Building Water Infrastructure to Improve Childhood Outcomes: Interventions to Decrease Childhood Lead Exposure from Private Wells

EPA Grant Number: 839279
Title: Building Water Infrastructure to Improve Childhood Outcomes: Interventions to Decrease Childhood Lead Exposure from Private Wells
Investigators: MacDonald Gibson, Jacqueline , de Bruin, Wandi Bruine , Cook, Phillip J , MacDonald, John M , Levine, Keith , Fisher, Michael
Current Investigators: Gibson, Jacqueline MacDonald , Levine, Keith , MacDonald, John M , Cook, Phillip J , de Bruin, Wandi Bruine , Fisher, Michael
Institution: Duke University , Indiana University , Research Triangle Institute , University of Leeds , University of Pennsylvania
Current Institution: University of North Carolina at Chapel Hill , University of Pennsylvania , University of Leeds , Research Triangle Institute , Duke University
EPA Project Officer: Hahn, Intaek
Project Period: January 1, 2018 through December 31, 2021
Project Amount: $800,000
RFA: Using a Total Environment Framework (Built, Natural, Social Environments) to Assess Life-long Health Effects of Chemical Exposures (2017) RFA Text |  Recipients Lists
Research Category: Human Health


While the recent Flint water crisis highlighted lead exposure risks in poorly managed municipal water supplies, little is known about lead in unregulated private wells.  Our preliminary data from Wake County, NC, suggest that lead prevalence in peri-urban private wells could be comparable to that in Flint during the water crisis, with 28% of households exceeding the 15-ppb EPA action level. This project will be the first to estimate how lead in well water affects children’s developmental outcomes. In addition, it will be the first to assess the association between lead in private well water and children’s blood lead. The interacting influences of the built (availability of regulated water service), natural (groundwater chemistry), and social (household and school settings) environments on lead exposure and children’s outcomes will be assessed.  In addition, behavioral and technical interventions will be evaluated.


We propose two overarching hypotheses. First, lead exposure in peri-urban NC communities drawing their water from unregulated wells exceeds that in neighborhoods with regulated water supplies.  Second, this increased lead exposure decreases end-of-grade test scores and increases juvenile delinquency rates.   


To characterize effects of lead in private well water on childhood developmental outcomes, children’s end-of-grade test results for 1995-2016 will be extracted from the NC Education Research Data Center and merged with blood lead measurements from NC LEAD, juvenile records from the NC Department of Juvenile Justice and Delinquency Prevention, and household drinking water source (private well or regulated utility) records from the Wake County Division of Revenue. The merged data will be analyzed using established (multi-level regression) and novel (Bayesian network) methods to characterize total environmental effects on lead exposure, educational, and juvenile delinquency outcomes. To assess associations between lead in private well water and children’s blood lead, we will analyze lead in tap water, dust, and paint in 300 randomly selected peri-urban private well households in Wake County, NC.  In each household, blood and plasma lead will be measured in one child under age 6.  Regression and Bayesian network approaches will be used to analyze associations between water lead and child’s blood lead and interactions with characteristics of the built, natural, and social environments. A risk communication intervention to help prevent lead exposure will be developed and tested via a randomized controlled trial.  An analysis of the costs and benefits of infrastructure and other technical interventions appropriate for different contexts will be prepared and disseminated to state and local health agencies.  

Expected Results:

Through this work, we will use a total environment framework (considering the built, natural, and social environments) to provide quantitative estimates of total lead exposure risks in peri-urban areas of the United States relying on unregulated private wells for their drinking water.  These risk estimates will consider exposures from drinking water and from household paint and dust. In addition, we will assess life-long health effects of these exposures by using causal inference methods (Bayesian networks) and will identify policy, engineering, and behavioral options for communities and environmental and public-health agencies to reduce exposures and mitigate adverse outcomes.  We will develop risk communication tools to increase awareness of these exposures and to empower communities to take preventive action. These outcomes will benefit society by establishing a baseline for lead exposure and risk in peri-urban areas of the United States relying on private wells for their drinking water; educating the public about risks from lead in these areas; and providing local communities, utilities, and environmental and public health agencies with options for reducing exposure and mitigating adverse impacts. Over the long term, these results are expected to benefit society by improving the health, developmental, and educational attainment of children in households relying on private wells for their drinking water.

Publications and Presentations:

Publications have been submitted on this project: View all 22 publications for this project

Journal Articles:

Journal Articles have been submitted on this project: View all 4 journal articles for this project

Supplemental Keywords:

Private water supplies; heavy metals; neurotoxicity; cognitive development; health effects; sensitive population; environmental justice; underbounding; socioeconomic; cost benefit; decision making; alternatives; environmental chemistry; geochemistry; environmental engineering; social science; epidemiology; environmental health; mathematics; modeling; monitoring; analytical; surveys; measurement methods; Southeast; North Carolina

Progress and Final Reports:

  • 2018 Progress Report
  • 2019 Progress Report