Grantee Research Project Results
2019 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 , Levine, Keith , MacDonald, John M , Cook, Phillip J , de Bruin, Wandi Bruine , 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 , University of Pennsylvania , University of Leeds , Research Triangle Institute , Duke University
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, 2019 through December 31,2019
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:
While the Flint water crisis highlighted lead exposure risks in poorly managed municipal water supplies, little is known about lead in unregulated private wells. Data from Wake County, NC, suggest that lead prevalence in private wells located on the borders of cities and towns could be comparable to that in Flint during the water crisis, with 28% of households exceeding the 15-ppb EPA action level. This ongoing project is the first to estimate how lead in well water affects children's developmental outcomes. In addition, it is 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 are being assessed. In addition, behavioral and technical interventions are being evaluated. The study is investigating two overarching hypotheses. First, lead exposure in NC households drawing their water from unregulated wells exceeds that in nearby households with regulated water supplies. Second, this increased lead exposure decreases end-of-grade test scores and increases juvenile delinquency rates.
The project has five objectives:
1. Characterize the effects of reliance on private well water as the primary household water source on children's blood lead, end-of-grade test results, retention in grade, learning disabilities, and juvenile delinquency.
Hypothesis 1: Children without municipal water service 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.
2. 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.
3. 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.
4. 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.
5. Prepare a report evaluating and comparing technical interventions to decrease lead exposure in private well water in different contexts.
Progress Summary:
Results were disseminated through one PhD dissertation, four master's theses, 10 conference presentations and posters, three invited seminars, and six journal articles, and a book chapter. These products are listed in Section 3.
· A manuscript describing our analysis of how water source, built environment, demographic, and socioeconomic factors contribute to the risk of elevated blood lead in children was submitted to Proceedings of the National Academy of Sciences for review.
· Working with the NC Department of Public Safety, we merged a database of youth encounters with the juvenile justice system to our database of children's blood lead levels and household water sources. This database includes 59,483 children tested for blood lead in Wake County between 2002 and 2017. Among these children, 517 had one or more complaints with the NC Juvenile Justice System; a total of 1998 complaints have been filed for juveniles in our data set.
· Preliminary analyses of the above, merged data set were conducted. These preliminary analyses demonstrate a highly significant increase in risk of encounters with the juvenile justice system, which is mediated by lead exposure, among children in houses with private well water, compared to children with community water serviced.
· Samples of children's blood, tap water, and floor and windowsill dust were collected from 44 households and analyzed for lead. Results were provided to participating households.
· Five households were recruited for "lead profiling," in which sequential water samples are collected and analyzed for metals to determine the likely sources of lead in tap water (water fixtures, household plumbing, or well components). Samples were collected and analyzed, and the results were returned to homeowners.
· A literature documenting previous studies of the effectiveness of risk communication to promote testing of private well water was completed and published in the Journal of Environmental Research and Public Health.
Perhaps the most meaningful outcome of the project occurring during 2019 was the successful campaign to obtain municipal water infrastructure for a majority African American neighborhood where some of our participants live. This neighborhood, the Irongate Drive community, had been trying for years to persuade the adjacent Town of Apex to extend water lines. There were longstanding water quality problems with the wells in Irongate. More recently, wells in many houses had begun to run dry. At one home, the well was completely dry, even though the owners had recently paid a well driller $10,000 to extend the depth of their well. This home was relying on water they hauled to their garage and stored in a cistern. The data on water quality and quantity problems that we gathered with the support of this project helped persuade the town leadership to consider the neighborhood's request. During 2019, we presented these data at a series of meetings with town managers, the water utility, and the mayor. We also held a dinner with community members. More than half of the families in the community attended. Also present was Dean Barbara Rimer of the UNC Gillings School of Global Public Health. In January 2020, the Apex Town Council agreed to annex the Irongate neighborhood and extend water lines into the community. A journal article documenting our work with this community was recently accepted for publications in the journal NEW SOLUTIONS: A Journal of Environmental and Occupational Health Policy.
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.
Our manuscript showing significant associations between household reliance on private well water and the risk of elevated blood Pb was peer reviewed by Proceedings of the National Academy of Sciences. The review comments were favorable. We have responded to them and are awaiting a publication decision.
We also filed a request with the Wake County, NC, Public School System for data on K-12 outcomes for children in our database.
Objective 2: Characterize the relationship between lead in private well water and children's blood lead.
Tap water, household dust, and children's blood samples were collected from 44 households. Results of these tests were returned to participants with information about preventing lead exposure.
Objective 3: Characterize lead sources in water in private well households with elevated lead concentrations, in order to support the development of technical interventions.
Five households relying on private wells for their water and having detectable lead in their kitchen tap water were recruited for this part of the study. A series of six sequential water samples was collected from each household, with varying amounts of flushing time between each, and tested for lead. Results to date indicate that flushing the tap for five minutes can remove 77% of the detected lead, on average, but is not sufficient for full exposure control due to extended lead release within the well and household plumbing system. Participating households were provided with water filters by leveraging funding from a project funded by the NC Policy Collaboratory.
Objective 4: Conduct a randomized controlled trial of a behavioral intervention to promote testing of private well water for lead and other contaminants.
This part of the project has been completed. The results are described in the PhD dissertation of Frank Stillo and the MSPH technical report of Erica Wood. Two manuscripts describing the risk communication and the results of the randomized-controlled trial are in the final stages of preparation. The NC Division of Public Health has circulated 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 are published as part of Abhishek Komandur's MSPH thesis. A manuscript for submission to a peer-reviewed journal is in preparation.
Future 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.
During 2020, we will focus on finalizing our analyses showing whether children relying on private well water are at increased risk of encounters with the juvenile justice systems due to increased risks of exposure to lead in drinking water and the resulting neurocognitive damage. We also will build a merged database linking our children's blood lead, water source, built environment, and demographic information to K-12 educational outcomes. We have now successfully established a relationship with the Director of Data, Strategy, and Analytics for the Wake County Public School System, who will work with us on the database merge.
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. This target population has been challenging to recruit. Planned recruiting methods include expanding the geographic area of our recruitment to include low-income Indiana residents relying on private well water and expansion of our North Carolina recruitment area to include households around Greensboro.
Objective 3: Characterize lead sources in water in private well households with elevated lead concentrations, in order to support the development of technical interventions.
We aim to recruit at least 10 additional households to participate in this part of the research and to collect water samples from these participants.
Objective 4: Conduct a randomized controlled trial of a behavioral intervention to promote testing of private well water for lead and other contaminants.
We plan to finalize two manuscripts describing the design of the risk communication and the results of the randomized-controlled trial.
Objective 5: Prepare a report evaluating and comparing technical interventions to decrease lead exposure in private well water in different contexts.
We plan to prepare a journal article presenting results of our quantitative analysis of the benefits for children's health of decreasing lead exposure among Wake County, NC, children relying on private wells. The article will also discuss potential interventions to decrease these exposures.
Journal Articles on this Report : 3 Displayed | Download in RIS Format
Other project views: | All 32 publications | 10 publications in selected types | All 10 journal articles |
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Stillo III F, de Bruin WB, Zimmer C, Gibson JM. Well water testing in African-American communities without municipal infrastructure:beliefs driving decisions. Science of the Total Environment 2019;686:1220-1228. |
R839279 (2019) |
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Redmon JH, Levine KE, Aceituno AM, Litzenberger K, Gibson JM. Lead in drinking water at North Carolina childcare centers:piloting a citizen science-based testing strategy. Environmental Research 2020:109126. |
R839279 (2019) |
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Ferguson A, Solo-Gabriele H. Children's exposure to environmental contaminants:an editorial reflection of articles in the IJERPH special issue entitled, 'Children's Exposure to Environmental Contaminants'. International Journal of Environmental Research and Public Health 2019, 16(22):4333. |
R839279 (2019) |
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Supplemental Keywords:
Water lead, blood lead, private well, child healthProgress 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.