Grantee Research Project Results
2018 Progress Report: Building Water Infrastructure to Improve Childhood Outcomes: Interventions to Decrease Childhood Lead Exposure from Private Wells
EPA Grant Number: R839279Title: Building Water Infrastructure to Improve Childhood Outcomes: Interventions to Decrease Childhood Lead Exposure from Private Wells
Investigators: Gibson, Jacqueline MacDonald , de Bruin, Wandi Bruine , Cook, Phillip J , MacDonald, John M , Levine, Keith , Fisher, Michael
Current Investigators: MacDonald Gibson, Jacqueline , Levine, Keith , MacDonald, John M , Cook, Phillip J , de Bruin, Wandi Bruine , Fisher, Michael
Institution: University of North Carolina at Chapel Hill , Research Triangle Institute , University of Leeds , Duke University , University of Pennsylvania
Current Institution: Duke University , Indiana University , University of Pennsylvania , University of Leeds , Research Triangle Institute
EPA Project Officer: Hahn, Intaek
Project Period: January 1, 2018 through December 31, 2020 (Extended to December 31, 2022)
Project Period Covered by this Report: January 1, 2018 through December 31,2018
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
Objective:
The research projectaimsto estimate how lead in well water affects children's developmental outcomes in North Carolina's peri-urban communities. The study willassess 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. The researchersproposetwo 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.
The proposed project has five objectives:
- Characterize the effects of exclusion from municipal water infrastructure on children's blood lead, end-of-grade test results, retention in grade, learning disabilities, and juvenile delinquency.
Hypothesis 1: Children without municipal water infrastructure will have a higher risk of elevated blood lead, which in turn will be associated with decreased educational performance and increased delinquency risk, in comparison to those with municipal infrastructure who are similarly situated on poverty, household size, and other covariates.
- Characterize the relationship between lead in private well water and children's blood lead.
Hypothesis 2: Lead concentrations in tap water in households served by private well water will be associated with blood lead levels in children in those households, such that children exposed to increased lead in their water will have higher blood lead concentrations.
- Characterize lead sources in water in private well households with elevated lead concentrations, in order to support the development of technical interventions.
Hypothesis 3.1: Tap water flushing will reduce lead to below 15 ppb for most homes.
Hypothesis 3.2: In a subset of homes, tap water flushing will increase the risk of lead exposure due to mobilization of particulate lead and lead sources upstream of the home plumbing.
- Conduct a randomized controlled trial of a behavioral intervention to promote testing of private well water for lead and other contaminants.
Hypothesis 4: Households receiving mental models-based risk communication materials will be more likely to test their water for lead and take action to prevent lead exposure than households in no-intervention control groups.
- Prepare a report evaluating and comparing technical interventions to decrease lead exposure in private well water in different contexts.
Progress Summary:
Outputs of Year 1
- The research protocol was for this work was approved by the University of North Carolina Institutional Review Board.
- Results were disseminated through one master's thesis, seven conference presentations and posters, four invited seminars, and two journal articles (one in review and two in preparation).
- A merged database incorporating drinking water source data (private well or community water system), children's blood lead levels, and other associated demographic and household characteristics was created for children in Wake County NC. This database includes more than 77,000 children whose blood was drawn between 1995 and 2018 as part of the NC LEAD program.
- Summary statistics were calculated, and multivariable mixed-effects ordinary least squares and logistic regression models were developed to characterize associations between drinking water source and lead exposure under objective 1. In addition, a preliminary Bayesian network model was developed to characterize these associations and simulate the impact of parameter permutations on estimates of lead exposure.
- A household questionnaire was developed, piloted, and implemented using the mWater mobile survey tool to capture social, environmental, behavioral, and demographic characteristics at the household level that could impact child lead exposure from a total environment perspective, and to link these data to environmental measurements of lead in water, household dust, and children's blood and plasma.
- Samples of children's blood, tap water, and floor and windowsill dust were collected from 28 households and analyzed for lead. Results were provided to participating households.
- A risk communication intervention to encourage households relying on private wells to test their water for lead and other contaminants was developed, pilot tested, and tested through a randomized-controlled trial (see thedescription of outcomes).
Outcomes of Year 1
Objective 1: Characterize the effects of exclusion from municipal water infrastructure on children's blood lead, end-of-grade test results, retention in grade, learning disabilities, and juvenile delinquency.
Robust associations were observed between use of a private well as a primary source of drinking water and blood lead levels in children in Wake County NC in multivariable mixed effects regression models. On average, children born in households with access to municipal piped water had significantly lower blood lead (p<0.001) than children in households relying on private wells. In addition, children with access to municipal water had significantly lower odds (p<0.001) of having blood lead concentrations above the 5 µg/dL threshold established by the Centers for Disease Control and Prevention as the threshold for elevated blood lead.
Objective 2: Characterize the relationship between lead in private well water and children's blood lead.
Twenty-eight households have been recruited to date. This sample size is too small to detect significant effects using regression models. However, preliminary results show a potential trend of increasing blood lead with exposure to lead in well water.
Objective 3: Characterize lead sources in water in private well households with elevated lead concentrations, in order to support the development of technical interventions .
Household recruitment to achieve objective 3 is expected to begin this summer.
Objective 4: Conduct a randomized controlled trial of a behavioral intervention to promote testing of private well water for lead and other contaminants.
During this year, the researchersdeveloped the behavioral (risk communication) interventionand completed the randomized-controlled trial to test the influence of the communication on private well testing behavior. Participants who recalled receiving the risk communication were significantly more likely to report in follow-up surveys that they had tested their water (p<0.01) or that they plan to do so in the near future (p<0.05). The researchershave shared the results with the NC Division of Public Health (NCDPH). The NCDPH is planning to circulate the risk communication to county health departments and others to promote private well testing. They have created an adapted version in poster format for distribution at county health clinics.
Objective 5: Prepare a report evaluating and comparing technical interventions to decrease lead exposure in private well water in different contexts.
A systematic literature review has been completed to identify which technical interventions have been field tested for lead removal in household settings in developed countries. The results will be inform the development of the report on technical interventions, to be completed this year.
Future Activities:
Planned Activities
Objective 1: Characterize the effects of exclusion from municipal water infrastructure on children's blood lead, end-of-grade test results, retention in grade, learning disabilities, and juvenile delinquency.
Future plans include integration of education and juvenile justice outcome data into the merged database and analysis of these data using mixed effects regression and Bayesian Network models to characterize associations between lead exposure in drinking water and educational and juvenile justice outcomes. A publication describing our finding of a significant increase in the risk of elevated childhood blood lead for children without municipal water service is currently in preparation. Additional publications and presentations based on these results are anticipated in year 2 and beyond.
Objective 2: Characterize the relationship between lead in private well water and children's blood lead.
We will continue to recruit more research participants and target households with lower socioeconomic status (SES), as a majority of our participants are currently high SES.Planned recruiting methods include further news releases, newspaper advertisements, and social media campaigns.
Objective 3: Characterize lead sources in water in private well households with elevated lead concentrations, in order to support the development of technical interventions .
Household recruitment to achieve objective 3 is expected to begin this summer.
Objective 4: Conduct a randomized controlled trial of a behavioral intervention to promote testing of private well water for lead and other contaminants.
The researchers are preparing two manuscripts for submission to the journal Risk Analysis. They will be submitted as a two-part series. The first paper will describe our method for designing our risk communication to promote private well testing. The second paper will provide the results of our randomized controlled trial to test the effectiveness of the communication.
Objective 5: Prepare a report evaluating and comparing technical interventions to decrease lead exposure in private well water in different contexts.
The researchers are gathering data for a case study evaluation of technical interventions for one African American community unserved by the surrounding community water system. This case study evaluation is expected to be completed by Spring 2020. In addition, the study will be producinga journal article based on the systematic review of prior research on technical interventions. The review is expected to be submitted to a technical journal during Fall 2019.
References:
Bruine de Bruin, Wändi, and Ann Bostrom. 2013. "Assessing What to Address in Science Communication." Proceedings of the National Academy of Sciences of the United States of America 110 Suppl: 14062-68. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3752171&tool=pmcentrez&rendertype=abstract.
Morgan, M. Granger, Ann Bostrom, Baruch Fischhoff, and Cynthia J. Atman. 2002. Risk Communication: A Mental Models Approach. Cambridge University Press. http://books.google.com/books?hl=en&lr=&id=ieXbkmYf3mAC&pgis=1 (January 5, 2014).
Journal Articles on this Report : 1 Displayed | Download in RIS Format
Other project views: | All 32 publications | 10 publications in selected types | All 10 journal articles |
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Hoponick Redmon, J., J. MacDonald Gibson, A. M. Aceituno, K. P. Woodward, and K. E. Levine. 2018. Invited commentary:Safeguarding children’s health:time to enact a health-based standard and comprehensive testing, mitigation, and communication protocol for lead in drinking water. North Carolina Medical Journal 79(5):51-55. |
R839279 (2018) |
not available |
Supplemental Keywords:
Water lead, blood lead, private well, child healthRelevant Websites:
Study Recruitment website Exit
Progress and Final Reports:
Original AbstractThe perspectives, information and conclusions conveyed in research project abstracts, progress reports, final reports, journal abstracts and journal publications convey the viewpoints of the principal investigator and may not represent the views and policies of ORD and EPA. Conclusions drawn by the principal investigators have not been reviewed by the Agency.