The primary goal of this Pilot Project was to collect data to determine the risk perceptions of impacted Navajo citizens living within three communities on the Navajo Nation, which include Upper Fruitland, NM, Shiprock, NM, and Aneth, UT, within one year of the Gold King Mine spill. Understanding the risk perception could help improve and build effective emergency response to future spills, help citizens improve their understanding of the spill, and further current understanding of exposure pathways by elucidating activities that could increase exposure such as increased contact with sediments through ceremonial practices. Data collected included attending community meetings to understand the concerns of the Navajo citizens regarding the health of the San Juan River, the impacts to health and livelihoods, and the response to the spill. Additional focus group meetings have been held to discuss activities and to refine the exposure pathways by discussing changes in exposure activities before and after the spill and to collect environmental samples to measure arsenic and lead levels. This research is on-going. The rapid approval of the SWEHSC Pilot Project support was essential in allowing the investigators to begin this timely study before NIH support could be obtained. An NIEHS R21 was received to continue this work (ES026948).