1. Elevated Blood Lead Levels: Statistical Analysis Meets Social Phenomena Ronnie Levin, Region 1 Barry D. Nussbaum, OEI U.S. Environmental Protection Agency 1 Presented to: EPA Quality Management Conference May 14, 2009

2. 2 Lead has thousands of commercial applications Octane booster for gasoline Radiation shields Sheathing for cables Solder: plumbing, stained glass, electronics Pigments: glazes, paint, newspaper ink Fine crystal Pesticides & plant growth regulators Hair preparations Water pipes Automobile batteries Fishing & diving weights Stabilizer in plastics

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4. 4 Lead in Gasoline and in Blood

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6. 6 The good news Average BLLs of US Children, 1972-2002

7. 7 Risk factors for elevated BLLs Age Season

8. 8 More risk factors Income –Income, Medicaid vs private insurance, own- rent home, # people in household, Race & ethnicity

9. 9 More risk factors Age of housing Location of residence –Children (1-5) in the 10 largest cities accounted for 46% of EBLs in 2003 but only 7% of the population that age Parental occupation Smoking

10. 10 We knew the job wasn’t finished… Landrigan et al (’02) estimated that residual benefits of reducing blood lead levels of children born in 1997 were $43.4 billion annually (present value) considering only reduced lifetime earnings

11. 11 And we knew we had more problems 30% of EBLs don’t have a proximate lead-paint source –5-20% don’t have ANY identified source Number of EBLs in Manchester NH doubled between 1997 and 2004 Imported lead-contaminated goods, and especially toys DC kids’ BLLs didn’t decrease after 2001 20% of ayurvedics have dangerous PB levels

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14. 14 What are the new Pb exposure frontiers? Paint Soil and dust Ethnic imports (foods, remedies, cosmetics, pottery & cooking utensils) Immigrants Parental occupational exposures Inadequately monitored foreign goods (paint, toys, consumer goods) Public drinking water

15. 15 These are airports servicing general aviation aircraft of which ~80% are piston engine aircraft using leaded avgas

16. 16 What does this all mean? Focusing on lead paint or even LBP where there is an EBL ISN’T ENOUGH Need cooperation across federal, state and local governments Need to control/eliminate Pb exposures BEFORE children are exposed –Primary prevention

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18. 18 But all is not lost in data analysis  Data was compiled from 5 different sources  NHANES - National Health and Nutrition Examination Survey (CDC)  TRI – Toxic Release Inventory (EPA)  AirData – Summary of AQS and NEI (EPA)  CBLS – Childhood Blood Lead Surveillance Program (CDC)  2000 United States Census (Census Bureau) *Analyzed separately due to privacy concerns

19. 19 Background Joshua Drukenbrod and Chad Harness (Fall 2007)  Industry Stand-Outs (NHANES)  Construction  Mfg. metal industries  Occupation Stand-Outs (NHANES)  Farm and nursery workers  Vehicle/mobile equp. Mechanics  Construction trade  Construction laborers  Origin Stand Out (NHANES)  Born in Mexico  try Stand-Outs (NHANES)  Construction  Mfg. metal industries  Repair services  Occupation Stand-Outs (NHANES)  Farm and nursery workers  Vehicle/mobile equp. Mechanics  Construction trade  Construction laborers  Origin Stand Out (NHANES)  Born in Mexico

20. 20 Background Steven Somers, Jessica Williams (Fall 2007), and Amanda Cambell (Spring 2008)  California, 2003 /2006 disparity:  Compared 2003 and 2006 California data  Determined the integrity of the 2006 data  Found new significant variables  Correlation between EBLL rates and:  Poverty rates in children under 6  Percent Pre-1950 homes  Percent Hispanic  Percent Agriculture

21. 21 What we learned from calling the states/counties…  Nevada (does not report to CDC) Started the program in 2006, therefore they don’t have a 3 year cohort necessary for reporting to the CDC They only data for Clark County When they find elevated levels, they make parents fill out an extensive, 22- page survey  Illinois (underestimated data on CDC web-site) Where the family lives while their house is being remediated is dependent upon the lead investigator When data is submitted to the CDC with missing information (i.e. address, city, etc.) the data is thrown out Requires a follow-up test for any child who tests with an EBLL  Wisconsin (had high levels in Milwaukee) Found that window sills have the highest levels of lead in them Have begun a prevention plan where all window sills are being replaced in older homes  1/3 of the homes have been remediated and the average EBLL rate has dropped from 31.9% to 5.9% in the past 10 years

22. 22 What we learned from calling the states/counties…  Pennsylvania Pennsylvania is a targeted screening state Some states test all 1 & 2 year old children (universal testing), and one can expect to find far fewer elevated results (proportionately) in such a large sample as compared to a state that target testing to high risk areas only  Cuyahoga, OH Federal law states that all children under the age of 3 who are on Medicaid must have their lead level tested Occupation of parents: Child got lead poisoning from father’s shooting range clothes “Some parents would rather not know if their child has an EBLL because they fear eviction.”  Kathy Shack, Cuyahoga County Official  Denver, CO Jane Mitchell, an Environmental Health Research Scientist for the Colorado Department of Health and Environment, informed us that the original data submitted by CO was incorrect and has since sent us the correct EBLL data

23. 23 Variables  Variables: % pre-1980 housing % population African American % population Hispanic % work force in agriculture % work force in construction % work force in manufacturing % work force in transportation % work force in education/health services TRI data Air Data Rural/Urban

24. 24 Analysis of North East Region

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