Low-level lead exposure and children's IQ: a meta-analysis and search for a threshold

Assessment of prevalence of elevated blood lead levels and risk factors among children and pregnant women in Bihar, India

BACKGROUND

While modeled estimates and studies in contaminated areas indicate high lead exposure among children in Bihar, India, local data on lead exposure in the child population is limited.

OBJECTIVES

To characterize lead exposure, and assess potential sources of lead exposure among a state-representative sample of children and their pregnant mothers residing in Bihar.

METHODS

Blood samples were collected from 697 children under five and 55 pregnant women from eight districts in Bihar. Blood lead levels were determined using capillary blood and a portable lead analyzer. Household demographics, home environment, behavior, and nutrition information were collected through computer-assisted personal interviews with primary caregivers. Logistic regression was used to assess associations between potential risk factors and elevated blood lead levels.

RESULTS

More than 90% of children and 80% of pregnant women reported blood lead levels ≥5 μg/dL. Living near a lead-related industry and pica behavior of eating soil were significantly associated with increased odds of having elevated blood lead levels. Additional risk factors for having a blood level ≥5 μg/dL included the use of skin lightning cream (aOR = 5.11, 95%CI: 1.62, 16.16) and the use of eyeliners (aOR = 2.81, 95%CI: 1.14, 6.93). Having blood lead levels ≥10 μg/dL was also significantly associated with the household member who had an occupation or hobby involving the use of lead (aOR = 1.75, 95%CI: 1.13, 2.72).

DISCUSSION

Elevated blood lead levels were prevalent among children and pregnant women in Bihar, indicating the urgent need for a comprehensive lead poisoning prevention strategy.

Impact of the COVID-19 Pandemic on Childhood Lead Testing and Blood Lead Levels

OBJECTIVE

To evaluate the effect of the COVID-19 pandemic on childhood lead testing and blood lead levels.

METHODS

A retrospective analysis of lead tests and results was performed across 3 urban medical centers during the pre-COVID-19 (March 10, 2019-March 9, 2020) and COVID-19 (March 10, 2020-March 10, 2022) periods. Interrupted time series analysis with quasi-Poisson regression was used to evaluate changes in lead testing between study periods. The relationship between sociodemographic features with detectable (≧2 µg/dL) and elevated (≧3.5 µg/dL) blood lead levels (BLLs) was assessed with multivariable logistic regression.

RESULTS

Among a total of 16,364 lead tests across 10,362 patients, weekly testing rates significantly decreased during COVID-19 (relative risk (RR) 0.64, 95% (confidence interval) CI 0.53-0.78). Census tracts with the greatest proportion of pre-1950s housing had a stronger association with detectable BLLs during the COVID-19 period (pre-COVID-19 adjusted odds ratio (aOR) 1.73, 95% CI 1.35-2.20; aOR 2.58, 95% CI 2.13-3.12; interaction P value .014). When limited to 1 year following COVID-19 (March 10, 2020-March 10, 2021), the association between both elevated BLLs (pre-COVID-19: aOR 1.49, 95% CI 0.87-2.53; COVID-19: aOR 3.51, 95% CI 1.98-6.25; interaction P value .032) and detectable BLLs with pre-1950s housing were greater during the COVID-19 period (pre-COVID-19: aOR 1.73, 95% CI 1.35-2.20; COVID-19: aOR 2.56, 95% CI 1.95-3.34; interaction P value .034).

CONCLUSIONS

The COVID-19 pandemic led to a significant reduction in lead surveillance and magnified the effect of known risk factors for lead exposure. Concerted clinical, public health, and community advocacy are needed to address care gaps and excess cases of lead poisoning.

Impact of in utero airborne lead exposure on long-run adult socio-economic outcomes: A population analysis using U.S. survey and administrative data

As a neurotoxin, early exposure to lead has long been assumed to affect socioeconomic outcomes well into adulthood. However, the empirical literature documenting such effects has been limited. This study documents the long-term effects of in utero exposure to air lead on adult socio-economic outcomes, including real earnings, disabilities, employment, public assistance, and education, using US survey and administrative data. Specifically, we match individuals in the 2000 US Decennial Census and 2001-2014 American Community Surveys to average lead concentrations in the individual's birth county during his/her 9 months in utero. We then estimate the effects of shocks to airborne lead conditional on observable characteristics, county fixed effects, county-specific time trends, and month-year fixed effects. We find a 0.5 μg/m3 decrease in air lead, representing the average 1975-85 change resulting from the passage of the U.S. Clean Air Act, is associated with an increase in earnings of 3.5%, or a present value, at birth, of $21,400 in lifetime earnings. Decomposing this effect, we find greater exposure to lead in utero is associated with an increase in disabilities in adulthood, an increase in receiving public assistance, and a decrease in employment. Looking at effects by sex, long-term effects for girls seem to fall on participation in the formal labor market, whereas for boys it appears to fall more on hours worked. This is the first study to document such long-term effects from lead using US data. We estimate the present value in 2020, from all earnings impacts from 1975 forward, to be $4.23 Trillion using a discount rate of 3%. In 2020 alone, the benefits are $252 B, or about 1.2% of GDP. Thus, our estimates imply the Clean Air Act's lead phase out is still returning a national dividend of over 1% every year.

Sex difference of pre- and post-natal exposure to six developmental neurotoxicants on intellectual abilities: a systematic review and meta-analysis of human studies

BACKGROUND

Early life exposure to lead, mercury, polychlorinated biphenyls (PCBs), polybromide diphenyl ethers (PBDEs), organophosphate pesticides (OPPs), and phthalates have been associated with lowered IQ in children. In some studies, these neurotoxicants impact males and females differently. We aimed to examine the sex-specific effects of exposure to developmental neurotoxicants on intelligence (IQ) in a systematic review and meta-analysis.

METHOD

We screened abstracts published in PsychINFO and PubMed before December 31st, 2021, for empirical studies of six neurotoxicants (lead, mercury, PCBs, PBDEs, OPPs, and phthalates) that (1) used an individualized biomarker; (2) measured exposure during the prenatal period or before age six; and (3) provided effect estimates on general, nonverbal, and/or verbal IQ by sex. We assessed each study for risk of bias and evaluated the certainty of the evidence using Navigation Guide. We performed separate random effect meta-analyses by sex and timing of exposure with subgroup analyses by neurotoxicant.

RESULTS

Fifty-one studies were included in the systematic review and 20 in the meta-analysis. Prenatal exposure to developmental neurotoxicants was associated with decreased general and nonverbal IQ in males, especially for lead. No significant effects were found for verbal IQ, or postnatal lead exposure and general IQ. Due to the limited number of studies, we were unable to analyze postnatal effects of any of the other neurotoxicants.

CONCLUSION

During fetal development, males may be more vulnerable than females to general and nonverbal intellectual deficits from neurotoxic exposures, especially from lead. More research is needed to examine the nuanced sex-specific effects found for postnatal exposure to toxic chemicals.

Common and Trace Metals in Alzheimer's and Parkinson's Diseases

Trace elements and metals play critical roles in the normal functioning of the central nervous system (CNS), and their dysregulation has been implicated in neurodegenerative disorders such as Alzheimer's disease (AD) and Parkinson's disease (PD). In a healthy CNS, zinc, copper, iron, and manganese play vital roles as enzyme cofactors, supporting neurotransmission, cellular metabolism, and antioxidant defense. Imbalances in these trace elements can lead to oxidative stress, protein aggregation, and mitochondrial dysfunction, thereby contributing to neurodegeneration. In AD, copper and zinc imbalances are associated with amyloid-beta and tau pathology, impacting cognitive function. PD involves the disruption of iron and manganese levels, leading to oxidative damage and neuronal loss. Toxic metals, like lead and cadmium, impair synaptic transmission and exacerbate neuroinflammation, impacting CNS health. The role of aluminum in AD neurofibrillary tangle formation has also been noted. Understanding the roles of these elements in CNS health and disease might offer potential therapeutic targets for neurodegenerative disorders. The Codex Alimentarius standards concerning the mentioned metals in foods may be one of the key legal contributions to safeguarding public health. Further research is needed to fully comprehend these complex mechanisms and develop effective interventions.

Exposure to metals among Electronic Nicotine Delivery System (ENDS) users in the PATH study: A longitudinal analysis

BACKGROUND

Few studies have evaluated Electronic Nicotine Delivery Systems (ENDS) in longitudinal studies, as a potential source of metals which may have carcinogenic, neurotoxic, and cardiotoxic effects. We evaluated metal body burden by ENDS use status in a longitudinal population-based national survey.

METHODS

We used the Population Assessment of Tobacco and Health (PATH) Study wave 1 (2013-2014), wave 2 (2014-2015), and wave 3 (2015-2016) adult data to assess urinary concentrations of seven metals among (1) ENDS only users who never used any nonelectronic tobacco products (n = 50), (2) ENDS only users who were former users of any nonelectronic tobacco products (n = 123) and (3) Never users (n = 1501) of any tobacco product.

RESULTS

Among ENDS only users who never used any nonelectronic tobacco products (n = 50), the geometric mean ratios (GMRs) of Cd and Pb were 1.25 (95%CI: 1.09-1.42) and 1.19 (95%CI: 1.05-1.34), respectively, compared to never users after adjustment for PATH Study wave, age, sex, race/ethnicity, education, region, secondhand smoke at home and work, and cannabis and other substance use. After the same adjustment, the corresponding GMRs were 1.48 (95%CI: 1.32-1.67) and 1.43 (95%CI: 1.28-1.60) for ENDS only users who were former users of any nonelectronic tobacco products (n = 123). No difference was observed in urinary concentrations of other metals comparing ENDS users to never users of any tobacco product.

DISCUSSION

ENDS users show higher urinary levels of Cd and Pb, including lifetime exclusive ENDS users compared to never users of any tobacco product. These findings are limited by the small sample size and could be related to underreporting of past combustible tobacco use or other factors. Metals typical of ENDS such as nickel and chromium unfortunately are not available in PATH. Studies assessing metal exposure associated with long term lifetime exclusive ENDS use (≥5 years) with larger sample size are needed.

The association between lead exposure and crime: A systematic review

Prior research has demonstrated an association between lead exposure and criminal behavior at the population-level, however studies exploring the effect of lead exposure on criminal behavior at the individual-level have not been reviewed systematically. The intent of this study is to complete a systematic review of all studies assessing individual-level exposures to lead and the outcomes of crime and antisocial behavior traits. We included peer reviewed studies that were published prior to August 2022 and were classified as cohort, cross-sectional, or case-control. Studies measuring the outcomes of crime, delinquency, violence, or aggression were included. The following databases were searched using a standardized search strategy: ProQuest Environmental Science Database, PubMed, ToxNet and the Public Affairs Information Service (PAIS). Seventeen manuscripts met our inclusion criteria. Blood lead was measured in 12 studies, bone lead in 3 studies, and dentine lead levels in 2 studies. This systematic review identified a wide range of diverse outcomes between exposure to lead at multiple windows of development and later delinquent, criminal and antisocial behavior. A review of all potential confounding variables included within each study was made, with inclusion of relevant confounders into the risk of bias tool. There is limited data at the individual level on the effects of prenatal, childhood, and adolescent lead exposure and later criminal behavior and more evidence is necessary to evaluate the magnitude of the associations seen in this review. Our review, in conjunction with the available biological evidence, suggests that an excess risk for criminal behavior in adulthood exists when an individual is exposed to lead in utero or in the early years of childhood. The authors report no conflict of interest and no funding source. Clinical trial registration: PROSPERO ID: CRD42021268379.

Lead exposure is correlated with reduced nesting success of an urban songbird

Lead exposure is a concern in urban ecosystems, with physiological and behavioral effects well documented in humans. Wildlife inhabiting urban ecosystems are also exposed to lead, yet little work has documented the sublethal effects of lead exposure in urban wildlife. We studied northern mockingbirds (Mimus polyglottos) in three neighborhoods of New Orleans, Louisiana, two with high soil lead and one with low soil lead, to better understand how lead exposure may influence mockingbirds' reproductive biology. We monitored nesting attempts, measured lead concentrations in blood and feathers of nestling mockingbirds, documented egg hatching and nesting success, and assessed rates of sexual promiscuity in relation to neighborhood soil lead levels. We found that nestling mockingbirds' blood and feather lead levels reflected the soil lead levels of their neighborhoods and nestling blood lead levels were similar to those of adult mockingbirds in the same neighborhoods. Nest success, as evaluated by daily nest survival rates, was higher in the lower lead neighborhood. Clutch sizes varied substantially across neighborhoods, but rates of unhatched eggs did not covary with neighborhood lead levels, suggesting that other drivers are influencing variation in clutch sizes and hatching success in urban habitats. At least one-third of nestling mockingbirds were sired by an extra-pair male, and there was no relationship between extra-pair paternity rates and neighborhood lead levels. This study provides insight on how lead contamination may influence reproduction in urban-dwelling wildlife and suggests that nestling birds could serve as useful bioindicators of lead levels in urban neighborhoods.

Forming a Critical Race Theory of Environmental Disaster: Understanding social meanings and health threat perception in the Flint Water Crisis

A Critical Race Theory of Environmental Disaster can aid researchers in better contextualizing racially disproportionate environmental disasters and their intricate social meanings to survivors. Such a theory, as proposed and operationalized here, incorporates interpretations of the causes and consequences of environmental disaster. In so doing, this theory weighs the racial and economic stratification often preceding environmental disaster and that which reflexively becomes more embedded in the aftermath. Focusing on the water crisis in the racially diverse, socioeconomically diminished city of Flint, Michigan, this article examines survey data from research conducted with city residents. The analysis considers residents' attitudes and beliefs around the crisis' scope and its intentionality and residents' health outcomes. Results suggest that various institutional and community-level mechanisms contribute to processes of meaning-making during crisis, or "crisis-making," finding consistent variation in residents' understanding of the nature and scope of the water crisis that is associated with specific cultural and health-related experiences. This construction substantiates that a Critical Race Theory of Environmental Disaster must consider not only race, but class in the context of race, as instrumental in developing social understandings of, and experiences with, environmental disaster.

Parent report of child behaviour: Findings from the Flint Registry cohort

BACKGROUND

Children in Flint, Michigan, have multiple risk factors for behavioural challenges, including exposure to lead during the Flint water crisis. However, their behavioural health status is largely unknown. Robust data from the Flint Registry can help understand the burden of behavioural outcomes and inform the allocation of resources.

OBJECTIVES

This population-level evaluation of Flint children's behavioural outcomes aims to answer the question: What is the burden of parent-reported child behaviour problems in Flint Registry enrolled children?

METHODS

This cross-sectional study describes parent-reported behavioural outcomes of children 2-17 years old who enrolled in the Flint Registry between December 2018 and December 2020. Parents/guardians completed behavioural assessments including the Behavior Assessment System for Children (BASC-3) Parent Rating Scale and Behavior Rating Inventory of Executive Function (BRIEF2) Screening Parent Form. Demographics of enrolees were compared with census data. Composite BASC-3 T scores were compared with national norms. Distributions for clinically relevant categories of BASC-3 and BRIEF2 scores were examined across age and sex groups.

RESULTS

Of the 3579 children included in this study (mean age 9.73 ± 3.96 years), about half were female and 79.7% were eligible for free or reduced-price lunch. Almost half of the children were reported to have clinically concerning scores on the BASC-3 Parent Rating Scale (44.7%) and the BRIEF2 Screening Parent Form (46.7%). Across most age and sex groupings, the reported adaptive skills were relatively low and behaviour symptoms relatively high.

CONCLUSIONS

Results reveal a substantial burden of parent-reported behavioural problems in Flint Registry children. This is clinically significant and indicates that a large number of children may require comprehensive neuropsychological evaluation and potential medical and/or educational services. Recognising the potential for long-term manifestations of childhood exposures to environmental hazards, longitudinal surveillance is critical to continue to identify and support participants.

Childhood Maltreatment, Blood Lead Levels, and Crime and Violence: A Prospective Examination

BACKGROUND

Research has shown that maltreated children are at increased risk for subsequent crime and violence and are more likely to reside in neighborhoods with a high likelihood of lead exposure. Other literature has reported associations between childhood lead exposure and antisocial and criminal behavior. Little is known about the relationships among childhood maltreatment, adult lead exposure, and crime and violence.

METHODS

As part of a prospective longitudinal study of the long-term consequences of childhood maltreatment, children with documented histories of abuse and neglect and demographically matched control children (ages 0-11 years) were followed into adulthood and interviewed. Participants included 556 individuals who had valid blood lead level (BLL) measures at a mean age of 41.2 years. Participants had a mean age of 50.5 (SD = 3.53) years at the time of the last criminal history check used to determine the number of arrests.

RESULTS

Childhood maltreatment predicted a higher number of arrests for any crime and any violence after the blood was collected but not higher BLLs in adulthood. There were significant paths from adult BLLs to arrests after the blood was collected, despite controlling for age, sex, race, and IQ and the inclusion of individual- and neighborhood-level socioeconomic status, and paths from neighborhood socioeconomic status to higher BLLs in models predicting any arrest and any violent arrest after the blood was collected.

CONCLUSIONS

These findings demonstrate how environmental toxins such as lead can affect outcomes in adulthood, including crime, and provide evidence that links neighborhood disadvantage to higher BLLs in adulthood.

Characteristics and sources of Pb exposure via household dust from the urban area of Shanghai, China

Household dust has been considered as an important pathway for children's environmental Pb exposure. Shanghai was one of the first cities in China that removed Pb from petrol and has been shown in our previous study to have the lowest childhood blood Pb levels in China. This study therefore examines household dust Pb (Pb^HD) in Shanghai in order to determine the extent and exposure risks of Pb^HD. Household vacuum cleaner dust samples (n = 40) were collected and analyzed for total Pb concentration, bio-accessible Pb concentration and Pb isotopic compositions (Pb^IC). The mean concentration of Pb^HD was 195 mg/kg, which is between 7 and 10 times the Pb concentration of background soil samples from Shanghai. Among the investigated homes, those living in neighborhoods with lower average estate prices have higher dust Pb exposure risks for children. Bio-accessibility of Pb in household dust ranged between 53 and 91%, with a mean value of 71%. Analysis of Pb^IC of household dust samples (²⁰⁸Pb/²⁰⁶Pb: 2.1096 ± 0.0054; ²⁰⁷Pb/²⁰⁶Pb: 0.8648 ± 0.0025) are a close match to Pb^IC of coal combustion and solid waste incineration and fit well with those of outdoor air Pb^IC and urban surface soil Pb^IC of Shanghai. The study shows that children living in Shanghai are subject to Pb^HD exposure, with children living in the homes with lower average price having increased susceptibility to Pb^HD exposure. The data indicate that Pb^HD is derived primarily from contemporary coal combustion and solid waste incineration rather than common legacy Pb sources (e.g., Pb petrol and paint). Practices including closing doors and windows on days with poor air quality or high wind and preventing shoe wearing inside homes will aid in minimizing outdoor surface soil and ambient particulate intrusion indoors.

Lead contamination of public drinking water and academic achievements among children in Massachusetts: a panel study

Background

Public drinking water can be an important source exposure to lead, which can affect children’s cognitive development and academic performance. Few studies have looked at the impact of lead exposures from community water supplies or their impact on school achievements. We examined the association between annual community water lead levels (WLLs) and children’s academic performances at the school district level.

Methods

We matched the 90th percentile WLLs with the grade 3–8 standardized test scores from the Stanford Education Data Archive on Geographic School Districts by geographic location and year. We used multivariate linear regression and adjusted for urbanicity, race, socioeconomic characteristics, school district, grade, and year. We also explored potential effect measure modifications and lag effects.

Results

After adjusting for potential confounders, a 5 μg/L increase in 90th percentile WLLs in a GSD was associated with a 0.00684 [0.00021, 0.01348] standard deviation decrease in the average math test score in the same year. No association was found for English Language Arts.

Conclusions

We found an association between the annual fluctuation of WLLs and math test scores in Massachusetts school districts, after adjusting for confounding by urbanicity, race, socioeconomic factors, school district, grade, and year. The implications of a detectable effect of WLLs on academic performance even at the modest levels evident in MA are significant and timely. Persistent efforts should be made to further reduce lead in drinking water.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12474-1.

Identifying periods of heightened susceptibility to lead exposure in relation to behavioral problems

BACKGROUND

Lead exposure is associated with behavioral problems in children, but the age(s) of greatest susceptibility to low-level lead exposure is unknown.

OBJECTIVE

We evaluated the association of repeated blood lead concentrations with parent-reported behaviors to identify periods of heightened susceptibility during infancy and childhood (HOME Study; Cincinnati, OH; 2003-2006; n = 244).

METHODS

We quantified lead in whole blood samples (ages 1, 2, 3, 4, 5, and 8 years) and assessed behavior using the Behavioral Assessment System for Children-2 (BASC-2; ages 2, 3, 4, 5, and 8 years). We used multiple informant models and modified Poisson regression to estimate covariate-adjusted associations of ln-transformed blood lead concentrations with continuous BASC-2 T-scores and the relative risk of behavior scores classified as at-risk or clinically significant, respectively.

RESULTS

We observed trends indicating that higher blood lead concentrations at all ages were adversely associated with scores on behavioral scales. On the Externalizing Problems and Adaptive Skills scales, these associations were strongest for blood lead concentrations at age 8 years (β = 3.1-point; 95% CI = 0.7, 5.4 and β = -2.2-point; 95% CI = -4.9, 0.5, respectively) compared with other ages. Overall, higher blood lead concentrations were associated with elevated risk of behavior scores classified as at-risk or clinically significant on the Adaptive Skills, Behavioral Symptom Index, and Externalizing Problems scales.

SIGNIFICANCE

Contemporary levels of lead exposure during the first 8 years of life were associated with ADHD-related behaviors, specifically aggression, hyperactivity, and conduct problems.

IMPACT STATEMENT

Our results highlight the importance of primary lead prevention across childhood.

Taurine-Derived Compounds Produce Anxiolytic Effects in Rats Following Developmental Lead Exposure

Lead (Pb2+) is a developmental neurotoxicant that disrupts the GABA-shift and subsequently causes alterations in the brain's excitation-to-inhibition (E/I) balance. Taurine is a well-established neuroprotective and inhibitory compound for regulating brain excitability. Since mechanistically taurine can facilitate neuronal inhibition through the GABA-AR, the present study examined the anxiolytic potential of taurine derivatives. Treatment groups consisted of the following developmental Pb2+-exposures: Control (0 ppm) and Perinatal (150 ppm or 1,000 ppm lead acetate in the drinking water). Rats were scheduled for behavioral tests between postnatal days (PND) 36-45 with random drug assignments to either saline, taurine, or taurine-derived compound (TD-101, TD-102, or TD-103) to assess the rats' responsivity to each drug in mitigating the developmental Pb2+-exposure and anxiety-like behaviors through the GABAergic system. Long-Evans hooded rats were assessed using an open field (OF) test for preliminary locomotor assessment. Twenty-four hours later, the same rats were exposed to the elevated plus maze (EPM) and were given an i.p. injection of 43 mg/Kg of the saline, taurine, or TD drugs 15 min prior to testing. Each rat was tested using the triple-blind random assignment method for each drug condition. The OF data revealed that Control female rats had increased locomotor activity over Control male rats, and the Pb2+-exposed males and females had increased locomotor activity when compared to the Control male and female rats. However, in the EPM, the Control female rats exhibited more anxiety-like behaviors over Control male rats, and the Pb2+-exposed male and female rats showed selective responsivity to TD drugs when compared to taurine. For Pb2+-exposed males, TD-101 showed consistent recovery of anxiety-like behaviors similar to that of taurine regardless of Pb2+ dose, whereas in Pb2+-exposed females TD-101 and TD-103 showed greater anxiolytic responses in the EPM. The results from the present psychopharmacological study suggests that taurine and its derivatives are interesting drug candidates to explore sex-specific mechanisms and actions of taurine and the associated GABAergic receptor properties by which these compounds alleviate anxiety as a potential behavioral pharmacotherapy for neurodevelopmental Pb2+ exposure.

Predicting childhood lead exposure at an aggregated level using machine learning

Childhood lead exposure affects over 500,000 children under 6 years old in the US; however, only 14 states recommend regular universal blood screening. Several studies have reported on the use of predictive models to estimate lead exposure of individual children, albeit with limited success: lead exposure can vary greatly among individuals, individual data is not easily accessible, and models trained in one location do not always perform well in another. We report on a novel approach that uses machine learning to accurately predict elevated Blood Lead Levels (BLLs) in large groups of children, using aggregated data. To that end, we used publicly available zip code and city/town BLL data from the states of New York (n = 1642, excluding New York City) and Massachusetts (n = 352), respectively. Five machine learning models were used to predict childhood lead exposure by using socioeconomic, housing, and water quality predictive features. The best-performing model was a Random Forest, with a 10-fold cross validation ROC AUC score of 0.91 and 0.85 for the Massachusetts and New York datasets, respectively. The model was then tested with New York City data and the results compared to measured BLLs at a borough level. The model yielded predictions in excellent agreement with measured data: at a city level it predicted elevated BLL rates of 1.72% for the children in New York City, which is close to the measured value of 1.73%. Predictive models, such as the one presented here, have the potential to help identify geographical hotspots with significantly large occurrence of elevated lead blood levels in children so that limited resources may be deployed to those who are most at risk.

The Problem Behind the Problem: Applying Human-Centered Design to Child Care in Flint

In response to the water crisis in Flint, Michigan, USA, early childhood education was one of the targets of intervention and prevention for children who were exposed to lead poisoning, because high-quality child care could potentially help improve their developmental trajectories. The Provider Empowerment Program used human-centered design (HCD) to uncover unmet and overlooked needs among child care providers. We discuss the theoretical framework that guided the project and led to a focus on family, friend, and neighbor (FFN) child care providers. We also present three examples of solutions that were uniquely shaped to meet the needs of FFN child care providers in Flint. Each solution was developed by a process that included taking the perspective of the people who faced the problem, spending time to understand the context of the problem, and uncovering the underlying problem which was not apparent at first. Recommendations for use of HCD in community-based problem-solving are discussed.

Correlation between lead exposure and cognitive function in 12-year-old children: a systematic review and meta-analysis

Lead exposure as a toxic material especially in children can be recognized as a harmful factor for cognitive function system. This meta-analysis was conducted to estimate the lead exposure effect on cognitive function among 6979 children less than 12 years. The 16 studies were divided into two clusters according to "duration of exposure" and "dose" using k-means partitioning clustering algorithm. Then, subgroup analysis has been performed based on the clustered studies. According to the results of the k-means clustering, dose and duration of exposure were significant factors between all considered variables. A stronger negative significant pooled correlation was observed in higher dose and duration cluster in comparison with another cluster including lower dose and duration (r = - 0.29, P-value < 0.001 vs. r = - 0.08, P-value < 0.001). Overall, a negative significant correlation was observed between lead exposure and cognitive function test score (r = - 0.22, P-value < 0.001). This study confirms the negative effect of lead on cognitive function in children, but needed further investigations to achieve the safe dose and duration of the lead exposure.

Lead exposure is associated with functional and microstructural changes in the healthy human brain

Lead is a toxin known to harm many organs in the body, particularly the central nervous system, across an individual's lifespan. To date, no study has yet investigated the associations between body lead level and the microstructural properties of gray matter areas, and brain activity during attention-demanding tasks. Here, utilizing data of diffusion tensor imaging, functional magnetic resonance imaging and cognitive measures among 920 typically developing young adults, we show greater hair lead levels are weakly but significantly associated with (a) increased working memory-related activity in the right premotor and pre-supplemental motor areas, (b) lower fractional anisotropy (FA) in white matter areas near the internal capsule, (c) lower mean diffusivity (MD) in the dopaminergic system in the left hemisphere and other widespread contingent areas, and (d) greater MD in the white matter area adjacent to the right fusiform gyrus. Higher lead levels were also weakly but significantly associated with lower performance in tests of high-order cognitive functions, such as the psychometric intelligence test, greater impulsivity measures, and higher novelty seeking and extraversion. These findings reflect the weak effect of daily lead level on the excitability and microstructural properties of the brain, particularly in the dopaminergic system.

Health and Economic Consequences of Lead Exposure Associated with Products and Services Provided by the Informal Economy

In low- and middle-income countries (LMICs), the presence of an informal economy can lead to human exposure to toxic metals such as lead (Pb). This paper demonstrates the local health and economic benefits of modifying practices within the informal economic sector in Madagascar. Specifically, leaded components in 504 locally manufactured household water pumps were replaced with unleaded components. Prior to the intervention, 32% of the household systems exhibited lead concentrations above the World Health Organization (WHO) provisional drinking water guideline of 10 μg/L, but after the intervention, fewer than 3% of the systems were in exceedance. The reduction of lead concentration is modeled to reduce the fraction of children with elevated BLLs (>5 μg/dL) from 34 to 13%. The reduction in BLLs is estimated to provide an average economic benefit of US$11 800 per child based on predicted increases in lifetime productivity. This corresponds to a total benefit of US$8.7 million for the 730 children aged 1-5 associated with the pumps, representing a return on investment of greater than 1000-to-1. Results demonstrate how the formation of partnerships between public, private, and civil society entities, as suggested by UN Sustainable Development Goal 17, can realize important local economic and health benefits in LMICs.

A novel calibration for L-shell x-ray fluorescence measurements of bone lead concentration using the strontium Kβ/Kαratio

Objective. Lead (Pb) is a well-known toxic element.In vivobone Pb concentration measurement is a long-term exposure metric complementary to blood Pb concentration measurement which is a metric of recent exposure.In vivohuman tibia bone Pb measurements using Pb K-shell or L-shell x-ray fluorescence (KXRF or LXRF) emissions were developed in the 1980s. KXRF bone Pb measurements using Cd-109 gamma rays and coherent-to-fluorescence ratio to account for differences between phantom andin vivomeasurements, was employed in human studies. Bone Pb LXRF method employed x-ray tubes. However, calibration procedures using ultrasound measurements of the soft tissue thickness (STT) proved inaccurate.Approach. In this study, bone and soft tissue (ST) phantoms simulatedin vivobone Pb measurements. Seven plaster-of-Paris cylindrical bone phantoms containing 1.01 mg g-1of strontium (Sr) were doped with Pb in 0, 8, 16, 29, 44, 59, and 74 μg g-1concentrations. Polyoxymethylene (POM), resin, and wax were each used to fabricate four ST phantoms in the approximate 1-4 mm thickness range. Pb LXRF measurements were performed using a previously developed optimal grazing incidence position method.Main results. Linear attenuation coefficients measurements of ST materials indicated that POM and resin mimicked well attenuation of Pb x-rays in skin and adipose tissue, respectively. POM and resin data indicated a bone Pb detection limit of 20 μg g-1for a 2 mm STT. Derived relationships between the Pb concentration, Pb LXRF and Sr Kβ/Kαratio data did not require STT knowledge. Applied to POM and resin data, the new calibration method yielded unbiased results.Significance.In vivobone Pb measurements in children were suggested following considerations of radiation dose, STT, detectability and distribution of Pb and Sr in bone. This research meets with the concerns regarding the negative effects of low levels of Pb exposure on neurodevelopment of children.

Developmental lead exposure and adult criminal behavior: A 30-year prospective birth cohort study

Using a variety of research designs and measures of lead absorption, numerous studies link childhood lead exposure to a range of cognitive and behavioral deficits, including low IQ, impulsivity, juvenile delinquency, and criminal behavior in adolescence and early adulthood. In this study, we tested the association between multiple measures of blood lead concentration assessed in childhood with criminal behavior in adulthood and across the life-course. Prospective data from the Cincinnati Lead Study (CLS) included blood lead measures quarterly across the first 78 months of life and the number of times a person was arrested across the life-course (from age 18 to 33 years) and in later adulthood (age 27 to 33 years). Childhood blood lead concentration prospectively predicted variation in adult arrests and arrests over the life-course, indicating lead absorption is implicated in the etiology of crime-especially in geographic areas where environmental sources of lead are more prevalent and concentrated. Efforts to decrease lead exposure in both developed and developing countries should be part of a comprehensive strategy to reduce social dislocation and crime.

Neighborhood-Level Lead Paint Hazard for Children under 6: A Tool for Proactive and Equitable Intervention

Lead is well known for its adverse health effects on children, particularly when exposure occurs at earlier ages. The primary source of lead hazards among young children is paint used in buildings built before 1978. Despite being 100% preventable, some children remain exposed and state and local policies often remain reactive. This study presents a methodology for planners and public health practitioners to proactively address lead risks among young children. Using geospatial analyses, this study examines neighborhood level measurement of lead paint hazard in homes and childcare facilities and the concentration of children aged 0-5. Results highlight areas of potential lead paint hazard hotspots within a county in the Midwestern state studied, which coincides with higher concentration of non-white children. This places lead paint hazard in the context of social determinants of health, where existing disparity in distribution of social and economic resources reinforces health inequity. In addition to being proactive, lead poisoning intervention efforts need to be multi-dimensional and coordinated among multiple parties involved. Identifying children in higher lead paint hazard areas, screening and treating them, and repairing their homes and childcare facilities will require close collaboration of healthcare professionals, local housing and planning authorities, and community members.

(Ascorb)ing Pb Neurotoxicity in the Developing Brain

Lead (Pb) neurotoxicity is a major concern, particularly in children. Developmental exposure to Pb can alter neurodevelopmental trajectory and has permanent neuropathological consequences, including an increased vulnerability to further stressors. Ascorbic acid is among most researched antioxidant nutrients and has a special role in maintaining redox homeostasis in physiological and physio-pathological brain states. Furthermore, because of its capacity to chelate metal ions, ascorbic acid may particularly serve as a potent therapeutic agent in Pb poisoning. The present review first discusses the major consequences of Pb exposure in children and then proceeds to present evidence from human and animal studies for ascorbic acid as an efficient ameliorative supplemental nutrient in Pb poisoning, with a particular focus on developmental Pb neurotoxicity. In doing so, it is hoped that there is a revitalization for further research on understanding the brain functions of this essential, safe, and readily available vitamin in physiological states, as well to justify and establish it as an effective neuroprotective and modulatory factor in the pathologies of the nervous system, including developmental neuropathologies.

Associations of metals and neurodevelopment: a review of recent evidence on susceptibility factors

PURPOSE OF REVIEW

Epidemiologic evidence exists that many metals are associated with adverse neurobehavioral effects in young children, including lead (Pb), methylmercury (meHg), manganese (Mn) and arsenic (As)5-8. Importantly, chemical insult can vary depending on host factors and exposure circumstance. This systematic review summarizes the recent literature investigating modifying factors of the associations between metals and neurodevelopment, including immutable traits (sex or genetics) or exposure conditions (timing or co-exposures).

RECENT FINDINGS

Of the 53 studies included in this review, the number investigating modification of exposure effects were: 30 for sex, 21 for co-exposures, 12 for timing of exposure, and six for genetic modifiers. Sex-specific effects of metal-neurobehavioral associations were inconclusive for all metals, likely due to the heterogeneity of outcome domains assessed and the exposure time points measured. Seven studies evaluated both sex and exposure timing as modifying factors using deciduous teeth or other biomarkers with repeated measures to characterize metals exposure over time. Only five studies used statistical methods for mixtures to evaluate associations of more than two metals with neurobehavioral domains.

SUMMARY

Despite the expansion of research on susceptibility to the neurodevelopmental effects of metals exposure, considerable gaps remain. This work remains critical, as characterizing susceptible subpopulations can aid in identifying biological mechanisms and is fundamental for the protection of public health.

Effect of environmental toxicants on neuronal functions

In the last few years, neurodegenerative diseases like Alzheimer's disease (AD) and Parkinson's disease (PD) have attracted attention due to their high prevalence worldwide. Environmental factors may be one of the biggest reasons for these diseases related to neuronal dysfunctions. Most of neuronal disorders are strongly associated with pre- and postnatal exposure to environmental toxins released from industries. Some of the neurotoxic metals such as lead, aluminum, mercury, manganese, cadmium, and arsenic as well as some pesticides and metal-based nanoparticles have been involved in AD and PD due to their ability to produce senile/amyloid plaques and NFTs which are the main feature of these neuronal dysfunctions. Exposure to solvents is also majorly responsible for neurodegenerative disorders. The present review highlights the impact of omnipresent heavy metals with some other neurotoxins on human health and how they give rise to neuronal dysfunctions which in turn causes socio-economic consequences due to increasing pollution worldwide. Graphical abstract.

Childhood maltreatment and lead levels in middle adulthood: A prospective examination of the roles of individual socio-economic and neighborhood characteristics

BACKGROUND

Lead is a common environmental hazard because of its past use as an additive to gasoline and household paint. Some evidence suggests that children with histories of child abuse and neglect are at elevated risk for residence in communities and households with less desirable characteristics and high levels of exposure to environmental hazards and toxins.

OBJECTIVES

To understand whether childhood maltreatment leads to higher levels of household dust lead and blood lead in adulthood and the extent to which characteristics of a person's physical environment or individual level socio-economic status (SES) (based on unemployment, poverty, and receipt of public assistance) contribute to understanding the relationship.

METHODS

A large prospective cohort design study in which abused and neglected children (ages 0-11) were matched with non-maltreated children and assessed in adulthood. Objective and subjective neighborhood characteristics were assessed at approximate age 40 and household dust lead (cleaned and less often cleaned) and blood lead levels were measured at age 41. Blood was collected through venipuncture by a registered nurse as part of a medical status exam.

RESULTS

Childhood maltreatment predicted higher levels of dust lead in less often cleaned household places, residence in worse neighborhoods defined by objective (census tract data) and subjective (reports of physical disorder and lack of social cohesion and control), and higher levels of poverty, receiving public assistance, and unemployment. Only objective neighborhood characteristics mediated the relationship between childhood maltreatment and dust lead level in adulthood. There were also significant paths from objective neighborhood disadvantage and individual level SES to higher levels of blood lead.

DISCUSSION

Thirty years after their childhood experiences, individuals with documented histories of childhood maltreatment are at higher risk for living in environments as adults with elevated lead levels that may impact other aspects of their lives and compromise their health.

Source Identification Analysis of Lead in the Blood of Japanese Children by Stable Isotope Analysis

Considering the negative effect of lead (Pb) on children's neurodevelopment, Pb exposure should be minimized to the lowest extent possible, though the blood Pb (BPb) concentrations in Japanese children are among the lowest in the world. To identify the sources of Pb in blood, isotope ratios (IRs: 207Pb/206Pb and 208Pb/206Pb) of Pb (PbIR) in whole blood from eight Japanese children were measured by multi-collector ICP mass spectrometry. Further, samples of house dust, soil, duplicate diet, and tobacco, collected from home environments, were also measured and were compared with PbIR of blood case by case. The relative contribution of Pb in the home environment to BPb were estimated by linear programming (finding an optimal solution which satisfy the combination of IRs and intakes from various sources) when appropriate. Source apportionment for three children could be estimated, and contributions of diet, soil, and house dust were 19-34%, 0-55%, and 20-76%, respectively. PbIR for the remaining five children also suggested that non-dietary sources also contributed to Pb exposure, though quantitative contributions could not be estimated. Non-dietary sources such as soil, house dust, and passive tobacco smoke are also important contributors to Pb exposure for Japanese children based on PbIR results.

New directions in understanding the role of environmental contaminants in child development: Four themes

Environmental contaminants, which include several heavy metals, persistent organic pollutants, and other harmful chemicals, impair several domains of child development. This article describes four themes from recent research on the impact of environmental contaminants on child development. The first theme, disparities in exposure, focuses on how marginalized communities are disproportionately exposed to harmful environmental contaminants. The second theme, complexity of exposures, encapsulates recent emphases on timing of exposures and mixtures of multiple exposures. The third theme, mechanisms that link exposures to outcomes, focuses on processes that elucidate how contaminants impact outcomes. The fourth theme, mitigating risks associated with exposures, sheds light on potential protective factors that could ameliorate many of the harmful effects of contaminant exposures. Developmental scientists are well positioned to contribute to interdisciplinary research that addresses these themes, which could foster additional conceptual and empirical innovations and inform policies and practices to mitigate risks and improve children's well-being.

A 25-year record of childhood blood lead exposure and its relationship to environmental sources

Broken Hill, the oldest silver (Ag)-zinc (Zn)-lead (Pb) mining community in Australia, has a legacy and ongoing problem of environmental Pb exposure that was identified as early as 1893. To reduce Pb exposure risks, identifying potential exposure pathways and related factors is a critical first step. This study examined blood lead (PbB) levels of children ≤60 months old (n = 24,106 samples), along with Pb concentrations in corresponding soil (n = 10,160 samples), petri-dish dust (n = 106 houses) and ceiling dust (n = 80 houses) over a 25-year period from 1991 to 2015. Regression analysis was used to examine the relationships between environmental Pb sources and children's blood lead (PbB) outcomes. Analysis of the dataset showed Aboriginal children in Broken Hill had a geometric mean PbB of 7.4 μg/dL (95% CI: 6.7-7.4) being significantly higher (p < 0.01) than non-Aboriginal children (PbB 6.2 μg/dL, 95% CI: 6.2-6.3) for all years between 1991 and 2015. Children at the age of 24-36 months had a higher PbB compared with other age groups. Higher PbB levels were also statistically associated with lower socio-economic status and children living in houses built before 1940 (p < 0.01). Blood Pb was also significantly correlated with both soil Pb and indoor petri-dish dust Pb loadings, confirming that these are important pathways for exposure in Broken Hill. A 100 mg/kg increase in soil Pb was associated with a 0.12 μg/dL increase in childhood PbB. In addition, PbB concentrations increased with indoor petri-dish dust Pb loadings (i.e., 0.08 μg/dL per 100 μg/m²/30 days). The 25-year data show that the risk of exposure at ≥ 10 μg/dL was seemingly unavoidable irrespective of residential address (i.e., children of all ages presenting with a ≥10 μg/dL across the whole city area). In terms of moving forward and mitigating harmful early-life Pb exposures, all children aged 24-36 months should be prioritised for feasible and effective intervention practices. Primary intervention must focus on mitigating contemporary ongoing dust emissions from the mining operations and the associated mine-lease areas along with household soil remediation, to help prevent recontamination of homes. Additional practices of dust cleaning using wet mopping and wiping techniques, vacuuming of carpets and furnishings, ongoing monitoring of children and household dust remain important but short-lived abatement strategies. Overall, the key goal should be to eliminate risk by removing contamination in the wider environment as well as in individual homes.

Prediction of Children’s Blood Lead Levels from Exposure to Lead in Schools’ Drinking Water—A Case Study in Tennessee, USA

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.

Estimating the national burden of mild intellectual disability in children exposed to dietary lead in China

The effects of lead as a dietary pollutant remain a global public health concern that needs urgent resolution. Children are highly susceptible to the adverse outcomes of lead pollution, as even low levels of lead may cause irreversible damage to intellectual development. Since several sources of lead exposure are present in the environment, it is necessary to identify the attributable burden of lead-related diseases arising from different exposure sources. In the present study, we used epidemiological data from studies around the nation to estimate the burden of mild intellectual disability (MID) attributed to lead exposure sources by using disability-adjusted life years (DALYs). To this end, a dose-response approach was used and a model comprising three components was established: exposure, dose-response, and DALYs module. In Chinese children aged 0-6 years, blood lead levels (BLLs) of 5.34 ± 3.09 μg/dL resulted in a MID incidence rate of 12.84 cases per 1000 children, with an estimated burden of disease (BoD) of 42.23 DALYs per 1000 children. Owing to dietary lead exposure, 36.64 healthy life years per 1000 children were lost, which was notably higher than the outcomes associated with exposure from other sources. This was consistent with the result that dietary exposure was the main contributor to children's lead exposure, accounting for 86.76%. According to the regional distribution based on the existing literature, the areas in China with higher BLLs were Heilongjiang, Shanxi, and Jiangxi. Our findings provided the information for lead risk management decisions and policies making.

Evaluation of Pb concentrations in selected vegetables and portable drinking water, and intelligent quotients of school children in Ishiagu-a Pb mining community: health risk assessment using predictive modelling

This study evaluates the concentrations of lead (Pb) in 6 selected vegetables and drinking water samples taken from an agricultural/mining town Ishiagu. This evaluation is important because these vegetables and water are major gateway of lead exposure through ingestion, especially children in the Pb mining environment. Pb at even very low concentrations has been shown to have adverse effect on developing brain and hence children's intellectual ability. The impact of lead-contaminated food/water intake on the cognitive function was focused on school children whose parents have lived in the Pb mining town for over 25 years before they were born. Non-invasive, "target risk quotient" (TRQ) methodology, based on the principle of predictive toxicology was adopted for our analysis. Samples of these vegetables harvested in July and August 2015, and water taken from homes at 4 different villages in Ishiagu town and neighbouring community Akaeze (control), were subjected to appropriate chemical treatment/digestion procedures and the concentrations of Pb determined using AA-700 Shimadzu model atomic absorption spectrophotometer. From 642 structured questionnaire administered to the teachers/children, the daily vegetable ingestion rates for each vegetable (mg/child/day) and estimated daily intakes (EDI) of lead were obtained. The results show that the concentrations of Pb in water samples and the 6 vegetables harvested from the lead mining town vary as distances increase from the mining sites while the total target hazard quotients (TTHQs) for the vegetable crops were greater than one (˃ 1). The cognitive functions of 160 school children (aged 6-8 years), sampled from 265 families based on their meeting the criteria for distances away from the mining site, were evaluated using Raven's Standard Progressive Matrices and psychometrics. The data generated were analysed using (SPSS) version 21.0 and results expressed as mean ± standard deviation of intelligent quotient (IQ). Students' t tests for independent samples were used to compare the IQ results for children in the lead mining area and non-mining area. A model based on predictive toxicology paradigm which can show a relationship between concentrations of lead in vegetables/water and cognitive function was developed. This model shows that there is a positive correlation between total lead concentrations in vegetables/water and children's cognitive function.

Contemporary blood lead levels of children aged 0-84 months in China: A national cross-sectional study

Despite the global abundance of studies on children's lead (Pb) exposure, the magnitude of Pb exposure among children across China remains unclear, especially for rural areas. In 2000, Pb was removed from petrol, marking a change in the sources of Pb exposure in China. To better understand children's Pb exposure and inform potential approaches to exposure reduction, we conducted a national blood Pb survey of 31,373 children (0-84 months old) from May 2013 to March 2015, using a multi-stage and multi-strata sampling method. Blood lead levels (BLLs) were tested using graphite furnace atomic absorption spectrometry with a detection limit of 1 µg/L. The results show that Chinese children had a contemporary geometric mean (GM) BLL of 26.7 μg/L, with 8.6% of BLLs exceeding 50 µg/L. Boys had higher BLLs (GM 27.2 μg/L) compared to girls (GM: 25.9 μg/L) (p < 0.001). Children at the age of 0-36 months had a lower PbB (GM 25.7 μg/L) level compared with those aged 36-84 months (GM 27.9 μg/L) (p < 0.001). When taking into account sociodemographic factors, a multivariate logistic regression analysis shows that the odds ratios (OR) of having a BLL of 27 µg/dL (i.e., median BLL of this study) or higher were 1.88 (95% CI: 1.76, 2.02) and 1.35 (95% CI: 1.22, 1.49) for homes using coal and biomass fuels, respectively, compared to those using gas or electricity. Meanwhile, children in homes close to roads were more likely to have BLLs exceeding 27 µg/dL (OR: 1.11, 95% CI: 1.03, 1.20). In China, rural children had higher BLLs compared to urban children. As a result of pediatric exposure to Pb, there were approximately 144 million and 36 million IQ points lost for rural children and urban children, respectively, revealing a disparity of Pb exposure between rural and urban areas in China. Cleaner domestic fuels and improved cooking/heating equipment will reduce contemporary Pb exposure in rural areas. In addition, the association between contemporary BLLs and distance away from roads further suggests that resuspension of legacy soil/dust Pb should not be neglected in future remediation programs and household interventions. As a large scale survey, this study provides evidence for revising the reference value of BLL, improving the guideline for clinical and public health management, and implementing interventions to prevent adverse health outcomes associated with low-level Pb exposure in children.

[Mental health and environmental health. A prospective view. SESPAS Report 2020]

Since the dawn of psychiatry, the environment has been an essential factor in the study and understanding of mental illness. Traditionally, the interrelationship between genome and environment has been a central theme in research on the etiopathogenesis of mental health problems and in the very conception of mental health. In its application to psychopathology and mental health, psychiatric enviromics was defined as «the study of environmental conditions and processes that promote mental health or increase the risk of developing mental disorders». However, environmental health -at least in Spain and in connection with its powers within the Spanish General Health System- has paid attention to aspects pertaining to risks associated with the physical, chemical and biological pollution of the air, the water and the ground, as well as to its correlation with food pollution. Although environmental risks such as air quality, extreme temperatures, noise, climate change and various environmental toxicants can play a particularly important role, they can hardly be identified as single etiopathogenic elements. This work reviews the recent literature on environmental research and problems of psychiatric morbidity and mortality. Although the results are inconclusive, future lines of research should consider a more agile interdisciplinary collaboration, allowing, on the one hand, a better understanding of mental illness and, on the other hand, to be able to shift from "traditional" environmental health to an environmental health that takes social environmental factors into account and seriously addresses the still little studied concept of "social pollution".

Oral exposure to lead for Japanese children and pregnant women, estimated using duplicate food portions and house dust analyses

BACKGROUND

Lead is a toxic metal abundant in the environment. Consumption of food contaminated at low levels of lead, especially by small children and pregnant women, raises a health concern.

METHODS

Duplicated food portions and drinking water were collected over 3 days from 88 children and 87 pregnant women in Shimotsuke, Tochigi, Japan. Participants were recruited in this study between January 2014 and October 2015. Dust was also collected from their homes. Lead concentrations were measured and consequent oral lead exposure levels were estimated for this population at high risk to environmental toxicants. Lead concentrations of peripheral and cord blood, taken from children and pregnant women, and were also analyzed.

RESULTS

Lead concentrations in food, drinking water, and house dust were low in general. Oral lead exposure to lead was higher for children (Mean ± SEM; 5.21 ± 0.30 μg/kg BW/week) than in pregnant women (1.47 ± 0.13 μg/kg BW/week). Food and house dust were main sources of lead contamination, but the contribution of house dust widely varied. Means ± SEM of peripheral and cord blood lead concentrations were 0.69 ± 0.04 μg/dL and 0.54 ± 0.05 μg/dL, respectively for pregnant women and 1.30 ± 0.07 μg/dL (peripheral only) in children. We detect no correlation between smoking situations and blood lead concentration in pregnant women.

CONCLUSION

We conclude that oral lead exposure levels for Japanese children and pregnant women were generally low, with higher concentrations and exposure for children than for pregnant women. More efforts are necessary to clarify the sources of lead contamination and reduce lead exposure of the population at high risk even in Japan.

Systematic review and meta-analyses of lead (Pb) concentrations in environmental media (soil, dust, water, food, and air) reported in the United States from 1996 to 2016

Environmental lead (Pb) contamination is a persistent public health issue that prominently impacts communities across the United States. Multimedia Pb exposure assessments are utilized to provide a holistic evaluation of Pb exposure and inform the development of programs and regulations that are protective of human health. To conduct multimedia exposure assessments, robust, media-specific environmental Pb concentration data are necessary. To support this effort, systematic review and meta-analysis methods were used to conduct a comprehensive synthesis of research measuring Pb in multiple environmental media (soil, dust, water, food, and air) over a 20-year period within the United States. The breadth of the resulting database allowed for the evaluation of sample characteristics that can serve as indicators of environmental Pb contamination. Random effects models run on literature and national survey datasets generated overall mean estimates of Pb concentrations that can be used for multimedia Pb exposure modeling for general and high-exposure-risk populations. Results from our study highlighted several important trends: 1) The mean estimate of Pb in residential soils is three times higher for urbanized areas than non-urbanized areas; 2) The mean estimate of Pb in produce reported in the literature is approximately three orders of magnitude greater than commercially-sourced raw produce monitored in national surveys; 3) The mean estimate of Pb in soils from shooting ranges is two times greater than non-residential Pb contaminated Superfund sites reported in the literature; 4) Research reporting environmental Pb concentrations for school and daycare sites is very limited; 5) Inconsistent sample collection and reporting of results limited synthesis efforts; and 6) The U.S. EPA's Air Quality System was the most robust, publicly available national survey resource. Results from these analyses will inform future multimedia Pb exposure assessments and be useful in prioritizing future research and program development.

Prenatal lead exposure and childhood executive function and behavioral difficulties in project viva

BACKGROUND

Lead is an established neurotoxicant and early life exposure to lead is associated with detrimental impacts on IQ and several neurobehavioral domains. Less is known, however, about effects of prenatal lead exposure below 5 μg/dL on executive function and on social, emotional and self-regulatory behaviors in childhood.

OBJECTIVES

To examine the association between prenatal lead exposure and childhood executive function and social, emotional and self-regulatory behaviors.

METHODS

We included 1006 mother-child pairs from the Project Viva prospective pre-birth cohort. We measured prenatal maternal lead in second-trimester erythrocytes. In mid-childhood (median 7.7 years), parents and teachers rated executive function related behaviors using the Behavior Rating Inventory of Executive Function (BRIEF) and behavioral difficulties using the Strengths and Difficulties Questionnaire (SDQ). We used multivariable linear regression models adjusted for maternal, paternal, and child characteristics and metal co-exposures.

RESULTS

Mean maternal erythrocyte lead concentration was 1.2 μg/dL (interquartile range [IQR] 0.8-1.5 μg /dL), equivalent to approximately 0.4 μg/dL in whole blood. In adjusted models, associations with parent and teacher-rated scales were largely null, although effect estimates were consistently positive, suggesting worse scores with increasing lead levels. For an IQR increase in lead, BRIEF Global Executive Composite (GEC) was 0.73 (95% CI: -0.06, 1.52) points higher for parent-rated scores and 0.42 (95% CI: -0.39, 1.23) points higher for teacher-rated scores. Associations were strongest for parent-rated BRIEF plan/organize (β = 0.85; 95% CI: 0.12, 1.59) and shift (β = 0.88; 95% CI: 0.01, 1.75) subscales, as well as the SDQ emotional problems subscale (β = 0.18; 95% CI: 0.03, 0.33).

DISCUSSION

In this cohort with lead levels commonly experienced by U.S. women, there were few statistically significant associations with childhood executive function and behavior. However, there was a trend of worse neurobehavioral scores with increasing prenatal lead concentrations, in particular for childhood emotional problems and capacity to plan/organize and shift. Our results highlight the importance of continuing efforts to eliminate lead exposure in the general population.

Environmental lead exposure is associated with neurocognitive dysfunction in children with chronic kidney disease

BACKGROUND

Environmental lead exposure is associated with cognitive impairment in healthy children, with deficits seen in intelligence quotient (IQ), attention, and behavior. Neurocognitive dysfunction is also a well-described complication among children with chronic kidney disease (CKD). The objective was to evaluate the association between blood lead levels (BLL) and performance on neurocognitive assessments in a cohort of children with CKD.

METHODS

Cross-sectional study of children with mild to moderate CKD from the Chronic Kidney Disease in Children (CKiD) multicenter prospective cohort study. The primary exposure was BLL. The primary outcome was performance on age-specific neurocognitive assessments evaluating IQ, executive functioning, attention, hyperactivity, and behavior. Multivariable linear regression was used to evaluate the association between BLL and neurocognitive performance, adjusted for key sociodemographic and clinical variables.

RESULTS

A total of 412 subjects were included with median age 15.4 years, median estimated GFR 39 mL/min/1.73², median BLL 1.2 mcg/dL, and median IQ score 99. In multivariable linear regression, higher BLL was associated with significantly lower IQ score (- 2.1 IQ points for every 1-mcg/dL increase in BLL, p = 0.029). Higher BLL was associated with worse scores on the Conners' Continuous Performance Test II Variability T-Score, a measure of inattention (+ 1.8 T-Score points for every 1-mcg/dL increase in BLL, p = 0.033).

CONCLUSIONS

Low-level lead exposure is associated with significantly lower IQ and more inattention in children with CKD, a population already at high risk for neurocognitive dysfunction. Universal screening for elevated BLL should be considered for all children with CKD at age 12-24 months.

Assessing the Anxiolytic Properties of Taurine-Derived Compounds in Rats Following Developmental Lead Exposure: A Neurodevelopmental and Behavioral Pharmacological Pilot Study

Lead (Pb²⁺) is a developmental neurotoxicant that causes alterations in the brain's excitation-to-inhibition (E/I) balance. By increasing chloride concentration through GABA-ARs, taurine serves as an effective inhibitory compound for maintaining appropriate levels of brain excitability. Considering this pharmacological mechanism of taurine facilitated inhibition through the GABA-AR, the present pilot study sought to explore the anxiolytic potential of taurine derivatives. Treatment groups consisted of the following developmental Pb²⁺-exposures: Control (0 ppm) and Perinatal (150 ppm or 1000 ppm lead acetate in the drinking water). Rats were scheduled for behavioral tests between postnatal days (PND) 36-45 with random assignments to either solutions of Saline, Taurine, or Taurine Derived compounds (i.e., TD-101, TD-102, or TD-103) to assess the rats' responsiveness to each drug in mitigating the developmental Pb²⁺-exposure through the GABAergic system. Long Evans Hooded rats were assessed using an Open Field (OF) test for preliminary locomotor assessment. Approximately 24-h after the OF, the same rats were exposed to the Elevated Plus Maze (EPM) and were given an i.p. injection of 43 mg/Kg of the Saline, Taurine, or TD drugs 15-min prior to testing. Each rat was tested using the random assignment method for each pharmacological condition, which was conducted using a triple-blind procedure. The OF data revealed that locomotor activity was unaffected by Pb²⁺-exposure with no gender differences observed. However, Pb²⁺-exposure induced an anxiogenic response in the EPM, which interestingly, was ameliorated in a gender-specific manner in response to taurine and TD drugs. Female rats exhibited more anxiogenic behavior than the male rats; and as such, exhibited a greater degree of anxiety that were recovered in response to Taurine and its derivatives as a drug therapy. The results from the present psychopharmacological pilot study suggests that Taurine and its derivatives could provide useful data for further exploring the pharmacological mechanisms and actions of Taurine and the associated GABAergic receptor properties by which these compounds alleviate anxiety as a potential behavioral pharmacotherapy for treating anxiety and other associated mood disorders.

Association between self-reported length of time in the USA and blood lead levels: National Health and Nutrition Examination Survey 2013-2016

OBJECTIVES

The aim of this study is to determine the association between length of time in the USA with blood lead (BPb).

DESIGN

Population-based cross-sectional study using data from the 2013-2016 National Health and Nutrition Examination Survey.

SETTING

USA.

PARTICIPANTS

5933 men and women (≥15 years); subgroups of men only (n=2867), women only (n=3064) and women of childbearing age (15-45 years) (n=1580).

PRIMARY AND SECONDARY OUTCOMES

The primary outcome was BPb concentration. The main exposure variable was self-reported number of years spent in the USA, categorised as: born in the USA; 0-4 years; 5-9 years; 10-19 years and ≥20 years. We used linear regression models adjusted for race/ethnicity, education, blood cotinine, age, sex (as appropriate) and accounted for complex survey design.

RESULTS

Women of childbearing age who have lived 0-4 years in the USA have, on average, a 54% (95% CI 36% to 75%) higher BPb compared with women born in the USA. Corresponding results for all women, men and the entire population were 49% (95% CI 34% to 66%), 49% (95% CI 28% to 75%) and 49% (95% CI 33% to 66%), respectively. Similar, statistically significant, results were observed for other time periods (5-9 years, 10-19 years and ≥20 years); the magnitude of the association decreased with increasing time in the USA.

CONCLUSIONS

This study provides additional evidence that newcomers to the USA may be a population at higher risk of elevated BPb.

Prevalence of Blood Lead among Children Living in Battery Recycling Communities in Greater Jakarta, Indonesia

This study aimed to assess the prevalence of blood lead levels (BLLs) among children 1 to 5 years old who reside near and distant to informally used lead-acid battery (ULAB) recycling locations and examine risk factors for elevated BLLs. A cross-sectional study was conducted in three greater Jakarta neighborhoods where informal ULAB recycling occurs. Venous BLLs among 279 children were analyzed using portable blood lead testing machines. Demographic, child activities, and sources of lead exposure inside and outside homes were assessed. Multivariate analysis was performed to evaluate factors associated with the prevalence of BLLs. Forty-seven percent of children had BLLs ≥ 5 µg/dL and 9% had BLLs ≥ 10 µg/dL. No differences in geometric mean BLLs were observed between children who lived near and distant to ULAB locations. Older child age groups [Prevalence Ratio (PR) 2.14, 95% Confidence Interval (CI) 1.16, 4.18) and low household income (PR 1.58, 95% CI 1.03, 2.40) were associated with BLLs 5-9 µg/dL. Low educational attainment of the child's father (PR 3.17, 95% CI 1.23, 8.16) and frequent outdoor child activity (PR 4.93, 95% CI 1.09, 22.21) were predictors of BLLs ≥ 10 µg/dL. This study shows the association between lead exposure among children and environmental sources. Public health officials can consider expanded surveillance, health care provider education, and development of strategies to reduce lead exposure.

Cost-benefit of point-of-use devices for lead reduction

BACKGROUND

Lead exposure represents a significant human health concern that often occurs with little warning to the consumer. Water lead levels can be mitigated by point-of-use (POU) devices such as reverse osmosis, distillation, or activated carbon with lead reduction media.

OBJECTIVES

This study assessed a partial cost-benefit of residential installation of POU devices to reduce lead concentrations in drinking water and examined the economic impact at the community level based on exposures reported in Flint, Michigan.

METHODS

We calculated the individual consumer breakeven point for each lead abatement option by subtracting the lifetime cost of device installation and maintenance from the lifetime cost of lead exposure through its impact on intelligence (IQ) and lifetime earnings. This approach was then extrapolated to the community level based on reported lead exposures in Flint, Michigan.

RESULTS

Based on operating POU device costs, lead absorption from water, and economic losses associated with reduced IQ, initial water lead levels associated with consumer breakeven points for reverse osmosis (7.31 µg/L), activated carbon (3.73 µg/L), and distillation (12.0 µg/L) were calculated. For example, an individual consuming water with 25 µg/L of lead, similar to the 90th percentile of concentrations measured in Flint, Michigan, would have an expected blood lead level of 1.25 µg/dL, a corresponding loss of 0.641 IQ points, and a lifetime economic earnings loss of $14,284. Over 70 years of continued use, activated carbon with lead reduction media is the least expensive device to maintain and operate as compared to reverse osmosis and distillation.

CONCLUSIONS

Infrastructure failures related to drinking water are unpredictable and exposure to contaminates can have significant economic ramifications. POU devices represent a cost-effective option to reduce the impact of lead exposure, particularly when water lead concentrations exceed regulated levels.