Grantee Research Project Results
2020 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: MacDonald Gibson, Jacqueline , Levine, Keith , MacDonald, John M , Cook, Phillip J , de Bruin, Wandi Bruine , Fisher, Michael
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, 2020 through December 31,2020
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.
- 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.
- Characterize the relationship between lead in private well water and children’s blood lead.
- Characterize lead sources in water in private well households with elevated lead concentrations, in order to support the development of technical interventions.
- Conduct a randomized controlled trial of a behavioral intervention to promote testing of private well water for lead and other contaminants.
- 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 master’s theses, four conference presentations, four invited seminars, six journal articles, and a book chapter. These products are listed in Section 3.
- One of the journal manuscripts was published in a very high-impact journal, Proceedings of the National Academy of Sciences. The journal editors commissioned a commentary to accompany the article. The commentary writer noted that our primary finding “highlights the inadequacy of current regulatory policy to protect the most highly exposed and susceptible communities and underscores the need for immediate public health interventions.”
- We added additional key variables to our curated database all children tested for blood lead in Wake County, NC, between 1998 and 2017, which we had previously matched to records of their individual water sources at the time of blood lead testing, characteristics of their households that might be related to lead exposure risk, and socioeconomic and demographic characteristics of their neighborhoods. Last year we provided this data set to the NC Department of Public Safety, and we obtained information about whether any of these children had been reported for acts of juvenile delinquency. We added this information to the curated data set. In 2020 we then prepared a proposal to the NC Education Research Center (NCERDC) to compile all available educational records for these children. The proposal was accepted, and in March 2021 the NCERDC provided these records to us. NCERDC was able to find educational records for 37,577 of the 59,705 children in our data set. (The remaining children likely moved out of state or enrolled in private school.)
- Working with the Information Technology Services department at Indiana University we established a secure server to store these identifiable data. This storage site meets all HIPAA requirements.
- 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.
- Twelve 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). Profiling experiments were completed, and the results were returned to homeowners.
Overall Project Outcomes
From a practical perspective, the most meaningful outcome may have been the extension of municipal water service into the majority African American Irongate Drive neighborhood of Apex, NC. In last year’s progress report we described how this community had been trying for years to persuade the adjacent town of Apex to extend water lines into their neighborhood. There were longstanding water quality problems with the wells in Irongate. More recently, wells in many houses had begun to run dry. During 2019, we presented data from our study showing health risks associated with the lack of municipal water access in this community to the Apex town manager, mayor, and utility representatives. The town voted to annex Irongate Drive and extend water service. Water service in the community began in May 2020. Working with the community, we took the opportunity for a natural experiment and tested water quality in kitchen taps before and after connection to the town service. We showed that the concentrations of lead at the tap decreased significantly and that these decreases were maintained over time after households connected to the Apex water supply. Before the households connected, 25% had water samples with lead concentrations above the 15-ppb action level for lead in community water systems, while no households exceeded this level at any time point after the water service connection. On average, lead concentrations decreased by more than 70% after homes connected to the town water supply, presumably due to the town’s use of corrosion inhibitors. This work was carried out as a master’s research project and will be submitted for publication in 2021.
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 2021, we will submit for publication our analysis showing that 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. We also will use our newly created database showing school performance data for these children to assess effects on their educational outcomes.
Objective 2: Characterize the relationship between lead in private well water and children’s blood lead.
We will resume our recruitment for this part of the study. To date we have successfully completed sampling and analysis for 49 homes. Recruitment was paused due to the pandemic. In summer 2021 we will resume recruitment with the assistance of a community group, American Indian Mothers, focusing on private wells in Robeson County, NC. This county is 42% Native American and 24% African American and is the poorest in NC. We anticipate our partnership with American Indian Mothers will greatly facilitate recruitment, which has been a challenge due to the need to enter people’s homes and collect a blood sample from a child.
Objective 3: Characterize lead sources in water in private well households with elevated lead concentrations, in order to support the development of technical interventions.
This part of the work has been completed, and results will be submitted for publication in 2021.
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 work has been completed.
Objective 5: Prepare a report evaluating and comparing technical interventions to decrease lead exposure in private well water in different contexts.
We plan to complete a quantitative analysis of the benefits for children’s health of decreasing lead exposure among Wake County, NC, children relying on private wells by (a) extending municipal water service, (b) providing water filters, (c) advising residents to flush their water taps before consumption, or (d) providing bottled water. This analysis will make use of the data collected as part of objectives 1, 2, and 3.
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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Type | Citation | ||
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Colley S, Kane P, Gibson J. Risk Communication and Factors Influencing Private Well Testing Behavior:A Systematic Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019;16(22):4333. |
R839279 (2020) |
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Fizer C, de Bruin W, Stillo F, Gibson J. Barriers to Managing Private Wells and Septic Systems in Underserved Communities:Mental Models of Homeowner Decision Making. JOURNAL OF ENVIRONMENTAL HEALTH 2018;16(22):4333. |
R839279 (2020) |
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Gibson J, MacDonald J, Fisher M, Chen X, Pawlick A, Cook P. Early life lead exposure from private well water increases juvenile delinquency risk among teens. Proceedings of the National Academy of Sciences of the United States of America 2022;119(6):e2110694119. |
R839279 (2020) R839279 (2021) |
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Supplemental Keywords:
Water lead, blood lead, private well, child healthRelevant Websites:
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.