Study design
The SHWS is a collaboration between three Great Plains Nations, the Indian Health Service (IHS), Columbia University, and the Johns Hopkins Bloomberg School of Public Health. This study utilized a two-arm cluster RCT design to determine the effectiveness of a multi-level community-led arsenic mitigation program in reducing arsenic exposure from water used for drinking and cooking (ClinicalTrials.gov Identifier: NCT03725592). Household enrollment took place between July 2018 and November 2019. Final follow-up visits took place between November 2020 and November 2021.