Elevated Blood Lead Levels in Children Associated With the Flint Drinking Water Crisis: A Spatial Analysis of Risk and Public Health Response

Hanna‐Attisha, Mona; LaChance, Jenny; Sadler, Richard C.; Schnepp, Allison Champney

doi:10.2105/ajph.2015.303003

Cited by 920 publications

(621 citation statements)

References 28 publications

Supporting

Mentioning

584

Contrasting

Unclassified

Order By: Relevance

“…Ecological research shows that black and high-poverty communities in Chicago have been disproportionately exposed to childhood lead poisoning (11,12), even after accounting for housing-related conditions, and recent discoveries of toxic neighborhoods in Flint, Michigan and East Chicago, Indiana point to the continuing nature of ecological threats from lead, both in the soil and water systems. In both of these cases, the neighborhoods most affected were predominantly black and poor, just as in Chicago (13,14). Moreover, a recurrent finding in United States cities is that concentrations of pollution and other industrial hazards tend to be highest in neighborhoods with large populations of African American and Hispanic residents (15,16).…”

Section: The Landscape Of Cumulative Adversitymentioning

confidence: 91%

Urban sustainability in an age of enduring inequalities: Advancing theory and ecometrics for the 21st-century city

Sampson

2017

Proc. Natl. Acad. Sci. U.S.A.

107

View full text Add to dashboard Cite

The environmental fragility of cities under advanced urbanization has motivated extensive efforts to promote the sustainability of urban ecosystems and physical infrastructures. Less attention has been devoted to neighborhood inequalities and fissures in the civic infrastructure that potentially challenge social sustainability and the capacity of cities to collectively address environmental challenges. This article draws on a program of research in three American cities—Boston, Chicago, and Los Angeles—to develop hypotheses and methodological strategies for assessing how the multidimensional and multilevel inequalities that characterize contemporary cities bear on sustainability. In addition to standard concerns with relative inequality in income, the article reviews evidence on compounded deprivation, racial cleavages, civic engagement, institutional cynicism, and segregated patterns of urban mobility and organizational ties that differentially connect neighborhood resources. Harnessing “ecometric” measurement tools and emerging sources of urban data with a theoretically guided framework on neighborhood inequality can enhance the pursuit of sustainable cities, both in the United States and globally.

show abstract

Section: The Landscape Of Cumulative Adversitymentioning

confidence: 91%

Urban sustainability in an age of enduring inequalities: Advancing theory and ecometrics for the 21st-century city

Sampson

2017

Proc. Natl. Acad. Sci. U.S.A.

107

View full text Add to dashboard Cite

show abstract

“…5,46,47 Children who reside in communities with lead service lines and inadequate anticorrosion control are also at increased risk for elevated blood lead concentrations. 48 Phasing out leaded gasoline and creating stricter national air lead standards led to large reductions in the contribution of airborne lead to children's blood lead concentrations. Still, in some communities, such as those surrounding regional airports, airborne lead is an important source of lead exposure.…”

Section: Sources and Variability Of Lead Exposurementioning

confidence: 99%

Prevention of Childhood Lead Toxicity

Lanphear¹,

Lowry²,

Ahdoot³

et al. 2016

Pediatrics

178

140

View full text Add to dashboard Cite

Blood lead concentrations have decreased dramatically in US children over the past 4 decades, but too many children still live in housing with deteriorated lead-based paint and are at risk for lead exposure with resulting lead-associated cognitive impairment and behavioral problems. Evidence continues to accrue that commonly encountered blood lead concentrations, even those below 5 µg/dL (50 ppb), impair cognition; there is no identified threshold or safe level of lead in blood. From 2007 to 2010, approximately 2.6% of preschool children in the United States had a blood lead concentration ≥5 µg/dL (≥50 ppb), which represents about 535 000 US children 1 to 5 years of age. Evidence-based guidance is available for managing increased lead exposure in children, and reducing sources of lead in the environment, including lead in housing, soil, water, and consumer products, has been shown to be cost-beneficial. Primary prevention should be the focus of policy on childhood lead toxicity.

show abstract

“…The role of poison centers in public health has been described; the centers can be an invaluable tool during toxicologic outbreaks. [28][29][30] However, a limitation of poison centers is that for the centers to identify an outbreak, health care providers must initiate contact with the centers. Common causes of overdose, such as those of opioids, which providers feel confident in managing, are often underreported.…”

Section: Discussionmentioning

confidence: 99%

Fatal Fentanyl: One Pill Can Kill

Sutter

Gerona

Davis

et al. 2016

Academic Emergency Medicine

128

View full text Add to dashboard Cite

Objective: The current national opioid epidemic is a public health emergency. We have identified an outbreak of exaggerated opioid toxicity caused by fentanyl adulterated tablets purchased on the street as hydrocodone/ acetaminophen.Methods: Over an 8-day period in late March 2016, a total of 18 patients presented to our institution with exaggerated opioid toxicity. The patients provided a similar history: ingesting their "normal dose" of hydrocodone/ acetaminophen tablets but with more pronounced symptoms. Toxicology testing and analysis was performed on serum, urine, and surrendered pills.Results: One of the 18 patients died in hospital. Five patients underwent cardiopulmonary resuscitation, one required extracorporeal life support, three required intubation, and two received bag-valve-mask ventilation. One patient had recurrence of toxicity after 8 hours after naloxone discontinuation. Seventeen of 18 patients required boluses of naloxone, and four required prolonged naloxone infusions (26-39 hours). All 18 patients tested positive for fentanyl in the serum. Quantitative assays conducted in 13 of the sera revealed fentanyl concentrations of 7.9 to 162 ng/mL (mean = 52.9 ng/mL). Pill analysis revealed fentanyl amounts of 600-6,900 lg/pill. The pills are virtually indistinguishable from authentic hydrocodone/acetaminophen tablets and are similar in weight. To date, our county has reported 56 cases of fentanyl opioid toxicity, with 15 fatalities. In our institution, the outbreak has stressed the capabilities and resources of the emergency department and intensive care units. Conclusions:A serious outbreak of exaggerated opioid toxicity caused by fentanyl-adulterated tablets purchased on the street as hydrocodone/acetaminophen is under way in California. These patients required higher dosing and prolonged infusions of naloxone. Additionally, observation periods off naloxone were extended due to delayed, recurrent toxicity. The outbreak has serious ramifications for public health and safety, law enforcement, and healthcare facilities and resources.

show abstract

Elevated Blood Lead Levels in Children Associated With the Flint Drinking Water Crisis: A Spatial Analysis of Risk and Public Health Response

Abstract: The percentage of children with elevated blood lead levels increased after water source change, particularly in socioeconomically disadvantaged neighborhoods. Water is a growing source of childhood lead exposure because of aging infrastructure.

Cited by 920 publications

References 28 publications

Urban sustainability in an age of enduring inequalities: Advancing theory and ecometrics for the 21st-century city

Urban sustainability in an age of enduring inequalities: Advancing theory and ecometrics for the 21st-century city

Prevention of Childhood Lead Toxicity

Fatal Fentanyl: One Pill Can Kill

Contact Info

Product

Resources

About