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# PE I ASSOCIATE SP. 3



### BLOO D LEA D LEVEL S I NCHILDRE N LIVIN G I NLEAD-BASE D PAINTE D

HOUSIN G UNIT S



## b y Ann e Pop e PE I Associates , Inc
. 50 5 Sout h Duk e Street , Suit e 50 3 Durham , Nort h Carolin a 27701-319 6

Contrac t No
. 68-02-430 9 Wor k Assignmen t No
. 9 PN365.9- 9
Projec t Office r Richar d B
. Atherto n Wor k Assignmen t Manage r Jef f Cohe n

STRATEGIE S AN D AI R STANDARD S DIVISIO N U.S
. ENVIRONMENTAL PROTECTIO NAGENC Y RESEARC H TRIANGL E PARK , NORT H CAROLINA2771 1

Januar y198 6

## P. 4

DISCLAIME R

Thi s repor t wa s prepare d b yPE I Associates , Inc. , Cincinnati , Ohio , unde r Contrac t No
. 68-02-4309 , Wor k Assignmen t No
. 9
. I t ha s bee n reviewe d b yth e Strategie s an d Ai r Standard s Divisio n o f th e Offic e o f Ai r Qualit yPlannin g and Standards , U.S
. Environmenta l Protectio n Agency , and approve d fo r publica

tion

. Approva l doe s no t signifi ytha t th e content s necessaril yreflec t th e view s an d policie s o f th e U.S
. Environmenta l Protectio n Agency
. Mentio n o f trad e name s o r commercia l product s i s no t intende d t o constitut e endorsemen t o r recommendatio n fo r use .

I IP. 5

CONTENT S
Page

. i v 

### v Table s Acknowledgmen t 

### 1

. Introductio n 1 2

. Relationshi p o f Bloo d Lea d Level s i n Childre n an d Presenc e
o f Lead-Base d Paint s i n Home s 2 3

. Distributio n o f Bloo d Lea d Level s i n Childre n 7 4

. Compariso n o f Bloo d Lea d Level s o f Childre n i n th e Genera l Populatio n an d Childre n Livin g i n Lead-Base d Painte d Home s 2 0 Reference s 2 4

i i i

## P. 6

TABLE S

Numbe r Pag e 1 Characteristic s o f Studie s onDistributio no f Lea dLevel s

i nU.S . Childre n9 2 Distributio no f Bloo dLea dLevel s i nU.S . Childre n1 2 3 Telephon e Surve y Participant s 1 8

i v

## P. 7

ACKNOWLEDGMEN T

Thi s repor t wa s prepare dfo r th e U.S . Environmenta l Protectio nAgenc y b y PE I Associates , Inc. , Cincinnati , Ohio . Mr . Jef f Cohe nwa s th e EP A Wor k Assignmen t Manager . Mr . Davi dDunba r serve da s th e Projec t Director ; Mr . Te d Johnso nwa s th e Projec t Manager . Th e principa l autho r wa s Ms . Ann e Pope . Th e autho r woul dlik e t o than k Mr . Jef f Cohe nfo r hi s guidanc e anddirectio n o nthi s Wor k Assignment . Th e autho r als o woul dlik e t o acknowledg e Mr . Te d Johnson , Ms . Alici a Ferdo , andMs . Donn a Sledg e fo r thei r assistanc e and cooperation .P. 8



### SECTIO N 1
INTRODUCTIO N

Th e U.S . Environmenta l Protectio nAgenc y (EPA ) i s currentl y

assessin g th e exposur e o f childre nunde r 7 year s o f ag e t o lea di nth e environment . Hig hlea dexposure s Ga nresul t i nelevate dbloo dlea dlevel s (PbB's ) i n children . On e importan t sourc e o f lea dexposur e i nchildre ni s th e ingestio n o f lead-base dpain t chips . Unde r Wor k Assignmen t No . 9 , Contrac t No . 68-02 - 4309 , PE I Associates , Inc. , (PEI ) ha s estimate dth e distributio no f PbB' s i n U.S . childre nlivin g i nlead-base dpainte dhousin g unit s (LPH's) . T o deter min e th e relationshi pbetwee nPbB' s i nchildre nan dresidenc y

o f childre ni n LPH's , PE I compare dth e distributio no f PbB' s i nchildre nresidin g i nLPH' s wit htha t i nchildre ni nth e genera l population . Thi s repor t als o contain s a revie w o f th e literatur e onPbB' s i nchildre nlivin g i nLPH' s andi nchil dre no f th e genera l populatio nan dsummarize s th e dat a i nterm s o f percentiles , geometri c means , andgeometri c standar ddeviations .P. 9

SECTIO N 2
RELATIONSHI P O F BLOO D LEA D LEVEL S I N CHILDRE N

AN D PRESENC E O F LEAD-BASE D PAINT S I N HOME S

Clinica l evidenc e indicate s tha t youn g childre nar e mor e likel y t o suffe r from

th e effect s o f lea d poisonin g tha nadult s becaus e childre nten d t o receiv e mor e exposur e t o environmenta l lea d source s an d t o absor b greate r amount s o f lea d tha nadults . Thi s exposur e i s du e primaril y t o th e greate r inclinatio no f childre nt o touch , mouth , an d inges t object s i n th e environment . Th e EP A ha s determine d tha t childre nunde r 7 year s o f ag e compris e th e primar y demographi c ag e grou p a t greates t ris k fro m lea d i n th e environment . Bloo d lea d level s (PbB's ) ar e th e mos t widel y use d indice s o f exposur e t o lea d i nchildren . PbB' s provid e a reliabl e indicato r o f th e amoun t o f lea d availabl e i nth e exchangeabl e body poo l an d allo w

th e evaluatio no f environmenta l lea d exposur e conditions . PbB , however , varie s wit htim e an d provide s onl y

a nindicatio no f recen t exposur e becaus e o f th e rapi d 1 2 clearanc e o f absorbe d lea d fro m blood . ' Th e short-ter m ingestio no f lea d i s no t normall y

associate d wit hsever e lea d toxicity , bu t i t ca ncaus e larg e transitor y

increase s i nPbB's . Chelatio ntreatment s fo r lea d poisonin g als o temporaril y decreas e PbB' s i nchildren . T o avoi d problem s associate d wit hth e tempora l variabilit y o f PbB's , PE I attempte d t o analyz e dat a o f investigation s tha t collecte d rando m bloo d sample s fro m childre n i nquantitie s numerou s enoug ht o b e representativ e and t o minimiz e whateve r variabilit y

exist s i nth e measurements . Investigation s o f lea d poisonin g i nchildre ni nvariou s citie s and State s provide d dat a o nth e numbe r o f childre nwh o ha d hig hPbB's . Thes e dat a mad e possibl e earl y identificatio nand treatmen t o f childre nwh o had lea d poisoning . I nmos t investigations , larg e number s o f childre nwh o wer e
assume d t o b e asymptomati c wer e screene d t o identif y childre nwh o require d furthe r evaluatio nbase d o nPbB . Children , whos e test s wer e initiall y posi tiv e fo r lea d toxicity , wer e furthe r teste d b y obta i nin g additiona l Pb B andP.1 0



### fre e erythrocyt e protoporphyri n(FEP ) measurement s t o diagnos e thei r condi tions . Physician s us e FE P measurement s t o validat e PbB' s i n children . Th e FE P test s wer e performe dt o determin e i f th e initiall y indicate dPbB wa s th e resul t o f a singl e unusua l ingestio no f lea do r o f regula r ingestio no f lea d
ove r a prolonge dperiod . I n additio nt o PbB an d FE P screenin g o f children , mos t investigation s als o surveye dothe r individual s i n th e hausehold s o f th e childre nwhos e test s wer e initiall y positiv e fo r lea dtoxicity . Thes e addi tiona l survey s wer e use dt o identif y th e source s o f lea dexposur e and t o examin e th e home s fo r th e presenc e o f lead-base dpaints . Currentl y 4 0 States , th e Distric t o f Columbia , and Puert o Ric o hav e some activitie s i n childhoo d lea dpoisonin g programs . Studie s o f PbB' s i n childre nar e difficul t t o compar e becaus e screenin g method s var y

amon g th e differen t investigation s and becaus e o f th e decrease s ove r tim e i n "cut-off " o r "clinicall y acceptable " PbB' s an d FEP' s fo r purpose s o f classifyin g lea dtoxicity . Earl y screenin g program s i n th e lat e 1960' s and earl y 1970' s concentrate donl y o n testin g childre nwh o wer e a t highes t ris k t o lea dexposure . Late r program s suc ha s th e Nationa l Healt h and . Nutritio nExaminatio nSurve y (NHANES ) surveye dth e genera l population . Th e "clinicall y

acceptable " level s fo r lea dtoxicit y hav e decrease da s fol lows : i n 197 1 th e Pb B was . 4 0 ug/dl ; i n 197 5 th e Pb B wa s 3 0 yg/d l and th e FE P wa s 6 0 yg/dl ; i n197 8 th e Pb B wa s 3 0 yg/d l an

d th e FE P wa s 5 0 yg/dl ; and 3 i n198 4 th e Pb

B wa s 2 5 yg/d l an

d th e FE P wa s 3 5 yg/dl . Currently , th e averag e PbB' s i n childre ni s 1 0 yg/d l an d th e "clinicall y

acceptable " PbB' s 3 i s 2 5 yg/dl . I n th e revie w o f th e studies , PE I ha s indicate dth e cut-of f PbB' s fo r th e threshol dzone . Studie s tha t measure dth e amoun t o f lea di n painte dsurface s i n home s o f childre n wit h elevate d PbB' s define d th e lea d conten t o f painte d surface s tha t constitute s a hazar dt o childre ni n differen t terms . 2 Currently , home s i n whic hpainte dsurface s contai n>0. 7 m g lead/c m

ar e 4 considere dhazardou s t o children . Man y studie s define dLPH' s a s home s i n whic hth e lea dconten t o f painte dsurface s wa s 1 percen t o r more . Th e term , "on e percen t lead-base dpaint " ha s variou s meanings . Th e percentag e o f 2 lea di n pain t doe s no t correspon ddirectl y o r indirectl y

t o mg/c m

a s thi s woul dindicat e th e presenc e o f lea di n singl e and multipl e layer s o f a

5 painte dsurface . Man y olde r homes , however , contai nlayer s o f lead-base dP.1 1

2 paint s coate d b

y paint s withou t lead ; therefore , mg/c m i s a n appropriat e uni t o f measur e fo r potentia l exposur e o f childre nt o othe r source s o f lead . I nit s revie w

o f th e literature , PE I indicate d th e criterio nfo r definin g a lead-base d pain t hazar d i n homes . Lea d poisonin g occur s i nchildre nunde r 7 year s o f ag e primaril y i n preschoo l ag e children . Man y o f th e screene d childre nwh o showe d elevate d PbB' s resid e i n olde r deterioratin g housin g unit s tha t contai nchalking , flaking. , and/o r peelin g lead-base d paints , and mos t o f th e childre nwit h result s positiv e fo r lea d toxicit y ar e i n th e 6 mont ht o 3 year s ag e grou p an d exhibi t pica

. ' Childre n wh o inges t lead-base d pain t chip s o rdus t containin g lead-base d pain t chip s and wh o resid e i n deteriorate d LPH' s ar e
a t greates t ris k o f exposur e t o lea d tha nothe r demographi c group s o f

3 7 children . ' Childre nma y als o b e expose d t o lea d i n urba nareas , area s
nea r smelters , and i n area s nea r road s wit hhig haverag e dail y traffi c volumes . Becaus e case s o f elevate d PbB' s hav e bee nreporte d amon g al l socio economi c groups , races , and sexe s o f children , lea d poisonin g i s a nationa l proble m wit hth e potentia l t o affec t a larg e numbe r o f youn g U.S . children . Numerou s studie s hav e attempte d t o identif y th e origin s o f elevate d PbB' s i n childre nunde r 7 year s o f age . Fro m 193 0 t o 1970 , elevate d PbB' s
wer e attribute d t o th e presenc e o f lead-base d paint s i n home s and children' s g pic a fo r pain t chip s and dust . Recen t investigation s b y Gilber t e t al . and Galk e e t al . sugges t tha t intac t lead-base d pain t als o contribut e t o 9 1 0 elevate d PbB' s i n children . ' Th e amoun t o f lea d pe r surfac e are a o f 2 painte d surfac e (mg/c m ) , th e integrit y

o f th e painte d Surface , and th e availabilit y

o f pain t chip s t o childre ndetermin e th e degre e o f lead-base d pain t hazar d t o children . I n poorl y maintaine d LPH's , peelin g lead-base d paint , weathe r powdere d paint , and broke nplaste r ar e source s o f lea d exposur e t o children , especiall y childre nwh o resid e i n urba narea s o f th e Northeas t and Midwest . Althoug hpeelin g and intac t lead-base d paint s ar e implicate d a s majo r
source s o f elevate d PbB' s i n children , no direc t evidenc e exists , and th e quantificatio n o f a specifi c dose-respons e relationshi p fo rlead-base d pain t exposur e and PbB' s ha s no t bee nachieved . Becaus e no singl e sourc e o f lea d in th e environmen t account s fo r elevate d PbB' s i n al l children , th e origin s o f C 1 1 1 p elevate d PbB' s i n childre n i s multifactoral

. ' ' Source s o f lea d i n th eP.1 2

bloo d includ e atmospheri c lea d fro m automotiv e an

d industria l emissions , soi l lead , lea d i nstree t and hous e dusts , occupationa l dusts , food , drinkin g 3 7 1 3 water , and lead-base d paints . ' ' Variou s studie s relat e PbB' s t o han d lea d levels , lea d concentratio ni nhous e dust , lea d concentratio ni noutdoo r dust s
and soils , LPH's. , and pica. 5 ' 6 ' 8 ' 9 ' 10,12 * 1 4 ' 1 5 ' 1 6 ' 1 7 Severa l investigation s attribut e elevate d PbB' s i nchildre nt o lea d i nhousedust , soil , and outdoo r 3 7 8 1 2 1 7 dust . ' ' ' ' Th e lea d i nhous e dus t and outdoo r dus t originate s fro m auto motiv e emissions , industria l emissions , secondar y occupationa l sources , and lead-base d paints . Pic a i s als o a larg e contributin g facto r t o elevate d PbB' s i nchildren . Childre nwit hpic a ofte nengag e i ntwo type s o f lea d ingestion- - regula r or frequen t hand-to-mout htransfe r o f dus t and soi l and irregula r Q eatin g o f pain t particles . I nthei r analyse s o f PbB' s i nchildre nresidin g i nLPH' s and home s with ou t lead-base d paints , Urba nand Gi 1 sin nshowe d low correlation s betwee nre sidin g i nLPH' s and PbB' s bu t the y demonstrate d stronge r correlation s betwee n th e ag e o f housin g unit s and PbB's . ' Th e ag e o f housin g unit s and th e lea d conten t o f painte d surface s ar e directl y related . Th e lea d conten t o f 2 0 pain t use d i nhome s buil t prio r t o 194 0 wa s <_5 0 percen t b y weight . I n 1940 , titantiu m

oxid e (Ti0 2 ) paint s wer e use d i nadditio nt o lead-base d paint s i nhomes . I n1955 , th e lead-conten t o f interio r paint s wa s limite d t o <t percen t lea d b

y weight , and i n1971 , th e sal e o f al l interio r lead-base d 2 0 paint s wa s banne d i nth e Unite d States . Today , th e lea d conten t o f paint s 1 4 i s limite d t o £ 0.0 6 percen t b y weight . Man y

o f th e home s buil t prio r t o 196 0 stil l contai nlead-base d paint s o ninterio r and exterio r surfaces , plasters , and putties . Althoug hth e surface s i nolde r housin g unit s ma y b e coate d wit h paint s containin g no lead , th e underlyin g coat s of lead-base d paint s stil l represen t a larg e sourc e o f lea d i na.child' s environment . Base d onth e relationship s betwee nag e o f home s and PbB' s i nchildre nand betwee nth e ag e
o f home s and amoun t of lea d inpaints , PE I assume s tha t elevate d PbB' s i n childre nwh o resid e i nolde r home s constructe d prio r t o 196 0 resul t primaril y fro m lead-base d pain t chips . Multipl e sociodemographi c factor s i nadditio nt o multipl e environmenta l factor s ente r int o th e explanatio no f wh y PbB' s var y

i nchildren . I nth e multipl e regressio nanalyse s b y Star k e t al. , onl y 11. 7 percen t o f th e 5 variatio ni nPbB' s o f childre ncoul d b e attribute d t o environmenta l factors .P.1 3



### Th e variable s may , however , b e intercorrelate d wit henvironmenta l lea dexpo sure . Sociodemographi c factor s tha t influenc e PbB' s o f childre ninclud e fam il y income , ag e o f children , locatio no f chil ddurin g th e day , numbe r o f famil y member s residin g i nhousin g units , marita l statu s o f parents , educatio no f hea do f household , wor k statu s o f hea do f household , race , ownershi po f hous in g units , ag e o f housin g units , conditio no f housin g units , supervisio no f
c i qi n 1 1 

### children , andcleanin g practice s i nhomes . ' ' ' Socia l characteristic s associate dwit hincrease d lea dexposur e i nchildre nar e low socioeconomi c status , disturbe dmother-chil drelationships , frequen t moves , singl e paren t family , underemployment , larg e famil y size , andinadequat e parenta l supervi 2 2 s i on . Therefore , i nadditio nt o a reductio ni nenvironmenta l source s o f lead , program s t o educat e individual s abou t lea dtoxicit y andsource s o f lea d i nhomes , social-welfar e programs , andcontinue dscreenin g o f childre nar e neede dt o decreas e lea dexposur e i nchildren . No stud y ha s determine dth e individua l effect s o f environmenta l and sociodemographi c factor s o nPbB' s i nchildren , bu t th e reductio no f lead-base d paint s ha s bee nth e prim e metho dfo r preventio no f lea dpoisonin g i nth e Unite dStates . Althoug hn o relationshi pbetwee nPbB' s andchildren' s resi denc y i nLPH' s ha s bee nestablished , a tren dha s bee nshow ni nth e literature . Therefore , th e relationshi pbetwee nPbB' s an dresidenc y

i nLPH' s need s t o b e describe dandquantifie dmor e fully . T o hel pdescrib e thi s relationship , PE I compare s studie s o f PbB' s i nchildre nwh o liv e i nLPH' s an dPbB' s inchildre n o f th e genera l populatio ni nSectio n4 o f thi s report .P.1 4

SECTIO N 3
DISTRIBUTIO N

O F BLOO D LEA D LEVEL S IN CHILDRE N

Th e lognorma l distributio nha s bee nshow nt o provid e a goo d fi t t o Pb B dat a fo r children , including , th e uppe r tai l o f th e distribution , whic h represent s childre nwh o ar e a t greates t ris k o f developin g lead-relate d healt heffects . A

lognorma l distributio ni s completel y specifie d i f it s geometri c mea nan d geometri c standar d deviatio nar e known . Consequently , thes e tw o parameter s provid e a convenien t wa y o f summarizin g and comparin g PbB dat a fro

m differen t studies . O f principa l interes t t o EP A wer e th e geometri c mean s and geometri c standar d deviation s o f PbB dat a fo r 1 ) childre ni nLPH's , 2 ) childre ni n th e genera l population , an d 3 ) childre ni nnon-LPH's . Findin g studie s appropriat e fo r estimatin g thes e statistic s wa s difficult . Man y o f th e investigation s reviewe d b y PE I onl y

screene d childre ni nhigh-ris k areas , reporte d th e numbe r o f childre nwh o ha d PbB' s abov e a specifie d amount , examine d onl y

th e home s o f childre nwit helevate d PbB' s fo r th e presenc e o f lead-base d paints , and reporte d th e percentag e o f childre nwit helevate d PbB' s wh o live d i nLPH's . Becaus e th e screene d high-ris k childre nar e no t typica l o f childre ni nth e genera l populatio no r o f childre nlivin g i n LPH's, . PE I di d no t us e PbB dat a obtaine d fro m studie s o f thes e high-ris k childre nt o determin e th e distributio no f PbB' s i neithe r th e childre ni n LPH' s o r thos e i nth e genera l population . Man y o f th e studie s faile d to . repor t geometri c mean s an d geometri c standar d deviations . Som e reporte d onl y th e percentag e o f childre nwh o ha d PbB' s elevate d abov e a specifi c level . Onl y 5 o f th e 2 0 studie s PE I reviewe d containe d calculate d geometri c mean s and/o r geometri c standar d deviations . PE I estimate d geometri c mean s an d geometri c standar d devia tion s fo r 4 o f thes e studie s b y graphicall y

fittin g lognorma l distribution s t o selecte d percentiles . Fo r on e study , PE I estimate d th e geometri c standar d deviatio nunde r th e assumptio ntha t th e distributio ni s lognorma l b y usin g th e followin g equation :P.1 5



### GS D = ex p(l n[(ASD/AM) 2 

### + 1]) 1 / 2



### wher e GS D = geometri c standar ddeviatio n AS D = arithmeti c standar ddeviatio n A M = arithmeti c mean .

Becaus e th e distributio no f PbB' s ove r a rang e o f value s wa s no t reporte d i nth e othe r 1 1 studies , PE I coul dno t estimat e geometri c mean s o r geometri c standar ddeviation s fo r thes e studies . Tabl e 1 provide s a brie f descriptio no f eac ho f th e 2 0 studie s o f PbB' s i nchildre no f th e genera l populatio nandPbB' s i nchildre nresidin g i nLPH's . Tabl e 2 summarize s th e availabl e dat a thes e studie s containe don distributio no f PbB' s i nchildren . Thi s tabl e includes : percentiles , geometri c means , an dgeometri c standar ddeviation s o f PbB' s i nchildre nwheneve r the y appeare di na report . I nsom e cases , geometri c mean s andgeometri c standar ddeviation s wer e estimate db y fittin g a lognorma l distributio nt o percentil e data . Fo r on e study , PE I estimate dth e geometri c standar ddevi atio nmathematicall y fro m th e arithmeti c mea nandarithmeti c standar d deviation . I nNHANE S II , th e firs t stud y liste d i nTable s 1 and 2 , PbB sample s wer e take no f 237 2 childre nage d6 month s t o 5 year s andlivin g i n6 4 samplin g ? 3 ? 4 ? 6 

### area s durin g 197 6 t o 1980 . ' ' Th e childre nwer e selecte dt o yiel da pro babilit y sampl e representativ e o f th e U.S . civilia npopulation . Th e PbB' s i n thes e childre nrange dfro m 2 t o 6 6 yg/dl . N

o statisticall y

significan t correlatio nwa s foun dt o exis t betwee nPbB' s andag e o r betwee nPbB' s and th e se xo f childre ni nthi s ag e bracket . Significan t correlation s betwee n PbB' s i nchildre nandrace , urbanization , andfamil y incom e wer e present , however , a potentia l sourc e o f bia s i nth e NHANE S I I result s coul db e th e poo r respons e rate . Initially , 506 9 childre nwer e selecte dfo r PbB sampling . O f these , 487 6 wer e interviewe dand411 8 wer e examined . Bloo d sample s wer e missin g fo r 163 4 o f th e 411 8 childre nbecaus e o f refusal s t o allo w th e bloo dtest s o r becaus e o f los s o f bloo dsample s durin g analy 2 3 sis . Onl y

4 7 percen t o f th e 506 9 childre ni nth e origina l sampl e produce d usabl e bloo dsamples .TABL E 1 . CHARACTERISTIC S O F STUDIE S O N DISTRIBUTIO N

O F BLOO D LEAD LEVEL S I N U.S . CHILDRE N

Referenc e
NHANE S jj23.24.2 5
ASTH O an

d
CDC 3,21,26-2 8

V O Billic k an

d Gray 6

Star k e t i 5 al . Simpso ne t i 2 9 al . Descriptio no f study
Genera l populatio n

Genera l populatio n

Genera l populatio n

LPH' s

Genera l populatio n

Genera l populatio n Locatio n Nationwid e

Nationwid e

Nationwid e
New Yor k Cit y New Yor k Cit y Cincinnat i

New Have n New Have n 2 7 citie s i n 2 3 state s Yea r

1976-198 0

1973-198 3

1975-197 6
1970-197 6 197 6

9/74-10/7 5 12/75-02/7 7
1971-197 2 Ag e o f

childre n 6 mo-5. 9 yr

1 yr-6. 9 yr

Childre n

1 mo-7 2 m

o 1 yr- 6 y r Comment s

197 3 dat a omi t Boston , New Yor k City , an

d Detroi t 197 4 dat a omi t New

Yor k Cit y and St . Loui s 1973-198 1 - CD C 1982-198 3 - ASTHO , omit s Wash ington , D.C . I n1982-1983 , 98.1 % o f childre n wit hPbB' s
_

> 3 0 yg/d l live d i n home s wit hlead-base d paint s 197 5 - HU D study , 58 % childre n wit hPbB' s
_

> 4 0 yg/d l liv e i n lead-base d painte d home s Cincinnat i - LPH' s contai n> 2

2 m g Pb/c m

(continued )

### TABL E 1 (continued )

Referenc e
1 • r .3 0 Lm-F u

Hammon d e t

, 3 1 al . Galk e e t

, 1 0 al .
Brunekref f

1 4 NAS i H
Barbar a Todd 3 2
Cat o Kirk 3 3 se y Joyc e La 3 4 Penn J H Descriptio no f stud y

Genera l populatio n

Genera l populatio n

Genera l populatio n

Genera l populatio n

Genera l populatio n
Genera l populatio n

Genera l populatio n

'Genera l populatio n Locatio n

2 1 citie s i n U.S . Illinoi s - 1 4 citie s Rura l Dutches s County , Ne w York , an

d Litchfiel d County , Con necticu t Cincinnat i

Charleston , Sout hCarolin a

Dalla s Omah a Nationwid e Waterbury , Connecticu t Chicag o

Ne w Yor k Cit y Yea r

1969-197 1
197 1
197 1

198 0

197 3

197 6 1971-197 7
1973-197 8
F Y198 4

F Y198 4

F Y198 4 Ag e o f

childre n
1 yr- 6 yr

3 mo- 3 yr

0- 5 yr

1 yr- 8 y r 1 yr- 5 yr

0- 6 yr

0- 6 yr

0- 6 y r Comment s

Study als o give s dat a fo r th e followin g ag e groups : 0- 1 yr, 1- 2 yr, 2- 3 yr, 3- 4 yr, an d 4- 5 yr

Screene d high-ris k childre n

Screene d high-ris k childre n

Screene d high-ris k childre n



### (continued )TABL E 1 (cont i

Referenc e Walte r 3 5 Sobolesk y

o- i • 1 9 Gilsin n

ru 1 2 Charne y

Urba n Shie r and Hall 3 6 ' 3 7

Yaffe e e t i 1 3 al . Gilber t e t al. 9
Landriga ne t al. 3 8 nued )

Descriptio no f stud y
Genera l populatio n

LPH' s Genera l populatio n

Genera l populatio n LPH' s Home s wit hn

d lead base d paint s
Genera l populatio n
LPH' s Home s wit hno lead base d paint s
Genera l populatio n LPH' s
LPH' s Home s wit hno lead base d paint s
LPH' s Home s wit hn o lead base d paint s Locatio n Philadelphi a

Nationwid e Ne w Yor k Cit y Ne w Have n St . Loui s Washington , DC Chicag o Illinoi s - 1 2 citie s Baltimor e Rochester , N

Y

Pittsburg h

Californi a

Springfield , Massachusett s

E l Pas o Yea r

F Y198 4

197 2 1970-197 1 197 0 1970-197 1 197 1 1968-197 1 197 1
197 0
198 1

1974-197 5

1979-198 0

197 2 Ag e o f

childre n 0- 6 y r

0-6. 9 y r

1 8 mo-3 5 m o



### 0-6. 9 yr

1-1 5 yr

1- 7 y r Comment s

Screene d high-ris k childre n

Numbe r o f U.S . childre nlivin g i nLPH' s wh o hav e PbB' s
_ > 4 0 yg / d l i s estimate d

Controls : < 3 0 yg/d l Cases : T o - 7 9 yg/d l Lead-base d paint s define d a s > 1 % P bi n pain t

Lead-base d paint s contai n> 1. 2

2 

### m g Pb/c m
Lea d paint s contai n>_ 1% P b
—.—.—',..,.
.

### TABL E 2 . DISTRIBUTIO N O F BLOO D LEA

D LEVEL S I

N U.S . CHILDRE N

r o Stud

y NHANE S I I
ASTH O an d CD C 197 3 197 4 197 5 197 6 197 7 197 8 197 9 198 0 198 1 198 2 198 3 Billic k an

d Gra y U.S . 197 5 U.S . 197 6 NY C 1970-7 6 NY C 197 6 Cincinnat i LPH' s Star k e t al . 9/74-10/7 5 12/75 - 2/7 7 Simpso netal . Lin-F u (1973 ) 2 1 U.S . citie s 1 4 IL citie s 2 rura l co . i n N Yan d C T Sampl e

siz e 2.37 2
277,34 6 371,95 5 440,90 4 404,81 8 380,49 6 397,96 3 464,75 1 502,92 5 535,73 0 552,23 5 676,57 1
440,65 0 512,53 2 766,96 7 103,01 6 8 1
4,46 1 2,31 3 2,04 3
344,65 7 6,15 1 23 0 Percentag e childre nwit hPbB' s (yg/dl ) < indicate d leve l 1 0 12. 2 1 5 2 0 75. 5

— 2 5 90. 9 3 0 9 6

91. 7 92. 6 93. 5 93. 0 94. 7 95. 9 98. 0 98. 4

10 0 35 4 0

99. 5

89. 9 94. 6 94. 5

93. 5 91. 4

75. 6

73. 9 81. 4 91. 0 45 5 0

99. 8

• 5 5

99. 0 6 0 99. 9

99. 6

99. 0 65 7 0

10 0 7 5 8 0

10 0

99. 2 PbB (ug/dl ) Arithmeti c Mea n 16. 0 s d 0.4 2 Geometri c Mea n 14. 9

29. 0 24. 9 34.0 a

26.5 a s d 1.4 7

1.26 a

1.58 a Valu e Minimu m 2. 0 Maximu

m 66. 0

7 0



### (continued )

C O

### TABL E 2 (continued )

0 0 Sampl e

Stud y siz e Hammond e t al . 13 1 Galk e e t al . 18 7 Brunekree f Dalla s 11 6 Omaha 24 2
NA S 2,380,94 2 Barbar a Todd 1,67 5 Cat o Kirkse y

40,00 0 Joyc e LaPenn145,00 0 Walte r Sobolesky

15,35 8 Gilsin n. LPH' s 2,400,000 ° Genera l popula tion : NY C 171,92 7 New Have n1,38 9 St . Loui s 5,04 8 Washington , D C 1,82 1 Baltimor e 93 9 Chicag o 147,48 0 1 2 I L citie s 6,58 0 Charne y Genera l popula tion9 9 LPH' s 3 6 Home s wit hno lead-base d paint s 6 3 Percentag e childre nwit hPbB' s (ug/dl ) < indicate d leve l 10 1 5 2 0

6. 1 2 5 3 0

93. 2 92. 5 90. 0 99. 3 95. 4

41. 1

51. 0 58. 7

63. 9 3 5 4 0

64. 0

75.0 b
73. 8 77. 1 69. 5 60. 8 68. 5 91.2 80. 6 1 5 5 0

88. 5 85. 8 83. 3 85. 4 89.7 5 5 6 0

98. 0

94. 7 92. 6 90. 0 92. 4 92. 7 97. 6 94. 9 

### 6 5 70

97. 7 96. 4

98. 7 96. 9

10 0 10 0

10 0 

### 7 5 8 0

97. 7

9 8 Pb

B Arithmeti c Mea n

37. 7 

### s d pg/dl ) Geometri c Mea n 12. 7 37 a

16. 0 23. 9

32.5 ? 27.5 a 31.0 ? 36.5 a 33.0 ? 16.5 ? 24.5 a 

### s d

1.24 a

1.46 a 1.58 a 1.64 ! 1.41 ? 1.48 ? 1.91 ? 1.76 a Valu e Minimu m 2. 2 18. 0 Maximu

m 46. 5 77. 0



### (continued )TABLE 2 (continued )

Stud y Urban , Shie r an d Hal l Genera l popula tion LPH' s Home s wi t hno lead-base d paint s Yaffe e e t al . Genera l popula tio n LPH' s Gilber t e t al . LPH' s Home s wit hn

u lead-base d paint s Landriga ne t al . LPH' s Home s wit hn

o lead-base d paint s Sampl e

siz e

45 6 39 1 6 5

15,00 0 1 0

4 8

1 2

4 7

8 5 Percentag e childre nwit hPbB' s (ug/dl ) < Indicate d leve l 1 0 1 5

20. 0 2 0

50. 0 25 3 0

90. 0

99. 3 80. 0

37. 5

10 0 3 5 4 0

99. 3 99. 0

6 8

6 1 4 5 5 0

10 0 5 5 6 0 6 5 7 0 75

10 0 8 0 Pb

B Arithmeti c Mea n

21. 9 22. 3 19. 5 s d

7. 0 7. 1 6. 3 Mg/dl ) Geometri c Mea n

20. 7 20. 9 18. 3 s

d

1.37 c 1.36 ^ 1.37 c Valu e Minimu m

0

2 8 Maximu

m

7 3

43

Geometri c mea nan

d geometri c standar d deviatio nar e estimate d b y graphicall y

fittin g lognorma l distributio nt o selecte d percentiles . Estimate d valu e b

y Judit hGilsinn . c Estimate d fro

m arithmeti c mean , arithmeti c standar d deviation , an d arithmeti c mea nunde r th e assumptio ntha t th e distributio ni s lognormal .P.2 2



### Th e Associatio no f Stat e and Territoria l Healt hOfficial s (ASTHO ) and Cente r fo r Diseas e Contro l (CDC ) screene dhigh-ris k childre nl-to-6-years old s i n th e genera l populatio nfo r elevate dPbB's. 3 

### ' 2 1 

### ' 26,27,2 8 

### Th e ASTH O
andCD C studie s onl y reporte dth e percentag e o f childre nwhos e PbB' s wer e elevate dabov e a "clinicall y acceptable " value . Fro m 197 3 t o 1975 , th e reporte d"clinicall y acceptable " PbB wa s 4 0 ug/dl ; and fro m 197 6 t o 1983 , i t wa s 3 0 ug/dl . Becaus e th e distribution s o f PbB' s wer e no t presente d i n th e stud y

results , PE I coul dno t estimat e th e geometri c mean s o r geometri c standar ddeviation s fo r thes e studies . Fro m 197 3 t o 1981 , CD C screene d fou r millio nchildre ni n variou s citie s i n th e Unite dStates . Th e reporte d result s wer e incomplet e fo r som e citie s i n 197 3 an d 1974 . Fo r example , bot hth e 197 3 and 197 4 dat a omitte dNe w Yor k City , wher e a majo r lea d poiso npreventio nprogra m wa s screenin g approximatel y 100,00 0 childre n annually . Fro

m 197 3 t o 1975. , th e rat e o f childre nwh o ha d PbB' s >

_4 0 yg/d l varie dregionall y

fro m 2 percen t i n EP A

Regio nI Xt o 9. 3 percen t i n EP A Regio nIII. 2 

### I n 1982 , ASTH O collecte d PbB dat a fro m 2 6 Stat e healt h agencies ; and i n 1983 , ASTH O collecte dPbB dat a fro m 3 3 Stat e healt h agencies . Th e ASTH O dat a wer e incomplet e and di d no t contai nresult s o f th e lea dpoisonin g progra m i n Washington , D.C . Durin g 198 2 and 1983 , th e percentag e o f high-ris k childre nwit hPbB' s
_ > 3 0 yg/d l varie di n differen t
area s (0.2 % i n Wes t Virginia , 1 % i n Ne w Yor k City , 2.5 % i n Bosto nand Chicago , 3.2 % i n Philadelphia , and 9.6 % i n St . Louis) . Th e Billic k and Gra y stud y containe dth e result s o f nationa l screenin g o f high-ris k

childre n b yth e CDC , screenin g o f high-ris k childre n i n Ne

w 

### Yor k City , and screenin g o f childre nwh o reside di n LPH' s i n Cincinnati . Thi s stud y

di d no t presen t an y distributio no f PbB' s i n children , bu t a clinicall y

acceptabl e PbB wa s reporte dfo r eac hscreening . Durin g 197 5 and 1976 , approximatel y

933,00 0 high-ris k childre nwer e screene db y th e CDC . Fort y t o 4 5 percen t o f th e high-ris k childre nwh o ha d PbB' s >

_4 0 yg/d l reside di n home s withou t lead-base dpaints . Fro m Marc h197 0 t o Decembe r 1976 , 766,90 0 high-ris k childre nwer e screene di n Ne w Yor k City . Durin g th e cours e o f th e study , th e mea nPbB i n childre ndecreased , seasona l variation s occurre dwit hpeak s i n Jul y and August , an

d 2 - t o 4-year-old s ha dth e highes t PbB's . In Cincinnati , 8 1 childre nwh o reside di n LPH' s

2 wit h>

_2 m g lead/c m

lea don painte dsurface s wer e screened . Al l 8 1 childre nhad PbB' s < 3 0 yg/dl . 1 5P.2 3

From 197 4 t o 1977 , two investigation s i nNe w Haven , Connecticut , measure d PbB' s i nchildre nage d on e mont ht o 7 2 months . Star k e t al . reporte d th e geometri c mean s fo r th e tw o investigation s and compare d th e PbB' s o f group s

. 5 o f childre nwit han d withou t suspecte d ris k factors . Th e characteristic s associate d wit helevate d PbB' s wer e foun d t o relat e t o th e impaire d abilit y o f
a famil y

t o provid e adequat e supervisio no f youn g children . Durin g 197 1 and 1972 , 230 9 childre nage d 1 t o 6 year s wer e screene d i n 2 7 citie s i n2 3 State s t o determin e th e percentag e o f childre nwit hPbB' s > ^ 4 0 yg/d l wh o live d i nolde r housin g units . I nal l bu t fou r cities , som e childre nwer e reporte d t o hav e PbB' s >

_4 0 yg/dl . I nth e fou r citie s wher e n o childre nha d elevate d PbB's , onl y a limite d numbe r o f childre nwer e screened . Usin g th e PbB distributio ndat a presente d b y Simpso ne t al. , PE I estimate d th e 2 9 geometri c mea nan d geometri c standar d deviation . Th e distributio no f PbB' s i nchildre nsurveye d b y blood-screenin g pro 3 0 gram s i n2 1 U.S . citie s durin g 196 9 t o 197 1 wa s discusse d b y Lin-Fu . Th e childre nreside d i nold , poorl y maintaine d neighborhoods . Th e surve y showe d tha t 8. 8 t o 32. 9 percen t o f th e screene d childre nha d PbB' s > 4 0 yg/dl , 0 t o

— 3 0 19. 4 percen t ha d PbB' s
_ > 6 0 yg/dl , and 0 t o 7. 6 percen t ha d PbB' s . > 8 0 yg/dl . Lin-F u als o reporte d th e result s o f blood-screenin g program s tha t teste d 615 1 childre ni n1 4 Illinoi s citie s wit hpopulation s o f 10,00 0 t o 150,00 0 and 23 0 childre ni nrura l area s o f Ne w Yor k and Connecticut . Tabl e 2 show s th e per centag e o f childre nwit hPbB' s
_ > 4 0 yg/d l t o decreas e i nless-populate d areas . Th e percentag e o f childre nwit hPbB' s
_ > 4 0 yg/d l decrease d fro m 26. 1 i nlarg e citie s t o 18. 6 i nmoderat e size d citie s and downt o 9 i nrura l areas . I n1980 , Hammon d e t al . screene d 13 1 Cincinnat i childre nage d 3 month s 3 1 t o 3 year s and relate d PbB' s i nchildre nt o environmenta l source s o f lead . Th e PbB's . o f th e screene d childre nrange d fro m 2. 2 t o 46. 5 yg/d l wit ha geo metri c mea nPbB o f 12. 7 yg/dl . Th e result s o f th e stud y establishe d a definit e relationshi p betwee nth e ag e o f housin g unit s and elevate d PbB' s i n children . Th e presenc e o f lea d i npain t contribute d onl y slightl y

t o th e elevate d PbB's . I n1973 , 18 7 newbor nt o 5 yea r ol d childre ni nCharleston , Sout hCarolina , wer e screene d t o determin e i f PbB' s wer e relate d t o residenc y i nLPH's . Thirty-si xpercen t o f th e childre nha d PbB' s > 4 0 yg/d l and 2 percen t ha d PbB' s > 6 0 yg/dl . Galk e e t al . foun d th e PbB' s i nchildre nt o var y wit hsoi l 1 6P.2 4



### lead , averag e dail y

traffi c volume , and lea di n exterio r paint . Th e rela tionshi pbetwee nlead-base dpaint s and elevate dPbB' s i n th e screene dchildren , however , wa s no t foun dt o b e significant . Brunekree f performe dregressio nanalyse s on dat a fro m 1 9 studie s con ducte di n Europ e and Nort hAmeric a t o determin e th e relationshi pbetwee nPbB' s andsource s o f lea di n th e environment . PE I ha s include dth e geometri c mea n PbB' s obtaine dfro

m screening s o f 11 6 childre ni n Dalla s and 24 2 childre ni n Omaha . Th e Dalla s stud y showe da relationshi pbetwee naverag e dail y traffi c volum e and PbB' s i n children . Th e increase dgeometri c mea nPb B o f childre n screene di n Omah a probabl y resulte dfro

m increase dlea demission s fro m smelter s locate di n th e cit y

an d surroundin g areas . Th e Nationa l Academ

y o f Science s (NAS ) presente dnationa l result s o f 1 4 urba nscreenin g program s i n th e Unite dStates . Approximatel y 2. 4 millio n childre nwer e screene dbetwee n197 3 and 197 8 b y loca l lea dpoisonin g contro l rograms . Nationally , 6. 8 percen t o f th e screene dchildre nha d elevate dPbB' s

_ > 3 0 yg/dl ; i n individua l cities , th e percentag e o f childre n wit h PbB' s >

_3 0 yg/d l range dfro

m 3 t o 20 percent . I na telephon e survey , PE I contacte dindividual s i n eigh t citie s acros s th e Unite dState s t o obtai ncurren t informatio nabou t lea dpoisonin g preven tio nprogram s i n th e cities . Tabl e 3 list s th e individual s wh o wer e contacted . Onl y fou r o f thos e contacte dreporte drelevan t information . I n th e fou r citie s represente db

y thi s information , th e percentag e o f screene dchildre nwit hPbB' s

_ > 3 0 yg/d l range dfro m 0. 7 percen t i n Ne w Yor k Cit y

t o 1 0 percen t i n Chicago . I n1972 , Gilsin nestimate d tha t o f th e 1 7 millio nU.S . childre n6 year s o f ag e o r younger , 2,400,00 0 reside di n high-ris k area s i n LPH' s and 600,00 0 1 9 childre nha d PbB' s >_4 0 yg/dl . Sh e calculate dth e numbe r o f childre nwit h elevate dPbB' s b

y analyzin g previou s dat a fro m blood-screenin g program s o f high-ris k children . Th e result s o f som e o f thes e blood-screenin g program s ar e presente di n Table s 1 and 2 . Gilsin ndevelope dand teste da mode l fo r performin g he r estimat e b y using.censu s trac t dat a fo r calibratio no f th e model . Whe nsh e use dSMS A dat a durin g th e applicatio no f th e model , sh e experience dproblem s wit haggregation . Th e Gilsin nmode l employe dth e follow in g equation :



## 1 7P.2 5



### TABL E 3 . TELEPHON E SURVE YPARTICIPANT S
Barbar a Tod d Program . Coordinato r Lea dPoiso nPreventio nProgram Waterbury , Connecticu t Cat o Kirkse y Environmenta l Healt hDivisio n D i recto r Lea dPoisonin g Preventio nProgram Chicago * Illinoi s Walte r Sobolesk y Lea dAbatemen t Progra m Philadelphia , Pennsylvani a Ell a Witherspoo n Lea dPoisonin g Preventio nProgram Washington , DC Davi dNordmeye r Environmenta l Stat e Specialis t fo r Minnesot a Minneapolis , Minnesot a E . Billic k Chicago , Illinoi s Marg o Branso n Environmenta l Assessmen t Program Dallas , Texa s Georg e Hanse l Nashville , Tennesse e Joyc e LaPen n Burea uo f Lea dPoisonin g Ne w Yor k City , Ne w

Yor k

, k , 0.296 7 . 0.248 4 E-k 6 

### (^)[0.747(-| ) (j}) " ]

wher e
E =

c 

### 6 = 

### H = P = d= th e predicte dnumbe r o f childre nwit helevate dPbB' s th e numbe r o f childre n6 year s o f ag e o r younge r th e tota l numbe r o f housin g unit s th e tota l populatio n th e numbe r o f dilapidate d an d deteriorate dhomes .

I na stud y

o f childre n1 8 t o 3 5 month s o f age , Charne y e t al . screene d 4 9 inner-cit y

childre ni n Rochester , Ne w York , wit hPbB' s o f 4 0 t o 7 0 yg/d l
andFEP' s > 5 9 yg/d l an d 5 0 inner-cit y

childre nwit hPbB' s <

_2 9 yg/d l an

d 1 ? FEP' s £5 9 yg/dl

. Forty-si xpercen t o f th e childre n wit h elevate d PbB' s 

### and2 6 percen t o f th e childre nwit hlo w PbB' s reside di n LPH's . Becaus e th e childre nwer e preselecte dfo r correlatin g residenc y i n LPH' s and PbB , th e 

## 1 8P.2 6



### Charne y stud y di dno t provid e anaccurat e distributio no f PbB' s i nchildre n wh o liv e i nLPH's . Fo r compariso nwit hth e NHANE S I I study , th e Pittsburg hstud y conducte d b y Shie r andHal l andanalyze db y Urba nproduce dth e bes t results. 1 8 

### ' 3 6 

### ' 3 7 

### Durin g 197 4 and 1975 , childre nage d6 year s andyounge r i n400 0 randoml y selecte dhome s i nPittsburg hwer e screene dfo r elevate d PbB's . Eigh t hundre d childre nwer e identifie da s eligibl e t o participat e i nth e study . Becaus e o f reluctanc e o f som e parent s t o allo w thei r childre nt o b e teste db y th e publi c healt hdepartmen t andlac k o f lead-base dpaint s i nsom e homes , however , onl y 45 6 childre nwer e actuall y screened , andonl y

39 1 o f thes e childre nlive din 2 LPH' s wit h> 2 mg lead/c m oninterio r painte dsurfaces . Room-by-roo m com pariso no f lea di npainted : surface s o f housin g unit s showe dtha t th e screene d childre nreside di ndwelling s wit hgreate r amount s o f lea dtha nth e tota l sur ve y population . Therefore , childre nno t screene d probabl y hadlowe r PbB' s tha nth e screene dchildren . I nth e Pittsburg hstudy , i f a relationshi pexiste d betwee nelevate dPbB' s i nchildre nandresidenc y i nLPH's , th e bia s wa s i nth e directio no f highe r PbB' s i nchildren . A ninvestigatio nb

y Yaffe e e t al . compare dth e PbB' s o f 1 0 childre nwh o live di na Californi a duple xwit ha naverag e pain t lea dconcentratio no f 63,00 0 1 3 ppm . Becaus e o f th e smal l sampl e size , however , result s o f th e Yaffe e stud y wer e no t compare dwit hthos e o f th e othe r 1 9 investigations . Gilber t e t al . examined.4 8 childre nwh o live di nLPH' s wit h>

_1. 2 m g 2 lead/c m onpainte dsurface s and1 2 childre nwh o reside di nhome s that con g taine dn o lead-base dpaints . Thirt y o f th e children , wh o hadPbB' s
_ > 5 0 yg/dl , wer e designate da s cas e children , andth e othe r 3 0 children , wh o hadPbB' s £ 3 0 yg/dl , wer e classifie da s controls , th e result s showe dthat 1 8 o f th e control s (60% ) live di nLPH' s and3 0 o f th e cas e childre n(100% ) live di n LPH's . Becaus e thi s investigatio ndi dno t scree nth e genera l populatio no f childre nwh o reside di nLPH's , th e result s o f th e Gilber t e t al . stud y wer e no t compare dwit hth e NHANE S I I results . I n1972 , Landriga ne t al . screene dth e PbB' s i nchildre nwh o reside di n 3 8 thre e area s o f E l Pas o that wer e nea r a smelter . Forty-seve nchildre nwh o lived.i nLPH' s havin g pain t wit h> 1 percen t lead.conten t and8 5 childre nwh o live di nhome s wit hn o lead-base dpaint s wer e screened . Thirty-tw o percen t
o f th e childre nwh o reside di nLPH' s and3 9 percen t o f th e childre nwh o reside di nhome s wit hn o lead-base dpaint s hadPbB' s >

_4 0 yg/dl . 1 9P.2 7



### SECTIO N 4
COMPARISO N

O F BLOO D LEA D LEVEL S O F CHILDRE N IN TH E GENERA L POPULATIO N

AN D CHILDRE N

LIVIN GIN LEAD-BASE D PAINTE D HOME S

Th e PbB screenin g program s presente di nTable s 1 and2 wer e yery diffi cul t t o compar e becaus e mos t program s screene donl y high-ris k childre nwh o wer e mor e likel y

t o b e expose dt o lead . Th e PbB' s i nhigh-ris k childre nwer e usuall y highe r tha nPbB' s i nchildre no f th e genera l population . O f th e reviewe dstudie s o f PbB' s i nchildre no f th e genera l population , NHANE S I I use da rando m

screenin g process , wherea s th e othe r studie s screene dhigh-ris k children . Th e latte r studie s include dASTH O andCDC , Billic k andGray , Star k
e t al. , Simpso ne t al. , Lin-Fu , Hammon de t al. , Galk e e t al. , Brunekreef , NAS , Barbar a Todd , Cat o Kirksey , Joyc e LaPenn , Gilsinn , andYaffe e e t al . NHANE S II , ASTH O andCDC , Billic k andGray , Simpso ne t al. , Lin-Fu , and NA S summarize ddat a fro m nationa l screenin g programs . Th e percentag e o f high ris k 1 t o 6 year s old s wit hPbB' s j ^ 4 0 ug/d l wa s greate r i nnationa l screenin g program s conducte dfro m 196 9 t o 197 2 tha nNHANE S II . Lin-F uandSimpso ne t a1 . reporte dtha t approximatel y 2 5 percen t o f th e high-ris k childre nscreene ddur in g 196 9 t o 197 2 hadPbB' s > 4 0 yg/dl , andNHANE S I I reporte donl y 0. 5 percen t
o f childre nscreene drandoml y hadPbB' s
_

> 4 0 yg/dl . Th e significan t differenc e betwee nth e result s o f NHANE S I I andLin-F uandSimpso ne t al . probabl y oc curre dbecaus e o f difference s i nth e characteristic s o f th e sampl e population s o f th e studies . Betwee n197 3 and1976 , approximatel y 6 percen t o f th e high ris k childre nscreene dnationall y b y CD C an dBillic k andGra y hadPbB' s
_

> 40 yg/dl ; th e numbe r range dfro m 5. 4 t o 10. 1 percent . Becaus e CDC , Billic k and Gray , Lin-Fu , andSimpso ne t al . screene donl y high-ris k children , th e per centage s o f childre nwit hPbB' s >

_40 yg/d l wer e probabl y no t representativ e o f th e genera l populatio nandwer e greate r tha nth e actua l percentag e o f th e childre nin.th e genera l populatio nwit hPbB' s 2 : 40 yg/dl . Therefore , th e reporte dpercentag e o f childre nwit hPbB's,2 : 40 yg/d l i nNHANE S I I i s probabl y mor e reasonable .



## 2 0P.2 8

Betwee n197 6 and 1981 , CD C screene d 1. 6 millio nhigh-ris k childre n nationally , and th e percentag e o f childre nwit hPbB' s >

_3 0 yg/d l range d fro m 8. 3 percen t i n197 6 t o 4. 1 percen t i n1981 . Fro m 197 3 t o 1978 , NA S reporte d tha t 2.3 8 millio nhig hris k childre nwer e tested , an d 6. 8 percen t ha d PbB' s

1 4 >

_3 0 yg/dl . Althoug hCD C an d NA S studie s showe d simila r percentage s o f high ris k childre nwit hPbB' s
_ > 3 0 yg/dl , NHANE S I I reporte d tha t 4 percen t o f th e 237 2 childre nrandoml y selecte d fo r screenin g ha d PbB' s >

_3 0 yg/dl . I n198 2
an d 1983 , approximatel y 2 percen t o f th e childre nscreene d b y ASTH O ha d PbB' s

_ > 3 0 yg/dl . Th e CD C an d ASTH O screenin g program s produce d result s simila r t o thos e o f th e NHANE S I I study . Othe r investigation s screene d high-ris k childre no f th e general popula tio ni nth e followin g areas : Ne w Yor k City , Cincinnati , Dallas , Omaha , Chicago , Philadelphia , Baltimore , Ne w Haven , St . Louis , Waterbury , Charleston , Sout hCarolina , mid-siz e citie s i nIllinoi s an d tw o rura l countie s i nNe w Yor k
an d Connecticut . Mos t o f thes e studie s (especiall y th e investigation s con ducte d prio r t o 1977 ) showe d highe r geometri c mean s and geometri c standar d deviation s tha nth e NHANE S I I study . Mos t o f th e screenin g program s i nindi vidua l citie s reporte d tha t greate r percentage s o f childre nha d PbB' s 2 1 3 0 yg/d l and PbB' s 2 : 4 0 yg/d l tha nchildre nscreene d durin g th e NHANE S I I survey . I n1980 , Hammon d showed. a lowe r geometri c mea n(12.7 yg/dl ) fo r 13 1 childre n 3 1 screene d i nCincinnat i tha nchildre nscreene d i nth e NHANE S I I study . Dat a
ar e no t availabl e t o determin e i f th e Hammon d valu e differ s significantl y fro m th e NHANE S I I value . I nfisca l yea r 1984 , th e percentag e o f childre n
screene d b

y lea d poisonin g preventio nprogram s i nWaterbury , Chicago , Phila delphia , and Ne w

Yor k Cit y

wh o had PbB' s >

_3 0 yg/d l range d fro m 0. 7 percen t i nNe w Yor k Cit y

t o 1 0 percen t i nChicago , Th e percentag e o f childre nwit h PbB' s >

_3 0 yg/d l fo r thes e fou r screenin g program s wer e i nagreemen t wit hth e percentage s reporte d b y NHANE S II . O f th e seve nstudie s tha t measure d th e PbB' s i nchildre nresidin g i nLPH's , th e Pittsburg hstud y conducte d b

y Shie r an d Hal l and analyze d b y Urba nwa s th e

1 0 oc onl y investigatio ntha t randoml y screene d childre nwh o reside d i nLPH's . ' Studie s performe d b y Charne y

e t al. , Yaffe e e t al. , Gilber t e t al. , an d Lan driga ne t al . compare d th e PbB' s i nchildre nan d level s o f lea d o npainte d 9 1 2 1 3 1 8 surface s o f home s fo r cas e and contro l groups . ' ' ' Becaus e th e fou r studie s di d no t scree nth e genera l populatio no f childre nwh o reside d i nLPH's ,
2 1P.2 9



### th e result s di dno t provid e anaccurat e distributio no f PbB' s i nchildre nwh o live di nLPH' s andth e studie s wer e no t compare d wit hresult s o f eithe r th e Pittsburg hstud y

o r th e NHANE S I I study . Billic k andGra y measure dPbB' s i n 8 1 childre nlivin g i nLPH' s in . Cincinnati , andfoun dtha t al l o f them had PbB' s < 3 0 yg/dl . Becaus e th e Cincinnat i stud y sample d fewe r childre ntha n th e Pittsburg hstud y andpresente dn o informatio nconcernin g sampl e selection , th e result s o f Billic k andGra y wer e no t compare dwit hth e result s o f NHANE S II . Th e Gilsin nmode l estimate dtha t 2 4 percen t o f childre nresidin g i n 1 9 LPH' s i nth e Unite dState s hadPbB' s 2 : 4 0 yg/dl . Becaus e Gilsinn' s result s wer e no t base do nrandom screenin g o f childre nwh o resid e i nLPH's , th e stud y wa s no t compare dwit hNHANE S II . Base donth e eliminatio no f si xo f th e studie s ando nth e samplin g methodolog y use di nth e Pittsburg hstudy , PE I compare d th e result s o f th e NHANE S I I stud y wit hthos e o f th e Pittsburg hinvestigation . I nPittsburgh , 0. 7 percen t o f al l screene dchildre nwh o reside di nLPH' s andi nhome s wit hn o lead-base dpaint s hadPbB' s >

_4 0 yg/dl , and0. 5 percen t
o f childre nscreene db y NHANE S I I ha dPbB' s ^4 0 ug/c 

### j i . 1 8 

### » 2 3 

### ' 2 4 

### ' 2 5 

### ' 3 6 

### ' 3 7 

### Th e geometri c mea nPbB o f th e NHANE S I I stud y (14.9 ) wa s lowe r tha nth e geometri c mea nPbB o f al l childre nscreene di nPittsburg h(20.7) . I nPittsburgh , 1 per cen t o f th e screene dchildre nwh o live d i nLPH' s hadPbB' s >

_4 0 yg/dl . Th e percentag e o f childre nwit hPbB' s >

_4 0 yg/d l wa s no t significantl y differen t fo r childre nscreene di nth e NHANE S I I study , screene dchildre nwh o live d i n home s wit hno lead-base dpain t i nPittsburgh , an dscreene dchildre nwh o resid edi nLPH' s i nPittsburgh . Compare dwit hth e NHANE S I I stud y results , th e geometri c mea nPbB' s wer e highe r bot hi nPittsburg hchildre nwh o reside di n LPH' s andhome s wit hno lead-base dpaints . Th e reporte dgeometri c mea nPb B i nchildre nscreene ddurin g NHANE S I I wa s 14. 9 yg/dl , an dth e geometri c stan dar ddeviatio nwa s 1.4 7 yg/dl . Fo r th e Pittsburg hstudy , th e reporte dgeo metri c mea nPbB' s o f childre nwer e 20. 7 yg/d l i nLPH' s an dhome s wit hn o lead-base dpaints , 20. 9 yg/d l i nLPH's , an d18. 3 yg/d l i nhome s wit hn o lead base dpaints . Althoug hPE I compare dth e result s o f th e NHANE S I I study wit hth e Pitts burg hstudy , th e result s o f th e compariso nma y b e misleadin g becaus e o f th e differen t year s tha t th e studie s wer e conducted . Fro m 197 5 (th e yea r o f th e Pittsburg hstudy ) t o 198 0 (th e fina l yea r o f th e NHANE S I I study) , lea dexpo sur e declined . Therefore , th e result s o f th e two studie s canno t be compare d
2 2P.3 0



### accuratel y

from th e availabl e literature . PE I provide d th e bes t compariso n o f th e data . T o provid e a bette r compariso no f PbB' s i nchildre no f th e genera l populatio nand i nchildre nwh o resid e i nLPH's , additiona l studie s o f randoml y

selecte d sample s o f childre nlivin g i nLPH' s ar e needed , especiall y

i nlarg e metropolita narea s o f th e Unite d States .



## 2 3P.3 1



### REFERENCE S

1 . Jenkins , D . Desig no f Pollutant-Oriente d Integrate dMonitorin g Systems , A Tes t Case : Environmenta l Lead . U.S . Environmenta l Protectio nAgency , La s Vegas , Nevada . EPA-600/4-76-018 , Apri l 1976 . 2 . U.S . Environmenta l Protectio nAgency . Ai r Qualit y Criteri a fo r Lead . Researc hTriangl e Park , Nort hCarolina , Augus t 198 3 (draft) . 3 . Lin-Fu , J . Childhoo dLea dPoisoning : Th e Nationa l Perspective . Pre sente d at : Childhoo dLea dPoisoning : I s i t Stil l a Problem ? A Symposium

fo r Healt hCar e Providers , Cincinnati , Ohio , Jun e 25 , 1985 . 4 . Persona l communicatio nfro m Verno nHouk , Cente r fo r Diseas e Control , Jul y 8 , 1985 . 5 . Stark , A. , e t al . Th e Relationshi po f Environmenta l Lea dt o Blood-Lea d Level s i nChildren . Environmenta l Research , 27:372-383 , 1982 . 6 . Billick , I. , andV . Gray . Lead-Base dPain t Poisonin g Research , Revie w andEvaluatio n1971-1977 . HU D RP-809 . U.S . Departmen t o f Housin g an d Urba nDevelopment , Washington , D.C , Jul y 1978 . 7 . Center s fo r Diseas e Control . Preventin g Lea dPoisonin g i nYoun g Children . U.S . Departmen t o f Healt handHuma nServices , Atlanta , Georgia , Januar y 19.85 . 8 . Hammond , P . Exposur e t o Lead . In : Lea dAbsorptio ni nChildren , J . J . Chisholm , Jr . an

dD . M . O'Hara , eds. , Urba nandSchwarzenberg , Baltimore , Maryland , 1982 . 9 . Gilbert , C , e t al . A Compariso no f Lea dHazard s i nth e Housin g Environ men t o f Lea dPoisone dChildre nVersu s Non-Poisone dControls , Journa l o f Environmenta l Scienc e andHealth , A14(3):145-168 , 1979 . 10 . Galke , W. , e t al . Environmenta l Determinant s o f Lea dBurden s i nChildren . Presente dat : Th e Internationa l Conferenc e o nHeavy Metal s i nth e En vironment , Toronto , Canada , 1975 . 11 . Lin-Fu , J . Undu e Absorptio no f Lea dAmon g Childre n- A Ne w Loo k a t a n Ol dProblem . Ne w

Englan dJourna l o f Medicine , 206:702-710 , 1972 . 12 . Charney , E. , e t al . Increase dLea dAbsorptio ni nInne r Cit y Children : Wher e Doe s th e Lea dCom e From ? Pediatrics , 65(2 ) :226-231 , 1980 .



## 2 4P.3 2

13 . Yaffee , Y. , e t al . Identificatio no f Lea d Source s i nCaliforni a Childre n Usin g th e Stabl e Isotopi c Rati o Technique . Archive s o f Environmenta l Health , 38(4):237-245 , 1983 . 14 . Nationa l Academ y o f Science s Committe e onLea d i nth e Huma nEnvironment . Lea d i nth e Huma nEnvironment . Nationa l Academ y o f Sciences , Washington , D.C , 1980 . 15 . Bornschein , P. , e t al . Th e Influenc e o f Socia l an d Environmenta l Factor s o nDus t Lead , Han d Lead , and Bloo d Lea d Level s i nYoun g Children , 1985 . 16 . Yostal , J. , e t al . Lea d Analysi s o f Hous e Dust : A Metho d fo r th e Detec tio no f Anothe r Sourc e o f Lea d Exposur e i nInne r Cit y Children . Environ menta l Healt hPerspectives , 7:91-97 , 1974 . 17 . Brunekreef , B . Th e Relationshi p Betwee nAi r Lea d and Bloo d Lea d i n Children : A

Critica l Review . Scienc e o f th e Tota l Environment , 38:79 - 123 , 1979 . 18 . Urban , W . Statistica l Analysi s o f Bloo d Lea d Level s o f Childre nSurveye d i nPittsburgh , Pennsylvania : Analytica l Methodolog y and Summar y

Results . NBSJ R76-1024 . Nationa l Burea u o f Standards , Washington , D.C , Apri l 1976 . 19 . Gilsinn , J . Estimate s o f th e Natur e an d Exten t o f Lea d Pain t Poisonin g i nth e Unite d States . NB S Tec hNot e 764 . Nationa l Burea u o f Standards , Washington , D.C , Decembe r 1972 . 20 . Berger , H . Th e NB S Lea d Pain t Poisonin g Project : Housin g an d Othe r Aspects . NB S Tec hNot e 759 . Nationa l Burea u o f Standards , Washington , D.C , Februar y

1973 . 21 . O'Hara , D . Socia l Favor s i nth e Preventio no f Increase d Lea d Absorptio n i nChildren . In : Lea d Absorptio ni nChildren , J . J . Chilsholm , Jr . and D . M . O'Hara , eds. , Urba nand Schwarzenberg , Baltimore , Maryland , 1982 . 22 . Stark , A. , e t al . Relationshi p o f Sociodemographi c Factor s t o Bloo d Lea d Concentration s i nNew Have nChildren . Journa l o f Epidemiolog y an d Commun it y Health , 36:133-139 , 1982 . 23 . Annest , J. , e t al . Bloo d Lea d Level s fo r Person s 6 Month s - 7 4 Year s o f Age : U.S. , 1976-1980 , Advanc e data , Vita l an d Healt hStatistic s o f th e Nationa l Cente r fo r Healt hStatistics , 79 , Ma y 1984 . 24 . Annest , J. , e t al . Bloo d Lea d Level s fo r Person s Age s 6 Month s - 7 4 Years . PH S 84-683 . U.S . Departmen t o f Healt han d Huma nServices , Nationa l Cente r fo r Healt hStatistics , Hyattsville , Maryland , Augus t 1984 . 25 . Mahaffey , K. , e t al . Nationa l Estimat e o f Bloo d Lea d Levels : U.S . 197 6 t o 1980 . Th e Ne w

Englan d Journa l o f Medicine , 307(10 ) :573-579 , 1982 .



### 2 5P.3 3

26 . Hopkins , D. , and V . Houk . Federally-Assiste d Screenin g Project s fo r Child hoo d Lea d Poisonin g Control , Th e Firs t Thre e Year s (Jul y 197 2 - Jun e 1975) . AJPH , 66(5):485-486 , Ma y 1976 . 27 . U.S . Cente r fo r Diseas e Control . Surveillanc e o f Childhoo d Lea d Poison in g - Unite d States . Morbidit y an d Mortalit y

Report , Repor t 31 , 132 - 134 , 1982 . 28 . U.S . Cente r fo r Diseas e Control . Surveillanc e o f Childhoo d Lea d Poison in g - Unite d States . Morbidit y an d Mortalit y

Weekl y Report , Repor t 28 , 117-118 , 1979 . 29 . Simpson , J. , e t al . Elevate d Bloo d Level s i nChildre n- A 2 7 Cit y Neighborhoo d Survey . Healt hService s Report , 88:419-422 , 1973 . 30 . Lin-Fu , J . Medica l Progress , Vulnerabilit y o f Childre nt o Lea d Exposur e and Toxicity . Ne w

Englan d Journa l o f Medicine , 289:1229-1233 , 1289 - 1293 , 1973 . 31 . Hammond , P. , e t al . Source s o f Lea d i nth e Urba nEnvironment . Presente d at : Symposiu

m onLea d Environmenta l Health , Durham , Nort hCarolina , Ma y 1985 . 32 . Persona l communicatio nfro m Barbar a Todd , Program Coordinato r wit hLea d Poiso nPreventio nProgram , Cit y o f Waterbury , Connecticut , Jul y 1985 . 33 . Persona l communicatio nfro m Cat o Kirksey , Environmenta l Healt hDivisio n Director , Lea d Poisonin g Preventio nProgram , Chicago , Illinois , Jul y 1985 . 34 . Persona l communicatio nfro m Joyc e LaPenn , Lea d Poisonin g Preventio n Program , Ne w

Yor k City , New

York , Jul y

1985 . 35 . Persona l communicatio nfro m Walte r Sobolesky , Lea d Abatemen t Program , Philadelphia , Pennsylvania , Jul y 1985 . 36 . Shier , B. , and W . Hall . Analysi s o f Housin g Dat a Collecte d i na Lead Base d Pain t Surve y

i nPittsburgh , Pennsylvania , Par t I . NBSI R77-1250 . Nationa l Burea u o f Standards , Washington , D.C , Marc h1977 . 37 . Shier , B . an

d Hall , W . Analysi s o f Housin g Dat a Collecte d i na Lead Base d Pain t Surve y

i nPittsburgh , Pennsylvania , Par t II , NBSI R77-1293 , Nationa l Burea u o f Standards , Washington , D.C , Jun e 1977 . 38 . Landrigan , P. , e t al . Epidemic . Lea d Absorptio nNea r anOr e Smelter , Th e Rol e o f Particulat e Lead . Th e Ne w Englan d Journa l o f Medicine , 292:123-129 , 1975 .



### 26