Improved Decision Making for Water Lead Testing in U.S. Child Care Facilities Using Machine-Learned Bayesian Networks.

Tap water lead testing programs in the U.S. need improved methods for identifying high-risk facilities to optimize limited resources. In this study, machine-learned Bayesian network (BN) models were used to predict building-wide water lead risk in over 4,000 child care facilities in North Carolina according to maximum and 90th percentile lead levels from water lead concentrations at 22,943 taps. The performance of the BN models was compared to common alternative risk factors, or heuristics, used to inform water lead testing programs among child care facilities including building age, water source, and Head Start program status. The BN models identified a range of variables associated with building-wide water lead, with facilities that serve low-income families, rely on groundwater, and have more taps exhibiting greater risk. Models predicting the probability of a single tap exceeding each target concentration performed better than models predicting facilities with clustered high-risk taps. The BN models' Fß-scores outperformed each of the alternative heuristics by 118-213%. This represents up to a 60% increase in the number of high-risk facilities that could be identified and up to a 49% decrease in the number of samples that would need to be collected by using BN model-informed sampling compared to using simple heuristics. Overall, this study demonstrates the value of machine-learning approaches for identifying high water lead risk that could improve lead testing programs nationwide.

Lead Levels in Tap Water at Licensed North Carolina Child Care Facilities, 2020-2021.

Objectives. To evaluate lead levels in tap water at licensed North Carolina child care facilities. Methods. Between July 2020 and October 2021, we enrolled 4005 facilities in a grant-funded, participatory science testing program. We identified risk factors associated with elevated first-draw lead levels using multiple logistic regression analysis. Results. By sample (n = 22 943), 3% of tap water sources exceeded the 10 parts per billion (ppb) North Carolina hazard level, whereas 25% of tap water sources exceeded 1 ppb, the American Academy of Pediatrics' reference level. By facility, at least 1 tap water source exceeded 1 ppb and 10 ppb at 56% and 12% of facilities, respectively. Well water reliance was the largest risk factor, followed by participation in Head Start programs and building age. We observed large variability between tap water sources within the same facility. Conclusions. Tap water in child care facilities is a potential lead exposure source for children. Given variability among tap water sources, it is imperative to test every source used for drinking and cooking so appropriate action can be taken to protect children's health. (Am J Public Health. 2022;112(S7):S695-S705. https://doi.org/10.2105/AJPH.2022.307003).

A Participatory Science Approach to Evaluating Factors Associated with the Occurrence of Metals and PFAS in Guatemala City Tap Water.

Limited information is available regarding chemical water quality at the tap in Guatemala City, preventing individuals, water utilities, and public health authorities from making data-driven decisions related to water quality. To address this need, 113 participants among households served by a range of water providers across the Guatemala City metropolitan area were recruited as participatory scientists to collect first-draw and flushed tap water samples at their residence. Samples were transported to the U.S. and analyzed for 20 metals and 25 per- and polyfluoroalkyl substances (PFAS). At least one metal exceeded the Guatemalan Maximum Permissible Limit (MPL) for drinking water in 63% of households (n = 71). Arsenic and lead exceeded the MPL in 33.6% (n = 38) and 8.9% (n = 10) of samples, respectively. Arsenic was strongly associated with groundwater while lead occurrence was not associated with location, water source, or provider. One or more PFAS were detected in 19% of samples (n = 21, range 2.1-64.2 ppt). PFAS were significantly associated with the use of plastic water storage tanks but not with location, water source, or provider. Overall, the high prevalence of arsenic above the MPL in Guatemala City tap water represents a potential health risk that current water treatment processes are not optimized to remove. Furthermore, potential contaminants from premise plumbing and storage, including lead and PFAS, represent additional risks requiring further investigation and public engagement.

A comparative review: Chronic Kidney Disease of unknown etiology (CKDu) research conducted in Latin America versus Asia.

INTRODUCTION: The incidence of chronic kidney disease of unknown or uncertain etiology (CKDu) is recognized as a global non-communicable health crisis. The goal of this work is to compare the types of research studies in Latin America and Asia, two regions with increasing CKDu incidence. METHODS: A comparative literature review was conducted to evaluate the CKDu research design for peer-reviewed articles published from 2015 to 2019. Full texts were reviewed to identify study location, study type, study design, risk factors evaluated, and if applicable, sample type and number. RESULTS: In Asia and Latin America, 82 and 65 articles were identified in total, respectively, with 55 field studies in Asia versus 34 in Latin America. In Asia, research was focused on drinking water (34), heavy metals (20), and agrochemical product usage (19) as potential risk factors. In Latin America, research focused mostly on heat stress/dehydration (36) and agrochemical product usage (18) as potential CKDu risk factors. Biological samples were collected more frequently than environmental samples, especially in Latin America. DISCUSSION: Research to pinpoint the risk factors associated with CKDu to date is not standardized and typically limited in geographical scope. The emphasis of CKDu research varies by geographic region, with a greater priority placed on water quality and chemical exposure in Asia, versus dehydration and heat stress in Latin America. Using a harmonized approach to CKDu research would yield improved understanding of the risk factors associated with CKDu and how they compare across affected regions.