CDC, NIOSH’s Adult Blood Lead Epidemiology and Surveillance (ABLES) Program [Robert Roscoe, ]  NIOSH--State partnership to prevent elevated BLLs in adults By state-based tracking of laboratory-reported BLLs By encouraging intervention research and practice  Surveillance case definition for an adult elevated BLL is 25  g/dL or greater ABLES public health goal in Healthy People 2010 is to reduce the rate of adults who have blood lead levels of 25  g/dL or greater to zero by 2010  OSHA currently Allows adults to return to work when their BLL falls below 40 mcg/dL But has National Emphasis Program to reduce lead levels Disclaimer: The findings and conclusions in this presentation have not been formally disseminated by the National Institute for Occupational Safety and Health and should not be construed to represent any agency determination or policy. TM

What does the national ABLES program do?  Fund and process data collection--37 sole-source contracts $22,120 ($21,440) per state, $805,200 for FY2006 (partial $18,800) Data management & validity Technical assistance and collaboration Medical Industrial hygiene Epidemiologic Communications Web topic page: National meeting (with CSTE) Listserv, MMWR and other publication TM

Strategic accomplishments from ABLES Program in FY06  Make ABLES data more useful to outsiders Publish ABLES report in MMWR (Roscoe, Graydon) posting of summary data on ABLES topic page (Graydon, Roscoe) OSHA--MOU to share ABLES (and IMIS) data (Roscoe, Boiano, SHEFS) NCEH—offer to Lead in Pregnancy Workgroup (Whelan, Roscoe)  Make ABLES data more useful to NIOSH and as NORA surveillance tool Construction sector--FY07 NORA proposal (Roscoe, Piacitelli, Boiano) Manufacturing & Mining sectors—offer of FY08 NORA collaboration (Roscoe) TM

What research does the national ABLES program take part in?  Research collaborations/partnerships Epidemiologic study led by Steenland of cancer (lung, stomach, brain, kidney), stroke, diabetes & non-malignant kidney disease AOEC Clinical BLL Guidelines NCEH NEDSS partnership for standardized surveillance NCEH Lead and Pregnancy workgroup NCEH Federal task force on nonresidential environmental lead sources Federal Lead-based paint task force TM

States reporting to ABLES in 2007 (37) ABLES states with contracts TM

National prevalence rate for adults with BLLs >25  g/dL based on ABLES data reported Residents plus nonresidents Residents only *Bureau of Labor Statistics, Current Population Survey TM

State prevalence rates for resident adults with peak blood lead levels >25  g/dL, averages < >20 Not an ABLES state Annual rate per 100,000 employed* *Bureau of Labor Statistics, Current Population Survey TM

Percent residents with BLLs >25  g/dL by race, ethnicity age, sex, reported by ABLES states average n = 3278 (66% race missing) Sex 94% male 6% female Age 1.6% years 96% years 2.4% 65 and older TM

Percent of adults with blood lead levels >25  g/dL by industrial sector, reported by ABLES states, average Lead sources: 94% occupational, 6% nonoccupational TM

Industries reporting greatest number of resident workers with elevated BLLs reported by 32 of 37 ABLES states, average 1.Manufacture of storage batteries [SIC 3691, NAICS ] ( 6%) 2.Painting, paperhanging & decorating [SIC 1721, NAICS ] (25%) 3.Mining of lead ores [SIC 1031, NAICS ] (20%) 4.Secondary smelting [SIC 3341, NAICS ] (13%) 5.Bridge and tunnel construction [SIC 1622, NAICS ] (21%) 6.Manufacture of primary batteries [SIC 3692, NAICS ] (19%) 7.Primary smelting [SIC 3339, NAICS ] (13%) 8.Lead paint removal [SIC 1799, NAICS ] (25%) 9.Copper foundries [SIC 3366, NAICS ] (18%) 10.Roll & draw nonferrous metals [SIC 3356, NAICS ] (18%) Industry [Standard Industrial Classification (SIC), North American Industry Classification System (NAICS)] Worker BLLs >25  g/dL Worker BLLs >40  g/dL (%) TM

Lead-exposed resident painters* with BLLs >=25 mcg/dL reported by 23** ABLES States in 2004, n = 742 * SIC 1799 and 1721, NAICS and ** CA, CT, FL, HI, IL, MA, MD, ME, MI, MN, MO, NC, NH, NJ, NY, OH, OK, OR, PA, TX, UT, WA, WI TM

How bad is under reporting—especially in the construction industry?  Only 23 ABLES states reported even one painter with a BLL >=25 mcg/dL (2004) AK, AZ, GA, IA, KS, MT, NE, NM, SC, WY reported no painters >= 25mcg/dL Could this be true? If not, were the painters not tested or were the tests not sent to state ABLES?  What can your state lead surveillance program do to make sure that appropriate testing for painters (and other under reported industries) is being done and reported to you?  Only 12 states reported painters with a BLL of <25 mcg/dL (2004) CA, FL, MA, ME, MN, MO, NH, NY, OK, PA, WI reported 1,325 painters tested <25/mcg/dL This lets National ABLES know that some tests on painters are being done. TM

Estimates of national prevalence rate for adults with BLLs >25  g/dL projected to 2010 based on ABLES data reported Residents plus nonresidents Residents only Projected rates for residents plus nonresidents (exponential) *Bureau of Labor Statistics, Current Population Survey [---Estimated national rates to ] TM

ABLES proposed pilot intervention project for NIOSH’s National Occupational Research Agenda (NORA) FY07  To lower BLLs in workers involved in lead-paint removal Renovation, remodeling, remediation, painting  By letting contract to have ABLES state or other entity develop and carryout model intervention ~$47,000 per year for three years Evaluate intervention effectiveness Develop information products for transfer to other states TM

Where is ABLES likely to go?  Grows ever-closer to NCEH’s childhood lead program Standardized data collection under NEDSS Greater efficiency for the states Joint childhood and adult lead surveillance clearance obtained from OMB in FY05  Possibly evolves into part of NIOSH’s Fundamental Program of Occupational Surveillance as the lead indicator Back to extramural funding, COSS participation  Possibly becomes part of an over-arching CDC program for occupational, environmental and injury surveillance  Disappears when competing NIOSH funding priorities become more important than lead surveillance? TM

States reporting to ABLES in 2007 (37) ABLES states with contracts 11 ABLES states with contracts & new Fundamental Surveillance Programs New Fundamental Surveillance Program, no ABLES contract TM