Evaluation of HUD-funded lead hazard control treatments at 6 years post-intervention

Using exterior housing conditions to predict elevated pediatric blood lead levels

Housing-based lead paint dust is the most common source of lead exposure for US-born children. Although year of housing construction is a critical indicator of the lead hazard to US children, not all housing of the same age poses the same risk to children. Additional information about housing condition is required to differentiate the housing-based lead risk at the parcel level. This study aimed to identify and assess a method for gathering and using observations of exterior housing conditions to identify active housing-based lead hazards at the parcel level. We used a dataset of pediatric blood lead observations (sample years 2000-2013, ages 6-72 months, n = 6,589) to assess associations between observations of exterior housing conditions and housing-based lead risk. We used graphical and Lasso regression methods to estimate the likelihood of an elevated blood lead observation (≥3.5 μg/dL). Our methods estimate a monotonic increase in the likelihood of an elevated blood lead observation as housing conditions deteriorate with the largest changes associated with homes in the greatest disrepair. Additionally we estimate that age of home construction works in consort with housing conditions to amplify risks among those houses built before 1952. Our analysis indicates that a survey of external housing conditions can be used in combination with age of housing in the identification process, at the parcel level, of homes that pose a housing-based lead hazard to children.

An interdisciplinary team-based approach for significantly reducing lower-level lead poisoning in U.S. children

Child lead poisoning damages central nervous system, immune, and renal function, and is the longest-standing public health epidemic in U.S. history. While primary prevention is the ultimate goal, secondary intervention is critical for curbing effects among children already exposed. Despite the lowering of child blood lead level (BLL) reference value in 2012 and again in 2021, few changes to secondary intervention approaches have been discussed. This study tested a novel interdisciplinary approach integrating ongoing child BLL-monitoring with education and home mitigation for families living in neighborhoods at high-risk of child lead exposure. In children ages 6 months to 16 years, most of whom had lowest range exposures, we predicted significantly reduced BLLs following intervention.

Methods

Twenty-one families with 49 children, were offered enrollment when at least 1 child in the family was found to have a BLL > 2.5 µg/dL. Child BLLs, determined by ICPMS, were monitored at 4- to 6-month intervals. Education was tailored to family needs, reinforced through repeated parent engagement, and was followed by home testing reports with detailed case-specific information and recommendations for no-cost/low-cost mitigation.

Results

Ninety percent of enrolled families complied with the mitigation program. In most cases, isolated, simple-to-mitigate lead hazard sources were found. Most prevalent were consumer products, found in 69% (11/16) of homes. Lead paint was identified in 56% (9/16) of homes. Generalized linear regression with Test Wave as a random effect showed that children's BLLs decreased significantly following the intervention despite fluctuations.

Conclusion

Lower-level lead poisoning can be reduced through an interdisciplinary approach that combines ongoing child BLL monitoring; repeated, one-on-one parent prevention education; and identification and no-cost/low-cost mitigation of home lead hazards. Biannual child BLL monitoring is essential for detecting and responding to changes in child BLLs, particularly in neighborhoods deemed high-risk for child lead poisoning.

The urban lead (Pb) burden in humans, animals and the natural environment

Centuries of human activities, particularly housing and transportation practices from the late 19th century through the 1980's, dispersed hundreds of millions of tons of lead into our urban areas. The urban lead burden is evident among humans, wild and domesticated animals, and plants. Animal lead exposures closely mirror and often exceed the lead exposure patterns of their human partners. Some examples: Pigeons in New York City neighborhoods mimicked the lead exposures of neighborhood children, with more contaminated areas associated with higher exposures in both species. Also, immediately following the lead in drinking water crisis in Flint MI in 2015, blood lead levels in pet dogs in Flint were 4 times higher than in surrounding towns. And combining lead's neurotoxicity with urban stress results in well-characterized aggressive behaviors across multiple species. Lead pollution is not distributed evenly across urban areas. Although average US pediatric lead exposures have declined by 90% since the 1970s, there remain well defined neighborhoods where children continue to have toxic lead exposures; animals are poisoned there, too. Those neighborhoods tend to have disproportionate commercial and industrial lead activity; a history of dense traffic; older and deteriorating housing; past and operating landfills, dumps and hazardous waste sites; and often lead contaminated drinking water. The population there tends to be low income and minority. Urban wild and domesticated animals bear that same lead burden. Soil, buildings, dust and even trees constitute huge lead repositories throughout urban areas. Until and unless we begin to address the lead repositories in our cities, the urban lead burden will continue to impose enormous costs distributed disproportionately across the domains of the natural environment. Evidence-based research has shown the efficacy and cost-effectiveness of some US public policies to prevent or reduce these exposures. We end with a series of recommendations to manage lead-safe urban environments.

A simple lead dust fall method predicts children's blood lead level: New evidence from Australia

We have measured dust fall accumulation in petri dishes (PDD) collected 6 monthly from inside residences in Sydney urban area, New South Wales, Australia as part of a 5-year longitudinal study to determine environmental associations, including soil. with blood lead (PbB) levels. The Pb loading in the dishes (n = 706) had geometric means (GM) of 24µg/m²/30d, a median value of 22µg/m²/30d with a range from 0.2 to 11,390µg/m²/30d. Observed geometric mean PbB was 2.4µg/dL at ages 2-3 years. Regression analyses showed a statistically significant relationship between predicted PbB and PDD. The predicted PbB values from dust in our study are consistent with similar analyses from the US in which floor dust was collected by wipes. Predicted PbB values from PDD indicate that an increase in PDD of about 100µg/m²/30d would increase PbB by about 1.5µg/dL or a doubling PbB at the low levels currently observed in many countries. Predicted PbB values from soil indicate that a change from 0 to 1000mg Pb/kg results in an increase of 1.7µg/dL in PbB, consistent with earlier investigations. Blood Pb levels can be predicted from dust fall accumulation (and soil) in cases where blood sampling is not always possible, especially in young children. Petri dish loading data could provide an alternative or complementary "action level" at about 100µg Pb/m²/30 days, similar to the suggested level of about 110µg Pb/m² for surface wipes, for use in monitoring activities such as housing rehabilitation, demolition or soil resuspension.

An investigation into porch dust lead levels

Lead in porch dust can expose children through direct contact or track-in to the home, but has not been adequately evaluated. At homes undergoing lead hazard control in Rochester, NY, we sampled settled dust lead on exterior porch floors at baseline, immediately post-lead hazard control and one-year post-work (n=79 homes with complete data) via wipe sampling and collected housing, neighborhood and soil data. Baseline GM porch floor dust lead loading (PbPD) was 68 µg/ft(2), almost four times more than baseline GM interior floor dust lead (18 µg/ft(2)). Immediate post-work PbPD declined 55% after porch floor replacement and 53% after porch floor paint stabilization (p=0.009 and p=0.041, respectively). When no porch floor work was conducted but lead hazard control was conducted elsewhere, immediate post-work PbPD increased 97% (p=0.008). At one-year, GM PbPD continued to decline for porch replacement (77% below baseline) and paint stabilization (72% below baseline), but where no porch floor work was done, GM PbPD was not significantly different than baseline (p<0.001, p=0.028 and p=0.504, respectively). Modeling determined that porch floor replacement had significantly lower one-year PbPD than stabilization when baseline PbPD levels were higher than 148 µg/ft(2) (the 77th percentile) but not at lower levels. Treatment of porches with lead paint results in substantial declines in PbPD levels. It is of concern that PbPD levels increased significantly at immediate post-work when lead hazard control was not conducted on the porch but was conducted elsewhere. Standards for porch lead dust should be adopted to protect children from inadequate clean-up after lead hazard control.

Persistent organic pollutants in dust from older homes: learning from lead

OBJECTIVES

We aimed to (1) evaluate the relation between home age and concentrations of multiple chemical contaminants in settled dust and (2) discuss the feasibility of using lead hazard controls to reduce children's exposure to persistent organic pollutants.

METHODS

As part of the California Childhood Leukemia Study, from 2001 to 2007, we used a high-volume small surface sampler and household vacuum cleaners to collect dust samples from 583 homes and analyzed the samples for 94 chemicals with gas chromatography-mass spectrometry and inductively coupled plasma mass spectrometry. We evaluated relations between chemical concentrations in dust and home age with Spearman rank correlation coefficients.

RESULTS

Dust concentrations of lead, polychlorinated biphenyls, organochlorine insecticides, and polycyclic aromatic hydrocarbons were correlated with home age (ρ > 0.2; P < .001), whereas concentrations of pyrethroid insecticides and polybrominated diphenyl ethers were not.

CONCLUSIONS

Dust in older homes contains higher levels of multiple, persistent chemicals than does dust in newer homes. Further development of strategies to reduce chemical exposures for children living in older homes is warranted.

Housing interventions and control of health-related chemical agents: a review of the evidence

Subject matter experts systematically reviewed evidence on the effectiveness of housing interventions that affect health outcomes associated with exposure to chemical agents, such as pesticides, lead, volatile organic compounds, as well as the radon gas. Particulates were also examined, and the role of ventilation on exposures was assessed. The review included both published literature and peer-reviewed reports from the US Environmental Protection Agency. Four of the 14 interventions reviewed had sufficient evidence to demonstrate their effectiveness and are ready for implementation: radon air mitigation by using active soil depressurization systems, integrated pest management to reduce exposures to pesticides, smoke-free home policies making indoor areas smoke-free (ie, no smoking allowed anywhere at any time), and residential lead hazard control. Four interventions needed more field evaluation, 3 needed formative research, and 3 either had no sufficient evidence of effectiveness or had evidence the interventions were ineffective. This evidence review shows that housing improvements are likely to help reduce radon-induced lung cancer, cardiovascular mortality related to secondhand smoke, and neurological effects from exposure to pesticides and lead paint. Investing in housing interventions may yield important savings from reduced disease and injury from avoidable exposures to chemical agents.

Childhood lead poisoning prevention through prenatal housing inspection and remediation in St. Louis, MO

OBJECTIVE

We assessed the screening and remediation of home lead hazards prenatally in a high-risk population, hypothesizing that average blood-lead level and the number of poisonings would drop by 25%.

STUDY DESIGN

One hundred fifty-two women underwent prenatal home inspections by certified lead inspectors. The hazards that were identified were remediated. The blood-lead levels of children of participating women were compared with matched control subjects.

RESULTS

Blood-lead levels were obtained from 60 children and compared with matched control subjects. The average blood-lead level of children in the treatment group was 2.70 μg/dL vs 3.73 μg/dL in control subjects (P = .019). The percentage of children with levels >10 μg/dL in the treatment group was 0% vs 4.2% in control subjects (P = .128).

CONCLUSION

Screening and remediation of houses of pregnant women is effective to reduce the average blood-lead level and number of children that exceed the federal level of concern for lead poisoning in a high-risk population.

Window replacement and residential lead paint hazard control 12 years later

Window replacement is a key method of reducing childhood lead exposure, but the long-term effectiveness has not been previously evaluated. Windows have the highest levels of interior lead paint and dust compared to other building components. Our objective was to conduct a follow-up study of residential window replacement and lead hazard control 12 years after homes were enrolled in an evaluation of the HUD Lead Hazard Control Grant Program, sampling settled lead dust in housing in four cities (n=189 homes). Previous work evaluated lead hazard controls up to 6 years after intervention using dust lead measurements and two years after intervention using both dust and blood lead data. But the earlier work could not examine the effect of window replacement over the longer time period examined here: 12 years. The individual homes were assigned to one of three categories, based on how many windows had been replaced: all replacement, some replacement, or non-replacement. Windows that were not replaced were repaired. We controlled for covariates such as site, housing condition, presence of lead paint, and season using longitudinal regression modeling. Adjusted floor and sill dust lead geometric mean dust lead loadings declined at least 85% from pre-intervention to 12 years after the intervention for homes with all replacement windows, some windows replaced and no windows replaced. Twelve years after intervention, homes with all replacement windows had 41% lower interior floor dust lead, compared to non-replacement homes (1.4 versus 2.4 μg/ft2, p<0.001), and window sill dust lead was 51% lower (25 versus 52 μg/ft2, p=0.006) while controlling for covariates. Homes with some windows replaced had interior floor and window sill dust lead loadings that were 28% (1.7 versus 2.4 μg/ft2, p=0.19) and 37% (33 versus 52 μg/ft2, p=0.07) lower, respectively, compared to non-replacement homes. The net economic benefit of window replacement compared to window repair (non-replacement) is $1700-$2000 per housing unit. Homes in which all windows were replaced had significantly lower lead dust. New windows are also likely to reduce energy use and improve home value. Lead-safe window replacement is an important element of lead hazard control, weatherization, renovation and housing investment strategies and should be implemented broadly to protect children.

Effects of HUD-supported lead hazard control interventions in housing on children's blood lead

The Evaluation of the US Department of Housing and Urban Development Lead-Based Paint Hazard Control Grant Program studied the effectiveness of the housing intervention performed in reducing the blood lead of children at four post-intervention times (6-months, 1-year, 2-years, and 3-years). A repeat measures analysis showed that blood lead levels declined up to three-years post-intervention. The results at each successive collection time were significantly lower than at the previous post-intervention time except for the difference between the levels at two and three years. At two-years post-intervention, geometric mean blood lead levels were approximately 37% lower than at pre-intervention. Children with pre-intervention blood lead levels as low as 10 μg/dL experienced substantial declines in blood lead levels. Previous studies have found substantial improvements only if a child's pre-intervention blood lead level was above 20 μg/dL. Individual interior lead hazard control treatments as grouped by Interior Strategy were not a significant predictor of post-intervention blood lead levels. However, children living in dwellings where exterior lead hazard control interventions were done had lower blood lead levels at one-year post-intervention than those living in dwellings without the exterior interventions (all other factors being equal), but those differences were only significant when the mean exterior paint lead loading at pre-intervention was about the 90th percentile (7.0mg/cm(2)). This observation suggests that exterior lead hazard control can be an important component of a lead hazard control plan. Children who were six to eleven months of age at pre-intervention had a significant increase in blood lead at one-year post-intervention, probably due to other exposures.

Boundary networks and Rochester's "smart" lead law: the use of multidisciplinary information in a collaborative policy process

The Rochester, New York, Coalition to Prevent Lead Poisoning formed in 2001 with the goal of eliminating childhood lead poisoning by 2010. The Coalition recruited diverse community stakeholders into a collaborative process committed to using the best available science. The Coalition successfully infused the debate about a new lead poisoning law with local data, national analyses, and the latest medical research. We argue that this was facilitated by a boundary network of individuals who provided technical input throughout the process. As a result of the Coalition's advocacy, in 2005 the Rochester City Council unanimously passed an ordinance that has been hailed as one of the nation's "smartest" lead laws. Many communities are looking to Rochester's new lead ordinance as a model. Both the process and outcome of this case provide valuable lessons for collaborative efforts to promote scientifically sound local environmental health policy.

Participatory testing and reporting in an environmental-justice community of Worcester, Massachusetts: a pilot project

BACKGROUND

Despite indoor home environments being where people spend most time, involving residents in testing those environments has been very limited, especially in marginalized communities. We piloted participatory testing and reporting that combined relatively simple tests with actionable reporting to empower residents in Main South/Piedmont neighborhoods of Worcester, Massachusetts. We answered: 1) How do we design and implement the approach for neighborhood and household environments using participatory methods? 2) What do pilot tests reveal? 3) How does our experience inform testing practice?

METHODS

The approach was designed and implemented with community partners using community-based participatory research. Residents and researchers tested fourteen homes for: lead in dust indoors, soil outdoors, paint indoors and drinking water; radon in basement air; PM2.5 in indoor air; mold spores in indoor/outdoor air; and drinking water quality. Monitoring of neighborhood particulates by residents and researchers used real-time data to stimulate dialogue.

RESULTS

Given the newness of our partnership and unforeseen conflicts, we achieved moderate-high success overall based on process and outcome criteria: methods, test results, reporting, lessons learned. The conflict burden we experienced may be attributable less to generic university-community differences in interests/culture, and more to territoriality and interpersonal issues. Lead-in-paint touch-swab results were poor proxies for lead-in-dust. Of eight units tested in summer, three had very high lead-in-dust (>1000 microg/ft2), six exceeded at least one USEPA standard for lead-in-dust and/or soil. Tap water tests showed no significant exposures. Monitoring of neighborhood particulates raised awareness of environmental health risks, especially asthma.

CONCLUSIONS

Timely reporting back home-toxics' results to residents is ethical but it must be empowering. Future work should fund the active participation of a few motivated residents as representatives of the target population. Although difficult and demanding in time and effort, the approach can educate residents and inform exposure assessment. It should be considered as a core ingredient of comprehensive household toxics' testing, and has potential to improve participant retention and the overall positive impact of long-term environmental health research efforts.

Lead levels in new enamel household paints from Asia, Africa and South America

In 2006 a report on the analysis for lead in 80 new residential paints from four countries in Asia revealed high levels in three of the countries (China, India and Malaysia) and low levels in a fourth country (Singapore) where a lead in paint regulation was enforced. The authors warned of the possible export of lead-painted consumer products to the United States and other countries and the dangers the lead paint represented to children in the countries where it was available for purchase. The need for a worldwide ban on the use of lead in paints was emphasized to prevent an increase in exposure and disease from this very preventable environmental source. Since the earlier paper almost 300 additional new paint samples have been collected from the four initial countries plus 8 additional countries, three from Asia, three from Africa and two from South America. During the intervening time period two million toys and other items imported into the United States were recalled because the lead content exceeded the United States standard. High lead paints were detected in all 12 countries. The average lead concentration by country ranged from 6988 (Singapore) to 31,960ppm (Ecuador). One multinational company sold high lead paint in one country through January 2007 but sold low lead paint later in 2007 indicating that a major change to cease adding lead to their paints had occurred. However, the finding that almost one-third of the samples would meet the new United States standard for new paint of 90ppm, suggests that the technology is already available in at least 11 of the 12 countries to produce low lead enamel paints for domestic use. The need remains urgent to establish effective worldwide controls to prevent the needless poisoning of millions of children from this preventable exposure.

Childhood lead poisoning: conservative estimates of the social and economic benefits of lead hazard control

BACKGROUND

This study is a cost-benefit analysis that quantifies the social and economic benefits to household lead paint hazard control compared with the investments needed to minimize exposure to these hazards.

OBJECTIVES

This research updates estimates of elevated blood lead levels among a cohort of children < or = 6 years of age and compiles recent research to determine a range of the costs of lead paint hazard control ($1-$11 billion) and the benefits of reduction attributed to each cohort for health care ($11-$53 billion), lifetime earnings ($165-$233 billion), tax revenue ($25-$35 billion), special education ($30-$146 million), attention deficit-hyperactivity disorder ($267 million), and the direct costs of crime ($1.7 billion).

RESULTS

Each dollar invested in lead paint hazard control results in a return of $17-$221 or a net savings of $181-269 billion.

CONCLUSIONS

There are substantial returns to investing in lead hazard control, particularly targeted at early intervention in communities most likely at risk. Given the high societal costs of inaction, lead hazard control appears to be well worth the price.

Exposure of U.S. children to residential dust lead, 1999-2004: I. Housing and demographic factors

BACKGROUND

Lead-contaminated house dust is a major source of lead exposure for children in the United States. In 1999-2004, the National Health and Nutrition Examination Survey (NHANES) collected dust lead (PbD) loading samples from the homes of children 12-60 months of age.

OBJECTIVES

In this study we aimed to compare national PbD levels with existing health-based standards and to identify housing and demographic factors associated with floor and windowsill PbD.

METHODS

We used NHANES PbD data (n=2,065 from floors and n=1,618 from windowsills) and covariates to construct linear and logistic regression models.

RESULTS

The population-weighted geometric mean floor and windowsill PbD were 0.5 microg/ft2 [geometric standard error (GSE)=1.0] and 7.6 microg/ft2 (GSE=1.0), respectively. Only 0.16% of the floors and 4.0% of the sills had PbD at or above current federal standards of 40 and 250 microg/ft2, respectively. Income, race/ethnicity, floor surface/condition, windowsill PbD, year of construction, recent renovation, smoking, and survey year were significant predictors of floor PbD [the proportion of variability in the dependent variable accounted for by the model (R2)=35%]. A similar set of predictors plus the presence of large areas of exterior deteriorated paint in pre-1950 homes and the presence of interior deteriorated paint explained 20% of the variability in sill PbD. A companion article [Dixon et al. Environ Health Perspect 117:468-474 (2009)] describes the relationship between children's blood lead and PbD.

CONCLUSION

Most houses with children have PbD levels that comply with federal standards but may put children at risk. Factors associated with PbD in our population-based models are primarily the same as factors identified in smaller at-risk cohorts. PbD on floors and windowsills should be kept as low as possible to protect children.

Exposure of U.S. children to residential dust lead, 1999-2004: II. The contribution of lead-contaminated dust to children's blood lead levels

BACKGROUND

The U.S. Centers for Disease Control and Prevention collected health, housing, and environmental data in a single integrated national survey for the first time in the United States in 1999-2004.

OBJECTIVES

We aimed to determine how floor dust lead (PbD) loadings and other housing factors influence childhood blood lead (PbB) levels and lead poisoning.

METHODS

We analyzed data from the 1999-2004 National Health and Nutrition Examination Survey (NHANES), including 2,155 children 12-60 months of age with PbB and PbD measurements. We used linear and logistic regression models to predict log-transformed PbB and the odds that PbB was >or=5 and >or=10 microg/dL at a range of floor PbD.

RESULTS

The population-weighted geometric mean (GM) PbB was 2.0 microg/dL (geometric standard error=1.0). Age of child, race/ethnicity, serum cotinine concentration, poverty-to-income ratio, country of birth, year of building construction, floor PbD by floor surface and condition, windowsill PbD, presence of deteriorated paint, home-apartment type, smoking in the home, and recent renovation were significant predictors in either the linear model [the proportion of variability in the dependent variable accounted for by the model (R2)=40%] or logistic model for 10 microg/dL (R2=5%). At floor PbD=12 microg/ft2, the models predict that 4.6% of children living in homes constructed before 1978 have PbB>or=10 microg/dL, 27% have PbB>or=5 microg/dL, and the GM PbB is 3.9 microg/dL.

CONCLUSIONS

Lowering the floor PbD standard below the current standard of 40 microg/ft2 would protect more children from elevated PbB.

Selecting a lead hazard control strategy based on dust lead loading and housing condition: II. Application of Housing Assessment Tool (HAT) modeling results

In Part I in this issue, modeling was used to identify a Housing Assessment Tool (HAT) that can be used to predict relative intervention effectiveness for a range of intervention intensities and baseline dust lead loadings in occupied dwellings. The HAT predicts one year post-intervention floor and windowsill loadings and the probability that these loadings will exceed current federal lead hazard standards. This article illustrates the field application of the HAT, helping practitioners determine the minimum intervention intensity needed to reach "acceptable" one year post-intervention levels, with acceptability defined based on specific project needs, local needs, regulations, and resource constraints. The HAT is used to classify a dwelling's baseline condition as good or poor. If the average number of interior non-intact painted surfaces per room is >/=2, then the dwelling is rated as poor. If exterior windows/doors are deteriorated and the average number of exterior non-intact painted surfaces per building side is >/=5, then the dwelling is rated as poor. If neither of these conditions is true, then the dwelling's HAT rating is good. The HAT rating is then combined with baseline average floor loading to help select the treatment intensity. For example, if the baseline floor loading is 100 mug/ft(2) (1,075 mug/m(2) and the HAT rating is poor, the probability that the one-year floor loading exceeds the federal standard of 40 mug/ft(2) (430 mug/m(2) is 27% for a high-intensity strategy (i.e., window lead abatement with other treatments) but is 54% for a lower-intensity strategy (i.e., cleaning and spot painting). If the HAT rating is good, the probability that the one-year floor loading exceeds 40 mug/ft(2) is approximately the same for low- and high-intensity strategies (18% for window lead abatement with other treatments compared with 16% for cleaning and spot painting). Lead hazard control practitioners can use this information to make empirically based judgments about the treatment intensity needed to ensure that one year post-intervention loadings remain below federal standards.

Selecting a lead hazard control strategy based on dust lead loading and housing condition: I. Methods and results

A methodology was developed to classify housing conditions and interior dust lead loadings, using them to predict the relative effectiveness of different lead-based paint hazard control interventions. A companion article in this issue describes how the methodology can be applied. Data from the National Evaluation of the HUD Lead Hazard Control Grant Program, which covered more than 2800 homes in 11 U.S. states, were used. Half these homes (1417) met the study's inclusion criteria. Interior interventions ranged from professional cleaning with spot painting to lead abatement on windows, and enclosure, encapsulation, or removal of other leaded building components. Modeling was used to develop a visual Housing Assessment Tool (HAT), which was then used to predict relative intervention effectiveness for a range of intervention intensities and baseline floor and windowsill dust lead loadings in occupied dwellings. More than 117,000 potential HATs were considered. To be deemed successful, potential HATs were required to meet these criteria: (1) the effect of interior strategy had to differ for HAT ratings of good vs. poor building condition and/or baseline dust lead loadings; (2) the HAT rating had to be a predictor of one year post-intervention loadings; (3) interior intervention strategy had to be a predictor of one-year loadings; (4) higher baseline loadings could not be associated with lower one-year loadings; and (5) neither exterior work nor site/soil work could result in higher predicted one-year loadings for either HAT rating. Of the 1299 HATs that met these criteria, one was selected because it had the most significant differences between strategy intensities when floors and sills were considered together. For the selected HAT, site/soil work was a predictor of one-year loadings for floors (p = 0.009) but not for sills (p = 0.424). Hazard control work on the building exterior was a predictor of both sill and floor one-year loadings (p = 0.004 and p < 0.001, respectively). Regardless of the type of interior intervention strategy, interior work was a predictor of both floor and sill one-year loadings (each p < or = 0.001).

Collaborating for primary prevention: Rochester's new lead law

In December 2005, the City Council of Rochester, New York, passed an amendment to its municipal code requiring inspection for and correction of lead hazards. Local lead poisoning prevention advocates had long recognized the need for stronger lead policy to address Rochester's high rate of childhood lead poisoning. Between 2000 and 2005, a diverse coalition of educators, healthcare professionals, community members, researchers, government officials, and many others worked to develop a strategy for ending childhood lead poisoning in Rochester by 2010. Their experience in defining the issue, mustering resources, and structuring their decision-making processes is informative for other communities seeking to overcome barriers to improved primary prevention policy.

Immediate and one-year post-intervention effectiveness of Maryland's lead law treatments

A 1994 Maryland law prescribes a lead-based paint risk reduction standard for pre-1950, privately owned rental housing. This standard, applied at each tenancy change, can be met by sampling to verify that dust lead loadings are within acceptable limits or by performing specific lead hazard reduction treatments, followed by an independent visual inspection without dust sampling. We evaluated the ability of visual inspection to predict treatment completion and dust lead loadings. Fifty-two Baltimore housing units were enrolled and received the law-specified treatments. Before treatment, study risk assessors conducted visual assessments and dust lead wipe sampling in each unit. After treatment, Maryland-certified visual inspectors conducted the law's required visual inspection, followed by the study risk assessors, who performed a separate visual assessment and collected dust wipe samples. One year later, study risk assessors performed another visual assessment and dust wipe sampling (n=34). Dust lead loadings declined significantly immediately after prescribed lead treatments were implemented. Fifty-three percent, 20%, and 47% of units had at least one sample that exceeded 1995 EPA/HUD floor, window sill and window trough clearance guidance of 100, 500 and 800 microg/ft2, respectively. Overall, 73% of units had one or more immediate post-intervention single surface sample results exceeding the 1995 clearance values that were in effect at the time of the study. One-year post-intervention loadings remained significantly below pre-intervention levels for floors but not window sills or troughs. Visual assessments alone, without dust lead testing, did not ensure that prescribed treatments were completed or that dust lead loadings were below clearance values.

Do the same houses poison many children? An investigation of lead poisoning in Rochester, New York, 1993-2004

OBJECTIVES

In several cities, researchers have found that a discrete number of properties owned by a small number of owners house multiple lead poisoned children over time. The purpose of this study was to determine whether or not a small number of properties were implicated in the poisoning of multiple children in Rochester, New York, between 1993 and 2004.

METHODS

We analyzed the patterns of ownership and repeated positive environmental investigations (i.e., documented lead hazards) in homes of lead poisoned children using county health department data during a 12-year period.

RESULTS

A small percentage (14.8%) of properties in which the health department found a lead hazard had previously documented lead hazards. When a second positive investigation occurred, the average elapsed time between investigations was a little less than three years. Only four property owners owned more than two properties that had multiple positive investigations.

CONCLUSIONS

In some cities, a small number of properties or property owners provide housing for a large percentage of lead poisoned children. However, this situation is not universal. In Rochester, a relatively small percentage of homes that housed a child with an elevated blood lead level have a history of housing lead poisoned children. In cities like Rochester, lead hazard reduction resources should focus on high-risk housing stock determined by factors such as age, value, and condition, rather than on those with a prior record of housing lead poisoned children.