We evaluated the results of first-draw testing from child care facilities across North Carolina to identify socioeconomic, demographic, and infrastructure-related factors associated with the risk of elevated lead in water in child care settings. To our knowledge, this study is the largest analysis of lead levels in child care facilities in the United States to date. The study provides critical new insight for facility staff and policymakers to make evidence-based decisions to improve the process of identifying, communicating, and eliminating water-related lead exposures where children learn and play. (author abstract)