Behavioral determinants of arsenic-safe water use among Great Plains Indian Nation private well users: results from the Strong Heart Water Study

Abstract

Background and aim: Long-term arsenic exposure in potable water remains a serious public health challenge in the United States. Rural communities with a high reliance on private wells, including American Indian communities, are disproportionately impacted by arsenic contaminated water. However, efforts to decrease arsenic exposure are limited. The objective of this study is to evaluate the behavioral determinants associated with exclusive arsenic-safe water use in the Strong Heart Water Study (SHWS). Methods: The SHWS is a randomized control trial designed to reduce arsenic exposure in American Indian Great Plains communities. All households received point-of-use arsenic filters installed at baseline and were followed for up to two years. At each visit questionnaires were administered evaluating water use and behavioral determinants based on the RANAS (risks, attitudes, norms, abilities, and self-regulation) model of behavior change. Results: Among 75 participants, exclusive use of arsenic-safe water for drinking and cooking at follow-up was associated with higher baseline levels of perceived disapproval from friends and family for using arsenic-unsafe water for drinking (OR: 0.06, 95% CI: 0.01-0.34) and cooking (0.13, 0.02-0.72) (injunctive norms), greater concern for getting sick from arsenic exposure (0.17, 0.04-0.65) (perceived vulnerability), more self-efficacy to use the arsenic filter for drinking (10.5, 1.49-73.2) and cooking (12.5, 1.88-83.1), and higher arsenic knowledge (6.88, 1.07-44.4). Higher commitment to using the arsenic filter was also a significant predictor of exclusive arsenic-safe water use for drinking (11.7, 1.63-83.5) and cooking (8.43, 1.17-60.8) at follow-up. Exclusive arsenic-safe water use was not associated with sex, age, or education. From baseline to follow-up, the SHWS trial significantly increased perceived vulnerability, self-efficacy, and injunctive norms, and decreased concern about the cost of arsenic filters. Conclusion: Future arsenic interventions in our partner communities should target these behavioral determinants of use of arsenic safe water. Keywords: arsenic, health behavior, water treatment, water