Developing a Hybrid Type 1 Effectiveness-Implementation Randomized Trial to Test a Table-Top Water Pitcher to Reduce Arsenic Exposure in Northern New England

Dartmouth College, Hanover NH

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Abstract

PROJECT SUMMARY Arsenic ranks first on the Agency for Toxic Substances and Disease Registry list of priority contaminants due to its known toxicity and the high potential for human exposure. In addition to being an established carcinogen, arsenic has been associated with a growing number of non-cancer outcomes, including cardiovascular disease. Contaminated drinking water is the primary source of arsenic exposure worldwide. In the U.S., populations that depend on private wells for their drinking water are particularly susceptible to arsenic exposure, as private well water is not regulated. Because arsenic is tasteless, odorless, and colorless, the only way to determine if drinking water is contaminated with arsenic is to test a water sample through a certified laboratory. However, because private well water is not regulated, this burden falls on the individual, and consequently arsenic testing rates are typically low. Even after learning of elevated arsenic concentrations in their drinking water, many people continue using the contaminated well water for cooking and drinking. This is due in part to the cost and feasibility of implementing existing mitigation strategies, such as installing point-of- entry reverse osmosis filtration systems. As a result, there has been growing interest in table-top water pitchers as a possible low-cost and accessible option for reducing exposure to arsenic-contaminated drinking water. Although a table-top pitcher has been identified that effectively reduces water arsenic concentrations in the laboratory, its real-world effectiveness has not been tested. Additionally, barriers and facilitators to the adoption, use, and sustainability of these pitchers have not been identified. There is therefore a need for a hybrid type 1 randomized trial to test the effectiveness and explore the implementation of a table-top water pitcher for reducing exposure to arsenic-contaminated drinking water. Through the proposed COBRE Research Project, Dr. Howe (Research Project Leader) will gain expertise in implementation science methods and conduct a feasibility study to generate preliminary data for an R01 application that supports the development of this hybrid type 1 trial. The initial feasibility study will focus on New Hampshire residents, as this is a state with a particularly high prevalence of private well users (50%) and elevated arsenic (25% of wells). The subsequent hybrid type 1 trial will be scaled up to other populations across northern New England, and future studies may further expand this to other IDeA states where arsenic exposure is also a major public health threat. Findings from these studies may identify a low-cost and accessible intervention for reducing exposure to a priority environmental toxicant and will inform strategies that improve the implementation of this intervention.