Academic journal article Environmental Health Perspectives

The Effect of Interior Lead Hazard Controls on Children's Blood Lead Concentrations: A Systematic Evaluation. (Children's Health Articles)

Academic journal article Environmental Health Perspectives

The Effect of Interior Lead Hazard Controls on Children's Blood Lead Concentrations: A Systematic Evaluation. (Children's Health Articles)

Article excerpt

Dust control is often recommended to prevent children's exposure to residential lead hazards, but the effect of these controls on children's blood lead concentrations is uncertain. We conducted a systematic review of randomized, controlled trials of low-cost, lead hazard control interventions to determine the effect of lead hazard control on children's blood lead concentration. Four trials met the inclusion criteria. We examined mean blood lead concentration and elevated blood lead concentrations ([greater than or equal to] 10 [micro]g/dL, [greater than or equal to] 15 [micro]g/dL, and [greater than or equal to] 20 [micro]g/dL) and found no significant differences in mean change in blood lead concentration for children by random group assignment (children assigned to the intervention group compared with those assigned to the control group). We found no significant difference between the intervention and control groups in the percentage of children with blood lead [greater than or equal to] 10 [micro]g/dL, 29% versus 32% [odds ratio (OR), 0.85; 95% confidence interval (CI), 0.56-1.3], but there was a significant difference in the percentage of children with blood lead [greater than or equal to] 15 [micro]g/dL between the intervention and control groups, 6% versus 14% (OR, 0.40; 95% CI, 0.21-0.80) and in the percentage of children with blood lead [greater than or equal to] 20 [micro]g/dL between the intervention and control groups, 2% versus 6% (OR, 0.29; 95% CI, 0.10-0.85). We conclude that although low-cost, interior lead hazard control was associated with 50% or greater reduction in the proportion of children who had blood lead concentrations exceeding 15 [micro]g/dL and [greater than or equal to] 20 [micro]g/dL, there was no substantial effect on mean blood lead concentration. Key words: blood lead, children, environmental exposure, lead-contaminated house dust, lead poisoning, prevention, randomized trial. Environ Health Perspect 110:103-107 (2002). [Online 19 December 2001]

http://ehpnet1.niehs.nih.gov/docs/2002/110p103-107haynes/abstract.html

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Despite dramatic reductions in children's blood lead concentrations over the last two decades, subclinical lead toxicity remains a significant risk for urban infants and children (1-3). Low-level elevation in blood lead concentration has been associated with cognitive deficits, aggressive behavior, and hearing dysfunction (4-7). The Centers for Disease Control and Prevention (CDC) have estimated that 890,000, or 4.4%, of U.S. children 5 years and younger have blood lead concentrations of 10 [micro]g/dL or higher (1). Moreover, there is increasing evidence that no detectable threshold exists for the adverse effects of lead exposure on neurodevelopment (6-8),

Efforts to prevent exposure of children to residential lead hazards include education and lead hazard controls. For the vast majority of children, educational efforts--such as dust control, hand washing, and reducing children's mouthing behaviors--represent the major strategy to reduce lead exposure, ingestion, and absorption (9,10). One professional dust intervention trial led to significant reductions in highly exposed children (11), but it is clear that education alone is not adequate to prevent children's exposure to lead, as measured by blood lead concentration (12-16). Moreover, despite considerable evidence that higher dietary calcium intake is associated with lower blood lead concentration, the beneficial effects of calcium supplementation on children's blood lead concentration remains uncertain (17).

Lead hazard controls typically are implemented only after a child is identified with a blood lead concentration consistently above 15 [micro]g/dL or 20 [micro]g/dL. For these children, there is a spectrum of lead hazard controls, including full abatement (complete removal of lead-contaminated paint), encapsulation (making lead-based paint inaccessible with construction material or polymers that are applied like paint), replacement of window and door frames, stabilizing deteriorated paint, and professional dust control (18). …

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