Educational and Societal Impacts of Lead Exposure

Lead exposure is a critical public health challenge that undermines educational achievement and perpetuates socio-economic disparities [1-4]. Despite a national trend of declining elevated blood lead levels over the past decade, Rhode Island (while still declining) continues to demonstrate the highest prevalence of children with confirmed blood lead levels at or above 5 µg/dL [5]. This data story explores how lead exposure among Elementary school-age children in Rhode Island between 2015 and 2024 is associated with various educational measures. Specifically, this will explore the observations of geographic municipality, chronic absenteeism, grade retention, test proficiency, school suspension, and how elevated blood lead levels are distributed across various equity subcategories.    

Research demonstrates statistically significant correlations between lead exposure, reduced cognitive functioning, and impairments in learning and memory [6]. Common sources of lead exposure include paint, dust, and drinking water. Lead has been shown to impact intraneuronal regulatory mechanisms [6].  

However, it is also crucial to acknowledge and account for socio-economic factors which inevitably affect selective subgroups [7]. Measures such as unemployment, household income, education level, and home ownership in various geographic areas have been shown to specifically alter childhood lead poisoning in Rhode Island [8]. Lead can be a marker for multiple unhealthy housing conditions that affect not only a child's ability to learn, but also whether a child is healthy enough to attend school.   

Rhode Island requires that all children receive two blood lead screening tests before they turn 36 months old. While approximately 65% of children are screened at least once by 18 months, only about 45% are screened twice by 36 months. For children with multiple confirmed blood lead level (BLL) tests on file, the highest recorded result, or "Max BLL," was used. 

This data story refers to children without a BLL test as "Not Tested" or having "No Test Data." These students may have come from out-of-state, have a medical provider out-of-state, have sought exemption for religious reasons, or have not been tested for unknown reasons. While there are legal requirements for healthcare providers surrounding lead screenings in Rhode Island, schools are not mandated to enforce or require these lead screenings as a prerequisite for enrollment. 

BLL screening results are reported by the amount of lead in micrograms per deciliter of blood (µg/dL). As of 2021, the Centers for Disease Control and Prevention's (CDC) reference level for children exposed to lead is 3.5 µg/dL or above.  This value is based on the 97.5th percentile of the blood lead distribution in U.S. children ages 1–5 years. Updating the reference value to 3.5 μg/dL from the previous reference value, 5 μg/dL, allows children within the 3.5–5 μg/dL range to receive prompt actions. [9, 10] 

Though lead exposure has decreased recently, 1 in every 13 rising kindergarten students has had a blood lead level of 3.5 µg/dL or above. 

According to the Rhode Island Department of Health (RIDOH) Lead Elimination Surveillance System, the percentage of children eligible to enter kindergarten in Rhode Island who have a test result with an elevated blood lead level (3.5+ µg/dL) decreased from 16% to 8% between 2016 and 2023. [11]  

The visualization above shows the distribution of blood lead level categories across Rhode Island municipalities throughout the years. You may use the Blood Lead Level Category selector to change the map view if you're interested in other categories of lead exposure. You can also compare years by choosing a different School Year from the provided options.  

Note: Two school years are shown together to limit suppression. Results are suppressed for counts of less than 10 for disclosure avoidance. 

From 2015 to 2024, the prevalence of elevated blood lead levels in Rhode Island children enrolled in Kindergarten through Grade 5 has decreased, promisingly. 

In the interactive dashboard above, you can see which municipalities have the highest concentration of Kindergarten through Grade 5 students who have ever had elevated blood lead levels. Additionally, in the 2015-2016 school year, 13 municipalities had prevalence rates over 25%; whereas no municipalities have had prevalence rates greater than 25% since the 2019-2020 school year. 

Again, you may use the Blood Lead Level Category selector to change the map view if you're interested in other categories of lead exposure. You can also compare years by choosing a different School Year from the drop-down box.  

Note: The denominator for displayed percentages is the total students tested, not the total students. Not all schools have comparable percentages of students with matched lead test data. 

Measured components of unhealthy housing are generally more prevalent in urban areas.

The map is a composite analysis of three key indicators of unhealthy housing:

1. Percent of children under six years old with first-time elevated blood lead levels (3.5+ µg/dL)
2. Percent of housing units built before 1979
3. Median family income

Each indicator was tallied by census tract and calculated according to the category of most concern (increasing values for all measures except median family income), then combined into a ranking of unhealthy housing.  

In reviewing the data on student absenteeism with varying levels of lead exposure, we observe a notable association between elevated lead exposure and higher rates of absenteeism.     

Families encounter several challenges when they are exposed to unhealthy environmental conditions. Poor housing quality is often linked to chronic sickness in children, leading to missed school days [12, 13]. Research shows that asthma is a significant factor in increased absenteeism [14-16]. Concurrently, lead exposure is frequently cited as an indicator of unhealthy environments that can worsen asthma symptoms. [11, 12] 

Grade retention tends to rise alongside higher levels of lead exposure.  

Grade retention refers to the number of students "held back" and asked to repeat a school year. Given the statistical correlation between elevated BLL in children and some cognitive and developmental delays, we expect to see an association between BLL and grade retention. [16] 

In this visualization, each bar represents the percentage of students in that respective grade in that respective BLL category. For example, in the 2023-24 school year, 4% of all 5th-grade students in the unelevated BLL category (0-3.49 µg/dL) had ever been retained. This contrasts to 6% of all 5th-grade students in the elevated BLL category (3.5+ µg/dL). 

While grade retention is intended to give struggling students additional time and support to master grade-level goals, studies show mixed results on academic performance. Additionally, research has shown that retained students are more likely to have many future social, behavioral, and emotional problems. Grade retention is one of the most potent predictors of dropout status and is linked to lower future earnings. [17]