Academic journal article Journal of Environmental Health

Elevated Blood Lead Levels in Buncombe County Children: Implications of Lowering the North Carolina Intervention Level to the Centers for Disease Control and Prevention Blood Lead Reference Value

Academic journal article Journal of Environmental Health

Elevated Blood Lead Levels in Buncombe County Children: Implications of Lowering the North Carolina Intervention Level to the Centers for Disease Control and Prevention Blood Lead Reference Value

Article excerpt

Introduction

Lead is among the most common environmental pollutants, and was used in gasoline, water pipes, and lead-based paint, which is the most significant source of lead exposure today in the U.S. (Anna, 2011). Although fatalities due to lead poisoning are rare in modern times, the risk of elevated blood lead levels (BLLs) and the adverse cognitive effects in children due to these exposures is still present (American Academy of Pediatrics, 2005). Children and infants are more vulnerable to lead poisoning due to the immaturity of their organ systems, growing bodies, high gastrointestinal absorption, and frequent hand-to-mouth habits (Cunningham, 2012). As a result of the increased susceptibility of younger populations, impairment in child development occurs and affects cognitive, behavioral, motor, and physical abilities (Binns, Campbell, & Brown, 2007). High BLLs in children have been shown to be associated with decreased IQ (Binns et al., 2007; Lanphear et al., 2005).

Knowledge of potential lead sources is crucial in determining high-risk populations. The three main sources of lead exposure in children in the U.S. are deteriorating lead-based paint, lead-contaminated dust, and lead-contaminated soil (Binns et al., 2007). Most homes built before 1960 and a few built before 1979 were painted with lead-based paint (Anna, 2011). Moreover, higher rates of lead poisoning were found in geographic areas with higher poverty and/or that have larger minority populations.

When investigating North Carolina, eastern counties that have children with high BLLs were also high-poverty areas with large minority populations (Hanchette, 2008). Many other high-poverty areas in the state, however, were not found to have elevated BLLs in children, indicating that there might be other explanations for higher lead exposures (Hanchette, 2008). Strategies for locating high-risk areas for childhood lead poisoning include selection based on GIS and narrowing down land parcels and neighborhoods based on poverty data and the year homes were constructed (Wilmott, 2009). Such strategies can eventually aide in the risk identification process for health departments and pediatricians (Wilmott, 2009). Considering these factors, lead toxicity in children typically comes from two groups: children living in impoverished conditions and aging homes with poor maintenance, and children from middle- and upper-class families that renovate aging homes without proper anti-contamination measures (Lanphear, 2005).

While the problem has lessened in recent decades, the issue has not vanished as children continue to be exposed to sources of lead. The most recent public health issue related to lead exposure was the contamination of the water supply in Flint, Michigan, exposing thousands of residents and increasing concerns of families for the safety of their children (McLaughlin & Shoichet, 2016). Moreover, recent research showed that BLLs <10 [micro]g/dL still have effects on childhood mental and physical development (Binns et al., 2007). In response to this growing evidence, the Advisory Committee on Childhood Lead Poisoning, in conjunction with the Centers for Disease Control and Prevention (CDC), is currently recommending that the level of lead exposure that is to be deemed a risk for children be reduced from the previous 10 [micro]g/dL to 5 [micro]g/dL (Cunningham, 2012). There still exists the consistent need for the promotion and funding of research to further understand the health effects of blood lead levels <10 [micro]g/dL (Binns et al., 2007).

Until the end of the year 2017, North Carolina Department of Health and Human Services (NC DHSS) considered an "elevated blood lead level" confirmed when a BLL was [greater than or equal to] 10 [micro]g/dL for two consecutive tests conducted within 6 months (NC DHSS, 1999). BLLs were tested through capillary (i.e., finger prick) or venous blood collection. The specific method of blood collection used, however, was not always indicated in the case records. …

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