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However, the causes of elevated lead in water and the benefits of lead in water avoidance strategies are often misunderstood. Based on experiences in the United States, this paper describes an oversimplified \u2018lead in water equation\u2019 to explain key variables controlling the presence of lead in drinking water to better inform public health practitioners, government officials, utility personnel, and concerned residents. We illustrate the application of the equation in Flint, Michigan and explore the primary household-level water lead avoidance strategies recommended during the crisis, including flushing, filtration, bottled water use, and lead pipe removal. In addition to lead reduction, strategies are evaluated based on costs and limitations. While these lead avoidance strategies will reduce water lead to some degree, the costs, limitations, and effectiveness of these strategies will be site- and event-specific. This paper presents a simplified approach to communicate key factors which must be considered to effectively reduce waterborne lead exposures for a wide range of decision makers.<\/jats:p><jats:p>This article has been made Open Access thanks to the generous support of a global network of libraries as part of the Knowledge Unlatched Select initiative.<\/jats:p>","DOI":"10.2166\/wh.2019.272","type":"journal-article","created":{"date-parts":[[2019,5,24]],"date-time":"2019-05-24T14:16:16Z","timestamp":1558707376000},"page":"540-555","update-policy":"https:\/\/doi.org\/10.2166\/iwapcrossmarkpolicypage","source":"Crossref","is-referenced-by-count":41,"title":["Understanding lead in water and avoidance strategies: a United States perspective for informed decision-making"],"prefix":"10.2166","volume":"17","author":[{"given":"Kelsey J.","family":"Pieper","sequence":"first","affiliation":[{"name":"Department of Civil and Environmental Engineering, Virginia Tech, 418 Durham Hall, Blacksburg, VA 24061, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrienne","family":"Katner","sequence":"first","affiliation":[{"name":"Department of Environmental and Occupational Health Sciences, Louisiana State University Health Science Center, New Orleans, LA 70112, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Kriss","sequence":"first","affiliation":[{"name":"Department of Civil and Environmental Engineering, Virginia Tech, 418 Durham Hall, Blacksburg, VA 24061, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Tang","sequence":"first","affiliation":[{"name":"Department of Civil and Environmental Engineering, Virginia Tech, 418 Durham Hall, Blacksburg, VA 24061, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc A.","family":"Edwards","sequence":"first","affiliation":[{"name":"Department of Civil and Environmental Engineering, Virginia Tech, 418 Durham Hall, Blacksburg, VA 24061, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"945","published-online":{"date-parts":[[2019,5,24]]},"reference":[{"key":"2020032620320514900_JWH-D-18-00272C1","unstructured":"111th Congress 2011 Reduction of Lead in Drinking Water Act. 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