Develop and evaluate the effectiveness of multi-level participatory interventions in reducing arsenic exposure among American Indian (AI) communities from North and South Dakota who participated in the Strong Heart Study (SHS).

Design, implement, and evaluate multi-level participatory interventions that can lead to a sustained reduction in arsenic exposure in adults and children in Cheyenne River, Oglala, and Spirit Lake communities in North/South Dakota by: 1) building local capacity at the tribal and community levels to ensure the long-term sustainability of the interventions. 2) conduct a 2-arm cluster-randomized controlled trial comparing arsenic removal device only to removal device and intensive education and promotion among 300 households, 600 participants.

Inclusion Criteria:

• Arsenic levels in household drinking water must be ≥10 µg/L
• Households must have ≥1 adult ≥18 years of age eligible and willing to participate.
• Household must have an active well on the property that is used for drinking water.
• Household must have indoor plumbing and a permanent heat source.
• Participant must plan to reside in the household for the next year, must reside in the residence for ≥4 days/week, and year round (i.e. all seasons).
• ≥1 household members must identify as American Indian.
• Household must be willing to grant study members access to the interior of their household for screening and data collection.

Exclusion Criteria:

• Arsenic levels in household drinking water <10 µg/L
• Households with no adult ≥18 years of age eligible and willing to participate.
• Households without an active well on the property that is used for drinking water (i.e. connected to municipal water supply).
• Households without indoor plumbing and/or a permanent heat source.
• Participant planning to reside in the household <1 year, residing in the residence for <4 days/week, or not year round (i.e. not during all seasons).
• No household member identifies as American Indian.
• Household unwilling to grant study members access to the interior of their household for screening and data collection.