Lead pollution is a critical public health crisis in Bangladesh, where 9.7 million children have blood lead levels (BLL) exceeding 10 µg/dL, ranking the country fourth highest globally. Prenatal and childhood lead exposure is associated with neurodevelopmental deficits, stunting, and adverse birth outcomes. This systematic review synthesizes evidence on lead exposure sources, health impacts, and regional disparities to inform urgent interventions.

Following PCC guidelines, a systematic review of studies published between 2000-2023 was conducted using PubMed, Scopus, Web of Science and Google Scholar. Studies assessing lead exposure pathways and health outcomes in maternal-child populations were included, while gray literature and non-English studies were excluded. Data on study design, population characteristics, exposure sources, and health outcomes were extracted.

Among 18 studies, findings indicate that 31-36% of pregnant women had BLL above 5 µg/dL. Major exposure sources included lead-adulterated turmeric (up to 483 ppm), lead-soldered cans, and informal battery recycling, where soil lead levels reached 1632 ppm. Regional disparities were evident, with industrial areas like Sirajdikhan reporting mean BLLs of 6.2 µg/dL compared to 1.6 µg/dL in Pabna. Higher maternal BLL was associated with increased risks of preterm birth (OR: 2.1) and miscarriage. In children, prenatal lead exposure was linked to reduced cognitive scores (-2.1 points per log-unit BLL increase, p<0.01) and a higher likelihood of stunting (OR: 1.8, 95% CI: CI:1.2-2.7). Boys exhibited greater growth deficits than girls. Epigenetic changes, such as altered DNA methylation of the GP6 gene, and increased neural tube defect prevalence were also observed.

Lead exposure in Bangladesh presents severe and irreversible health risks. Findings underscore the urgent need for policy action, including strict bans on lead-adulterated spices, regulating informal battery recycling, and expanding BLL monitoring in high-risk regions. Community engagement and maternal-child health programs are essential to mitigating the long-term effects of lead exposure in Bangladesh.

Exposure to lead and asbestos can have lifelong health impacts, especially for children. Clean Classrooms for Carolina Kids is a once-in-a-generation program to identify and eliminate exposure to lead in water, lead-based paint, and asbestos hazards at every child care facility and public school—approximately 9,000 facilities—across North Carolina. Supported by unprecedented state funding and multi-sector partnerships, this initiative leverages a data-driven approach to improve children’s health and create safer learning environments. This presentation will highlight four key components of the program: (1) policy, funding, and collaboration strategies that enabled large-scale implementation; (2) a centralized online portal that streamlines participation, data sharing, and compliance tracking; (3) an integrated risk communication framework that builds trust and supports informed decision-making; and (4) results and findings on risk factors for lead and asbestos exposure in child care facilities and schools, mitigation strategies, and lessons learned. To date, we identified lead in water above the 1 ppb American Academy of Pediatrics’ reference level and above 10 ppb in 20% and 3% of samples, respectively. One or more taps at 52% of facilities exceeded 1 ppb, and 12% exceeded 10 ppb. Among 2,564 facilities reviewed for lead-based paint and 2,563 for asbestos, 24% and 35%, respectively, required further inspection. Lead-based paint hazards were found in 34% of inspections, significantly higher than asbestos hazards, which were identified in 6%. Overall, we found that a child’s learning environment is commonly a potential lead and asbestos exposure source. Scientifically rigorous hazard testing programs, paired with infrastructure improvements, could eliminate early childhood exposure to lead and asbestos, and support school readiness, social-emotional development, and lifelong health.

Background/Purpose: Extreme heat is associated with adverse pregnancy outcomes. We aimed to identify motivators for protective action during extreme heat among pregnant individuals.

Methods: In May 2024, we conducted a representative national panel survey of U.S. adults. We collected 6223 survey responses, from which we restricted our analytic sample to pregnant females (n=212). We used multivariable linear regression models to examine components of the Health Belief Model (susceptibility, severity, barriers, perceived benefits, self-efficacy, and cues to action), demographic characteristics, county days with heat index ≥90 degrees Fahrenheit, and having received guidance from one’s doctor, in relation to self-reported likelihood of taking protective actions on days with high heat. Each Health Belief Model component was comprised of responses to several 1-5 point Likert-scale questions, which were summed and standardized on a scale of 0-10 prior to inclusion in multivariable models. Likelihood of taking action (model outcome) represented the sum of responses to eight questions asked on a 1-5 Likert scale (range 13-40).

Results: Over one-third (38%) of pregnant individuals said a doctor had never discussed how heat exposure could impact their health. Likelihood of taking each protective action assessed ranged from 50-80%. For each unit increase in perceived benefits, self-efficacy, and cues to action scores, likelihood of taking action scores increased by 0.6 (95% CI, 0.2-0.9), 1.7 (95% CI, 1.4-2.1), and 0.5 (95% CI, 0.1-0.9), respectively. Compared to non-Hispanic White respondents, Native Hawaiian Pacific Islander, Middle Eastern, and Black respondents had protective action scores that were 3.2 (95% CI, 1.2-5.3), 2.7 (95% CI, 0.1-5.2), and 1.6 (95% CI, 0.2-3.0) points higher, respectively. Other factors assessed were not associated with taking protective actions.

Conclusions: Among pregnant individuals, perceived benefits, self-efficacy, and cues to action represent areas of opportunity for public health action, to reduce heat-related adverse pregnancy outcomes.

Young children exposed to pesticides are at risk for long-term cognitive, neurological, respiratory, and developmental problems. Interventions to reduce pesticide exposure in child care focused on integrated pest management (IPM), but have not measured center- or child-level pesticide exposures. Our NIEHS-funded IPM intervention’s goal was to reduce preschool-age children's exposure to pesticides in child care centers using objective measures of pesticides. Eighty-five child care centers and 393 preschool-age children enrolled. Five Northern California counties were randomized to receive the 7-month IPM or physical activity intervention. Baseline and post-intervention measures included surveys, observations of IPM practices, carpet dust samples, and individual silicone wristbands. Results showed significant increases in IPM practices in the IPM versus control centers (F(df)=14.76(4,154), p<.05). Dust and wristbands detected bifenthrin, cypermethrin, trans- and cis-permethrin, fipronil in the majority of the child care centers. There were no significant differences in pesticide concentrations in the IPM versus control centers post-intervention. Tobit regression models of carpet dust concentrations showed significant increases in trans-permethrin (z=5.18, p<.05), cis-permethrin (z=5.84, p<.05), bifenthrin (z=2.09, p<.05) and piperonyl (z=3.46, p<.05) and in the wristbands, there were significant decreases in bifenthrin (z=-4.76, p<.05) and cypermethrin (z=-2.09, p<.05) post-intervention (spring) versus baseline (fall). Behavioral (e.g., IPM practices, hand washing, products on-site) and physical (e.g., proximity to agriculture fields, pest management professional, doormats) factors were associated with baseline pesticide concentration. Future analyses will focus on seasonal trends and predictors of post-intervention pesticide concentrations. Reducing pesticide exposures is challenging and may be limited by seasonal variation in pest control, directors limited time to focus on IPM, and delays in reporting back results. The environmental health intervention had a community-based approach supporting public health as a national priority.

Protecting children from the long-term health effects of extreme weather events, widely attributed to changing climate patterns, requires that spaces they spend time in are resilient, including childcare spaces. Family childcare (FC) is one important setting that has not received adequate attention from extreme weather event preparedness researchers. Family childcare is unique in that care is provided in the home of the caregiver. This means that FC homes exist in two worlds: as both the private homes of caregivers and important childcare settings. Because current licensing standards do not include provisions for extreme weather events, the resilience of these spaces largely depends on provider’s awareness of risks and their practical and financial ability to address them. To assess the knowledge, attitudes and beliefs regarding these events among members of this this critical childcare workforce, we surveyed family childcare providers in Illinois. Eligible participants were licensed family childcare providers in the state who were comfortable responding to a questionnaire in English. Among the 25 FC providers in Illinois who have responded to date, 72% identified as White, 12% identified as Black, and 4% identified as Hispanic or Latino/a. Our results suggest respondents do not consider extreme weather events to be a risk to children in their care. For example, 56% rated climate change as “almost no risk” or “low risk” and 75% rated heat as “almost no risk” or “low risk” to the children in their care. Although the sample size is small, the average tenure of these providers is 21 years, suggesting that even among experienced FC providers, there is an opportunity to engage on the topic of extreme weather events due to climate change to make climate resilience a more salient issue. Ongoing work is focused on collecting similar data at the national level to facilitate comparisons across geographic regions.