Eliminating

Childhood

Lead Poisoning:

A Federal Strategy Targeting

Lead Paint Hazards

Presidentís Task Force

on Environmental

Health Risks and

Safety Risks

to Children
Eliminating

Childhood

Lead Poisoning:

A Federal Strategy Targeting

Lead Paint Hazards

February 2000

Presidentís Task Force on

Environmental Health Risks

and Safety Risks to Children
Preface

The following story is true. Lead

poisoning can be prevented by

identifying whether lead hazards in

a home are present and by learning how to

safely address them.

One Familyís Story

Like any other parent, the most important

priority in my life is to provide my three

children, Damien, Samuel, and Nathan, with

a happy and healthy homeóa place where

they can grow, learn, and develop into

productive adults. What I didnít know was

that our home would threaten my childrenís

health.

In April of 1996, my family and I managed to

save enough to buy our own home. Within

four months of moving in, our pride and joy

evaporated when Samuel, then 10 months

old, was diagnosed with a blood lead level

of 32 micrograms per deciliter (μg/dL). I

soon learned that my sonís blood lead level

was three times above the limit thought to

cause future learning problems. A greater

shock was that the lead paint, dust and soil

in and around our treasured home was the

culprit.

Worse yet, a month later, Samuelís lead level

had risen to 50 μg/dL. He was hospitalized

that same afternoon and for three long,

agonizing days he stayed in the hospital and

began treatment. During Samuelís

hospitalization, my husband and I spent

many hours attempting to make our home

lead safe, all the while keeping vigil over

Sam. For nearly 4 years, Sam had his blood

tested every two months. We continued to

improve our home through repair loans to

make it safe. Today, our house has new

windows, and lead abatement has been

completed on the interior and exterior of

our home. Samuelís

blood lead level has

dropped below 10 μg/dL.

To see Samuel, now 4

years old, you would

never know what this

happy, beautiful little

boy has had to endure.

Our sonís lead

poisoning could have

been prevented if we

had known to check for lead and how to

keep our home lead safe. Today, families

receive this information when they buy or

rent an older home. It is critical that

parents receive this information so that

they can take the necessary steps to

protect their family. I share my story with

the hope that other families and their

children will learn about the dangers of lead,

and that one day soon, lead poisoning will

be a disease of the past.
Eliminating Childhood Lead Poisoning: A Federal Strategy Targeting Lead Paint Hazards
About the Presidentís Task Force on Environmental

Health Risks and Safety Risks to Children...................................................................... i

Members of the Presidentís Task Force on Environmental

Health Risks and Safety Risks to Children .................................................................... iii

Members of the Lead Poisoning Prevention Workgroup ................................................... .v

Executive Summary ............................................................................................................ 1

Budget Summary ................................................................................................................ 9

Introduction ..................................................................................................................... 11

Current and Ongoing Federal Programs and Activities .................................................... 15

Strategy ............................................................................................................................ 21

Recommendations ........................................................................................................... 29

Resources ......................................................................................................................... 39

References ........................................................................................................................ 41

Appendix: Methodology Used to Project Numbers of Lead Poisoned Children and

Trends in the American Housing Stock, 2000-2010 (Developed for this Document)

Figures

Figure 1: National Blood Lead Levels ................................................................................. 2

Figure 2: Potential Impacts of Various Actions on the Number of

Low-Income Lead Poisoned Children ............................................................................ 4

Figure 3: Lead Toxicity in Children ................................................................................... 11

Figure 4: Certificate of Lead Hazard Control.................................................................... 14

Figure 5: Potential Impacts of Various Actions on the Number of

Low-Income Lead Poisoned Children .......................................................................... 26

Tables

Table 1: Pre-1960 Units at Risk of Having Lead Paint Hazards in 2010.................................. 5

Table 2: Estimated Average Annual Costs of Options to Address

Lead Paint Hazards In Pre-1960 Housing, 2001- 2010 .................................................. 5

Table 3: Federal Agency Roles on Lead Poisoning Prevention ........................................... 7

Table 4: Lead Consumption in Housing per Decade ........................................................ 22

Table 5: HUD National Lead Paint Survey Data (1990) .................................................... 22

Table 6: Pre-1960 Units at Risk of Having Lead Paint Hazards in 2010................................ 23

Table 7: Estimated Average Direct Annual Costs of Options to Address

Lead Paint in Pre-1960 Housing, 2001-2010 ............................................................... 24

Table 8: Preliminary Outcome Data for HUD Lead Paint Hazard Control

Grant Program Evaluation ........................................................................................... 27

Table of Contents
Eliminating Childhood Lead Poisoning: A Federal Strategy Targeting Lead Paint Hazards
I

n recognition of the growing body of

scientific information demonstrating

that Americaís children suffer more

than adults from environmental health risks

and safety risks, President William Jefferson

Clinton issued Executive Order 13045 on

April 21, 1997, directing each federal agency

to make it a high priority to identify, assess,

and address those risks. In issuing this

order, the President also created the Task

Force on Environmental Health Risks and

Safety Risks to Children, co-chaired by

Donna E. Shalala, Secretary of the U.S.

Department of Health and Human Services,

and Carol M. Browner, Administrator of the

U.S. Environmental Protection Agency. The

Task Force was charged with recommending

strategies for protecting childrenís

environmental health and safety.

About the Presidentís Task Force on

Environmental Health Risks and

Safety Risks to Children

This Strategy has been developed by an

interagency work group of the Presidentís

Task Force on Environmental Health Risks

and Safety Risks to Children. Workgroup

representatives are listed on page five.

The goal of the workgroup was to develop a

set of recommendations to eliminate

childhood lead poisoning in the United

States as a major public health problem by

the year 2010. This report focuses primarily

on expanding efforts to correct lead paint

hazards (especially in low-income housing),

a major source of lead exposure for

children.

i
Eliminating Childhood Lead Poisoning: A Federal Strategy Targeting Lead Paint Hazards

ii
Members of the Presidentís

Task Force on Environmental

Health Risks and Safety

Risks to Children

Honorable Donna E. Shalala

Co-chair

Secretary

U.S. Department of Health and Human Services

Honorable Carol M. Browner

Co-chair

Administrator

U.S. Environmental Protection Agency

Honorable Andrew Cuomo

Secretary

U.S. Department of Housing and Urban

Development

Honorable Janet Reno

Attorney General

U.S. Department of Justice

Honorable Alexis Herman

Secretary

U.S. Department of Labor

Honorable Bill Richardson

Secretary

U.S. Department of Energy

Honorable Richard Riley

Secretary

U.S. Department of Education

Honorable Dan Glickman

Secretary

U.S. Department of Agriculture

Honorable Rodney Slater

Secretary

U.S. Department of Transportation

Honorable Jacob J. Lew

Director

Office of Management and Budget

Honorable George Frampton

Chair

Council on Environmental Quality

Honorable Ann Brown

Chairman

U.S. Consumer Product Safety Commission

Honorable Martin N. Bailey

Chair

Council of Economic Advisors

Honorable Neal Lane

Director

Office of Science and Technology Policy

Honorable Gene Sperling

Assistant to the President for Economic Policy

Honorable Bruce Reed

Assistant to the President for Domestic Policy

iii
Eliminating Childhood Lead Poisoning: A Federal Strategy Targeting Lead Paint Hazards

iv
Members of the Lead Poisoning

Prevention Workgroup

Joanne K. Rodman, Chair

Senior Advisor, Office Of Childrenís Health

Protection

U.S. Environmental Protection Agency

Principal Contributors

David E. Jacobs

Director, Office of Lead Hazard Control

U.S. Department of Housing and Urban

Development

Thomas Matte

Medical Epidemiologist

Centers for Disease Control and Prevention

U.S. Department of Health and Human Services

Linda Vlier Moos

Associate Director

National Program Chemicals Division

Office of Pollution Prevention and Toxics

U.S. Environmental Protection Agency

Bruce Nilles

Attorney

Environment and Natural Resources Division

U.S. Department of Justice

Workgroup Members

Claudia Magdalena Abendroth

Office of Management and Budget Executive

Office of the President

Duane Alexander

Director

National Institute of Child Health and Human

Development

National Institutes of Health

U.S. Department of Health and Human Services

Lt Col Isaac Atkins

Director

Occupational Health and Safety Force Protection

Office of the Secretary

Department of Defense

Michelle Altemus

Council on Environmental Quality

Executive Office of the President

Jesse Baskerville

Director

Toxic and Pesticides Enforcement Division

Office of Enforcement and Compliance Assurance

U.S. Environmental Protection Agency

Victoria Belfit

Lead Program Team Leader

US Army Center for Health Promotion and

Preventive Medicine

Department of Defense

Joel Busenberg

Oak Ridge National Laboratory

U.S. Department of Energy

Edith Brashares

Office of Tax Policy

U.S. Department of the Treasury

Doreen Cantor

National Program Chemicals Division

Office of Pollution Prevention and Toxics

U.S. Environmental Protection Agency

v
Eliminating Childhood Lead Poisoning: A Federal Strategy Targeting Lead Paint Hazards

Joseph Carra

Office of Pollution Prevention and Toxic Substances

U.S. Environmental Protection Agency

Jean M. Diggs

Office of State and Community Programs

Office of Energy Efficiency and Renewable Energy

U.S. Department of Energy

Phil Ellis

Office of Economic Policy

U.S. Department of the Treasury

Denis Feck

Office of State and Community Programs

Office of Energy Efficiency and Renewable Energy

U.S. Department of Energy

Pamela Gilbert

Executive Director

Consumer Product Safety Commission

Richard Jackson

Director

National Center for Environmental Health

Centers for Disease Control and Prevention

U.S. Department of Health and Human Services

Jennifer Kerekes

Office of Childrenís Health Protection

U.S. Environmental Protection Agency

Woodie Kessel

Senior Child Health Science Advisor

Office of Public Health Service

U.S. Department of Health and Human Services

Charles Lee

Deputy Director

Office of Environmental Justice

U.S. Environmental Protection Agency

Maureen Lydon

Associate Director

Chemical, Commercial Services, & Municipal

Division

Office of Enforcement and Compliance Assurance

U.S. Environmental Protection Agency

Gail N. McKinley

Office of State and Community Programs

Office of Energy Efficiency and Renewable Energy

U.S. Department of Energy

Rebecca Morley

Office of Lead Hazard Control

U.S. Department of Housing and Urban

Development

Bryan Nix

Facilities Policy Division

Army Office of the Assistant Chief of Staff for

Installation Management

Department of Defense

Robin Delany-Shabazz

Office of Juvenile Justice and Delinquency Programs

Office

Office of Justice Programs

U.S. Department of Justice

Stevenson Weitz

Office of Lead Hazard Control

U.S. Department of Housing and Urban

Development

Elaine Wright

Deputy Director Air Protection Division

Region III

U.S. Environmental Protection Agency

Jerry Zelinger

Medical Advisor Center for Medicaid and State

Operations

Health Care Financing Administration

U.S. Department of Health and Human Services

The workgroup acknowledges the

contributions of Peter Ferko, Rick Nevin,

Eric Oetjen, and Kim Taylor of ICF

Consulting, Inc.

Graphics developed and provided by

Dorothy Allen, Matt Ammon, Dana Bres,

and Harry Hudson.

vi
1

This report, for the first time,

presents a coordinated federal

program to eliminate childhood

lead poisoning in the United States. It

describes how lead poisoning harms

children, how pervasive lead poisoning is,

and how lead paint hazards in housing can

be eliminated in 10 years. To achieve the

goal of making children safe from lead

hazards, the President's FY2001 budget

increases federal funding for several agencies, including the Environmental Protection Agency (EPA) and the Department of

Justice (DoJ), and provides for a 50%

increase in lead hazard control grants

issued by the U.S. Department of Housing

and Urban Development (HUD). The budget

also maintains the current level of funding

for lead programs at the Department of

Health and Human Services (DHHS). In this

report, we are proposing 10-year plan that

will create 2.3 million lead-safe homes for

low-income families with children, thereby

resulting in net benefits of $8.9 billion, as

estimated by HUD.

Executive Summary

Recommendations: The following recommendations are key to a successful lead

hazard control strategy:

■ Act before children are poisoned:

Target federal grants for low-income housing

and leverage private and other non-federal

funds to control lead paint hazards; promote education for universal lead-safe

painting, renovation, and maintenance work

practices; and ensure compliance and

enforcement of lead paint laws.

■ Identify and care for lead-poisoned

children: Improve early intervention by

expanding blood lead screening and followup services for at-risk children, especially

Medicaid-eligible children.

■ Conduct research: Improve prevention

strategies, promote innovative ways to drive

down lead hazard control costs and quantify the ways in which children are exposed

to lead.

■ Measure progress and refine lead

poisoning prevention strategies: Implement monitoring and surveillance programs.

(See page 29 for the full list of recommendations.)

The Lead Problem

Lead is highly toxic, especially to young

children. It can harm a child's brain, kidneys, bone marrow, and other body systems. At high levels, lead can cause coma,

convulsions, and death. The National

Academy of Sciences has reported that

comparatively low levels of lead exposure

are harmful. Levels as low as 10 micrograms

of lead per deciliter of blood (μg/dL) in

infants, children, and pregnant women are

associated with impaired cognitive function,

behavior difficulties, fetal organ development, and other problems.1

 In addition, low

levels of lead in children's blood can cause

reduced intelligence, impaired hearing and

reduced stature.2

 Lead toxicity has been

well-established, with evidence of harmful

effects found in children whose blood lead

levels exceed 10 μg/dL.3,4

■ Lead poisoning is a completely

preventable disease.

■ Residential lead paint hazards

in homes of children can be

virtually eliminated in 10 years.

■ Every child deserves to grow

up in a home free of lead paint

hazards.
2

Eliminating Childhood Lead Poisoning: A Federal Strategy Targeting Lead Paint Hazards

No single definition of "lead poisoning" suits

all purposes. From a public health perspective,

the key questions are: 1) At what level does

lead poisoning have a preventable adverse

impact on health? and 2) What is the magnitude of the health problem? In this report, the

term "lead poisoning" is used to describe

blood lead levels of 10 μg/dL or above in

children under six.

Lead Paint In Housing -

Particularly Low-Income

Housing

The most current national survey shows

that nearly 1 million children are lead

poisoned.5

 A large body of evidence shows

that the most common source of lead

exposure for children today is lead paint in

older housing and the contaminated dust

and soil it generates.6-14 Poisoning from lead

paint has affected millions of children since

this problem was first recognized more than

100 years ago15, 16 and it persists today

despite a 1978 ban on the use of lead in

new paint.17 Although all children living in

older housing (where lead paint is most

prevalent) are at risk, low-income and

minority children are much more likely to be

exposed to lead hazards. For example, 16%

of low-income children living in older

housing are poisoned, compared to 4.4% of

all children (see Figure 1).5 Therefore,

eliminating lead paint hazards in older lowincome housing is essential if childhood

lead poisoning is to be eradicated.

Other Sources Of Childhood

Lead Poisoning

Lead exposure among young children has

been dramatically reduced over the last two

decades because of the phase-out of lead

from gasoline, food and beverage cans, and

new house paint, and because of reductions

of lead in industrial emissions, drinking

water, consumer goods, hazardous waste

sites, and other sources. As a

result of these past and ongoing efforts, children's blood

lead levels have declined over

80% since the mid-1970s.5

 In

1978 there were about 14.8

million poisoned children in

the United States. By the early

1990s, that number had

declined to 890,000 children.

The long-term vision of this

strategy is to eliminate childhood lead poisoning in the

United States.

Figure 1

National Blood Lead Levels

Eliminating Childhood Lead Poisoning: A Federal Strategy Targeting Lead Paint Hazards
3

Further Efforts Needed To

Eliminate Lead Poisoning

In Children

Despite progress, lead poisoning remains

one of the top childhood environmental

health problems today.14 Without further

action, over the coming decades large

numbers of young children may be exposed

to lead in amounts that could impair their

ability to learn and to reach their full potential. To help accelerate the progress in

eliminating this disease, this report has

been compiled to examine what needs to be

done to make children's housing lead-safe

and to provide early intervention for children at highest risk. Specifically, it examines

what actions need to be taken before children

are poisoned. This report shows that the

number of poisoned children can be greatly

reduced over the next decade as a result of

demolition, renovation, regulation, and

increased federal subsidy and leveraged

private funding (Figure 2). Additional efforts

will continue to address exposures from

other sources, such as lead in exterior soil

and dust, drinking water, and air emissions.

Goals: This Strategy advances two goals:

1. By 2010, eliminate lead paint hazards in housing where children under

six live. This goal can be accomplished

through the following:

■ federal grants and leveraged private

funding to identify and eliminate lead paint

hazards in order to produce an adequate

supply of lead-safe housing for low-income

families with children;

■ outreach and public education to increase awareness of lead hazards and how

to address them; and

■ enforcement of lead safety laws and

regulations.

2. By 2010, elevated blood lead levels

in children will be eliminated through:

■ increased compliance with existing

policies concerning blood lead screening;

and

■ increased coordination across federal,

state and local agencies responsible for

outreach, education, technical assistance,

and data collection related to lead screening and abatement.

Infrastructure Now Exists

Title X of the 1992 Housing and Community

Development Act, otherwise known as the

Residential Lead-Based Paint Hazard Reduction Act (Public Law 102-550), mandated

the creation of an infrastructure that would

correct lead paint hazards in housing. Title

X also redefined ìlead paint hazardsî and

how they can be controlled. Based on

scientific research in the 1980's, Congress

defined a ìhazardî to include deteriorated

lead paint and the lead-contaminated dust

and soil it generates. The infrastructure has

been developed and includes the following:

■ Grant programs to make homes lead safe,

now active in over 200 cities

■ Training of thousands of workers doing

housing rehabilitation, remodeling, renovation, repainting, and maintenance to help

them do their work in a lead-safe way

■ Licensing of inspectors and abatement

contractors

■ Compliance with and enforcement of lead

safety laws and regulations

■ Disclosure of lead paint problems before

sale or lease

■ National and local education and

outreach programs

Vision:

Eliminate childhood lead

poisoning in the United

States
4

Eliminating Childhood Lead Poisoning: A Federal Strategy Targeting Lead Paint Hazards

■ Promulgation of federal standards of care

■ Worker protection regulations

Modern Lead-Safe

Methods

New low-cost methods are now available to

identify and fix hazardous housing. Field

studies have shown that modern lead

hazard control methods have been effective

in reducing levels of lead-contaminated

house dust by an average of 60%, with an

average decline in blood lead levels of about

25%.19 House dust is the most common

exposure pathway through which children

are exposed to lead paint. Older housing is

continually being demolished, renovated, or

abated. Current projections show that,

without this further action, several million

children would be poisoned over the next

several decades. Figure 2 depicts the

potential impacts of various actions on the

number of lead poisoned children.

Figure 2

Potential Impacts of Various

Actions on the Number of

Low-Income Lead Poisoned

Children

HUD indicates that 2.3 million housing units

will be at risk of lead paint hazards in 2010,

if current trends continue (Table 1). Direct

federal financial assistance for housing

occupied by low-income families will continue to be needed.14 These funds can be

used to leverage private resources to create

lead-safe housing. In some jurisdictions, it

may be possible to create enough lead-safe

housing for families, yet not necessarily

address all housing units with lead paint. In

other jurisdictions, virtually all housing will

need to be made lead-safe to protect

children.

Economic Costs And

Benefits Of Making

Homes Lead Safe

Ideally, lead paint in housing would be

permanently abated. However, the challenge

today is to quickly eliminate lead paint

hazards in as many dwellings as possible.
5

Table 1

Pre-1960 Units at Risk of

Having Lead Paint Hazards in

2010

Abatement alone is unlikely to achieve this

goal, absent significant funding from nonfederal sources. Interim controls (specialized maintenance and safe repainting and

renovation work practices) followed by ongoing management provide the best opportunity for success to leverage private funding to the fullest extent possible and

thereby protect the largest number of

Housing Stock

Number of

Housing

Units

(millions)

Total Units at Risk of Lead Paint Hazards in 1999 24.0

Reduction Due to Demolition, 2000-2010 -1.8

Reduction Due to Substantial Renovation, 2000-2010 -3.8

Subtotal (Total Units at Risk of Lead Paint Hazards in 2010) 18.4

20% of Subtotal Occupied by Low-Income Families 3.7

Reduction Due to HUD Regulation of Federally-Assisted Housing,

2000-2010 -1.4

Total Low-Income Units in 2010 At Risk of Lead Paint Hazards 2.3

children in the near term. If ongoing management is not implemented consistently,

lead hazards could reappear. Lead paint

must be safely managed until the building is

demolished, renovated, or abated.

HUD compared the costs of two approaches to controlling lead paint hazards:

1) managing lead paint on an ongoing basis

Source: American Housing Survey, Current Population Survey, Residential Energy Consumption Survey (Appendix)

Table 2

Estimated Average Annual

Costs of Options to Address

Lead Paint Hazards in Pre-1960

Housing, 2001ñ2010

Pre-1960 Housing Stock

Lead Hazard

Screening and

Interim Controls

($1,000 per unit)

Inspection/Risk

Assessment and

Full Abatement of

Lead Paint

($9,000 per unit)

All Pre-1960 Housing at Risk of Lead Paint Hazards

(1.84 million units/year) $1.84 billion $16.6 billion

Pre-1960 Housing Occupied by Low-Income Families

Not Covered by HUD Regulation (230,000 units/year) $230 million $2.1 billion

Source: Evaluation of the HUD Lead Hazard Control Grant Program; The Economic Analysis for the HUD Lead Paint Regulation for

Federally Assisted Housing (see Appendix)
6

Eliminating Childhood Lead Poisoning: A Federal Strategy Targeting Lead Paint Hazards

to ensure it does not become hazardous

(interim controls); and 2) permanent abatement for all pre-1960 housing with lead

paint and for low-income housing where

risks are greatest (Table 2). The Department

determined that the benefits of eliminating

lead hazards greatly exceed the costs for all

cases.

Based on conservative assumptions, the

quantifiable monetary benefit (which does

not include all benefits) of eliminating lead

paint hazards through interim controls in

the nation's pre-1960 low-income housing

stock over the next 10 years will be $11.2

billion at a 3% discount rate ($3.5 billion at

a 7% discount rate). The net benefits of

interim controls are $8.9 billion at a 3%

discount rate and $1.2 billion at a 7%

discount rate. The monetary benefit of

abatement of low-income housing is estimated at $37.7 billion at a 3% discount rate

[$20.8 billion at a 7% discount rate (see

Appendix)]. The benefit of permanently

abating lead paint is considerably greater

because more children would benefit over a

considerably longer time span. The quantified monetary benefits may underestimate

the actual benefits because of the many

unquantifiable benefits associated with

eliminating childhood lead paint poisoning.

Other Key Federal

Activities

Table 3 presents a summary of federal

agency programs and duties for dealing with

lead poisoning.

In addition to expanding the HUD lead

hazard control grant program, this strategy

recognizes other important federal activities

that need to be continued or increased to

confront childhood lead poisoning.

Enforcing lead regulations is important to

reduce exposure to lead hazards. This

strategy recommends increasing enforcement of the Lead Paint Disclosure Rule,

concentrating on housing with a history of

lead-poisoned children, or that has physical

or management problems indicating the

likely presence of lead paint hazards. Other

lead paint rules addressing certification and

training, pre-renovation education, use of

safe and reliable work practices, and management and disposal of lead-based paint

debris also need to be implemented using

integrated strategies that combine compliance assistance, incentives, monitoring and

enforcement.

Even with a substantial expansion of resources for residential lead hazard control,

a significant number of dwellings that could

house families with young children will

remain with lead hazards. The public health

benefits of hazard control activities should

be increased by outreach programs to

identify at-risk familiesóespecially those

with pregnant women or young infants who

live in homes with lead hazardsóand link

them to existing lead safe housing and

resources for hazard control.

Improving early intervention by expanding

blood lead screening and follow-up services

for at-risk children is a key component of

this strategy. Recommendations include

ensuring that targeted case management

for lead poisoned Medicaid children includes coordination of medical treatment

services with environmental, housing, and

social interventions to identify and eliminate sources of lead exposure.

Research to develop new cost-effective lead

hazard control technologies, evaluate

hazard control techniques for urban lead

contaminated soil and exterior dust, and

improve portable blood lead analyzer

technology is also advocated. In addition,

monitoring programs to measure progress

and refine lead poisoning prevention strategies are needed.
7

Agency Programs and Duties

Department of Housing and

Urban Development

Lead Hazard Control Grant Program, enforcement of

Disclosure Rule (with EPA and DoJ) and Federally-Assisted

Housing Lead Paint Regulations, National Survey of Lead

Paint in Housing, Lead Hotline (with EPA), Internet listing

of lead paint professionals, public education and training

of housing professionals and providers and others,

technical assistance, research.

Department of Health and Human Services:

Centers for Disease

Control and Prevention

(CDC)

Blood Lead Screening Grant Program, public education to

medical and public health professionals and others,

National Health and Nutrition Examination Survey, quality

control for laboratories analyzing blood lead specimens,

research.

Health Care Financing

Administration (HCFA)

Covers and reimburses for lead screening and diagnosis,

lead poisoning treatment, and follow-up services for

Medicaid-eligible children.

National Institute of Child

Health and Human

Development (NICHHD)

Conducts and supports laboratory, clinical, and

epidemiological research on the reproductive,

neurobiologic, developmental, and behavioral processes

including lead poisoning related research.

Health Resources and

Services Administration

(HRSA)

Directs national health programs to assure quality health

care to under-served, vulnerable, and special need

populations including children with lead poisoning.

The Agency for Toxic

Substances and Disease

Registry (ATSDR)

Undertakes the study of blood lead in populations near

Superfund sites and funds State health agencies to

undertake this type of work.

Food and Drug

Administration

Enforces standards for lead in ceramic dinnerware;

monitors lead in food.

National Institutes of

Health Basic research on lead toxicity.

Table 3

Federal Agency Roles on Lead

Poisoning Prevention

Table continues on next page
8

Eliminating Childhood Lead Poisoning: A Federal Strategy Targeting Lead Paint Hazards

Agency Programs and Duties

Environmental Protection Agency

(EPA)

Authorizes States to license lead paint professionals;

environmental laboratory accreditation; enforcement of

disclosure Rule (with HUD and DOJ) and Pre-Renovation

Notification Rule; Hazardous Waste Regulation; public

education to parents, environmental professionals, and

others; training curriculum design; Lead Hotline (with

HUD); research; addresses lead contamination at

industrial waste sites including drinking water and

industrial air emissions.

Department of Justice

Enforces Federal Lead Paint Disclosure Rule (with HUD

and EPA), defends Federal lead paint regulations,

enforces pollution statutes including hazardous waste

laws.

Consumer Product Safety

Commission

Enforces ban of lead paint; investigates and prevents the

use of lead paint in consumer products; initiates recalls of

products containing lead that present a hazard; conducts

dockside surveillance and intercepts imported products

that present a risk of lead poisoning; recommends

elimination of lead from consumer products through

Guidance Policy on lead.

Occupational Safety and Health

Administration

Worker protection regulations.

Department of the Treasury

Evaluates financial incentives (such as tax credits) for

lead hazard control.

Department of Energy Conducts weatherization activities in a lead-safe manner.

Department of Defense

Administers lead-based paint/lead hazard management

programs in 250,000 family housing and child-occupied

facilities worldwide, administers childhood lead poisoning

prevention programs on installations worldwide,

administers research and development programs to

develop new cost-effective technologies for lead paint

management and abatement, partner with other Federal

agencies to develop policies and guidance for lead hazard

management on a national level.

Table 3 (continued)

Federal Agency Roles on Lead

Poisoning Prevention

Eliminating Childhood Lead Poisoning: A Federal Strategy Targeting Lead Paint Hazards
9

Budget Summary

FY99 Enacted FY2000 Enacted Budget FY2001 President's Budget

Area/Activity $ Area/Activity $ Area/Activity $

Environmental Protection Agency

■ Inspection, Enforcement

and Compliance

■ Education and Outreach

■ Decrease Toxic Waste

$1M

$2M

$1M

$4M

■ Inspection, Enforcement

and Compliance

■ Education and Outreach

■ Decrease Toxic Waste

$1M

$2M

$1M

$4M

■ Inspection, Enforcement

and Compliance

■ Education and Outreach

■ Decrease Toxic Waste

$3M

$2M

$1M

$6M

Department of Housing and Urban Development

■ Hazard Control Grants in

Private Low-Income

Housing

■ Public Education,

Technical Assistance,

Research

■ Healthy Homes

Initiative

■ (Enforcement)

$60M

$10M

$10M

(not a

separate

line item)

$80M

■ Hazard Control Grants in

Private Low-Income

Housing

■ Public Education,

Technical Assistance,

Research

■ Healthy Homes

Initiative

■ (Enforcement)

$60M

$10M

$10M

(not a

separate

line item)

$80M

■ Hazard Control Grants in

Private Low-Income

Housing

■ Public Education,

Technical Assistance,

Research

■ Healthy Homes

Initiative

■ Enforcement

$90M

$10M

$10M

$10M

$120M

Department of Health and Human Services (CDC only)

■ Screening, Medical and

Env. Management,

Outreach and Education

$38M ■ Screening, Medical and

Env. Management,

Outreach and Education

$38M ■ Screening, Medical and

Env. Management,

Outreach and Education

$38M

Department of Justice

■ Enforcement $0.1M ■ Enforcement $0.1M ■ Enforcement $0.3M

Consumer Product Safety Commission

■ Inspection, Enforcement

and Compliance

■ Education and Outreach

$0.1M

$0.1M

$0.2M

■ Inspection, Enforcement

and Compliance

■ Education and Outreach

$0.1M

$0.1M

$0.2M

■ Inspection, Enforcement

and Compliance

■ Education and Outreach

$0.1M

$0.1M

$0.2M

Department of Defense

Not Available

Total $122.3M $122.3M $164.5M

Presidentís Task Force on

Environmental Health Risks

and Safety Risks to Children

Lead Poisoning Prevention

Strategy Budget Summary
10

Eliminating Childhood Lead Poisoning: A Federal Strategy Targeting Lead Paint Hazards
11

The Lead Poisoning

Problem

Lead poisoning is entirely preventable. However, nearly 1 million

children living in the United States

have blood lead levels high enough to

impair their ability to think, concentrate,

and learn.5

 Lead is highly toxic and affects

virtually every system of the body. It can

damage a child's kidneys and central

nervous system and cause anemia. At very

high levels, lead can cause coma, convulsions, and death. Even low levels of lead

are harmful. Levels as low as 10 micrograms

of lead per deciliter of blood (μg/dL) are

associated with decreased intelligence,

behavior problems, reduced physical

stature and growth, and impaired hearing

(see Figure 3).1,2 A child is estimated to

lose 2 IQ points for each 10 μg/dL increase

in blood lead level.4

 One study suggests

that lead exposure may be associated with

juvenile delinquent behavior.20 Lead toxicity

has been well-established, with evidence of

harmful effects found in children whose

blood lead levels exceed 10 μg/dL.3,4,21

No single definition of ìlead poisoningî

suits all purposes. From a public health

perspective, the key questions are: 1) At

what level does a preventable adverse

impact on health occur? and 2) What is the

magnitude of this health problem? In this

report, the term ìlead poisoningî is used to

describe blood lead levels of 10 μg/dL or

above in children under six.

Lead is most hazardous to the nation's

roughly 24 million children under the age of

6. Their still-developing nervous systems

are particularly vulnerable to lead, and their

normal play activities expose them to lead

paint hazards and lead-contaminated dust

and soil. Children between ages one and

three are at greatest risk because of normal

hand-to-mouth activity and the increase in

mobility during their second and third years

which make lead hazards more accessible

to them.

Introduction

Major progress on lead poisoning has been

achieved through a combination of primary

prevention measures that have eliminated

major sources of lead exposure and through

secondary prevention programs that ensure

screening and interventions for children

who have already been poisoned. These

changes were brought about through the

efforts and collaborations of many federal

agencies (see Table 3) and their State, local,

and private-sector partners. As reported in

the National Health and Nutrition Examination Survey (NHANES), the proportion of

children age 1-6 with lead poisoning fell to

4.4% in 1991-94. This was a more than 80%

decline from 1976-80.5

Figure 3

Toxicity of Blood Lead

Concentration in Blood

(μg Pb/dL) in Children

Adapted from ATSDR, Toxicological Profile for Lead
12

Eliminating Childhood Lead Poisoning: A Federal Strategy Targeting Lead Paint Hazards

Despite these accomplishments, nearly 1

million children in the United States have

lead poisoning. This remaining problem is

especially acute in certain population

groups. For example, among children living

in pre-1946 dwellings (when the use of lead

in paint was most common), the prevalence

of lead poisoning is five times higher than

among children living in homes built after

1973 (most of which do not have lead

paint)5

 Nationally, children in Medicaid also

represent a high-risk group, comprising 80%

of children with blood lead levels 15 μg/dL

and above.22

Although any child is potentially at risk, lowincome children living in deteriorated older

housing (especially in inner-city neighborhoods) shoulder a disproportionately larger

share of lead-poisoning cases. For example,

16% of low-income children living in housing

built prior to 1946 are lead poisoned.5

Without new prevention and control efforts,

a large number of young children may

continue to be exposed to lead paint

hazards over the coming decades.

Sources of Lead

Poisoning

Potential sources of lead exposure in

children vary greatly in magnitude. Many of

these sources have already been addressed

and have directly contributed to the dramatic decline in blood lead levels to date.

The U.S. Environmental Protection Agency

(EPA) has virtually eliminated lead in gasoline, and has placed strict limits on the

amount of lead in drinking water and on

lead emitted from industrial facilities. EPA

has also phased out lead in pesticides and,

with the Department of Justice (DoJ), has

addressed lead contamination at many

Superfund sites. In cooperation with the

Food and Drug Administration (FDA), food

processors virtually eliminated the use of

lead solder in domestically-canned food and

beverages. FDA also has established strict

standards concerning the amount of lead

that can leach from ceramicware into

beverages and foods. The Occupational

Safety and Health Administration (OSHA)

has regulated lead exposure for workers,

which also benefits the children of those

workers who may have been placed at risk

via take-home exposures (such as lead dust

on work clothing). Lead in residential paint

was phased out and completely banned by

the Consumer Product Safety Commission

(CPSC) in 1978. In addition, CPSC has

addressed lead contamination in children's

toys, miniblinds, playground equipment,

and other sources, and continues to conduct special dockside inspections to look

for imported children's products containing

lead that present hazards. Public education

efforts have been launched to publicize the

dangers of lead in folk remedies, pottery

glazing, art supplies, cosmetics, fishing

sinkers, and other products.

A large body of evidence indicates that the

most important remaining exposure sources

for children are lead hazards in their residential environmentódeteriorated lead

paint, house dust, and lead-contaminated

soil.6-14 Lead paint poisoning was first

identified over 100 years ago.15, 16 Even
13

though lead paint has been banned in the

United States since 1978, the Department

of Housing and Urban Development (HUD)

estimated in 1990 that it still remains in

about 64 million dwelling units.17,23 Exposure

to this paint poses a threat to children,

especially as the paint deteriorates or is

disturbed during renovation activities.

Children are exposed to lead from paint

either directly by eating paint chips10 or

indirectly by ingesting lead-contaminated

house dust or soil through normal hand-tomouth contact.11, 12 Unless proper precautions are followed, lead paint can contaminate dust or soil when it deteriorates or is

disturbed during maintenance, repainting,

remodeling, demolition, or lead paint

removal.13, 14 In fact, dust and soil contaminated from lead paint are now the main

sources of lead exposure for children.

Residences with exterior lead paint are more

than three times as likely to have higher

levels of lead in the surrounding soil (exceeding 500 parts per million) than are

dwellings without exterior lead paint (21%

versus 6%).17, 23 For buildings with deteriorating exterior lead paint, soil contamination is

eight times more common (48%) than at

residences without exterior lead paint.17,23

Without measures to prevent children's

exposure to contaminated dust and debris,

extensive removal of lead paint from homes

of poisoned children has been shown to

cause increases in children's blood lead

levels.24,25,26 Consequently, federal, state,

and local regulations and guidelines have

prohibited certain hazardous paint removal

methods and required safe-work practices,

cleaning, and lead dust testing ("clearance")

prior to re-occupancy.27

Recent long-term studies19,28,29 of lead

hazard controls have evaluated strategies

that combined measures to repair deteriorated lead paint with other measures to

reduce and prevent re-accumulation of lead

dust. The studies showed that these treatments resulted in substantial, sustained

reductions in interior lead dust and

children's blood lead levels.

Protecting All Children

Although the risks are greatest for lowincome children living in older housing, all

children should grow up in lead-safe homes.

Targeted education and training of painters,

renovators, remodelers, maintenance

workers, landlords, parents, and others,

combined with tax or other financial incentives, can be used to protect children not

directly served by federal grants and leveraged private financial assistance. Promoting

universal lead-safe remodeling and repainting work practices, occupant protection,

and cleanup and dust testing can ensure

that no child need be exposed to lead paint

hazards.

Federal Resources and Leveraged

Private Resources to Create LeadSafe Housing

After receiving a $3 million lead hazard control grant from HUD, The City

Council of Milwaukee passed a local

ordinance requiring all housing units

in two high-risk neighborhoods to be

made lead-safe. HUD funds and

approximately $400,000 in leveraged

private funds are being used to partially defray landlords' costs of complying with the ordinance. So far,

about one-fourth of all units in the

targeted neighborhoods have been

made lead-safe. When completed,

the program will make nearly 1,000

homes safe for children.

Boston has leveraged $3.7 million in

non-federal funds with $7.7 million in

HUD lead-hazard control grants.
14

Eliminating Childhood Lead Poisoning: A Federal Strategy Targeting Lead Paint Hazards

Figure 4

Certificate of Lead Hazard

Control

The HUD lead paint hazard control grant

program is not an entitlement for all housing with lead paint hazards, but rather a

limited funding pool. The program can be

used to not only address lead paint hazards

directly, but also to leverage private funding

and prompt market forces. As more leadsafe housing is created, more landlords and

homeowners may be motivated to address

lead paint hazards in their units in order to

realize increased property values associated

with lead hazard control in a competitive

market.

In addition, landlord motivation can be

increased by providing an easily-understood

"seal of approval" showing which units are

lead-safe (and conversely, which are not).

Rhode Island, Milwaukee, and a few other

jurisdictions already provide such certificates (see Figure 4 for the certificate used in

Milwaukee). Such measures will promote

increased competition, especially in markets

where landlords have difficulty attracting

tenants, and will help to increase property

values and marketing appeal. In some areas,

it may not be necessary to make all units

lead-safe, but rather to create enough units

so that families can find them without

incurring significantly greater costs.

In other jurisdictions, however, competitive

market forces may not be sufficient to

prompt significant private funding of leadhazard controls, because landlords and lowand middle-income homeowners are unlikely to be able to take on additional debt.

In such circumstances, direct federal subsidies and/or tax incentives may need to be

considered.

(address)
15

Lead Paint Hazard

Identification And

Control

Federal programs addressing lead

poisoning involve standards and

regulations for lead paint inspections, risk assessments, and abatement;

enforcement and compliance with lead

regulations; grants to States, cities, and

counties to control lead paint hazards in

low-income privately-owned housing; grants

to States, territories, and Indian tribes to

run EPA-approved programs for accreditation of training providers and certification

of lead paint professionals; inspections for

lead paint hazards in high-risk residential

units; evaluation of lead paint detection

and abatement methods; development of

new technologies; and laboratory accreditation. Virtually all of these activities were

authorized under Title X of the 1992 Housing and Community Development Act (The

Residential Lead Hazard Reduction Act).

Lead Paint Regulations

EPA regulations cover training, certification

(licensing) of lead paint professionals

(inspectors, risk assessors, abatement

contractors, and workers), and accreditation of training providers by State and

Tribal governments (or by EPA in the

absence of a State/Tribal program). Published in 1996, these regulations include

requirements to ensure that lead inspection

and abatement professionals are capable of

and required to use work practices that are

safe, reliable, and effective. HUDís Lead

Paint Hazard Control Grant Program requires that certified workers be used in its

grant program for low-income privatelyowned dwelling units. Today 36 States, plus

the District of Columbia, Puerto Rico, and

two Indian tribes have enacted lead paint

certification laws. In those States that do

not have such laws, EPA will implement

certification programs in March 2000 under

Current and Ongoing Federal

Programs and Activities

the authority of Title X. Tens of thousands

of inspectors; risk assessors; abatement

contractors; painting, renovation, and

maintenance workers; and others across the

country have been trained or certified, and

the system is in place to train many more.

HUD provides a grant to maintain a nationwide listing (by State) of certified firms via

the Internet (www.leadlisting.org) and a tollfree automated telephone system (1-888-

LEADLIST) to help the public locate qualified firms to address lead paint concerns.

The Federal Lead Paint Hotline (1-800-424-

LEAD) also provides important information.

The Disclosure Rule and Pre-Renovation

Education Rule are aimed at providing

information to tenants and homeowners.

Published jointly by EPA and HUD in 1996,

the lead paint Disclosure Rule requires

sellers, landlords, and agents to provide

lead hazard information and to disclose

information about the presence of known

lead paint and/or lead paint hazards to

prospective homeowners and tenants in

pre-1978 housing prior to their housing

purchase or rental decision. This rule also

gives buyers the opportunity to have the

homes tested for lead prior to purchase.

Attorney General Janet Reno joined HUD

Secretary Andrew Cuomo, EPA Administrator Carol Browner, District of Columbia

Mayor Anthony Williams, and local enforcement personnel at a press conference on

July 15, 1999, to announce the first judicial

actions and nationwide enforcement actions against landlords who had violated

this rule.

The lead paint Pre-Renovation Education

Rule, which became effective June 1, 1999,

requires persons conducting renovations for

compensation to distribute awareness

information to those receiving renovation

services concerning potential hazards

created when paint is disturbed. These

regulations are an important component of

public education activities.
16

Eliminating Childhood Lead Poisoning: A Federal Strategy Targeting Lead Paint Hazards

Federally-Assisted Housing

HUD has issued hazard control requirements for housing receiving federal assistance and for federally-owned housing that

is being sold. This new regulation, published

on September 15, 1999, will take effect one

year after publication. For the first time,

modern lead paint hazard control will

become an integral part of most federallyassisted housing programs. For example,

clearance examinations, which ensure that a

property is safe for children following repair

or hazard control work, will now be required

for all housing rehabilitation and maintenance programs receiving federal assistance

whenever lead paint may be disturbed.

Grants

HUD operates the Lead Paint Hazard

Control Grant Program to control lead paint

hazards in privately-owned housing occupied by low-income families and to build

local lead abatement and inspection capacity. Additional eligible activities include

relocation during hazard control work (to

ensure that children are not inadvertently

exposed to lead in the course of the work),

public education, job training and job

creation programs to enable low-income

residents to become employed in the lead

abatement and associated construction

trades, and blood lead testing (if not reimbursable from another source).

These grants, which are now active in over

200 cities, are awarded competitively each

year to ensure that communities with the

greatest need and capacity are served first.

The grants stimulate the effective collaboration of local health, housing, and community development agencies as well as local

community-based organizations. They also

stimulate leveraging of additional privatesector funding.

The Department of Health and Human

Services (DHHS), through the Centers for

Disease Control and Prevention (CDC),

provides grants to support childhood lead

poisoning prevention programs. These

grants, mainly to support secondary prevention efforts, are provided to State and local

health departments.

In some jurisdictions, HUD grant funds are

being used to remediate lead hazards in

dwellings where poisoned children have

been identified. In addition, CDC works with

HUD to promote collaboration with local

health agencies that administer leadpoisoning prevention programs.

EPA provides grants to States, territories,

tribes, and the District of Columbia to

develop and implement programs to accredit training providers, certify lead paint

workers and firms, and enforce workpractice standards to ensure that risk

assessments, inspections, and abatement

of lead-based paint hazards are properly

performed by a well-trained and experienced workforce.

Compliance Assurance And

Enforcement Of Lead

Regulations

Enforcing lead regulations is an important

component of programs established to

reduce exposure to lead hazards. Most of

the new rules mandated by Title X have now

been successfully promulgated. Compliance

assistance, compliance monitoring, and

enforcement of these new rules are critical

to producing the full benefits of these

regulations. DoJ, HUD, and EPA are responsible for enforcing the new requirements.

The strategy for enforcing the Disclosure

Rule targets properties with a history of

lead-poisoned children, buildings where

lead paint hazards may exist, instances of

substantial non-compliance, or places for

which tips and complaints have been filed

through the National Lead Information

Clearinghouse (1-800-424-LEAD). To promote enforcement actions that are already

underway across the country, DoJ has

provided each of its U.S. Attorneysí Offices

with guidance on how cases can be investigated, developed, and resolved.
17

To help regulated communities comply with

lead regulations, EPA and HUD undertake

compliance assistance activities such as

targeted and mass mailings, seminars/

workshops, collaboration with trade associations, and on-site assistance. In March

1999, EPA began enforcing the accreditation

requirements for training providers. Beginning in March 2000, EPA will enforce certification work practice requirements in States

that do not have an authorized program.

CPSC has banned residential paint that

contains more than 0.06% lead as well as

toys and other articles intended for use by

children that bear lead-containing paint in

excess of 0.06% by weight. CPSC continues

to investigate and prevent the use of leadcontaining paint in consumer products. For

example, the Commission has provided

guidance to State health officials and others

about identifying and controlling lead paint

on public playground equipment. CPSC has

also identified a number of disparate

products that present a risk of lead poisoning from sources other than paint. These

products, which include vinyl miniblinds,

crayons, and childrenís jewelry, are intended

for use by children or are simply used in or

around the household or in recreation. The

determination that a product presents a risk

of lead poisoning may result in a recall or

replacement with a substitute. In addition,

the Commission has issued an official

guidance policy that urges manufacturers to

eliminate lead in consumer products (16

CFR s 1500.230).

CPSCís contribution to protecting children

from lead poisoning involves a collaboration

with the U.S. Customs Service to conduct

surveillance as products enter the United

States and to intercept imported childrenís

products that may present a risk of lead

poisoning.

Education And Outreach

Educating the public on the dangers of

exposure to lead is an important component of reducing childhood lead poisoning.

Title X specifically mandates federal agencies to conduct public education and

outreach efforts.

Current federal activities include the

bilingual Lead Hotline (1-800-424-LEAD);

the National Lead Information

Clearinghouse; numerous publications and

pamphlets (many in both Spanish and

English) targeted to parents, homeowners,

and building managers; a major Hispanic

outreach program (including Spanish public

service announcements, specially designed

materials, etc.); and advertising campaigns

using local bus and subway systems, movie

theaters, and mass media. In addition, in FY

2000 EPA is initiating a new grant program

for education and outreach in Indian

Country.

HUD has provided grants to train painters,

renovators, remodelers, maintenance

workers, landlords, and others to recognize

and control lead hazards. Working with EPA

and HUD, CPSC communicates vital information on lead to the public through its

hotline, website, and health and safety

information disseminated through the

Commissionís State Partners Program (a

cooperative program with State and local

governments).

In addition to encouraging screening and

follow-up of lead-poisoned children, CDCís

Childhood Lead Poisoning Prevention grants

support education and outreach efforts.

Local grantees use a variety of individual

and community-level strategies. Educational

materials are developed for health-care

providers, managed-care organizations, and

parents to communicate the importance of

lead screening in high-risk children, especially Medicaid-eligible children. Other

DHHS agencies, such as the Health Resources and Services Administration (HRSA)

and the Administration for Children and

Families (ACF), also conduct childhood leadpoisoning prevention outreach and education efforts for at-risk populations. For

example, HRSAís Maternal and Child Health

Branch, in conjunction with CDC, supports

the National Lead Training and Resource

Center in Louisville, KY. This Center provides
18

Eliminating Childhood Lead Poisoning: A Federal Strategy Targeting Lead Paint Hazards

education and training to health-care

professionals (at federal, state, and local

levels) who work in the field of childhood

lead-poisoning prevention.

Identification And Early

Intervention For Children

With Lead Poisoning

The programs just described are oriented

toward identifying and controlling hazards

in housing before they poison children. An

immediate response is also needed, however, to help children who have already been

poisoned. These children must be screened

to identify and correct the source of their

lead exposure and thereby prevent further

increases in blood lead levels. Medical

treatment, nutritional interventions, and

early intervention to address developmental

consequences of lead poisoning may also

be required.

CDC, through its National Childhood Lead

Poisoning Prevention Grant Program,

provides grants to State and local health

departments to promote screening of at-risk

children and to ensure appropriate medical

and environmental case management is

provided for lead poisoned children. In

addition, CDC provides management and

technical assistance to grantees to build

their program and surveillance capacity. All

these programs focus on identifying and

screening high-risk children (through blood

lead testing) and ensuring the provision of

case management services. An important

part of case management is to ensure that

investigations are conducted to identify

sources of lead exposure and to ensure

their remediation. Because CDC grants may

not be used to pay for lead hazard

remediation work, these programs face a

significant challenge to identify public and

private resources to finance such work in

low-income housing.

In November 1997, CDC released new

screening guidance, ìScreening Young

Children for Lead Poisoning: Guidance for

State and Local Health Officials,î30 that

specifically addresses the issue of reaching

high-risk children, including children enrolled in Medicaid. CDC requires all Statelevel lead poisoning prevention grantees to

develop screening plans consistent with

CDC guidance. CDCís prevention efforts are

supported by the Health Care Financing

Administrationís (HCFA) Medicaid program,

which has required lead screening as part of

the Early and Periodic Screening, Diagnostic

and Treatment (EPSDT) general health

screening guidelines since April 1990.

According to the General Accounting Office

(GAO), the Medicaid population accounts

for a high proportion of lead poisoned

children.22 HCFA, CDC, HRSA, and other

DHHS agencies have been working together

to increase lead screening of enrolled

Medicaid and other vulnerable children and

to improve access to, and the provision of,

needed follow-up services for lead-poisoned

children. Key elements of the ongoing

interagency work are to: 1) ensure compliance with federal lead-screening policies, 2)

develop better State-specific data on lead

screening and blood lead levels in children,

3) develop a strategy for educating providers and the public about lead poisoning;

and 4) promote working relationships with

federally-funded programs involved in

childhood lead poisoning issues and other

activities. For example, federally-subsidized

Community Health Centers (CHCs) are an

important source of care for Medicaid

children and other high-risk populations.

HRSA plans to update and reissue a Lead

Policy Information Notice to all CHCs in the

near future.

Head Start programs, which serve approximately 800,000 low-income children 3-5

years of age across the country, represent

an important opportunity to ensure screening of low-income children who were not

previously screened at ages 1 and 2. The

Administration for Children and Families

(ACF) works to ensure that grantees implement Head Start Performance Standards

concerning lead screening.

In June 1991, the Report of the House

Committee on Appropriations, which
19

accompanied H.R. 2521 to the 1992 Department of Defense (DOD) Appropriations Bill,

tasked DOD to organize a Lead Paint Task

Force, to coordinate activities with other

federal agencies, and to follow guidance

established by CDC regarding lead paint

activities and childhood lead poisoning

prevention. Since that time, policies and

guidance for lead hazard management and

childhood lead poisoning prevention programs for military personnel have been

coordinated by DOD, as well as within the

individual services, on an ongoing basis.

DOD has administered childhood blood

lead screening programs since 1992. As

required by DOD policy, military installations

have proactive lead hazard management

programs that include health risk assessments of facilities, health screening of

children and workers, and lead hazard

controls. The blood lead screening results,

one measure of the effectiveness of these

programs, indicate that these programs are

working. According to DOD Office of Health

Affairs data from 1992 to the present, blood

lead levels above 10 μg/dL of military

dependents are consistently below 2%, well

under the general population (4.4%).

Research

HUD is conducting the nationís largest

study of the effectiveness of modern leadhazard control methods used by its grantees.19 The study involves nearly 3,000

dwelling units, hundreds of which have been

followed for at least 3 years. The main

outcome measures are childrenís blood lead

levels and levels of lead in house dust. HUD

has sent several interim reports on the

evaluation to Congress, with a major report

expected in 2001. Preliminary data show

that childrenís blood lead levels declined by

an average of about 25% and dust lead

levels on floors, window sills, and window

troughs declined by an average of about

60% (see Table 8 on p. 27). These sustained

declines have been replicated in a smaller

study at Johns Hopkins University.28,29

HUD is also conducting research on lead

paint hazard evaluation and control methods. This research includes: 1) improving, in

conjunction with EPA, on-site inspection

methods such as spot test kits and x-ray

fluorescence (XRF) instruments; 2) improving laboratory methods used for risk assessments, such as collection and analysis of

dust wipe and soil samples; 3) assessing the

hazards of lead soil and lead dust in carpets, upholstery, air ducts, and other places

where lead can accumulate; 4) improving

risk assessments in single-family and

multifamily housing; 5) assessing the lead

risks to residents from construction, repair,

and maintenance projects; 6) using surveys

of lead hazard control projects and programs to assess and improve lead hazard

control methods, and using laboratory and

field testing to evaluate likely candidates for

improvements in specific control techniques; and 7) assessing public awareness

and understanding of lead paint hazard

issues, and identifying approaches for

increasing this understanding.

EPA has conducted research that focuses

on lead remediation in soils in four areas:

1) identification of mineral forms of lead in

soil, 2) effects of mineral forms on

bioavailability, 3) in vitro and in vivo measures

of lead bioavailability, and 4) conversions of

lead minerals in soil systems. EPA has been

evaluating chemical reactions of metals in

soil to allow appropriate exposure assessments and to develop environmentally nonintrusive amendments to soil that reduce

bioavalability and mobility. In 1999, EPA

researchers discovered a method to render

lead-contaminated soil safe for humans by

immobilizing lead, potentially reducing its

bioavailability. This method could potentially decrease the number of children

suffering from lead poisoning.

EPA also evaluates (in conjunction with

HUD) detection and abatement methods

including encapsulants, test kits, and x-ray

fluorescence (XRF) lead paint analyzers. In

addition, EPA plans to assess existing

impediments and barriers to developing new
20

Eliminating Childhood Lead Poisoning: A Federal Strategy Targeting Lead Paint Hazards

technologies and the need for new methods

to promote development of new lead

detection and abatement technologies. As

regulations are developed that establish

standards for renovation, remodeling, and

deleading on buildings and superstructures,

EPA will use its authority under Title X to

evaluate products used for detection,

abatement, and deleading.

CDC is conducting and supporting applied

research in preventing lead poisoning.

Examples of current projects include three

randomized trials of primary prevention

strategies to avoid increases in blood lead

levels. In each study, interventions begin

prenatally in order to reduce exposure

before infants become mobile and begin

ingesting contaminated dust and soil.

CDC is undertaking research to improve the

quality of blood lead measurements and to

develop new technology to provide immediate results with portable, low-cost blood

lead analyzers. Under the Blood Lead

Laboratory Reference System (BLLRS), CDC

sends blood lead specimens for quarterly

analysis to over 275 laboratories worldwide.

The results are then compared to known

reference values. Participating laboratories

are advised of their performance, and

consultation is offered to improve performance.

In collaboration with DOE, EPA, and industry partners, DoD has developed many new

technologies in the areas of encapsulation

and abatement, training, and soil

remediation. The U.S. Army is currently

conducting demonstrations and validations

of these technologies. The thermal spray

vitrification (TSV) process was developed by

the Army to remove hazardous lead paint

from steel structures. Because of the

environmental stability of the waste, vitrification has been designated the Best Demonstrated Available Technology (BDAT) by

the EPA. The U.S. Navy funded the development of a real-time lead-dust monitor to

analyze airborne lead exposure during

construction and abatement activities. The

Army is working on developing environmentally-friendly paint strippers and innovative

technologies, such as chemical stabilization

and phytoextraction, for the abatement of

lead in soil.

Surveillance And

Monitoring

The National Health and Nutrition Examination Survey (NHANES), which is administered by CDC, is the only source of periodic

nationally-representative data on blood lead

levels in the U.S. population. Data from the

NHANES are used to track trends in blood

lead levels, identify high-risk populations,

and support regulatory and policy decisions.

The next NHANES survey will, for the first

time, include a measurement of lead in

house dust that will provide valuable data

on the population distribution of this

important source of exposure. This effort is

funded by HUD and was designed

collaboratively by CDC and HUD.

CDC provides funding and technical assistance for States to develop laboratorybased surveillance systems to determine

blood lead levels in children. Data from

these State systems can be linked to data

from the State Medicaid Agency (SMA) to

monitor SMA compliance with HCFA policy.

CDC uses data submitted by State systems

to form a national surveillance database.

The Agency for Toxic Substances and

Disease Registry (ATSDR) is the public

health arm of the Superfund Program.

ATSDR undertakes the study of blood lead

in populations near Superfund sites and

funds State health agencies to undertake

this type of work. ATSDRís work in this area

has helped to guide development of policies

covering the cleanup of sites contaminated

with lead.
21

I

ncreased efforts to control lead paint

hazards in older housing are needed

to eradicate childhood lead poisoning.

Lead hazards should be controlled before

children are poisoned. The need for additional resources is greatest in deteriorated

low-income housing, where lead hazards

are especially common. Other ongoing

efforts will continue to control exposure

from other lead sources and to focus

attention on expanding efforts to provide

early intervention for children at highest

risk.

The foundation for solving this problem has

been established over the past decade. A

qualified, licensed pool of inspection and

hazard control contractors now exists, and

the system for training and certifying more

people is in place. Hazard control techniques have been implemented and shown

to be effective in over 200 cities through

HUDís grant program for privately-owned

low-income housing. A standard of care

has been established through HUDís new

regulation published on September 15,

1999 covering all federally-assisted housing.

Known lead paint hazards now must be

disclosed at the time of sale or lease of

most pre-1978 residential properties where

children may reside. Despite these and

other advances, more must be done if the

nation is to achieve the vision of eradicating childhood lead poisoning.

This document estimates the additional

resources needed over the next 10 years to

eliminate lead paint hazards in housing with

Strategy

young children. Projections are based on

the third National Health and Nutrition

Examination Survey (NHANES)óPhase 2,

the 1997 American Housing Survey, the

1999 Economic Analysis accompanying the

HUD regulation covering federally-assisted

housing, the Residential Energy Consumption Survey, U.S. Geological Survey data on

the historical use of lead in paint, and the

1990 HUD National Survey of Lead paint in

Housing (see the Appendix to this report for

a detailed description of the methodology

used to make these projections).

Number Of Housing Units

With Lead Paint Hazards

That Need To Be

Addressed

Any house with lead paint could eventually

pose a hazard to young children. Most such

houses, however, do not contain immediate

lead hazards. Although about 60% of the

nationís housing stock contains lead paint,

only 4.4% of all children under 6 have blood

lead levels above 10 μg/dL.5,17

Between 86-95% of all lead in paint is

contained in housing built before 1960 (see

Tables 4 and 5). Therefore, resources to

address residential lead paint hazards

Vision:

Eliminate childhood lead

poisoning in the United

States

■ Lead poisoning is a completely

preventable disease.

■ Residential lead paint hazards

in homes of children can be

virtually eliminated in 10 years.

■ Every child deserves to grow

up in a home free of lead paint

hazards.
22

Eliminating Childhood Lead Poisoning: A Federal Strategy Targeting Lead Paint Hazards

Table 4

Lead Consumption in Housing

per Decade

Source: U.S. Geological Survey, American Housing Survey (see Appendix)

* White lead data from 1914-1923 is used to estimate consumption between 1910 and 1920 because 1914 is the earliest year of available data.

Table 5

HUD National Lead Paint

Survey Data (1990)

Pre-40

1940-

1959

1960-

1978 Total

Lead Paint Surface Area (million sq. feet)

Interior 15,912 8,247 5,279 29,438

Exterior 25,969 12,635 10,502 49,106

Average Lead Paint Concentration (mg/sq.cm)

Interior 5.7 2.5 2.0

Exterior 6.1 4.2 3.2

Total Lead in Lead Paint

(1000 tons) 255 75 45 376

Interior 93 21 11 125

Exterior 162 54 34 251

Percent of Total Lead in

Paint 68% 20% 12% 100%

Interior 74% 17% 9% 100%

Exterior 65% 22% 14% 100%

Source: HUD National Survey of Lead Paint in Housing17

should be targeted to pre-1960 units, with

the oldest or most-deteriorated houses

being treated first.

Analysis of American Housing Survey data

(see Appendix) indicates that there are

about 24 million pre-1960 dwelling units in

1999 at risk of having lead paint hazards.

These are units with interior lead paint that

have not undergone major renovation (e.g.,

total window replacement). The number of

demolitions and renovations through 2010

in Table 6 is based on rates experienced

between 1989 and 1997 as reported in the

American Housing Survey conducted by the

Bureau of the Census.

In addition to demolition and renovation

(including private hazard control), additional

units will undergo hazard control as a result of

HUDís regulation for federally-assisted housing. Based on the Economic Analysis for the

rule, HUD estimates that it will produce 1.4

million pre-1960 lead-safe units during the 10

years from 2000 to 2010.

Table 6 shows that about 5.6 million units

will undergo demolition and renovation over

Lead

Consumption

(thousands

of tons)

Decade-End

Occupied

Units

(millions)

White Lead

per Unit

(pounds)

1991 AHS

Units

(millions)

Lead Paint In

Housing

(thousand tons)

Percent of

All Lead

Paint

Before

Rehab

After

Rehab

1914-23* 1340 24.35 110 9.02 496 413 49.1%

1920-29 1663 29.91 87 5.06 221 184 21.9%

1930-39 1158 34.86 42 5.98 126 104 12.4%

1940-49 1665 42.83 22 7.67 84 72 8.6%

1950-59 1012 53.02 7 12.51 44 37 4.5%

1960-69 863 63.45 3 14.52 22 20 2.4%

1970-79 654 80.39 1 21 11 10 1.2%

1,004 841 100%

Eliminating Childhood Lead Poisoning: A Federal Strategy Targeting Lead Paint Hazards
23

the next 10 years, assuming current trends

continue. In short, this means that by the

year 2010, 18.4 million pre-1960 units will

remain at risk of having lead paint that

could one day pose a threat to children if

nothing more is done.

Households with incomes less than 1.3

times the poverty level [Poverty Income

Ratio (PIR) <1.3] occupy about 20% of all

units. A PIR<1.3 was used here because it

was the definition of low-income used in

NHANES and because it is a good approximation of the low-income eligibility criterion

used in the HUD grant program (see Appendix). Applying this percentage to the 18.4

million units with lead paint that exist prior

to the implementation of the HUD rule

results in 3.7 million units occupied by

families with incomes less than 1.3 times

the poverty level. Subtracting the 1.4

million units affected by the HUD rule

(because virtually all these will be occupied

by families with incomes of PIR<1.3) yields

a remainder of 2.3 million units. Thus, over

a 10-year period, an average of 230,000

units would need to be evaluated and any

identified lead paint hazards controlled

each year.

Many of these remaining 2.3 million units

may not pose any problem if they are

maintained in such a way that the lead paint

does not become hazardous. Tax credits,

market forces, public education, and other

incentives can encourage moderate- and

upper-income owners to address lead paint

before it becomes hazardous. For lowincome families, however, direct federal

financial assistance and leveraged private

funding will continue to be needed because

no other effective option exists.18

Cost Of Controlling

Childrenís Exposure To

Lead Paint In Housing

The cost of controlling lead paint hazards in

any given house depends on the unitís

condition, extent of lead hazards, type of

building components coated with lead

paint, and type of hazard control method

employed. Economies of scale also exist for

multifamily housing.

Table 6

Pre-1960 Units at Risk of

Having Lead Paint

Hazards in 2010

See Appendix for methods and data sources used to derive these estimates.

Housing Stock

Number of

Housing

Units

(millions)

Total Units at Risk of Lead Paint Hazards in 1999 24.0

Reduction Due to Demolition, 2000-2010 -1.8

Reduction Due to Substantial Renovation, 2000-2010 -3.8

Subtotal (Total Units at Risk of Lead Paint Hazards in 2010) 18.4

20% of Subtotal Occupied By Low-Income Families 3.7

Reduction Due to HUD Regulation of Federally-Assisted Housing -1.4

Total Low-Income Units in 2010 Requiring Federal Assistance 2.3
24

Eliminating Childhood Lead Poisoning: A Federal Strategy Targeting Lead Paint Hazards

Housing is kept viable through both capital

improvements and ongoing maintenance.

Similarly, short-term (interim controls) and

long-term (abatement) methods are employed to control lead paint hazards.

Definitions for these methods can be found

in Title X of the 1992 Housing and Community Development Act. Both methods have

been shown to be effective in controlling

childhood exposures to lead. Interim

controls involve the repair of deteriorated

paint and require continuing evaluation and

management to ensure that the lead paint

remains intact and non-hazardous. Abatement, a more permanent solution, involves

the removal of painted building components, construction of a durable enclosure

or covering, and/or paint removal.

Table 7 presents the estimated average

annual costs of addressing residential lead

paint in pre-1960 housing over the next 10

years. Costs are estimated for two approaches: 1) interim control of lead paint

hazards identified through lead hazard

screening (a low-cost way to identify the

likelihood of lead hazards), and 2) abatement of lead paint identified through a

complete inspection/risk assessment of all

lead paint and all lead paint hazards).

Average costs are based on the HUD Economic Analysis31 presented in the regulation

on federally-assisted housing and the

evaluation of the HUD Lead Paint Hazard

Control Grant Program,19 which are currently

the most complete sources of cost data for

this field. The cost estimates are from

actual cost data obtained from HUD grantees and from interviews with lead hazard

control contractors.

For the interim controls approach, these

data show an average cost of $120/unit for

lead hazard screening and an average

hazard control cost of $2,500 per unit (to

cover paint stabilization, window work,

cleanup, and clearance). To arrive at an

overall average cost, these costs are applied

to one-third of the units to be addressed

because the Economic Analysis of the HUD

rule indicates that about one-third of pre-60

units with lead paint will have lead paint

hazards (see Appendix). Thus, per-unit

interim control costs are $120 + (32% x

$2500) = $920 (or about $1,000).

The $2,500 estimate for the interim controls

approach includes $1,000 for exterior paint

stabilization, $500 for interior paint stabilization, $300 for window work (to repair

friction surfaces that produce lead-contaminated dust), $350 for cleanup, $150 for

clearance testing, and $200 for relocation,

administrative, and other costs. These

Table 7

Estimated Average Direct

Annual Costs of Options to

Address Lead Paint in Pre1960 Housing, 2001-2010

Source: Evaluation of the HUD Lead-Hazard Control Grant Program; The Economic Analysis for the HUD Lead Paint Regulation for

Federally Assisted Housing (see Appendix)

Pre-1960 Housing Stock

Lead Hazard

Screening and

Interim Controls

($1,000 per unit)

Inspection/Risk

Assessment and

Full Abatement of

Lead Paint

($9,000 per unit)

All Pre-1960 Housing with Lead Paint

(1.84 million units/year) $1.84 billion $16.6 billion

Pre-1960 Housing Occupied by Families

with PIR<1.3, Not Covered by HUD

Regulation (230,000 units/year)

$230 million $2.1 billion
25

costs do not include any other housing

rehabilitation costs that may also be incurred at the time of hazard control.

For the more-permanent abatement approach, an average cost of $500/unit for the

lead paint inspection and risk assessment is

applied to all units to be addressed, as well

as an average abatement cost of $8,500 per

unit (including cleanup and clearance),

because virtually all units have some lead

paint. Thus, per-unit abatement costs are

$8,500 + $500 = $9,000.

Comparing The Costs Of

Short- And Long-Term

Hazard Controls

Investments in housing consist of ongoing

maintenance activities and capital improvements. Specialized short-term maintenance

(interim controls) can eliminate lead paint

hazards as long as such maintenance is

continued. Lead paint hazards can also be

permanently controlled through long-term

abatement methods. Short-term maintenance activities include repair of deteriorated paint and cleanup, treatment of

painted friction surfaces (e.g., windows) that

create lead-contaminated dust, followed by

dust testing. Long-term methods include

removal of building components coated

with lead paint (e.g., window replacement),

enclosure (e.g., new siding), and other

methods. Both interim controls and abatement have been shown to produce leadsafe dwellings.

To leverage private funding to the fullest

extent possible, this report recommends

that low-income housing be made lead-safe

using interim controls followed by ongoing

management until the building is either

demolished or abated. If ongoing management is not implemented consistently,

however, lead hazards may reappear. The

challenge today is to eliminate lead paint

hazards in as many dwellings as possible.

Ideally, all housing with lead paint would be

permanently abated. Abatement alone,

however, is unlikely to achieve this goal

within the foreseeable future, unless significant funding is provided from non-federal

sources. Because resources are limited,

interim controls followed by either ongoing

management and/or abatement provide the

best opportunity for success and permit

local entities to implement a strategy

consistent with local needs.

Benefits Of Eliminating

Childhood Lead Poisoning

Using conservative assumptions, the quantifiable monetary benefit (which does not

include all benefits) of eliminating lead paint

hazards through interim controls in the

nationís pre-1960 low-income housing stock

over the next 10 years will be $11.2 billion

at a 3% discount rate ($3.5 billion at a 7%

discount rate). The net benefit is therefore

approximately $8.9 billion at a 3% discount

rate (or $1.2 billion at a 7% discount rate).

The monetary benefit of abatement of lowincome housing is estimated at $37.7 billion

using a 3% discount rate [$20.8 billion using

a 7% discount rate (see Appendix)]. The

benefit of permanently abating lead paint in

all housing is considerably greater because

more children would benefit over a considerably longer time span.

The quantified monetary benefits include

savings associated with avoided medical

care, avoided special education, increased

lifetime earnings due to increased cognition,

and market benefits due to improvements in

housing. Other more intangible benefits

may exist, but they have not been fully

studied and are not included in this total.

These benefits may include avoided hypertension in later life; improvements in

childrenís height, physical stature, hearing,

and vitamin D metabolism; and expenses

and emotional costs involved in caring for

poisoned children. In short, the quantified

monetary benefits cited may underestimate

the actual benefits because of the many

unquantifiable benefits associated with

eliminating childhood lead paint poisoning.

The overall benefit of this 10-year strategy is

displayed in Figure 5, which shows that
26

Eliminating Childhood Lead Poisoning: A Federal Strategy Targeting Lead Paint Hazards

childhood lead paint poisoning can be

drastically reduced by 2010 through expanded prevention efforts. Without such

efforts, about 135,000 children from lowincome families living in pre-1960 housing

will continue to be poisoned annually at the

end of the next decade.

Federal Funding

Federal funds can be used to leverage

private resources to create lead-safe housing. In some jurisdictions, it may be possible to create enough lead-safe housing for

families, yet not necessarily address all

housing units with lead paint. In other

jurisdictions, virtually all housing will need

to be made lead-safe to protect children.

Public and private funding should be increased substantially to help control lead

paint hazards in housing. The HUD LeadHazard Control Grant program is currently

funded at $60 million/year. Beginning in FY

2001, the Administration will request an

increase of 50%, to $90 million. Funding in

Figure 5

Potential Impacts of Various

Actions on the Number of LowIncome Lead Poisoned

Children

later years needs to be increased further

based in part on the ability to leverage

private financing and on updated surveys of

childrenís blood lead levels and lead paint

hazards in housing. The FY 2001 Presidentís

Budget also funds lead programs in other

federal agencies including EPA, DHHS, DoJ,

and DoD. (See budget summary on page 9)

Evaluation Of The HUD

Lead Hazard Control

Grant Program

Table 8 shows preliminary data on blood

lead levels in resident children and lead

levels in house dust. The preliminary data

compiled in the evaluation of the HUD lead

paint grant program show that modern

hazard control techniques employed by

cities and States receiving HUD grants are

effective in drastically reducing both blood

lead and dust lead levels. A major report on

these findings will be completed in 2001.
27

Blood (n=485 children) Dust

Decline in

Median Blood

lead Level

(% of

baseline)

% of Children

With Increases

Greater Than 3

μg/dL Compared

to Baseline

% of Children

With Decreases

Greater Than 3

μg/dL Compared

to Baseline

Median % of Lead Dust

Decline Comparing

Baseline and Clearance

(n=1,943 dwelling

units)

Median % of Lead Dust

Decline Comparing

Baseline and 2 Years

After Control

(n=568 units)

Strategy* All measured at 12 months Floors Sills Troughs Floors Sills Troughs

02 25% 9% 43% 14% 80% 98% 43% 64% 57%

03 31% 10% 58% 10% 68% 91% 57% 68% 88%

04 26% 6% 59% 33% 92% 100% 73% 79% 96%

05 17% 7% 38% 68% 97% 100% 66% 92% 96%

06 **   93% 95% 97% **  ** **

02 28% 8% 55% 67% 94% 100% 69% 88% 94%

03 17% 6% 42% 35% 96% 100% 79% 92% 99%

04 24% 3% 55% 49% 94% 100% 58% 81% 95%

01   **  38% 91% 100% 85% 89% 88%

02 **   62% 95% 100% 92% 92% 93%

03 **  ** ** 46% 92% 99% 86% 76% **

Table 8 Preliminary Outcome

Data for HUD Lead Paint Hazard

Control Grant Program

Evaluation (Vacant and Occupied

Dwelling Units Combined)

* Strategy codes refer to increased intensity of hazard control

**Less than 15 results

Median baseline blood lead level = 10 μg/dl

Median baseline dust lead level. Floors=22 μg/sq.ft., Sills=316 μg/sq.ft., Troughs=5,665 μg/sq.ft

Blood and dust data from February 1999 dataset Site Exterior Interior
28

Eliminating Childhood Lead Poisoning: A Federal Strategy Targeting Lead Paint Hazards
29

The budget proposals of federal

agencies are accompanied by

performance goals and measures

for their programs and activities. These

annual performance goals and measures

will be used to assess progress toward the

goals presented here. Longer-term

progress toward the vision of the Strategy -

to eliminate lead poisoning in children in

the United States - will be measured

through the National Survey of Lead Paint

Hazards in Housing and the National

Health and Nutrition Examination Survey

(NHANES).

I. Primary Prevention

Recommendations:

Prevent Lead Exposure

In Children

Recommendations

Increase the availability of

lead-safe dwellings by

increasing federal funding of

HUDís lead hazard control

grant program and by

leveraging private and other

non-federal funding.

The HUD grant program should be expanded to enable local governments and

others involved to accelerate the production of lead-safe housing units. The program should continue to emphasize control

of lead paint hazards in pre-1960 lowincome privately-owned housing units where

young children are expected to reside.

Over the past decade, HUD grants have

been provided to local and State governments to enable them to eliminate lead

paint hazards in low-income privatelyowned dwellings. In most cases, these are

the only financial resources available to

make such dwellings safe for resident

children in this housing. Each year for the

past 4 years, HUD funds were available to

make an award to an average of only one in

four applicants.

Active HUD lead paint hazard control grant

programs now exist in 200 cities across the

country. These programs have helped

create a large trained workforce, local leadpoisoning prevention ordinances, job

creation and job training programs for lowincome residents, new collaboration between local housing and health departments, and locally-driven public education

and outreach campaigns. Because the

capacity now exists, the future grants can

be restructured in several ways. Specifically,

the 3-year-grant period can be reduced to 2

years because most future grantees will not

need the planning period to organize the

work. Grants should continue to be

awarded competitively to target the funds

to jurisdictions with the greatest need and

capacity. Grants should also be used to

leverage private and non-federal resources.

Goal

By 2010, lead paint hazards in

housing where children under

six live will be eliminated

through:

■ Federal grants and leveraged

private funding to be used for

the identification and elimination

of lead paint hazards to produce

an adequate supply of lead-safe

housing for low-income families

with children

■ Outreach and public education

■ Enforcement and compliance

assistance and monitoring
30

Eliminating Childhood Lead Poisoning: A Federal Strategy Targeting Lead Paint Hazards

Increase compliance

monitoring and enforcement

of lead paint regulations.

New federal regulatory responsibilities

demand a new emphasis on enforcement.

In addition to authorizing federal grants to

owners of low-income privately-owned

housing to correct lead paint hazards, Title

X also provides for streamlined and more

effective federal regulations that collectively

provide a comprehensive framework for

eliminating lead paint hazards. Most of the

new regulations mandated by Title X have

now been issued in final form. Together,

compliance with these regulations:

■ ensures that parents receive the information they need to protect their children

before they are obligated under a new sales

or lease contract or before renovation work

is begun in their residence;

■ provides a skilled, trained, and licensed

workforce to implement safe work practices

that will prevent renovation and hazard

control activities from inadvertently poisoning children;

■ creates new standards of care to protect

resident children from lead paint hazards;

and

■ ensures safe management and disposal of

lead paint debris.

The disclosure rule requires sellers, landlords, and agents to provide lead hazard

information and to disclose information

about known lead paint and lead paint

hazards to prospective homeowners and

tenants in pre-1978 housing prior to their

rental or purchase decisions. This rule also

gives buyers the opportunity to conduct an

inspection for lead paint hazards. A 1998

HUD-funded survey conducted through the

Bureau of the Census showed poor compliance with this rule. At least 36% of survey

respondents were certain that they did not

receive the required information when they

bought or rented pre-1978 housing, and

another 52% were uncertain. Enforcement

of the disclosure rule, which cannot be

delegated to the States, rests with EPA,

HUD, and DoJ. Enforcement can take the

form of administrative actions by EPA or

HUD, and civil or criminal referrals to DoJ.

Efforts to enforce the disclosure rule need

to be increased to prompt improved compliance. Enforcement actions should

continue to be concentrated in housing with

a history of lead poisoned children, in

housing with physical or management

problems that indicate the likely presence of

lead paint hazards, and in places for which

tips and complaints are received from the

public. Targeted inspections and enforcement efforts should be increased through

close federal cooperation with local health

departments to identify landlords of housing with lead-poisoned children as well as

through cooperation with local law enforcement authorities responsible for enforcing

local lead paint ordinances.

EPA will have responsibility for enforcing

four other lead paint rules in those States

and on tribal lands without authorized

programs. These rules will address certification and training, pre-renovation education,

use of safe and reliable work practices at

expanded locations, and management and

disposal of lead paint debris. The Agency

should encourage States, tribes, and territories to adopt approved programs, given the

critical role they play in protecting children

from lead poisoning.

The Federal Government should expand its

use of integrated strategies that combine

compliance assistance, incentives, monitoring, and enforcement. These techniques,

which have been effective in addressing

environmental and compliance problems in

other program areas, will complement the

more traditional enforcement efforts.
31

These national and regional integrated

initiatives should be tailored to the pertinent lead rule involved and include an

appropriate mix of the following:

■ Compliance assistance, which includes

targeted and mass mailings, seminars/

workshops, collaboration with trade associations and local groups, on-site assistance, and publicizing the toll-free phone

number (800-424-LEAD) to report tips and

complaints;

■ Compliance incentives, such as a

window of opportunity to audit, disclose,

and correct violations as well as to receive

penalty waivers or reductions in accordance

with EPAís auditing and small-business

policies;

■ Compliance monitoring, including

coverage of urban and low-income neighborhoods and follow-up to tips and complaints, with a priority focus on sites inhabited by children or pregnant women; and

■ Targeted enforcement actions.

The new regulation for federally-assisted

housing, which takes effect September

2000, will also require enforcement. During

the year-long phase-in period, HUD will

conduct a wide variety of training and

educational activities for HUD constituents

such as non-profit housing providers, public

housing authorities, landlords enrolled in

rental subsidy and other programs, and

organizations using HUD-funded housing

rehabilitation, maintenance, and finance

programs.

Without this increased enforcement, the full

benefits of lead paint regulations will not be

realized. Increased enforcement will raise

awareness of the precautions that can be

taken to protect children from lead poisoning and to reduce both lead paint hazards

and childrenís exposure to lead.

Conduct education and

environmental intervention

for families with children at

high risk for future lead

poisoning and provide a link

between education and public

health programs so that

families have access to

assistance programs.

Community-Level

National campaigns to educate parents,

landlords, renovation and remodeling

workers, housing inspectors, public health

professionals, and others about lead poisoning should be expanded. In 1999 the

Senate passed a resolution establishing the

last week in October as National Childhood

Lead Poisoning Prevention Week and the

President issued a message of support.

Individualized Education Through

Public Health Agencies

Even with a substantial expansion of resources to control residential lead hazards,

a significant number of dwellings that could

house families with young children will

remain with lead hazards for several years.

Outreach programs on the public health

benefits of hazard control activities should

be extended to identify at-risk families,

especially those with pregnant women or

young infants who live in homes with lead

hazards. These outreach programs should

be linked to existing lead-safe housing

programs and resources for hazard control.

Federally-supported State and local childhood lead poisoning prevention programs

currently focus their limited resources to

ensure screening and follow-up of children

with elevated blood lead levels. With

additional federal support and leadership,

such programs should expand their efforts

to identify at-risk families and provide

services to them before children are poisoned. To best serve at-risk families, such

efforts should be coordinated with existing
32

Eliminating Childhood Lead Poisoning: A Federal Strategy Targeting Lead Paint Hazards

programs such as Women and Infant Care

(WIC) and Healthy Start. Families identified

should receive education about lead poisoning prevention, be offered lead hazard

assessments of their homes, and be assisted in obtaining appropriate services

(such as HUD lead hazard control grants) to

remediate identified lead hazards. Programs

should also provide social services and

other assistance to families for which

relocation to lead-safe housing is the best

alternative. Neighborhood lead exposure

sources should be assessed and addressed

in collaboration with State and local environmental agencies and community organizations.

Conduct a study of lead

hazards in child-care centers.

CPSC, in collaboration with HUD and EPA,

should consider conducting a study of

children in both home-based and institutional child-care centers to determine if

they are being exposed to lead hazards. If

children in the centers are at risk, child-care

centers should be included in the strategy

to prevent lead poisoning in children while

they are at the centers.

Coordinate federal

weatherization and leadhazard control programs.

DOE provides funds to more than 970 local

governments and non-profit organizations

annually to weatherize and reduce energy

consumption in approximately 67,000 lowincome housing units. The DHHS lowincome energy-assistance program also

funds weatherization projects. Some

communities are already leveraging funds

from both HUDís lead hazard control

program and these weatherization programs

to cost-effectively reduce the use of energy

and control lead paint hazards simultaneously. As a part of this strategy, HUD,

DOE, HHS, and EPA have begun to identify

and implement additional actions to ensure

weatherization activities are consistent with

modern lead hazard control techniques, and

increase the collaboration between these

successful programs to yield additional

health benefits and cost savings. This

collaboration should actively continue.

Specifically:

■ DOE and HHS, in partnership with HUD

and EPA, should ensure all federally-funded

weatherization activities are conducted in a

manner consistent with modern lead hazard

control techniques. This includes providing

lead hazard control education and training

opportunities for all weatherization workers.

■ DOE, HHS, and HUD should consider

conducting a study of the cost and health

benefits of simultaneously conducting

weatherization and lead hazard control

activities, including an assessment of the

types of weatherization activities that

provide the greatest energy savings and

lead hazard reduction (e.g., window replacement).

■ DOE, HHS, and HUD should emphasize

collaboration between their respective

weatherization and lead hazard control

grant programs to ensure their grantees

combine these two activities in a costeffective and safe manner.

■ HUD and EPA should include information

about the energy savings associated with

lead hazard reduction activities in their

relevant educational programs and materials.

Explore the use of financial

incentives (such as tax

credits or deductions) or

federal grants to control lead

paint hazards in housing

occupied by low- and

moderate-income families

with young children not

served by HUD grants.

The HUD grant program targets assistance

to residences with lead paint hazards that

are occupied by low-income families with

children under the age of six. Since public

funds may not be available for some low-
33

Current Tax Treatment of

Hazard Control Costs

The costs of deleading an owner-occupied residence cannot be deducted, but

may be added to the basis of the property if the deleading costs are capital

expenditures. Deleading costs incurred by landlords of residential and nonresidential property are either currently deducted, or must be capitalized and

recovered over the useful life of the property. Whether deleading costs are

deductible or must be capitalized depends on the facts and circumstances of

the situation.

In general, removing lead paint and replacing it with non-lead paint is considered a repair and is currently deductible by landlords. The paint can be

either inside or outside the building. If a $10,000 expense can be currently

deducted (expensed), then the taxpayer can include $10,000 as a deduction

on the tax return for the year the expenditure was paid or incurred. Replacing all the windows in a building generally would be a capital expenditure.

Thus, if the property is initially purchased for $200,000 and $10,000 is incurred to replace all the windows, then the basis in the property is $210,000

($200,000 + $10,000). This $210,000 basis may be recovered through

depreciation over the useful life of the building or upon its sale. Replacing

some windows may be a repair and currently deductible or it may be a capital expenditure, depending upon whether the replacements are determined

to have materially added to the value or prolonged the useful life of the

building. For a family with a young child who suffers or had suffered from

lead poisoning, the cost of removing or covering lead paint in areas of the

dwelling in poor repair and readily accessible to the child may be a deductible medical expense. Medical expenses are deductible to the extent that

they exceed 7.5 percent of annual income. Expenses that would otherwise

be considered capital expenditures may be deducted in the current year to

the extent that the cost exceeds the resulting increase in the value of the

property. In other cases, the costs of deleading an owner-occupied residence

cannot be deducted, but may be added to the basis if the deleading costs are

capital expenditures.

and moderate-income families with children, additional financial incentives may be

warranted. This recommendation calls for

further work to determine the specific

federal grants or tax incentives that would

most efficiently encourage proper control of

hazards in homes occupied by low- and

moderate-income families.

Given federal resource constraints and the

financial capacity of higher-income families

to pay for proper hazard control, the financial incentives should be targeted to lowand moderate-income families or to owners

of residential rental property serving these

families. Further exploration on the specifics of the financial incentives would enable

a careful weighing of the advantages and

disadvantages of each proposal.
34

Eliminating Childhood Lead Poisoning: A Federal Strategy Targeting Lead Paint Hazards

II. Secondary Prevention

Recommendations:

Increase Early

Intervention For LeadPoisoned Children

Increase compliance with

existing HCFA policies

concerning blood lead

screening.

CDC recommends that State and local

jurisdictions develop screening guidelines to

target children at high risk of lead poisoning

based on community and individual risk

factors. Data from phase II of the third

National Health and Nutrition Examination

Survey (NHANES II, 1991-1994) show that

children in Medicaid represent a high-risk

group comprising 83% of all children with

blood lead levels of 20 μg/dl and above. As

of October 1998, HCFA policy requires that

all children enrolled in Medicaid receive a

screening blood lead test at age 12 and 24

months. Data reflecting this 1998 policy on

lead screening in the Medicaid population

are not yet available. A GAO study, based

on claim data from 1994 and 1995, was

conducted in 15 States prior to the new

policy. This study showed that less than

20% of Medicaid children had been

screened nationally (based on NHANES

data) and that screening rates varied widely

from State to State but were less than 50%

in all cases.22

The following discussion recommends a

number of additional measures. After GAO

issued a report indicating that about half of

the written policies on lead screening were

inconsistent with HCFA policy, HCFA released a letter to State Medicaid Directors

(SMDs) reiterating the HCFA policy on lead

screening and the importance of such

screening. In addition, HCFA plans to

individually contact States not currently in

compliance with HCFA policy and work with

their SMDs to bring policies into compliance.

Lead screening in the Medicaid population

should be routinely monitored to track

compliance with HCFA and SMA policies.

Most States, however, do not have systems

to routinely monitor screening penetration

and the prevalence of elevated blood lead

levels in the Medicaid population. HCFA

Form-416 used by SMAs to report services

provided under EPSDT should be revised to

promote the development of data systems

for identifying Medicaid children who have

received blood lead screening. CDC and

HCFA should continue and expand upon

ongoing efforts to support and assist State

health departments and SMAs to link blood

lead surveillance data to Medicaid data.

Such efforts will improve the quality of data

needed to monitor the penetration and

prevalence of lead screening. HCFA should

require SMAs to monitor and report on lead

screening penetration. In cooperation with

CDC, HCFA should develop specific performance goals for lead screening and require

Goal

By 2010, eliminate elevated

blood lead levels in children

through:

■ increased compliance with

existing policies concerning

blood lead screening; and

■ increased coordination across

federal, state and local agencies responsible for outreach,

education, technical assistance,

and data collection related to

lead screening and lead hazard

control*

*Note: HCFA, CDC, and CDC's Advisory Committee on

Childhood Lead Poisoning Prevention will be developing criteria to

evaluate requests from State Medicaid Agencies (SMAs) to waive

the current Medicaid requirement to screen all Medicaid-eligible

children. These waiver requests are based on data provided by

SMAs on the prevalence of elevated blood lead levels in their

Medicaid-eligible population.

Eliminating Childhood Lead Poisoning: A Federal Strategy Targeting Lead Paint Hazards
35

SMAs to develop plans for improvement

when performance goals are not met.

HCFA and CDC should continue to provide

guidance and technical assistance to SMAs

to ensure that lead screening requirements

are incorporated into Medicaid-managed

care contracts and that adherence to such

requirements is monitored.

Because the risk of lead poisoning varies

substantially among geographic areas and

demographic groups, the risk among Medicaid populations in different states also will

likely vary substantially. It is further expected that some SMAs will request waivers

from HCFAís lead screening policy. HCFA is

currently working with CDC and CDCís

Advisory Committee on Childhood Lead

Poisoning Prevention to develop criteria for

reviewing such waivers based upon actual

data on blood lead levels in a Stateís

Medicaid-eligible population.

Support community-based

outreach, education, and

advocacy efforts for lead

screening of Medicaid-eligible

children.

In addition to the intervention through

health-care-providers, an important part of

the efforts to increase the use of clinical

preventive services involves the education

and empowerment of consumers of health

care to enable them to seek out preventive

care. Efforts should be expanded to inform

Medicaid-eligible families with young children of the need for lead screening. CDC

should encourage the lead poisoning

prevention programs of State and local

health departments to partner with community-based organizations (CBOs) in such

outreach and education efforts. Logical

partners in this effort would include CBOs

currently involved in outreach and education activities to increase immunization

coverage and those working to increase

enrollment of eligible families in the Medicaid program and related health insurance

entitlements. SMAs may fund the latter as

an administrative expense under HCFA

rules.

Ensure compliance with

Medicaid policy on casemanagement services and

one-time on-site

identification of the source of

lead among Medicaid-eligible

children with lead poisoning.

The most important part of the treatment of

childhood lead poisoning is the identification and elimination of the sources of lead

exposure. In addition, case management

services are needed to coordinate interventions related to environmental, housing,

medical, and social factors. GAO found

that most SMAs did not reimburse for

environmental and case-management

services, perhaps because current HCFA

policy indicates that these may be covered

services. The October 22, 1999, letter from

HCFA to SMAs clarified HCFA policies

regarding the coverage of investigations to

determine the source of lead and casemanagement services. It is recommended

that HCFA actively encourage SMAs not

currently covering environmental and casemanagement services to provide this benefit

and that CDC and HCFA provide technical

assistance to SMAs for implementing such a

benefit.

Encourage and provide

technical assistance to SMAs

to explore options for

covering additional

environmental treatment

services for children with lead

poisoning.

Essential environmental services needed to

identify and control lead exposure in the

environment of children with elevated blood

lead levels may not be routinely covered

under current HCFA policy. For example,

HCFA regulations do not permit reimbursement for laboratory analysis of environmental samples such as dust, paint, soil, or

water. Although visual inspection of paint
36

Eliminating Childhood Lead Poisoning: A Federal Strategy Targeting Lead Paint Hazards

and on-site x-ray fluorescence (XRF) analysis to measure lead in paint may be covered

services, research and current guidelines

developed by HUD (together with CDC)

indicate that laboratory measurements,

especially of lead in house dust, bare soil,

and drinking water, are necessary to identify

sources of exposure. One possible option

for coverage of additional environmental

services for Medicaid-eligible children with

elevated blood lead levels is through a 1115

demonstration waiver, whereby Medicaid

savings can be applied to the provision of

additional benefits. For example, Rhode

Island was approved to expand its Statewide 1115 Medicaid demonstration waiver

to cover the cost of replacing windows in

the homes of children diagnosed with lead

poisoning. Although replacing windows is

not a covered item under the ìregularî

Medicaid program, Rhode Island was able to

obtain HCFA approval for this because it

financed the program with Medicaid savings

created through other aspects of its 1115

waiver. This innovative program is expected

to improve the health of lead poisoned

children by removing a major source of

contamination from their homes. Under the

HHS lead initiative, HCFA has committed to

provide technical assistance to SMAs

developing such waiver applications.

III. Research

Develop and evaluate new

cost-effective lead paint

hazard control technologies.

New technologies are continually being

developed to make lead paint hazard

identification and control services more

affordable. Research is needed to help

develop, evaluate, and market new products. For example, x-ray fluorescence

technologies may be able to provide rapid

on-site analysis of lead levels in house dust.

Use of this technology would eliminate the

need for laboratory analysis. New durable

coating products may render lead paint

inaccessible for long periods of time and

may reduce the amount of dust generated.

Further research also is needed to develop

methods of removing lead paint in ways

that do not generate dust, thus reducing

occupational exposures and the need for

extensive cleanup following lead hazard

control work.

Extend field-based housing

studies on the longevity of

lead paint hazard controls.

For the past several years, HUD has sent an

annual report to Congress measuring the

cost-effectiveness of the grant program.

The main outcome measures in this report

are blood lead levels in resident children

and levels of lead in house dust. Current

plans are to follow the trends in the houses

studied over a 3-year period, with a major

report due in 2001. Preliminary data indicate that large reductions in house-dust

lead levels have been achieved and maintained (see Table 8)

To evaluate the full longevity potential of

the modern hazard control techniques

employed by HUDís grantees, the study

should be extended for another 7 years to

fully measure the relative cost-effectiveness

of different hazard control methods. These

data will also be crucial to understanding

the long-term durability of interim control

methods.

Develop hazard control

techniques for evaluating

exterior urban leadcontaminated soil and dust.

Research has shown that soil and dust from

a number of sources of lead, including

fallout from leaded gasoline, paint, and

hazardous waste sites are important contributors to childrensí exposure. Even

though lead in gasoline was banned in the

late 1970s, the soil in urban settings (especially near roadways) that have not been

disturbed for long periods may still contain

elevated levels of lead.

Although not tested for their effectiveness,

specific actions might reduce exposure to

lead in some situations. For example, soil
37

with a thin layer of contaminated lead may

be tilled to reduce lead concentration to

acceptable levels. These and other methods require further study.

Determine the extent to

which activities such as

building demolition, aging

paint deterioration, and

industrial paint removal from

buildings and structures

contribute to urban soil

contamination and dust

loadings.

Additional efforts are needed to more fully

understand the complex problem stemming

from the release and movement of lead in

the environment. Particular attention needs

to be paid to sources of exterior contamination, how they contribute to soil and dust

exposures, and the resulting exposure to

children.

Although significant efforts have been made

to gain an understanding of residential

environments and exposure pathways

related to lead paint and lead-contaminated

interior dust, more research is needed to

understand the external environment.

For lead contamination already in place, the

critical public health question concerns the

best methods for remediation. Limited data

indicate that building demolition and

deterioration or removal of leaded paint

from buildings and other large structures

such as bridges may also contribute to

ongoing contamination. Additionally, efforts

to reduce exposure to existing contamination may be ineffective if neighborhoods are

recontaminated by uncontrolled emissions

from paint deterioration, paint removal, or

demolition of buildings and structures.

Thus, additional research is needed to

determine the amount of contamination

associated with these activities and to

achieve effective controls.

Support further research and

development to improve

portable blood lead analyzer

technology.

The LeadCareTM hand-held blood lead

analyzer can almost immediately determine

a blood lead level in a clinic or field setting,

thereby allowing faster retesting and followup as appropriate. Although this development has the potential to increase the

penetration of lead screening, two technical

problems need to be addressed prior to the

wider use and utility of this instrument.

First, because the only commercially available device is classified as ìmoderately

complex,î clinical providers must acquire

Clinical Laboratory Improvement Act (CLIA)

certification. A simpler ìCLIA-waivedî

device would make portable blood lead

instruments more attractive to clinical

providers. Second, to ensure that lead

screening results from physician offices can

be easily reported to health authorities for

monitoring and follow-up purposes, technology should be further developed to allow

these instruments to provide easy and

secure electronic transmissions of demographic and blood lead data.

IV. Surveillance And

Monitoring

Support State-based blood

lead surveillance systems and

the capacity to use data

linkage to monitor lead

screening in the Medicaid

population.

The goals of CDCís childhood blood lead

surveillance activity are to: 1) assist States

in developing laboratory-based systems for

surveying blood lead levels among children,

2) help States in the analysis and dissemination of lead surveillance data, and 3) use

data from State systems to form a national

surveillance database. To achieve these

goals, CDC provides technical assistance,

develops and provides computer software,

provides funding through grants, and
38

Eliminating Childhood Lead Poisoning: A Federal Strategy Targeting Lead Paint Hazards

compiles surveillance data submitted by

State programs. To support efforts to

monitor and increase screening in high-risk

groups, especially among Medicaid children,

CDC currently funds four State projects to

estimate the prevalence of elevated blood

lead levels and screening penetration in the

Medicaid population. CDC should continue

to support such efforts.

Repeat the National Survey of

Lead Paint Hazards in

Housing by 2005.

HUD conducted surveys of the prevalence

of lead paint in the nationís housing stock

in 1991 and again in 1999-2000. Results of

the most recent survey, which includes data

from 830 homes chosen to represent the

entire U.S. housing stock, are expected to

be available by late 2000. The survey

should be repeated in 2005 to assess

progress toward the 2010 goal.

Continue blood lead

measurements in future

NHANES.

The National Health and Nutrition Examination Survey (NHANES) administered by CDC

represents the only source of periodic,

nationally representative data on blood lead

levels in the U.S. population. Data from the

NHANES have been invaluable in tracking

trends in blood lead levels, identifying highrisk populations, and supporting regulatory

and policy decisions. The last available

NHANES covered the period 1991-1994.

NHANES is now being implemented as a

continual survey that will provide data from

a representative sample of the U.S. population every year. As this strategy is implemented, it is crucial that blood lead measurements remain a part of the NHANES in

order to track the success of the overall

prevention effort at the national level.
39

Hotlines

The National Lead Information Center

1-800-424-LEAD (5323)

(EPA, HUD, CDC)

EPAís Safe Drinking Water Hotline

1-800-426-4791

HUDís Healthy Homes Hotline

1-800-HUDS-FHA

Web sites

Environmental Protection Agency:

www.epa.gov/lead

US Department Housing & Urban

Development: www.hud.gov/lea

Listing of Lead Service Providers:

www.leadlisting.org (or 1-888-LEADLIST)

Centers for Disease Control

(888-232-6789):

www.cdc.gov/nceh/ncehhome.htm

Consumer Product Safety Commission

(800-638-2772): www.cpsc.gov

Key Publications

Protect Your Family From Lead in Your Home

(EPA, CPSC, HUD), EPA 747-K-99-001, April

1999 (disclosure pamphlet) Available in

Spanish

Lead in Your Home: A Parentís Reference Guide

(EPA), EPA 747-B-99-003, May 1999 (70-

page comprehensive guide)

Lead Poisoning and Your Children (EPA), EPA

800-B-92-002, February 1995 (trifold with

foldout poster of tips) Available in

Spanish

Runs Better Unleaded ñ How to Protect Your

Children From Lead Poisoning (EPA), EPA 747-

F-99-005A, August 1999 (trifold brochure

for parents, caregivers)

Resources

Lead Paint Safety: A Field Guide for Painting,

Home Maintenance, and Renovation Work, HUD,

EPA, CDC, HUD Office of Lead Hazard

Control, HUD-1779-LHC, June 1999

Guidelines for the Evaluation and Control Of

Lead-Based Paint Hazards in Housing,

HUD-1539-LBP, July 1995; updated Chapter

7, 1997, 700 pages

How to Check For Lead Hazards In Your Home,

HUD, EPA, Consumer Federation of

America, HUD Office of Lead Hazard

Control

Moving Toward A Lead-Safe America: A

Report to the Congress of the United

States, HUD Office of Lead Hazard Control,

Feb. 1997

Putting the Pieces Together: Controlling Lead

Hazards in the Nationís Housing, Lead-Based

Paint Hazard Reduction and Financing Task Force,

HUD-1542-LBP, June 1995

Lead-Based Paint Training Curriculum for

Maintenance and Renovation Workers (from

www.hud.gov/lea)
40

Eliminating Childhood Lead Poisoning: A Federal Strategy Targeting Lead Paint Hazards
41

Endnotes

1. National Academy of Sciences, Measuring

Lead Exposure in Infants, Children, and Other

Sensitive Populations, Committee on Measuring Lead in Critical Populations, Board on

Environmental Studies and Toxicology,

Commission on Life Sciences, National

Academy of Sciences, National Academy

Press, Washington, DC, 1993.

2. Case Studies in Environmental Medicine,

Lead Toxicity, Agency for Toxic Substances

and Disease Registry (ATSDR), Revised

September 1992, U.S. Department of

Health and Human Services.

3. Centers for Disease Control, Preventing Lead

Poisoning in Young Children: A Statement by the

Centers for Disease Control, Report No. 99-

2230, Atlanta, Ga.: CDC, U.S. Department

of Health and Human Services, 1991; and

neurotoxicity review in U.S. Environmental

Protection Agency, Air Quality Criteria for

Lead: Supplement to the 1986 Addendum,

Research Triangle Park NC, Office of Health

and Environmental Assessment, Environmental Criteria and Assessment Office, EPA

Report No. EPA/600-8-89-049F, 1990

4. Schwartz, J., ìLow-Lead Level Exposure and

Childrenís IQ: A Meta-analysis and Search

for a Threshold,î Environ. Res. 65:42-55,

1994.

5. Centers for Disease Control and Prevention,

ìUpdate: Blood Lead LevelsñUnited States

1991-1994,î Morbidity and Mortality Weekly

Report, U.S. Department of Health and

Human Services/Public Health Service, Vol

46, No.7, Feb 21, 1997, p. 141-146 and

erratum in vol 46, No. 26, p. 607, July 4,

1997.

6. Lanphear B.P. Emond M, Jacobs D.E.,

Weitzman M, Tanner M., Winter N., Yakir B.,

Eberly S, ìA Side by Side Comparison of

Dust collection Methods for Sampling

Lead-Contaminated House Dust,î Env. Res.

68:114-123, 1995.

7. Clark, C.S., R. Bornschein, P. Succop, S.

Roda, and B. Peace, ìUrban Lead Exposures

of Children in Cincinnati, Ohio,î Journal of

Chemical Speciation and Bioavailability, 3(3/

4):163-171, 1991.

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R.P., Dietz B., Bornschein R.L., Succop.,

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Children,î Australasian Medical Gazette, Vol.

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17. U.S. Department of Housing & Urban

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Report to Congress, Washington, D.C., 1990.

18. Putting the Pieces Together: Controlling Lead

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19. Evaluation of the HUD Lead Paint Hazard

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with update from Feb 1999 dataset, Columbia, MD.

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GE, Greenhouse JB, ìBone lead levels and

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275:363-369, Feb 7, 1996.

21. Centers for Disease Control, Preventing Lead

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Centers for Disease Control, Report No. 99-

2230, Atlanta, Ga.: CDC, U.S. Department

of Health and Human Services, 1991.

22. U.S. General Accounting Office, Lead

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Effectively Reaching At-Risk Children, GAO/

HEHS-99-18, Washington DC, January 1999.

23. Environmental Protection Agency, Report on

the HUD National Survey of Lead paint in

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1995.

24. Farfel MR, Chisolm JJ. ìHealth and environmental outcomes of traditional and modified practices for abatement of residential

lead paint,î Am J Public Health, 1990;80:1240-

45.

25. Amitai Y, Graef JW, Brown MJ, et al. ìHazards

of ëdeleadingí homes of children with lead

poisoning,î Am J Dis Child 1987;141:758-760.

26. Swindell SL, Charney E, Brown MJ, Delaney J.

ìHome abatement and blood lead changes

in children with class III lead poisoning,î

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27. U.S. Department of Housing and Urban

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Lead Hazard Control), Guidelines for the

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Housing HUD-1539-LBP, Washington, D.C.

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28. Farfel MR, Chisholm JJ, Rohde CA. ìThe

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221.

29. Environmental Protection Agency. Lead Paint

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Atlanta, GA, November 1997.

31. Economic Analysis of the Final Rule on Lead paint:

Requirements for Notification, Evaluation and

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Control, Washington, DC, September 7,

1999.
43

Other References

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Gerstle, R.S., Kahn, N., and Cochrane, R.E.,

ìHazards of Deleading Homes of Children

with Lead Poisoning, American Journal of the

Disabled Child, 141, 1987, p. 758-760.

Amitai 1991. Amitai, Y., M.J. Brown, J.W. Graef,

and E. Cosgrove. ìResidential Deleading:

Effects on the Blood Lead Levels of LeadPoisoned Children,î Pediatrics 88(5):893-897.

Annest 1984. Annest, J. L., and Mahaffey, K.,

ìBlood Lead Levels for Persons Aged 6

Months to 74 Years, United States 1976-80,î

Vital and Health Statistics, Series 11, 1984, No.

233, DHHS Publ. No. (PHS) 84-1683,

Washington, D.C.

Aschengrau 1994. Aschengrau A., Beiser A.,

Bellinger A., et al. ìThe Impact of Soil Lead

Abatement on Urban Childrenís Blood Lead

Levels; Phase II Results from the Boston

Lead-In-soil Demonstration Project,î

Environmental Research 1994: 67:125-148.

Aschengrau 1997. Aschengrau A. Beiser A,

Bellinger D, Copenhafer D, Weitzman M.

ìResidential lead paint hazard remediation

and soil lead abatement: their impact

among children with mildly elevated blood

lead levels,î Am J. Public Health 1997;

87:1698-1702.

ATSDR 1988a. ATSDR (Agency for Toxic Substances and Disease Registry). 1988. The

Nature and Extent of Lead Poisoning in Children

in the United States: A Report to Congress.

Atlanta, GA.: U.S. Department of Health and

Human Services.

Bellinger 1987. Bellinger, D., A. Leviton, C.

Waternaux, H. Needleman, and M.

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1654.
Eliminating

Childhood

Lead Poisoning:

A Federal Strategy Targeting

Lead Paint Hazards

Presidentís Task Force

on Environmental

Health Risks and

Safety Risks

to Children

Appendix

Methodology Used to Project Numbers of

Lead Poisoned Children and Trends in the

American Housing Stock, 2000-2010
ELIMINATING CHILDHOOD LEAD POISONING:

A FEDERAL STRATEGY TARGETING LEAD PAINT HAZARDS

Appendix

Methodology Used to Project Numbers of Lead Poisoned Children

and Trends in the American Housing Stock, 2000-2010

February, 2000

Prepared by

ICF Consulting

President’s Task Force on

Environmental Health Risks and Safety Risks to Children
President’s Task Force on Environmental Health Risks Page A-i

and Safety Risks to Children

TABLE OF CONTENTS

Page

Appendix: Methodology Used to Project Numbers of Lead Poisoned Children and

Trends in the American Housing Stock, 2000-2010 ........................................................................A-1

1. NHANES III Phase 2 Data and Limitations....................................................................................A-2

2. Combining American Housing Survey and NHANES Data to Estimate the Number of

Lead Poisoned Children in 1993 and 1997 ...................................................................................A-4

3. Using American Housing Survey, Residential Energy Consumption Survey, and

National Lead Paint Survey Data to Project the Number of Housing Units With

“High” and “Low” Risk of Lead Paint Hazards..............................................................................A-11

4. Calculating Lead Poisoning Prevalence for Children in High and Low Risk Housing..................A-16

5. Forecasting Lead Poisoning Prevalence by PIR and Age of Housing Based on

Percentage of Housing Stock With High Risk of Lead Paint Hazards .........................................A-17

6. Projecting the Number of Lead Poisoned Children in Low and High Risk Units,

Before and After Adjustment for HUD Rule for Federally Assisted Housing................................A-19

7. Adjusting Projections for Lead Poisoned Children to Reflect Impact of Expanded

HUD Lead Hazard Control Grant Program..................................................................................A-22

8. Estimating the Benefits and Net Benefits of an Expanded Lead Hazard

Control Grant Program ................................................................................................................A-25
President’s Task Force on Environmental Health Risks Page A-ii

and Safety Risks to Children

LIST OF TABLES

Page

Table 1. Prevalence of Children Under Age 6 With Blood Lead Levels ≥10 μ g/dL,

by PIR, MSA Size, and Year House Built (% of children within each cell)............................................A-3

Table 2. Prevalence of Children Under Age 6 With Blood Lead Levels ≥ 15 μ g/dL,

by PIR, MSA Size, and Year House Built (% of children within each cell)............................................A-3

Table 3. NHANES Phase 2 Blood Lead Data for Children Under Age 6 (raw numbers) ....................................A-5

Table 4. 1993 Number of Children (in millions) Under Age 6 by PIR and MSA..................................................A-6

Table 5: 1993 Number of Children (in thousands) Under Age 6 With Blood Lead Levels ≥10 μ g/dL,

by PIR and MSA Size (1993 American Housing Survey Children Times

NHANES Phase 2 Prevalence ≥10 μ g/dL)...........................................................................................A-6

Table 6: 1993 Number of Children (in thousands) Under Age 6 With Blood Lead Levels ≥15 μ g/dL,

by PIR and MSA Size (1993 American Housing Survey Children Times

NHANES Phase 2 Prevalence ≥15 μ g/dL)...........................................................................................A-7

Table 7. 1997 Number of Children (in millions) Under Age 6 by PIR and MSA..................................................A-8

Table 8. Percentage Change in Numbers of Children Under Age 6 from 1993 to 1997.....................................A-8

Table 9. 1997 Number of Children (in thousands) Under Age 6 With Blood Lead Levels ≥10 μ g/dL,

by PIR and MSA size (1997 American Housing Survey Children Times

NHANES Phase 2 Prevalence ≥10 μ g/dL)...........................................................................................A-9

Table 10: 1997 Number of Children (in thousands) Under Age 6 With Blood Lead Levels ≥15 μ g/dL,

by PIR and MSA Size (1997 American Housing Survey Children Times

NHANES Phase 2 Prevalence ≥15 μ g/dL).........................................................................................A-10

Table 11. Changes in Housing Stock Reflected in Estimated Change in Number of Lead Poisoned

Children Under Age 6 from 1993 to 1997 (occupied units in millions)................................................A-10

Table 12. Residential Energy Consumption Survey and American Housing Survey data on

Window Replacement.........................................................................................................................A-11

Table 13. Percent of Units With Window Versus Siding Replacement > $2K, by PIR

(American Housing Survey 1994-97, Owner Occupied Units)............................................................A-12

Table 14. 1985-1997 Changes in Tenure Status (Across 7 American Housing Survey Samples) .....................A-13

Table 15. Units With No Lead Paint, and Demolition and Rehab Rates, by Year Built.......................................A-13

Table 16. Forecast Change in High and Low Risk Units Resulting from 1989-97 Demolition

and Rehab (Window Replacement) Rates (housing units in millions) ................................................A-15

Table 17. Distribution of Children<6 and Percent Above 10 μg/dL by PIR, Housing Unit Risk,

and Year Built .....................................................................................................................................A-17

Table 18. Post-74 Units with Children<6, by PIR and Year Built With Percent Moved in 1993 and

Percent Near Older Units....................................................................................................................A-18

Table 19. Projected Number of High Risk Units and Associated Change in Lead Poisoning Prevalence..........A-20
President’s Task Force on Environmental Health Risks Page A-iii

and Safety Risks to Children

Table 20. Projected Number of Children with Avoided Lead Poisoning Due to HUD Rule

for Assisted Units................................................................................................................................A-21

Table 21. Projected Number of Lead Poisoned Children under Six (in thousands) Before

 and After HUD Rule and Expanded HUD Lead Hazard Control Grant Program ...............................A-23

Table 22. Comparison of Low PIR and Percent of Area Income (X%) Criteria for HUD

Lead Hazard Control Grant Program..................................................................................................A-22

Table 23. HUD National Lead Paint Survey Data on Surface Area with Lead Paint,

Average Lead per Unit of Surface Area, and Percent of Lead by Year of Construction.....................A-24

Table 24. Estimated Average Paint Lead by Decade of Construction (housing units in millions).......................A-25

Table 25. Monetized Health Benefits and Market Benefits (dollars in millions) of Expanded

HUD Lead Hazard Control Grant Program .........................................................................................A-27

Table 26. Estimated Total Costs, Benefits, and Net Benefits of Options to Address Lead Paint

in 2.3 Million Pre-1960 Housing Units Occupied by Low-Income Families Not Covered

by HUD Rule, 2001-2010 ($ billion) ....................................................................................................A-28
President’s Task Force on Environmental Health Risks Page A-1

and Safety Risks to Children

Appendix

Methodology Used to Project Numbers of Lead Poisoned Children and

Trends in the American Housing Stock, 2000-2010

This document explains how the number of children under age 6 with lead poisoning can be projected for

future years. The projections, before and after Federal intervention, combine data from the following

sources:

♦ The Third National Health And Nutrition Examination Survey (NHANES III) Phase 2

♦ The American Housing Survey

♦ The Residential Energy Consumption Survey

♦ The HUD National Lead Paint Survey

The lead poisoning projections show that ongoing demolition and rehabilitation of older housing units,

which account for most of the lead paint in housing, should result in a steady decline in the number of lead

poisoned children over the next decade. In the absence of Federal intervention, however, this analysis

estimates that there would still be 185,000 lead poisoned children under age six living in pre-1975 housing

in the year 2010, in households with a poverty income ratio (PIR) of less than 1.3. (PIR is equal to

household income divided by the poverty income level, so households with PIR below 1.3 are under 130

percent of the official poverty level).

The methodology used to project the number of lead poisoned children, and the benefits of Federal

intervention, are explained below in eight sections:

1. NHANES III Phase 2 data and limitations.

2. Combining American Housing Survey and NHANES data to estimate the number of lead poisoned

children in 1993 and 1997.

3. Using American Housing Survey, Residential Energy Consumption Survey, and HUD National

Lead Paint Survey data to forecast number of housing units with “high” and “low” risk of lead paint

hazards.

4. Calculating the prevalence of children with lead poisoning for high and low risk housing.

5. Forecasting lead poisoning prevalence by PIR and age of housing based on the percentage of the

housing stock with a high risk of lead paint hazards.

6. Projecting the number of lead poisoned children in low and high risk units, before and after

adjustment for the HUD rule for Federally assisted housing.

7. Adjusting projections for lead poisoned children to reflect the impact of an expanded HUD Lead

Hazard Control Grant Program.

8. Estimating the benefits and net benefits of an expanded Lead Hazard Control Grant Program.
Appendix: Methodology Used to Project Numbers of Lead Poisoned Children

and Trends in the American Housing Stock, 2000-2010

President’s Task Force on Environmental Health Risks Page A-2

and Safety Risks to Children

In this document, the term “lead poisoned children” refers to children with blood lead levels above 10

μg/dL. CDC guidelines have established this level as a threshold for public health response and one at

which the evidence for harm to children’s health is well established. However, considerable evidence also

links blood lead levels below 10 μg/dL in young children to cognitive losses (lower IQ) that reduce the

average lifetime earnings of such children. Lead paint hazard control activities provide the greatest benefit

to children who avoid lead poisoning, but these same activities also benefit other children by reducing the

average blood lead for children below 10 μg/dL. The Economic Analysis for the HUD Lead Paint

Regulation for Federally Assisted Housing estimates the combined monetized health benefit per housing

unit where lead hazards are controlled. This “unit benefit” includes the benefit to children who avoid lead

poisoning, plus the benefit of lower blood lead levels for other children (below 10 μg/dL). Although the first

seven sections of this document focus on the projected number of the lead poisoned children, the analysis

of benefits in Section 8 includes the total benefit of lead hazard reduction, including the benefit of lower

blood lead levels for children below 10 μg/dL.

1. NHANES III Phase 2 Data and Limitations

Tables 1 and 2 show NHANES III Phase 2 data on the prevalence of children under age 6 with blood lead

levels above 10 and 15 μ g/dL, within year of home construction, poverty income ratio (PIR), and

Metropolitan Statistical Area (MSA) population categories. The “don’t know” category refers to NHANES

respondents who didn’t know the age of their housing unit. People in older housing units may be less

likely to know the age of their unit, which suggests that most of the “don’t know” units are older units. This

would also explain why the prevalence of children with lead poisoning in the “don’t know” category is

similar to the prevalence in older units.

NHANES III Phase 2 reported the prevalence of children above 10 μ g/dL by age of housing, MSA

population, and three PIR categories. These data were recreated for Table 1 to ensure that this analysis

reflects the same population weights and statistical methods reflected in the NHANES data reported in

Morbidity and Mortality Weekly Report (February 21, 1997). For the remainder of this analysis, however,

only two PIR categories were used - above and below 1.3 (families above and below 130% of the poverty

income level, where poverty income is adjusted for family size and inflation but not for geographic

variations in income). This was done because the small amount of NHANES sample data for higher

income children was inadequate to support projections with any reasonable degree of confidence.

Tables 1 and 2 both indicate that lower income children and children in older housing are more likely to be

lead poisoned. Table 1 shows a surprisingly high prevalence of low-income children in post-73 housing

with blood lead > 10 μ g/dL, but Table 2 shows that almost none of these low-income children in post-73

housing have blood lead > 15 μ g/dL. In fact, the prevalence of children above 15 μ g/dL is also extremely

low in 1946-73 housing. The prevalence of children with blood lead levels above 15 μ g/dL is especially

high for children with PIR less than 1.3, in pre-46 housing in MSAs with population greater than one

million.
Appendix: Methodology Used to Project Numbers of Lead Poisoned Children

and Trends in the American Housing Stock, 2000-2010

President’s Task Force on Environmental Health Risks Page A-3

and Safety Risks to Children

Table 1. Prevalence of Children Under Age 6 With Blood Lead Levels ≥10 μg/dL,

by PIR, MSA Size, and Year House Built

(% of children within each cell)

Year House Built:

Pre-1946 1946-1973 Post-1973 Don’t know

Characteristic % % % %

PIR ≤ 1.3 (low) 16.37 7.25 4.33 6.02

1.3 < PIR ≤ 3.5 (Medium) 4.09 2.01 0.38 2.95

3.5 < PIR < 8.5 (High) 0.87 2.65 0 0

PIR > 1.3 3.19 2.24 .22 2.81

MSA population< 1 million 5.77 3.06 2.51 2.17

MSA population ≥ 1 million 11.49 5.80 0.81 7.89

PIR ≤ 1.3 and MSA pop < 1 million 10.62 3.82 6.48 2.92

PIR ≤ 1.3 and MSA pop ≥ 1 million 22.27 9.09 2.65 8.39

PIR >1.3 and MSA pop < 1 million 3.03 2.38 0.22 0.52

PIR >1.3 and MSA pop ≥ 1 million 3.35 2.10 0.21 4.22

Source: Third National Health and Nutrition Examination Survey—Phase 2, 1991-1994 (MMWR, February 21, 1997).

Table 2. Prevalence of Children Under Age 6 With Blood Lead Levels ≥ 15 μg/dL,

by PIR, MSA Size, and Year House Built

(% of children within each cell)

Year House Built:

Pre-1946 1946-1973 Post-1973 Don’t know

Characteristic % % % %

PIR ≤ 1.3 (low) 6.75 1.19 0.12 3.60

1.3 < PIR ≤ 3.5 (Medium) 1.77 0.16 0.38 0.21

3.5 < PIR ≤ 8.5 (High) 0 00 0

PIR > 1.3 1.27 0.10 0.22 0.20

MSA population < 1 million 1.44 0.63 0.67 0.13

MSA population ≥ 1 million 5.71 0.70 0.21 4.66

PIR ≤ 1.3 and MSA pop < 1 million 1.35 1.30 0 0

PIR ≤ 1.3 and MSA pop ≥ 1 million 12.30 1.13 0.21 6.35

PIR >1.3 and MSA pop < 1 million 1.67 0 0.22 0.52

PIR >1.3 and MSA pop ≥ 1 million 0.88 0.20 0.21 0

Source: Third National Health and Nutrition Examination Survey—Phase 2, 1991-1994
Appendix: Methodology Used to Project Numbers of Lead Poisoned Children

and Trends in the American Housing Stock, 2000-2010

President’s Task Force on Environmental Health Risks Page A-4

and Safety Risks to Children

Table 3 shows the sample size limitations of the NHANES data, which could distort the projected number

of lead poisoned children in post-73 housing. The total NHANES sample of children under 6 with blood

lead, MSA, and PIR data is 2214, but only 13 children living in post-73 housing were above 10 μ g/dL and

only three were above 15 μ g/dL. The limitations of the NHANES sample result in large 95% confidence

intervals around the prevalence estimates in Tables 1 and 2. For example, the prevalence estimate of

16.37% for children with PIR less than 1.3 in pre-46 housing has a 95% confidence interval of 9.9% to

27.2%. For children with PIR less than 1.3 in post-73 housing, the prevalence estimate of 4.33% has a

95% confidence interval of 2.1% to 9.1%.

The small prevalence of lead poisoned children in post-73 housing multiplied by the large number of

children in post-73 housing still results in a significant number of lead poisoned children. With the growth

in post-73 housing between 1993 and 1997, the estimated number of lead poisoned children in post-73

housing will grow accordingly. This estimate would be reasonable only if the lead poisoning prevalence for

children in post-73 housing were entirely due to lead hazards unrelated to housing (and if no progress in

reducing such hazards were anticipated). However, American Housing Survey data indicate that over

one-third of all families with children under 6 in 1993 moved into their then current residence within the

previous two years, and almost half moved within the previous three years. Therefore, it is likely that many

lead poisoned children in post-73 housing were exposed to lead paint hazards at an older previous

residence. Others may have been exposed at a friend or relative’s residence, and still others may have

been exposed to lead paint hazards from older buildings in their immediate neighborhood. For all of these

reasons, a reduction in older units with lead paint hazards is also likely to reduce the lead poisoning

prevalence for children in post-73 housing.

2. Combining American Housing Survey and NHANES Data to Estimate the Number

of Lead Poisoned Children in 1993 and 1997

Table 4 shows the total number of children under 6 by year of home construction, PIR, and MSA size,

based on 1993 American Housing Survey data. Table 5 combines the NHANES data from Table 1 with the

American Housing Survey data from Table 4 to estimate the number of children under 6 with blood lead

levels above 10 μ g/dL in 1993. American Housing Survey data are reported in slightly different time

intervals than NHANES data, so pre-40 housing is associated with pre-46 prevalence estimates (most

housing built in the 1940s was built after 1945) and post-74 housing is associated with post-73 prevalence

estimates. Each cell or household category in Table 5 reflects the prevalence of children under 6 with

blood lead levels above 10 μ g/dL for that housing category in Table 1 multiplied by the total number of

children under 6 in that household category from Table 4. (The NHANES data relating to the “don’t know”

age of housing category were not used in this analysis). These calculations yield estimates of 887,000 to

993,000 for the total number of children above 10 μ g/dL, versus 930,000 reported by MMWR (based on

population census weights). (MMWR revised this estimate to 890,000 in an erratum published July 4,

1997). Table 6 applies the same approach to combine NHANES data in Table 2 with American Housing

Survey data in Table 4 to estimate the number of children under 6 with blood lead levels above 15 μ g/dL

in 1993. Of particular interest in Table 6 is the fact that children under 6 with PIR less than 1.3, in pre-46

housing, and in MSAs with population greater than one million account for more than half of all children

under 6 with blood lead levels above 15 μ g/dL.
Appendix: Methodology Used to Project Numbers of Lead Poisoned Children

and Trends in the American Housing Stock, 2000-2010President’s Task Force on Environmental Health Risks and Safety Risks to Children

Table 3. NHANES Phase 2 Blood Lead Data for Children Under Age 6

(raw numbers)

Year House Built:

Pre- 1946 1946-1973 Post 1973 Don’t Kn

Total ≥ 10 ≥ 15 Total ≥ 10 ≥ 15 Total ≥ 10 ≥ 15 Total ≥ 10 

Children with PIR < 1.3 192 35 13 511 45 10 294 11 1 230 17 Children with PIR > 1.3 147 9 5 341 10 1 412 2 2 87 4 Total 339 44 18 852 55 11 706 13 3 317 21 Children in MSA < 1 million 159 14 4 339 16 5 388 9 2 145 4 Children in MSA ≥ 1 million 209 35 16 550 41 7 356 6 2 206 21 Total 368 49 20 889 57 11 744 15 4 351 25 PIR ≤ 1.3 & MSA < 1 million 74 10 2 179 9 4 152 6 0 94 3 PIR ≤ 1.3 & MSA ≥ 1 million 118 25 11 332 36 6 142 5 1 136 14 PIR >1.3 & MSA < 1 million 73 3 2 145 5 0 221 1 1 37 1 PIR >1.3 & MSA ≥ 1 million 74 6 3 196 5 1 191 1 1 50 3 Total 339 44 18 852 55 11 706 13 3 317 21 

Source: U.S., Third National Health and Nutrition Examination Survey—Phase 2, 1992-1994
Appendix: Methodology Used to Project Numbers of Lead Poisoned Children

and Trends in the American Housing Stock, 2000-2010

President’s Task Force on Environmental Health Risks Page A-6

and Safety Risks to Children

Table 4. 1993 Number of Children (in millions) Under Age 6 by PIR and MSA

Year House Built:

Pre-1940 1940-1974 Post 1974

Children with PIR ≤ 1.3 1.98 3.53 1.89

Children with PIR > 1.3 2.75 6.18 6.50

Total 4.73 9.71 8.39

Children in MSA population area < 1 million 2.60 4.76 5.68

Children in MSA population area > 1 million 2.13 4.95 2.71

Total 4.73 9.71 8.39

Children with PIR ≤ 1.3, MSA pop < 1million 1.02 1.83 1.33

Children with PIR ≤ 1.3, MSA pop > 1 million 0.96 1.7 0.56

Children with PIR > 1.3, MSA pop < 1 million 1.58 2.94 4.34

Children with PIR > 1.3, MSA pop > 1 million 1.17 3.24 2.16

Total 4.73 9.71 8.39

Source: U.S. Bureau of the Census and U.S. Department of Housing and Urban Development, “American

Housing Survey for the United States in 1993.”

Table 5: 1993 Number of Children (in thousands) Under Age 6

With Blood Lead Levels ≥10 μg/dL, by PIR and MSA Size

(1993 American Housing Survey Children Times

NHANES Phase 2 Prevalence ≥10 μg/dL)

Year House Built:

Pre-1940 1940-74 Post-74 Total

Number % of total Number % of total Number % of total Number % of total

Children with PIR ≤ 1.3 324 (36%) 256 (28%) 82 (9%) 662 (73%)

Children with PIR > 1.3 88 (10%) 138 (15%) 13 (2%) 239 (27%)

Total (all PIR) 412 (46%) 394 (43%) 95 (11%) 901

Children in MSA < 1 million 150 (15%) 147 (15%) 142 (14%) 439 (44%)

Children in MSA > 1 million 245 (25%) 287 (29%) 22 (2%) 554 (56%)

Total (all MSA) 395 (40%) 434 (44%) 164 (16%) 993

With PIR ≤ 1.3, MSA pop < 1 million 109 (12%) 70 (8%) 86 (10%) 265 (30%)

With PIR ≤ 1.3, MSA pop > 1 million 213 (24%) 155 (17%) 15 (2%) 383 (43%)

With PIR > 1.3, MSA pop < 1 million 48 (5%) 70 (8%) 9 (1%) 127 (14%)

With PIR > 1.3, MSA pop > 1 million 39 (4%) 68 (8%) 5 (1%) 112 (13%)

Total (all MSA and PIR) 409 (45%) 363 (41%) 115 (14%) 887

Sources: U.S. Bureau of the Census and U.S. Department of Housing and Urban Development, “American Housing Survey for the United

States in 1993.” And U.S., Third National Health and Nutrition Examination Survey—Phase 2, 1992-1994
Appendix: Methodology Used to Project Numbers of Lead Poisoned Children

and Trends in the American Housing Stock, 2000-2010

President’s Task Force on Environmental Health Risks Page A-7

and Safety Risks to Children

Table 6. 1993 Number of Children (in thousands) Under Age 6

With Blood Lead Levels ≥15 μg/dL, by PIR and MSA Size

(1993 American Housing Survey Children Times

NHANES Phase 2 Prevalence ≥15 μg/dL)

Year House Built:

Pre-1940 1940-74 Post-74 Total

Number % of total Number % of total Number % of total Number % of total

Children with PIR ≤ 1.3 134 (57%) 42 (18%) 3 (1%) 179 (76%)

Children with PIR > 1.3 36 (15%) 6 (3%) 14 (6%) 56 (24%)

Total (all PIR) 170 (72%) 48 (21%) 17 (7%) 235

Children in MSA < 1 Million 37 (14%) 30 (12%) 38 (14%) 105 (40%)

Children in MSA > 1 Million 117 (45%) 35 (13%) 6 (2%) 158 (60%)

Total (all MSA) 154 (59%) 65 (25%) 44 (16%) 263

With PIR ≤ 1.3, MSA pop < 1M 14 (6%) 24 (10%) 0 (0%) 38 (16%)

With PIR ≤ 1.3, MSA pop > 1M 118 (51%) 19 (8%) 1 (1%) 138 (60%)

With PIR > 1.3, MSA pop < 1M 26 (11%) 0 (0%) 10 (4%) 36 (16%)

With PIR > 1.3, MSA pop > 1M 10 (4%) 6 (2%) 5 (2%) 21 (8%)

Total (all MSA and PIR) 168 (72%) 49 (21%) 16 (7%) 233

Sources: U.S. Bureau of the Census and U.S. Department of Housing and Urban Development, “American Housing Survey for the United

States in 1993.” And U.S., Third National Health and Nutrition Examination Survey—Phase 2, 1992-1994

Table 7 shows the total number of children under 6 by year of home construction, PIR, and MSA size,

based on 1997 American Housing Survey data, and Table 8 shows the percentage change in each

household category (cell) between the 1993 and 1997 American Housing Survey data. The American

Housing Survey data in Tables 4 and 7 indicate that the total number of children under 6 declined from

22.8 million in 1993 to 22.2 million in 1997 (the Census Bureau also projects virtually no growth in the

number of children under 6 through about 2008). Two other trends over these four years would also

reduce the number of lead poisoned children. First, the population of children under 6 with PIR less than

1.3 actually fell by about one million, while children with PIR greater than 1.3 grew by 0.4 million. Second,

the decline in children with PIR below 1.3 was entirely in pre-73 housing, and disproportionately in pre-46

housing. The shift of low PIR children to newer housing appears to reflect two trends with the older

housing stock. First, many older units in poor condition are demolished each year. Second, substantial

rehabilitation and gentrification of older neighborhoods reduces the number of older units that serve low

PIR families with young children.
Appendix: Methodology Used to Project Numbers of Lead Poisoned Children

and Trends in the American Housing Stock, 2000-2010

President’s Task Force on Environmental Health Risks Page A-8

and Safety Risks to Children

Table 7. 1997 Number of Children (in millions) Under Age 6 by PIR and MSA

Year House Built:

Pre-1940 1940-1974 Post 1974

Children with PIR ≤ 1.3 1.37 3.05 1.98

Children with PIR > 1.3 2.79 6.11 6.91

Total 4.16 9.16 8.89

Children in MSA population area < 1 Million 2.19 4.26 6.29

Children in MSA population area > 1 Million 1.97 4.90 2.60

Total 4.16 9.16 8.89

Children with PIR ≤ 1.3, MSA pop < 1M .68 1.36 1.40

Children with PIR ≤ 1.3, MSA pop > 1M .69 1.69 .62

Children with PIR > 1.3, MSA pop < 1M 1.51 2.90 4.89

Children with PIR > 1.3, MSA pop > 1M 1.28 3.21 1.98

Total 4.16 9.16 8.89

Source: U.S. Bureau of the Census and U.S. Department of Housing and Urban Development,

“American Housing Survey for the United States in 1997.”

Table 8. Percentage Change in Numbers of Children Under Age 6 from 1993 to 1997

Year House Built:

Pre-1940 1940-1974 Post-1974

% Change since 1993

Children with PIR ≤ 1.3 -31% -14% +5%

Children with PIR > 1.3 +1% -1% +6%

Total (all PIR) -12% -6% +6%

Children in MSA population area < 1 Million -16% -11% +11%

Children in MSA population area > 1 Million -8% -1% -4%

Total (all MSA) -12% -6% +6%

Children with PIR ≤ 1.3, MSA pop < 1M -33% -26% +5%

Children with PIR ≤ 1.3, MSA pop > 1M -28% -1% +11%

Children with PIR > 1.3, MSA pop < 1M -4% -1% +13%

Children with PIR > 1.3, MSA pop > 1M +9% -1% -8%

Total (all MSA and PIR) -12% -6% +6%

Sources: U.S. Bureau of the Census and U.S. Department of Housing and Urban Development,

“American Housing Survey for the United States in 199,” and “American Housing Survey for

the United States in 1997.”
Appendix: Methodology Used to Project Numbers of Lead Poisoned Children

and Trends in the American Housing Stock, 2000-2010

President’s Task Force on Environmental Health Risks Page A-9

and Safety Risks to Children

The net effect of these trends on the estimated number of lead poisoned children in 1997 is shown in

Tables 9 and 10. Each household category in Table 9 reflects the NHANES prevalence of children under

6 with blood lead levels above 10 μ g/dL for that housing category in Table 1 multiplied by the total 1997

American Housing Survey number of children under 6 in that household category from Table 7. The

calculations that reflect PIR yield estimates of about 775,000 children above 10 μ g/dL in 1997 versus

estimates of about 900,000 in 1993. Table 10 applies the same approach to combine NHANES data in

Table 2 with American Housing Survey data in Table 7 to estimate the number of children under 6 with

blood lead levels greater than 15 μ g/dL in 1997. The calculations in Table 10 that reflect PIR yield

estimates of about 190,000 children above 15 μ g/dL in 1997 versus estimates of about 230,000 in 1993.

Table 9. 1997 Number of Children (in thousands) Under Age 6

With Blood Lead Levels ≥10 μg/dL, by PIR and MSA size

(1997 American Housing Survey Children Times

NHANES Phase 2 Prevalence ≥10 μg/dL)

Year House Built:

Pre-1940 1940-74 Post-74 Total

Number % of total Number % of total Number % of total Number % of total

Children with PIR ≤ 1.3 224 (29%) 221 (29%) 86 (11%) 531 (69%)

Children with PIR > 1.3 89 (12%) 136 (18%) 15 (2%) 241 (31%)

Total (all PIR) 313 (41%) 357 (46%) 101 (13%) 771

Children in MSA < 1 Million 126 (13%) 131 (14%) 158 (17%) 415 (44%)

Children in MSA > 1 Million 227 (24%) 284 (30%) 21 (2%) 532 (56%)

Total (all MSA) 353 (37%) 415 (44%) 179 (19%) 948

With PIR ≤ 1.3, MSA < 1M 72 (9%) 52 (7%) 91 (12%) 215 (28%)

With PIR ≤ 1.3, MSA > 1M 154 (20%) 154 (20%) 16 (2%) 323 (41%)

With PIR > 1.3, MSA < 1M 46 (6%) 69 (9%) 11 (1%) 126 (16%)

With PIR > 1.3, MSA > 1M 43 (6%) 67 (9%) 4 (1%) 114 (15%)

Total (all MSA and PIR) 315 (40%) 342 (44%) 122 (16%) 779

Sources: U.S. Bureau of the Census and U.S. Department of Housing and Urban Development, “American Housing Survey for the

United States in 1997.” And Third National Health and Nutrition Examination Survey—Phase 2, 1991-1994
Appendix: Methodology Used to Project Numbers of Lead Poisoned Children

and Trends in the American Housing Stock, 2000-2010

President’s Task Force on Environmental Health Risks Page A-10

and Safety Risks to Children

Table 10: 1997 Number of Children (in thousands) Under Age 6

With Blood Lead Levels ≥15 μg/dL, by PIR and MSA Size

(1997 American Housing Survey Children Times

NHANES Phase 2 Prevalence ≥15 μg/dL)

Year House Built:

Pre-1940 1940-74 Post 74 Total

Number % of total Number % of total Number % of total Number % of total

Children with PIR ≤ 1.3 93 (49%) 36 (19%) 2 (1%) 132 (70%)

Children with PIR > 1.3 35 (19%) 6 (3%) 15 (8%) 57 (30%)

Total (all PIR) 129 (68%) 42 (22%) 17 (9%) 189

Children in MSA < 1 Million 31 (12%) 27 (11%) 42 (17%) 100 (40%)

Children in MSA > 1 Million 108 (43%) 34 (14%) 5 (2%) 148 (59%)

Total (all MSA) 140 (56%) 61 (24%) 48 (19%) 249

With PIR ≤ 1.3, MSA < 1M 9 (5%) 18 (9%) - (0%) 27 (14%)

With PIR ≤ 1.3, MSA > 1M 85 (45%) 19 (10%) 1 (1%) 105 (55%)

With PIR > 1.3, MSA < 1M 25 (13%) - (0%) 11 (6%) 36 (19%)

With PIR > 1.3, MSA > 1M 11 (6%) 6 (3%) 4 (2%) 22 (12%)

Total (all MSA and PIR) 131 (69%) 43 (23%) 16 (8%) 190

Sources: U.S. Bureau of the Census and U.S. Department of Housing and Urban Development, “American Housing Survey for the

United States in 1997.” And U.S., Third National Health and Nutrition Examination Survey—Phase 2, 1991-1994

Table 11 summarizes housing stock changes from 1993 through 1997 that are reflected in the declining

estimated number of lead poisoned children. First, pre-46 units account for most housing demolition.

Second, the average number of children per housing unit declined slightly. Third, the percentage of

children with PIR below 1.3 declined sharply in pre-46 housing.

Table 11. Changes in Housing Stock Reflected in Estimated Change

in Number of Lead Poisoned Children Under Age 6 from 1993 to 1997

(occupied units in millions)

Year of home

construction

1993

Occupied

Units

1997

Occupied

Units

Percent

Change

per year

Children

< 6 per

1993 unit

Children

< 6 per

1997 unit

1993 percent

of children

< 6 with

PIR < 1.3

1997 percent

of children

< 6 with

PIR < 1.3

pre-40 19.9 19.4 -0.57% 0.24 0.21 42% 33%

1940-74 44.4 44.3 -0.07% 0.22 0.21 36% 33%

Post-74 30.4 35.8 4.07% 0.28 0.25 23% 22%

Sources: U.S. Bureau of the Census and U.S. Department of Housing and Urban Development, “American Housing Survey for the

United States in 1993” and “American Housing Survey for the United States in 1997.”
Appendix: Methodology Used to Project Numbers of Lead Poisoned Children

and Trends in the American Housing Stock, 2000-2010

President’s Task Force on Environmental Health Risks Page A-11

and Safety Risks to Children

3. Using American Housing Survey, Residential Energy Consumption Survey, and

National Lead Paint Survey Data to Project the Number of Housing Units With

“High” and “Low” Risk of Lead Paint Hazards

The estimated number of lead poisoned children in 1997 derived in Section 2 does not account for

housing rehabilitation between 1993 and 1997, which could further reduce the number of lead poisoned

children in 1997. In the short run, remodeling and rehabilitation work without safe practices and adequate

cleanup can increase the blood lead levels of resident children exposed to lead dust. In the long run,

however, substantial rehabilitation will generally reduce lead paint hazards by removing housing

components with lead paint. This may be especially true when lead paint is removed from friction and

impact surfaces as a result of window and door replacement. In fact, the HUD Evaluation data show that

the lead paint hazard intervention strategies selected most often by Grantees were window work and/or

window replacement, paint stabilization, and cleanup.

Table 12 shows Residential Energy Consumption Survey and American Housing Survey data on the

percent of units that have replaced all of their windows prior to 1990, and from 1990 through 1997. The

1993 Residential Energy Consumption Survey data asks respondents if they have replaced all of their

windows in the last two years (1992-93), in the last three to four years (1990-91) or earlier (pre-1990). The

1995 and 1997 American Housing Survey data report the number of units that replaced windows and

doors and the amount that each unit spent on this housing upgrade. Table 12 shows the percent of

American Housing Survey units spending more than $2000 on window and door replacement in each twoyear survey period, as a rough estimate of the percent of units replacing all of their windows. Since 1990,

the American Housing Survey and Residential Energy Consumption Survey data show that about 1.6%

per year of all pre-1970 units have replaced all of their windows.

Table 12. Residential Energy Consumption Survey and

American Housing Survey data on Window Replacement

1993 Residential Energy

Consumption Survey:

All Windows Replaced

American Housing

Survey: > $2K Age of

Housing

Pre-90 1990-91 1992–93 1994–95 1996-97

1990-1997

Average/Year

Pre-40 13.1% 3.7% 3.3% 2.5% 2.4% 1.5%

1940-49 11.0% 3.5% 3.8% 3.0% 2.6% 1.6%

1950-59 10.3% 4.1% 4.4% 3.4% 2.3% 1.8%

1960-69 4.7% 2.8% 3.6% 2.9% 2.9% 1.5%

1970-79 1.1% 1.4% 2.0% 2.1% 2.2% 1.0%

Although replacing all the windows in a housing unit is not equivalent to abating lead paint hazards, and

certainly does not abate all lead paint in the unit, it may serve as a good indicator for substantial

rehabilitation and for housing in good condition. The Cincinnati longitudinal study found that children living

in deteriorated older housing had mean blood lead levels that were almost twice the mean blood lead of

children living in rehabilitated housing and pre-WWII housing in satisfactory condition. Dust lead levels in

deteriorated housing were also substantially higher than dust lead levels in rehabilitated housing and pre

WWII housing in satisfactory condition. Housing condition was assessed as “satisfactory” if the house
Appendix: Methodology Used to Project Numbers of Lead Poisoned Children

and Trends in the American Housing Stock, 2000-2010

President’s Task Force on Environmental Health Risks Page A-12

and Safety Risks to Children

appeared to be well maintained and had no peeling paint visible from the street. Deteriorated housing was

lacking one of both of these features. Rehabilitated units were extensively rehabilitated about 10 to 20

years prior to this study, with interiors that were frequently gutted and exteriors that were often sandblasted

or chemically cleaned. These three categories of housing in the Cincinnati study were all in the same

general location, so the variation in blood lead and dust lead levels should be primarily attributable to the

extent of lead paint hazards in each unit.

Replacing all of the windows in an older house demonstrates a level of housing reinvestment that probably

results in a relatively low risk of future lead paint hazards, similar to the rehabilitated and satisfactory

housing in the Cincinnati study. The extent of lead paint removal in units that replace all of their windows

is not as great as in the extensively rehabilitated housing in Cincinnati, but window replacement does

remove lead paint from an important friction and impact surface that could have contributed to future lead

dust levels. Furthermore, the level of housing investment from window replacement is a strong indication

that other upgrades and repairs will be made to the same housing unit over time. At a minimum, housing

units where all of the windows have been replaced are also likely to satisfy the Cincinnati criteria Analysis

for “satisfactory” condition.

Table 13 shows American Housing Survey data on window and siding replacements costing more than

$2000, for owner-occupied units, by PIR. The units that reported window replacement costing more than

$2000 in 1994-95 and in 1996-97 were not generally the same units that reported siding replacement

costing more than $2000 during the same four year period, but the siding and window replacement data

do show a similar pattern by PIR. Households with PIR above 1.3 are more likely to make either type of

investment in their homes. It is reasonable to assume that units with all the windows replaced are also

likely to have siding replaced over time, and to have other upgrade and upkeep investments made to

maintain or enhance home value. Therefore, it is reasonable to use window replacement rates as a proxy

for rehabilitation affecting lead paint hazards.

Table 13. Percent of Units With Window Versus Siding Replacement > $2K, by PIR

(American Housing Survey 1994-97, Owner Occupied Units)

Window and Door Replacements PIR<1.3 1.3<PIR<3.5 3.5>PIR

Pre-20

1920-39

1940-49

2.7%

1.7%

3.9%

4.5%

4.7%

4.6%

6.0%

6.1%

7.8%

Siding Additions and Replacements PIR<1.3 1.3<PIR<3.5 3.5>PIR

Pre-20

1920-39

1940-49

0.9%

0.4%

0.5%

2.5%

2.3%

1.9%

4.1%

2.6%

2.7%

Although Table 13 reflects American Housing Survey data for owner-occupied units only, Residential

Energy Consumption Survey data show that the percent of rental units that report all windows replaced in

recent years is the same or slightly higher than the percent of owner occupied units that report all windows

replaced. Furthermore, Table 14 shows that the tenure status of older housing units changed substantially

between 1985 and 1997. About 37% of all pre-1940 housing units were rental units in 1989, but 55%

were rental units during at least one of the 7 American Housing Surveys from 1985 through 1997, and only
Appendix: Methodology Used to Project Numbers of Lead Poisoned Children

and Trends in the American Housing Stock, 2000-2010

President’s Task Force on Environmental Health Risks Page A-13

and Safety Risks to Children

about 23% were rental units throughout this period. Therefore, window and siding replacement rates for

owner-occupied housing will be reflected in both owner-occupied and rental units over time.

Table 14. 1985-1997 Changes in Tenure Status

(Across 7 American Housing Survey Samples)

1989 American

Housing Survey

Percent Rented

Percent Ever Rented

in 1985–97 American

Housing Survey

Percent Always Rented

in 1985–97 American

Housing Survey

Pre-20

1920-39

1940-49

36%

37%

32%

54%

55%

50%

22%

24%

19%

Tables 15 and 16 combine data on demolition rates, window replacement rates, and HUD National Lead

Paint Survey data on the percent of units without interior lead paint, to forecast the change in high-risk and

low-risk units from 1989 through 1997. The second column of Table 15 shows HUD National Lead Paint

Survey data on the percent of units without interior lead paint, by year built (post-74 units are assumed to

have virtually no interior lead paint). The third and fourth columns show the number of occupied units, by

year built, in 1989 and in 1997. The fifth column of Table 15 shows the annual percentage change in

number of units, by year built, and the next two columns show how demolition rates might differ for low and

high-risk pre-75 housing.

Table 15. Units With No Lead Paint, and Demolition and Rehab Rates, by Year Built

No interior

lead paint

Occupied Units

(millions)

1989-97 Demolition

rate per year

Window Replacement

(Rehab) rate per year Year

Built 1990 1989 1997 All High Risk Low Risk All High Risk Low Risk

Pre-40 17% 20.82 19.44 0.86% 0.95% 0.40% 1.60% 1.85% 0.40%

1940-59 31% 20.90 19.80 0.68% 0.80% 0.40% 1.60% 1.85% 1.05%

1960-74 51% 25.49 24.49 0.50% 0.60% 0.40% 1.25% 1.50% 1.00%

Post-74 100% 26.48 35.76 NA NA NA NA NA NA

Low-risk units in 1989 can be defined as units without interior lead paint. Lead paint was used so

extensively prior to 1940 that it might be reasonable to assume that most pre-40 units without interior lead

paint have already undergone substantial rehabilitation (removing interior lead paint). The percent of units

with all windows replaced prior to 1990 (13.1% from Table 12) is very similar to the percent without interior

lead paint in 1990 (17%), which also suggest that most pre-40 units without interior lead paint have had

substantial rehabilitation. This suggests that low-risk units are less likely to be demolished because

rehabilitated units are less likely to be demolished. Therefore, the annual demolition rate of .86% for pre40 housing is assumed to reflect a weighted average of .95% for high-risk housing and 0.4% for low-risk

housing (.83x.95 + .17x0.4 = .86).
Appendix: Methodology Used to Project Numbers of Lead Poisoned Children

and Trends in the American Housing Stock, 2000-2010

President’s Task Force on Environmental Health Risks Page A-14

and Safety Risks to Children

HUD National Lead Paint Survey data show that 31% of 1940-59 units had no interior lead paint in 1990,

and 51% of 1960-78 units had no interior lead paint. Within either housing category, older units are more

likely to have interior lead paint and are also likely to be demolished at a higher rate than newer units

without lead paint. Also, the percent of 1940-59 units with all windows replaced before 1990 (about

10.6%) suggests that many pre-60 units without lead paint may have undergone substantial rehabilitation.

Therefore, the annual demolition rate of 0.68% for 1940-59 housing is assumed to reflect a weighted

average of .80% for high-risk housing and 0.4% for low-risk housing (.69x.80 + .31x0.4 = 0.68). Similarly,

the annual demolition rate of 0.50% for 1960-74 housing is assumed to reflect a weighted average of .60%

for high-risk housing and 0.4% for low-risk housing (.49x.60 + .51x0.4 = 0.50).

The last three columns of Table 15 show the annual window replacement rate by year built, and how rates

differ for low and high-risk pre-75 housing. Table 12 shows that about 1.6% of all pre-70 units replace all

of their windows each year, but only about one percent of units built in the 1970s replace all their windows

each year. Most pre-40 units and many 1940-59 units without lead paint in 1990 are likely to have

undergone rehabilitation (window replacement) prior to 1990, and it is unlikely that these units would

replace all of their windows again for many years. Therefore, the annual rehab rate of 1.6% for pre-40

housing is assumed to reflect a weighted average of 1.85% for high-risk housing and 0.40% for low-risk

housing (.83x1.85 + .17x0.4 = 1.6). Also, the annual rehab rate of 1.6% for 1940-59 housing is assumed to

reflect a weighted average of 1.85% for high-risk housing and 1.05% for low-risk housing (.69x1.85 +

.31x1.05 = 1.6). The annual rehab rate of 1.25% for 1960-74 housing is assumed to reflect a weighted

average of 1.5% for high-risk housing and 1.0% for low-risk housing (.49x1.5 + .51x1.0 = 1.6).

Table 16 shows how the data in Table 15 are used to forecast changes in the high and low-risk housing

stock. The number of high-risk units in 1989 reflects the total number of occupied units in 1989 multiplied

by the percent of units with interior lead paint, by year built. Pre-40 high-risk units are expected to decline

by 2.8% per year (1.85% rehabilitated plus .95% demolished), 1940-59 high risk units decline by 2.65%

per year (1.85% rehabilitated plus 0.8% demolished), and 1960-74 high risk units decline by 2.1% per year

(1.5% rehabilitated and 0.6% demolished). Post-74 low-risk units increase by 3.73% per year with new

construction. Low-risk pre-75 units experience a 0.4% demolition rate, but this decline is more than offset

by the rehab rate for pre-75 high-risk units (rehabilitation of high-risk units moves these units to the low-risk

category). Based on the assumptions detailed above, Table 16 shows the high-risk housing stock would

decline from 44.2 million units in 1989 to 34.1 million units in 1999, while the low-risk housing stock would

rise from 49.5 million units in 1989 to 67.1 million units in 1999.

The HUD National Lead Paint Survey indicated that lead in residential paint and associated lead dust

hazards are both disproportionately concentrated in pre-60 units. Table 16 shows that 24 million high-risk

pre-60 units remained in the housing stock in 1999 (13 million pre-40 units and 11 million 1940-59 units).

The last column of Table 16 shows that 3.8 million of these high-risk pre-60 units will be rehabilitated by

2010 (2.1 million pre-40 units and 1.1 million 1940-59 units) and another 1.8 million units will be

demolished (1.1 million pre-40 units and 0.7 million 1940-59 units). In the absence of Federal action, this

would still leave 18.4 million high-risk pre-1960 units in 2010.
Appendix: Methodology Used to Project Numbers of Lead Poisoned Children

and Trends in the American Housing Stock, 2000-2010President’s Task Force on Environmental Health Risks and Safety Risks to Children

Table 16. Forecast Change in High and Low Risk Units Resulting from 1989-97

Demolition and Rehab (Window Replacement) Rates

(housing units in millions)

Housing Type 1989 Units Annual Rate of Change 1990 1991 1992 1993 1994 1995 1996 1997 

High Risk Units

pre-40 17.28 -2.80% 16.80 16.3 15.9 15.4 15.0 14.6 14.2 13.8 

1940-59 14.42 -2.65% 14.04 13.7 13.3 13.0 12.6 12.3 11.9 11.6 1960-74 12.49 -2.10% 12.23 12.0 11.7 11.5 11.2 11.0 10.8 10.5 

 Rehab

pre-40 -1.85% 0.32 0.31 0.30 0.29 0.29 0.28 0.27 0.26 

1940-59 -1.85% 0.27 0.26 0.25 0.25 0.24 0.23 0.23 0.22 1960-74 -1.50% 0.19 0.18 0.18 0.18 0.17 0.17 0.16 0.16 

 Demolition

pre-40 -0.95% 0.16 0.16 0.16 0.15 0.15 0.14 0.14 0.13 

1940-59 -0.80% 0.12 0.11 0.11 0.11 0.10 0.10 0.10 0.10 1960-74 -0.60% 0.07 0.07 0.07 0.07 0.07 0.07 0.07 0.06 

Low Risk Units

pre-40 3.54 -0.4%+HR rehab* 3.8 4.1 4.4 4.7 5.0 5.2 5.5 5.7 

1940-59 6.48 -0.4%+HR rehab* 6.7 7.0 7.2 7.4 7.6 7.8 8.0 8.2 1960-74 13.00 -0.4%+HR rehab* 13.1 13.3 13.4 13.5 13.6 13.7 13.9 14.0 

Post-74 26.48 +3.73% 27.5 28.5 29.6 30.7 31.8 33.0 34.2 35.5 

High Risk Units 44.19 43.1 42.0 40.9 39.9 38.8 37.8 36.9 35.9 Low Risk Units 49.50 51.2 52.9 54.5 56.3 58.0 59.8 61.5 63.4 Percent High Risk 47.2% 45.7% 44.3% 42.8% 41.5% 40.1% 38.8% 37.5% 36.2% Change in High Risk % -3.1% -3.2% -3.2% -3.2% -3.3% -3.3% -3.4% -3.4% 

* High risk (HR) units that become low risk units due to rehabilitation (window replacement).
Appendix: Methodology Used to Project Numbers of Lead Poisoned Children

and Trends in the American Housing Stock, 2000-2010

President’s Task Force on Environmental Health Risks Page A-16

and Safety Risks to Children

4. Calculating Lead Poisoning Prevalence for Children in High and Low Risk

Housing

NHANES data can be combined with the data in Section 3 to estimate the lead poisoning prevalence for

children in high versus low risk housing, by PIR and age of housing. As a first step, this analysis assumes

that the lead poisoning prevalence in older low-risk units is approximately equal to the prevalence in post1974 units. This assumption may understate the lead poisoning prevalence in older low-risk units because

our definition of “low-risk” includes units with lead paint, and older units are more likely to be in older

neighborhoods with dust and soil hazards created by deteriorating exterior lead paint from other buildings.

Even in post-74 housing, however, the prevalence of lead poisoned children is much higher among

households with a PIR below 1.3, suggesting that neighborhood lead paint risks may also be reflected to

some extent in the post-74 prevalence data.

If we assume that the prevalence of lead poisoned children in low-risk older housing is approximately the

same as the prevalence in post-74 housing, than we can estimate the prevalence of lead poisoned

children in high-risk older housing based on the percent of older housing that is high risk. Table 16 shows

the following distribution for older housing in 1994, at the end of NHANES III Phase 2:

♦ Pre-40: 75% high risk (15 million out of 20 million units)

♦ 1940-74: 53% high risk (24 million out of 45 million units)

These weighting factors can be used to estimate the following prevalence data:

♦ X1 = lead poisoning prevalence for children with PIR under 1.3 in low-risk housing = 4.33%

♦ X2 = lead poisoning prevalence for children with PIR above 1.3 in low-risk housing = 0.22%

♦ X3 = lead poisoning prevalence for children with PIR under 1.3 in high risk pre-40 housing

♦ X4 = lead poisoning prevalence for children with PIR above 1.3 in high risk pre-40 housing

♦ X5 = lead poisoning prevalence for children with PIR under 1.3 in high risk 1940-74 housing

♦ X6 = lead poisoning prevalence for children with PIR above 1.3 in high risk 1940-74 housing

The values for X1 (4.33%) and X2 (0.22%) are assumed to equal the NHANES III Phase 2 prevalence

values for post-73 housing. The values for the other four categories can then be derived from the

weighted-average NHANES prevalence values for pre-46 and 1946-73 housing, as follows:

♦ .25*4.33 + .75*X3 = 16.37

X3 = (16.37 – (.25*4.33))/0.75 = 20.38%

♦ .25*.22 + .75*X4 = 3.19

X4 = (3.19 – (.25*.22))/0.75 = 4.18%

♦ .47*4.33 + .53*X5 = 7.25

X5 = (7.25 – (.47*4.33))/0.53 = 9.84%

♦ .47*.22 + .53*X6 = 2.24

X6 = (2.24 – (.47*.22))/0.53 = 4.00%
Appendix: Methodology Used to Project Numbers of Lead Poisoned Children

and Trends in the American Housing Stock, 2000-2010

President’s Task Force on Environmental Health Risks Page A-17

and Safety Risks to Children

These calculations indicate a lead poisoning prevalence of about 4% for children with PIR below 1.3 in

low-risk housing (X1) and for children with PIR above 1.3 in high-risk housing (X4 and X6). The lead

poisoning prevalence for children with PIR above 1.3 in low-risk housing is only 0.22%. The lead

poisoning prevalence is much higher for children with PIR below 1.3 in high-risk housing: 20.38% for

children in pre-40 housing and 9.84% for children in 1940-74 housing during the NHANES III Phase 2

sampling period (1992-1994).

5. Forecasting Lead Poisoning Prevalence by PIR and Age of Housing Based on

Percentage of Housing Stock With High Risk of Lead Paint Hazards

The forecast decline in high risk units (Table 16) combined with the higher lead poisoning prevalence

estimates for high risk units (derived in Section 4) indicates that the overall lead poisoning prevalence

should decline with the decline in high risk units. Furthermore, data presented in this section suggest that

lead poisoning prevalence estimates for children in low risk housing should also decline with the decline in

the high-risk housing stock.

Table 17 shows the distribution of children (% of children<6) by PIR and age of housing, based on 1993

American Housing Survey data. Lead poisoning prevalence estimates are also shown for high and low

risk housing, by PIR and age of housing category. Only 25.5% of children below a PIR of 1.3 lived in post74 housing in 1993, whereas 42.2% of children above a PIR of 1.3 lived in post-74 housing.

Table 17. Distribution of Children<6 and Percent Above 10 μg/dL

by PIR, Housing Unit Risk, and Year Built

Year Built Percent of Children<6 High Risk Unit (% EBL) Low Risk Unit (% EBL)

PIR<1.3 PIR >1.3 PIR<1.3 PIR >1.3 PIR<1.3 PIR >1.3

Pre-40 26.8% 17.8% 20.38% 4.19% 4.33% 0.22%

1940-59 21.9% 17.8% 9.84% 3.96% 4.33% 0.22%

1960-74 25.8% 22.2% 9.84% 3.96% 4.33% 0.22%

Post-74 25.5% 42.2% NA NA 4.33% 0.22%

All 100.0% 100.0%

Table 18 provides additional detail on the distribution of children in post-74 housing, whether they moved

into their post-74 unit during 1993, and whether other residential buildings within 300 feet are described in

the 1993 American Housing Survey as “older” or “very mixed.” These data show that children below a PIR

of 1.3 in post-74 housing are more likely to live in 1975-79 housing, more likely to have moved to this unit

in 1993, and more likely to live near older residential buildings than are children with PIR above 1.3.
Appendix: Methodology Used to Project Numbers of Lead Poisoned Children

and Trends in the American Housing Stock, 2000-2010

President’s Task Force on Environmental Health Risks Page A-18

and Safety Risks to Children

Table 18. Post-74 Units with Children<6, by PIR and Year Built

With Percent Moved in 1993 and Percent Near Older Units

Post-74 Units Percent of Row:

with Children<6 Moved in 1993 Near Older Units

PIR <1.3, 1975-79 40.6% 40.3% 21.0%

1980-84 26.6% 27.6% 19.3%

Post-84 32.8% 33.5% 38.7%

Post-74 100.0% 34.7% 26.6%

PIR >1.3, 1975-79 26.8% 29.4% 18.6%

80-84 21.6% 27.7% 20.3%

Post-84 51.6% 24.4% 23.1%

Post-74 100.0% 26.4% 21.3%

The data in Table 18 suggest that the higher lead poisoning prevalence for low PIR children in post-74

housing may be largely attributable to lead paint hazards in a previous residence and/or from nearby

residences with exterior lead paint hazards. With respect to neighborhood lead paint hazards, 26.6% of

low PIR children in post-74 housing and 38.7% of those in post-84 housing live near older buildings that

could have deteriorating lead paint. Almost all of the post-74 units in the American Housing Survey that do

not describe nearby buildings as “older” or “very mixed” describe the nearby buildings as “about the same”

age as the American Housing Survey unit. About two thirds of low PIR children in post-74 housing are in

1975-84 housing units, where nearby buildings “about the same” age (based on a visual evaluation) could

also include many pre-74 buildings with deteriorating lead paint.

The percent of low PIR children in Post-74 housing who moved in 1993, and the percent of low PIR

children by age of housing, can be combined to estimate the extent to which the low PIR lead poisoning

prevalence in Post-74 housing reflects lead paint hazards in a previous residence. The 1993 American

Housing Survey was completed in October, so children who moved into the unit in 1993 could not have

been there more than 10 months. To the extent that families with children are more likely to move during

summer, those who moved in during 1993 had probably only been in their new home for a few months, on

average. If we assume that the lead poisoning prevalence for these children reflects the lead poisoning

prevalence for their previous housing category, then the lead poisoning prevalence for low PIR children in

post-74 housing can be described as a weighted-average that incorporates the following values:

♦ 4.33% is the lead poisoning prevalence for children with PIR under 1.3 in Post-74 housing

♦ 16.37% is the lead poisoning prevalence for children with PIR under 1.3 in Pre-40 housing

♦ 7.25% is the lead poisoning prevalence for children with PIR under 1.3 in 1940-74 housing

♦ 34.7% of children with PIR below 1.3 in post-74 housing moved in 1993

♦ 26.8% of all children with PIR<1.3 live in Pre-40 housing

♦ 47.7% of all children with PIR<1.3 live in 1940-74 housing

If the low PIR children who moved to post-74 units in the past year reflect the distribution of all low PIR

children by age of housing, then lead poisoning prevalence for low PIR children in post-74 units who

haven’t moved recently (Y) can be estimated as follows:

4.33% = .347 * (.268*16.37% + .477*7.25%) + .653*Y = 2.72% + .653*Y

Y = (4.33% – 2.72%)/0.653 = 2.47%
Appendix: Methodology Used to Project Numbers of Lead Poisoned Children

and Trends in the American Housing Stock, 2000-2010

President’s Task Force on Environmental Health Risks Page A-19

and Safety Risks to Children

This calculation indicates that almost half of the lead poisoning prevalence for low PIR children in post-74

housing may actually reflect their exposure to lead paint in previous residences built before 1974. The

neighborhood lead paint hazards discussed above would explain some additional portion of the lead

poisoning prevalence for low PIR children in post-74 housing. Finally, with 40.6 percent of low PIR

children in post-74 housing living in 1974-79 housing, many of these children are also exposed to lead

paint hazards in their own unit, because lead paint for residential use was not banned until 1978. For all of

these reasons, it is reasonable to expect that the decline in high-risk units over time will also reduce the

lead poisoning prevalence for low PIR children living in low-risk units.

6. Projecting the Number of Lead Poisoned Children in Low and High Risk Units,

Before and After Adjustment for HUD Rule for Federally Assisted Housing

Table 19 shows how the projected decline in high-risk housing is likely to reduce the lead poisoning

prevalence for children under age six in two ways. First, the projected decline in high-risk units will reduce

the percent of children living in high-risk units. Second, the prevalence of lead poisoned children in lowrisk units should also decline as the declining number of high-risk units reduces both the risk of

neighborhood lead hazards and the percent of children poisoned in a previous residence. In particular,

Table 19 assumes that the lead poisoning prevalence for each category of housing (derived in Section 4

for 1993) will decline each year at a rate equal to the rate of decline in the high-risk housing percentage of

the total housing stock. Based on these assumptions, the number of lead poisoned children each year is

calculated by multiplying the lead poisoning prevalence for each housing and PIR category by the number

of housing units and the number of children per unit.

The decline in the number of lead poisoned children from 1993 to 1997 reflects both changes in the

housing stock and changes in the percent of older units with poor children between 1993 and 1997, as

discussed in Section 2. The projections beyond 1997 are all based on the 1997 American Housing Survey

data on the average number of children per unit, and the percent of units with PIR below 1.3. The change

in these two variables between 1993 and 1997 is why the number of lead poisoned children is estimated to

have declined more rapidly between 1993 and 1997. Continued declines in the baseline number of lead

poisoned children after 1997 reflect only the projected rate of demolition and housing rehabilitation

(window replacement) which reduce the number of high-risk units.

The projection in Table 19 implicitly assumes that eliminating all high-risk housing would also eliminate all

childhood lead poisoning. Of course, this assumption is not entirely realistic because lead paint hazards

are not the only cause of lead poisoning. However, the analyses presented above suggests that

eliminating lead paint hazards could very nearly eliminate childhood lead poisoning, or at least reduce the

overall lead poisoning prevalence to the very low 0.22% prevalence already achieved for children in post74 housing with PIR above 1.3.

Table 20 shows the number of low PIR children protected from lead poisoning by the HUD rule for

Federally assisted housing. The lead poisoning prevalence estimates for this projection reflect a weightedaverage of the prevalence for low and high risk housing, by age of construction. The number of units in

2000 reflects the number of units covered by the first year of the HUD rule, as reported in the Economic

Analysis for the HUD rule for Federally Assisted Housing. The number of units in 2001 reflects the phasein of additional public housing and project-based assistance units covered by the rule. The number of

children protected is equal to the number of units in each category multiplied by the number of children per

unit and the corresponding lead poisoning prevalence.
Appendix: Methodology Used to Project Numbers of Lead Poisoned Children

and Trends in the American Housing Stock, 2000-2010President’s Task Force on Environmental Health Risks and Safety Risks to Children

Table 19. Projected Number of High Risk Units and Associated Change in Lead Poisoning Prevalence

High Risk Housing Units 1993 1994 1995 1996 1997 1998  Percent High Risk 41.5% 40.1% 38.8% 37.5% 36.2% 34.9%  Change in High Risk Percent -3.2% -3.3% -3.3% -3.4% -3.4% -3.4% Lead Poisoning Prevalence High Risk, PIR>1.3pre-40 4.19% 4.1% 3.9% 3.8% 3.7% 3.5%  High Risk, PIR>1.31940-74 3.96% 3.8% 3.7% 3.6% 3.5% 3.3%  Low Risk, PIR>1.3 0.22% 0.2% 0.2% 0.2% 0.2% 0.2%  High Risk, PIR<1.3pre-40 20.38% 19.7% 19.1% 18.4% 17.8% 17.2%  High Risk, PIR<1.31940-74 9.84% 9.5% 9.2% 8.9% 8.6% 8.3%  Low Risk, PIR<1.3 4.33% 4.2% 4.0% 3.9% 3.8% 3.6%  Pre-40, PIR<1.3 16.6% 15.8% 15.1% 14.4% 13.7% 13.0%  1940-74, PIR<1.3 7.3% 7.0% 6.7% 6.5% 6.2% 5.9% Projected Number of children under 6 (in thousands) with blood lead levels above 10 μg/dl with PIR > 1.3

Housing Category Children<6/unit %PIR>1.3 1993 1994 1995 1996 1997 1998 

High-Risk pre-40 0.214 67.0% 89 85 81 77 72 68 

1940-59 0.216 66.0% 71 68 64 61 57 54 1960-74 0.199 67.3% 64 60 56 53 49 46 

Low Risk pre-40 0.214 67.0% 1 1 2 2 2 2 

1940-59 0.216 66.0% 2222221960-74 0.199 67.3% 444443

Post-74 0.249 77.7% 14 14 14 13 13 13 

Projected Number of children under 6 (in thousands) with blood lead levels above 10 μg/dl with PIR < 1.3

High-Risk pre-40 0.214 33.0% 313 278 243 208 173 162 

1940-59 0.216 34.0% 104 96 89 81 73 69 1960-74 0.199 32.7% 88 81 73 66 59 56 

Low Risk pre-40 0.214 33.0% 20 19 18 17 15 15 

1940-59 0.216 34.0% 26 25 24 24 23 22 1960-74 0.199 32.7% 45 43 40 37 34 33 

Post-74 0.249 22.3% 82 80 78 76 74 75 

All Children<6 with blood lead levels > 10 μg/dl 925 857 788 720 651 621 
Appendix: Methodology Used to Project Numbers of Lead Poisoned Children

and Trends in the American Housing Stock, 2000-2010President’s Task Force on Environmental Health Risks Page A-21and Safety Risks to Children

Table 20. Projected Number of Children with Avoided Lead Poisoning Due to HUD Rule for Assisted Un

EBL Prevalence 2000 2001 2002 2003 2004 2005 2006 2007 200

 Pre-40, PIR<1.3 11.8% 11.2% 10.6% 10.1% 9.6% 9.1% 8.6% 8.2% 7.7 1940-74, PIR<1.3 5.4% 5.2% 5.0% 4.8% 4.6% 4.4% 4.2% 4.0% 3.8

Projected Number of children (in thousands) with avoided blood lead levels > 10 μg/dL due to HUD rule for Federally assist

TBR Units (thousands) Children<6 per unit 2000 2001 2002 2003 2004 2005 2006 2007 2

2000 2001

pre-40 80 80 1.76 16.5 15.7 14.9 14.2 13.5 12.8 12.1 11.5 10

1940-59 99 99 1.76 9.4 9.0 8.7 8.3 7.9 7.6 7.2 6.9 6.1960-74 163 163 1.76 15.6 15.0 14.3 13.7 13.1 12.5 12.0 11.4 10

Public Housing

pre-40 16 33 0.70 1.4 2.6 2.4 2.3 2.2 2.1 2.0 1.9 1.

1940-59 66 131 0.70 2.5 4.8 4.6 4.4 4.2 4.0 3.8 3.7 3.1960-74 82 164 0.70 3.1 6.0 5.7 5.5 5.2 5.0 4.8 4.6 4.

Project-based

pre-40 97 109 0.34 3.9 4.1 3.9 3.7 3.5 3.4 3.2 3.0 2.

1940-59 97 109 0.34 1.8 1.9 1.8 1.8 1.7 1.6 1.5 1.5 1.1960-74 385 468 0.34 7.1 8.3 7.9 7.6 7.3 6.9 6.6 6.3 6.

Other non-rehab

pre-40 14 14 0.34 0.6 0.5 0.5 0.5 0.5 0.4 0.4 0.4 0.

1940-59 11 11 0.34 0.2 0.2 0.2 0.2 0.2 0.2 0.2 0.1 0.1960-74 27 27 0.34 0.5 0.5 0.5 0.4 0.4 0.4 0.4 0.4 0.

Total Non-Rehab

pre-40 207 236 22.3 23.0 21.8 20.7 19.7 18.7 17.7 16.8 15

1940-59 272 349 13.9 16.0 15.3 14.6 14.0 13.4 12.8 12.2 111960-74 657 822 26.4 29.7 28.4 27.2 26.0 24.9 23.8 22.7 21

 Pre-75 1,136 1,407 63 69 66 63 60 57 54 52 49 Cumulative Non-Rehab 63 131 197 259 319 376 430 482 53
Appendix: Methodology Used to Project Numbers of Lead Poisoned Children

and Trends in the American Housing Stock, 2000-2010

President’s Task Force on Environmental Health Risks Page A-22

and Safety Risks to Children

Rehabilitation covered by the HUD rule is not reflected in Table 20 to avoid any double counting of the

overall reduction in high-risk units resulting from rehabilitation. The American Housing Survey and

Residential Energy Consumption Survey data on window replacement used to project the decline in highrisk units should include Federally assisted rehabilitation. The Economic Analysis for the HUD rule shows

that about 40% of assisted rehabilitation units report window and door replacement as part of their

rehabilitation work in the 1995 American Housing Survey, and other assisted units may have replaced

windows in earlier years.

7. Adjusting Projections for Lead Poisoned Children to Reflect Impact of Expanded

HUD Lead Hazard Control Grant Program

Table 21 shows the additional number of low PIR children protected from lead poisoning by an expanded

HUD Lead Hazard Control Grant Program. The number of units addressed each year reflects a phase-in

strategy that emphasizes pre-40 units first, and shifts to more 1940-59 units in later years. The estimated

number of children protected reflects the average number of children per unit multiplied by the lead

poisoning prevalence for low PIR children by age of housing. Table 21 assumes that the number of young

children per unit is similar to the Tenant-Based Rental units subject to the HUD rule for Federally assisted

housing. The HUD rule applies to Tenant-Based Rental units with children under age six, and American

Housing Survey data indicate that about half of these units have children ages one or two. In the case of

the expanded Lead Hazard Control Grant Program, the concentration of young children in these units

assumes that public health officials can direct families with young children (and those expecting a child) to

units that have undergone hazard reduction or passed the hazard screen. The combination of the HUD

rule and this expanded HUD Lead Hazard Control Grant Program could eliminate low-PIR lead poisoned

children in pre-60 housing, and virtually eliminate low-PIR lead poisoned children in pre-1974 housing, by

2010. The analysis in Section 5 also suggests that this action would also substantially eliminate low-PIR

lead poisoned children in post-74 housing, by eliminating the risk from previous residences and reducing

neighborhood risks.

The projections in Table 21 assume that households with PIR less than 1.3 will realize all the benefits from

the expanded Lead Hazard Control Grant Program. The eligibility criteria for the HUD Lead Hazard

Control Grant Program are actually stated in terms of households with income between 50% and 80% of

area income. Table 22 shows American Housing Survey data indicating that households with PIR below

1.3 will almost always meet the HUD criteria, and 56.6% to 81.8% of households that meet the HUD

criteria will also have PIR below 1.3.

Table 22. Comparison of Low PIR and Percent of Area Income (X%)

Criteria for HUD Lead Hazard Control Grant Program

X=80% X=70% X=60% X=50%

PIR< 1.3 & income < X% of area median 28.9% 28.8% 28.6% 26.9%

Only PIR < 1.3 0.3% 0.4% 0.7% 2.3%

Only income < X% of area median 22.2% 17.2% 11.5% 6.0%

Neither 48.6% 53.6% 59.2% 64.8%

Total 100% 100% 100% 100%

PIR < 1.3 as Percent of Less than X% 56.6% 62.6% 71.3% 81.8%
Appendix: Methodology Used to Project Numbers of Lead Poisoned Children

and Trends in the American Housing Stock, 2000-2010President’s Task Force on Environmental Health Risks and Safety Risks to Children

Table 21. Projected Number of Lead Poisoned Children under Six (in thousands)

Before and After HUD Rule and Expanded HUD Lead Hazard Control Grant Program

2000 2001 2002 2003 2004 2005 2006 2007 2008 

Baseline Projection for Lead Poisoned Children with PIR<1.3 (thousands) Pre-40 158 149 141 133 125 118 111 104 98  1940-59 83 79 75 71 67 64 61 57 54  1960-74 81 77 74 70 67 64 61 58 55  Pre-1975 322 305 289 274 259 245 232 220 208 Children Protected by HUD Rule (Non-Rehab) (thousands) Pre-40 22 23 22 21 20 19 18 17 16  1940-59 14 16 15 15 14 13 13 12 12  1960-74 26 30 28 27 26 25 24 23 22  Pre-1975 63 69 66 63 60 57 54 52 49 Additional Children Protected by Expanded HUD Lead Hazard Control Grant Program Units (thousands) Pre-40 80 100 120 130 130 120 120 120  Pre-40 Cumulative 80 180 300 430 560 680 800 920  1940-59 20 50 80 120 120 130 140 150  1940-59 Cumulative 20 70 150 270 390 520 660 810 Avoided Number of Lead Poisoned Children Due to HUD Lead Hazard Control Grant Program (thousands) Pre-40 0 9 19 30 41 51 59 65 71  1940-59 0 1 3 7 12 17 22 26 31  Pre-60 0 10 23 37 53 68 80 92 102 Summary Projection for Lead Poisoned Children with PIR<1.3 (thousands)Baseline Projection 322 305 289 274 259 245 232 220 208  After HUD Rule 259 237 224 211 200 188 178 168 158  After Expanded Grant Program 259 227 201 174 146 121 98 76 56 Pre-60 Baseline Projection 241 228 215 203 192 181 171 162 152  After HUD Rule 205 189 178 168 159 149 141 133 125  After Expanded Grant Program 205 179 156 131 105 82 61 41 23 
Appendix: Methodology Used to Project Numbers of Lead Poisoned Children

and Trends in the American Housing Stock, 2000-2010

President’s Task Force on Environmental Health Risks Page A-24

and Safety Risks to Children

The expanded Lead Hazard Control Grant Program units in Table 21 are all pre-60 units because data

from the HUD National Lead Paint Survey and the US Geological Survey both indicate that lead in

residential paint is disproportionately concentrated in pre-60 units. The Economic Analysis of the HUD rule

also found that health benefits of lead dust removal in 1960-78 housing are only about 60% of the benefits

for lead dust removal in pre-60 units (because pre-60 units are more likely to exceed the dust hazard

standard by a substantial amount).

Table 23 shows HUD National Lead Paint Survey data on the total surface area with lead paint, the

average lead concentration in lead paint, and total tons of lead in paint by age of housing. These data

indicate that post-60 housing accounts for only 9% of all lead in interior paint, and only about 14% of all

lead in exterior paint.

Table 23. HUD National Lead Paint Survey Data on Surface Area with Lead Paint,

Average Lead per Unit of Surface Area, and Percent of Lead by Year of Construction

Pre-40 1940-1959 1960-1978 Total

Lead paint Surface Area (million sq. feet)

 Interior 15,912 8,247 5,279 29,438

 Exterior 25,969 12,635 10,502 49,106

Average lead paint Concentration (mg/sq.c)

 Interior 5.7 2.5 2.0

 Exterior 6.1 4.2 3.2

Total Lead in lead paint (1000 tons) 255 75 45 376

 Interior 93 21 11 125

 Exterior 162 54 34 251

Percent of Total Lead in lead paint 68% 20% 12% 100%

 Interior 74% 17% 9% 100%

 Exterior 65% 22% 14% 100%

Table 24 shows data on white lead consumption, by decade, from 1914-78 (US Geological Survey). White

lead data for 1914-23 in Table 24 are used to estimate consumption from 1910 to 1920 because 1914 is

the earliest year of available data. A small percentage of white lead was consumed in ceramics, greases,

chemicals, plasterizers and stabilizers but the majority of white lead was used in paint. In fact, the paint

industry accounted for about 95 percent of total white lead pigment consumption during the 1930s.

For comparison with white lead, Table 24 also shows consumption of red lead and litharge from 1920-78

(US Geological Survey). Litharge is primarily used in storage batteries. Red lead was used mostly for

ceramics, lubricants, petroleum, rubber, glass, and other industrial applications, and was used very little in

the paint industry as varnishes, enamels and glazes. The limited application of red lead by the paint

industry was often as a rust-inhibiting primer coat for exterior metals, including bridges and automobiles,

which were covered by a finish coat of different composition. The industrial uses of red lead are especially

apparent in the data for the 1940s when there was a sharp increase in red lead and litharge consumption

during World War II, while housing starts were sharply lower during the same period. The increase in red

lead consumption in 1941 was specifically associated with efforts by the automobile industry to produce a

record number of vehicles before converting to war production. Industrial lead consumption can result in

paraoccupational lead exposure for young children (lead brought home from work exposure, usually on
Appendix: Methodology Used to Project Numbers of Lead Poisoned Children

and Trends in the American Housing Stock, 2000-2010

President’s Task Force on Environmental Health Risks Page A-25

and Safety Risks to Children

work clothes) but white lead used in house paint would have the far more pervasive effect on children’s

blood lead levels. Therefore, the white lead data for each decade in Table 24 are used to estimate the

amount of lead in residential paint in housing built before 1978.

Table 24. Estimated Average Paint Lead by Decade of Construction

(housing units in millions)

Lead Consumption

(thousand tons)

1991 White Lead

(thousand tons)

White

Lead

Red Lead

and Litharge

Decade-End

Occupied

Units

White Lead

pounds per

Unit

1991

Housing

Units Before

Rehab

After

Rehab

Percent

of All

White

Lead

1914-23 1,340 0 24.35 110 9.02 496 413 49.1%

1920-29 1,307 356 29.91 87 5.06 221 184 21.9%

1930-39 737 421 34.86 42 5.98 126 104 12.4%

1940-49 476 1,189 42.83 22 7.67 84 72 8.6%

1950-59 196 816 53.02 7 12.51 44 37 4.5%

1960-69 82 781 63.45 3 14.52 22 20 2.4%

1970-79 29 625 80.39 1 21 11 10 1.2%

4,111 4,187 1,004 841 100%

The white lead data for each decade in Table 24 are divided by total occupied units at the end of each

decade (United States Census Bureau) to estimate the tons of lead consumed per occupied unit during

each decade. The white lead per unit is then multiplied by the number of occupied units that remained in

the housing stock in the 1991 American Housing Survey, before subtracting the paint lead removed by

rehab. Finally, the lead tons remaining in each age of housing category is reduced by the percentage of

units with all windows replaced prior to 1991, as an estimate of substantial rehabilitation.

The calculations in Table 24 yield an estimate 841,000 tons of lead in paint remaining in pre-80 housing in

1991. This estimate is higher than the estimate of 376,000 tons in Table 23 for three reasons. First, the

data in Table 24 are adjusted for housing rehabilitation but not for all the paint lead removed from older

units by decades of paint peeling and scraping. Second, the estimates in Table 24 assume that all paint

lead is used in residential units, but commercial buildings actually account for some of the paint lead

consumed. Finally, the data in Table 23 reflect only the surface area of paint above the one mg per

square centimeter federal definition of lead paint, whereas some of the paint lead in Table 24 was used in

paint with a lead concentration below this threshold. In spite of these differences in methodology, the

overall distribution of paint lead in Table 24 confirms the HUD National Lead Paint Survey data showing

that post-60 housing accounts for a very small percentage of total paint lead in housing. The data in Table

24 also suggest that pre-20 units may account for a surprisingly high percentage of paint lead in housing.

8. Estimating the Benefits and Net Benefits of an Expanded Lead Hazard Control

Grant Program

Lead paint hazard control activities provide the greatest benefit to children who avoid lead poisoning, but

these same activities also benefit other children by reducing the average blood lead for children below 10

μg/dL. The Economic Analysis for the HUD Lead Paint Regulation for Federally Assisted Housing
Appendix: Methodology Used to Project Numbers of Lead Poisoned Children

and Trends in the American Housing Stock, 2000-2010

President’s Task Force on Environmental Health Risks Page A-26

and Safety Risks to Children

estimates the combined monetized health benefit per housing unit where lead hazards are reduced. This

“unit benefit” includes the benefit to children who avoid lead poisoning, plus the benefit of lower blood lead

levels for children below 10 μg/dL.

The Economic Analysis for the HUD rule showed that almost all of the monetized benefit of reducing lead

paint hazards results from the present value of increased lifetime earnings associated with higher IQ levels

due to avoided childhood lead exposure. Cognitive ability is reduced, on average, by about one-quarter IQ

point for every one μg/dL increase in childhood blood lead. A reduction of one IQ point reduces lifetime

earnings, on average, by about $9,600 at a 3 percent discount rate, and by about $2,200 at a 7 percent

discount rate. Therefore, a one μg/dL increase in childhood blood lead reduces average lifetime earnings

by about $2,400 at a 3 percent discount rate, and by about $550 at a 7 percent discount rate. The

Economic Analysis for the HUD rule also cites research indicating the average avoided increase in blood

lead due to hazard reduction activities, and the average number of children per housing unit, to estimate

the average monetized benefit of lead hazard reduction per housing unit.

Table 25 shows the health and market benefits associated with the expanded HUD Lead Hazard Control

Grant Program, assuming that lead paint hazards will be found in approximately one-third of all units

inspected. Only units that are treated (units where lead paint hazards are found) incur the costs and

realize the associated market benefits of lead hazard reduction. The Economic Analysis of the HUD rule

shows that pre-40 units account for about 53 percent of all pre-60 units with lead paint, and 1940-59 units

account for the other 47 percent. The Economic Analysis also shows that 44 percent of pre-40 units and

18 percent of the 1940-59 units have deteriorated lead paint. Therefore, about one-third (32 percent) of all

pre-60 units are expected to have lead paint hazards (.44 * 53% + .18 * 47% = 32%).

The health benefit estimates in Table 25 also assume that the number of young children per unit is similar

to the Tenant-Based Rental units subject to the HUD rule for Federally assisted housing. (The Economic

Analysis for the HUD rule estimates that 75-80% of health benefits are realized by children ages one and

two). Table 25 further assumes that one-third of the children in units inspected and/or treated by the HUD

Lead Hazard Control Grant Program will realize the benefits of hazard reduction, because about one-third

of the children living in these units would otherwise have lived in units with lead paint hazards. The

Economic Analysis benefit estimates for interim controls assume 5 years of avoided paint chip ingestion

(paint stabilization) and 5 years of avoided lead dust hazards. Abatement, by definition, protects against

lead paint hazards for at least 20 years.

In addition to monetized health benefits, the Economic Analysis for the HUD rule shows that interim

controls and lead hazard abatement also provide maintenance and rehabilitation market benefits. A large

part of the cost of interim controls is paint stabilization, but more than 90 percent of this cost reflects the

market value of paint repair, and less than 10 percent reflects the incremental cost of safe practices

associated with lead hazards. In the case of abatement, the Economic Analysis estimates that about 80

percent of the total cost is offset by the market benefits of housing rehabilitation (including window

replacement) and only 20 percent is an incremental cost of lead hazard reduction. Table 25 shows the

following estimated market benefits for the expanded HUD Lead Hazard Control Grant Program:

♦ $1.058 billion for interim controls

♦ $15.64 billion for hazard abatement
Appendix: Methodology Used to Project Numbers of Lead Poisoned Children

and Trends in the American Housing Stock, 2000-2010President’s Task Force on Environmental Health Risks and Safety Risks to Children

Table 25. Monetized Health Benefits and Market Benefits (dollars in millions) of Expanded HUD Lead Hazard Contro

Monetized Health Benefits: 2001 2002 2003 2004 2005 2006 2007 2008 

Interim Control Benefits at 3%5-year avoided paint hazards $27 $48 $60 $75 $75 $75 $78 $81 5-year avoided dust hazards $370 $657 $822 $1,027 $1,027 $1,027 $1,068 $1,109 Total $397 $705 $881 $1,102 $1,102 $1,102 $1,146 $1,190 Cumulative $397 $1,102 $1,983 $3,085 $4,186 $5,288 $6,434 $7,624 Interim Control Benefits at 7%5-year avoided paint hazards $8 $14 $17 $21 $21 $21 $22 $23 5-year avoided dust hazards $85 $151 $189 $236 $236 $236 $246 $255 Total $93 $165 $206 $258 $258 $258 $268 $278 Cumulative $93 $258 $464 $721 $979 $1,236 $1,504 $1,782 Abatement Benefits at 3%20-year avoided paint hazards $59 $104 $130 $163 $163 $163 $170 $176 20-year avoided dust hazards $806 $1,433 $1,791 $2,239 $2,239 $2,239 $2,329 $2,418 Total $865 $1,537 $1,922 $2,402 $2,402 $2,402 $2,498 $2,594 Cumulative $865 $2,402 $4,324 $6,726 $9,128 $11,530 $14,028 $16,622 Abatement Benefits at 7%20-year avoided paint hazards $17 $30 $37 $47 $47 $47 $48 $50 20-year avoided dust hazards $185 $330 $412 $515 $515 $515 $536 $556 Total $202 $359 $449 $562 $562 $562 $584 $607 Cumulative $202 $562 $1,011 $1,572 $2,134 $2,696 $3,280 $3,886 

Interim Control Market Benefits $41 $74 $92 $115 $115 $115 $120 $124  Cumulative $41 $115 $207 $322 $437 $552 $672 $796 Abatement Market Benefits $612 $1,088 $1,360 $1,700 $1,700 $1,700 $1,768 $1,836  Cumulative $612 $1,700 $3,060 $4,760 $6,460 $8,160 $9,928 $11,764 
Appendix: Methodology Used to Project Numbers of Lead Poisoned Children

and Trends in the American Housing Stock, 2000-2010

President’s Task Force on Environmental Health Risks Page A-28

and Safety Risks to Children

Table 26 summarizes the total costs, health benefits, market benefits, and net benefits over 10 years of the

interim control and hazard abatement options for addressing lead paint hazards in pre-1960 housing

occupied by low-income families not covered by the HUD rule. Abatement yields a higher net benefit

based on a 3% discount rate for health benefits, but interim controls yield a higher net benefit based on a

7% discount rate for health benefits.

Table 26. Estimated Total Costs, Benefits, and Net Benefits of Options to

Address Lead Paint in 2.3 Million Pre-1960 Housing Units Occupied by

Low-Income Families Not Covered by HUD Rule, 2001-2010

($ billion)

Lead Hazard Screen and

Interim Controls

($1000 per unit)

Inspection/Risk Assessment and Full

Abatement of Lead paint

($9,000 per unit)

Cost

Health Benefit at 3%

Market Benefit

Net Benefit

($2.3)

$10.1

$1.1

$8.9

($20.7)

$22.1

$15.6

$17.0

Cost

Health Benefit at 7%

Market Benefit

Net Benefit

($2.3)

$2.4

$1.1

$1.2

($20.7)

$05.2

$15.6

$00.1

Source: Evaluation of the HUD Lead Hazard Control HUD Lead Hazard Control Grant Program; The Economic Analysis

for the HUD Lead Paint Regulation for Federally Assisted Housing.