Another ecologic study attempting to infer associations with very weak correlations. Would nonconsumption of food be associated with a lower prevalence of elevated dental caries?
Sanders AE, Slade GD. Blood Lead Levels and Dental Caries in U.S. Children Who Do Not Drink Tap Water. American journal of preventive medicine. 2017 Nov 18. pii: S0749-3797(17)30495-6. doi: 10.1016/j.amepre.2017.09.004.
INTRODUCTION: This study’s purpose is to determine whether nonconsumption of tap water is associated with lower prevalence of elevated blood lead levels and higher prevalence of dental caries in children and adolescents.
METHODS: Cross-sectional data from the National Health and Nutrition Examination Survey 2005-2014 recorded drinking water source (n=15,604) and blood lead levels (n=12,373) for participants aged 2-19 years, and dental caries experience for the 2011-2014 subset (n=5,677). The threshold for elevated blood lead level was ≥3 μg/dL. A binary outcome indicated presence or absence of dental caries experience. Multivariable generalized linear models estimated adjusted prevalence ratios with 95% confidence limits.
RESULTS: In analysis conducted in 2017, 15% of children and adolescents did not drink tap water, 3% had elevated blood lead levels ≥3 μg/dL, and 50% had dental caries experience. Children and adolescents who did not drink water were less likely than tap water drinkers to have an elevated blood lead level (adjusted prevalence ratios=0.62, 95% confidence limits=0.42, 0.90). Nonconsumers of tap water were more likely to have dental caries (adjusted prevalence ratios=1.13, 95% confidence limits=1.03, 1.23). Results persisted after adjustment for other covariates and using a higher threshold for elevated blood lead level.
CONCLUSIONS: In this nationally representative U.S. survey, children and adolescents who did not drink tap water had lower prevalence of elevated blood lead levels and higher prevalence of dental caries than those who drank tap water.
Zartarian V, Xue J, Tornero-Velez R, Brown J. Children’s Lead Exposure: A Multimedia Modeling Analysis to Guide Public Health Decision-Making. Environmental health perspectives 2017 Sep 12;125(9):097009. doi: 10.1289/EHP1605.
BACKGROUND: Drinking water and other sources for lead are the subject of public health concerns around the Flint, Michigan, drinking water and East Chicago, Indiana, lead in soil crises. In 2015, the U.S. Environmental Protection Agency (EPA)’s National Drinking Water Advisory Council (NDWAC) recommended establishment of a “health-based, household action level” for lead in drinking water based on children’s exposure.
OBJECTIVES: The primary objective was to develop a coupled exposure-dose modeling approach that can be used to determine what drinking water lead concentrations keep children’s blood lead levels (BLLs) below specified values, considering exposures from water, soil, dust, food, and air. Related objectives were to evaluate the coupled model estimates using real-world blood lead data, to quantify relative contributions by the various media, and to identify key model inputs.
METHODS: A modeling approach using the EPA’s Stochastic Human Exposure and Dose Simulation (SHEDS)-Multimedia and Integrated Exposure Uptake and Biokinetic (IEUBK) models was developed using available data. This analysis for the U.S. population of young children probabilistically simulated multimedia exposures and estimated relative contributions of media to BLLs across all population percentiles for several age groups.
RESULTS: Modeled BLLs compared well with nationally representative BLLs (0-23% relative error). Analyses revealed relative importance of soil and dust ingestion exposure pathways and associated Pb intake rates; water ingestion was also a main pathway, especially for infants.
CONCLUSIONS: This methodology advances scientific understanding of the relationship between lead concentrations in drinking water and BLLs in children. It can guide national health-based benchmarks for lead and related community public health decisions.
Deshommes E, Laroche L, Deveau D, Nour S, Prévost M. Short- and Long-Term Lead Release after Partial Lead Service Line Replacements in a Metropolitan Water Distribution System. Environ Sci Technol. 2017 Aug 9. doi: 10.1021/acs.est.7b01720.
Thirty-three households were monitored in a full-scale water distribution system, to investigate the impact of recent (<2 yr) or old partial lead service line replacements (PLSLRs). Total and particulate lead concentrations were measured using repeat sampling over a period of 1-20 months. Point-of-entry filters were installed to capture sporadic release of particulate lead from the lead service lines (LSLs). Mean concentrations increased immediately after PLSLRs and erratic particulate lead spikes were observed over the 18 month post-PLSLR monitoring period. The mass of lead released during this time frame indicates the occurrence of galvanic corrosion and scale destabilization. System-wide, lead concentrations were however lower in households with PLSLRs as compared to those with no replacement, especially for old PLSLRs. Nonetheless, 61% of PLSLR samples still exceeded 10 μg/L, reflecting the importance of implementing full LSL replacement and efficient risk communication. Acute concentrations measured immediately after PLSLRs demonstrate the need for appropriate flushing procedures to prevent lead poisoning.
Trueman BF, Sweet GA, Harding MD, Estabrook H, Bishop DP, Gagnon GA. Galvanic Corrosion of Lead by Iron (Oxyhydr)oxides: Potential Impacts on Drinking Water Quality. Environmental science and technology. 2017 May 30. doi: 10.1021/acs.est.7b01671.
Lead exposure via drinking water remains a significant public health risk; this study explored the potential effects of upstream iron corrosion on lead mobility in water distribution systems. Specifically, galvanic corrosion of lead by iron (oxyhydr)oxides was investigated. Coupling an iron mineral cathode with metallic lead in a galvanic cell increased lead release by 531 µg L-1 on average-a nine-fold increase over uniform corrosion in the absence of iron. Cathodes were composed of spark plasma sintered Fe3O4 or α-Fe2O3 or field-extracted Fe3O4 and α-FeOOH. Orthophosphate immobilized oxidized lead as insoluble hydroxypyromorphite, while humic acid enhanced lead mobility. Addition of a humic isolate increased lead release due to uniform corrosion by 81 µg L-1 and-upon coupling lead to a mineral cathode-release due to galvanic corrosion by 990 µg L-1. Elevated lead in the presence of humic acid appeared to be driven by complexation, with 208Pb and UV254size-exclusion chromatograms exhibiting strong correlation under these conditions (R2average = 0.87). A significant iron corrosion effect was consistent with field data: lead levels after lead service line replacement were greater by factors of 2.3 – 4.7 at sites supplied by unlined cast iron distribution mains compared with the alternative, lined ductile iron.
Rosen MB, Pokhrel LR, Weir MH. A discussion about public health, lead and Legionella pneumophila in drinking water supplies in the United States. The Science of the total environment. 2017 Jul 15;590-591:843-852. doi: 10.1016/j.scitotenv.2017.02.164.
Lead (Pb) in public drinking water supplies has garnered much attention since the outset of the Flint water crisis. Pb is a known hazard in multiple environmental matrices, exposure from which results in long-term deleterious health effects in humans. This discussion paper aims to provide a succinct account of environmental Pb exposures with a focus on water Pb levels (WLLs) in the United States. It is understood that there is a strong correlation between WLLs and blood Pb levels (BLLs), and the associated health effects. However, within the Flint water crisis, more than water chemistry and Pb exposure occurred. A cascade of regulatory and bureaucratic failures culminated in the Flint water crisis. This paper will discuss pertinent regulations and responses including their limitations after an overview of the public health effects from Pb exposure as well as discussion on our limitations on monitoring and mitigating Pb in tap water. As the Flint water crisis also included increased Legionnares’ disease, caused by Legionella pneumophila, this paper will discuss factors influencing L. pneumophila growth. This will highlight the systemic nature of changes to water chemistry and public health impacts. As we critically analyze these important aspects of water research, we offer discussions to stimulate future water quality research from a new and systemic perspective to inform and guide public health decision-making.
Sampling for lead in drinking is easier said than done. There are scientific and technical issues that complicate sampling and interpretation of testing results. It is important to understand that the purpose of sampling for lead under the USEPA lead rule is not exposure assessment. The primary goal is to confirm whether or not the water system is practicing optimal corrosion control. Seems to me that we are at a critical juncture in regulating lead in drinking water and some innovative thinking is needed to develop and move forward with a regulatory approach that will be effective in reducing lead exposure.
Goovaerts P. Monitoring the aftermath of Flint drinking water contamination crisis: Another case of sampling bias? Sci Total Environ. 2017 Mar 2. pii: S0048-9697(17)30440-0. doi: 10.1016/j.scitotenv.2017.02.183.
The delay in reporting high levels of lead in Flint drinking water, following the city’s switch to the Flint River as its water supply, was partially caused by the biased selection of sampling sites away from the lead pipe network. Since Flint returned to its pre-crisis source of drinking water, the State has been monitoring water lead levels (WLL) at selected “sentinel” sites. In a first phase that lasted two months, 739 residences were sampled, most of them bi-weekly, to determine the general health of the distribution system and to track temporal changes in lead levels. During the same period, water samples were also collected through a voluntary program whereby concerned citizens received free testing kits and conducted sampling on their own. State officials relied on the former data to demonstrate the steady improvement in water quality. A recent analysis of data collected by voluntary sampling revealed, however, an opposite trend with lead levels increasing over time. This paper looks at potential sampling bias to explain such differences. Although houses with higher WLL were more likely to be sampled repeatedly, voluntary sampling turned out to reproduce fairly well the main characteristics (i.e. presence of lead service lines (LSL), construction year) of Flint housing stock. State-controlled sampling was less representative; e.g., sentinel sites with LSL were mostly built between 1935 and 1950 in lower poverty areas, which might hamper our ability to disentangle the effects of LSL and premise plumbing (lead fixtures and pipes present within old houses) on WLL. Also, there was no sentinel site with LSL in two of the most impoverished wards, including where the percentage of children with elevated blood lead levels tripled following the switch in water supply. Correcting for sampling bias narrowed the gap between sampling programs, yet overall temporal trends are still opposite.
Zhong B, Giubilato E, Critto A, Wang L, Marcomini A, Zhang J. Probabilistic modeling of aggregate lead exposure in children of urban China using an adapted IEUBK model. The Science of the total environment. 2017 Feb 7. pii: S0048-9697(16)32629-8. doi: 10.1016/j.scitotenv.2016.11.164.
Lead, a ubiquitous pollutant throughout the environment, is confirmed to be neurotoxic for children by pulmonary and oral routes. As preschool children in China continue to be exposed to lead, we analyzed the available biomonitoring data for preschool children in urban China collected in the period 2004-2014 through a literature review. To identify apportionment of lead exposure sources for urban children in China, we modified the IEUBK model with a Monte Carlo module to assess the uncertainty and variability of the model output based on limited available exposure data and compared the simulated blood lead levels with the observed ones obtained through literature review. Although children’s blood lead levels in urban China decreased statistically over time for the included studies, changes in blood lead levels in three economic zones and seven age groups except for two age-specific groups were no longer significant. The GM-predicted BLLs and the GM-observed BLLs agreed within 1μg/dL for all fourteen cities. The 95% CIs for the predicted GMs and the observed distribution (GM±GSD) overlapped substantially. These results demonstrated the plausibility of blood lead prediction provided by the adapted IEUBK model. Lead exposure estimates for diet, soil/dust, air, and drinking water were 12.01±6.27μg/day, 2.69±0.89μg/day, 0.20±0.15μg/day, and 0.029±0.012μg/day, respectively. These findings showed that the reduction of lead concentrations in grains and vegetables would be beneficial to limit the risk of dietary lead exposure for a large proportion of preschool children in urban China.