Lead pipe & plumbing material replacement interventions

There is some evidence that replacing lead pipes, plumbing material, and fixtures reduces lead contamination in water and reduces lead exposure (Latham 2022, Patel 2020b, Triantafyllidou 2014). Full replacement of lead pipes and plumbing material reduces lead levels in drinking water (CDC-Lead in drinking water 2024, Katner 2018). 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 pipes (CDC MMWR-Brown 2012, Cartier 2012, Cartier 2013, Edwards 2014). Proper use and maintenance of certified water filtration systems can reduce lead contamination in water during lead pipe and plumbing material replacement projects (Kutzing 2022, Aljadani 2023). Experts suggest that lead pipe and plumbing material replacement can also reduce blood lead levels (BLLs), especially in children (CDC MMWR-Brown 2012, US EPA-Lead in drinking water). 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 Angeles (Latham 2022, Triantafyllidou 2014). 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 water (Pfadenhauer 2016). The effectiveness of point-of-use filters, even NSF/ANSI 53 certified filters, varies based on water composition, conditions, and chemistry after stagnation (Pan 2022); filters can also break, clog, be installed incorrectly, and be overused past expiration dates (Katner 2018).

Using plastic pipe connections or incorporating an insulating spacer between the pipes in partial lead pipe replacement can avoid the corrosion that increases lead release (Wang 2012, St. Clair 2012). Education efforts, system monitoring, and point-of-use certified filters can help prevent lead exposure and lead poisoning during initial increases in lead release (Kutzing 2022, CDC MMWR-Brown 2012). When lead remains in the water service system, contamination can be increased by corrosive water, water sitting in pipes, warm water temperatures (Latham 2022, Laidlaw 2016, WCLPP-Report 2014), and high flow rates (Cartier 2012). 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 campaigns (Jarvis 2021, US EPA-3Ts).

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 students (Sauve-Syed 2023). 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 damage (Arora 2024, Coulton 2023, Armstrong 2014, Berg 2012, NCHH-Jacobs 2009). Newborn infants and fetuses are especially vulnerable to effects of lead exposure that disrupts brain development (Arora 2024, Vigeh 2014); a St. Louis-based study suggests prenatal screening and proactive lead hazard remediation can prevent exposure among some newborns (Berg 2012). 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 activity (Coulton 2023, Gibson 2022, Wolpaw Reyes 2015). Higher prenatal and childhood blood lead levels have been associated with increased adult arrest rates and arrests for violent offenses (Wright 2008). Reduced lead exposure may be linked to reductions in violent crime roughly twenty years after exposure would have occurred (NBER-Wolpaw Reyes 2007, Feigenbaum 2015).

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 levels (Patel 2020b). 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 ppb (Garvey 2024). 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 ppb (Cradock 2022a). 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 children (Garvey 2024, Cradock 2022a, Umunna 2020) and federal guidance is recommended (Patel 2020b, Cradock 2022a). Policies to enforce the stricter AAP standards increase the cost of and need for lead remediation (Garvey 2024). 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 months (Latham 2022).

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 overall (Cochrane-Nussbaumer-Streit 2020, Gould 2009) and for lead pipe replacement specifically (Brookings-Campbell 2021). 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 replacement (Brookings-Campbell 2021). 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 costs (Jones 2012). 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 billion (Brookings-Campbell 2021).

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 infrastructure (Latham 2022, Gerlak 2022, Fawkes 2021, LeBron 2019, Katner 2018). 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 incomes (Fawkes 2021). 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 comprehensive plumbing and pipe replacement is needed to complete remediation and prevent continued disproportionate lead exposure in school water supplies (Latham 2022).

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 water (LeBron 2019). Water infrastructure inequality and the burden of corroding lead pipes disproportionately affects communities of color and communities with low incomes who cannot afford remediation (Levin 2024, Katner 2018). Lead service lines frequently extend onto private property, which complicates replacement if property owners cannot afford to replace the privately-owned section of pipes (Brookings-Campbell 2021). 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 cannot (Katner 2018).

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 testing (Umunna 2020) and rural water systems appear to have more water quality violations than urban systems (Patel 2020b). Available evidence suggests children that rely on private well water, especially living in rural areas, have higher risks of lead exposure via drinking water (Mulhern 2020) and increased risk of teenage juvenile delinquency due to lead contaminated water than children that rely on public water supplies (Gibson 2022).

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 incomes (Teye 2021, Lynch 2020, White 2015, Balza 2024). 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 levels (Teye 2021, Gleason 2019). 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 high (Teye 2021).

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 decrease (Teye 2021). 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 areas (Marshall 2020a). Children from families with lower incomes also have higher risks of nutritional problems, especially iron deficiency, which can increase lead absorption and elevate BLLs (Hauptman 2023, AAP-Policy statement 2021).

By the late 19^th 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 time (Bloomberg-Bliss 2016, Levin 2024). 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 water (Bloomberg-Bliss 2016). Lead industry leaders knowingly sold products containing toxic lead, then publicly campaigned to avoid responsibility for those actions and claimed that lead poisoning was only a problem among individuals and families of color and those living in poverty (Bloomberg-Bliss 2016).

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 pollution (Teye 2021, Lynch 2020). Water infrastructure in many of these communities is now 100 or 150 years old, deteriorating, leaking, and at-risk of microbial contamination (Levin 2024). 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 soil (Hauptman 2023, Howarth 2023, Bravo 2022). 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. (Levin 2024, Cushing 2023a, Gerlak 2022). 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 incomes (Levin 2024, Cushing 2023a, Latham 2022).

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 1988 (Dignam 2019, Hauptman 2023). 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 pipes (Dignam 2019).

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 land (Levin 2024).

Legislation and lead hazard removal have reduced childhood lead exposure, with population level decreases in BLLs since the 1970s (Dignam 2019, AAP-Policy statement 2021). As of 2010, 23 states have adopted comprehensive lead prevention laws (Hauptman 2023). 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 York (Howarth 2023). 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 remain (Dignam 2019, Hauptman 2023). 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 color (Bloomberg-Bliss 2016). The World Health Organization estimates that lead exposure worldwide accounts for over 1 million deaths annually and over 24 million years of healthy life lost (Balza 2024); however, the WHO does not have an international enforceable standard for drinking water quality, just guidelines for developing and reviewing national or regional standards (Levin 2024).

• 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 children tested for lead exposure by ages 1 or 2? Are schools, childcare centers, and homes all being tested for lead hazards?
• 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?

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 exposure (WH-Replacing lead pipes 2024, WH-LPPAP, Brookings-Campbell 2021). 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 ppb (US EPA-PLCRI, Brookings-Campbell 2021). The EPA also administers the Water Infrastructure Improvements for the Nation (WIIN) Grant Program that awards funding to states, territories, and tribes for testing and lead remediation in schools for drinking water (US EPA-WIIN Grants).

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 pipes (Patel 2020b, WCIJ-Schmidt 2016). The effort began in 2001, took over a decade, and cost approximately $19.4 million (WCIJ-Schmidt 2016). 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 million (BWL-Lead information). 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 expense (Brookings-Campbell 2021). Toledo, Ohio has also combined funding sources to replace all lead pipes in the city without cost to property owners (NLC-Mehrotra 2023). 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 neighborhoods (NYC DEP-LSL replacement). Denver, Colorado also has a lead service line replacement program that subsidizes the cost of pipe replacement for homeowners with low incomes (NLC-Mehrotra 2023). The Public Utilities Commission in San Francisco, California removed all known lead utility service lines in the 1980s and maintains a lead service line replacement program for both utility-owned and customer-owned service lines that tests water and checks to identify lines made of lead, galvanized pipe, or unknown materials (SFPUC-Lead).

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 homebuyers (EDF-State LSL policies). 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 contamination (WI DNR-LSL). 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 initiatives (LSLRC, LSLRC-Equity analysis).

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 replacement (US EPA-Lead contacts). 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 Hotline (US EPA-Protect your family).

‡ Resources with a focus on equity.

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).

Flint Water Study-Guide and resources - Flint Water Study. FlintWaterStudy.org guide and resources.

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.

NDWA-Safety - National Drinking Water Alliance (NDWA). (n.d.). Safety: Resources for drinking water safety. Retrieved March 28, 2025.

NMC PHC-Guidance and tools - Navy and Marine Corps Public Health Center (NMC PHC). Guidance and tools.

NRDC-Fedinick 2021 - Fedinick, K. (2021, May 13). Millions served by water systems detecting lead. NRDC (Natural Resources Defense Council).

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.

US EPA-3Ts - U.S. Environmental Protection Agency. (n.d.). 3Ts for reducing lead in drinking water.

US EPA-EJScreen - U.S. Environmental Protection Agency (U.S. EPA). EJScreen: Environmental justice screening and mapping tool.

US EPA-Lead - U.S. Environmental Protection Agency (U.S. EPA). Lead: Lead poisoning is preventable.

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). (n.d.). Protect your family from sources of lead.

WKKF-Guide 2016 - The Kellogg Foundation (WKKF). (2016). Managing lead in drinking water at schools and early childhood education facilities report. Retrieved March 28, 2025.

* Journal subscription may be required for access.

AAP-Policy statement 2021 - Council on Environmental Health, Lanphear, B. P., Lowry, J. A., Ahdoot, S., Baum, C. R., Bernstein, A. S., Bole, A., Brumberg, H. L., Campbell, C. C., Lanphear, B. P., Pacheco, S. E., Spanier, A. J., & Trasande, L. (2016). Prevention of childhood lead toxicity. Policy statement reaffirmed April 2021. Pediatrics, 138(1).

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.

Armstrong 2014 - Armstrong R, Anderson L, Synnot A, et al. Evaluation of evidence related to exposure to lead. Canberra: National Health and Medical Research Council; 2014.

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.

Balza 2024* - Balza J, Bikomeye JC, Flynn KE. Effectiveness of educational interventions for the prevention of lead poisoning in children: A systematic review. Reviews on Environmental Health. 2024.

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.

Bloomberg-Bliss 2016 - Bliss L. The long, ugly history of the politics of lead poisoning. Bloomberg. February 9, 2016.

Bravo 2022 - Bravo MA, Zephyr D, Kowal D, Ensor K, Miranda ML. Racial residential segregation shapes the relationship between early childhood lead exposure and fourth-grade standardized test scores. Proceedings of the National Academy of Sciences. 2022;119(34):e2117868119.

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.

BWL-Lead information - Lansing Board of Water and Light (BWL). BWL lead protection strategy.

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.

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.

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.

CDC-Lead CLPP - Centers for Disease Control and Prevention (CDC), National Center for Environmental Health. Childhood Lead Poisoning Prevention (CLPP) program.

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).

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.

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.

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.

Cushing 2023a* - Cushing, L. J., Dobbin, K. B., Jelks, N. O., Liu, X., & Morello-Frosch, R. (2023). Water insecurity and population health: Implications for health equity and policy. Health Affairs Health Policy Brief.

Dignam 2019* - Dignam T, Kaufmann RB, LeStourgeon L, Brown MJ. Control of lead sources in the United States, 1970-2017: Public health progress and current challenges to eliminating lead exposure. Journal of Public Health Management and Practice. 2019;25:S13-S22.

EDF-State LSL policies - Environmental Defense Fund (EDF). State efforts to support LSL replacement.

Edwards 2014 - Edwards M. Fetal death and reduced birth rates associated with exposure to lead-contaminated drinking water. Environmental Science & Technology. 2014;48(1):739-746.

Fawkes 2021 - Fawkes, L., & Sansom, G. (2021). Preliminary study of lead-contaminated drinking water in public parks—An assessment of equity and exposure risks in two Texas communities. International Journal of Environmental Research and Public Health, 18(12), 6443.

Feigenbaum 2015 - Feigenbaum JJ, Muller C. Lead exposure and violent crime in the early twentieth city. Cambridge: Harvard University; 2015.

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.

Gerlak 2022 - Gerlak, A. K., Louder, E., & Ingram, H. (2022). Viewpoint: An intersectional approach to water equity in the U.S. Water Alternatives, 15(1), 1–12.

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.

Gleason 2019* - Gleason, J. A., Nanavaty, J. V., & Fagliano, J. A. (2019). Drinking water lead and socioeconomic factors as predictors of blood lead levels in New Jersey’s children between two time periods. Environmental Research, 169, 409–416.

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.

Hauptman 2023* - Hauptman M, Rogers ML, Scarpaci M, Morin B, Vivier PM. Neighborhood disparities and the burden of lead poisoning. Pediatric Research. 2023;94:826-836.

Howarth 2023* - Howarth MV, Eiser AR. Environmentally mediated health disparities. American Journal of Medicine. 2023;136(6):518-522.

Jarvis 2021* - Jarvis, P., & Fawell, J. (2021). Lead in drinking water – An ongoing public health concern? Current Opinion in Environmental Science & Health, 20, 100239.

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.

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.

Kutzing 2022 - Kutzing, S., Rego, C., Schoettle, T., Adeem, K., & Stewart, T. (2022). Effective point‐of-use filtration for lead removal. Journal AWWA, 114(1), 26–35.

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.

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.

LeBron 2019 - LeBrón, A. M. W., Torres, I. R., Valencia, E., Dominguez, M. L., Garcia-Sanchez, D. G., Logue, M. D., & Wu, J. (2019). The state of public health lead policies: Implications for urban health inequities and recommendations for health equity. International Journal of Environmental Research and Public Health, 16(6), 1064.

Levin 2024 - Levin, R., Villanueva, C. M., Beene, D., Cradock, A. L., Donat-Vargas, C., Lewis, J., Martinez-Morata, I., Minovi, D., Nigra, A. E., Olson, E. D., Schaider, L. A., Ward, M. H., & Deziel, N. C. (2024). U.S. drinking water quality: Exposure risk profiles for seven legacy and emerging contaminants. Journal of Exposure Science & Environmental Epidemiology, 34(1), 3–22.

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.

Lynch 2020 - Lynch EE, Meier HCS. The intersectional effect of poverty, home ownership, and racial/ethnic composition on mean childhood blood lead levels in Milwaukee County neighborhoods. PLoS ONE. 2020;15(6):e0234995.

Marshall 2020a* - Marshall AT, Betts S, Kan EC, et al. Association of lead-exposure risk and family income with childhood brain outcomes. Nature Medicine. 2020;26:91-97.

Mulhern 2020 - Mulhern, R., & MacDonald Gibson, J. (2020). Under-sink activated carbon water filters effectively remove lead from private well water for over six months. Water, 12(12), 3584.

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.

NCHH-Jacobs 2009 - Jacobs DE, Baeder A. Housing interventions and health: A review of the evidence. Columbia: National Center for Healthy Housing (NCHH); 2009.

NLC-Mehrotra 2023 - Mehrotra, A. (2023, May 24). Prioritizing equity and public health: Collaborative strategies for lead pipe replacement. National League of Cities.

NRDC-Fedinick 2021 - Fedinick, K. (2021, May 13). Millions served by water systems detecting lead. NRDC (Natural Resources Defense Council).

NYC DEP-LSL replacement - Department of Environmental Protection (DEP). Lead Service Line Replacement Program. City of New York.

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.

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.

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