Background
HEART, SECONDARY
Arsenic contamination in potable water has long been recognized as a serious public health concern globally [Reducing arsenic exposure from private wells is challenging. First, homeowners must be aware of their water quality. Arsenic is both tasteless and odorless, meaning that private well users will know their arsenic contamination levels only through water arsenic testing. Many studies have assessed factors influencing well water arsenic testing, identifying barriers such as a lack of awareness, lack of access to testing services, high prices for arsenic tests, and low perceived vulnerability [Significant barriers to reducing arsenic exposure in water used for drinking and cooking often stem from gaining access to, and the sustained use of, arsenic-safe water sources [Only a handful of studies have assessed behavioral and situational factors associated with using and maintaining an arsenic removal device or other mitigation option to reduce arsenic exposure [In this study, we assessed the behavioral determinants associated with arsenic-safe water use based on the Risks, Attitudes, Norms, Abilities, and Self-regulation (RANAS) model of health behavior change [The Strong Heart Water Study (SHWS) is an RCT of a multi-level, community-led arsenic mitigation program to reduce arsenic exposure in drinking and cooking water among the Lakota and Dakota Nations in the American Great Plains region [The primary aim of this study was to prospectively evaluate the behavioral determinants associated with exclusive arsenic-safe water use in the SHWS. The secondary aims were to measure changes in behavioral factors from the beginning to end of the intervention and determine the impact of behavioral determinants on arsenic filter change. This is the first RCT of a water arsenic intervention program in the Americas.