Childhood Lead poisoning

What causes lead poisoning? Many things in our everyday lives put infants, children and adults in danger of lead poisoning. Lead-based paint was used in many homes built before 1978. The older the home, the more likely that windows, cupboards, doors porches, and outdoor surfaces contain leadbased paint. Children are most often poisoned by lead dust and lead paint in older homes. Lead dust can come from repairing areas with lead paint, opening and closing windows, and through normal wear and tear of painted areas. Lead dust settles to the floor and gets on children's hands and toys. it enters their bodies when they put their hands or toys into their mouths. We now realize just how dangerous lead is. There are things you can do to keep your children safe from lead poisoning.

Children are far more vulnerable to lead exposure than adults, absorbing 30% to 75% of lead which reaches their digestive track, as compared with 11% for adults. 14Poor nutritional status (particularly calcium, vitamin C, or iron deficiencies) increases susceptibility to lead poisoning by increasing lead absorption. 15ad exposure has severe and long-lasting effects on children.While treatment for lead exposure has the potential to reduce further brain damage, it does not undo damage which has already occurred. 16Lead can cause loss of intelligence, learning disabilities, hyperactivity, short attention spans, behavioral problems, aggression, and hearing and speech impediments. 17,18ny of the effects of lead exposure may not become evident until a child begins school.Cognitive and developmental problems may emerge at critical transition points in childhood, such as first grade, fourth grade, and middle school. 19A recent Rhode Island report suggests a relationship between elevated blood lead levels and repeating a grade and/or poor performance on standardized tests. 20timated economic losses attributable to lead exposure (due to reductions in IQ and consequent reductions in earnings expectations) amount to an estimated $135 million per year in Rhode Island and more than $43 billion per year nationally. 21The societal costs of childhood lead exposure include the loss of lifetime earnings due to decreased cognition as well as medical and special education costs. 22

THE IMPACT OF LEAD EXPOSURE LEAD EXPOSURE: UNSAFE AT ANY LEVEL
"Because there is no apparent threshold below which adverse effects of lead do not occur, 'EBLL' [elevated blood lead level] must be defined arbitrarily." 11search suggests that all lead exposure results in negative impacts on children and that there may in fact be no definable threshold for "safe" lead exposure.Discernible decreases in IQ, short-term memory, reading, arithmetic and nonverbal reasoning scores are associated with increasing blood levels, even with levels below 5µg/dL. 12ood lead level is measured in micrograms of lead (.000001 gram) per deciliter (one-tenth of a liter) of whole blood (abbreviated as µg/dL).Since the 1960s, the Centers for Disease Control has repeatedly redefined lead poisoning based on a growing body of research, reducing the elevated blood lead level threshold from 60 µg/dL in the 1960s to 10 µg/dL in 1991. 13cording to state law, all Rhode Island children between the ages of nine months and six years must be screened for lead, usually on an annual basis. 23As of 2001, approximately 78% of Rhode Island children were being screened for blood lead, far exceeding estimated national screening rates of 10 to 25%. 24The overall screening rate for children enrolled in RIte Care (Rhode Island's Medicaid managed care program) is even higher: 80% of children enrolled in RIte Care are screened for lead, compared with fewer than 20% of children enrolled in Medicaid across the United States. 25Private, office-based health care providers in Rhode Island have screening rates of about 68%, significantly below the 85-91% screening rates of other providers (such as hospital clinics and health centers). 26

Children at Greatest Risk
Children with elevated blood levels are found in every community in Rhode Island.However, those at greatest risk are poor, minority and urban children, as well as children in older homes undergoing renovation.

Children in Homes Undergoing Renovation
All children residing in homes with lead paint are potentially at-risk for lead poisoning.Children in homes undergoing renovation are particularly at risk unless work is performed by a licensed lead abatement contractor employing safe abatement practices, children are not present during the abatement/ renovation and the premises are tested for lead dust at the conclusion of the work.The riskiest practices are sanding, scraping or removing lead paint with a heat gun. 27,28 2002, children in the core cities were three times as likely to have elevated blood lead levels as children in the remainder of the state.The lack of housing that is safe and affordable is closely related to lead poisoning.In Rhode Island, 38% of renters are unable to afford the fair market rent for a two-bedroom unit. 33any low-income families have no choice but to live in older dwellings with deteriorating lead paint, placing children at risk for lead poisoning. 34High housing costs also result in a disproportionate percentage of income being spent on rent, reducing funds available for food.Poor nutrition and anemia further increase a child's susceptibility to lead poisoning. 35 March of 2002, the General Assembly and the Governor approved funding for the Neighborhood Opportunities Program which will create 200 new units of lead safe affordable housing over two years, in addition to grants for renovation, demolition and homeownership opportunities.The Neighborhood Opportunities Program is a ten-year program to develop 1,000 units of affordable housing.However, funding beyond the first two years is uncertain.Without additional, sustained investment in housing, the need for affordable housing units will continue to far exceed the supply.The second measure of lead poisoning in Rhode Island is a count of 3-year-olds who have ever had an elevated blood lead level.It is reported by reference to the year in which they are expected to enter kindergarten, e.g."children entering kindergarten in 2004" includes all children who were born between 9/1/98 and 8/31/99. 37This rate counts 3-year-old children who have ever had elevated blood lead levels (not just in the last year) and is limited to younger children who are more likely to ingest lead.This is the better measure for ascertaining the rates of children likely to be affected by lead poisoning over the course of their lives.This count includes the full history of a child's lead screening rather than only the most recent year.
In Rhode Island, the Department of Health regularly measures two rates of lead poisoning in children.The first, the number and percentage of children under age 6 with elevated blood lead levels ( ≥10 µg/dl), is based on the highest lead test results within the last year for all screened children under age 6.This is the count of children poisoned each year.Lead hazards can be reduced by repairing or encapsulating deteriorated paint or removing parts exposed to friction (such as windows and doors), in compliance with safe practices and licensing standards for contractors.Complete removal of interior lead paint, while the only way to guarantee permanent lead safety, is usually significantly more costly.Removing lead from the soil around the home is also an important element of abatement.The Department of Environmental Management is responsible for oversight of exterior lead hazard abatement. 47

targeting inspections
According to the Centers for Disease Control and Prevention, "The only certain way to prevent future exposure to lead from paint in a dwelling is to remove all leaded paint from the dwelling."Because of the costs and logistics of doing so safely, particularly when units are occupied, the CDC indicates that this may not always be practical. 49search indicates that limited prevention resources can be maximized by targeting lead hazard inspections to: • All units at addresses where children have been previously lead poisoned.
• All units at addresses with indicators of poor housing quality (e.g.code violations).
• Addresses owned by owners of other properties where children have been lead poisoned. 50

Abatement
" A public nuisance is an unreasonable interference with a right common to the general public; it is behavior that unreasonably interferes with the health, safety, peace, comfort or convenience of the general community." 51 the mid-1920s, there was strong and ample evidence of the toxicity of lead paint to children.The dangers represented by lead paint caused many other countries to enact bans on the use of white lead for interior paint decades before the 1978 ban of lead paint by the U.S. Consumer Products Safety Commission. 52 October of 1999, the Attorney General of the State of Rhode Island filed a lawsuit against eight manufacturers of lead pigment and paint, alleging that they had actual knowledge of the health risk posed by lead long before it was banned from paint products in the U.S. in 1978, that the companies intentionally misled the public, and that they created a public nuisance.The Attorney General sought damages to fund the costs of lead abatement, lead detection, medical care and special education for lead poisoned children. 53

Screening Policies for Medicaid recipients
In 1998, the Health Care Financing Administration (HCFA) mandated that all children enrolled in Medicaid receive screening blood lead tests at ages 12 months and 24 months. 57e Clean Air Act amendment in 1970 is an example of how policy can positively affect public health.The Act required the phase-out of lead in gasoline and contributed to a 60% to 80% reduction in blood lead levels since the mid 1970s. 54Other federal policies addressing lead safety include: • Help cities and towns set aside sufficient land and resources to meet their affordable housing requirements under state law.
• Work with institutions of higher education to create more student housing to decrease competition for affordable housing.
• Preserve and maintain existing affordable units that could be lost due to expiration of federal project-based assistance or prepayment of federally-assisted mortgages.A statewide plan and investment of incentive grants and loans may be necessary.
• Use lead-safe work practices and lead hazard mitigation strategies in all local, state and federally-funded housing production and repair programs in Rhode Island.

Recommendations
One successful model for improving inspection and enforcement is New Jersey's rental unit registration/fee requirement.Registration includes owner and property manager contact information.Tenants in a non-registered building may not be evicted for any reason, including nonpayment of rent.A fee schedule charged every five years helps finance a periodic inspection of all rental properties in the state.The program has been effective in tracking ownership, financing inspection and code enforcement, and improving housing quality. 59 a 1997 Policy Statement, The American Public Health Association (APHA) noted that the cost of abating lead hazards and treating lead poisoning is many billions of dollars, that the lead paint industry continued to promote the sale of lead paint for decades despite awareness of its dangers, and that "the principle of 'polluter pays' is well-established in cases of environmental damage and public health problems."APHA took the position that the lead paint industry should be held responsible for financing a solution to lead poisoning, and that that responsiblility should be enforced through legislation, negotiation, fees or litigation. 60

Financial Responsibility of Lead Paint Industry Rental Unit Registration/Fees
36

Rates of childhood Lead Poisoning Children (Age 3) With a History of Lead Poisoning
Source: RI Department of Health

Treatment to Abatement: ADDRESSING THE NEEDS OF Rhode Island CHILDREN EXPOSED TO LEAD
*Core cities are Central Falls, Newport, Pawtucket, Providence, West Warwick and Woonsocket.Data are based on highest lead test result in calendar year 2002.Data include both capillary (fingerstick) and venous tests.*Core cities are Central Falls, Newport, Pawtucket, Providence, West Warwick and Woonsocket.Source: Rhode Island Department of Health, Childhood Lead Poisoning Prevention Program, 2002.Source: Managing Elevated Blood Lead Levels Among Young Children (2002).Atlanta, GA: Centers for Disease Control and Prevention.

Lead Action Project Advocacy, Education, Parent Support National Policy Responses to Lead Poisoning Federal Title X: Disclosure Requirements and Certification Programs The
Residential Lead Hazard Reduction Act of 1992 (Title X) requires disclosure of lead-based paint and hazards at the time of sale or rental for all residential properties built before 1978.Title X also mandates that states enact lead paint certification programs to train inspectors, assessors, and contractors.55 The Childhood U.S.

Department of Housing and Urban Development: Assisted Housing HUD
enacted lead hazard control procedures for federally owned housing and housing receiving federal assistance, effective September of 2000.All housing rehabilitation and maintenance programs receiving federal assistance must be carried out in a lead safe manner.56