Abstract
The associations between environmental lead exposure and high school educational outcomes in four communities located in New South Wales, Australia, were examined in this ecological study. A mixed model analysis was performed to account for each school's results being more similar than results for other schools. The effect of environmental lead exposure on mean results for five educational outcomes was examined. 'Leaded' schools with more than five per cent of students living in the highest lead risk areas were tested against non-leaded 'comparison' schools that were matched by a pre-defined socio-educational advantage rating. A small disadvantage was found for leaded schools for four out of five outcomes, which was statistically significant for three outcomes: Higher School Certificate English (p < 0.01), School Certificate Mathematics (p < 0.05), and Australian Tertiary Admissions Rank eligibility rate (p < 0.01). This study adds to the large body of evidence in Australia and elsewhere supporting the importance of primary prevention to protect health at multiple stages of development.