1. Soil and lead poisoning Mary Jo Trepka, MD, MSPH

2. Outline Importance of childhood lead poisoning Childhood lead poisoning in Miami- Dade County Risk factors in Miami-Dade County Health department services Relevance to students What we still don’t know

3. What is so important about childhood lead poisoning? Can lead to permanently lowered IQs Children more susceptible Ubiquitous in environment Urban poor and minorities disproportionately affected

5. What is a safe lead level? Current action level = 10 μg/dL Estimated 2.6-5.8 point IQ decline for increase from 10 to 20 μg/dL Under 10 μg/dL safe? –7.4 point IQ decline for 1-10 μg/dL –Cognitive and academic deficits for BLL < 5 μg/dL (Schwartz, et al, Env Res 1994, Bellinger, et al Pediatrics 1992, Canfield, et al NEJM 2003, Lanphear, et al Pub Health Rep 2000)

6. What is so important about childhood lead poisoning? Can lead to permanently lowered IQs Children more susceptible Ubiquitous in environment Urban poor and minorities disproportionately affected

9. What is so important about childhood lead poisoning? Can lead to permanently lowered IQs Children more susceptible Ubiquitous in environment Urban poor and minorities disproportionately affected

10. Sources of lead Soil Dust Paint Pottery Occupation/hobbies Folk remedies Tiles Water

15. Sources of lead Soil Dust Paint Pottery Occupation/hobbies Folk remedies Tiles Water

16. Occupations with possible lead exposure Auto repair/radiator repair Painting Construction work Steel welding and cutting Plumbing Police work Maritime industry

17. Hobbies with possible lead exposure Fishing sinkers Working with cars, car parts, or car batteries Painting Stained-leaded glass work Shooting guns at firing ranges Working with model cars or boats Pottery work

18. What is so important about childhood lead poisoning? Can lead to permanently lowered IQs Children more susceptible Ubiquitous in environment Urban poor and minorities disproportionately affected

19. NHANES blood lead levels among children aged 1-5 years, United States, 1976-2000 YearGeometric mean BLLS Prevalence BLLs > 10 μg/dL Estimated no. children with BLLs > 10 μg/dL 1976-8014.988.2%13.5 million 1988-913.68.6%1.7 million 1991-942.74.4%0.9 million 1999- 2000 2.22.2%0.4 million Source: CDC MMWR 2003;52:SS10

20. Prevalence of lead poisoning by housing age Nationwide 2.2 % of 1-5 year-olds Housing 8.6% Pre-1946 4.6% 1946-73 1.6% Post-1973 Source: CDC, 1999-2000 NHANES

21. Prevalence of lead poisoning by race/ethnicity and income among those in pre-1946 housing Differs by race/ethnicity 22% black 13% Mexican American 6% white Differs by income 16% low 4% middle 1% high Source: CDC, 1999-2000 NHANES

22. Childhood lead poisoning in Miami-Dade County Prevalence –Florida: 3.2% (Hopkins, et al, J Fla Med Assoc. 1995) –Miami-Dade Countywide: unknown Central urban area: estimated 8% Surveillance: average 431 cases a year among children (1998-2002) Underscreening –Florida 17% (GAO Report) –Miami-Dade 23% (analysis of Medicaid data)

23. Lead poisoning cases by gender, Miami-Dade County – 2002 Source: Miami-Dade County Health Department, Vital and Morbidity Statistics 2002

24. Population < 6 years, 2000, and reported lead poisoning cases by race and ethnicity, 1999-2001, Miami-Dade County PopulationCases Source: 2000 US Census and Miami-Dade County Health Department

25. Sources of lead hazards based on environmental home inspections 188 inspections 89 (47%) inspections found no hazards (55 of these inspections in imported cases) ‘Other sources’: fishing weights, parental occupations, hobbies, water, objects/statues Source: Miami-Dade County Health Department Childhood Lead Poisoning Prevention Program 2003

26. Risk factors for lead poisoning in Miami-Dade County Living in a home built prior to 1950 Living in central urban area Low socio-economic status Living in a recently remodeled home Sibling or playmate with lead poisoning Refugee status

31. Lead poisoning prevalence among children screened at the Refugee Health Assessment Center*, July 1, 2001 to June 30, 2002

32. Childhood Lead Poisoning Prevention Program Screening Surveillance Follow-up Public and professional education Primary prevention Evaluation

34. Relevance to students’ lives May live in neighborhoods with soil lead hazards and may have younger siblings at risk May become parents and will need to know about preventing lead poisoning in their own children May be exposed in workplace or during hobbies in future

35. What we still don’t know How to remove lead from soil How to cover soil to prevent exposure If there is a safe lead level Extent of behavioral effects How to bring about lead abatement Risk factors among immigrant children