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Yu Chen,^1,2 Alexander van Geen,³ Joseph H. Graziano,⁴ Alexander Pfaff,⁵ Malgosia Madajewicz,⁶ Faruque Parvez,⁴ A.Z.M. Iftekhar Hussain,⁷ Vesna Slavkovich,⁴ Tariqul Islam,⁸ and Habibul Ahsan^1,9

¹Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA; ²Department of Environmental Medicine and New York University Cancer Institute, New York University School of Medicine, New York, New York, USA; ³Lamont-Doherty Earth Observatory of Columbia University, Palisades, New York, USA; ⁴Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, USA; ⁵The Earth Institute, Columbia University, New York, New York, USA; ⁶Department of Economics, School of International and Public Affairs, Columbia University, New York, New York, USA; ⁷National Institute of Preventive and Social Medicine, Dhaka, Bangladesh; ⁸Columbia University Arsenic Research Project, Dhaka, Bangladesh; ⁹Departments of Health Studies, Medicine, and Human Genetics, University of Chicago Cancer Research Center, Chicago, Illinois, USA

Abstract
Background: There is a need to identify and evaluate an effective mitigation program for arsenic exposure from drinking water in Bangladesh.

Objective: We evaluated the effectiveness of a multifaceted mitigation program to reduce As exposure among 11,746 individuals in a prospective cohort study initiated in 2000 in Araihazar, Bangladesh, by interviewing participants and measuring changes in urinary As levels.

Methods: The interventions included a) person-to-person reporting of well test results and health education ; b) well labeling and village-level health education ; and c) installations of 50 deep, low-As community wells in villages with the highest As exposure.

Results: Two years after these interventions, 58% of the 6,512 participants with unsafe wells (As ≥ 50 µg) at baseline had responded by switching to other wells. Well labeling and village-level health education was positively related to switching to safe wells (As < 50 µg/L) among participants with unsafe wells [rate ratio (RR) = 1.84 ; 95% confidence interval (CI) , 1.60–2.11] and inversely related to any well switching among those with safe wells (RR = 0.80 ; 95% CI, 0.66–0.98) . The urinary As level in participants who switched to a well identified as safe (< 50 µg As/L) dropped from an average of 375 µg As/g creatinine to 200 µg As/g creatinine, a 46% reduction toward the average urinary As content of 136 µg As/g creatinine for participants that used safe wells throughout. Urinary As reduction was positively related to educational attainment, body mass index, never-smoking, absence of skin lesions, and time since switching (p for trend < 0.05) .

Conclusions: Our study shows that testing of wells and informing households of the consequences of As exposure, combined with installation of deep community wells where most needed, can effectively address the continuing public health emergency from arsenic in drinking water in Bangladesh.

Key words: arsenic, Bangladesh, epidemiology, environmental epidemiology, intervention. Environ Health Perspect 115:917–923 (2007) . doi:10.1289/ehp.9833 available via http://dx.doi.org/ [Online 5 February 2007]

Address correspondence to H. Ahsan, Department of Health Studies, The University of Chicago, 5841 South Maryland Ave., Suite N102, Chicago, IL 60637 USA. Telephone: (773) 834-9956. Fax: (773) 834-0139. E-mail: habib@uchicago.edu

We thank our staff, field workers, and study participants in Bangladesh, without whom this work would not have been possible.

This research was supported by grants P42ES10349, P30ES09089, and ES000260 from the National Institute of Environmental Health Sciences, and grants R01CA107431, R01CA102484, and CA016087 from the National Institutes of Health.

The authors declare they have no competing financial interests.

Received 16 October 2006 ; accepted 5 February 2007.