Science AMA Series: We are Dr. Debbie Cory-Slechta, acting chair of Environmental Medicine, and Dr. Katrina Korfmacher, policy scientist and lead exposure expert, both at the University of Rochester Medical Center. We are here to answer your questions about lead exposure and health risks. AMA!

Abstract

Hi, Reddit! I’m Debbie Cory-Slechta, Ph.D., acting chair and professor of Environmental Medicine at the University of Rochester Medical Center in Rochester (URMC), New York. My lab conducts research on the effects of lead exposure on the developing brain. In particular, we want to know if other negative factors, like maternal stress during pregnancy or offspring stress during development can enhance the toxicity of lead – or other similar neurotoxic metals. We hope to understand whether positive versus negative early behavioral experiences can change the trajectory of developmental consequences caused by lead and/or prenatal stress exposures.

Hi Reddit! I’m Katrina Korfmacher, Ph.D., associate professor of Environmental Medicine at URMC. Lead poisoning is one of the most significant childhood environmental health risks in Rochester, NY. As a member of the Rochester Coalition to Prevent Lead Poisoning, I helped develop and implement a local law that has contributed to a nearly 90 percent drop in the number of kids with elevated blood lead levels in Rochester over the past 15 years. My policy research focuses on translating information about lead exposure health risks into relevant policy at the local, state, and federal levels.

We will be back at 1 pm to answer your questions. Ask us anything!

How likely is it that violent crime and antisocial behavior from earlier eras was linked to lead poisoning? I've heard this theory (particularly with regard to leaded gasoline emissions) to explain everything from urban violence to the seeming explosion of serial murder in the 70s, and I wonder how true it is.

STRENGTHoftheBEAR

With respect to your question regarding lead exposure and violence, there are several studies that have demonstrated correlations between elevated blood lead exposures and crime. Its validity still remains open as many other things, some of which may vary with lead exposure, have also changed over the past 20+ years. However, it is notable that the highest levels of lead exposure are typically in communities that have many other risk factors (poverty, stress, drug use, racism) that can also increase rates of crime and thus the 'addition' of these risk factors may be a more reasonable explanation.


I grow a garden in my back yard in the city. Should I be worried about lead poisoning from the veggies I grow? I'm concerned that some of the old houses/garages nearby could have had peeling paint over the years and I'm curious to know if the vegetables absorb the lead from the soil?

ad14789

Thanks for your question about gardening in the city, a lot of people wonder about that. Lead can be taken up by plants, but different amounts of lead gets into different kinds of plants and parts of plants. Most studies have found that there isn't a big risk from eating most types and parts of plants, but the bigger concern is accidentally eating dirt. So it's a good idea to wash your hands after gardening and wash your veggies well. That said, the amount of lead in soil can vary a lot, and can be quite high in areas that may have contamination from pre-1978 gasoline, paint and industrial sources. So it is a good idea to get your soil tested for lead! Sometimes your city, cooperative extension, or environmental consultants can help.


There hasn't been much coverage lately about Flint's water supply issues. Is the water coming out of the tap there safe to drink yet or are residents still relying upon bottled water? If the issue has been resolved, how was it done?

shiruken

Flint residents have largely remained reliant upon bottled water even though they have been told by city officials that the water is now safe to drink. That reflects the loss of trust by the community in city and state government. In the interim, water pipes are being replaced in Flint as this is an old infrastructure of pipes that can enhance the problem of lead in drinking water. That will obviously take some time. While clearly this is an important source of lead exposure, however, the greatest exposures occur through lead contaminated dust/dirt/soil. Since the housing stock in Flint is also older, it has likely been a major contributor to lead in soil and ultimately to dust/air. For that reason, I have some concerns about only focusing on the water lead levels, since replacing the pipes alone will not remove all of the paint/housing related lead that the community faces.


Hiya and thanks for joining us today.

With thousands of cities across the US known to have unsafe levels of lead, what is being done at a national level to address this?

What are the long term effects of having municipal water at >15μg/L?

PHealthy

Let me talk about two different avenues related to activities of the Centers for Disease Control where I served as a member the Advisory Committee for Childhood Lead Poisoning Prevention (ACCLPP). At that time, the CDC had a policy that any blood lead less than 10 ug/dl was below the 'level of concern'. However, data had been steadily accumulating, from multiple studies in multiple locations, demonstrating effects of increasingly lower blood lead values on children's IQ/cognition. The CDC was reluctant to change this as it wasn't sure what to tell people to do at increasingly lower blood lead levels. The ACCLPP formed a subcommittee to readdress the 'level of concern' and separate the science from the policy issues. This subcommittee made two recommendations: first, eliminate the use of the phrase level of concern because levels that were safe could not be identified. Even the lowest levels of exposure in these studies (e.g., 2 ug/dl) were still associated with effects in children. Secondly, define a 'reference' level, based on current population blood lead levels, at which interventions would occur in relation to housing or sources of exposure. CDC accepted both of these recommendations which are its current policy. CDC had a lead poisoning prevention branch with a significant amount of funding that was awarded in the form of


Hiya and thanks for joining us today.

With thousands of cities across the US known to have unsafe levels of lead, what is being done at a national level to address this?

What are the long term effects of having municipal water at >15μg/L?

PHealthy

I wanted to address the question about water. Be aware that the standard you cite from the lead and copper rule is not health-based. A good explanation of this distinction may be found here under the link from "health-based standard":http://blogs.edf.org/health/2016/03/25/lead-hal/?_ga=2.93094169.500309960.1500572915-1955864289.1500572915


Welcome,

What are the significant roadblocks you have encountered that are preventing the implementation of more effective policies to deal with lead exposure issues?

adenovato

Money. At the local level, cities and counties worry about introducing or implementing laws that place additional costs on homeowners and landlords that might drive up housing costs. Cities with limited budgets also worry about the costs of testing, implementing, and enforcing laws. However, several cities and states have found affordable and effective ways of doing this.

The other big worry that can be a roadblock is fear of liability. Owners worry that if they test for and find lead, they will be sued.

At the state and national level, there are also budget and economic concerns to stronger lead prevention policies and implementation/enforcement of existing policies.

Many studies have shown that lead prevention pays off in avoided costs (IQ loss, medical costs, criminal justice costs, etc.) however, since these benefits won't be seen for decades, the up front costs of avoiding lead poisoning tends to be a big roadblock.


Currently, developmental lead levels in children are tested at around two years of age. Given information on different windows of critical development would you suggest that this testing is sufficient or would you suggest additional or alternate testing timepoints?

sloth_pug

It is very clear that early development is a period of particular vulnerability to the effects of lead exposure, with the brain as a target. However, while it is clearly important to screen young children for elevated lead exposure so that any accumulation can be dealt with, it is important to remember that much of development takes place during pregnancy which is another period of heightened risk. This is because lead acts by mimicking calcium, and calcium comprises the infrastructure of the bone. In fact >95% of the lead in the body is stored in the bone. During pregnancy, calcium requirements are very high and the bone breaks down to provide calcium. This process results in mobilization of lead that has been stored in the bone into the bloodstream. Indeed, blood lead values increase markedly during pregnancy. This same phenomenon can occur during breastfeeding when calcium requirements are also very high. Thus, screening of women during pregnancy or who are intending to become pregnant should very much be considered.


Second question: I work with advanced high school students on independent research projects. Would you have any recommendations for low-tech sampling projects that might reveal significant lead exposure risks in our community? We'd prefer not to be redundant with normal regulatory sampling projects.

TBS1962

It's great that you are thinking about doing this! Lead can be such a great issue for problem-based learning in nearly every field. That said, it's important to be careful of exposing kids to lead...and of exposing homeowners to legal risk. Any 'knowledge' of lead needs to be reported to future buyers or renters under the federal disclosure rule, so think through the consequences of acquiring information (especially on private property) first. https://portal.hud.gov/hudportal/HUD?src=/program_offices/healthy_homes/enforcement/disclosure

That said, there are so many things you can do to identify and call attention to risks! You can buy lead swabs at a hardware store to test lead in dust and paint chips - just be aware that it is easy to MISS lead hazards with these, because they can get clogged with dirt and because lead can be patchily distributed (i.e. you might test a low-lead spot on a porch floor, but there may be high levels of lead two feet away). If you have a budget for soil testing, that can also be interesting, but remember the same thing about patchiness. There are lots of good resources on lesson plans and ideas on different science education and environmental health sites (like EPA, CDC, and NIEHS) but I always encourage people to think through the possible outcomes before embarking on actual environmental monitoring in this highly regulated area.


Second question: I work with advanced high school students on independent research projects. Would you have any recommendations for low-tech sampling projects that might reveal significant lead exposure risks in our community? We'd prefer not to be redundant with normal regulatory sampling projects.

TBS1962

It's great that you are thinking about doing this! Lead can be such a great issue for problem-based learning in nearly every field. That said, it's important to be careful of exposing kids to lead...and of exposing homeowners to legal risk. Any 'knowledge' of lead needs to be reported to future buyers or renters under the federal disclosure rule, so think through the consequences of acquiring information (especially on private property) first. https://portal.hud.gov/hudportal/HUD?src=/program_offices/healthy_homes/enforcement/disclosure

That said, there are so many things you can do to identify and call attention to risks! You can buy lead swabs at a hardware store to test lead in dust and paint chips - just be aware that it is easy to MISS lead hazards with these, because they can get clogged with dirt and because lead can be patchily distributed (i.e. you might test a low-lead spot on a porch floor, but there may be high levels of lead two feet away). If you have a budget for soil testing, that can also be interesting, but remember the same thing about patchiness. There are lots of good resources on lesson plans and ideas on different science education and environmental health sites (like EPA, CDC, and NIEHS) but I always encourage people to think through the possible outcomes before embarking on actual environmental monitoring in this highly regulated area.


Second question: I work with advanced high school students on independent research projects. Would you have any recommendations for low-tech sampling projects that might reveal significant lead exposure risks in our community? We'd prefer not to be redundant with normal regulatory sampling projects.

TBS1962

It's great that you are thinking about doing this! Lead can be such a great issue for problem-based learning in nearly every field. That said, it's important to be careful of exposing kids to lead...and of exposing homeowners to legal risk. Any 'knowledge' of lead needs to be reported to future buyers or renters under the federal disclosure rule, so think through the consequences of acquiring information (especially on private property) first. https://portal.hud.gov/hudportal/HUD?src=/program_offices/healthy_homes/enforcement/disclosure That said, there are so many things you can do to identify and call attention to risks! You can buy lead swabs at a hardware store to test lead in dust and paint chips - just be aware that it is easy to MISS lead hazards with these, because they can get clogged with dirt and because lead can be patchily distributed (i.e. you might test a low-lead spot on a porch floor, but there may be high levels of lead two feet away). If you have a budget for soil testing, that can also be interesting, but remember the same thing about patchiness. There are lots of good resources on lesson plans and ideas on different science education and environmental health sites (like EPA, CDC, and NIEHS) but I always encourage people to think through the possible outcomes before embarking on actual environmental monitoring in this highly regulated area.


Second question: I work with advanced high school students on independent research projects. Would you have any recommendations for low-tech sampling projects that might reveal significant lead exposure risks in our community? We'd prefer not to be redundant with normal regulatory sampling projects.

TBS1962

See below starting with "Its great that you are thinking about doing this"


[deleted]

[deleted]

Hooray for Cleveland! From what I have heard, the city is working hard to develop systematic way to check all pre-1978 rental houses for health hazards like lead BEFORE anyone gets poisoned - that's what is meant by proactive. Why do some places already have it? Because their communities and leaders have mobilized around the idea that children should not be poisoned by the homes they live in. Older rental housing in poor condition continues to be the greatest source of lead risk for children, although many kids are also poisoned in homes their family owners, during renovations, from bare soil, or other sources. It is also important to remember that lead poisoning can't be treated, only prevented. In many high-risk neighborhoods, kids move frequently and spend time in multiple houses. So, many areas with high numbers of lead poisoned kids have looked toward proactively inspecting for lead hazards. In many cities, lead is part of more comprehensive inspections that also look at other health hazards like fire, electrical, trip/fall hazards, pests, mold, etc., which makes a lot of sense.


Thanks for coming!

You said you helped develop a local law--is there any chance it could be made a state or federal law? As a scientist, how do you work to help achieve policy change?

asbruckman

We participate in the local lead coalition in several ways (summarizing research, identifying models in others, analyzing local data, etc.). This coalition worked with educators, child advocates, health professionals, city, county, and many others to write a law and implementation system that works well for Rochester. This law relies on proactively (i.e. before anyone is poisoned) inspecting all pre-1978 rental housing as part of regular code inspections. Different systems may work better for different cities, depending on their housing stock, economy, where kids are at greatest risk, etc. Although this particular law might not work well at the state or national level, policy approaches that target lead hazards in housing at the local level are clearly important to addressing the remaining problems.


In the past few years the EPA lowered the lead exposure standards, requiring sheathing during some paint removal projects. Do you have a sense if contractors are actually complying with these regulations? I get the feeling this rule is being skirted. Would you consider this a significant threat?

TBS1962

I assume you are referring to the EPA's Renovation Repair and Painting Rule. You can find more information about it here, including EPA enforcement actions https://www.epa.gov/lead/renovation-repair-and-painting-program. That said, there are current proposals to drastically cut funding for EPA's enforcement of that rule. This is an important rule because in many communities, a significant percentage of childhood lead poisonings are due to unsafe repair work (around 14% by last check in NYS). Compliance probably varies a lot from place to place, and it's important to note that EPA has welcomed reports of unsafe practices or uncertified professionals to aid their enforcement, so local attention can help. Also, many towns now require contractors to submit their RRP certification along with building permit applications for work in pre-1978 housing; this helps remind contractors and landlords about this federal law and support compliance. Check to see if your town does this - if not, you can ask them to!


I've recently started working at an electronics recycler that processes a lot of old TVs with leaded glass. We pass air rating testing and wear masks and further PPE depending on our workstation, but no matter what, at the end of the day, the inside of my nose and my mucus is completely black when I'm washing up.

I spend a lot of time convincing myself that there's some untold amount of lead trapped in my sinuses that is slowly killing me, no matter how hard I wash up, because I'll still get black tissues hours later. How close to reality is this nervousness?

jaerick

Hi Jaerick. Its a bit difficult to answer your question. There are metal exposures in electronic recycling that can include lead but also metals such as cadmium and mercury as you are probably aware. As you also state, your workplace passes air rating testing and PPE is being used to further reduce exposures. So clearly your employer is aware of and responsive to the potential harms. I wonder if along with this, there is any medical monitoring going on, such as levels of metals, including lead, in blood? This is something that the National Institute of Occupational Safety and Health would recommend. Depending upon the size (numbers of employees) at your work place, this may be required by the Occupational Safety and Health Administration (OHSA). I'm also directing you to a very recent study that address this issue and talking about in electronic scrap recycling facilities:

J Occup Environ Hyg. 2017 Jun;14(6):401-408. doi: 10.1080/15459624.2016.1269179. Metal Exposures at three U.S. electronic scrap recycling facilities.

Ceballos D1, Beaucham C2, Page E2.


Thank you for taking the time to answer our questions!

What were some of the factors that lead to the passage of your local bill?
What were some of the groups acting against you, and how did you overcome the obstacles that they presented?

leadteamtrenton

You are very welcome. It required a lot of work by a lot of people in the community, and that was the key: building public and political support. As you may be aware, this was initiated by former elementary school principal Dr. Ralph Spezio. you can watch his TEDX talk here: https://www.youtube.com/watch?v=mSwHSE6_ZoI He passionately made the point that everyone in the community cares about kids and their potential to learn, grow, and thrive. He asked what each sector -educators, landlord, city government, religious groups, lawyers, health professionals - could do to prevent lead from robbing kids of this potential. Once you get everyone pointed in that direction, they may disagree on how to get there, but having that common goal front and center helps. The second point is science-based action - using the best medical research, housing studies, and evaluation of other's experiences, combined with local data, to develop solutions. The third is piloting - a lot of the things we tried were new, and if we didn't have good evidence they would work, we tried them small scale, with safety valves, to test them out. Generally they did, and we could grow them to scale. These approaches helped respectfully and systematically address concerns that were raised, and make sure they were addressed without compromising the goal of protecting kids.


Does lead-tainted water or food have a taste? Otherwise, what are early signs that it exists? Can it get into vaporized water in very hot areas of the world?

clairepansies

Lead-tainted food and water as we encounter in the environment aren't really going to have a distinctive taste that can alert you to them. At very high levels, lead actually has a sweet taste; the Romans actually used lead subacetate as a sweetener. But this would be like using it in pure form at very high concentrations. The absence of any way to detect it is one of the reasons that we continue to do monitoring and screening of various sources. As to your second question, neither of us are chemists, but I would not think that lead would be in vaporized water itself but remain in the source. If you take water and boil it for example, you are increasing the concentration of lead in the water because you would be simultaneously decreasing the volume


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