1 This study was supported by the Department of Health, the Executive Yuan, Taiwan (Grant DOH89-TD-2106, NSC 89- 2320-B-037-045), and Kaohsiung City Government Health Department. 2 To whom correspondence should be addressed at Graduate Institute of Occupational Safety and Health, Kaohsiung Medical University, 100 Shih-Chuang First Road, Kaohsiung City, Taiwan, 807. Fax: #886-7-3115948. E-mail: kmco6849@ms14. hinet.net. Environmental Research Section A 89, 12 } 18 (2002) doi:10.1006/enrs.2002.4342, available online at http://www.idealibrary.com on Relationship between Blood Lead Concentrations and Learning Achievement among Primary School Children in Taiwan 1 Chao-Ling Wang,* - Hung-Yi Chuang,? A Chi-Kung Ho,- ? Chun-Yuh Yang,A Jin-Lian Tsai,- Ting-Shan Wu, B and Trong-Neng Wu- *Department of Family Medicine, Yuan’s General Hospital; -Graduate Institute of Occupational Safety and Health, Kaohsiung Medical University; ?Department of Occupational Medicine, Koahsiung Medical University Hospital; ASchool of Public Health, College of Health Science, Kaohsiung Medical University; Institute of Medicine, Kaohsiung Medical University; and BThe Koahsiung City Government’s Health Department Received July 6, 2001 Over the past 20 years lead has been proven to exert an inBuence on the intelligence of children. Especially for children exposed to environmental lead, average blood lead was often lower than the ofAcially recognized intoxication level. Because Kaohsiung is an industrial area in Taiwan and lead exposure is an important environmental issue, we attempted to ascertain the extent to which environ- mental lead inBuences the achievement of primary school children. We randomly selected 934 children from 32 primary schools in 11 districts of Kaohsiung City. Blood lead levels of the children were checked, and they were administered a questionnaire about their family information. Scores of several courses were used in this study on the relationship between a child’s blood lead and his or her academic perfor- mance (Ranking with his or her classmates), includ- ing Chinese (reading and writing short Chinese articles), Mathematics, History and Society, and Natural Science. Multiple regression models were done with adjustments for the confounding effects of their parents’ socioeconomic levels. The mean (SD) of 934 blood lead level was 5.50 (1.86) g/dL. Spearman’s coefAcient showed that class rankings in Chinese, Mathematics, Natural Science, and His- tory and Society were all strongly associated with blood lead levels (P0.01). The multiple regression models revealed that blood lead level exerts a stron- ger inBuence on childern’s language ability (Chinese) than on their ability to calculate (Mathe- matics). Our results suggest that environmental lead exposure adversely affects a child’s academic achievement, making a direct link between expo- sure to lead and academic attainment.  2002 Elsevier Science (USA) Key Words: children; blood lead; learning achieve- ment; school attainment. INTRODUCTION The rapid industrialization of the past three dec- ades has resulted in prosperity and democratization in Taiwan; however, it has also led to environmental pollution. Lead is one of the leading sources of pollu- tion in Taiwan. As mentioned in previous studies, in Taiwan about 10% of lead workers have high blood lead levels (Wu et al., 1998a,b). In addition, two previous studies found that children residing near a battery factory had lower intelligence than those residing in a control area (Rabinowitz et al., 1992; Wang et al., 1992). In those studies, the authors suggest that lead concentrations in the soil and air might have had a signi7cant effect on the children’s intelligence. Kaohsiung City, a southern port city and industrial center in Taiwan, is well known for its air and water pollution problems. Exhaust gas from motor vehicles is an area of great public concern. Lead from leaded gasoline and various industries has been the main source of lead pollution in this area. Although the phase out of leaded gasoline started before 1988 and by 2000 it was totally phased out in Taiwan, there are still concentrations of lead in waste and dust deposits. 12 0013-9351/02 $35.00  2002 Elsevier Science (USA) All rights reserved.