Lead pipe & plumbing material replacement interventions
Drinking water becomes contaminated with lead through contact with corroded pipes and plumbing material that contains lead. The amount of lead in drinking water varies with different water temperatures, water acidity or alkalinity, mineral types and amounts in water, time in contact with lead, and whether protective coatings line pipes1, 2. Lead pipes and plumbing material, also called water infrastructure, carry water from treatment plants to faucets and includes water mains, service lines, as well as on-site plumbing1, 3. Lead pipes, plumbing material, and fixtures can be replaced by individual property owners or by public water systems. Interventions to support replacement can coordinate resources at the local, state, and federal levels, use regulations and policies to increase water testing and monitoring, provide certified NSF/ANSI standard 53 filters to reduce lead exposures during water infrastructure replacement, strengthen certification standards for filters, and can address water infrastructure replacement in any setting, including homes, schools, childcare centers, workplaces, public buildings or parks1, 2, 3, 4.
As of 2014, the federal Safe Drinking Water Act (SDWA) prohibits use of plumbing material that is not lead-free, defined as 0.25% lead for pipes, fittings, and fixtures, and 0.20% for solder and flux5. The 1991 Lead and Copper Rule (LCR) requires water utilities to monitor water quality and to act if more than 10% of monitored taps exceed 15 parts per billion (ppb), the U.S. Environmental Protection Agency’s (EPA’s) lead action level for drinking water6. In 2021, EPA data shows roughly 7 million people had water from systems with lead contamination levels exceeding 15 ppb7. The Food and Drug Administration’s lead action level for bottled water is 5 ppb and more than 61 million Americans have drinking water exceeding this limit7. The American Academy of Pediatrics’ lead action level is 1 ppb and over half the U.S. population, 186 million people, have drinking water from systems exceeding that limit7. Scientists indicate there is no safe blood lead level (BLL) for individuals of any age, including fetuses8, 9 and lead exposure negatively affects nearly all systems in the human body10. The Centers for Disease Control and Prevention (CDC) blood lead reference level for initiating public health actions to prevent further exposure and mitigate health effects is 3.5 micrograms per deciliter (µg/dL); it is estimated that over 500,000 children have BLLs at or above this level8.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Reduced lead exposure
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
Improved health outcomes
What does the research say about effectiveness?
There is some evidence that replacing lead pipes, plumbing material, and fixtures reduces lead contamination in water and reduces lead exposure4, 11, 12. Full replacement of lead pipes and plumbing material reduces lead levels in drinking water1, 3. Partial lead service line replacement can reduce lead levels in the long-term, but can increase lead release in the short-term, especially if metal connections couple lead pipes to copper pipes13, 14, 15, 16. Proper use and maintenance of certified water filtration systems can reduce lead contamination in water during lead pipe and plumbing material replacement projects17, 18. Experts suggest that lead pipe and plumbing material replacement can also reduce blood lead levels (BLLs), especially in children13, 19. Additional evidence is needed to confirm the effects of full and partial lead pipe and plumbing material replacement on BLLs.
Lead pipe and plumbing material replacement projects can reduce lead contamination in school water, as seen in New York City, Seattle, and Los Angeles11, 12. Full lead service line replacement removes the source of corrosion and lead leaching, reducing the likelihood of lead exposure. Lead pipe and plumbing material replacement appears to be most effective when combined with educational interventions. Filtering systems, water treatment measures, and other engineering interventions may also reduce lead in drinking water20. The effectiveness of point-of-use filters, even NSF/ANSI 53 certified filters, varies based on water composition, conditions, and chemistry after stagnation2; filters can also break, clog, be installed incorrectly, and be overused past expiration dates3.
Using plastic pipe connections or incorporating an insulating spacer between the pipes in partial lead pipe replacement can avoid the corrosion that increases lead release21, 22. Education efforts, system monitoring, and point-of-use certified filters can help prevent lead exposure and lead poisoning during initial increases in lead release13, 17. When lead remains in the water service system, contamination can be increased by corrosive water, water sitting in pipes, warm water temperatures11, 23, 24, and high flow rates14. Comprehensive initiatives to remove lead from drinking water should include increased water testing and monitoring, certified point-of-use filters for improved short-term protection, full lead pipe and plumbing material replacement, enforceable regulations, and public awareness campaigns25.
Studies of lead exposure effects after the Flint, Michigan water contamination disaster show reduced academic achievement, decreased math and reading proficiency, and increased disciplinary actions among exposed students26. Lead abatement can improve physical and mental health outcomes for children and adults by reducing developmental disorders, attention deficit hyperactivity disorder-related behaviors (ADHD), anemia, hypertension, and kidney and brain damage9, 27, 28, 29, 30. Newborn infants and fetuses are especially vulnerable to effects of lead exposure that disrupts brain development9, 31; a St. Louis-based study suggests prenatal screening and proactive lead hazard remediation can prevent exposure among some newborns29. Childhood lead exposure is associated with an increased likelihood that children and teenagers engage in adverse behaviors such as aggression, violence, crime, and risky sexual activity27, 32, 33, 34. Higher prenatal and childhood blood lead levels have been associated with increased adult arrest rates and arrests for violent offenses35. Reduced lead exposure may be linked to reductions in violent crime roughly twenty years after exposure would have occurred36, 37.
The USDA National School Lunch Program requires schools to provide access to safe drinking water; however, it does not require or monitor school water quality tests. A Government Accountability Office nationwide survey found only 43% of school districts tested water for lead, and 37% of those districts had lead concentrations above state action levels4. A California-based study shows 18% of schools have lead contamination above the U.S. Food and Drug Administration (FDA) action level of 5 ppb and 75% exceed the American Academy of Pediatrics’ (AAP) recommendation of 1 ppb38. National data on school water testing programs show many states are not yet testing school water for lead, and all states that have water testing programs have found some schools with lead contaminated water exceeding 5 ppb39. Broad implementation of water testing, tracking, and remediation of lead pipes and plumbing for schools across the country is needed to ensure safe drinking water for children38, 39, 40 and federal guidance is recommended4, 39. Policies to enforce the stricter AAP standards increase the cost of and need for lead remediation38. Extensive school testing and remediation efforts, as in New York City, frequently face challenges in identifying all water outlets needing remediation and delays that leave fixtures out of service for several months11.
Although lead pipe and plumbing material replacement is time and cost intensive, cost benefit analysis finds positive net benefits and a high rate of return for lead abatement programs overall41, 42 and for lead pipe replacement specifically43. An EPA analysis suggests that the benefits of reducing lead exposure by replacing all lead service lines are about 4 times more than the cost and the Environmental Defense Fund (EDF) estimates a 3 to 1 return for every dollar invested in lead pipe replacement43. Economic modeling suggests that future earnings and decreased medical costs for children who benefit from lead abatement programs range from 2-20 times the estimated costs44. The EPA estimates that replacing a lead service line costs about $4,700 on average and that 6 to 10 million lead service lines are in the U.S., so the cost to replace all of them would range from $28 billion to $47 billion43.
How could this strategy advance health equity? This strategy is rated potential to decrease disparities: suggested by expert opinion.
Lead pipe and plumbing material replacement is a suggested strategy to reduce racial and economic disparities in exposure to lead contaminated drinking water, especially when resources for remediation are provided to communities of color with low incomes that are disproportionately burdened by lead water infrastructure3, 11, 58, 59, 60. A Texas-based study of water quality in public parks shows higher lead contamination levels in water fountains in public parks in neighborhoods of color with lower incomes than in neighborhoods that are predominantly white with higher incomes59. Lead pipe and plumbing material replacement can reduce lead contamination in water, including in schools; however, racial disparities in lead exposure through school water supplies persist. For example, Black children experience higher lead exposures through school water than white children, and more remediation is needed to prevent disproportionate lead exposure in school water supplies11.
Lead water infrastructure from water mains to lead service lines is a community-wide lead exposure pathway, which requires community-level remediation policies, not only individual property owner responses, to reduce lead exposure through drinking water60. Water infrastructure inequality and the burden of corroding lead pipes disproportionately affects communities of color and communities with low incomes who cannot afford remediation3, 10. Lead service lines frequently extend onto private property, which complicates replacement if property owners cannot afford to replace the privately-owned section of pipes43. Many water utilities have “gifted” ownership of lead service line pipes to private owners to avoid the cost and responsibility of replacing the pipes, which can increase disparities in lead contaminated water exposure since private owners with higher incomes can afford to remediate pipes and those with lower incomes cannot3.
Access to safe drinking water in schools varies by location; a California-based study shows urban schools have a higher likelihood of water systems being lead contaminated and exceeding action levels than suburban schools. Rural and town school systems have the highest likelihood of not participating in water testing40 and rural water systems appear to have more water quality violations than urban systems4. Available evidence suggests children that rely on private well water, especially living in rural areas, have higher risks of lead exposure via drinking water61 and increased risk of teenage juvenile delinquency due to lead contaminated water than children that rely on public water supplies33.
Lead hazards are a persistent environmental injustice that disproportionately affects children of color, children from families that immigrated to the U.S., children living in urban areas, and children living in areas with lower incomes62, 63, 64, 65. Racial disparities in BLLs between Black children and white children ages 1-5 years old have decreased in recent decades; however, disparities persist, with Black children suffering from higher BLLs and higher lead exposures than white children, even at the highest income and highest education levels62, 66. Black children, especially younger children, also have the highest outlier BLLs; the data show potentially thousands of Black children with BLLs of 40 μg/dL or more and no children from any other racial or ethnic group with BLLs that high62.
Available data suggest that children living in households with higher education levels have lower rates of lead exposure than children living in households with less formal education, and as income levels increase, BLLs among children decrease62. Children from families with lower income levels living in areas with higher risk of lead exposure experience negative brain development and cognitive outcomes more than children from families with higher income levels living in the same higher risk areas67. Children from families with lower incomes also have higher risks of nutritional problems, especially iron deficiency, which can increase lead absorption and elevate BLLs68.
What is the relevant historical background?
By the late 19th century, lead’s toxic and harmful effects were known, yet the lead industry and many businesses profited from selling lead for use in pipes, paint, and gasoline, and a lot of pipes and plumbing material made with lead was first installed in the U.S. during this time10, 69. Lead was also part of many consumer goods, including toys and household appliances. By the 1950s, millions of children had been poisoned by lead, either chronically or acutely, and public health officials had documented the irreversible effects of childhood lead poisoning from lead exposures in paint and contaminated water69. Powerful leaders of the lead industry avoided responsibility for knowingly selling products containing toxic lead and claimed that lead poisoning was only a problem among individuals and families of color and those living in poverty69.
Formerly redlined neighborhoods are more likely to be communities of color with lower incomes and fewer resources, affected by polluting industries and waste dumping sites, comprised of older and deteriorating houses with lead-based paint and lead pipes and plumbing, located near lead-polluting industries, and surrounded by heavy traffic with residual effects from leaded gasoline pollution62, 63. Water infrastructure in many of these communities is now 100 or 150 years old, deteriorating, leaking, and at-risk of microbial contamination10. Children of color experience disproportionate adverse exposures, including to lead, living in racially segregated, formerly redlined neighborhoods. Government disinvestment and the systematic concentration of poverty has increased and exacerbated lead hazards as housing stock deteriorates, lead water service lines degrade, and industry and waste dumping sites further contaminate the air and soil68, 70, 71. Systemic racism, underinvestment, regulatory abandonment, and failure to protect tribal water rights have caused severe water insecurity, poor water quality, water unaffordability, and water crises for many communities of color and communities with low incomes across the U.S.10, 58, 72. Climate change impacts, especially increasing water temperatures, precipitation variability, and extreme weather events, also have the potential to increase disparities in water insecurity, access, and quality and to increase lead contamination in drinking water for communities of color and communities with low incomes10, 11, 72.
The Safe Drinking Water Act of 1974 established limits for lead levels in drinking water, but it wasn’t until the 1986 amendment that requirements for lead-free plumbing were included, and those did not take effect until 198868, 73. The Lead and Copper Rule of 1991 identified corrosion of lead pipes and service lines as a major source of lead-contaminated drinking water and encouraged corrosion control and line replacement. Replacement efforts that only partially replace lead pipes can dislodge lead-containing minerals and contaminate drinking water. After serious water contamination events as in Flint, Michigan and Washington, D.C. many cities are attempting to fully replace their lead water service lines; however, private connections to public service lines are typically paid for by homeowners, which may increase disparities in who has access to clean water from lead-free pipes73.
Despite their sovereign status, many Native communities in the U.S. have been denied authority to protect their access to and the quality of their drinking water, at its source or through water systems. Only 80 Tribes have some authority to establish water quality standards and protect their drinking water sources, and only the Navajo Nation has full authority from the federal government to regulate the operation of the 170 public water systems on their land10.
Legislation and lead hazard removal have reduced childhood lead exposure, with population level decreases in BLLs since the 1970s73. As of 2010, 23 states have adopted comprehensive lead prevention laws68. Several local and state governments have adopted legislation that requires lead testing for children at age 1 or 2, including Philadelphia and Pittsburgh, as well as Connecticut, Delaware, Maryland, New Jersey, and New York70. However, roughly half a million children aged 1 to 5 still have BLLs at or above 5 μg/dL, when it is known that there is no safe blood lead level and significant disparities in lead exposure by race, ethnicity, and income remain68, 73. Government decisions about what it is worth to save communities and people suffering from lead hazard exposure are value judgments that have been influenced by explicit and implicit bias with disastrous effects for many communities of color69. The World Health Organization estimates that lead exposure worldwide accounts for over 1 million deaths annually and over 24 million years of healthy life lost65; however, the WHO does not have an international enforceable standard for drinking water quality, just guidelines for developing and reviewing national or regional standards10.
Equity Considerations
- What lead pipe and plumbing material replacement interventions exist in your community? Are these interventions comprehensive, with additional funding available for households that need help to remediate lead pipes or plumbing? What funding could be made available for temporary point-of-use filters, implementation support, and monitoring, especially during and immediately following remediation?
- What neighborhoods in your community have higher exposure risks for lead contaminated water? Who has the decision-making power to prioritize reducing disproportionate lead exposure risks in your community?
- In your community, are there neighborhoods relying on private wells that could be connected to a new community water system or integrated into an existing system? If not, how could your community support private well stewardship, water testing and monitoring, certified point-of-use water filters, and education about filter installation and maintenance?
- Is your community replacing lead pipes and plumbing material hazards before children are exposed to lead contaminated water, as is recommended to prevent irreversible serious harm, or reacting to blood lead level tests after lead exposures have occurred?
- Are all pathways to lead exposure considered and addressed through preventative lead poisoning efforts in your community? What partnerships or collaborations could support addressing lead hazards in contaminated dust, soil, water, and air?
Implementation Examples
As of 2024, the Bipartisan Infrastructure Law has dedicated $15 billion for grants and loans to support states in replacing lead pipes across the country, though this is less than the original $45 billion proposal to replace all lead service lines. The Biden-Harris administration also developed the Lead Pipe and Paint Action Plan to coordinate resources and efforts at the federal, state, and local levels to address lead hazards. Over 9 million homes, schools, daycares, and businesses receive water that has traveled through lead pipes. The lead pipe replacement funding is part of President Biden’s Justice40 Initiative, which aims for 40% of investment benefits to be designated for communities of color with low incomes, to address disproportionate lead exposure43, 45, 46. In 2023, the U.S. Environmental Protection Agency (EPA) proposed the Lead and Copper Rule Improvements with regulations that require water utilities to replace all lead service lines over the next 10 years, increase water testing, and lower the Lead Action Level from 15 ppb to 10 ppb43, 47.
The Madison Water Utility in Madison, Wisconsin was the first major water utility in the nation to fully replace all of the city’s lead pipes4, 48. The effort began in 2001, took over a decade, and cost approximately $19.4 million48. The Lansing Board of Water & Light (BWL) in Lansing, Michigan also removed all lead service lines; the project began in 2004, removed 12,150 active lead service lines, and cost $44.5 million49. Newark, New Jersey replaced approximately 18,500 lead service lines in roughly two years at no cost to their residents. The effort was supported by the state legislature, which approved public funds for the project even when lead service lines were on private property, by a city ordinance allowing line replacement on private property without homeowners’ permission, and by a $120 million bond that covered most of the expense43. Toledo, Ohio has also combined funding sources to replace all lead pipes in the city without cost to property owners50. New York City’s Department of Environmental Protection offers a Lead Service Line Replacement Program that replaces lead or galvanized steel service lines at no cost to homeowners in eligible neighborhoods51. Denver, Colorado also has a lead service line replacement program that subsidizes the cost of pipe replacement for homeowners with low incomes50.
The Environmental Defense Fund (EDF) provides information about 17 states across the country with proactive policies that support community lead service line replacement programs by setting statewide goals for replacement, funding the effort, creating inventories and maps of lead service lines, mandating and establishing standards for replacement practices, and requiring disclosure of lead service lines to potential homebuyers52. The Wisconsin Department of Natural Resources encourages taking lead pipes removed from water service to be properly recycled, so lead can be re-used, for example, in lead-acid batteries or lead shielding, instead of generating hazardous waste that must be managed appropriately to avoid more lead contamination53. The Lead Service Line Collaborative works together to promote voluntary full lead service line replacement across the country, providing communities with guides, tools, and resources to support these initiatives54, 55.
The EPA’s 10 regional offices each have a designated Regional Lead Coordinator who oversees lead poisoning prevention efforts, including lead pipe and plumbing material replacement56. Individuals can have their drinking water tested for lead contamination through certified laboratories; lists of certified laboratories are available through state or local drinking water authorities or by calling the EPA’s Safe Drinking Water Hotline57.
Implementation Resources
‡ Resources with a focus on equity.
LSLRC - Lead Service Line Replacement Collaborative. Our goal is to accelerate voluntary lead service line replacement in communities across the United States.
LSLRC-Equity analysis‡ - Lead Service Line Replacement Collaborative. Guide to equity analysis.
CDC-Lead in drinking water 2024 - Childhood Lead Poisoning Prevention Program. (2024, April). About lead in drinking water. U.S. Centers for Disease Control and Prevention (CDC).
NRDC-Fedinick 2021 - Fedinick, K. (2021, May 13). Millions served by water systems detecting lead. NRDC (Natural Resources Defense Council).
US EPA-Lead - U.S. Environmental Protection Agency (U.S. EPA). Lead: Lead poisoning is preventable.
US EPA-EJScreen - U.S. Environmental Protection Agency (U.S. EPA). EJScreen: Environmental justice screening and mapping tool.
US EPA-Lead in drinking water - U.S. Environmental Protection Agency (U.S. EPA). Ground water and drinking water: Basic information about lead in drinking water.
US EPA-Protect your family - U.S. Environmental Protection Agency (U.S. EPA), U.S. Consumer Product Safety Commission, U.S. Department of Housing and Urban Development (U.S. HUD). Protect your family from lead in your home. Washington, D.C.: U.S. Environmental Protection Agency (EPA); 2012.
US EPA-3Ts - U.S. Environmental Protection Agency. 3Ts for reducing lead in drinking water.
NSF-Lead in drinking water - NSF International. Lead in drinking water and a consumer guide to NSF certified lead filtration devices for reduction of lead in drinking water.
NMC PHC-Guidance and tools - Navy and Marine Corps Public Health Center (NMC PHC). Guidance and tools.
Flint Water Study-Guide and resources - Flint Water Study. FlintWaterStudy.org guide and resources.
Footnotes
* Journal subscription may be required for access.
1 CDC-Lead in drinking water 2024 - Childhood Lead Poisoning Prevention Program. (2024, April). About lead in drinking water. U.S. Centers for Disease Control and Prevention (CDC).
2 Pan 2022 - Pan, W., & Giammar, D. E. (2022). Point-of-use filters for lead removal from tap water: Opportunities and challenges. Environmental Science & Technology, 56(8), 4718–4720.
3 Katner 2018 - Katner, A.L., Brown, K., Pieper, K., Edwards, M., Lambrinidou, Y., & Subra, W. (2018). America’s path to drinking water infrastructure inequality and environmental injustice: The case of Flint, Michigan. The Palgrave handbook of sustainability: Case studies and practical solutions (pp. 79-97). Springer International Publishing.
4 Patel 2020b - Patel, A. I., Hecht, C. E., Cradock, A., Edwards, M. A., & Ritchie, L. D. (2020). Drinking water in the United States: Implications of water safety, access, and consumption. Annual Review of Nutrition, 40(1), 345–373.
5 US EPA-SDWA Sec 1417 - U.S. Environmental Protection Agency (U.S. EPA). Section 1417 of the Safe Drinking Water Act (SDWA): Prohibition on use of lead pipes, solder, and flux.
6 US EPA-LCR - U.S. Environmental Protection Agency (U.S. EPA). Drinking water requirements for states and public water systems: Lead and Copper Rule (LCR).
7 NRDC-Fedinick 2021 - Fedinick, K. (2021, May 13). Millions served by water systems detecting lead. NRDC (Natural Resources Defense Council).
8 CDC-Lead CLPP - Centers for Disease Control and Prevention (CDC), National Center for Environmental Health. Childhood Lead Poisoning Prevention (CLPP) program.
9 Arora 2024 - Arora J, Singal A, Jacob J, Garg S, Aeri R. Chapter 4: A systematic review of lead exposure on mental health. In: Kumar N, Jha AK. Lead toxicity mitigation: Sustainable nexus approaches. Cham: Springer International Publishing; 2024:51-71.
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11 Latham 2022 - Latham, S., & Jennings, J. L. (2022). Reducing lead exposure in school water: Evidence from remediation efforts in New York City public schools. Environmental Research, 203, 111735.
12 Triantafyllidou 2014 - Triantafyllidou, S., Le, T., Gallagher, D., & Edwards, M. (2014). Reduced risk estimations after remediation of lead (pb) in drinking water at two U.S. school districts. Science of The Total Environment, 466–467, 1011–1021.
13 CDC MMWR-Brown 2012 - Brown MJ, Margolis S. Lead in drinking water and human blood lead levels in the United States. Morbidity and Mortality Weekly Report (MMWR). 2012;61(Suppl):1-9.
14 Cartier 2012 - Cartier C, Arnold RB, Triantafyllidou S, Prévost M, Edwards M. Effect of flow rate and lead/copper pipe sequence on lead release from service lines. Water Research. 2012;46(13):4142-4152.
15 Cartier 2013 - Cartier C, Doré E, Laroche L, et al. Impact of treatment on Pb release from full and partially replaced harvested lead service lines (LSLs). Water Research. 2013;47(2):661-671.
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18 Aljadani 2023 - Aljadani, A., Corwin, C. J., Woodrow, A. H., Peschel, N., Himyak, R., Poncelet-Johnson, N., Seidel, C. J., & Masters, S. V. (2023). Efficacy of pitcher filters for drinking water lead reduction: A challenge and demonstration study in Denver, CO. ACS ES&T Water, 3(10), 3323–3334.
19 US EPA-Lead - U.S. Environmental Protection Agency (U.S. EPA). Lead: Lead poisoning is preventable.
20 Pfadenhauer 2016 - Pfadenhauer LM, Burns J, Rohwer A, Annette E. Effectiveness of interventions to reduce exposure to lead through consumer products and drinking water : A systematic review. Environmental Research. 2016;147:525-536.
21 Wang 2012 - Wang Y, Jing H, Mehta V, Welter GJ, Giammar DE. Impact of galvanic corrosion on lead release from aged lead service lines. Water Research. 2012;46(16):5049-5060.
22 St. Clair 2012 - St. Clair J, Stamopoulos C, Edwards M. Technical note: Increased distance between galvanic lead: Copper pipe connections decreases lead release. Corrosion. 2012;68(9):779-783.
23 Laidlaw 2016 - Laidlaw M, Filippelli G, Sadler R, Gonzales C, Ball A, Mielke H. Children’s blood lead seasonality in Flint, Michigan (USA), and soil-sourced lead hazard risks. International Journal of Environmental Research and Public Health. 2016;13(4):358.
24 WCLPP-Report 2014 - Wisconsin Childhood Lead Poisoning Prevention Program (WCLPP), Wisconsin Department of Health Services (WI DHS). 2014 Report on childhood lead poisoning in Wisconsin. 2016.
25 Jarvis 2021 - Jarvis, P., & Fawell, J. (2021). Lead in drinking water – An ongoing public health concern? Current Opinion in Environmental Science & Health, 20, 100239.
26 Sauve-Syed 2023 - Sauve-Syed, J. (2023). Lead exposure and student outcomes: A study of Flint schools. Health Economics, hec.4776.
27 Coulton 2023 - Coulton C, Richter FGC, Cho Y, et al. Making the case for lead safe housing: Downstream effects of lead exposure on outcomes for children and youth. Health and Place. 2023;84.
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29 Berg 2012 - Berg DR, Eckstein ET, Steiner MS, Gavard JA, Gross GA. Childhood lead poisoning prevention through prenatal housing inspection and remediation in St. Louis, MO. American Journal of Obstetrics and Gynecology. 2012;206(3):199.e1-199.e4.
30 NCHH-Jacobs 2009 - Jacobs DE, Baeder A. Housing interventions and health: A review of the evidence. Columbia: National Center for Healthy Housing (NCHH); 2009.
31 Vigeh 2014 - Vigeh M, Yokoyama K, Matsukawa T, Shinohara A, Ohtani K. Low level prenatal blood lead adversely affects early childhood mental development. Journal of Child Neurology. 2014;29(10):1305-1311.
32 Fesko 2023 - Fesko L. First lead, now no bed? The unintended impacts of lead abatement laws on eviction. Journal of Environmental Economics and Management. 2023;117:1-38.
33 Gibson 2022 - Gibson, J. M., MacDonald, J. M., Fisher, M., Chen, X., Pawlick, A., & Cook, P. J. (2022). Early life lead exposure from private well water increases juvenile delinquency risk among U.S. teens. Proceedings of the National Academy of Sciences, 119(6), e2110694119.
34 Wolpaw Reyes 2015 - Wolpaw Reyes J. Lead exposure and behavior: Effects on antisocial and risky behavior among children and adolescents. Economic Inquiry. 2015;53(3):1580-1605.
35 Wright 2008 - Wright JP, Dietrich KN, Ris MD, et al. Association of prenatal and childhood blood lead concentrations with criminal arrests in early adulthood. PLoS Medicine. 2008;5(5):e101.
36 NBER-Wolpaw Reyes 2007 - Wolpaw Reyes J. Environmental policy as social policy? The impact of childhood lead exposure on crime. National Bureau of Economic Research (NBER). 2007. Working Paper 13097.
37 Feigenbaum 2015 - Feigenbaum JJ, Muller C. Lead exposure and violent crime in the early twentieth city. Cambridge: Harvard University; 2015.
38 Garvey 2024 - Garvey, K. A., Edwards, M. A., Blacker, L. S., Hecht, C. E., Parks, J. L., & Patel, A. I. (2024). A comprehensive examination of the contaminants in drinking water in public schools in California, 2017-2022. Public Health Reports, 139(3), 369–378.
39 Cradock 2022a - Cradock, A. L., Barrett, J. L., Poole, M. K., Flax, C. N., Vollmer, L., & Hecht, C. (2022). Lead concentrations in U.S. school drinking water: Testing programs, prevalence, and policy opportunities, 2016‒2018. American Journal of Public Health, 112(S7), S679–S689.
40 Umunna 2020 - Umunna, I. L., Blacker, L. S., Hecht, C. E., Edwards, M. A., Altman, E. A., & Patel, A. I. (2020). Water safety in California public schools following implementation of school drinking water policies. Preventing Chronic Disease, 17, 200366.
41 Cochrane-Nussbaumer-Streit 2020 - Nussbaumer-Streit B, Mayr V, Dobrescu AI, et al. Household interventions for preventing domestic lead exposure in children. Cochrane Database of Systematic Reviews. 2020;(10):CD006047.
42 Gould 2009 - Gould E. Childhood lead poisoning: Conservative estimates of the social and economic benefits of lead hazard control. Environmental Health Perspectives. 2009;117(7):1162-1167.
43 Brookings-Campbell 2021 - Campbell, S. Wessel, D. (2021, May 13). What would it cost to replace all the nation’s lead water pipes? The Brookings Institution.
44 Jones 2012 - Jones DJ. Primary prevention and health outcomes: Treatment of residential lead-based paint hazards and the prevalence of childhood lead poisoning. Journal of Urban Economics. 2012;71(1):151-164.
45 WH-Replacing lead pipes 2024 - The White House. (2024, May). Biden-Harris Administration announces $3 billion to replace toxic lead pipes and deliver clean drinking water to communities across the country [Fact sheet].
46 WH-LPPAP - The White House. (2021, December). The Biden-Harris Lead Pipe and Paint Action Plan [Fact sheet].
47 US EPA-PLCRI - U.S. Environmental Protection Agency. (2023, November). Proposed Lead and Copper Rule Improvements.
48 WCIJ-Schmidt 2016 - Schmidt S. First in the nation: City of Madison replaced all lead pipes. WisconsinWatch.org; Wisconsin Center for Investigative Journalism (WCIJ). February 1, 2016.
49 BWL-Lead information - Lansing Board of Water and Light (BWL). BWL lead protection strategy.
50 NLC-Mehrotra 2023 - Mehrotra, A. (2023, May 24). Prioritizing equity and public health: Collaborative strategies for lead pipe replacement. National League of Cities.
51 NYC DEP-LSL replacement - Department of Environmental Protection (DEP). Lead Service Line Replacement Program. City of New York.
52 EDF-State LSL policies - Environmental Defense Fund (EDF). State efforts to support LSL replacement.
53 WI DNR-LSL - Wisconsin Department of Natural Resources. Lead service line (LSL) replacements: Lead pipe waste management.
54 LSLRC - Lead Service Line Replacement Collaborative. Our goal is to accelerate voluntary lead service line replacement in communities across the United States.
55 LSLRC-Equity analysis - Lead Service Line Replacement Collaborative. Guide to equity analysis.
56 US EPA-Lead contacts - U.S. Environmental Protection Agency (U.S. EPA). Lead: Contacts in EPA regional offices for lead-based paint exposure prevention efforts.
57 US EPA-Protect your family - U.S. Environmental Protection Agency (U.S. EPA), U.S. Consumer Product Safety Commission, U.S. Department of Housing and Urban Development (U.S. HUD). Protect your family from lead in your home. Washington, D.C.: U.S. Environmental Protection Agency (EPA); 2012.
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