This piece was published in partnership with Southerly. This is the second story of a two-part series investigating childhood lead poisoning in Jackson, Mississippi. Read part one: Tap water could be linked to dangerous lead levels in Jackson's kids. Mississippi isn't keeping track.

Lead hides in Mississippi. It lurks in old peeling paint that chips off walls, often finding its way into kids' mouths. It burrows beneath the fertile soil, where it can get into vegetables or track home on work boots. Lead sheds from leaded gasoline that for decades fueled vehicles and is still allowed in planes and agriculture equipment. And it leaches into tap water from corroded pipes and parts. 

Once it's in a child's blood, lead causes irreversible neurological damage, even at low levels. Lead can impede brain development in children, and the symptoms mimic—and are even correlated with—Attention-Deficit/Hyperactivity Disorder (ADHD). Higher loads of lead can damage children and adults' kidneys and nervous systems. 

Despite the known risk, lead regulation—from federal rules to state enforcement and local execution—is a patchwork that often leaves families in the dark and unprotected. But across Mississippi, community-based researchers, health care practitioners, and advocates are working to get families more accessible and thorough information on their lead risk and how to prevent harm. 

"Lead may be invisible, but the children are not."

Part of the problem that exacerbates lead exposure is lack of coordinated public health efforts, says Sandra Melvin, epidemiologist and founder of Mississippi's Institute for the Advancement of Minority Health. 

"Lead, even though we know the devastating impact that it can have on families and children, it's not at the forefront," she said. "Lead may be invisible, but the children are not. The children that all of a sudden have ADHD who can't sit down, the children who ended up in special ed because they live in homes that have started to affect their brain functioning—it's invisible, but the results are not."

Because lead comes from multiple sources, it can be hard to trace. And often, kids with lead poisoning have multiple exposure points, like leaded water from school and leaded paint at home. For the majority of public health interventions across the U.S. and the South, paint is seen as the main culprit of poisoning: About half of children enrolled in Mississippi State Department of Health's (MSDH) lead prevention program trace paint as the main source of lead in their home. However, experts argue water should be considered just as significant of a potential lead source—and just as preventable. A third of children whose homes were assessed for lead exposure also found lead in the water, leached from pipes or faucets.

See also: Salt, Soil, & Supper— The social contracts of municipal water systems

In Hinds County, where Jackson is located, two-thirds of homes were built before the Environmental Protection Agency banned lead paint and reduced lead plumbing in new buildings. In Jackson, about 88% of homes likely had leaded paint as of 2019. Even modern "lead-free" plumbing can still contain some lead, and state officials report there are lead pipes or parts in Jackson's water distribution system.

Experts say water exposure should be considered just as an important source of lead, especially for young children. In April, Southerly used MSDH data to map neighborhood-level pockets of risk in Jackson, showing that the capital city's neighborhoods with lead-in-water overages are also home to kids with dangerous levels of lead in their bodies. Southerly's map represented the first known effort to map neighborhood-level pockets of risk in Mississippi. MSDH said it doesn't do this sort of analysis because different departments house the data. 

Still, Melvin says from an intervention perspective, it's too late to act when once clusters pop up. 

"I think we should give families more credit to be able to assess the risks, knowing that some families might not want any lead in their water."

"We need to ask those questions before the child is exposed," she said.  

Despite lead-in-water overages correlating with poisoned kids, data collection and interventions are sparse. 

That's why her nonprofit recently launched a new lead prevention program, "Healthy Homes, Healthy Families" to not only connect families with lead screening and prevention resources, but also to train trusted community members on lead risks to look out for, like decaying plumbing and chipping paint.

No matter the source, lead permanently damages the brain and body. The damage can compound with multiple exposures to lead, like from both water and paint. Older homes and schools with old lead water fountain fixtures and lead paint create small high-risk areas for young children as well. No federal or Mississippi law currently requires schools to be tested for lead.

Melvin adds that, especially in Mississippi where one in five residents live in poverty, the impact of home-based lead exposure is cyclical. 

"In areas that are most affected by this, with old homes, those kids end up left behind because we just think, 'Oh, they're just acting out or they have ADHD,'" she said. "But it could be their environment that is causing some of the problems."

Melvin points to Jackson's long standing lead-in-water issues  as pressing examples of why she and other public health practitioners need to figure out how to deliver public health messages that highlight the issue. 

After the state announced in early 2016 that Jackson had severe lead spikes during the previous years' water sampling—when nearly a quarter of all samples exceeded the federal lead limit of 15 parts per billion (ppb) and almost all had some lead flowing from the tap—state officials said the results were "home-dependent," and not indicative of overall water quality. But they still advised pregnant people and children to avoid the water. Today, Jackson is still under federal review for lead-in-water overages, though recent samples have improved

But, when there's a disturbance to water flow, like the recent winter storms that knocked out Jackson's safe water flow for over a month, or a system has naturally acidic water, leaded plumbing or pipes can leach into the water supply and flow from the tap. 

Other experts point to lax federal and state regulations. Federal water regulations were never meant to ensure lead-free water across any given distribution system even though there is no safe level of lead in drinking water. The EPA only requires water utilities to test a small sample of homes for lead in drinking water every few years. And even then, the utility only has to address lead mitigation and prevention if 10% or more of tested taps show a high level of lead—considered 15 ppb. 

"These are the things that we're supposed to have as human beings—clean drinking water. We know lead is there, but it's not an issue that for a lot of people is at the forefront," Melvin said. "So it's here in Mississippi, we just have to focus."

Young kids are at highest risk for irreversible lead poisoning, and older homes are more likely to have lead lurking in places where small kids can ingest it.

But there are easy steps your family can take that will have a big impact on reducing lead exposure in your home:

If you have paint peeling from the wall, assume it has lead in it. Door jambs and window sills tend to be a major source of lead paint peel, and are easily accessed by young children.

Prevent kids from getting to the area and try to stop the peeling. If your house was built before 1978, lead paint was probably used. You can chip off a section and get it tested. In Jackson, the city planning office runs a program to remove lead paint from houses. Remember: lead paint chips have a sweet taste, so children tend to put them in their mouths.

Test your water and use a certified lead filter. Running water for 30 seconds before using is a good way to flush toxins as well. Lead is still allowed in plumbing, though it was majorly reduced in 1986. If your home was built before then, you might have lead service lines that run water into the house, or heavily leaded fixtures throughout the home. Ask your plumber if they've seen lead plumbing in the neighborhood and contact your water utility about the most recent round of Lead and Copper Rule testing. 

You can check results with the EPA here and in Mississippi here. These results have to be published in your utility's annual Consumer Confidence Report. Mississippi lists water systems that contain lead service lines here.

Make sure young children are screened for lead exposure with their pediatrician. 

Make sure work boots and tools have a separate storage area, away from young kids. Don't forget, lead can be tracked home with dirt and soil, too.

The most permanent fix to reduce lead exposure from water is to replace lead service lines and parts. Different from other water toxicants, lead is rarely in the source water (the surface or groundwater that utilities pull from), but it leeches in from old pipes, parts, and fixtures on the way to the tap. Replacing miles of underground plumbing is expensive and requires cities to know where the lead lines are—but many don't track them.

More than two-thirds of Mississippi counties have lead plumbing somewhere in their distribution system, but the statewide inventory does not keep record of how many lead pipes it has or where they are. Mississippi officials did not respond to a nationwide survey that recently tracked the number of lead service lines across the country. 

Lead exposure experts point out that other fixes can help limit exposure: testing more taps to identify problem areas, providing lead-filters for drinking water fountains and faucets, and simply running the tap for 30 seconds before drinking. 

Stephanie Showalter-Otts researches lead-in-water, particularly in the Mississippi Delta. She argues the approach to limiting lead exposure is backwards: Most U.S. remediation strategies wait until hot spots arise, then issue testing guidance, as happened in Jackson in 2016

Showalter-Otts' National Sea Grant team at the University of Mississippi recently found lead in two-thirds of all Delta homes tested. By leveraging community partnerships, her team holds public education sessions at community events, then offers to test folks' water for lead while educating them on the dangers of lead-in-water. She said that the information families get from their public water system often isn't enough to inform or engage about true lead risk. 

"To mitigate your exposure to lead, we actually have to change behavior somehow, especially with drinking water," said Showalter-Otts. 

She has collaborated with the state health department to test families' drinking water whose children showed elevated blood lead levels, but weren't high enough to trigger state involvement. During the first full year of state referrals, UM received 53 referrals from the state, but less than half of families returned samples. Getting buy-in from families has been hard during COVID-19, Showalter-Otts said, but she hopes with continued community-based partnerships, families will grow more aware and comfortable with the outreach portion of the referral program. 

Of the 19 samples received in 2020, results ranged from no lead detected to 81 ppb. The three highest samples were all from private wells, which are unregulated by federal lead rules. If a homes' water tests above 5 ppb—the standard that the Food and Drug Administration uses for bottled water—the UM program provides the family with a water filter and coordinates with local water utilities and schools.

"If there was more attention on these low cost interventions, instead of complete removal of lead pipes, there might be less concern," she said. "I think the facilities are worried they have to spend lots of money and hassle replacing pipes."

The UM team's research touches on two pieces that are key to lead exposure reduction: data collection and intervention. But it's one of only a handful of lead-in-water interventions in the state to do both. Meanwhile, lead paint reduction interventions have gained slow traction since 2016. 

Jackson, Hattiesburg, and the state health department have federal Housing and Urban Development (HUD) grants to eliminate lead hazards in housing, increase awareness of lead hazards and childhood lead testing rates, and expand workforce capacity in the housing sector to provide certified lead hazard control services. 

Southern states are underrepresented in federal lead remediation grants, compared to Rust Belt and northern states, but HUD's investment comprises the most concerted federal effort to support communities' lead paint prevention programs.

See also: Jackson's water crisis—How you can help

Behavior from water regulators and utilities is harder to change—especially when a don't-ask-don't-tell phenomenon prevails. "I feel like there is a sense that if we don't look for it, we won't find it," Showalter-Otts said. "And then we won't have to do anything about it because we really can't (afford to) do anything about it."

Take the EPA's policy to intervene when drinking water samples reach 15 pbb. She said if a household with kids has 14 ppb of lead in their water, just a point underneath the federal action-level, it's still a huge hazard and concern. 

"And I think we should give families more credit to be able to assess the risks, knowing that some families might not want any lead in their water," she added.  

Though all kids using Medicaid health insurance are supposed to be tested, less than a quarter are annually in Mississippi. It worsened during the COVID-19 pandemic when annual wellness visits and subsequent lead screenings plummeted, while in-home exposures from leaded water and paint spiked for children in older homes due to lockdowns.

"Testing guidelines don't test until kids are 12 months old. You're not picking up if it's an infant on formula—that's going to be water exposure, but you're not going to know for a year," Showalter-Otts said, adding that there are vast gaps within the timing of the lead testing recommendations. "They're based on lead paint, when kids start to crawl, and they're not set up to detect that water for exposure," Showalter-Otts said.  

Mississippi has the lowest rate of breastfeeding in the nation, meaning more infants are on water-mixed formula than anywhere else in the U.S. WIC centers across the state, where new moms are encouraged to breastfeed, were all recently closed, eliminating a contact point the UM project was hoping to leverage for more community education.

"It seems like to me part of the solution is that targeting," she said. "If (the state) paid more attention to the water systems that were having problems, then you could do that targeted outreach, knowing we have more children on formula and with likely exposure." 

In lieu of better federal regulation and more state infrastructure upgrade investment,  Showalter-Otts is working with Mississippi State University researchers on a "Sip Safe" campaign to test day care and schools' drinking water sources. It's the only known lead-testing intervention in the state to target children's drinking water sources. 

Jason Barrett, associate professor with Mississippi State University's Water Resources Research Institute, has long advocated for better education outreach around lead-in-water, especially where kids are involved. Young children are at the highest risk for damage from lead exposure, but federal programs have historically stopped short of requiring water tests for lead in known likely sources, like schools. 

But Barrett, along with partners at University of Mississippi, are using EPA grant funds to test schools free of charge through its Sip Safe program.

"With the increased interest that we do see with lead-in-drinking-water, the Sip Safe program is an opportunity for any licensed child care facility in the state, any public school system in the state that are serving kids six-years-old and younger to have their facility screened for lead," he said, adding it's an opportunity for schools to get ahead of the curve with pending new federal regulation, and to give peace-of-mind if their water is safe. 

The Sip Safe team has sampled about 40 child care facilities across the state as of August, and many water sources are coming back with elevated lead levels (using a 5 ppb standard). The team works with centers on low-cost interventions, like turning off water fountains, implementing flushing protocols, and using filters.

"Our findings are demonstrating to me that there are lead risks throughout the state that are going undetected because the water systems aren't exceeding the 15 ppb action level," Showalter-Otts said. Without a state or federal law, getting facilities to participate in the testing has been tricky, she added, in part because many facilities think water coming from the municipal water utility must be safe. It's a common misconception, and part of the program's education emphasis, she added. 

Current EPA regulations do not require school or day care testing, but new revisions—currently under review by the agency—will require water systems to start testing elementary schools and day cares by 2024. Experts have long pointed to the rule's shortcomings, citing childhood exposure and transparency as neglected by the rule, and say the new revisions don't go far enough.

"Plus we have resources available, publications available to them, their owners, their staff, the parents," Barrett said, adding that most families don't understand lead-in-water issues or how to protect themselves simply because there aren't enough education campaigns in their communities. "We've got a curriculum generated to leave with the facilities, if they want to do some type of (additional) lead-in-drinking-water education themselves. And it's all available at a phone call or an email."

Showalter-Otts at UM echoes the importance of individualized education, adding it's not a one-size fits all.

"The educational piece is important so people understand where the exposure is coming from, and that there are things that they can do to reduce their exposure that are low cost," she said, adding those solutions include installing a filter, simply flushing your pipe and/or using bottled water to make baby formula. "We think that it's important to empower families to be able to make the decisions that make sense to them."

This story was supported by Solutions Journalism Network. You can republish this story for free through the SoJo Exchange.

More in environmental justice

Erica Hensley covers health in the Deep South, where she focuses on women’s health and regional disparities. She’s the recipient of Atlanta Press Club’s investigative reporting Award of Excellence for reporting on lead exposure, which spawned the state environmental agency to change how it regulates lead testing.