Children With Elevated Blood Lead Levels Related to Home Renovation, Repair, and Painting Activities -- New York State, 2006-2007

EM Franko, DrPH; JM Palome; MJ Brown, ScD; CM Kennedy, DrPH; LV Moore, PhD

Disclosures

Morbidity and Mortality Weekly Report. 2009;58(3):55-58. 

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Content

Although blood lead levels (BLLs) ≥10 µg/dL are associated with adverse behavioral and developmental outcomes, and environmental and medical interventions are recommended at ≥20 µg/dL, no level is considered safe.[1,2] A 1997 analysis conducted by the New York State Department of Health (NYSDOH) indicated that home renovation, repair, and painting (RRP) activities were important sources of lead exposure among children with BLLs ≥20 µg/dL in New York state (excluding New York City) during 1993-1994.[3] Subsequently, local health departments in New York state began to routinely collect information about RRP activities when investigating children's home environments for lead sources. This report updates the 1997 analysis with data from environmental investigations conducted during 2006-2007 in New York state (excluding New York City) for 972 children with BLLs ≥20 µg/dL. RRP activities were identified as the probable source of lead exposure in 139 (14%) of the 972 children. Resident owners or tenants performed 66% of the RRP work, which often included sanding and scraping (42%), removal of painted materials or structures (29%), and other activities (29%) that can release particles of lead-based paint. RRP activities continued to be an important source of lead exposure during 2006-2007. Children living in housing built before 1978 (when lead-based paint was banned from residential use) that are undergoing RRP activities should be considered at high risk for elevated BLLs, and appropriate precautions should be taken to prevent exposure.

Since 1993, New York state regulations* have required BLL testing for all children at ages 1 and 2 years. In 2007, 83% of children were tested at least once before age 3 years, but only 41% were tested at ages 1 and 2 years (NYSDOH, unpublished data, 2008). Regulations also require laboratories to report all BLLs to NYSDOH, which then provides results to respective local health departments. For all children reported with BLLs ≥20 µg/dL, local health departments are required to conduct environmental investigations to determine potential sources of exposure and recommend actions to reduce or eliminate exposures following CDC guidelines.[1,2] Investigations include questioning about any activities that might have disturbed lead-based paint, including RRP activities, inspection of the home and household items for evidence of cracked or peeling paint, and water testing. If available, paint chips are tested for lead.

During 2006-2007, local health departments conducted environmental investigations for all 972 children reported in New York state with BLLs ≥20 µg/dL. In January 2008, NYSDOH abstracted data from local health department records to identify investigations in which RRP activities were determined to be the most likely source of lead exposure and in which no other source of exposure was identified. RRP activities were considered the most likely source if an activity occurred that might have generated dust or paint chips that could have been inhaled or ingested. Lead-based paint that was intact and in good condition was not considered a source of exposure. For each case, abstracted data included 1) child's age, 2) blood test date, 3) BLL, 4) address and approximate age of dwelling, 5) activities that might have disturbed paint, and 6) identity of person who performed the RRP work.

The results indicated that, during 2006-2007, the elevated BLLs of 139 (14%) of the 972 children with BLLs ≥20 µg/dL were related to RRP activities ( Table 1 ). Among the 139 children, 63 (45%) had BLLs of 20-24 µg/dL, 24 (17%) had BLLs of 25-29 µg/dL, and 52 (38%) had BLLs e30 µg/dL. Most of the children (71%) were aged 1-2 years, and 25% were aged 3-5 years. The 139 children resided in 131 homes; eight homes had two children per home, and all other homes had only one child. All but one of the homes were built before 1978. Of 131 homes in which environmental investigations were conducted, 56 (43%) were identified as urban, 36 (28%) as suburban, and 39 (30%) as rural.

*Title 10 NYCRR Part 67, available at http://www.health.state.ny.us/environmental/lead/laws_and_regulations/chapter_2_subpart_67.htm.

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