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Purpose: Native Americans and Latinos have higher COVID‐19 infection and mortality rates and may have limited access to diagnostic testing. Home‐based testing may improve access to care in rural and underserved populations. This study tests the effect of community health worker (CHW) support on accessibility, feasibility, and completion of COVID‐19 home testing among Native American and Latino adults living on the Flathead Reservation in Montana and in Yakima Valley, Washington. Methods: A two‐arm, multisite, pragmatic randomized controlled trial was conducted using block randomization stratified by site and participant age. Active arm participants received CHW assistance with online COVID‐19 test kit registration and virtual swabbing support. The passive arm participants received standard‐of‐care support from the kit vendor. Logistic regression modeled the association between study arm and test completion (primary outcome) and between study arm and test completion with return of valid test results (secondary outcome). Responses to posttest surveys and interviews were summarized using deductive thematic analysis. Findings: Overall, 63% of participants (n = 268) completed COVID‐19 tests, and 50% completed tests yielding a valid result. Active arm participants had higher odds of test completion (odds ratio: 1.66, 95% confidence interval [1.01, 2.75]). Differences were most pronounced among adults ≥60 years. Participants cited ease of use and not having to leave home as positive aspects, and transportation and mailing issues as negative aspects of home‐based testing. Conclusions: CHW support led to higher COVID‐19 test completion rates, particularly among older adults. Significant testing barriers included language, educational level, rurality, and test kit issues. [ABSTRACT FROM AUTHOR]

The nitrogen and oxygen isotopic compositions of nitrate in pore water extracts from unsaturated zone (UZ) core samples and groundwater samples indicate at least four potential sources of nitrate in groundwaters at the U.S. DOE Hanford Site in south-central Washington. Natural sources of nitrate identified include microbially produced nitrate from the soil column (δ15N of 4-8‰ , δ18O of -9 to 2‰) and nitrate in buried caliche layers (δ15N of 0-8‰, δ18O of -6 to 42‰). Isotopically distinct industrial sources of nitrate include nitric acid in low-level disposal waters (δ15N ≈ 0‰, δ18O ≈ 23‰) and co-contaminant nitrate in high-level radioactive waste from plutonium processing (δ15N of 8-33‰, δ18O of 9 to 7‰). The isotopic compositions of nitrate from 97 groundwater wells with concentrations up to 1290 mg/L NO3- have been analyzed. Stable isotope analyses from this study site, which has natural and industrial nitrate sources, provide a tool to distinguish nitrate sources in an unconfined aquifer where concentrations alone do not These data indicate that the most common sources of high nitrate concentrations in groundwater at Hanford are nitric acid and natural nitrate flushed out of the UZ during disposal of low-level wastewater. Nitrate associated with high-level radioactive UZ contamination does not appear to be a major source of groundwater nitrate at this time. [ABSTRACT FROM AUTHOR]