arsenic MCL at the final follow-up visit during the 2-year study period [35]. This finding was observed despite only 46% of households reporting changing their arsenic filter cartridge within the 2-year program period.…”

Section: Implementation Challenges and Associated Barriers And Facili...mentioning

confidence: 99%

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Implementing a Community-Led Arsenic Mitigation Intervention for Private Well Users in American Indian Communities: A Qualitative Evaluation of the Strong Heart Water Study Program

Anderson

Bear

Zacher

et al. 2023

IJERPH

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Arsenic is a naturally occurring toxicant in groundwater, which increases cancer and cardiovascular disease risk. American Indian populations are disproportionately exposed to arsenic in drinking water. The Strong Heart Water Study (SHWS), through a community-centered approach for intervention development and implementation, delivered an arsenic mitigation program for private well users in American Indian communities. The SHWS program comprised community-led water arsenic testing, point-of-use arsenic filter installation, and a mobile health program to promote sustained filter use and maintenance (i.e., changing the filter cartridge). Half of enrolled households received additional in-person behavior change communication and videos. Our objectives for this study were to assess successes, barriers, and facilitators in the implementation, use, and maintenance of the program among implementers and recipients. We conducted 45 semi-structured interviews with implementers and SHWS program recipients. We analyzed barriers and facilitators using the Consolidated Framework for Implementation Research and the Risks, Attitudes, Norms, Abilities, and Self-regulation model. At the implementer level, facilitators included building rapport and trust between implementers and participating households. Barriers included the remoteness of households, coordinating with community plumbers for arsenic filter installation, and difficulty securing a local supplier for replacement filter cartridges. At the recipient level, facilitators included knowledge of the arsenic health risks, perceived effectiveness of the filter, and visual cues to promote habit formation. Barriers included attitudes towards water taste and temperature and inability to procure or install replacement filter cartridges. This study offers insights into the successes and challenges of implementing an arsenic mitigation program tailored to American Indian households, which can inform future programs in partnership with these and potentially similar affected communities. Our study suggests that building credibility and trust between implementers and participants is important for the success of arsenic mitigation programs.

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Section: Intervention Characteristicsmentioning

confidence: 54%

Section: Implementation Challenges and Associated Barriers And Facili...mentioning

confidence: 99%

Implementing a Community-Led Arsenic Mitigation Intervention for Private Well Users in American Indian Communities: A Qualitative Evaluation of the Strong Heart Water Study Program

Anderson

Bear

Zacher

et al. 2023

IJERPH

Self Cite

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“…The 47% reduction in urinary arsenic from baseline to the final follow-up visit with delivery of the SHWS program is supported by the water arsenic findings from this RCT, where we found that at the final household visit 93% of POU arsenic filters were effective in reducing water arsenic below the US EPA MCL of

. 39 In addition to reducing arsenic exposure, we found a reduction in MMA%, an arsenic metabolite that has been associated with higher risk of cardiovascular disease and cancer. 47 Although significant changes were not observed in DMA% and iAs% for the overall study population, these three main arsenic species are interrelated, and therefore the impact of arsenic metabolism may be better observed in one species, with the additional impact split between the other two species.…”

Section: Discussionmentioning

confidence: 75%

“…Complete study methods have been previously described. 39 – 41 In summary, a two-arm cluster RCT (cRCT) was conducted in a Northern Great Plains American Indian Nation from July 2018 to May 2021, where a cluster was a household (ClinicalTrials.gov Identifier: NCT03725592). Households were recruited through a community-led water arsenic testing program.…”

Section: Methodsmentioning

confidence: 99%

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

George,

Zacher,

Endres

et al. 2024

Environ Health Perspect

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Background: 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. Objective: 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. Methods: A cluster randomized controlled trial (cRCT) was conducted to evaluate the effectiveness of the SHWS arsenic mitigation program over a 2-y period on a ) urinary arsenic, and b ) 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). Results: 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%). Discussion: 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

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“…Epigenetic clocks may also become a tool for evaluating interventions 21 to reduce environmental exposures, says senior author Ana Navas-Acien, a professor of environmental health sciences at Columbia University. Navas-Acien says the communities from which participants were drawn consider these and other SHS findings to be important in helping “motivate additional work and leverage resources to improve their water sources and infrastructure, as well as other health care initiatives.” 22 …”

mentioning

confidence: 99%

Marking Time: Epigenetic Aging May Partially Explain the Arsenic–Cardiovascular Disease Link

Schmidt

2024

Environ Health Perspect

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Evaluation of a water arsenic filter in a participatory intervention to reduce arsenic exposure in American Indian communities: The Strong Heart Water Study

Cited by 6 publications

References 40 publications

Implementing a Community-Led Arsenic Mitigation Intervention for Private Well Users in American Indian Communities: A Qualitative Evaluation of the Strong Heart Water Study Program

Implementing a Community-Led Arsenic Mitigation Intervention for Private Well Users in American Indian Communities: A Qualitative Evaluation of the Strong Heart Water Study Program

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

Marking Time: Epigenetic Aging May Partially Explain the Arsenic–Cardiovascular Disease Link

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