Childhood lead poisoning is a significant global health concern, particularly impacting neurological development and cardiovascular health. While various sources of lead exposure are known (leaded gasoline, paint, etc.), refugee populations, often carrying lead-contaminated items from their home countries, face heightened risks. Afghan refugee children resettled in Washington State have the highest prevalence of elevated BLLs among refugee populations in the US. Previous interventions identified aluminum cookpots, including traditional Afghan pressure cookers, as a potential source of lead exposure within this community. Most research on lead-contaminated cookware has focused on lead-glazed ceramics. However, artisanal aluminum cookware, often made from recycled scrap metal containing lead, is another significant source, particularly in developing countries. This study aimed to quantify lead levels in aluminum cookpots used by Afghan refugee families, measure lead leaching during simulated cooking and storage, and assess stainless steel as a safer alternative.

Extensive literature documents the health effects of lead exposure, particularly in children. Major sources of lead exposure have been identified, including leaded gasoline, industrial activities, paint, and various consumer products. Refugee children are disproportionately affected, often carrying a lead body burden and facing further exposure in their resettlement locations. Studies highlight the high prevalence of elevated BLLs in Afghan refugee children in the US, compared to other refugee populations. Previous research emphasizes the lead contamination of ceramic cookware, with leaching increased by factors like glaze deterioration, food pH, and cooking temperature. Aluminum cookware, due to its low cost and heat conductivity, is widely used, especially in developing nations, where its production from lead-containing scrap metal is a concern. Existing research shows that lead leachability increases with temperature and cookware age, and acidic foods enhance lead extraction. In contrast, stainless steel cookware has been shown to have significantly lower aluminum and lead concentrations when used for cooking traditional foods.

This study analyzed 40 aluminum cookpots (15 donated by Afghan families, 25 purchased new) and 5 stainless steel cookpots. Lead content was measured using a handheld X-ray fluorescence (XRF) analyzer at multiple locations on each cookpot. A novel leachate method, adapted from existing standards (ASTM C 738-94 and FDA EAM Method 4.1), was developed to estimate lead migration into food. This method involved simmering 4% v/v acetic acid in each cookpot for 15 min, followed by a 24-hour storage period at room temperature. Aliquots were analyzed for lead concentration using Inductively Coupled Plasma-Mass Spectrometry (ICP-MS). Results were compared to FDA's interim reference levels (IRLs) for lead exposure (3 µg/day for children, 12.5 µg/day for women of childbearing age), assuming a 250 mL serving size.

XRF analysis revealed high lead concentrations in many aluminum cookpots, with a maximum detected concentration of 68,926 ppm (in a pressure cooker vent pipe). Median lead concentrations ranged from below the limit of detection (LOD) to over 14,000 ppm. Leachate testing showed significant lead leaching in many aluminum cookpots. At 15 minutes, lead doses ranged from 0.015 to 398 µg/day, exceeding the childhood IRL in 23 cookpots and the adult IRL in 16. After 24 hours, lead doses ranged from 0.050 to 1940 µg/day, exceeding the childhood IRL in 27 cookpots and the adult IRL in 23. Notably, all donated (Afghan community) cookpots exceeded the childhood IRL. In contrast, stainless steel cookpots showed significantly lower lead leaching, with no cookpots exceeding the childhood or adult IRLs. While some stainless steel cookpots exhibited higher nickel and chromium release at low pH, these levels were not considered a significant health concern for most individuals.

The study demonstrates that aluminum cookpots, both those brought from Afghanistan and those available for purchase in the US, represent a significant source of lead exposure. The high lead concentrations and leaching observed in Afghan pressure cookers are particularly concerning, especially considering common cooking practices. The findings extend beyond the Afghan refugee community, highlighting a broader public health issue involving imported aluminum cookware. The significantly lower lead leaching from stainless steel cookpots confirms its suitability as a safer alternative. The study's results emphasize the need for international regulatory action and public health interventions to address the issue of lead contamination in cookware.

This study reveals a previously unrecognized source of lead exposure through aluminum cookware, impacting both Afghan refugee families and the broader US population. Stainless steel represents a safer alternative. Recommendations include regulating the metal content of aluminum cookware, developing third-party certification based on health-based standards, updating WHO guidance, establishing a regulatory standard for lead content in cookware, lowering the FDA's IRL for children to align with the updated CDC BLRV, preventing the import and sale of lead-containing cookware, and public health information campaigns.

Selection bias may exist due to the inclusion of previously identified high-lead cookpots from the Afghan community. Lack of follow-up BLL testing limits assessment of the impact of cookpot removal on children's BLLs. The leachate method may underestimate lead levels under typical high-pressure cooking conditions. The small sample size of stainless steel cookpots limits the generalizability of those findings. The assumed daily serving size of 250 mL may not accurately reflect actual consumption.