Air Date: Week of August 29, 2003

Three young adults who are part of Dr. Dietrich’s research group tell stories of their troubles with the law, and problems they've faced in their lives. Bruce Lanphear, lead researcher and head of the new environmental health center at Cincinnati Children’s Hospital, explains the connection between lead and crime. Dr. Lanphear is beginning a new study and is recruiting 400 pregnant women in an attempt to further reveal the impact of lead on child development.

Transcript

[SOUNDS OF PEOPLE YELLING]

CURWOOD: Welcome back to Living on Earth, I’m Steve Curwood in Cincinnati. We’re home again with Tony. He’s a 22-year-old who was exposed to lead as a child.

All his life, researchers have been monitoring him as part of a study of the long term effects of lead. Like many in the study, Tony has trouble concentrating. He says he can’t keep a job or a steady girlfriend. In fact, it was hard for him to sit down and talk. For Tony, life is chaotic. But there is one way Tony can deal with the world around him. That’s his music.

[RAP MUSIC]

TONY: The studio’s like my own little world, man. Once I’m in there it’s like my own world, man. I’m separate from everybody, man, everybody.

CURWOOD: So, what do you do in the studio when you go there?

TONY: I’m all over, man. I’m an artist. I might help you produce a track. I might just sit there and mess with the mix board, make sure your vocals and everything are right. I’m everywhere, man.

CURWOOD: Music is the only thing that can capture Tony’s attention for any length of time. It’s been that way all his life. Back in elementary school he says his teachers constantly complained about him not paying attention and acting out in class.

TONY: Hyper, man, that’s probably the perfect word for me, man. Hyper, man.

CURWOOD: Yeah?

TONY: Hyper, yeah.

CURWOOD: Then, when he was 14, Tony started life “on the streets,” as he puts it. Selling drugs was easy money.

TONY: You don’t think about the consequences. You’re out here making money, doing it illegal. One day might make 400, next day you might make 900. Now you got something you can do, you know what I’m saying? “Tony, we’re going to go out.” Well, I got a little money in my pocket, I can go out, too, come on. Know what I’m saying? And then you go out, one thing lead to another. It was like that.

CURWOOD: Did you get hurt at all?

TONY: Yeah, I got stabbed…

CURWOOD: Yeah, what happened?

TONY: Got shot right here. And I got stabbed on my stomach.

CURWOOD: That’s rough.

TONY: That’s the street life, man.

CURWOOD: So, what changed your mind about the street life?

TONY: Came about 2000, my son came.

CURWOOD: You got a boy?

TONY: Yeah, I got a son. When he came, it was just like, it was, it was just something that clicked with me. You know what I’m saying? Either you’re going to be here with him or you’re going to be here by yourself. My father was always there for me, so I figured I got to be there for my son. It was either leave the streets alone and raise him or don’t raise him and end up in jail or dead. So I took the other way.

LAQUISHA: All right, my first name, Laquisha. I’m 18 and I live in Janann Hills.

CURWOOD: Laquisha is part of the same lead study that follows Tony. Like Tony, she has to come here to the clinic for regular check-ins. And like Tony, Laquisha has spent some time in jail. But it’s not drugs that get her into trouble, it’s her temper. She gets into fights easily and was kicked out of public school. Laquisha seems quiet enough. It’s hard to imagine her blowing up. But if something sets her off, she just can’t help herself.

LAQUISHA: And I be trying to get help for it. But for real, for real I don’t know how to go about doing it. But sometimes I just get so mad. It could just be over little stuff and if I just don’t sit down and just be still and just try to cool down, I just blow up and just start tearing everything up. And I don’t be liking to be that way because after I get finished it be like, man, like why did I do this? I just be so mad. But I just can’t help it sometimes.

CURWOOD: Laquisha has been to anger management class but it didn’t seem to help much. Not only does she easily lose her temper, she also easily loses her train of thought.

LAQUISHA: Like, I’ll be focused for a minute and then I just get on something else. I don’t know what’s be happening and I be asking my momma, like, and my momma just be like, you know what I’m saying? You got to forget about everything else and really concentrate. And I’ll be telling her, like, one minute I’m concentrating and then I just go out of focus like.

CURWOOD: At the Cincinnati Children’s Hospital, researchers have joined in the effort to see if the troubles of people like Tony and Laquisha are a function of their exposure to lead in early childhood. Certainly they had lead levels that today would be considered unacceptable. And lead is a potent neurotoxin. That means it can interfere with the brain’s chemicals, functions, and development. But science is not yet able to draw a straight line between lead poisoning and any given act of antisocial behavior. Bruce Lanphear heads the hospital’s Environmental Health Center.

LANPHEAR: There’s some evidence from the animal literature that it can alter either the binding of neurotransmitters or the release of neurotransmitters. But, again, the specific mechanism that causes any particular problem, whether it’s intellectual impairments, or lower IQ scores, or whether it’s impulsivity, or attentional problems, we don’t know what the connection is. And it may be more than one.

CURWOOD: Lowered IQ, trouble with learning, poor impulse control, and the lack of ability to plan ahead, all make it harder to make good choices in bad situations. And Dr. Lanphear says more studies are providing additional support for the link between lead and crime. For example, recent findings by University of Pittsburgh researchers show that teens with a history of lead poisoning are twice as likely to be considered delinquent by the law, their school, or their family.

LANPHEAR: So there’s actually quite a bit of evidence that begins to link lead as a potent neurotoxin and conduct disorder, or antisocial behavior, or criminal behavior. And while it’s always very difficult, because it’s a very charged topic, to make any definitive links, there certainly is a growing body of evidence that really substantiates some of the work that’s now been ongoing for over 20 years.

CURWOOD: To help unravel the secret life of lead, Bruce Lanphear and Kim Dietrich are heading up a five-year, multi-pronged study funded by the National Institute for Environmental Health Sciences. As part of this new round of research, they are conducting two unprecedented studies on lead and crime. Both involve Kim Dietrich’s research group that includes Tony and Laquisha. One study seeks to identify any physical changes in the brain.

LANPHEAR: We’ll take that same group of children, now young adults, and using imaging techniques try to see whether lead exposure impacts the function, or make-up of the brain. So, are certain parts smaller or more dense, for example. Does that tie into the delinquency that we’re seeing?

CURWOOD: Another study asks these same young adults about their behavior and screens them psychologically. By correlating results with known childhood lead exposures, researchers will try to tease out what influence, if any, lead has on adult anti-social behaviors.

COMPUTER: Please enter the subject’s last name, enter the code.

CURWOOD: Most people are reluctant to discuss criminal behavior, so the team has designed a talking computer program in the hopes it’ll be easier to confess to a machine.

COMPUTER: Please enter the subject’s six digit ID, enter the code.

CURWOOD: Louis, a young man with bright yellow shirt and a shy smile, sits at the computer. He’s in the neighborhood office of Kim Dietrich today for his psychological testing. After his one-on-one confidential interview with a research assistant, the computer queries Louis for about an hour.

COMPUTER: How many times in the last year have you purposely damaged or destroyed property belonging to your parents or other family members? Type a number for your answer. Your answer was number 2, once…

CURWOOD: Louis has been coming to the clinic since he was an infant. Some of his earliest memories involve playing games here.

LOUIS: They had little Sesame Streets on the walls. The Oscar and all the Sesame Street characters. They’d give us little toys and stuff.

CURWOOD: You’re smiling when you talk about this. Sounds like you really liked coming to visit here.

LOUIS: Yeah, it’s all right.

CURWOOD: Didn’t they poke you with needles, and want to take blood?

LOUIS: Nah, that ain’t that bad. That ain’t a bad part. Nah. They’d keep you comforted while they do that.

CURWOOD: So, this was a fun place to come to?

LOUIS: Yeah.

CURWOOD: For Louis, life away from the neighborhood lead clinic was not as kind. He’s lived in 28 foster homes. He’s been in and out of jail for robbery. And he was even featured in a local newspaper story about kids from a city high school who were having a tough time getting by.

CURWOOD (TO LOUIS): Some of the lead research shows that people who’ve had this question of lead are twice as likely to wind up dealing with the juvenile system, if they hadn’t had it. Think it had any effect on you like that?

LOUIS: I don’t know. Might have, might haven’t. My record is…probably yeah, probably yeah.

CURWOOD: Louis is now out on parole on a robbery conviction. He says he doesn’t want to go back to jail, but in his world he feels his options are limited. His rap says it all.

LOUIS: Now people want to know how I make a living. The same way you do, the only difference is I’m dealing. I’d rather live my life on the straight road and do a legal, I only end up running back to the arms of evil. I got to see and I can’t stand to watch the store. I’d rather sell dope and make it look like we live large. And take the charge. Pay lawyers so I don’t do long behind bars. When I get out, back on block, I’m still waving down cars. And it’s a new way to hustle every time I get out. It seems that every day my momma’s always cussing me out. She’s gonna leave, but I love her, and it’s stressing me more. And I can’t leave this game knowing that my pockets are sore. So I stay grounded not knowing what tomorrow will bring and I wonder… that’s it now. Cut it off right there.

CURWOOD: Bruce Lanphear says while much of the dangers of lead are well documented, society has remained relatively indifferent to the problem, with millions of homes still contaminated by lead paint. That makes it important, he says, for people to understand the link between lead and crime.

LANPHEAR: Partly because, right now, many families and many decision-makers in the United States feel like lead doesn’t affect them at all. I think to the extent that we begin to recognize that lead, or any other toxins, or any other risk factors for that matter increase the rates of criminal behavior, that’s something people feel vulnerable to. Criminals cross over from one neighborhood to the next. And so, when we begin to make connections between lead and criminal behavior, that’s something that people can’t just say, that’s fine, it affects inner city kids, it doesn’t affect my kids. They can’t say that about crime.

[SOUND OF DOOR OPENING AND CLOSING, WALKING IN STAIRWELL]

CURWOOD: The Cincinnati lead team has learned a great deal about the effects of lead but there is still much more work to be done. So at the University of Cincinnati Hospital, Bruce Lanphear’s team is recruiting a whole new cohort of pregnant women. Some of the data to be collected will be used to verify results so far. Other data will break new ground these scientists hope. And nothing can happen without new moms. Amy Kalkbrenner is in charge of enrolling 400 pregnant women and keeping them and their children coming back for the next three years, if not longer. Not an easy task. Today, the soon-to-be-moms are coming in for their first doctor’s appointments and Amy waits at the hospital’s obstetrics clinic, constantly checking and re-checking her notes

KALKBRENNER: Just because we’re at the very beginning of the study, and so this is new to me, as well as being new to the staff. And often times what I’ll do when something is just absolutely brand-spanking new and unexpected, I don’t like to ask my staff to just jump in and do it. Because I don’t want to put them in a tremendously uncomfortable situation. So, oftentimes I’ll sort of do the first few, see how it’s going, feel my way through it, model it a little for them. So it kind of puts the burden back on me to do the screening today.

CURWOOD: Ms. Kalkbrenner hopes to convince suitable candidates to be part of the new study. In exchange, they get some free home improvements and a few hundred dollars to spend at the grocery store. One question these women and their babies may help answer is how much lead is too much. Today, the official threshold of concern is 10 micrograms of lead per deciliter of blood. That’s drastically tightened from the 30 micrograms that was permitted back when Kim Dietrich started his cohort two decades ago. Yet Dr. Lanphear has already conducted short-term studies that show that even 10 micrograms may have harmful effects. Among 5,000 children, he found cognitive deficits from even these tiny amounts of lead, raising the question that there may be no truly safe levels of lead exposure for children.

LANPHEAR: From a population perspective, what we can say about lead exposure is that if there is no discernable threshold, and that’s what the research points to, then 90 percent of the children who are adversely affected by lead in this country never have a blood level that exceeds 10 micrograms per deciliter.

CURWOOD: Dr. Lanphear has also found that the greatest loss of IQ occurs in the earliest stages of lead toxicity.

LANPHEAR: So, going from a blood lead of less than one to a blood lead of 10, on average, is associated with about a seven-point drop in IQ. In contrast, if we looked at a population of children going from 10 micrograms to 20 micrograms per deciliter, there’s only about an estimated two and a half point drop in IQ.

CURWOOD: These new studies are expected to confirm these earlier results, says Dr. Lanphear. But, with evidence that even tiny amounts of lead can affect intelligence, the Cincinnati team wants to explore the role small amounts of lead could play in ADHD, attention deficit hyperactivity disorder. Dr Lanphear says if this research shows a link between lead and this widely publicized condition, it might spark broad public interest since millions of children suffer from ADHD.

LANPHEAR: I think the problem with looking at minor changes or decrements in IQ is that they’re subtle. They’re hard to measure. With ADHD it’s a clinical disease, it’s a clinical diagnosis. And if we can say there’s a 50 percent increase in ADHD for every 10 micrograms increase in blood lead, it may be that people understand that easier.

CURWOOD: For this new study, the team is recruiting 400 pregnant women from middle class and poor neighborhoods in and around Cincinnati. Half of the group will receive extensive home lead abatement.

LANPHEAR: We’ll go in, measure the home. If there’s lead in dust, lead in water, lead in soil, lead in the paint, if the paint is peeling or in disrepair…so if the dust lead levels are excessive, but we don’t find that the paint is in poor condition, we may just do a clean-up. In other cases, the windows may be in really poor shape. We’ll replace the windows. If there’s lead contaminated soil, we’ll do something to cover that up.

CURWOOD: Dr. Lanphear says these efforts should keep child blood lead levels from rising above three micrograms. A control group, involving the homes of 200 pregnant women, will not receive lead abatement. Dr. Lanphear anticipates children in these homes will have more learning disabilities and developmental disorders even though they will have blood lead levels that are considered safe by the government. But Dr. Lanphear doesn’t feel it’s right to improve the lives of half the group and doing nothing for the others. So, for the control group his team is providing help to reduce household hazards, the most common cause of death for children under five.

LANPHEAR: We will put stair gates in place. If indicated, we will turn down water temperature below 120 degrees to make it less likely to burn a child. We’ll put window guards in for multi-level dwellings where there’s over two stories. We will put latches or safety locks on cabinets where cleaners are kept, where medications are kept.

CURWOOD: So far, there are funds to evaluate all the children in the study at 12, 24, and 36 months. But Dr. Lanphear hopes his research will continue over the lifetimes of the children, providing data on the impact of lead for years to come, just as Kim Dietrich has done. But meanwhile, back at the OB clinic, there’s a little snag.

FEMALE: Okay, Christy as of yet has not shown in…

CURWOOD: Clipboard in hand, Dr. Lanphear’s project director Amy Kalkbrenner tells us she thought she’d be much further recruiting participants. She didn’t plan on speaking with these women for the first time today, but efforts to contact them by phone didn’t work much at all.

KALKBRENNER: And I guess I thought more of the time we’d find valid phone numbers. And it’s been about 75 percent of the phone numbers are just completely wrong.

CURWOOD: She later heard from nurses at this low-income clinic that wrong numbers are common here. The women move frequently, phones are disconnected, and sometimes, a wrong number might be given to forestall hospital bill collectors.

KALKBRENNER: I’ve actually been working to prepare this study for just a little over a year. Which is a pretty long time to work on something before it starts. I think this is the longest start-up time I’ve ever had. So, I guess the irony is that even after a year plus of preparation, when the day actually comes, there’s still just a lot of unexpected, a lot of unknown. I don’t want to say chaos, but a little bit of chaos.

CURWOOD: We’ll see how Amy Kalkbrenner does on her first day recruiting pregnant women for the new research cohort later on, but first, a look at the history and politics of lead research, right after this.

[Music: Deadly Avenger “The Bayou” Back to Mine/Everything but the Girl (Ultra 2001)]

ANNOUNCER: Funding for Living on Earth comes from the World Media Foundation. Major contributors include the Ford Foundation, for reporting on U.S. environment and development issues, and the William and Flora Hewlett Foundation, for coverage of Western issues. Support also comes from NPR member stations, and the Noyce Foundation, dedicated to improving math and science instruction from kindergarten through grade 12. And Bob Williams and Meg Caldwell, honoring NPR’s coverage of environmental and natural resource issues, and in support of the NPR President’s Council.