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Special issue of AJPH Illuminates Lead Risks Throughout U.S., Prevention Steps

Date: Sep 30 2022

Contact: APHA Media Relations

The dangers of lead are virtually everywhere in the United States.

A series of national studies about lead exposures are featured in a special supplement of the American Journal of Public Health in collaboration with the Centers for Disease Control and Prevention, which show the widespread impact of lead contamination in drinking water, in game meat and exposure to lead from firearms.

The supplement, entitled, Ubiquitous Lead: Risks, Prevention-Mitigation Programs, and Emerging Sources of Exposure, reveals higher than normal lead exposure in school drinking water in states without water-lead testing programs, and elevated lead in tap water at childcare centers, lead contamination in game meat donated to food banks, and reveals how veterans may have been exposed to lead from firearms.

It covers a range of topics including industrial and occupational lead, sources of lead exposure, blood lead testing efforts, surveillance methods and community prevention actions. The articles also reflect the government prevention efforts, and strategies for prevention of exposure.

Although lead exposure has been significantly reduced since the 1970s and 1980s when federal policies were implemented to eliminate lead in paint and reduce lead in passenger car gasoline, people remain at risk, especially children. The evidence demonstrates that children living in poverty and some minority children bear a disproportionate risk of exposure, though lead contamination is widespread.

No level of lead exposure is safe, especially for children. Even low levels of lead in blood have been shown to affect learning, ability to pay attention and academic achievement. A blood test is the best way to determine if a child has been exposed to lead.

“Given the almost ubiquitous nature of lead, wider swaths of children are potentially at risk,” write Tanya Telfair LeBlanc, PhD, MS, Robert Svendsen, PhD, and Paul Allwood, PhD, guest editors from the CDC Division of Environmental Health Science and Practice in the National Center for Environmental Health. “The time for action is now. Lead poisoning prevention is complex and requires a recalibration of current public health approaches and perspectives.”

LeBlanc is senior health scientist, for the CDC’s Lead Poisoning Prevention and Surveillance Branch (LPPSB- proposed). Svendsen, is director of the Division of Environmental Health Science and Practice. Allwood, is the branch chief of the LPPSB.

“Lead poisoning prevention, as a model for the future of public health, forces us to boldly confront equity issues such as safe housing, clean drinking water, safe schools and childcare facilities, environmental justice, community infrastructure repair, occupational risks and so on,” they write. “We must protect young children from exposure prevention should be a national priority.”

The studies published in the supplement show:

  • Lead contamination in school drinking water in seven states suggested that many public schools were without drinking water-lead testing programs. Angie L. Cradock, principal research scientist and deputy director of the Harvard Prevention Research Center, analyzed data on lead concentration in drinking water samples in 2018.
  • Elevated levels in tap water in 4,005 licensed North Carolina childcare centers from 2020 to 2021.Well-water reliance was the largest risk factor, followed by Head Start programs and building age. Of 22,943 samples analyzed, 3 percent of the tap water exceeded the N.C. hazard level and 25 percent exceeded the American Academy of Pediatrics reference level, according to Jennifer Hoponick Redmon, director of environmental health and water quality at the RTI International, and colleagues.
  • In an essay entitled “Biting the bullet: a call for action on lead contaminated meat in food banks, Samantha Totoni, MPH, and her co-authors at the Department of Environmental and Occupational Health at the University of Pittsburgh School of Public Health, signal possible lead contamination in over one 1 million kg of hunted deer meat donated to U.S. food banks each year. They called for primary prevention efforts to protect recipients of donated hunter’s bounty from lead-exposed meat.
  • Gina Oda, MS, a public health surveillance and research investigator for the U.S. Department of Veteran Affairs, and other authors in “Exposure Sources Among Veterans with Elevated Blood Lead Levels, United States, 2015–2021,” examine the characteristics and sources of exposure in veterans with elevated blood lead levels. Firearms were the largest exposure source among veterans with elevated blood lead level.

Since 1978, lead has been prohibited in paint products and reduced in passenger car gasoline since the 1980s. But lead is abundant in soil and may be found in homes built before 1978, in layers of paint beneath the surface and in original plumbing pipes.

Lead can be inhaled in dust particles or in fumes from burning lead-painted wood, imported items such as cookware, toys, cosmetics, arts and crafts, and firearms ammunition and fishing tackle. Such potential exposure routes continue to pose public health risks as the Flint, Mich. water crisis demonstrated in 2014.

Still, federal authorities have been working continuously to overcome the lead impact.

Pointing to the national response, Patrick Breysse, PhD, CIH, director of the CDC’s National Center for Environmental Health/Agency for Toxic Substances and Disease Registry and colleagues summarized the work of federal agencies working collaboratively in the President’s Task Force on Environmental Health and Safety Risks to Children to update national regulatory standards, guidance, educational tools, and programs focused on risk mitigation in individual communities.

Dr. Allwood of the CDC provided historical perspectives in “Two Diseases that Are One: An Historical Perspective on the CDC Childhood Lead Poisoning Prevention Program” which chronicle and detail over 50 years of lead poisoning prevention activities at the Centers for Disease Control and Prevention.

In articles that highlight prevention strategies in the field, Stephanie Yendell, a senior epidemiology supervisor at the Minnesota Department of Health and colleagues write about a program that mitigates take-home lead exposure in a Minnesota fishing tackle and battery terminal plant in a piece, “Tackling the Lead Gremlins: A Response to Take-Home Lead Exposure.”

Trisha Calabrese, an editor at the American Academy of Pediatrics, and colleagues in “An Innovative Approach to Increase Lead Testing by Pediatricians in Children, United States, 2019-2021” described a national tele-mentoring program to educate pediatricians on the importance of lead testing during ordinary medical practice. Evaluation results indicate two weeks to one month after training, over 80% of participants reported increased lead testing and practice changes.

“We must protect young children from exposure to lead to ensure that future leaders have the mental capacity to confront the challenges ahead,” said LeBlanc and her co-authors. “Thus, childhood lead exposure prevention should be a national priority.”

The special AJPH supplement, Ubiquitous Lead: Risks, Prevention-Mitigation Programs, and Emerging Sources of Exposure, is available online. To request a full copy of a study or for information on scheduling interviews, contact APHA Media Relations.

This issue was funded by the Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Environmental Health Science and Practice, Lead Poisoning Prevention and Surveillance Branch (Proposed) under contract number 75D30121P10856. The opinions expressed are those of the authors and do not represent the official views of, nor an endorsement by the Centers for Disease Control and Prevention, the U. S. Department of Health and Human Services, or the U.S. Government.


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