HUD’s New Rule on Elevated Blood Lead Levels Victor L Powell Enforcement Advisor HUD Office of Lead Hazard Control and Healthy Homes (202-402-7591; Victor.L.Powell@HUD.gov) September 18, 2017

HUD as a health promotion agency United States Housing Act of 1937 Sec. 2, as originally enacted: It is the policy of the United States to promote the general welfare of the Nation by employing its funds and credit, as provided in this Act, to assist the several States and their political subdivisions to remedy the unsafe and unsanitary housing conditions and the acute shortage of decent, safe, and sanitary dwellings for families of lower income ….

HUD Office of Lead-Based Paint Abatement and Poisoning Prevention (1991) Created by FY 1991 HUD appropriations act Responsible for all HUD lead-based paint abatement and poisoning prevention activities (including, but not limited to, research, abatement, training regulations and policy development) Office has been renamed 3 times, including to reflect its 1999 expansion to “healthy homes,” i.e., identifying and controlling residential health and safety hazards broadly

Residential Lead-Based Paint Hazard Reduction Act of 1992 Known as “Title X” because the act was issued as that title of the larger Housing and Community Development Act of 1992 The main current legislation covering lead paint, dust and soil in housing (and, for EPA, child-occupied facilities) Has provisions for HUD, EPA, OSHA, NIOSH, GAO Among HUD provisions, the major ones are: Lead Hazard Control Grant Programs Lead Disclosure Rule Lead Safe Housing Rule

Lead Safe Housing Rule Approach HUD issued the LSHR (1999) on evaluation and reduction of lead-based paint hazards in federally owned and assisted housing Holds federal housing agencies (HUD, USDA, VA, DoD, etc.) to a higher standard than for private housing owners and subsidizers Agencies must require looking for LBP and/or LBP hazards (deteriorated LBP, high lead in dust or soil); reduce hazards using lead-safe work practices, notify occupants of results of hazard evaluation and hazard control

Lead Safe Housing Rule Implementation Integrate lead-safe work practices into training, ongoing housing maintenance, finance, and rehabilitation in target housing funded by HUD assistance programs Require practices based on type of assistance, not specific housing programs LSHR incorporated by reference into assistance program regulations

Lead Safe Housing Rule Effectiveness LSHR and other HUD rules and monitoring have been effective in reducing children’s lead exposure per prevalence of LBP hazards While the national prevalence of housing units with LBP hazards for which lead-safe work practices are required by the LSHR, called “significant lead-based paint hazards” is 21.9%, the prevalence is 12.3% among Government-assisted housing units [95% CI = 3.0 - 21.6%; P < .05]. (HUD. American Healthy Homes Survey (2011), tbl. 5-1; see also Dewalt F, Cox, D, et al. J. Env. H. 78(5):22-29 (2015).)

Lead Safe Housing Rule Outcome LSHR and other HUD rules and monitoring have resulted in young children having lower blood lead levels than those in unassisted housing “[C]hildren living in assisted housing had a significantly lower geometric mean BLL [blood lead level] (1.44 µg/dL; 95% confidence interval [CI] = 1.31, 1.57) than comparable children who did not receive housing assistance (1.79 µg/dL; 95% CI = 1.59, 2.01; P < .01). The prevalence ratio for BLLs of 3 micrograms per deciliter or higher was 0.51 (95% CI = 0.33, 0.81; P < .01).” (Ahrens K, Haley B, et al. AJPH 106(11):2049-2056 (2016).)

LSHR and Children’s Blood Lead Levels [1] 1999: While not mandated by Title X, in issuing the LSHR, HUD required prompt response when a child < 6 y living in most HUD-assisted housing had a BLL > 20 µg/dL, which CDC had called, in 1997, “the level requiring medical and environmental intervention” (Screening Young Children for Lead Poisoning); HUD called this BLL its “environmental intervention blood lead level.” > 20 µg/dL, or >15 µg/dL if repeated > 3 mo. Risk assessment <15 days, control LBP hazards <30 days after risk assessment report

LSHR and Children’s Blood Lead Levels [2] 2012: CDC accepted the recommendations of its Advisory Committee on Childhood Lead Poisoning Prevention, to, among other items: Eliminate concept and use of “blood lead level of concern” because of absence of no known no-effects threshold Use a “reference range value,” based on BLL of top 2.5th percentile of U.S. children ages 1–5 per 4 years of NHANES, to identify children who have been exposed to lead and require case management

LSHR and Children’s Blood Lead Levels [3] HUD began considering amending the LSHR, including assessing whether CDC guidance was being implemented and, if so, if significant problems had arisen and how to overcome them. September 1, 2016: HUD proposed its LSHR EBL amendment: Would reduce BLL triggering environmental investigation to level CDC recommends for environmental investigation (now 5 µg/dL) Change trigger if CDC changes its guidance

LSHR and Children’s Blood Lead Levels [4] Proposed LSHR EBL amendment: Would enhance evaluation of child’s unit from risk assessment to environmental investigation (adding inquiry into other potential sources), per CDC guide and HUD Guidelines’ chapter 16 on EBLs Would keep original LSHR’s 15 day period for evaluation, and 30 day period for control of LBP hazards identified

LSHR and Children’s Blood Lead Levels [5] Proposed LSHR EBL amendment: If LBP hazards found in child’s unit, would require reassessing other assisted units in the property with children under age 6, using a lead risk assessment Other tenant-based rental assistance (housing choice voucher) units excepted; based on Congress’ 1991 intent for that program; these would have visual assessments for deteriorated paint Would expand reporting of cases to HUD

LSHR and Children’s Blood Lead Levels [6] January 13, 2017: After considering 68 public comments with 378 recommendations, HUD issues final rule of EBL amendment to LSHR Retains main measures in proposed rule Makes refinements per public comments Adds requirement for risk assessments (vs. visual assessments for deteriorated paint) in tenant-based rental assistance (voucher) units to protect children further Compliance required starting July 13, 2016

Categories of Assisted Target Housing Covered by EBL Amendment Project-based assistance: HUD contracts with housing owner to provide housing to low- income or certain other families Public housing: HUD contracts with Public Housing Agency for it to provide PHA-owned housing to low-income or certain other families Tenant-based rental assistance: HUD provides a housing choice voucher to a low-income family to use for obtaining a reduced rent (difference paid by HUD) from an owner Owners agree to HUD requirements, which, for target housing, includes lead safety provisions

EBL Response for Project-Based Assisted Housing Owner informs HUD Field Office & OLHCHH of EBL case (5 days) Owner conducts environmental investigation of child’s unit (15 days) If LBP hazards found, owner conducts risk assessment of other assisted units w/child<age 6 in property (30 days if <20 units, else 90 days) Owner controls LBP hazards (30/90 days) Owner sends documentation of completion of each step to HUD Field Office (10 days) OLHCHH is a public health agency for data sharing under HIPAA

EBL Response for Public Housing PHA informs HUD Field Office & OLHCHH of EBL case (5 days) PHA conducts environmental investigation of child’s unit (15 days) PHA conducts risk assessment of other assisted units w/child<age 6 in property (30/90 days) PHA controls LBP hazards (30/90 days) PHA sends documentation of completion of each step to Field Office (10 days)

EBL Response for Tenant-Based Assisted Housing Owner informs PHA of EBL case (5 days) PHA informs HUD Field Office & OLHCHH (5 days) PHA conducts environmental investigation of child’s unit (15 days) PHA conducts risk assessment of other assisted units w/child<age 6 in property (30/90 days) Owner controls LBP hazards (30/90 days) Owner sends documentation of completion of LBP hazard control re child’s unit to PHA (5 days) PHA sends documentation of completion of each step to Field Office (10 days)

HUD’s regulatory definition of EBL: LSHR EBL Definition [1] HUD’s regulatory definition of EBL: Elevated blood lead level means a confirmed concentration of lead in whole blood of a child under age 6 equal to or greater than the concentration in the most recent guidance published by the U.S. Department of Health and Human Services (HHS) on recommending that an environmental intervention be conducted. (When HHS changes the value, HUD will publish a notice in the Federal Register, with the opportunity for public comment, on its intent to apply the changed value to this part, and, after considering comments, publish a notice on its applying the changed value to this part.)

LSHR EBL Definition [2] Effect of potential CDC recommendations change: Note that the statistically-based reference range value BLL can be used for a variety of responses, clinical as well as environmental, but need not apply to all responses. See, e.g., chelation threshold recommendation, not changed by the 2012 CDC guidance The BLL for recommending environmental intervention can be based on the known effectiveness of measures to control lead exposures from the residential environment

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