Notes

Outline

Lead Poisoning: Myths and Responsibilities Lead Hazards and Indiana’s Windows of Opportunity Project Prepared by Tom Neltner On June 29, 2001

Myth #1 Thanks to the ban on lead in gasoline, paint, food products, and other consumer products, we have almost eliminated lead poisoning.

Lead Poisoning Has Dropped Dramatically In 1970s, more than 80% of population had elevated blood lead levels.  Now, less than 10% have elevated blood lead levels. In 1970s, lead poisoning symptoms especially in urban areas were common.  Now, a child with symptoms is unusual. A success story for prevention!

However! According to the Centers for Disease Control and Prevention, lead remains the greatest environmental threat to the health of young children, and lead poisoning is entirely preventable.

Indiana’s Situation

Indiana’s Situation A lead poisoned child is a child with blood lead levels more than 10 ug/dL. Medical intervention is needed when blood levels exceed 20 ug/dL. Based on 1999 data STATE 7.2% Marion 9.5% Allen 8.8% St. Joseph 8.4% Vanderburgh 8.2% Elkhart       8.0% Lake 6.5%

So Why Aren’t We Seeing the Problem? Asymptomatic at lower levels of concern! Impaired cognition and lower IQ Reduced reaction time Increased distractibility, impulsiveness More reading disability Increased high-school drop-outs

Children Are Most At-Risk! Incomplete development of blood-brain barrier Effect on developing nervous system Increased absorption, retain more lead than adults per body weight Hand-to-mouth behavior High metabolic rate

Federal Regulatory Conclusions “Young children are especially vulnerable to the toxic effects of lead because their nervous systems are still developing and they absorb more of the lead to which they are exposed.  Many of the health effects associated with lead are thought to be irreversible.  Moreover, the effects at lower levels of exposure are often asymptomatic.” January 5, 2001 Federal Register, Vol. 66, No. 4, page 1207.  Preamble to the Environmental Protection Agency’s regulation regarding the identification of dangerous levels of lead Rule was reaffirmed by Bush Administration

Are Levels < 10 ug/dL Safe? “EPA maintains its position that there is no known threshold for lead.  EPA decided not to use a level lower than 10 ug/dL because the evidence indicates that health effects at lower levels of exposure are less well substantiated, based on a limited number of children, and observation of subtle molecular changes that are not currently thought to be sufficiently significant to warrant national concern.” January 5, 2001 Federal Register, Vol. 66, No. 4, page 1215.  Preamble to the Environmental Protection Agency’s regulation regarding the identification of dangerous levels of lead.  Rulemaking reaffirmed by Bush Administration.

Which Children Are At-Risk? Nationally: Low-income children - 8 times more likely to be lead poisoned. African-American children – 5 times more likely. Indiana: Uses targeted screening so no comparable estimates available. For children younger than 2 years old, we saw the following Black – 9.5% White – 4.5%

The Indiana Algorithm Indiana State Department of Health and Ball State University did a comprehensive analysis of state blood lead data and 1990 census data. Study developed a formula to predict the percentage of children in a neighborhood who are estimated to be lead poisoned. 667 of 5450 census blocks estimated more than 20% of children may be lead poisoned.

The Indiana Algorithm 0.55 times the percentage of pre-1950 housing. 0.36 times the percentage of African-American residents. 0.11 times the poverty scale: Female-headed families; Renter-occupied housing; and Children five years or younger in poverty.

The Pre-1950 Housing Factor State 33.7% Vanderburgh 41.5% St. Joseph 39.9% Lake 34.1% Allen 29.6% Marion 29.2%

The Income Factor National Lead Poisoning Rates in Children Younger than 6 9% if Medicaid v. 3% if Non-Medicaid 60% with blood lead levels ³ 10 ug/dL 83% with blood lead levels ³ 20 ug/dL Comment on Screening Rates: About 80% of children not tested despite long-standing Medicaid requirement for 100% testing.

St. Joseph County

St. Joseph County

St. Joseph County

Marion County

Who is At-Risk in Indiana? Enrolled in Medicaid. Lives in one of the 667 census block groups in 35 targeted counties. Family answers yes or don’t know to any question on the Lead Risk Questionnaire. Sibling of a child with elevated BLL.

Indiana’s Blood Lead Screening Questionnaire Does child live in or visit house or building that was built before 1978? Does child have sibling or playmate that has or had lead poisoning? Does anyone in home work in an industry or have a hobby that uses lead, such as in a battery factory, steel smelter or work with stained glass?

Myth #1 – We beat lead poisoning Yes, if you live in housing built after 1978. But, not true for: Residents in old housing – primarily doing renovation and rehabilitation. Low-income residents African-American residents

Myth #2 Only children who eat lead-based paint chips are at-risk.

Dust v. Chips “A statistically significant relationship was found between a composite measure of house dust lead in an entire house (both concentration and loading) and children’s blood lead concentration, controlling for age and season.” Lead-based Paint Abatement and Repair and Maintenance Study in Baltimore: Findings Based on Two Years of Follow-Up, U.S. EPA, EPA No. 747-R-97-005, December 1997.

Why Dust? Invisible – Parents don’t know children are exposed. Difficult to clean – Most vacuums will spread dust around room. Deteriorated paint – As housing ages, more old paint deteriorates and forms dust.

EPA’s New Standards for Dust On January 5, 2001, EPA set standards for lead poisoning in target housing and child-occupied facilities.  Lead is considered a hazard if any of the following levels are exceeded:   40 ug/ft2 of lead in dust on floors (bare floors or carpeted); 250 ug/ft2 of lead in dust on interior window sills and 400 ppm of lead in bare soil in children's play areas or 1200 ppm average for bare soil in the rest of the yard.

How Low is 40 ug/ft2? If a packet of sugar were lead, then one packet of sugar spread evenly over 25,000 ft2 would be at the standard. 25,000 ft2 is about 1/3 of a football field. At this level, there would be a 1% to 5% probability that a child living in the home would be develop lead poisoning.

Myth #2 – Paint chips are the problem Paint chips were only a part of the problem.  We now know the dust from deteriorated paint is the primary source of the problem.

Myth #3 Good housekeeping and maintenance would take care of the problem.

2000 National Lead Survey 96 million homes 38 million have lead based paint 29 million have interior lead based paint 53% in Midwest have lead-based paint 25 million have significant lead-based paint hazards 16 million have significant interior dust levels 14 million have significant deteriorated paint 6 million have significant soil lead levels

2000 National Lead Survey 16.4 million homes have children younger than 6 4.4 million have significant lead-based paint hazards 4.8 million homes have low-income residents 1.4 million have significant lead-based paint hazards.

2000 National Lead Survey Percent of homes with deteriorated lead-based paint. 3% if built between 1960 and 1977 32% if built between 1940 and 1959 56% if built before 1940 Percent exceeding dust level standards 6% above floor dust standard 14% above window sill dust standard 55% above window trough dust clearance standard

2000 National Lead Survey Interior and exterior paint on windows have much higher concentrations of lead than other components. Interior and exterior paint on windows is more likely to have lead than other components.

The Problem with Windows More likely to have lead-based paint. Lead levels are likely to be higher. Sun and rain makes paint more likely to be deteriorated. Area between inside and outside windows less likely to be maintained. Windows are used more in low-income homes.

Myth #3 – Housekeeping is enough Housekeeping is important but . . . If the windows have lead-based paint, the home it is extremely difficult to make a home lead-safe. Once windows are replaced and serious deteriorated paint is addressed, housekeeping can prevent lead poisoning. Housekeeping must be done properly – standard vacuums won’t work.

Indiana “Windows of Opportunity” Project Part of Governor O’Bannon’s Building Bright Beginnings Initiative. Funded with special redistribution of Children’s Health Insurance Program funds. Every state and local dollar is matched with $2.57 in federal funds State has reserved $50 million of these federal funds for “Windows of Opportunity” Need $20 million in local funds before mid-2002.

Project Description Replace lead-based paint windows in old homes. In these homes, check children for lead poisoning and work with them to minimize the effects of lead.

Priorities Homes that have already poisoned children. Homes built before 1978, especially those built before 1950. Homes with many children such as home-day-care centers. Homes with low-income residents. Homes in high-risk neighborhoods as identified by Indiana State Department of Health.

Who will do the work? Family and Social Services Agency will be lead agency. One or two contractors will manage project. 24 local community action agencies will do the window replacement through their existing weatherization programs.