Behavioral Determinants of Arsenic-safe Water Use Among Great Plains Indian Nation Private Well Users: Results from The Community-Led Strong Heart Water Study Arsenic Mitigation Program

Overview

Journal Environ Health

Publisher Biomed Central

Specialty Environmental Health

Date 2023 May 14

PMID 37183246

Authors

Kelly Endres

Tracy Zacher

Francine Richards

Lisa Bear Robe

Martha Powers

Joseph Yracheta

David Harvey

Lyle G Best

Reno Red Cloud

Annabelle Black Bear

Steve Ristau

Dean Aurand

Leslie Skinner

Jamie Perin

Christa Cuny

Marie Gross

Elizabeth D Thomas

Ana Rule

Kellogg Schwab

Lawrence H Moulton

Marcia OLeary

Ana Navas-Acien

Christine Marie George

Affiliations

Soon will be listed here.

Abstract

Background: The objective of this study was to evaluate the behavioral determinants associated with exclusive use of arsenic-safe water in the community-led Strong Heart Water Study (SHWS) arsenic mitigation program.

Methods: The SHWS is a randomized controlled trial of a community-led arsenic mitigation program designed to reduce arsenic exposure among private well users in American Indian Great Plains communities. All households received point-of-use (POU) arsenic filters installed at baseline and were followed for 2 years. Behavioral determinants selected were those targeted during the development of the SHWS program, and were assessed at baseline and follow-up.

Results: Among participants, exclusive use of arsenic-safe water for drinking and cooking at follow-up was associated with higher self-efficacy for accessing local resources to learn about arsenic (OR: 5.19, 95% CI: 1.48-18.21) and higher self-efficacy to resolve challenges related to arsenic in water using local resources (OR: 3.11, 95% CI: 1.11-8.71). Higher commitment to use the POU arsenic filter faucet at baseline was also a significant predictor of exclusive arsenic-safe water use for drinking (OR: 32.57, 95% CI: 1.42-746.70) and cooking (OR: 15.90, 95% CI: 1.33-189.52) at follow-up. From baseline to follow-up, the SHWS program significantly increased perceived vulnerability to arsenic exposure, self-efficacy, descriptive norms, and injunctive norms. Changing one's arsenic filter cartridge after installation was associated with higher self-efficacy to obtain arsenic-safe water for drinking (OR: 6.22, 95% CI: 1.33-29.07) and cooking (OR: 10.65, 95% CI: 2.48-45.68) and higher perceived vulnerability of personal health effects (OR: 7.79, 95% CI: 1.17-51.98) from drinking arsenic-unsafe water.

Conclusions: The community-led SHWS program conducted a theory-driven approach for intervention development and evaluation that allowed for behavioral determinants to be identified that were associated with the use of arsenic safe water and changing one's arsenic filter cartridge. These results demonstrate that theory-driven, context-specific formative research can influence behavior change interventions to reduce water arsenic exposure. The SHWS can serve as a model for the design of theory-driven intervention approaches that engage communities to reduce arsenic exposure.

Trial Registration: The SHWS is registered with ClinicalTrials.gov (Identifier: NCT03725592).

Citing Articles

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 C, Zacher T, Endres K, Richards F, Robe L, Harvey D Environ Health Perspect. 2024; 132(3):37007.

PMID: 38534131 PMC: 10967367. DOI: 10.1289/EHP12548.

An overview of the Be Well Home Health Navigator Program to reduce contaminants in well water: Design and methods.

Irvin V, Kile M, Lucas-Woodruff C, Cude C, Anderson L, Baylog K Contemp Clin Trials. 2024; 140:107497.

PMID: 38471641 PMC: 11065571. DOI: 10.1016/j.cct.2024.107497.

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 D, Black Bear A, Zacher T, Endres K, Saxton R, Richards F Int J Environ Res Public Health. 2023; 20(3).

PMID: 36768048 PMC: 9915175. DOI: 10.3390/ijerph20032681.

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