A new study has linked lead exposure to kitchen cookware, which was first noticed in Afghan children in King County.

Steve Whittaker, who is a research services program manager and toxicologist for the King County Hazardous Waste Management Program, was one of the lead authors of the study.

“We first became aware of the issue of Afghan children having high blood lead levels when the Department of Health reported some data showing that amongst all refugee children resettled in Washington state, Afghan children had what we call the highest prevalence of blood lead levels,” said Whittaker.

The prevalence of lead exposure in Afghan children led to the Hazardous Waste Management Program teaming up with a public health nurse to better understand the situation. Investigators went to the homes of families who had Afghan children with high blood lead levels, and used an instrument called an XRF analyzer as a screening tool to measure lead levels.

Investigators found ceramic dishes that are known to contain lead, as well as jewelry and personal care products — all of which was not new. What Whittaker found surprising was that some of the aluminum cookpots brought with the refugees from Afghanistan to the United States contained hundreds, if not thousands, of parts per million of lead.

XRF testing locations on an aluminum Afghan pressure cookers. Top left: Pressure cooker body. Bottom left: Base. Top right: Outer surface of lid. Bottom right: Inner surface of lid. Courtesy of Journal of Exposure Science & Environmental Epidemiology.

“There are a number of studies in the scientific literature that show that in some developing countries, aluminum cookware can be manufactured from scrap metal,” said Whittaker.

Whittaker explained how in some parts of the world, entire communities are set up next to junkyards and scrapyards which carry recycled aluminum. He also described how any aluminum that is found, such as engine parts and aircraft parts get placed into a large cauldron where it is melted down.

“What we suspect is happening is that some of this cookware that was brought from Afghanistan was actually manufactured in this way—from scrap aluminum that was contaminated with lead,” said Whittaker.

Whittaker mentioned how the Centers for Disease Control and Prevention recommends that refugees undergo a comprehensive medical exam when arriving to the U.S., including a blood lead test.

Lead exposure reaches far beyond the Afghan refugee community

“What we found was that many cookpots that you can buy readily here in King County and throughout the United States also have very high lead levels,” said Whittaker. “Although we started this investigation with the Afghan community … this lead contaminated imported aluminum cookware is widely available in the United States and does pose a potential lead poisoning risk to many communities in the United States.”

Once Whittaker learned that cookpots with high lead levels could be bought online and throughout the country, the Hazardous Waste Management team shared their findings with the Food and Drug Administration (FDA).

According to Whittaker, the FDA does not currently have a standard or regulations for the amounts of lead in metal cookware. Whittaker reached out to the local FDA office in King County, who has begun an investigation to find out where the cookware is coming from, who is importing and distributing it, and where it’s being sold.

“What we’re hoping is that the FDA will develop some new regulations to prevent the importation, distribution and sale of this cookware in the United States,” said Whittaker.

Lack of testing in King County

“We’re testing very few children for lead and so we really don’t know if there is a lot of exposure from the aluminum cookware at this point because we’re just not testing enough children,” said Amy Shumann, Manager of the Lead and Toxics Program at Public Health—Seattle & King County.

According to Shumann, children who are eligible for Medicaid are required to have a blood lead test at 12 and 24 months, although currently, that is not happening.

“Right now, only about 18% of Medicaid eligible children in King County are being tested,” said Whittaker. “I think mostly many providers don’t think that their patients are at risk, or they’re not familiar with the state of Washington screening guidelines and how to assess possible risk, so it’s often not brought up to families.”

Shumann brought up how medical providers will test a child’s blood lead levels if the child begins to display developmental delays, including speech delays, feeding delays, and behavioral issues, which are symptoms of blood lead poisoning.

“I think it can be challenging, especially in the last couple of years with COVID,” said Shumann. “We know that children generally are behind on their vaccines and well-child checks because parents are nervous about bringing their kids into medical clinics in COVID times.”

Shumann noted that testing rates have gone down as a direct result, and that healthcare providers have mentioned that they have so much to cover during a routine visit, that it becomes difficult to fit everything in.

Although blood lead testing percentages have been falling short in King County, Public Health—Seattle and King County has been partnering with groups to facilitate continuous medical education for providers in relations to childhood lead poisoning prevention and increasing testing rates.

“We have been working with medical providers for the last few years to try to increase testing rates, and we also work with families—do a lot of outreach in the community to try to encourage families to bring it up with their providers if they think that they might have risk factors,” said Shumann.

Range of symptoms with few treatment options

Signs such as delayed learning, delayed speech, and behavioral issues can later surface as a result of lead exposure in children. Shumann explained how lead poisoning can impact the fetus of a pregnant person through crossing the placenta.

“At high levels it could cause miscarriage or stillbirth but can cause those learning delays and behavior problems later,” said Shumann.

According to Whittaker, there’s a variety of symptoms of lead exposure that are nonspecific in adults: abdominal pain; cramps; vomiting; constipation; headaches; joint pain; difficult thinking or concentrating; fatigue; irritability; and loss of weight or appetite.

Low levels of lead exposure in adults can cause hypertension, high blood pressure, impotence, and reproductive health issues. High levels of lead may lead to paralysis, personality changes and mood swings and trouble sleeping.

“One of the other issues with being exposed to lead at work is the problem of what we call ‘take home exposure,’ where it’s very easy to take lead home with you from a job site or a factory, where you can contaminate an entire family,” said Whittaker.

According to Whittaker, incidents of take-home lead exposure have been seen in families throughout King County.

“For most of the cases that we see in King County there is no treatment,” said Shumann. “Normally, what is done is when a child has elevated blood lead, the investigators in the Hazardous Waste Program are going to be looking and working together with the family, looking for the source of the lead to try and get that lead out of the child’s environment so they’re not exposed anymore.”

Shumann explained how over time, blood lead levels will decrease if the exposure is taken care of. Good nutrition is recommended for children exposed to lead to decrease the amount of lead that gets absorbed into bones.

“The half-life of lead in blood—at least for adults—is typically about a month,” added Whittaker. “Barring any further exposure, we often see blood lead levels come down by a half every month.”

Know how to prevent lead exposure

“We have this new and unique finding about cookware, but there are lots of other sources that we need to be concerned about as well,” said Whittaker.

Shumann suggested families educate themselves about potential sources of lead, such as old toys, jewelry, coal, and stained glass making, among others. For families that live in homes built prior to 1978, she recommends checking the home to make sure paint is intact, as well as frequent damp dusting and mopping to reduce the amount of lead dust that is present. Taking off shoes prior to entering the house is another suggestion.

“What we really recommend for families—if they have any concerns—is to get their children tested, especially at 12 and 24 months when kids are crawling, putting everything in their mouth,” said Shumann. “Those are times, developmental stages when lead poisoning is more probable just because of those behaviors.”

Whittaker recommends replacing imported aluminum cookware with stainless steel. If looking for new aluminum cookware, he recommends ensuring the certification of NSF International is on the packaging due to the low levels of lead and other toxic chemicals.

“We do understand that not everybody has the resources to be able to go out and buy new cookware, and so if you’re continuing to use aluminum cookware—imported aluminum cookware—there are some simple things that you can do to protect yourself and your family,” said Whittaker.

Washing the cookware with warm water, a delicate scrubber, mild soap, and then rinsing and drying the cookware immediately after is suggested. Whittaker recommends using wooden or silicone utensils to prevent scratching the surface of the cookware, and to wash pots by hand. Storing food outside of the cookware is another recommendation.

Click here for further information on preventing lead exposure.

Courtesy of Hazardous Waste Management Program.