Article

Failing Our Children: Lead in U.S. School Drinking Water

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Abstract

Lead is the most prevalent toxicant in U. S. school drinking water. Yet for the vast majority of schools, federal regulation for testing taps and remediating contamination is voluntary. Using school case studies, this article discusses the regulatory vacuum that leaves children unprotected from potential exposure to very high lead doses through consumption of school water. Controlling lead hazards from water fountains, coolers, and other drinking water outlets in schools requires improved sampling protocols that can capture the inherent variability of lead release from plumbing and measure both the particulate and dissolved lead present in water. There is a need to reevaluate the potential public health implications of lead-contaminated drinking water in schools. Accounting for this misunderstood and largely overlooked exposure source is necessary in order to better understand and address childhood lead poisoning in the U. S.

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... The recommended guideline of 20 µg/L applied to lead in school water is considered more stringent than the 15 µg/L lead action level for homes, because a 250 mL water sample under the LCCA tends to concentrate the lead in collected samples, compared to the 1-L samples collected under the LCR (US EPA, 2010). Passage of the LCCA in 1988 prompted many schools to test for lead in drinking water, but state adoption and enforcement of the guideline was often weak and even nonexistent (Lambrinidou et al., 2010). By 1990 many schools had not repaired or removed lead-tainted coolers, used sampling protocols other than those recommended by EPA, carried out very limited or inappropriate sampling, or failed to conduct water testing at all (Lambrinidou et al., 2010). ...
... Passage of the LCCA in 1988 prompted many schools to test for lead in drinking water, but state adoption and enforcement of the guideline was often weak and even nonexistent (Lambrinidou et al., 2010). By 1990 many schools had not repaired or removed lead-tainted coolers, used sampling protocols other than those recommended by EPA, carried out very limited or inappropriate sampling, or failed to conduct water testing at all (Lambrinidou et al., 2010). ...
... In support of this hypothesis, it was recently revealed that a child with elevated blood lead from water in Greenville, North Carolina, was exposed in a day care center (E. Robertson, personal communication, March 24, 2006), and environmental assessments in Washington, DC, attributed a child's elevated blood lead to contaminated water (7,300 µg/L lead) at an elementary school (Lambrinidou et al., 2010). Concerns related to a case of adult lead exposure for a teacher in an Oregon school in 2008 gave impetus to testing of tap water for water fountains at work, which revealed high lead in water (Y. ...
Article
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Lead is widely recognized as one of the most pervasive environmental health threats in the United States, and there is increased concern over adverse health impacts at levels of exposure once considered safe. Lead contamination of tap water was once a major cause of lead exposure in the United States and, as other sources have been addressed, the relative contribution of lead in water to lead in blood is expected to become increasingly important. Moreover, prior research suggests that lead in water may be more important as a source than is presently believed. The authors describe sources of lead in tap water, chemical forms of the lead, and relevant U.S. regulations/guidelines, while considering their implications for human exposure. Research that examined associations between water lead levels and blood lead levels is critically reviewed, and some of the challenges in making such associations, even if lead in water is the dominant source of lead in blood, are highlighted. Better protecting populations at risk from this and from other lead sources is necessary, if the United States is to achieve its goal of eliminating elevated blood lead levels in children by 2020.
... Only the~10% of US schools which are regulated as public water suppliers are subject to the federal Environmental Protection Agency (EPA) Lead and Copper Rule (LCR) of 1991 (Lambrinidou et al., 2010). The LCR has set a lead action level of 15 μg/L in 1 L first-draw water samples and requires water testing, remediation and public notification when exceeded (US EPA, 2006). ...
... The remaining~90% of US schools (classified as non-public water suppliers) are not subject to any mandatory water testing/remediation requirement, but instead rely on non-enforceable voluntary guidelines under the Lead Contamination Control Act (LCCA) of 1988 (Lambrinidou et al., 2010). These guidelines recommend that the water lead level (WLL) should not exceed 20 μg/L in any 250 mL firstdraw sample from school water outlets (US EPA, 2006). ...
... These guidelines recommend that the water lead level (WLL) should not exceed 20 μg/L in any 250 mL firstdraw sample from school water outlets (US EPA, 2006). Based on limited peer-reviewed literature or book chapters, schools in Pennsylvania (Bryant, 2004), Washington (Boyd et al., 2008), Missouri (Gnaedinger, 1993), California (Lambrinidou et al., 2010), Maryland (Lambrinidou et al., 2010), North Carolina (Maas et al., 1994), Iowa (Choquette and Gergely, 1992), New Jersey (Murphy, 1993), Kansas (Massey and Steele, 2012), Utah (Costa et al., 1997), and the District of Columbia (Lambrinidou et al., 2010) are known to have exceeded the LCCA recommendation of 20 μg/L lead in water. ...
... For example, public school buildings in low-income neighborhoods have not been updated in decades and house incredible potential for lead exposure. More importantly, lead is the most prevalent toxicant in U.S. school drinking water, however many schools are not testing their water and are not addressing the potential lead exposure 11 . Federal regulations only require voluntary testing and remediation of lead and many low-income schools do not have the funding and personnel to test and remediate the lead in their schools 11 . ...
... More importantly, lead is the most prevalent toxicant in U.S. school drinking water, however many schools are not testing their water and are not addressing the potential lead exposure 11 . Federal regulations only require voluntary testing and remediation of lead and many low-income schools do not have the funding and personnel to test and remediate the lead in their schools 11 . This is a perfect example of the environmental and policy level action that is needed to eliminate childhood lead exposure, especially in the public-school system. ...
Thesis
Lead exposure affects millions of children and families. Children and pregnant women are at higher risk for lead exposure due to the negative impact lead has on child and fetus development. There is no safe level of lead exposure and even small amounts of exposure to children can lead to developmental delays and behavioral issues in adolescence and adulthood. Lead exposure can occur through multiple pathways, but exposure to lead dust from lead paint in older homes is the most common form of exposure for children. Allegheny County, Pennsylvania, holds a high burden of lead due to the profoundly old infrastructure and industrial history. Due to this environment, children and pregnant women are at a constant risk for being exposed to lead. The Allegheny County Health Department mobilized a campaign to improve childhood blood lead level screening and provide education and resources for families. Included in this effort, was creating and disseminating education materials targeted to pregnant women and families. While the importance of evaluating health communication is widely known, it is often not prioritized, and evaluations are not commonly conducted. The proposed evaluation can identify if the print materials contributed to individual changes in lead-safe behaviors and overall improved knowledge and awareness of lead exposure. The public health significance of this paper is that it will contribute to limited information available on conducting proper and useful evaluations of health communication. Ultimately, this information can be used to improve public health education efforts and improve the reach of public health education.
... A single fountain within a given SDC can present close to 100fold variations in Pb concentrations (Deshommes et al., 2016;Doré et al., 2018). Yet, some authors suggested that even as sparse as they might be, peak concentrations within this variation pattern could contribute to a worrying increase BLL of attending children (Lakind, 1998;Lambrinidou et al., 2010;Triantafyllidou et al., 2014a). Besides, Pb in drinking water from schools have recently been associated with significant, though mild, deprivation of educational outcomes in Ontario, Canada (Buajitti et al., 2021). ...
... Moreover, for a given elevated mean exposure, the sequential peak exposure pattern for Pb concentrations in tap water in itself may contribute to increase BLL, as compared to constant exposure (Fig. 2). This supports a possible health concern as a result of short-term peak Pb exposures alone through drinking water, in particular if the baseline level is already sufficiently elevated, as argued by some authors (Lakind, 1998;Lambrinidou et al., 2010). Considering the upper percentile values in infants, this BLL increase can result in occasionally exceeding the CDC's BLL threshold value of 5 μg/dL. ...
Article
The aim of this study was to assess the impact of exposure to tap water lead concentration ([Pb]TW) occurring in schools or daycares on blood lead level (BLL) of attending children. Given the potentially wide variations in space and time of ([Pb]TW) documented in the literature, a simple probabilistic toxicokinetic (STK) model that allows the simulation of the time-varying evolution of BLL in response to these variations was developed. Thus, basic toxicokinetic equations were assembled to simulate BLL in a typical infant, toddler and pupil. The STK model’s steady-state BLL predictions showed good correspondence when validated against Integrated Exposure and Uptake BioKinetic model predictions for comparable [Pb]TW values. Exposures to three distributions of [Pb]TW in specific sets of Canadian schools and daycares documented in the scientific literature were simulated probabilistically with Monte Carlo simulations. For the highest distribution of [Pb]TW simulated (median, 90th percentile = 24, 412 μg/L), average annual BLL (median, 97.5th percentile) varies between 1.5 and 6.4 μg/dL in infant and 1.1 and 3 μg/dL in pupils. Toddler’s results were midway between those from the infants and pupils. Under this exposure scenario, the infant may present BLL > 5 μg/dL for a significant number of days over the course of the academic year (median; 97.5th: 17; 227 days). However, peak exposure may remain unnoticed if rare and drowned out by the background BLL. In conclusion, even if they may be sparse, peak exposure episodes to [Pb]TW in schools and daycares may suffice to increased BLL in attending individuals. This finding emphasizes the need for further characterization of [Pb]TW in schools and daycares in order to identify potentially problematic institutions and therefore avoid undesirable exposures for the attending individuals.
... A school or child care facility is considered a public water supplier when it serves water to more than 25 individuals a day using its own water source, which most commonly is groundwater from a well. 6 These are few and usually concentrated in rural areas. Therefore, the vast majority are not directly regulated by the SDWA. ...
... For example, Lambrinidou et al. evaluated that as of 2010 approximately 89%−92% of all schools within the United States were not required to test for Pb in drinking water. 6 According to estimates from the Government Accountability Office, 98,000 public schools and 500,000 child care centers are not directly regulated by the directives of the SDWA. 7 Even for those facilities under the SDWA, the data available may be incomplete. ...
Article
Few schools and child care facilities test for Pb in their drinking water. Reviewing the United States Environmental Protection Agency Lead and Copper rule data can contribute to guiding future legislation on Pb testing. This work aims to (i) identify variations in Pb levels in North Carolina school and child care drinking water by building age, (ii) evaluate the effect of corrosion control measures on reducing these levels, and (iii) evaluate the adequacy of Pb reporting limits according to modern instrumentation. To achieve these objectives, information on 26,608 water samples collected in 206 North Carolina child centers between 1991 and 2019 has been analyzed. Lead concentrations were above a recently proposed 5 μg/L trigger level in 12.3%, 10.4%, 7.5%, and 0.9% of samples from pre-1987, 1987−1990, 1991−2013, and post-2013 buildings, respectively. Thus, recently proposed legislation requiring testing only for pre-1987 (or pre-1991) buildings will fail to identify all centers at risk. The odds that a greater than 5 μg/L Pb level is detected has been decreasing over the years, with a faster decreasing rate for buildings reporting corrosion control. Over 15% of samples report a method detection limit of 5 μg/L. For accurate results, future legislation should require sub-μg/L detection limits, which are easily achievable with commonly available instrumentation.
... Sensitivity Analysis: The model was run for 78 iterations to determine the effects on the geometric mean BLL on the target population (11-to 17-year-old secondary school students). This consisted of 2 soil concentrations (20, 260 µg/g) for each of 13 average first draw school drinking water lead concentrations (0, 5,10,15,20,25,30,35,40,45,50,55, 60 µg/L) and 3 baseline BLLs (2, 7, 12 µg/dL). ...
... The school district's lead concentration data is summarized in Table 1. The maximum value (18,800 µg/L) is over 40% greater than the maximum concentration reported recently in Flint, Michigan (13,200 µg/L in 2015) [31] and over 2.5 times greater than the maximum value reported in Washington D.C. (7500 µg/L in 2004) [45]. Although the average ages of the district's elementary, middle, and high school buildings were all greater than 50-years-old, the original Lead Contamination and Control Act (LCCA)-issued to help mitigate lead in school drinking water [46]-had been implemented only 31 years prior to the 2019 sampling. ...
Article
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Lead (Pb) exposure can delay children’s mental development and cause behavioral disorders and IQ deficits. With children spending a significant portion of their time at schools, it is critical to investigate the lead concentration in schools’ drinking water to prevent children’s exposure. The objectives of this work were to predict students’ geometric mean (GM) blood lead levels (BLLs), the fractions of at-risk students (those with BLLs > 5 μg/dL), and the total number of at-risk students in one Tennessee school district. School drinking water lead concentration data collected in 2019 were input into the Integrated Exposure Uptake Biokinetic (IEUBK) model and the Bowers’ model to predict BLLs for elementary school students and secondary school students, respectively. Sensitivity analyses were conducted for both models. Drinking water concentrations were qualitatively compared with data collected in 2017. Two scenarios were evaluated for each model to provide upper and median estimates. The weighted GM BLL upper and median estimates for elementary school students were 2.35 μg/dL and 0.99 μg/dL, respectively. This equated to an upper estimate of 1300 elementary school students (5.8%) and a median estimate of 140 elementary school students (0.6%) being at risk of elevated BLLs. Similarly, the weighted GM BLL upper and median estimates for secondary school students were 2.99 μg/dL and 1.53 μg/dL, respectively, and equated to an upper estimate of 6900 secondary school students (13.6%) and a median estimate of 300 secondary school students (0.6%) being at risk of elevated BLLs. Drinking water remediation efforts are recommended for schools exhibiting water lead concentrations greater than 15 μg/L. Site-specific soil lead concentration data are recommended since the IEUBK was deemed sensitive to soil lead concentrations. For this reason, soil lead remediation may have a greater impact on lowering children’s BLLs than drinking water lead remediation. Remediation efforts are especially vital at elementary schools to reduce the population’s baseline BLL and thus the BLL projected by Bowers’ model.
... Legacy lead service lines, lead-bearing plumbing components, and low sampling rates can all cause unsafe lead levels at individual household taps to remain undetected (Riblet et al., 2019;Triantafyllidou and Edwards, 2012). Consequently, compliance with the Lead and Copper Rule action level is not considered adequately protective for children and formula-fed infants, who represent the population most vulnerable to lead exposure (Lambrinidou et al., 2010;Redmon et al., 2018;Triantafyllidou and Edwards, 2012). ...
Article
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Lead in drinking water continues to put children at risk of irreversible neurological impairment. Understanding drinking water system characteristics that influence blood lead levels is needed to prevent ongoing exposures. This study sought to assess the relationship between children's blood lead levels and drinking water system characteristics using machine-learned Bayesian networks. Blood lead records from 2003 to 2017 for 40,742 children in Wake County, North Carolina were matched with the characteristics of 178 community water systems and sociodemographic characteristics of each child's neighborhood. Bayesian networks were machine-learned to evaluate the drinking water variables associated with blood lead levels ≥2 μg/dL and ≥5 μg/dL. The model was used to predict geographic areas and water utilities with increased lead exposure risk. Drinking water characteristics were not significantly associated with children's blood lead levels ≥5 μg/dL but were important predictors of blood lead levels ≥2 μg/dL. Whether 10% of water samples exceeded 2 ppb of lead in the most recent year prior to the blood test was the most important water system predictor and increased the risk of blood lead levels ≥2 μg/dL by 42%. The model achieved an area under the receiver operating characteristic curve of 0.792 (±0.8%) during ten-fold cross validation, indicating good predictive performance. Water system characteristics may thus be used to predict areas that are at risk of higher blood lead levels. Current drinking water regulatory thresholds for lead may be insufficient to detect the levels in drinking water associated with children's blood lead levels.
... Numerous cases of elevated amounts of lead in drinking water in institutional or nonresidential buildings have been reported in recent years (Boyd et al. 2008a, b;Elfland et al. 2010;Lambrinidou et al. 2010;Cartier et al. 2012;Deshommes et al. 2012). Lead exposure to particularly young children is of great concern due to adverse health effects (Canfield et al. 2003;Bellinger 2008;Boyd et al. 2008b; Barn et al. 2013), and the extent of lead issues in nonresidential buildings is critical. ...
Article
Exposure to lead in drinking water poses a risk for various adverse health effects, and significant efforts have been made to monitor and eliminate lead exposure in drinking water. This study focused on the localization of lead exposure from 71 drinking water fountains in nonresidential buildings in order to determine the source of elevated lead and understand the effects of fountains associated with lead concentration in drinking water. Drinking water fountains containing lead-lined cooling tanks and brass fittings were found to release lead concentrations in excess of 10 μg/L, and fountains with low or infrequent usage and those with cooling tanks produced the highest concentrations (in excess of 20 μg/L) of lead. One particular fountain model found at several locations throughout the institution was associated with some of the highest lead concentrations measured throughout the study. This fountain was recalled in the United States, but not in Canada. This article adds to existing research demonstrating that drinking water fountains are a potentially significant and underappreciated source of lead exposure in nonresidential buildings.
... Numerous cases of elevated amounts of lead in drinking water in institutional or nonresidential buildings have been reported in recent years (Boyd et al. 2008a, b;Elfland et al. 2010;Lambrinidou et al. 2010;Cartier et al. 2012;Deshommes et al. 2012). Lead exposure to particularly young children is of great concern due to adverse health effects (Canfield et al. 2003;Bellinger 2008;Boyd et al. 2008b; Barn et al. 2013), and the extent of lead issues in nonresidential buildings is critical. ...
... Pb can be either in particulate or dissolved form and the concentration of each form can be influ- enced by water conditions (i.e., pH, hardness), as well as network operational conditions (i.e., residence time, temperature, corro- sion inhibitor, flow rate) [11,[13][14][15][16][17][18]. Pb levels in U.S. buildings have been reported to range from 0.2 to 13,000 g/L in first draw water samples, and 0.2 to 7400 g/L in flushed (30 s) water samples [18,[19][20][21][22]. If water quality or operational conditions are altered, excessive metal leaching from piping components and pipe scales can occur as evidenced by Pb poisonings in Washington D.C. [2]. ...
Article
The influence of polymer aging, water pH, and aqueous Pb concentration on Pb deposition onto low density polyethylene (LDPE) was investigated. LDPE pellets were aged by ozonation at 85 °C. ATR-FTIR and X-ray photoelectron spectroscopy (XPS) analysis of aged LDPE surfaces showed that a variety of polar functional groups (>CO<, >CO, >COO) were formed during aging. These functional groups likely provided better nucleation sites for Pb(OH)2 deposition compared to new LDPE, which did not have these oxygen-containing functional groups. The type and amount of Pb species present on these surfaces were evaluated through XPS. The influence of exposure duration on Pb deposition onto LDPE was modeled using the pseudo-first-order equation. Distribution ratios of 251.5 for aged LDPE and 69.3 for new LDPE showed that Pb precipitates had greater affinity for the surface of aged LDPE compared to new LDPE. Aged LDPE had less Pb surface loading at pH 11 compared to loading at pH 7.8. Pb surface loading for aged LDPE changed linearly with aging duration (from 0.5-7.5 h). Pb surface loading on both new and aged LDPE increased linearly with increasing Pb initial concentration. Greater Pb precipitation rates were found for aged LDPE compared to new LDPE at both tested pH values.
... 16 School-age children may also be at particular risk for lead exposure, given that only 10% of schools nationwide are required to comply with the EPA's standards for water lead levels. 17 The presence of lead in drinking water can be attributed to plumbing materials used in cities and buildings. 15 As water leaves treatment plants, it travels through lead-based materials such as pipes and solder. ...
Article
Children are uniquely susceptible to the health consequences of water contamination. In this review, we summarize the existing, robust literature supporting the importance of examining specific water contaminants (i.e., lead, nitrates, arsenic, perchlorate) and the routes of contamination in the United States and globally. We also discuss the health effects of exposure to contaminated water and significant disparities related to access to clean water. Lastly, we offer strategies for prevention and intervention—including those focused on the individual patient level—and review the current US policy framework pertaining to regulation of these toxicants. A key message in this article is that exposure to water contaminants have serious and long-lasting consequences on children’s health. This review summarizes current existing literature and adds policy recommendations supporting clean water for children. Information from this review has two potential impacts: Guide health professionals in screening and/or treating children’s health problems resulting from water contaminant exposure. Guide policy makers in using evidence-based approaches to improve water quality and clean water access.
... The switch to chloramine disinfectant (electro-) chemically destabilized the protective tetravalent lead oxide scale, resulting in unsafe soluble Pb accumulation in the water (17). Serious lead contamination concerns in public schools have occurred in Los Angeles, Baltimore, and Seattle (18). As urban infrastructure continues to age and worldwide access to drinking water becomes increasingly threatened (19), the corrosion of drinking water distribution systems becomes more important than ever (20). ...
Article
Full-text available
The Flint water crisis raised questions about the factors resulting in unacceptable soluble lead concentrations in the city's drinking water. Although water treatment strategies, failure to follow regulations, and unethical behavior were all factors, knowledge deficits at the intersection of several scientific fields also contributed to the crisis. Pursuit of opportunities to address unresolved scientific questions can help avert future lead poisoning disasters. Such advances will enable scientifically based, data-driven risk assessments that inform decisions involving drinking water systems. In this way, managers and decision makers can anticipate, monitor, and prevent future lead in water crises.
... Lead in drinking water, including from school drinking water systems, has been linked to low-and moderate-level lead exposure (5) and elevated blood-lead levels in children (6). Identification and remediation of lead exposure from school drinking water has been identified as an important public health priority because of known risks in children from both acute and chronic exposure, including neuro-motor impairments, intellectual deficits, and behavioral issues (7)(8)(9). ...
Article
Purpose: Using province-wide lead testing data from school drinking water systems and standardized educational assessments, to investigate the association between lead exposure in schools and educational outcomes in Ontario, Canada for 2008-09 to 2015-16 school years. Methods: Lead testing data were linked to assessment results in reading, writing, and mathematics from Ontario's Education Quality and Accountability Office and school neighborhood characteristics from the Ontario Marginalization Index. Sequential negative binomial models were used to estimate the relative risk of lower EQAO achievement in schools with lead exceedances in the preceding year, compared to those without. Results: Between 2008-09 and 2015-16, 78% of schools with EQAO scores were linked to lead testing results. In schools with lead exceedances, 8% more students failed to achieve the provincial standard for math (95%CI = 1.07-1.09), 6% more students failed to achieve the provincial standard for reading (95%CI = 1.05-1.08), and 10% more students failed to achieve the provincial standard for writing (95%CI = 1.08-1.11). Associations of attenuated magnitude persisted after covariate adjustment. Conclusions: Routinely-collected lead testing data from school drinking water systems are associated with educational outcomes in the school-aged population, and may present an opportunity for ongoing investigation of childhood lead exposures.
... The particular use patterns in schools (long periods of disuse overnight, weekends and vacations) foster high WLLs. Detectable concentrations of lead in school water systems have been documented in at least 38 US states and the District of Columbia, including several exceedances of the federal drinking water standard (Lambrinidou et al., 2010;Olson and Pullen Fedinick, 2016;Young and Nichols, 2016). Urban schools, which tend to be older than suburban schools, are also more likely to have plumbing components containing lead. ...
Article
Centuries of human activities, particularly housing and transportation practices from the late 19th century through the 1980’s, dispersed hundreds of millions of tons of lead into our urban areas. The urban lead burden is evident among humans, wild and domesticated animals, and plants. Animal lead exposures closely mirror and often exceed the lead exposure patterns of their human partners. Some examples: Pigeons in New York City neighborhoods mimicked the lead exposures of neighborhood children, with more contaminated areas associated with higher exposures in both species. Also, immediately following the lead in drinking water crisis in Flint MI in 2015, blood lead levels in pet dogs in Flint were 4 times higher than in surrounding towns. And combining lead’s neurotoxicity with urban stress results in well-characterized aggressive behaviors across multiple species. Lead pollution is not distributed evenly across urban areas. Although average US pediatric lead exposures have declined by 90% since the 1970s, there remain well defined neighborhoods where children continue to have toxic lead exposures; animals are poisoned there, too. Those neighborhoods tend to have disproportionate commercial and industrial lead activity; a history of dense traffic; older and deteriorating housing; past and operating landfills, dumps and hazardous waste sites; and often lead contaminated drinking water. The population there tends to be low income and minority. Urban wild and domesticated animals bear that same lead burden. Soil, buildings, dust and even trees constitute huge lead repositories throughout urban areas. Until and unless we begin to address the lead repositories in our cities, the urban lead burden will continue to impose enormous costs distributed disproportionately across the domains of the natural environment. Evidence-based research has shown the efficacy and cost-effectiveness of some US public policies to prevent or reduce these exposures. We end with a series of recommendations to manage lead-safe urban environments.
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In recent times the issue of lead in drinking water has drawn national attention and concern. On that basis we sampled for lead in drinking water in 16 elementary schools in Tallahassee Florida - water fountains and cafeteria water taps - which revealed that lead concentrations in 30 of 32 samples exceeded the American Academy of Pediatrics 1 part per billion lead recommendation. The school system responded by flushing water pipes daily thus reducing lead levels in drinking water. We recommend further remedial action, namely installation of point-of-use NSF/ANSI Standard 53 water filters certified to reduce lead, on drinking water sources in the schools. This is an inexpensive option that can rapidly be implemented and offers greater certainty that lead levels - both dissolved and particulate lead - will be appropriately reduced. Given that allowable lead levels in potable water plumbing - pipes and fittings - was relatively high in the US until 2014, the use of lead-removal certified water filters should be considered broadly for drinking water sources used by young children – in schools, daycares and residences. Pediatricians have an important role in reducing their patients’ exposure to lead, by assessing and educating their patients, and via advocating for protective policies.
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Estimating the risk of lead contamination of schools' drinking water at the State level is a complex, important, and unexplored challenge. Variable water quality among water systems and changes in water chemistry during distribution affect lead dissolution rates from pipes and fittings. In addition, the locations of lead-bearing plumbing materials are uncertain. We tested the capability of six machine learning models to predict the likelihood of lead contamination of drinking water at the schools' taps using only publicly available datasets. The predictive features used in the models correspond to those with a proven correlation to the dominant, but commonly unavailable, factors that govern lead leaching: the presence of lead-bearing plumbing materials and water quality conducive to lead corrosion. By combining water chemistry data from public reports, socioeconomic information from the US census, and spatial features using Geographic Information Systems, we trained and tested models to estimate the likelihood of lead contaminated tap water in over 8000 schools across California and Massachusetts. Our best-performing model was a Random Forest, with a 10-fold cross validation score of 0.88 for Massachusetts and 0.78 for California using the average Area Under the Receiver Operating Characteristic Curve (ROC AUC) metric. The model was then used to assign a lead leaching risk category to half of the schools across California (the other half was used for training). There was good agreement between the modeled risk categories and the actual lead leaching outcomes for every school; however, the model overestimated the lead leaching risk in up to 17% of the schools. This model is the first of its kind to offer a tool to predict the risk of lead leaching in schools at the State level. Further use of this model can help deploy limited resources more effectively to prevent childhood eld exposure from school drinking water.
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Using critical race structuralism (CRS), a new contribution, as well as primary and secondary data, this article explores the role of science in teaching social justice issues in urban education. In the United States, a teaching workforce, which is predominately White, middle class, and female, intersects with an increasingly diverse student population, creating a need for culturally responsive teaching practices, particularly in science, technology, engineering, and math (STEM), and science, technology, engineering, arts, and math (STEAM) classes. An investigation of existing literature reveals the need for greater emphasis on environmental racism and social justice as they pertain to students living in low-income and urban communities. Our findings reveal that CRS can be utilized in a collective effort to transform teacher education programs and teacher pedagogy, to effectively address environmental racism and other social justice issues in urban schools and communities.
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On May 7-9, 2012, obesity prevention leaders, including public health professionals across federal, state and local levels, policymakers and decision makers, community leaders as well as researchers engaged in policy, systems and environmental (PSE) efforts related to obesity prevention, convened at the Weight of the Nation (WON) conference in Washington, D.C. In recognition of the growing interest in the relationship between the food system and public health, and obesity in particular, organizers of the WON invited leading experts from multiple disciplines to work as a committee to plan five sessions related to these topics. These experts decided to expand the focus of the sessions to include public drinking water systems and to organize sessions with the goal of identifying solutions to create a healthy, sustainable, and equitable food and water system. This paper presents the key themes, challenges, and potential solutions and discussed within the Food and Water System: Agriculture, Access and Sustainability track (hereinafter referred to as the “Food and Water System Track”).
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Simplistic conventional models predict that a greater mass of lead will be released from lead pipes exposed to higher velocity and flow durations. However, if galvanic Pb-Cu connections are present, or if a highly protective Pb(IV) scale can be formed, reduced flow can markedly increase the mass of lead release to water and resultant consumer exposure. Three chemical mechanisms were identified that can reduce lead release at higher flow including (1) formation of Pb(IV), (2) potential reversal of Pb:Cu couples, after which galvanic corrosion sacrifices copper and lead is protected, and (3) reduced formation of corrosive microenvironments at lead surfaces in galvanic couples. Potential reversal occurred only in the presence of free chlorine with continuous flow, and it did not occur with chloramine, with intermittent flow, or if orthophosphate was present. For both disinfectants, electrochemical measurements supported a mass balance of lead release demonstrating that a greater total mass of lead release occurred with intermittent flow than with continuous flow.
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We reviewed the sources of lead in the environments of U.S. children, contributions to children's blood lead levels, source elimination and control efforts, and existing federal authorities. Our context is the U.S. public health goal to eliminate pediatric elevated blood lead levels (EBLs) by 2010. National, state, and local exposure assessments over the past half century have identified risk factors for EBLs among U.S. children, including age, race, income, age and location of housing, parental occupation, and season. Recent national policies have greatly reduced lead exposure among U.S. children, but even very low exposure levels compromise children's later intellectual development and lifetime achievement. No threshold for these effects has been demonstrated. Although lead paint and dust may still account for up to 70% of EBLs in U.S. children, the U.S. Centers for Disease Control and Prevention estimates that >or=30% of current EBLs do not have an immediate lead paint source, and numerous studies indicate that lead exposures result from multiple sources. EBLs and even deaths have been associated with inadequately controlled sources including ethnic remedies and goods, consumer products, and food-related items such as ceramics. Lead in public drinking water and in older urban centers remain exposure sources in many areas. Achieving the 2010 goal requires maintaining current efforts, especially programs addressing lead paint, while developing interventions that prevent exposure before children are poisoned. It also requires active collaboration across all levels of government to identify and control all potential sources of lead exposure, as well as primary prevention.
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Given the association between iron deficiency and lead absorption, we hypothesized that variants in iron metabolism genes would predict higher blood lead levels in young children. We examined the association between common missense variants in the hemochromatosis (HFE) and transferrin (TF) genes and blood lead levels in 422 Mexican children. Archived umbilical cord blood samples were genotyped for HFE (H63D and C282Y) and TF (P570S) variants. Blood lead was measured at 24, 30, 36, 42, and 48 months of age. A total of 341 subjects had at least one follow-up blood lead level available and data available on covariates of interest for inclusion in the longitudinal analyses. We used random-effects models to examine the associations between genotype (HFE, TF, and combined HFE + TF) and repeated measures of blood lead, adjusting for maternal blood lead at delivery and child's concurrent anemia status. Of 422 children genotyped, 17.7, 3.3, and 18.9% carried the HFE H63D, HFE C282Y, and TF P570S variants, respectively. One percent of children carried both the HFE C282Y and TF P570S variants, and 3% of children carried both the HFE H63D and TF P570S variants. On average, carriers of either the HFE (beta = 0.11, p = 0.04) or TF (beta = 0.10, p = 0.08) variant had blood lead levels that were 11% and 10% higher, respectively, than wild-type subjects. In models examining the dose effect, subjects carrying both variants (beta = 0.41, p = 0.006) had blood lead 50% higher than wild-type subjects and a significantly higher odds of having a blood lead level > 10 microg/dL (odds ratio = 18.3; 95% confidence interval, 1.9-177.1). Iron metabolism gene variants modify lead metabolism such that HFE variants are associated with increased blood lead levels in young children. The joint presence of variant alleles in the HFE and TF genes showed the greatest effect, suggesting a gene-by-gene-by-environment interaction.
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Samples from drinking water fountains in 50 schools in New Jersey were collected at specific times during a typical school day and analyzed for lead, copper, pH, alkalinity, and hardness. First-draw lead and copper levels (medians 0.010 mg/l and 0.26 mg/l, respectively) decreased significantly after 10 min of flushing in the morning (medians 0.005 mg/l lead and 0.068 mg/l copper), but levels increased significantly by lunchtime (medians 0.007 mg/l lead and 0.12 mg/l copper) after normal use of fountains in the morning by students. Corrosive water, as defined by the aggressive index, contained significantly higher levels of lead and copper (medians 0.012 mg/l and 0.605 mg/l, respectively) than noncorrosive water (medians 0.005 mg/l and 0.03 mg/l, respectively). Images p240-a
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Lead is a confirmed neurotoxicant, but the lowest blood lead concentration associated with deficits in cognitive functioning and academic achievement is poorly defined. The purpose of the present study was to examine the relationship of relatively low blood lead concentrations-especially concentrations <10 micrograms per deciliter (microg/dL)--with performance on tests of cognitive functioning in a representative sample of US children and adolescents. The authors used data from the Third National Health and Nutrition Examination Survey (NHANES III), conducted from 1988 to 1994, to assess the relationship between blood lead concentration and performance on tests of arithmetic skills, reading skills, nonverbal reasoning, and short-term memory among 4,853 children ages 6-16 years. The geometric mean blood lead concentration for children n the study sample was 1.9 microg/dL; 172 (2.1%) had blood lead concentrations > or =10 microg/dL. After adjustment for gender, race/ethnicity, poverty, region of the country, parent or caregiver's educational level, parent or caregiver's marital status parent, serum ferritin level, and serum cotinine level, the data showed an inverse relationship between blood lead concentration and scores on four measures of cognitive functioning. For every 1 microg/dL increase in blood lead concentration, there was a 0.7-point decrement in mean arithmetic scores, an approximately 1-point decrement in mean reading scores, a 0.1-point decrement in mean scores on a measure of nonverbal reasoning, and a 0.5-point decrement in mean scores on a measure of short-term memory. An inverse relationship between blood lead concentration and arithmetic and reading scores was observed for children with blood lead concentrations lower than 5.0 microg/dL. Deficits in cognitive and academic skills associated with lead exposure occur at blood lead concentrations lower than 5 microg/dL.
Article
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Despite dramatic declines in children's blood lead concentrations and a lowering of the Centers for Disease Control and Prevention's level of concern to 10 microg per deciliter (0.483 micromol per liter), little is known about children's neurobehavioral functioning at lead concentrations below this level. We measured blood lead concentrations in 172 children at 6, 12, 18, 24, 36, 48, and 60 months of age and administered the Stanford-Binet Intelligence Scale at the ages of 3 and 5 years. The relation between IQ and blood lead concentration was estimated with the use of linear and nonlinear mixed models, with adjustment for maternal IQ, quality of the home environment, and other potential confounders. The blood lead concentration was inversely and significantly associated with IQ. In the linear model, each increase of 10 microg per deciliter in the lifetime average blood lead concentration was associated with a 4.6-point decrease in IQ (P=0.004), whereas for the subsample of 101 children whose maximal lead concentrations remained below 10 microg per deciliter, the change in IQ associated with a given change in lead concentration was greater. When estimated in a nonlinear model with the full sample, IQ declined by 7.4 points as lifetime average blood lead concentrations increased from 1 to 10 microg per deciliter. Blood lead concentrations, even those below 10 microg per deciliter, are inversely associated with children's IQ scores at three and five years of age, and associated declines in IQ are greater at these concentrations than at higher concentrations. These findings suggest that more U.S. children may be adversely affected by environmental lead than previously estimated.
Article
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Few studies provide data directly relevant to the question of whether blood lead concentrations < 10 microg/dL adversely affect children's cognitive function. We examined the association between blood lead concentrations assessed throughout early childhood and children's IQ at 6 years of age. Children were followed from 6 months to 6 years of age, with determination of blood lead concentrations at 6, 12, 18, and 24 months, and 3, 4, 5, and 6 years of age. At 6 years of age, intelligence was assessed in 194 children using the Wechsler Preschool and Primary Scale of Intelligence-Revised. We used general linear and semiparametic models to estimate and test the association between blood lead concentration and IQ. After adjustment for maternal IQ, HOME scale scores, and other potential confounding factors, lifetime average blood lead concentration (mean = 7.2 microg/dL; median = 6.2 microg/dL) was inversely associated with Full-Scale IQ (p = 0.006) and Performance IQ scores (p = 0.002). Compared with children who had lifetime average blood lead concentrations < 5 microg/dL, children with lifetime average concentrations between 5 and 9.9 microg/dL scored 4.9 points lower on Full-Scale IQ (91.3 vs. 86.4, p = 0.03). Nonlinear modeling of the peak blood lead concentration revealed an inverse association (p = 0.003) between peak blood lead levels and Full-Scale IQ down to 2.1 microg/dL, the lowest observed peak blood lead concentration in our study. Evidence from this cohort indicates that children's intellectual functioning at 6 years of age is impaired by blood lead concentrations well below 10 microg/dL, the Centers for Disease Control and Prevention definition of an elevated blood lead level.
Article
Under the Lead Contamination Control Act of 1988 (LCCA), states were required to establish programs to assist schools and day care centers in identifying potential lead contamination problems in their buildings and to suggest remedies for such identified problems. This paper presents the results of the program that was established in the State of Missouri. Even though the schools and day care centers were not required under the Act to test for lead or even respond to the program, many did. Of the 528 public school districts in Missouri, 49.6% responded to the program, and 28.5% of the districts tested for lead in their drinking water. Of the 1,123 day care centers, 25.9% responded to the program and 7.5% of them tested for lead. The results of the testing showed that in the schools 5.7% of all the outlets tested were above the 20 ppb action level recommended under the LCCA, and in the day care centers 2.4% exceeded the action level.
Article
Objective. Lead is a confirmed neurotoxicant, but the lowest blood lead concentration associated with deficits in cognitive functioning anc academic achievement is poorly definec. The purpose of the present study was to examine the relationship of relatively low blood lead concentrations-especially concentrations <10 micrograms per deciliter (μg/dL) with performance on tests of cognitive function ng in a representative sample of US children and adolescents, Methods. The authors used data from the Third National Health and Nutrition Examination Survey (NHANES III), conducted from 1988 to 1994, to assess the relationship between blood lead concentration and performance on tests of arithmetic skills, reading skil s. nonverbal reasoning, and short-term memory among 4,853 children ages 6-16 years. Results. The geometric mean blood lead concentration for child en in the study sample was 1.9 μg/dL: 172 (2.1%) had blood lead concentrations ≥10 μg/dL. After adjustment for gender, race/ethn city, poverty, region of the country, parent or caregiver's educational level, parent or caregiver's marital status parent, serum ferritin level, and serum cotinine leve, the data showed an inverse relationship between blood lead concentration and scores on four measures of cognitive functioning. For every! μg/dL increase in blooc lead concentration, there was a 0.7-point decrement in mean arithmetic scores, an approximately I-point decrement n mean reading scores, a 0.1-point decrement in mean scores on a measure of nonverbal reasoring, and a 0.5-point decrement in mean scores on a measure of short-term memory, An inverse relationship between blood lead concentration and arithmetic and reading scores was observed for children with blood lead concentrations lower than 5.0 μg/dL Conclusion. Deficits n cognitive and academic skills associated with lead exposure occur at blood lead concentrations lower than 5 μg/dL.
Article
A switch from free chlorine to chloramine disinfectant triggered problems with excessive lead in Washington, D.C., drinking water. High levels of lead originated in the service lines, but excessive lead was also derived from solder or brass plumbing materials. In many cases, the highest lead concentrations emerged from the tap after about 1 min of flushing—a troublesome outcome, given that routine public notification recommended that consumers flush for about a minute to minimize lead exposure. Bench-scale testing found that chlorine reacts with soluble Pb⁺² to rapidly precipitate a red–brown-colored lead solid that was insoluble even at pH 1.9 for 12 weeks; this solid did not form in the presence of chloramine. Further experiments indicated that chloramines sometimes dramatically worsened lead leaching from brass relative to free chlorine, whereas new lead pipe was not strongly affected.
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This paper examines the important, and oftentimes dominant, role of particles in lead and copper corrosion by-product release from stagnant pipes. For copper pipes, orthophosphate generally reduced soluble copper levels compared to pipes with no inhibitor but had little effect on particulate copper, while pipes dosed with polyphosphate generally had higher levels of particulate copper, probably due to the formation of a less durable copper-phosphate solid. For lead, the vast majority of lead by-products were particulate, and particulate release in low pH and low alkalinity waters was associated with hydrocerrusite scales. Orthophosphate and polyphosphate tended to decrease particulate lead species, possibly due to the formation of a lead-phosphate solid. For both lead and copper pipes, zinc orthophosphate did not show any. significant advantages compared to orthophosphate alone, generally due to the increased release of particulate lead or copper species which may be associated with a zinc-phosphate precipitate. Finally, the occurrence of particulate and colloidal species, especially lead, was confirmed by utility tap water sampling.
Article
The presence of lead particles in tap water is an under-appreciated cause of lead poisoning in the United States. Routine water sampling procedures can "miss" lead particles present in drinking water. Consequently, the true extent of human exposure through this type of lead contamination can be underestimated. The authors describe recent cases of lead poisoning in Washington, D.C., Greenville, N.C., and Durham, N.C., when approved water sampling procedures did not show cause for alarm. Also, the authors compare the bioavailability of lead particles when ingested to their detection in drinking water samples and, in turn, compare human exposure to what utilities detect in water samples. Their findings reveal the potential limitations in current lead detection methods. This information can be used to improve current water sampling and preservation procedures.
Book
In The Great Lead Water Pipe Disaster, Werner Troesken looks at a long-running environmental and public health catastrophe: 150 years of lead pipes in local water systems and the associated sickness, premature death, political inaction, and social denial. The harmful effects of lead water pipes became apparent almost as soon as cities the world over began to install them. Doctors and scientists noted cases of acute illness and death attributable to lead in public water beginning in the middle of the nineteenth century, and an editorial in the New York Herald called for the city to study the matter after a bizarre illness made headlines in 1868. But officials took no action for many years. New York City, for example, did not take any steps to reduce lead levels in water until 1992, long after the most serious damage had been done. By then, in any case, much of the old lead pipe had been replaced with safer materials. Troesken examines the health effects of lead exposure, analyzing cases from New York City, Boston, and Glasgow and many smaller towns in Massachusetts, New Hampshire, and England. He draws on period accounts, government reports, court decisions, and economic and demographic analysis to document the widespread nature of the problem, the recognized health effects--particularly for pregnant women and young children--and official intransigence. He presents an accessible overview of the old and new science of lead exposure--explaining, for example, why areas with soft water suffered more harmful effects than areas with hard water. And he gives us compelling and vivid accounts of the people and politics involved. The effects of lead in water continue to be felt; many older houses still have lead service pipes. The Great Lead Water Pipe Disaster is essential reading for understanding this past and ongoing public health problem.
Article
Incidence of EBL (blood lead > or =10 microg/dL) for children aged < or = 1.3 years in Washington, DC increased more than 4 times comparing 2001-2003 when lead in water was high versus 2000 when lead in water was low. The incidence of EBL was highly correlated (R2 = 0.81) to 90th percentile lead in water lead levels (WLLs) from 2000 to 2007 for children aged < or = 1.3 years. The risk of exposure to high water lead levels varied markedly in different neighborhoods of the city. For children aged < or =30 months there were not strong correlations between WLLs and EBL, when analyzed for the city as a whole. However, the incidence of EBL increased 2.4 times in high-risk neighborhoods, increased 1.12 times in moderate-risk neighborhoods, and decreased in low-risk neighborhoods comparing 2003 to 2000. The incidence of EBL for children aged < or =30 months also deviated from national trends in a manner that was highly correlated with 90th percentile lead in water levels from 2000 to 2007 (R2 = 0.83) in the high-risk neighborhoods. These effects are consistent with predictions based on biokinetic models and prior research.
Article
The lead found in drinking water can be a source of lead poisoning to young children, particularly those who consume large amounts of water. The authors describe a 13-month-old infant who was discovered to have plumbism during routine evaluation. The lead source was ultimately traced to the daily administration of powdered formula which was prepared with home tap water having a first-draw lead content of 130 parts per billion. This case suggests that whenever infants are fed powdered formula, consideration should be given to analysis of the home tap water for lead content.
Article
Lead poisoning is the most common disease of environmental origin in the United States today. Adult lead poisoning results primarily from exposure by inhalation in the workplace. Pediatric lead poisoning results principally from the ingestion of lead from environmental media, including paint chips, dust, soil, drinking water, ceramics, and medications. Lead is toxic to many organ systems, among them developing erythrocytes, the kidneys, and the nervous system. Lead-induced toxicity to the central nervous system causes delayed development, diminished intelligence, and altered behavior. In young children, this effect has been demonstrated convincingly to occur at blood lead levels between 10 and 20 micrograms per dl. The Centers for Disease Control and Prevention has recommended that a blood lead level of 10 micrograms per dl or higher be considered evidence of increased lead absorption, and the National Academy of Sciences has concurred in that recommendation. Unresolved issues in need of further study include the frequency of screening young children for lead, the question of whether women should be offered screening for lead before conceiving a pregnancy, the role of x-ray fluorescence analysis in assessing lead in bone, and the appropriate legislative response of the United States government to lead-based paint abatement.
Article
Over the 20-year period since the first issue of Environmental Health Perspectives was published, there has been considerable progress in the understanding of the potential toxicity of exposure to lead. Many of these advances have been reviewed in published symposia, conferences, and review papers in EHP. This brief review identifies major advances as well as a number of current concerns that present opportunities for prevention and intervention strategies. The major scientific advance has been the demonstration that blood lead (PbB) levels of 10-15 micrograms/dL in newborn and very young infants result in cognitive and behavioral deficits. Further support for this observation is being obtained by prospective or longitudinal studies presently in progress. The mechanism(s) for the central nervous system effects of lead is unclear but involve lead interactions within calcium-mediated intracellular messenger systems and neurotransmission. Effects of low-level lead exposure on blood pressure, particularly in adult men, may be related to the effect of lead on calcium-mediated control of vascular smooth muscle contraction and on the renin-angiotensin system. Reproductive effects of lead have long been suspected, but low-level effects have not been well studied. Whether lead is a carcinogen or its association with renal adenocarcinoma is a consequence of cystic nephropathy is uncertain. Major risk factors for lead toxicity in children in the United States include nutrition, particularly deficiencies of essential metals, calcium, iron, and zinc, and housing and socioeconomic status. A goal for the year 2000 is to reduce prevalence of blood lead levels exceeding 15 micrograms/dL. Images FIGURE 2.
Article
This article discusses the issue of lead contamination of drinking water, noting the various regulatory-driven measures that have been adopted in the U.S. since 1986 to address this public health issue. The article summarizes the literature on the dynamics of tap water lead contamination and discusses this widespread source of lead exposure in the context of the latest research evidence.
Article
Water utility managers and public-health officials may be getting the wrong message about what happened during Washington, D.C.'s drinking-water crisis.
Pitt Probes Boy's Lead Poisoning
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Report Says Lead Levels in Schools' Water Not Dire
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Safe Drinking Water Committee, Drinking Water and Health
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Factors Influencing the Rate of Lead Release in Domestic Plumbing Systems
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Blood and Water: The Long Search for the Source of a Baby's Lead Poisoning
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Baltimore City Public Schools' CEO Announces System-Wide Shift to Bottled Drinking Water " [press release
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http://www. nbclosangeles.com/news/health/LAUSD-Schools-Shut-Down-Faucets-Due-to-Lead- Levels
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Brief Report: Lead Poisoning from Ingestion of a Toy Necklace -Oregon
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Leaded Water Still On in Some DC Schools
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High Levels of Lead are Discovered in Valley School Drinking Fountain
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Historical Development of the National Primary Drinking Water Regulations
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Death of a Child After Ingestion of a Metallic Charm-Minnesota
  • U S Centers For
  • Disease Control
U.S. Centers for Disease Control and Prevention, "Death of a Child After Ingestion of a Metallic Charm-Minnesota, 2006," Morbidity and Mortality Weekly Report, March 23, 2006, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm55d323a1.htm accessed September 28, 2009. 72. Ibid.
From Concerned Parent to Crusader for Safe Water
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Despite Law, Study Finds, Water in US Schools May Contain Lead 01/us/despite-law-study-finds-water-in-us-schools-may-contain-lead
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Lead and Public Health
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School Drinking Water Contains Toxins
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Faucets Shut Off at Schools Due to High Lead Levels
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Drinking Water: EPA Should Strengthen Ongoing Efforts to Ensure that Consumers are Protected from Lead Contamination
  • U S Government Accountability
  • Office
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Tests Find Elevated Lead Levels at Five Schools, DC Council Told
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T. Labbe, "Tests Find Elevated Lead Levels at Five Schools, DC Council Told," Washington Post, February 15, 2007.
Schools' Water Fails Lead Testing
  • D Bach
D. Bach, "Schools' Water Fails Lead Testing," Seattle Post-Intelligencer, April 30, 2004.
Attachment A—Board Adopted Policy E10.00 and Procedures E10.01
  • Seattle Public
  • Schools
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