Investigating aluminum cookpots as a source of lead exposure in Afghan refugee children resettled in the United States

The study examines the high prevalence of elevated blood lead levels (BLLs) among Afghan refugee children resettled in the U.S., particularly Washington State, and evaluates whether aluminum cookpots used by these families are a significant source of lead exposure. Lead poisoning in children remains a major global public health problem with no safe exposure level and documented impacts on neurological development and cardiovascular health. Refugee children often arrive with existing lead body burdens and may encounter additional exposures in the U.S. The CDC has established a blood lead reference value (BLRV) for action (recently lowered to 3.5 µg/dL), and refugee children are recommended to be screened. Surveillance data in Washington State and national studies show Afghan children have among the highest rates of elevated BLLs after arrival. Local public health interventions in King County identified aluminum cookpots—especially traditional Afghan pressure cookers—as frequently containing lead. Prior literature indicates lead can leach from cookware (notably ceramics and artisanal aluminum), with leaching influenced by temperature, acidity, and duration of contact. Stainless steel has been suggested as a safer alternative. This study’s purpose is to quantify lead content and leaching from aluminum cookpots used by Afghan families under simulated cooking and storage conditions and to assess stainless steel as a safer option.

Prior work has documented multiple sources of pediatric lead exposure, including leaded paint, contaminated water systems, and lead-glazed ceramics. Research on ceramics shows lead leaching increases with use, temperature, acidity, and contact time. Aluminum cookware made from scrap metals in developing regions has been linked to significant lead exposure; manufacturing often uses lead-containing materials such as batteries and electronic components. Studies in West Africa, South Africa, and elsewhere reported leaching of lead from artisanal aluminum cookware, with greater leaching at higher temperatures and with acidic foods, and sometimes increasing with repeated use. In contrast, stainless steel cookware generally shows lower lead levels, though nickel and chromium can leach, especially with acidic foods; such metals are more relevant for individuals with sensitization rather than a general toxic risk. These findings motivated a focused examination of aluminum cookpots from Afghan households and comparison to stainless steel alternatives.

- Acquisition: 45 cookpots were obtained (Nov 2019–May 2021): 40 aluminum (15 used/donated by Afghan families; 25 newly purchased from online/retail sources such as Amazon, Etsy, AliBaba) and 5 new/unused stainless steel items (4 pressure cookers, 1 stock pot) to evaluate safer alternatives. - XRF screening: Handheld Bruker S1 Titan XRF analyzer used (Nov 2019–Jun 2021). Each item was screened at ~20–50 locations across lids, inner/outer walls, bases, handles, and ancillary components (e.g., rivets, vent pipes). Results reported in ppm with 3-sigma error terms; data offloaded via Bruker Instrument Tools software. Additional metals (Al, Cr, Mn, Fe, Co, Ni, Cu, As, Cd) were recorded to infer component composition and assess stainless steel leachates. Data with >50% measurements below LOD considered tentative. - Leachate protocol: Because no standard exists for metals migration from cookware, methods were adapted from ASTM C738-94 and FDA EAM 4.1. Cookware was washed, rinsed, and filled with 4% v/v acetic acid (TraceMetal grade in 18.2 MΩ DI water), heated to a simmer on a cast-iron electric burner. After 15 minutes of simmering, a 100 mL aliquot was collected (t = 15 min). The vessel then sat 24 h at 20–24 °C and a second 100 mL aliquot was taken (t = 24 h). Samples were refrigerated at 4 °C and analyzed by ICP-MS (EPA 200.8/6020A optimized for acetic acid). Serving size assumed 250 mL (≈1 cup) to estimate daily lead dose. - Health-based benchmarks: Results compared to FDA interim reference levels (IRLs) for dietary lead intake: 3 µg/day for children and 12.5 µg/day for women of childbearing age, aligned to keeping BLLs below the prior CDC BLRV of 5 µg/dL.

- Aluminum cookware lead content: Numerous aluminum cookpots had lead >100 ppm. The highest measured lead concentration in a component (pressure cooker vent pipe) was 68,926 ppm. Pressure cookers frequently had brass-like vent components with high copper and lead. - Aluminum leaching at 15 minutes: Lead in leachate ranged 0.00006–1.59 µg/mL, corresponding to estimated doses of 0.015–398 µg per 250 mL serving. 23 of 40 cookpots exceeded the child IRL (3 µg/day) and 16 met or exceeded the adult IRL (12.5 µg/day). All donated Afghan-community cookpots exceeded the child IRL. - Aluminum leaching after 24 hours: Lead in leachate increased in all items (up to ~150-fold); range 0.0002–7.77 µg/mL, with estimated doses 0.050–1,940 µg per 250 mL. 27 of 40 exceeded the child IRL and 23 exceeded the adult IRL. One pressure cooker exceeded the child IRL by ~650-fold. - Stainless steel cookware: Median lead by XRF was below LOD to 67 ppm; highest spot values (104 and 132 ppm) occurred in vent pipes. Leachate lead concentrations were low: 0.00018–0.0015 µg/mL at 15 min (0.045–0.375 µg/serving), and 0.00006–0.00054 µg/mL at 24 h (0.015–0.135 µg/serving). No stainless steel item exceeded child or adult IRLs. - Market availability and broader risk: Traditional Afghan pressure cookers and various aluminum cookware types (calderos, steamers, skillets) were available in U.S. marketplaces and some imported items (from China, India, Colombia, Taiwan) also leached lead above IRLs, indicating a wider public health concern beyond refugee communities.

The findings directly address the research objective by demonstrating that many aluminum cookpots used by Afghan refugee families contain substantial lead, and under realistic cooking and storage conditions can leach lead at levels exceeding FDA dietary IRLs, plausibly contributing to elevated BLLs observed in Afghan children. The identification of very high lead in pressure-cooker vent components underscores the importance of assessing ancillary parts such as brass valves. The study extends prior evidence on artisanal aluminum cookware by documenting higher lead content and leachate levels than previously reported. The observation that comparable aluminum products available in U.S. markets can also leach significant lead indicates this is a broader public health issue affecting other residents and communities. Stainless steel generally performed as a safer alternative for lead, though the potential for nickel and chromium release—especially in acidic conditions—suggests that material selection and component composition still warrant scrutiny, particularly for individuals with metal sensitivities. Overall, results support interventions to replace lead-leaching cookware with safer options and to improve regulatory oversight and consumer awareness.

This study provides the first evidence that aluminum cookware brought by Afghan refugee families to the U.S. can be an important source of lead exposure for children and adults, and that some aluminum cookware sold in the U.S. also poses risk. Stainless steel appears to be a safer alternative for lead, though ancillary components should be evaluated for lead-containing alloys. The authors recommend: establishing regulatory standards and test methods for lead in cookware; implementing third-party certification and international guidance (e.g., WHO) addressing artisanal aluminum cookware; aligning FDA’s childhood IRL with the updated CDC BLRV (suggested to 2.1 µg/day); using FDA authority to restrict import/sale of lead-containing cookware; enhancing culturally competent outreach to immigrant communities; increasing pediatric BLL screening and follow-up; investing in public health infrastructure for surveillance and interventions. Future work includes testing cookware used by other immigrant communities and evaluating leaching of other toxic metals (e.g., cadmium, cobalt, manganese).

- Selection bias: 15 of 40 aluminum cookpots were donated items previously flagged as high-lead during home assessments. - Attribution limits: No longitudinal BLL data to quantify the specific contribution of cookware removal to child BLL reductions; multiple other lead sources identified (e.g., glazed dishes, spices, cosmetics, jewelry). - Method constraints: Pressure cookers were not allowed to pressurize and boiling was limited to 15 minutes; actual cooking may yield higher leaching. Some XRF datasets had >50% results below LOD. Colorimetric lead tests were unreliable without abrading surfaces. - Sample scope: Small number of stainless steel items limits generalizability for stainless steel leaching behavior. - Exposure assumptions: Daily intake assumed 250 mL per person; real consumption may differ, under- or over-estimating dose.