1. California Dept. of Health Services Childhood Lead Poisoning Prev. Br. Childhood Lead Poisoning Prevention in California Presentation to the Border States Lead Issues Meeting in El Paso January 26, 2006 Joseph G. Courtney California Department of Health Services Childhood Lead Poisoning Prevention Branch

2. California Dept. of Health Services Childhood Lead Poisoning Prev. Br. CA Childhood Lead Poisoning Prevention (CLPP) Program Established by legislation beginning in late 1980s that created program mandates and created fee support. Fees are on industries that have put lead into the environment (motor vehicle fuel, paint, air emitters)

3. California Dept. of Health Services Childhood Lead Poisoning Prev. Br. Program Mandates: State level Adopt regulations on evaluating and screening children for lead poisoning Establish protocols for screening Ensure appropriate case management, including environmental assessments and educational activities to reduce a child’s exposure to lead Collect and analyze information related to these activities

4. California Dept. of Health Services Childhood Lead Poisoning Prev. Br. State CLPPB Partners Other State Agencies Food and Drug Branch Occupational Health Branch Environmental Health Laboratory Office of Binational Border Health Refugee Health Attorney General—Prop 65 enforcement Federal Agencies –CDC: Cooperative Agreement (LA County also has one) –FDA –EPA –HUD

5. California Dept. of Health Services Childhood Lead Poisoning Prev. Br. CLPP Local Program Activities 46 Local programs have contracts with the State Branch to carry out mandates of CLPP at local level: informing- outreach and education promote screening local surveillance case management environmental investigation identify new lead hazards

6. California Dept. of Health Services Childhood Lead Poisoning Prev. Br. If High Lead Level Found in a Child Interventions and services (usually by local CLPPP) referred for primary provider, as needed, for medical assessment and treatment program referrals (WIC, housing agencies) environmental investigation for lead sources and remediation steps are noted nutritional guidance and prevention of additional lead poisonings

7. California Dept. of Health Services Childhood Lead Poisoning Prev. Br. California Profile POPULATION: Most populous state in the U.S. Nearly 34 million residents in 2000 (12% of U.S. total) 14% increase since 1990

8. California Dept. of Health Services Childhood Lead Poisoning Prev. Br. California Child Population 10.7 million children under age 21 years About 520,000 births per year Over 1 million children age 1 and 2

9. California Dept. of Health Services Childhood Lead Poisoning Prev. Br. California Profile 58 counties with a huge range of population: Alpine Co. pop. 1,208 Los Angeles: 9.5 million 8 counties populations have over one million people The most populous counties (LA, Orange, San Diego) in south

10. California Dept. of Health Services Childhood Lead Poisoning Prev. Br. California Population Served MANY IN POVERTY: 46% of children live in households with incomes less than 200% of the Federal Poverty Level (FPL) About 500,000 children age 1 and 2 years below 200% FPL

11. California Dept. of Health Services Childhood Lead Poisoning Prev. Br. California Population Served ETHNIC DIVERSITY: In 2000, no group a majority: 32% Hispanic 11% Asian 6% African American 47% White Of children less than 18 years, 42% were Hispanic

12. California Dept. of Health Services Childhood Lead Poisoning Prev. Br. California Profile DIVERSITY: 30% of the U.S. foreign-born population lives in California 33% of residents speak a language other than English at home Over 1/3 of school-age children speak a language other than English at home

13. California Dept. of Health Services Childhood Lead Poisoning Prev. Br. California Housing Profile Ranks 3 rd in U.S. for largest number of old housing units Over 2 million units constructed before 1950 8.6 million units before 1980

14. California Dept. of Health Services Childhood Lead Poisoning Prev. Br. California Housing Profile Approximately 14% of young children live in pre-1950 housing Approximately 70% live in pre-1980 housing

15. California Dept. of Health Services Childhood Lead Poisoning Prev. Br. Who is Routinely Screened for Lead? Screening to identify children with elevated blood lead levels is focused on those considered most at risk Young children in government-assisted programs: Medi-Cal (Medicaid), WIC, EPSTD service providers or Any child with other risk factors as indicated

16. California Dept. of Health Services Childhood Lead Poisoning Prev. Br. Medical Provider Requirements Regulations mandate: All children age 6 to 72 months receive anticipatory guidance on lead hazards Children in government-assisted health programs receive blood lead tests age 12 and 24 months (to 72 months if not done) Other children assessed for housing Pb risk and tested if indicated

17. California Dept. of Health Services Childhood Lead Poisoning Prev. Br. Laboratory Reporting MANDATES: universal reporting of all blood lead test results (as of 1/1/03) electronic reporting (as of 1/1/05)

18. California Dept. of Health Services Childhood Lead Poisoning Prev. Br. Current Blood Lead Results During FY 04-05  Over 650,000 blood lead tests reported to CLPPB  4,287 with elevated lead tests > 10  g/dL (0.6%)  3,452 newly identified children with elevated blood leads  715 new lead poisoning “cases” (BLL > 20  g/dL or persistent values > 15  g/dL )  % children with elevated levels and # cases decreasing

19. California Dept. of Health Services Childhood Lead Poisoning Prev. Br.

20. The Distribution of Lead Poisoning Cases by Race/Ethnicity, 2001-2004

21. California Dept. of Health Services Childhood Lead Poisoning Prev. Br. California Lead Poisoning Source Analyses (cases with environmental investigations 2000-2002) 69-90% had either a soil, paint, or dust source (depending on the contamination action level used) 36% had at least one non-soil/paint/dust source 6-14% had ONLY a non soil/paint/dust source 4-17% had NO source identified

22. California Dept. of Health Services Childhood Lead Poisoning Prev. Br. Most Common Non-Dust/Paint/Soil Sources Found (cases with environmental investigations 2000-02) Take-Home of Occupational Exposure: 12.5% Home remedy: 10.4% Hobby: 5.9% Pottery/Ceramics: 2.6% All “Other” non-d/p/s sources: 9% (includes all candy and other food items, jewelry, etc.

23. California Dept. of Health Services Childhood Lead Poisoning Prev. Br. California BRFS 52% of those with young children living in a pre-1978 home had undergone renovation or repair in the prior 12 months 6% used Mexican ceramics to store, serve, or prepare food 21% ate Mexican candy (37% of Latino households)

24. California Dept. of Health Services Childhood Lead Poisoning Prev. Br. Alternative Sources 2005 Jewelry Indian silver foil Cribs Holiday mugs Vinyl lunch boxes Chinese kimchi Tattoo ink Chinese cured plums Ayurvedic remedies Moroccan tajines Litargirio Children’s sunglasses Mexican candy/seasonings Turmeric

25. California Dept. of Health Services Childhood Lead Poisoning Prev. Br. New Lead in Candy Law (AB 121) Became law Jan 1, 2006  Requires CA DHS to ensure that candy does not contain lead in excess of the naturally occurring level. This level to be established by new regs by 7/1/06.  DHS shall test candies for lead and establish procedures for candy makers for testing and certifying candy.  Imposes penalties on those who knowingly sell lead-contaminated candy

26. California Dept. of Health Services Childhood Lead Poisoning Prev. Br.