tag:theconversation.com,2011:/id/topics/blood-lead-levels-23848/articlesBlood lead levels – The Conversation2024-03-07T13:32:32Ztag:theconversation.com,2011:article/2180212024-03-07T13:32:32Z2024-03-07T13:32:32ZLead from old paint and pipes is still a harmful and deadly hazard in millions of US homes<figure><img src="https://images.theconversation.com/files/572091/original/file-20240130-19-tg1jv8.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3763%2C2822&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">When lead-based paint blisters and cracks, lead dust may be released in the air. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/lead-based-paint-abatement-royalty-free-image/1735464372?phrase=lead%2Bpoisoning%2B">Douglas Rissing/iStock via Getty Images Plus</a></span></figcaption></figure><p>Lead is a potent neurotoxin that causes severe health effects such as <a href="https://doi.org/10.1186/s12889-023-15874-7">neurological damage, organ failure and death</a>. </p>
<p>Widely used in products such as paint and gasoline until the late 1970s, lead continues to contaminate environments and harm the health of people around the world. </p>
<p>The World Health Organization estimates that more than <a href="https://www.who.int/news-room/fact-sheets/detail/lead-poisoning-and-health#">1 million deaths each year are attributable to lead poisoning</a>, with the highest exposures in developing nations. Lead continues leaching from old paint, pipes and industrial sources into soils, homes and waterways across the globe. </p>
<p>In more recent years, this number has risen at an incredible pace, with some research showing that nearly 5.5 million adults <a href="https://doi.org/10.1016/S2542-5196(23)00166-3">die from lead-related health complications</a>.</p>
<p>I am a <a href="https://hhs.purdue.edu/directory/aaron-specht/">health physicist</a> and my research focuses on ways to improve the technology <a href="https://doi.org/10.1021/acs.est.0c06622">used to screen for lead</a> and other <a href="https://doi.org/10.1021/acs.est.1c00937">environmental toxicants</a>. In developing and applying my technologies to see how people are affected by toxicants like lead, I have tested more than 20,000 people around the world over the past five years.</p>
<p>This preventable health crisis especially threatens children during periods of <a href="https://doi.org/10.1289/ehp.7688">critical brain development</a> but can also <a href="https://doi.org/10.1093/aje/kwh333">impair intellectual development</a> and <a href="https://doi.org/10.1016/S2468-2667(18)30025-2">long-term health</a> in adults. Understanding and addressing this persistent problem will require improved monitoring, targeted remediation and a great deal more awareness and dialogue.</p>
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<figcaption><span class="caption">Lead is especially toxic to children under age 6.</span></figcaption>
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<h2>How lead damages the body</h2>
<p>Lead enters the body through three routes: <a href="https://www.atsdr.cdc.gov/csem/leadtoxicity/exposure_routes.html">ingestion, absorption or inhalation</a>. Once inside, <a href="https://doi.org/10.3390/ijerph182212051">lead mimics calcium</a> by binding to proteins and enzymes where calcium is typically involved. </p>
<p>Lead looks a lot like calcium to many of the systems in our body. By hijacking these calcium-dependent processes, lead disrupts many normal functions ranging from neurological function to cardiovascular health. </p>
<p>When lead replaces calcium in these processes, it causes <a href="https://www.who.int/news-room/fact-sheets/detail/lead-poisoning-and-health#">irreversible damage</a>, even at low levels of chronic exposure. Studies show that low levels of lead are associated with dangerous <a href="https://doi.org/10.1016%2Fj.envres.2016.10.007">lifelong illnesses such as Alzheimer’s</a> and <a href="https://doi.org/10.1289%2Fehp.9785">heart disease</a>.</p>
<p>Furthermore, like calcium, lead accumulates <a href="https://doi.org/10.1289/ehp.919133">in our teeth and bones</a>. This compounds lead’s adverse effects as our bodies grow and age, since the lead in bone will reappear as our body looks to its calcium stores during periods of growth or, critically, during pregnancy. </p>
<p>Lead exposure can come from many sources in our daily life, from water systems using <a href="https://www.epa.gov/ground-water-and-drinking-water/lead-service-lines">lead water lines</a> and <a href="https://www.hud.gov/program_offices/healthy_homes/healthyhomes/lead">legacy exposures from old paint</a> to things that people often don’t think about, such as <a href="https://doi.org/10.1016/j.envres.2023.115719">lead in firearms</a> or <a href="https://doi.org/10.1016/j.envres.2020.109860">metal pots and pans</a>. </p>
<p>Researchers often see <a href="https://doi.org/10.1001/jamapediatrics.2018.2382">exposures from soils</a> in highly polluted areas, but sometimes it can be <a href="https://doi.org/10.1016/j.jenvman.2022.115904">present in old donated toys</a> at a child’s day care. </p>
<p>Late in 2023, investigators working with the Centers for Disease Control and Prevention found <a href="https://www.cdc.gov/nceh/lead/news/lead-poisoning-outbreak-linked-to-cinnamon-applesauce-pouches.html">dangerous levels of lead in applesauce</a>, likely stemming from a cinnamon spice grinder. This highlights the <a href="https://www.nytimes.com/2024/02/27/world/europe/lead-applesauce-food-safety.html">Food and Drug Administration’s failures</a> in keeping lead out of the U.S. food supply. </p>
<h2>Fragmented testing</h2>
<p>Blood lead screening <a href="https://www.cdc.gov/nceh/lead/data/national.htm">serves as the first line of defense</a> against lead exposure, particularly in high-risk individuals and primarily in children. However, <a href="https://toxicfreefuture.org/research/children-at-risk/state-lead-screening-policies/">testing protocols and recommendations vary widely</a>, and most states lack universal testing mandates. </p>
<p>Even in cases where universal screening programs exist, the data obtained can be insufficient. This is because blood tests capture only recent exposure, and universal testing oftentimes mandates only one test of children within a six-year window. </p>
<p>This fragmented system, combined with research indicating that many doctors <a href="https://doi.org/10.1136/oemed-2023-109210">deviate from lead testing guidelines</a>, allows exposures to go undetected until irreversible neurological damage has been done. </p>
<p>We are hopeful that as research like ours draws more attention to the gravity of this issue, universal, standardized screening will become the norm across the U.S. This would save many children – and generations to come – from ongoing and preventable exposures.</p>
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<figcaption><span class="caption">Lead toxicity doesn’t affect just children.</span></figcaption>
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<h2>How testing is done</h2>
<p>Monitoring lead levels typically involves a <a href="https://www.cdc.gov/nceh/lead/prevention/blood-lead-levels.htm">simple blood test</a>, generally ordered by your doctor. These tests are widely available but <a href="https://doi.org/10.1016/j.chemosphere.2021.129832">can easily be inaccurate</a> based on when the test was taken. Since <a href="https://doi.org/10.1038%2Fs41370-018-0036-y">blood lead levels can change quickly</a>, children who get tested several weeks after exposure could falsely test as normal. </p>
<p>Moreover, because there is no requirement for doctors to be trained in how to test for and treat lead exposure, many pediatricians <a href="https://doi.org/10.1136/oemed-2023-109210">lack awareness about lead screening protocols</a>. As a result, many at-risk people <a href="https://doi.org/10.1289/EHP10335">are not being tested</a>. </p>
<p>When tests are given, they may yield inaccurate results due to the <a href="https://doi.org/10.1038%2Fs41370-018-0036-y">rapid changes in blood lead</a>. Or sometimes results are not properly reported to local health departments. Further complicating this, in 2010, the Centers for Disease Control and Prevention declared that the country’s progress in removing lead from gasoline was a <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6019a5.htm">great public health achievment</a>. As a result, many lead-testing programs in the U.S. were discontinued, leading to critical information gaps. </p>
<p>However, there is some reason for optimism. Some state-based lead surveillance programs that were phased out in the early 2000s have been returning in recent years. A good example is my home state of Indiana. A law that <a href="https://www.in.gov/health/lead-and-healthy-homes-division/information-for-health-care-providers/testing-requirements/">went into effect on Jan. 1, 2023</a>, requires all health care providers serving children to offer lead testing to their patients. </p>
<p>Efforts from statewide programs like these will lead to more opportunities to inform physicians and to screen vulnerable populations.</p>
<h2>Ways to get tested</h2>
<p>Blood is by far the most widely used indicator for lead exposure. However, <a href="https://doi.org/10.1038/s41370-018-0036-y">in blood, lead dissipates quickly</a>, and after about a few weeks to a month, an exposure that was high enough to cause damage is no longer measurable from blood lead.</p>
<p>As part of my research, we have developed a handheld device that is able to <a href="https://doi.org/10.3109/1354750X.2016.1139183">noninvasively measure lead from bone</a> in minutes. Picture a Star Trek tricorder. We have patented the method we use to calculate lead in bone but currently have not commercialized it. </p>
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<a href="https://images.theconversation.com/files/579700/original/file-20240304-28-hr1ffe.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A hand wrapped around the handle of a small black, silver and gray lead-measuring device." src="https://images.theconversation.com/files/579700/original/file-20240304-28-hr1ffe.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/579700/original/file-20240304-28-hr1ffe.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=798&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579700/original/file-20240304-28-hr1ffe.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=798&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579700/original/file-20240304-28-hr1ffe.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=798&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579700/original/file-20240304-28-hr1ffe.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1003&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579700/original/file-20240304-28-hr1ffe.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1003&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579700/original/file-20240304-28-hr1ffe.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1003&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The author holds the Star Trek-esque device that he and his team developed at Purdue University.</span>
<span class="attribution"><span class="source">Aaron James Specht</span>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
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<p>Bone lead is reflective of <a href="https://doi.org/10.1289/ehp.9783">years to decades of exposure</a> and is a more accurate test to reflect the permanence of damage induced by lead in the body. Bone lead has also been shown to have a strong relationship with <a href="https://doi.org/10.1515/reveh.2009.24.1.15">lead accumulation in the brain</a>, since lead hijacks places in both the bone and the brain where calcium is normally present. </p>
<p>Efficient and routine blood lead testing in children during their developmental stages could definitively identify exposure sources as they emerge. </p>
<p>While bone measurements allow researchers and physicians to effectively <a href="https://doi.org/10.1088/1361-6579/aa904f">measure years to decades of exposure</a>, health departments and the CDC currently lack the infrastructure to deploy this technology in communities that are highly affected by lead. </p>
<h2>What you can do</h2>
<p>People concerned about lead exposure <a href="https://www.cdc.gov/nceh/lead/prevention/testing-children-for-lead-poisoning.htm#">should request a blood lead test</a> from their doctor. Parents of young children should proactively ask pediatricians to conduct lead screening. If you live in an old home, especially one with peeling paint, you can contact your local health department to test for possible lead paint. </p>
<p>Additionally, your local water service provider should be able to tell you if lead water lines are in use leading to your home. Unfortunately, lead has no particular smell or taste to differentiate it from other possible contaminants.</p>
<p>Children and adults with elevated blood lead levels should talk to their pediatrician or doctor about effective <a href="https://www.cdc.gov/nceh/lead/advisory/acclpp/actions-blls.htm">follow-up testing</a> and potential dietary changes to promote lead excretion naturally. </p>
<p>For very high exposures, a treatment known as <a href="https://www.atsdr.cdc.gov/csem/leadtoxicity/patient_treatment.html#">chelation therapy</a>, which involves an oral medication that binds to lead so that it can be excreted in urine, has been shown to be <a href="https://doi.org/10.1203/00006450-200011000-00007">effective at reducing blood lead levels</a>. </p>
<p>These people should also notify their local health department, which can identify and remove lead sources in their environment to eliminate the risk to both current and future residents.</p><img src="https://counter.theconversation.com/content/218021/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Aaron Specht receives funding from the National Institutes of Health, Centers for Disease Control, and JPB Foundation. </span></em></p>Although the US banned lead-based paint in 1978, homes built before then commonly contain lead paint.Aaron Specht, Assistant Professor of Health Physics, Purdue UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2122562023-09-07T12:23:32Z2023-09-07T12:23:32ZSecondhand smoke may be a substantial contributor to lead levels found in children and adolescents, new study finds<figure><img src="https://images.theconversation.com/files/545649/original/file-20230830-19-lkn4ka.jpg?ixlib=rb-1.1.0&rect=77%2C0%2C8660%2C5717&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Childhood exposure to lead can limit cognitive development and cause a drop in IQ.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/mother-smoking-near-children-royalty-free-image/1291760178?phrase=secondhand+smoke+children&adppopup=true">Yamasan/iStock via Getty Images Plus</a></span></figcaption></figure><p>Secondhand smoke may be an important but overlooked source of chronic lead exposure in kids and adolescents. That is the <a href="https://doi.org/10.1186/s12889-023-16005-y">key finding of our recent study</a>, published in the journal BMC Public Health.</p>
<p>We analyzed national data on blood lead levels and secondhand smoke exposure in 2,815 U.S. children and teenagers ages 6 to 19 from 2015 to 2018. We looked at levels of lead and a nicotine metabolite – a substance known as cotinine produced in the body’s chemical process that forms when tobacco smoke is inhaled. Levels of cotinine indicate exposure to tobacco smoke.</p>
<p>We found that the average blood lead levels in the intermediate and high tobacco smoke exposure groups were 18% and 29% higher, respectively, than those in the group with the lowest tobacco smoke exposure. The lowest lead exposure group was comparable to the U.S. average. A greater number of boys had detectable lead levels in their blood, as did a greater number of Black children and adolescents, compared with the other ethnic groups we studied. </p>
<p>Elevated blood levels were more common in children ages 6 to 10 than in older participants. Notably, children from low-income households showed 27% higher blood lead levels compared with those from high-income households. </p>
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<figcaption><span class="caption">The damage lead does to the body is irreversible.</span></figcaption>
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<h2>Why it matters</h2>
<p>Lead, unlike many other toxins, does not get diluted when exposure decreases. Nor does the body excrete it naturally. Instead, it accumulates in the bones and leaches into blood. The only way to remove it is through an <a href="https://www.atsdr.cdc.gov/csem/leadtoxicity/patient_treatment.html">oral medical treatment</a>.</p>
<p>Exposure to lead can cause numerous and <a href="https://doi.org/10.1515/reveh.2009.24.1.15">severe neurological problems</a>, including nerve damage, cognitive problems, <a href="https://doi.org/10.1073/pnas.2118631119">loss of IQ points</a> and possibly even conditions such as <a href="https://doi.org/10.2174/156720512800617991">Alzheimer’s disease</a> and <a href="https://doi.org/10.1016/j.neuro.2011.11.008">schizophrenia</a>.</p>
<p>Lead exposure is more harmful to younger children than older children and adults because their bodies are still developing and they are growing so rapidly.</p>
<p><a href="https://www.cdc.gov/nceh/lead/prevention/populations.htm">Children at high-exposure risk</a> often come from low-income households in older homes built before 1978, when lead paint was still used. Young children’s frequent hand-to-mouth activity provides a pathway for lead exposure at home. Lead-containing water pipes in these older, low-income housing areas also contribute to the issue.</p>
<p>Children and others can also be exposed to lead through a variety of everyday household items, including <a href="https://www.fda.gov/food/environmental-contaminants-food/questions-and-answers-lead-glazed-traditional-pottery">some ceramic cookware and dishes</a>, some <a href="https://doi.org/10.1177/0009922806294068">vinyl lunchboxes</a> – especially those manufactured outside the United States – many common <a href="https://www.popularmechanics.com/home/food-drink/a38413337/heavy-metals-found-in-herbs-spices/">spices</a> and some <a href="https://www.reuters.com/article/uk-toys-lead/lead-found-in-toys-and-backpacks-in-u-s-stores-idUKN1023090320071010">toys</a>, <a href="https://www.fda.gov/cosmetics/potential-contaminants-cosmetics/lead-cosmetics">hair-coloring products and cosmetics</a>. Lead exposure has even been traced to <a href="https://doi.org/10.5334/aogh.2754">some candies</a> from Mexico.</p>
<p>Over the past four decades, U.S. regulators have banned <a href="https://www.cdc.gov/nceh/lead/prevention/sources/paint.htm#">lead-based paint for residential use</a> and <a href="https://www.eia.gov/energyexplained/gasoline/history-of-gasoline.php#">leaded gasoline</a>. This has led to a significant decrease in lead exposure from major traditional sources. </p>
<p>Despite continued efforts, lead exposure continues to pose a risk. Our findings help create awareness of the link between secondhand tobacco smoke and lead exposure, especially for young people. Approximately 35% of U.S. children, or over 23 million, were <a href="https://www.cdc.gov/nchs/products/databriefs/db348.htm">exposed to secondhand smoke between 2013 and 2016</a>, according to the Centers for Disease Control and Prevention. </p>
<h2>What’s next</h2>
<p>We are working within our local areas to educate parents and school administrators about the dangers of lead poisoning, including exposure from secondhand smoke. Our efforts include encouraging individuals and communities to test their drinking water for lead and to take actions to reduce children’s lead exposure from drinking water.</p>
<p>We plan to conduct further studies to quantify the contribution of various sources to lead exposure. We believe that this research will enhance our understanding of children’s exposure and contribute to the improvement of environmental health disparities.</p>
<p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take on interesting academic work.</em></p><img src="https://counter.theconversation.com/content/212256/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Researchers found that children exposed to secondhand smoke had higher than average levels of lead in their blood.Genny Carrillo, Associate Professor of Environmental and Occupational Health, Texas A&M UniversityTaehyun Roh, Assistant Professor of Epidemiology, Texas A&M UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1739632021-12-17T13:27:20Z2021-12-17T13:27:20ZThe US is making plans to replace all of its lead water pipes from coast to coast<figure><img src="https://images.theconversation.com/files/438106/original/file-20211216-21-126318e.jpg?ixlib=rb-1.1.0&rect=0%2C267%2C4965%2C3181&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Workers prepare to install new water pipes in Walnut Creek, California, on April 22, 2021.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/workers-with-east-bay-municipal-utility-district-stack-news-photo/1313906917">Justin Sullivan/Getty Images</a></span></figcaption></figure><p>The Biden administration has released a plan to accelerate removal of <a href="https://www.whitehouse.gov/briefing-room/statements-releases/2021/12/16/fact-sheet-the-biden-harris-lead-pipe-and-paint-action-plan/">lead water pipes and lead paint</a> from U.S. homes. As a <a href="http://scholar.google.com/citations?user=MEp4948AAAAJ&hl=en">geochemist and environmental health researcher</a> who has studied the heartbreaking impacts of lead poisoning in children for decades, I am happy to see high-level attention paid to this silent killer, which <a href="https://doi.org/10.1029/2018GH000167">disproportionately affects poor communities of color</a>.</p>
<p>Childhood lead poisoning has <a href="https://doi.org/10.1367/1539-4409(2003)003%3C0027:POLTIU%3E2.0.CO;2">declined significantly in the U.S.</a> over the past 50 years. That’s largely due to the elimination of leaded gasoline in the 1980s and the banning of most lead-based paints.</p>
<p>But the U.S. Environmental Protection Agency estimates that <a href="https://www.whitehouse.gov/briefing-room/statements-releases/2021/12/16/fact-sheet-the-biden-harris-lead-pipe-and-paint-action-plan/">up to 10 million households and 400,000 schools and child care centers</a> have service lines or other fixtures that contain lead. These pipes are ticking time bombs that can leach toxic lead into drinking water if they corrode. As long as they remain in service, children and families are vulnerable.</p>
<p>The same is true of lead paint, which is still present in many homes built before consumer use of lead paint was banned in 1978. Because it tastes sweet, children sometimes chew on paint chips or painted wood.</p>
<p>The Biden administration <a href="https://www.whitehouse.gov/briefing-room/statements-releases/2021/12/16/fact-sheet-the-biden-harris-lead-pipe-and-paint-action-plan/">will spend US$15 billion</a> from the recently enacted infrastructure bill to replace lead service lines, faucets and fixtures over the next five years and is seeking additional money in the pending <a href="https://www.congress.gov/bill/117th-congress/house-bill/5376">Build Back Better Act</a> to reduce lead hazards in public housing and low-income communities. I see this as a key priority, since Black children and children living in poverty have average blood lead levels that are 13% higher than the national average. </p>
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<h2>Lead poisoning does permanent damage</h2>
<p>Lead poisoning is a major public health problem because lead has permanent impacts on the brain, particularly in children. Young brains are <a href="https://developingchild.harvard.edu/science/key-concepts/brain-architecture/">still actively forming</a> the amazing network of neurons that comprise their hardware. </p>
<p>Neurons are designed to use calcium, the most abundant mineral in the human body, as a transmitter to rapidly pass signals. Lead molecules look a lot like calcium molecules, so if they are present in a child’s body, they can penetrate the brain, impair neuron development and cause permanent neural damage.</p>
<p>Children with lead poisoning have lower IQs, poor memory recall, high rates of attention deficit disorder and low impulse control. They tend to <a href="https://www.cdc.gov/nceh/lead/prevention/health-effects.htm">perform poorly at school</a>, which reduces their earning potential as adults. They also face increased risk of <a href="https://www.kidney.org/atoz/content/lead-exposure-and-kidney-function">kidney disease</a>, <a href="https://doi.org/10.1289/ehp.9785">stroke and hypertension</a> as they age. Research has found strong connections between lead poisoning and <a href="https://www.brookings.edu/blog/up-front/2017/06/01/new-evidence-that-lead-exposure-increases-crime/">incarceration for violent crimes</a>. </p>
<p>Today researchers estimate that <a href="https://www.aafp.org/afp/2019/0701/p24.html">about 500,000 U.S. children</a> still have elevated blood lead levels. Health experts widely agree that there is <a href="https://www.who.int/news-room/fact-sheets/detail/lead-poisoning-and-health">no known “safe” blood lead concentration</a>. </p>
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<h2>Where are the lead pipes?</h2>
<p>The Biden administration’s plan calls for replacing 100% of lead service lines across the nation – a goal that the EPA aims to <a href="https://www.nbcboston.com/news/national-international/epa-to-tighten-rules-for-lead-in-drinking-water-details-plan-to-replace-nations-pipes/2592292/">write into regulations by 2024</a>. Step 1 is finding the pipes. </p>
<p>Most U.S. cities have countless miles of lead service lines buried beneath streets and sidewalks and feeding into people’s homes. Utilities don’t know where many of these aging lines are and don’t have enough data to map them. Replacing them will require significant analysis, modeling, data and some guesswork.</p>
<p>Old service lines have caused lead poisoning outbreaks in such places as Washington, D.C.; <a href="https://www.britannica.com/event/Flint-water-crisis">Flint, Michigan</a>; and <a href="https://www.njspotlight.com/2021/01/op-ed-lessons-from-newarks-aggressive-replacement-of-lead-service-lines/">Newark, New Jersey</a>. <a href="https://doi.org/10.1073/pnas.1913749117">The chemistry is a bit different</a> in each case. </p>
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<a href="https://images.theconversation.com/files/398412/original/file-20210503-23-1cvv9hr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Worker standing in a trench dug in the street hands a piece of pipe to a colleague." src="https://images.theconversation.com/files/398412/original/file-20210503-23-1cvv9hr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/398412/original/file-20210503-23-1cvv9hr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=554&fit=crop&dpr=1 600w, https://images.theconversation.com/files/398412/original/file-20210503-23-1cvv9hr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=554&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/398412/original/file-20210503-23-1cvv9hr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=554&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/398412/original/file-20210503-23-1cvv9hr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=696&fit=crop&dpr=1 754w, https://images.theconversation.com/files/398412/original/file-20210503-23-1cvv9hr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=696&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/398412/original/file-20210503-23-1cvv9hr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=696&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Workers remove water service lines in Trenton, New Jersey, on Jan. 9, 2020. The city is replacing 37,000 lead pipes over five years.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/LeadWaterPipesNewJersey/3de7106d9ea547e89027f07a6e502a10/photo">AP Photo/Mike Catalini</a></span>
</figcaption>
</figure>
<p>Lead service lines typically develop a protective “plaque” of minerals on their inside walls after a short time, which effectively separates the toxic lead pipe from the water flowing through it. This coating, which is called scale, remains stable if the chemistry of the water coursing through it doesn’t change. But if that chemistry is altered, disaster can ensue.</p>
<p>In 2002, Washington, D.C., shifted from chlorine to chloramine for treating its water supply. Chloramine is a more modern disinfectant that does not <a href="https://theconversation.com/can-drinking-water-be-delivered-without-disinfectants-like-chlorine-and-still-be-safe-55476">form dangerous reactive chlorinated byproducts</a> as chlorine can. </p>
<p>This rapidly corroded the protective plaque lining the city’s pipes, flushing highly absorbable lead into homes. <a href="https://www.washingtonpost.com/local/dcs-decade-old-problem-of-lead-in-water-gets-new-attention-during-flint-crisis/2016/03/17/79f8d476-ec64-11e5-b0fd-073d5930a7b7_story.html">Tens of thousands of children were exposed</a> over two years before the problem was adequately identified and fixed. </p>
<p>In Flint, state-appointed managers decided to save money during a fiscal crisis in 2014 by switching from Detroit water to water from the Flint River. But regulators <a href="https://doi.org/10.1021/acs.est.6b04034">did not require enough chemical analysis</a> to determine what additives should be used to maintain the pipe plaque. And they skipped the typical step of adding phosphate, which binds chemically with lead and prevents it from leaching out of pipes, in order to save <a href="https://www.scientificamerican.com/article/q-a-what-really-happened-to-the-water-in-flint-michigan/">about $100 per day</a>. </p>
<p>Corrosion chemistry is well controlled in many U.S. cities, but it is not a perfect science. And utilities don’t always have detection systems that adequately alert water suppliers to dangers at the tap. That’s why removing lead pipes is the only sure way to avoid the threat of more water crises. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/AiU7GHzD_Ck?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Households can use some basic tests to identify water pipes that may be made of lead.</span></figcaption>
</figure>
<h2>Cities will need to innovate</h2>
<p>While $15 billion is a big investment, experts agree that <a href="https://www.brookings.edu/blog/up-front/2021/05/13/what-would-it-cost-to-replace-all-the-nations-lead-water-pipes/">it’s not enough to replace all lead pipes nationwide</a>. For example, the estimated cost of replacing all of Flint’s lead service lines is <a href="https://www.freep.com/story/news/local/michigan/flint-water-crisis/2016/05/27/flint-lead-lines-water-crisis/85032096/">about $50 million</a> – and there are <a href="https://www.vox.com/policy-and-politics/2019/6/12/18661193/lead-pipes-paint-flint-michigan-usa-cost-fix">thousands of U.S. cities to fix</a>. </p>
<p>My own city, Indianapolis, has a population of about 850,000 – about 10 times larger than Flint – and officials have only a rough idea of where to find the lead service lines. There are ways to <a href="https://www.wateronline.com/doc/statistical-modeling-in-support-of-lead-service-line-identification-inventory-and-replacement-0001">statistically model</a> the likelihood that a given portion of the water system has lead service lines, using information such as water main sizes, locations and construction dates, but they are imperfect. </p>
<p>Cities will need to get creative to make whatever funds they get go as far as possible. As one example, I am working with colleagues to develop a citizen science project that will provide <a href="https://www.hud.gov/sites/dfiles/PA/documents/2020_Lead-HH-Technical-Studies-Grant-Awards.pdf">thousands of tests for lead at taps around Indianapolis</a>. This effort, a partnership with the University of Notre Dame funded by the U.S. Department of Housing and Urban Development, may augment modeling with real data on levels of lead in homes, and will increase public awareness of this issue. </p>
<p>[<em>Over 140,000 readers rely on The Conversation’s newsletters to understand the world.</em> <a href="https://memberservices.theconversation.com/newsletters/?source=inline-140ksignup">Sign up today</a>.]</p>
<p>In spite of these challenges, I believe more urgency on this issue is long overdue. Every lead pipe that’s replaced will pay off in higher lifetime earnings and lower rates of illness for families that gain access to safer tap water.</p>
<p><em>This is an updated version of an <a href="https://theconversation.com/bidens-infrastructure-plan-targets-lead-pipes-that-threaten-public-health-across-the-us-158277">article</a> originally published on May 4, 2021.</em></p><img src="https://counter.theconversation.com/content/173963/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gabriel Filippelli does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It will cost tens of billions of dollars to find and remove all the lead service lines that deliver water to US homes and schools. A public health expert explains why he sees it as money well spent.Gabriel Filippelli, Chancellor's Professor of Earth Sciences and Executive Director, Indiana University Environmental Resilience Institute, IUPUILicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1709292021-11-05T12:28:50Z2021-11-05T12:28:50ZA new, lower threshold for lead poisoning in children means more kids will get tested – but the ultimate solution is eliminating lead sources<figure><img src="https://images.theconversation.com/files/430091/original/file-20211103-23-1r7sfwm.jpg?ixlib=rb-1.1.0&rect=41%2C0%2C4639%2C3069&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Testing kids for lead exposure starts with a fingertip prick. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/brian-jones-a-first-responder-for-livingston-county-news-photo/506974822">Brett Carlsen/Getty Images</a></span></figcaption></figure><p><em>The U.S. Centers for Disease Control and Prevention has <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7043a4.htm?s_cid=mm7043a4_w">updated its blood lead reference value</a> – the level at which children ages 1-5 are considered to have high exposure to lead. Since 2012, this threshold had been set at 5 micrograms of lead per deciliter of blood; children at or above this level represented the top 2.5% with the highest blood lead levels in the nation. Now, in response to recent federal health surveys, the CDC has updated that number to 3.5 micrograms per deciliter. Environmental scientist <a href="https://scholar.google.com/citations?user=MEp4948AAAAJ&hl=en">Gabriel Filippelli</a>, who has studied urban lead poisoning in children, explains what this shift means for public health.</em></p>
<h2>Will this change affect how doctors detect and treat childhood lead poisoning?</h2>
<p>The Centers for Disease Control periodically reviews national data on blood lead levels in children. This new lower value is the <a href="https://www.cdc.gov/nceh/lead/data/blood-lead-reference-value.htm">average blood lead level exceeded by 2.5% of children tested</a>. </p>
<p>Many clinics have an on-site screening device that uses electrochemical detection to quickly test a small amount of blood from a fingertip prick. If children test positive, doctors refer them to have a larger blood sample drawn from a vein and analyzed in a diagnostic laboratory. The clinical test is fast, cheap and relatively painless, but the venous blood draw is the gold standard for diagnosing lead poisoning. </p>
<p>On-site clinical devices typically can detect lead at concentrations as low as 3.2 micrograms per deciliter, so the new CDC guidance means that nearly all children who show positive results at the screening level will be referred for follow-up testing. That’s much more protective from a public health perspective. </p>
<p>However, it will <a href="https://www.beckershospitalreview.com/public-health/new-cdc-standard-may-double-the-number-of-children-with-lead-poisoning.html">roughly double</a> the number of children who are classified as at highest risk for lead poisoning. Formerly, children had to have at least 5 micrograms per deciliter of lead in their blood to fall into that group; now it will include thousands more children with slightly lower blood lead levels. </p>
<p>Larger numbers of children means that many states will have trouble affording testing and follow-up care – which can involve <a href="https://www.aap.org/en/patient-care/lead-exposure/treatment-of-lead-poisoning/">dietary changes and medications</a>, as well as removing lead exposure sources – unless Congress increases federal support for programs to prevent and treat lead poisoning.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1437437173691727877"}"></div></p>
<h2>How are children commonly exposed to lead?</h2>
<p>The most pervasive source, especially in cities, is soil and dust generated from soil. Thanks to many years of emissions from degraded lead-based paint, leaded gasoline and industrial sources, typical urban soils have lead concentrations that <a href="https://doi.org/10.1016/j.envint.2021.106582">range from benign to toxic</a>. Children are exposed when they touch or play in contaminated dirt or inhale the dust. </p>
<p>The U.S. Environmental Protection Agency’s limit for lead in soils in public play areas is <a href="https://www.atsdr.cdc.gov/csem/leadtoxicity/safety_standards.html#:%7E:text=Soil%20contains%20lead%20concentrations%20less,play%20areas%20%5BEPA%202000a%5D.">400 parts per million</a>. That’s significantly higher than typical background levels, which are roughly 20 to 50 parts per million. This action level has remained in place for decades, even though studies indicate that it’s <a href="https://doi.org/10.1289/EHP10376">unacceptably high as a public health guideline</a>. </p>
<p>Some U.S. states, <a href="https://dtsc.ca.gov/faq/what-are-acceptable-concentrations-of-lead-in-soil-in-california/">such as California</a>, have much lower limits. In my experience, it’s not unusual to find urban soils with much higher levels, particularly near the exterior walls of buildings where lead may accumulate from degraded paints or <a href="https://doi.org/10.3390/ijerph15071531">dust buildup</a>. </p>
<p>The most lead-contaminated neighborhoods in cities are often the poorest and home to the <a href="https://doi.org/10.1146/annurev-soc-073117-041222">highest percentage of nonwhite children</a>. This is a legacy of <a href="https://www.npr.org/2017/05/03/526655831/a-forgotten-history-of-how-the-u-s-government-segregated-america">racist housing practices</a> that concentrated people of color in less desirable neighborhoods. Residents in these zones can have significantly higher rates of elevated blood lead levels than people in wealthier neighborhoods.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/430093/original/file-20211103-23-mwrpi9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Young girl in front of a public housing complex." src="https://images.theconversation.com/files/430093/original/file-20211103-23-mwrpi9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/430093/original/file-20211103-23-mwrpi9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/430093/original/file-20211103-23-mwrpi9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/430093/original/file-20211103-23-mwrpi9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/430093/original/file-20211103-23-mwrpi9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/430093/original/file-20211103-23-mwrpi9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/430093/original/file-20211103-23-mwrpi9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Kaelynn Lott, one of 120 children living at the West Calumet Housing Complex in East Chicago, Indiana, who tested positive for lead poisoning. After soil at the complex was found to contain high levels of lead and arsenic in 2016, the city ordered over 1,000 residents to relocate.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/kaelynn-lott-a-resident-at-the-west-calumet-housing-complex-news-photo/599443064">Joshua Lott/Getty Images</a></span>
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<p>Lead-based paint is also a major exposure risk, particularly in poorly maintained buildings. Lead paint tastes sweet, so children sometimes chew on paint chips or painted wood.</p>
<p>Lead water pipes are a third source, although less common than paint or soil. Many cities and towns across the U.S. have <a href="https://theconversation.com/bidens-infrastructure-plan-targets-lead-pipes-that-threaten-public-health-across-the-us-158277">lead service lines</a> that deliver water to homes. If their water is treated properly, a protective plaque forms on the inside of water pipes and seals their lead content away from the water. </p>
<p>But some cities, including <a href="https://wtop.com/dc/2016/04/flint-d-c-s-drinking-water-crisis-even-worse/">Washington, D.C.</a>, <a href="https://www.nytimes.com/2021/08/11/nyregion/newark-lead-pipes-drinking-water.html">Newark</a>, New Jersey, and <a href="https://www.npr.org/sections/thetwo-way/2016/04/20/465545378/lead-laced-water-in-flint-a-step-by-step-look-at-the-makings-of-a-crisis">Flint, Michigan</a>, have changed their water sources or treatment processes in ways that stripped out the protective plaque and carried lead to household taps. These water crises disproportionately affected communities of color. </p>
<h2>How does lead exposure at these levels affect children’s health?</h2>
<p>Historically, public health interventions focused on acutely poisoned children who exhibited clear neurocognitive issues such as attention deficit, memory lapses, agitation and even tremors. As lead was slowly removed from most home uses in the mid-20th century and the U.S. population’s blood lead levels decreased, these obvious clinical presentations for lead poisoning declined.</p>
<p>What we see now are more subtle neurocognitive deficits, which scientists and medical experts measure through neurological and behavioral testing. A child who is diagnosed as having high blood lead levels today may perform poorly on standardized exams, behave disruptively in the classroom or at home or have trouble retaining information. Follow-up research in Flint shows that many infants and toddlers who were exposed to lead in water there in 2015 <a href="https://www.cbsnews.com/news/flint-water-crisis-effect-on-children-60-minutes-2020-03-15/">are struggling now that they are in school</a>. </p>
<p>These types of tests show that blood lead levels even lower than the new standard <a href="https://doi.org/10.1016/j.ntt.2020.106888">still affect performance</a>. This research is the basis for statements from scholars and the CDC that <a href="https://www.cdc.gov/nceh/lead/prevention/health-effects.htm">there is no safe blood lead level in children</a>.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/p7WTBVVXsrQ?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A study that tracked 579 children born in the 1970s in New Zealand for more than 30 years found modest but long-lasting mental health and personality effects from exposure to lead early in life.</span></figcaption>
</figure>
<h2>What’s the trend for childhood lead poisoning in the US?</h2>
<p>It has been falling since most major environmental sources of lead, such as leaded gasoline, lead-based paints and industrial emissions, were eliminated starting in the 1970s. Recent analyses show that the median blood lead level for all U.S. children between ages 1 and 5 is about 0.7 micrograms per deciliter today, compared with <a href="https://www.epa.gov/americaschildrenenvironment/ace-biomonitoring-lead">15 micrograms per deciliter in the late 1970s</a>. </p>
<p>But Black children and children living in poverty have average blood lead levels that are <a href="https://www.epa.gov/americaschildrenenvironment/ace-biomonitoring-lead">13% higher than this national average</a>, which means that many of them are at risk. </p>
<p>For example, in a 2019 study, I worked with colleagues at Notre Dame to analyze blood lead levels of over 18,000 children in St. Joseph County, Indiana, which includes the town of South Bend. In some neighborhoods, over 30% of children had blood lead levels higher than 5 micrograms per deciliter, and over 65% of the census tracts had average blood lead levels <a href="https://doi.org/10.1057/s41271-018-0155-7">over that safety limit</a>. </p>
<p>We also found that there was no systematic, risk-informed approach to testing. In areas that had the highest potential risks based on poverty levels, less than 6% of eligible children had lead test results reported to the county health department – the same rate as in other, wealthier census tracts. Without more screening, and more work to eliminate lead exposure in the communities most at risk, this problem won’t be solved for a long time.</p>
<p><em>This article has been updated to add a link to an article calling for lower limits on lead in soils in public play areas.</em></p>
<p>[<em>Understand new developments in science, health and technology, each week.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-understand">Subscribe to The Conversation’s science newsletter</a>.]</p><img src="https://counter.theconversation.com/content/170929/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gabriel Filippelli receives funding from the Housing and Urban Development Agency. </span></em></p>The Centers for Disease Control has announced a new, stricter standard for lead poisoning in children, which will more than double the number of kids considered to have high blood lead levels.Gabriel Filippelli, Chancellor's Professor of Earth Sciences and Executive Director, Indiana University Environmental Resilience Institute, IUPUILicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1164082019-05-15T10:43:35Z2019-05-15T10:43:35ZTooth fairy study reveals children near lead smelters are exposed to dangerous lead in the womb<figure><img src="https://images.theconversation.com/files/274192/original/file-20190513-183093-w2bd7d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A worker recycling lead in a lead acid battery recovery facility.</span> <span class="attribution"><a class="source" href="https://upload.wikimedia.org/wikipedia/commons/0/08/Recycling_lead_in_a_lead-acid_battery_recovery_facility.jpg">National Institute for Occupational Safety and Health</a></span></figcaption></figure><p>The environmental tragedy in Flint, Michigan, in which drinking water contaminated with lead raised fears of potential health effects for exposed children, revealed the <a href="http://doi.org/10.2105/AJPH.2015.303003">failure of a regulatory system</a> to protect residents from lead exposure. </p>
<p>Until 2015 the Exide Technologies lead-acid battery smelter, in southeast Los Angeles County, California, recycled approximately <a href="http://doi.org/10.1089/env.2017.0019">11 million lead acid batteries</a> per year while operating on temporary state permits. This <a href="http://graphics.latimes.com/exide-battery-plant/">violated multiple federal environmental regulations</a> and exposed over 100,000 residents to lead and other toxic metals. The result was large-scale environmental disaster with <a href="https://www.latimes.com/local/lanow/la-me-exide-cleanup-story-so-far-20151121-story.html">lead contamination</a> of the air and soil in largely Latino communities. </p>
<p>As an environmental scientist and epidemiologist, I sought to understand lead pollution in children growing up in this area. For my research I collaborated with local community organizations and relied on an archive of biological samples that families often save: baby teeth. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/274178/original/file-20190513-183106-1e3abql.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/274178/original/file-20190513-183106-1e3abql.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/274178/original/file-20190513-183106-1e3abql.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=269&fit=crop&dpr=1 600w, https://images.theconversation.com/files/274178/original/file-20190513-183106-1e3abql.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=269&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/274178/original/file-20190513-183106-1e3abql.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=269&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/274178/original/file-20190513-183106-1e3abql.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=338&fit=crop&dpr=1 754w, https://images.theconversation.com/files/274178/original/file-20190513-183106-1e3abql.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=338&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/274178/original/file-20190513-183106-1e3abql.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=338&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://envhealthcenters.usc.edu/infographics/infographic-living-near-lead">USC Environmental Health Centers</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<h2>Understanding lead exposure</h2>
<p>Measuring historic exposure at toxic waste sites is often one of the most challenging aspects to understanding and anticipating future health impacts. Blood levels reflect exposure only from the past four weeks. But past exposure may be important indicators of harm. </p>
<p>Deciduous teeth, or “baby teeth,” incorporate minerals, including toxic metals, beginning in around the second trimester and continuing through early childhood. The formation of teeth occurs incrementally, like tree rings, so it is possible to reconstruct a child’s exposure to lead while in the womb and during the first year of life. </p>
<p>A initiative called the <a href="http://doi.org/10.1021/acs.est.9b00429">Truth Fairy Project</a> aimed to address this. Academics collaborated with the community living in southeast Los Angeles County to examine 50 shed deciduous teeth from 43 children living their entire lives within two miles of the Exide smelter. </p>
<p><a href="http://doi.org/10.1021/acs.est.9b00429">My team compared the levels of lead</a> in teeth to lead levels in the soil. We discovered a significant trend. The more lead in the soil in residential neighborhoods, the higher the levels in the teeth – both prenatally and during the first year of life.</p>
<p>We continue to collaborate with the community to work toward prevention of lead exposure and cleanup of the contaminated soil. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/274181/original/file-20190513-183077-1ezvpwz.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/274181/original/file-20190513-183077-1ezvpwz.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/274181/original/file-20190513-183077-1ezvpwz.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=432&fit=crop&dpr=1 600w, https://images.theconversation.com/files/274181/original/file-20190513-183077-1ezvpwz.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=432&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/274181/original/file-20190513-183077-1ezvpwz.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=432&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/274181/original/file-20190513-183077-1ezvpwz.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=543&fit=crop&dpr=1 754w, https://images.theconversation.com/files/274181/original/file-20190513-183077-1ezvpwz.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=543&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/274181/original/file-20190513-183077-1ezvpwz.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=543&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://envhealthcenters.usc.edu/infographics/infographic-living-near-lead">USC Environmental Health Centers</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<h2>Lead is still a potent toxicant</h2>
<p>Compelling scientific evidence concludes that there is <a href="http://doi.org/10.1289/ehp.7688">no safe threshold of childhood lead exposure</a>. </p>
<p>Lead (Pb) is a toxic metal that can cause <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2560844/">damage to almost all organs and organ systems</a>. <a href="http://doi.org/10.1289/ehp.10424">Cognitive deficits</a> and neurodevelopmental delays are associated with <a href="http://doi.org/10.1289/ehp.11241">even very low levels of Pb exposure</a>. </p>
<p>Lead poisoning persists nationwide, with over <a href="http://doi.org/10.1016/j.jpeds.2016.05.005">500,000 children still burdened by elevated blood lead levels</a> (>5 microgram per deciliter, ug/dL) as of 2016. <a href="http://doi.org/10.1542/peds.2017-1400">Outdated regulations for lead</a> have failed to protect children’s health.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/274184/original/file-20190513-183109-ss3c4u.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/274184/original/file-20190513-183109-ss3c4u.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=668&fit=crop&dpr=1 600w, https://images.theconversation.com/files/274184/original/file-20190513-183109-ss3c4u.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=668&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/274184/original/file-20190513-183109-ss3c4u.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=668&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/274184/original/file-20190513-183109-ss3c4u.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=840&fit=crop&dpr=1 754w, https://images.theconversation.com/files/274184/original/file-20190513-183109-ss3c4u.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=840&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/274184/original/file-20190513-183109-ss3c4u.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=840&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://envhealthcenters.usc.edu/infographics/infographic-living-near-lead">USC Environmental Health Centers</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<h2>Lead-acid battery smelters in the US</h2>
<p>Despite marked reductions in the use of lead in gasoline additives, <a href="https://doi.org/10.3133/sir20145086">ambient air emissions from lead-smelting</a> operations remain high in neighboring communities. The U.S. is second only to China as a producer of refined lead, producing about 11% of the world’s refined lead <a href="http://www3.cec.org/islandora/en/item/11220-hazardous-trade-examination-us-generated-spent-lead-acid-battery-exports-and">through recycling lead-acid batteries</a> at smelters. The tonnage of lead-acid batteries recycled in U.S. smelter facilities has more than doubled over the last 40 years, as the industry has rapidly consolidated production to a handful of facilities. Currently, <a href="http://doi.org/10.1289/ehp.11241">a few urban communities in the U.S.</a> bear the majority of pollution from recycling lead-acid batteries.</p>
<p>The Truth Fairy project provides further evidence that environmental injustice can be transmitted from mother to child via lead pollution. This burden is <a href="http://doi.org/10.1007/s40615-015-0124-9">disproportionately borne by disadvantaged communities</a>. </p>
<p>However, lead exposure in children is preventable. The most effective way to prevent lead poisoning involves reducing exposure through the identification and control of lead sources in in air, water, dust, soil and paint – before exposure occurs.</p>
<p>Today, however, agencies by and large focus on secondary prevention, <a href="http://doi.org/10.1126/science.281.5383.1617">investigating causes of elevated blood lead levels</a> only after individuals have suffered exposure. This leaves major gaps in the US public health system for lead exposure prevention, particularly with respect to low-income and communities of color.</p><img src="https://counter.theconversation.com/content/116408/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jill Johnston receives funding from NIH/NIEHS. </span></em></p>Lead contamination is not just a problem for Flint, Michigan. It is an issue in many regions. One epidemiologist figured out how to measure past lead exposure using treasured biological samples.Jill Johnston, Assistant Professor of Preventive Medicine, University of Southern CaliforniaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/682202017-04-05T19:18:06Z2017-04-05T19:18:06ZPeople who shoot risk unhealthy levels of lead exposure<figure><img src="https://images.theconversation.com/files/145143/original/image-20161109-19092-prkury.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Shooters exposed to lead at work over long periods of time, like military personnel in firing ranges, risk a range of medical complaints.</span> <span class="attribution"><span class="license">Author provided</span></span></figcaption></figure><p>A gun is a dangerous weapon for obvious reasons. But there are less obvious risks to those who use them. New research shows people who shoot, for work or leisure, risk lead poisoning.</p>
<p>Our just published <a href="http://ehjournal.biomedcentral.com/articles/10.1186/s12940-017-0246-0">review</a> shows how exposure to lead from bullets, airborne particles in shooting ranges and other sources shows up in shooters’ blood at levels we believe pose a health risk.</p>
<h2>Who’s at risk?</h2>
<p>Security personnel, police officers and members of the military who fire guns at shooting ranges for work, and members of the public who shoot at firing ranges for recreation, are at risk.</p>
<p>Large numbers of shooters are involved, particularly in the US, where there are about <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6316a3.htm">16,000-18,000</a> indoor firing ranges. In the US, about <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6316a3.htm">one million</a> law enforcement officers train regularly at indoor firing ranges each year and <a href="http://www.nssf.org/PDF/research/TargetShootingInAmericaReport.pdf">20 million people</a> practice target shooting as a leisure activity.</p>
<p>The Geological Survey calculated that in 2012 about <a href="http://minerals.usgs.gov/minerals/pubs/commodity/lead/mis-201301-lead.pdf">60,100 metric tonnes</a> of lead were used in ammunition and bullets in the US. Given that lead is the dominant metal in bullets and primers (which initiates the combustion of gunpowder in the bullet cartridge), there are large numbers of people exposed by firing bullets.</p>
<p>It’s difficult to estimate how many Australians shoot at ranges and are exposed to lead. While the Sporting Shooters Association of Australia says it has <a href="https://www.ssaa.org.au/">180,000 members</a>, not all use shooting ranges.</p>
<h2>How are shooters exposed to lead?</h2>
<p>Shooters are exposed to lead when firing lead bullets. The bullet primer is about 35% <a href="https://pubchem.ncbi.nlm.nih.gov/compound/Lead_styphnate">lead styphnate</a> and <a href="https://pubchem.ncbi.nlm.nih.gov/compound/lead_dioxide#section=Top">lead dioxide</a> (also known as lead peroxide). When a shooter fires a bullet, lead particles and fumes originating from the primer discharge at high pressures from the gun barrel, very close to the shooter. </p>
<p>Shooters are also exposed to lead from the bullet itself as some parts disintegrate into fragments due to misalignments in the gun barrel. The extreme heat during the firing of a bullet results in some vapourisation of these lead fragments.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/163751/original/image-20170403-25858-zx66yo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/163751/original/image-20170403-25858-zx66yo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/163751/original/image-20170403-25858-zx66yo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/163751/original/image-20170403-25858-zx66yo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/163751/original/image-20170403-25858-zx66yo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/163751/original/image-20170403-25858-zx66yo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/163751/original/image-20170403-25858-zx66yo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Lead from bullets can fragment and vapourise, exposing shooters to airborne fragments and particles, which they breathe in or ingest.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/465583928?size=medium_jpg">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>Shooters inhale lead particles emitted during the firing of a gun, whether that’s from the primer or the bullet itself. Once deposited in the lower respiratory tract, lead particles (and different chemical forms of lead) are almost completely absorbed into the bloodstream.</p>
<p>Lead dust from the shooting range also sticks to shooters’ clothes and can potentially contaminate vehicles and homes. Shooters can also ingest lead particles by transferring them from their hands into their mouths when they smoke, eat or drink.</p>
<p>Shooters’ blood lead levels tend to be higher <a href="http://journals.sagepub.com/doi/pdf/10.3109/10915818909018076">the more bullets shot, the more lead in the air</a> at shooting ranges and the <a href="https://www.ncbi.nlm.nih.gov/pubmed/18654794">increased calibre of weapon</a>.</p>
<h2>What our review found</h2>
<p>We reviewed 36 studies that measured blood lead levels at shooting ranges. The studies were from 15 countries, but most were from the US. About two-thirds of the studies looked at people who used shooting ranges for work.</p>
<p>We found blood lead levels of at least one of the participants in 31 of 36 studies had an elevated blood lead level. This means more than the current adult blood lead reference level of <a href="https://www.cdc.gov/niosh/topics/ables/description.html">5µg/dL</a>, or 5 micrograms of lead per decilitre of blood, as recommended by the US Centers for Disease Control and Prevention and National Institute of Occupational Safety and Health.</p>
<p>Importantly, we found elevated blood lead levels (greater than 5µg/dL) in shooters using both indoor and outdoor shooting ranges, consistent with the release of the fine grained primer-based lead close to the shooter’s face and body.</p>
<h2>How does lead affect the body?</h2>
<p>The US National Toxicology Program reviewed the <a href="https://ntp.niehs.nih.gov/pubhealth/hat/noms/lead/index.html">evidence</a> for health effects associated with chronic lead exposure in adults and children at levels identified in our literature review.</p>
<p>They found such blood lead levels were associated with a range of neurological, psychiatric, fertility and heart problems.</p>
<p>While studies have not specifically investigated all these outcomes in shooters, it is biologically plausible these conditions are associated with raised blood levels resulting from exposure to lead at shooting ranges. But few studies have been conducted on the shooting population to be sure.</p>
<p>There is a particular risk to women of child-bearing age exposed to lead at firing ranges because of the uptake and storage of lead in the mother’s bones where it <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3485653/">substitutes for calcium</a>.</p>
<p>This is a particular problem for pregnant women, because the foetus requires calcium from her bones. So the foetus could be exposed to the mother’s lead stores during critical times in development. This could cause <a href="http://www.who.int/ceh/publications/leadguidance.pdf">serious neurological disorders</a> when born. </p>
<p>Female shooters can also pass on the lead exposure to their children through breast milk. Additionally, <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5423a1.htm">multiple</a> <a href="http://www.nejm.org/doi/full/10.1056/NEJM199909093411118#t=article">studies</a> have shown raised blood lead levels in children shooting guns at firing ranges due to direct exposure. Studies <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3485653/">show</a> raised blood levels in children are linked with range of health problems. These range from being inattentive, hyperactive and irritable, to delayed growth, decreased intelligence, and short-term memory loss.</p>
<h2>How do we limit lead exposure?</h2>
<p>The ultimate solution to protect the health of shooters is to replace all primers and bullets with lead–free substitutes, which are already available.</p>
<p>We recommend measures such as ensuring adequate exhaust ventilation and wet-cleaning of surfaces at firing ranges, requiring people who work at firing ranges to have their blood lead levels checked, and for similar testing for frequent shooters.</p>
<p>We also recommend shooters be aware of the risks of lead exposure and follow guidelines recommended by health organisations such as the <a href="http://c.ymcdn.com/sites/www.cste.org/resource/resmgr/OccupationalHealth/ManagementGuidelinesforAdult.pdf">Council of State and Territorial Epidemiologists</a> or <a href="http://www.safeworkaustralia.gov.au/sites/SWA/about/Publications/Documents/990/decision-regulation-impact-statement-managing-risks-associated-with-lead-in-the-workplace.pdf">Safe Work Australia</a>.</p><img src="https://counter.theconversation.com/content/68220/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gabriel Filippelli receives funding from Indiana University through the Indiana Clinical and Translational Sciences Institute</span></em></p><p class="fine-print"><em><span>Howard Walter Mielke receives funding from ATSDR (Agency for Toxic Substances and Disease Registry) and HUD (Housing and Human Development) and the Greater New Orleans Foundation.
I am the unenumerated President of Lead Lab, Inc. which is an education and research non-profit organization.
I do not have any conflicts of interest.
</span></em></p><p class="fine-print"><em><span>Andrew Ball, Brian Gulson, and Mark A.S. Laidlaw do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Millions of people who shoot, for work or leisure, risk lead poisoning, according to new research.Mark A.S. Laidlaw, Vice Chancellors Postdoctoral Fellow, RMIT UniversityAndrew Ball, Professor of Environmental Microbiology, RMIT UniversityBrian Gulson, Macquarie UniversityGabriel Filippelli, Professor, IUPUIHoward Walter Mielke, Professor, Department of Pharmacology, Tulane University School of Medicine, Tulane UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/527522016-01-11T19:21:14Z2016-01-11T19:21:14ZPregnant women and parents misled about dangers of living with lead pollution<figure><img src="https://images.theconversation.com/files/107473/original/image-20160107-14922-1kcvcsx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pregnant women in three Australian cities are not told that lead exposure during pregnancy is linked to miscarriage and early delivery.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/luca_montanari/5359952368/in/photolist-9aDa6S-9iTDci-uo8KM-n5aP1-83r6uD-dv947e-JGaEV-4CNLPu-bGhdin-p1vWq-7Sq3rb-2Jahu-6tdonT-6LUnuU-RmrUe-2awR9t-4qBEBq-5dYQxS-4obmhs-5ZFH3v-pnQQCT-5kqhjC-uo8Ta-62ngiQ-5WRED1-w1Z8cL-2dK3NE-bnFCji-4XEj55-2P4cSm-9hx7Qo-6tpfh8-4erPVu-3fJbgC-4enQZe-5mX5qM-25pEQF-6L1zLU-5TtEe7-9L72Bq-dBMuBC-px5pXo-dwxNHm-sgtVRL-6s5e9z-67sQwx-5nYsUe-6z42e6-4erQ2h-b7a2S6">Flickr/Luca Montanari</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p>Parents in three Australian states are being given misleading information about the dangers of lead exposure for babies and small children – including failing to warn pregnant women about the risks of miscarriage.</p>
<p>Lead is particularly harmful to unborn babies and young children. As the <a href="http://www.who.int/mediacentre/factsheets/fs379/en/">World Health Organization</a> warns, “there is no known level of lead exposure that is considered safe”. Childhood lead exposure is estimated to contribute to about 600,000 new cases of children developing intellectual disabilities every year.</p>
<p>Yet <a href="http://ehjournal.biomedcentral.com/articles/10.1186/s12940-015-0085-9">our research</a>, published in the international journal <a href="http://www.ehjournal.net/">Environmental Health</a>, found that official online educational materials aimed at people in Broken Hill in New South Wales, Mount Isa in Queensland and Port Pirie in South Australia understate the health risks of lead for fetuses, babies and children.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/107353/original/image-20160106-13295-rsie7b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/107353/original/image-20160106-13295-rsie7b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/107353/original/image-20160106-13295-rsie7b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/107353/original/image-20160106-13295-rsie7b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/107353/original/image-20160106-13295-rsie7b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/107353/original/image-20160106-13295-rsie7b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/107353/original/image-20160106-13295-rsie7b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/107353/original/image-20160106-13295-rsie7b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Mount Isa in north-west Queensland.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/robandstephanielevy/3537194475/in/photolist-fQiinw-Curwec-974Qcp-e6FvdR-uRHgZW-9px957-8P93Na-8P8LSZ-4jU9rU-dMN9if-6oz3FD-7NznNH-wbhZwo-av9Nxu-m2sCPB-71gtDk-7NgS6c-5PXfZu-7pnLNC-5PWHfz-5QEFTh">Rob and Stephanie Levy/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>All three cities are home to an active lead mine or smelter.</p>
<p>With slogans such as <a href="http://www.leadnsw.com.au/">“Lead, it’s in our hands”</a> and <a href="http://www.livingwithlead.com.au/">“Living safely with lead”</a>, the cities’ health education programs all promote the idea that parents can sufficiently protect their children from lead exposure through individual actions, such hand washing, household cleaning, and taking precautions in the garden. </p>
<p>Yet there is no evidence to show that’s true. In 2014, a group of international experts <a href="http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006047.pub4/abstract">reviewed 14 studies involving 2656 children</a>. They found that “educational and dust control interventions are not effective in reducing blood lead levels of young children”. They also concluded that there was “insufficient evidence” to show that reducing children’s exposure to contaminated soil would reduce blood lead levels.</p>
<p>So what exactly are parents in Broken Hill, Mount Isa and Port Pirie being told? And what risks are pregnant women and families in the United States being clearly warned about that parents in Australia are not?</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/107348/original/image-20160106-13263-8xq99e.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/107348/original/image-20160106-13263-8xq99e.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/107348/original/image-20160106-13263-8xq99e.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=383&fit=crop&dpr=1 600w, https://images.theconversation.com/files/107348/original/image-20160106-13263-8xq99e.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=383&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/107348/original/image-20160106-13263-8xq99e.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=383&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/107348/original/image-20160106-13263-8xq99e.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=481&fit=crop&dpr=1 754w, https://images.theconversation.com/files/107348/original/image-20160106-13263-8xq99e.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=481&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/107348/original/image-20160106-13263-8xq99e.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=481&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Clowning around? A blog post about teaching Port Pirie kids about ‘safe practises around lead’, despite health experts warning that ‘there is no known level of lead exposure that is considered safe’.</span>
<span class="attribution"><a class="source" href="http://tenforthemportpirie.blogspot.com.au/">tenforthemportpirie.blogspot.com.au, accessed 6 January 2016</a></span>
</figcaption>
</figure>
<h2>Why do American parents get clearer warnings than Australians?</h2>
<p>Emissions from lead mining and smelting activities in Broken Hill, Mount Isa and Port Pirie have been linked to higher levels of lead in local children’s blood. </p>
<p>These blood lead levels exceed the National Health and Medical Research Council’s (NHMRC) new public health intervention level of 5 micrograms per decilitre in about <a href="http://www.abc.net.au/news/2015-05-20/high-blood-lead-levels-confirmed-in-half-of-broken-hill-children/6483398">half of all children in Broken Hill</a> and <a href="https://www.sahealth.sa.gov.au/wps/wcm/connect/fba2f5004987061fa943a94564a15cee/Port+Pirie+Blood+Lead+Levels+Analysis+of+blood+lead+levels+for+the+first....pdf?MOD=AJPERES&CACHEID=fba2f5004987061fa943a94564a15cee">Port Pirie</a>, as <a href="https://theconversation.com/the-verdicts-in-we-must-better-protect-kids-from-toxic-lead-exposure-41969">explained in The Conversation</a> last year. </p>
<p>Lead exposure puts children at risk of significant health effects including developmental, learning and behavioural problems. For example, a <a href="https://theconversation.com/australian-children-exposed-to-toxic-mining-metals-do-worse-at-school-48343">recent study</a> found that children living closest to the Broken Hill mine had lower school test scores and were more likely to be diagnosed with developmental disabilities.</p>
<p>All three cities have online lead health education programs. In Broken Hill, the <a href="http://www.leadnsw.com.au/">www.leadnsw.com.au</a> program was developed by a local health clinic and the NSW government. Mount Isa’s website <a href="http://www.livingwithlead.com.au/">www.livingwithlead.com.au</a> involves the Queensland government, Mount Isa Mines, and the local council.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/107347/original/image-20160106-13282-1wyazg8.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/107347/original/image-20160106-13282-1wyazg8.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/107347/original/image-20160106-13282-1wyazg8.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=364&fit=crop&dpr=1 600w, https://images.theconversation.com/files/107347/original/image-20160106-13282-1wyazg8.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=364&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/107347/original/image-20160106-13282-1wyazg8.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=364&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/107347/original/image-20160106-13282-1wyazg8.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=457&fit=crop&dpr=1 754w, https://images.theconversation.com/files/107347/original/image-20160106-13282-1wyazg8.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=457&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/107347/original/image-20160106-13282-1wyazg8.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=457&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A screenshot from Mount Isa’s Living with Lead homepage, which still uses the slogan ‘Living Safely with Lead’.</span>
<span class="attribution"><a class="source" href="http://www.livingwithlead.com.au/">www.livingwithlead.com.au accessed 6 January 2016</a></span>
</figcaption>
</figure>
<p>In Port Pirie, the SA government and lead smelter operator Nyrstar have <a href="http://tenforthemportpirie.blogspot.com.au/2014/10/what-is-tlap-targeted-lead-abatement.html">worked together</a> on the Targeted Lead Abatement Program, or <a href="http://www.tlap.com.au/">www.tlap.com.au</a>. (TLAP’s website is currently down, with a message saying the site has “crashed”.)</p>
<p>As part of our new study, we compared those Australian websites with international best practice, published by the US Centers for Disease Control and Prevention (US <a href="http://www.cdc.gov/">CDC</a>). We found important differences between them.</p>
<p>Like the World Health Organization, the <a href="http://www.cdc.gov/nceh/lead/">US CDC plainly states</a>: “No safe blood lead level in children has been identified.”</p>
<p>In contrast, at the time of our analysis, <em>none</em> of the materials from Broken Hill, Mount Isa or Port Pirie made such a clear statement about lead exposure and harm to children.</p>
<p>As our article went through the peer review process, one page of the Mount Isa website “<a href="http://www.livingwithlead.com.au/about-lead/">About Lead</a>” was updated to include a new statement:</p>
<blockquote>
<p>There is no safe level of lead that has been proven not to cause any health problems.</p>
</blockquote>
<p>However, that statement is not repeated on other pages, including the one labelled <a href="http://www.livingwithlead.com.au/mount-isa/mount-isa-children/">Mount Isa Children</a>, which instead begins with advice to “Wash hands regularly”.</p>
<p>The US CDC also warns parents that the “effects of lead exposure cannot be corrected” and that “even low levels of lead in blood affect children.”</p>
<p>At the time of our analysis, only the Broken Hill site contained comparable information on low-level exposure and the fact that lead can cause permanent damage to children.</p>
<h2>Missing warnings for pregnant women and kids at higher risk</h2>
<p>All three of the Australian websites left out important risks of lead exposure during pregnancy.</p>
<p>The US CDC has a page specifically on <a href="http://www.cdc.gov/nceh/lead/tips/pregnant.htm">lead and pregnant women</a>, using blunt language to warn women that lead exposure during pregnancy can “put you at risk for miscarriage” and “cause your baby to be born too early or too small”. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/107480/original/image-20160107-4331-1e1jkl0.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/107480/original/image-20160107-4331-1e1jkl0.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/107480/original/image-20160107-4331-1e1jkl0.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=808&fit=crop&dpr=1 600w, https://images.theconversation.com/files/107480/original/image-20160107-4331-1e1jkl0.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=808&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/107480/original/image-20160107-4331-1e1jkl0.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=808&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/107480/original/image-20160107-4331-1e1jkl0.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1016&fit=crop&dpr=1 754w, https://images.theconversation.com/files/107480/original/image-20160107-4331-1e1jkl0.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1016&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/107480/original/image-20160107-4331-1e1jkl0.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1016&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">From the Broken Hill website, showing when it’s recommended local toddlers get blood tests to check for lead poisoning.</span>
<span class="attribution"><a class="source" href="http://www.leadnsw.com.au/#!hygiene/cn8w">Lead NSW</a></span>
</figcaption>
</figure>
<p>In contrast, none of the three Australian sites mentioned those crucial risks to babies. (Compare the <a href="http://www.cdc.gov/nceh/lead/tips/pregnant.htm">clear US advice</a> to that given to pregnant women <a href="http://www.leadnsw.com.au/#!starting-a-family/c16ls">in Broken Hill</a> and <a href="http://www.livingwithlead.com.au/mount-isa/mount-isa-residents/">Mount Isa</a>.)</p>
<p>People can often be affected by lead exposure without showing obvious symptoms. Yet only the Broken Hill materials provided parents with a schedule for when they should have their children’s blood tested for lead exposure.</p>
<p>The US CDC also discusses the fact that racial minorities and low-income families may be at higher risk of lead exposure. Only in Broken Hill were racial differences in blood lead levels discussed, even though higher average blood lead levels have been reported in Indigenous children in both Mount Isa and Broken Hill.</p>
<h2>Patchy advice for parents on kids playing outdoors</h2>
<p>Our study also found that incomplete information on the risks of lead in soil, even though soil and dust are major pathways of exposure. Only the Broken Hill materials said that:</p>
<blockquote>
<p>many local yards exceed the national soil lead safety level.</p>
</blockquote>
<p>While the other cities’ websites acknowledged that soil may be contaminated, none of the three contain information on the acceptable Australian standard for lead in gardens (300 milligrams per kilogram) or the percentage of gardens that exceed the standard in each city. They also didn’t tell residents how they could get their soil tested to evaluate their family’s risk. </p>
<p>Because lead contamination is widespread in Broken Hill, Mount Isa and Port Pirie, and the potential for children to be exposed in their homes, gardens, and play areas is very real, the three websites make many recommendations for reducing children’s exposure.</p>
<p>These include intensive interior and exterior cleaning, personal hygiene, gardening, diet and food preparation. But the advice was not consistent across the communities. </p>
<p>For example, in Broken Hill and Mount Isa parents have been advised to let children play in areas with grass or turf cover or to provide a sand pit. But in Port Pirie, no specific advice on children’s play areas was given, except to cover bare soil.</p>
<p>Only in Port Pirie were parents advised to wash outdoor play structures. A recent study, however, found playground washing to be of <a href="https://theconversation.com/toxic-playgrounds-broken-hill-kids-exposed-to-poisonous-dust-32325">limited effectiveness</a> for reducing children’s lead exposure if contamination is ongoing.</p>
<p>Advice on eating homegrown vegetables also varied. In Port Pirie, children and pregnant women are told not to eat “leafy vegetables like lettuce, silverbeet, cabbage, broccoli and cauliflower”. No similar advice was provided in the other communities.</p>
<p>Additionally, some advice on <a href="http://semspub.epa.gov/work/11/175343.pdf">how to reduce exposure</a> to lead that <em>is</em> <a href="http://www.epa.gov/sites/production/files/documents/reduc_pb.pdf">supported by research</a> has not being shared with families in all three cities. Two examples include:</p>
<ul>
<li>Door mats to reduce tracked in lead: this recommendation is supported by research but was only provided in Mount Isa.</li>
<li>HEPA filters for vacuuming: even though both South Australia Health and US EPA recommend the use of HEPA filters on vacuums in communities with lead contamination to minimise the spread of lead dust when vacuuming, this advice was not offered in Broken Hill or Mount Isa. In Port Pirie, HEPA filters were only said to be “preferred.”</li>
</ul>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/E6KoMAbz1Bw?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Canadian expert Dr Bruce Lanphear explains how extremely low levels of toxins including lead can affect a child’s brain development.</span></figcaption>
</figure>
<h2>What needs to happen to make Australian kids safer?</h2>
<p>The health education programs in Broken Hill, Mount Isa and Port Pirie currently place the overwhelming burden on parents to keep lead out of their children’s bodies, even though they are living in communities with <a href="https://theconversation.com/reducing-the-harms-of-toxic-air-in-mining-and-smelting-communities-25999">historical and ongoing contamination</a>.</p>
<p>Lead pollution is not a problem that parents can solve on their own. Reducing or eliminating lead emissions, removing children from the sources of exposure, and cleaning up environmental contamination is critical. </p>
<p>Based on our research, we recommend revising the advice to people in all three of these communities so that it is as clear and comprehensive as what is published by the US Centers for Disease Control and Prevention. Parents and pregnant women in Broken Hill, Mount Isa and Port Pirie need to be given <em>all</em> of the evidence-based advice about reducing lead exposure.</p>
<p>Those revisions should be led by the NHMRC, as Australia’s leading expert health body. And that work should be coordinated across the three cities, so that families aren’t given different advice depending on where they live. There should also be rigorous and independent evaluation of these programs to determine if they are effective.</p>
<p>Better lead health education is important. But it is also not a substitute for eliminating lead in children’s homes, play areas and gardens.</p>
<p><em>* Do you have any questions about lead pollution and what advice families should be getting? Leave your questions below and Donna Green will be available for an Author Q&A between 1-2pm AEDT on Tuesday January 12.</em></p><img src="https://counter.theconversation.com/content/52752/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Parents in three Australian states are being given misleading advice about the dangers of lead to babies and small children – including failing to warn pregnant women about miscarriage risks.Marianne Sullivan, Assistant Professor of Public Health, William Paterson UniversityDonna Green, Senior Lecturer and Researcher at the Climate Change Research Centre (CCRC) & Associate Investigator for the ARC Centre of Excellence for Climate Systems Science, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.