Participatory Interventions to Reduce Arsenic in American Indian Communities

 描述(申请人提供)：背景：在强心研究(SHS)中，在亚利桑那州、俄克拉何马州和北/南达科他州的美国印第安人(AI)中，慢性低到中等砷暴露于饮用水中与心血管疾病、糖尿病、肾脏疾病和癌症的风险增加有关。迫切需要有效的干预措施，以减少人工智能社区的砷暴露，这些社区依赖私人水井作为饮用水和烹饪的主要水源。目的：本研究的目的是设计、实施和评估多层次参与性干预措施，以持续减少北/南达科他州人工智能社区的砷暴露，这些社区仍然暴露在饮用水中砷水平较高的环境中。初步研究：在最近的一项初步研究中，来自北达科他州的SPIRIT湖和南达科他州的Pine Ridge的50%的私人水井的饮用水砷含量超过了美国环保局的标准(10？g/L)。设计和背景：本研究将分为三个阶段：(1)形成性研究和规划；(2)多层次干预的实施和评估；(3)在家庭、部落、地区和国家各级的传播。形成研究和规划阶段将通过深入访谈和焦点小组讨论、社区咨询委员会讲习班和试点研究来开发和试点砷干预措施。我们将建设当地的能力，以确保干预计划的长期可持续性，方法是为社区成员制定培训计划，使用快速现场试剂盒测试水源中的砷，安装和维护使用点砷去除设备，并传播已开发的健康信息。在干预阶段，我们将进行一项双臂随机对照试验，前瞻性地跟踪300户家庭和600名参与者(每户2人)，以评估所开发的多水平干预在6个月期间降低尿砷浓度以及心血管疾病(细胞黏附分子)和糖尿病(糖化血红蛋白)生物标志物的有效性。第一个ARM将在社区推动者的一次家访期间接受水砷测试和除砷设备(标准计划)。第二个ARM将接受水砷检测，一个除砷设备，以及一个由社区推动者进行的5次家访的强化健康促进计划(密集健康促进计划)。为了评估长期可持续性，我们将测量尿液和水中的砷，并在基线后1至3年收集基于水表的用水量和自我报告的设备维护数据。在传播阶段，我们将与部落首领和印度卫生服务密切合作，传播研究结果，并制定可持续的砷缓解政策，以升级已制定的干预计划，将其他人工智能社区包括在内。意义：这项研究将是第一次开发、实施和评估参与性多水平干预措施，以减少人工智能社区私人水井中的砷暴露，并确定干预措施是否可以减少砷暴露以及心血管疾病和糖尿病的早期生物标志物。

 DESCRIPTION (provided by applicant): Background: In the Strong Heart Study (SHS), chronic low-to-moderate arsenic exposure in drinking water is associated with an increased risk of cardiovascular disease, diabetes, kidney disease, and cancer in American Indians (AI) from Arizona, Oklahoma, and North/South Dakota. Effective interventions are urgently needed to mitigate arsenic exposure in AI communities who rely on private wells as the main source of water for drinking and cooking. Objective: The purpose of the study is to design, implement, and evaluate multi-level participatory interventions that can lead to a sustained reduction in arsenic exposure in AI communities in North/South Dakota that remained exposed to elevated arsenic levels in drinking water. Preliminary studies: In a recent pilot study, >50% of private wells from Spirit Lake (North Dakota) and Pine Ridge (South Dakota) had arsenic levels in drinking water exceeding the US Environmental Protection Agency standard (10 ¿g/L). Design and setting: This study will be divided into 3 phases: (1) Formative research and planning; (2) Implementation and evaluation of the multi-level intervention; and (3) Dissemination at the household, tribal, regional, and national levels. The formative research and planning phase will develop and pilot arsenic interventions through in- depth interviews and focus group discussions, a community advisory board workshop, and a pilot study. We will build local capacity to ensure the long-term sustainability of the intervention program by developing a training program for community members to test water sources for arsenic using rapid field kits, installing and maintaining point of use arsenic removal devices, and disseminating the developed health messages. During the intervention phase we will conduct a two-arm cluster-randomized controlled trial to prospectively follow 300 households and 600 participants (2 per household) to evaluate the effectiveness of the developed multi- level intervention in reducing urine arsenic concentrations and biomarkers of cardiovascular disease (cell adhesion molecules) and diabetes (glycated hemoglobin) during a 6 month period. The first arm will receive water arsenic testing and an arsenic removal device during one home visit by a community promoter (standard program). The second arm will receive water arsenic testing, an arsenic removal device, and an intensive health promotion program of 5 home visits by a community promoter (intensive health promotion program). To assess the long-term sustainability, we will measure arsenic in urine and water, and collect meter-based water use and self-reported device maintenance data 1 to 3 years after baseline. During the dissemination phase, we will work closely with tribal leaders and the Indian Health Service to disseminate study findings and develop sustainable arsenic mitigation policies to upscale the developed intervention programs to include other AI communities. Significance: This study will be the first to develop, implement, and evaluate a participatory multi-level intervention to reduce arsenic exposure from private wells in AI communities and to determine if the intervention can reduce arsenic exposure and early biomarkers of cardiovascular disease and diabetes.