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Soil and lead poisoning

Soil and lead poisoning. Mary Jo Trepka, MD, MSPH. Outline. Importance of childhood lead poisoning Childhood lead poisoning in Miami-Dade County Risk factors in Miami-Dade County Health department services Relevance to students What we still don’t know.

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Soil and lead poisoning

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  1. Soil and lead poisoning Mary Jo Trepka, MD, MSPH

  2. Outline • Importance of childhood lead poisoning • Childhood lead poisoning in Miami-Dade County • Risk factors in Miami-Dade County • Health department services • Relevance to students • What we still don’t know

  3. What is so important about childhood lead poisoning? • Can lead to permanently lowered IQs • Children more susceptible • Ubiquitous in environment • Urban poor and minorities disproportionately affected

  4. What is a safe lead level? • Current action level = 10 μg/dL • Estimated 2.6-5.8 point IQ decline for increase from 10 to 20 μg/dL • Under 10 μg/dL safe? • 7.4 point IQ decline for 1-10 μg/dL • Cognitive and academic deficits for BLL < 5 μg/dL (Schwartz, et al, Env Res 1994, Bellinger, et al Pediatrics 1992, Canfield, et al NEJM 2003, Lanphear, et al Pub Health Rep 2000)

  5. What is so important about childhood lead poisoning? • Can lead to permanently lowered IQs • Children more susceptible • Ubiquitous in environment • Urban poor and minorities disproportionately affected

  6. What is so important about childhood lead poisoning? • Can lead to permanently lowered IQs • Children more susceptible • Ubiquitous in environment • Urban poor and minorities disproportionately affected

  7. Sources of lead • Soil • Dust • Paint • Pottery • Occupation/hobbies • Folk remedies • Tiles • Water

  8. Sources of lead • Soil • Dust • Paint • Pottery • Occupation/hobbies • Folk remedies • Tiles • Water

  9. Occupations with possible lead exposure • Auto repair/radiator repair • Painting • Construction work • Steel welding and cutting • Plumbing • Police work • Maritime industry

  10. Hobbies with possible lead exposure • Fishing sinkers • Working with cars, car parts, or car batteries • Painting • Stained-leaded glass work • Shooting guns at firing ranges • Working with model cars or boats • Pottery work

  11. What is so important about childhood lead poisoning? • Can lead to permanently lowered IQs • Children more susceptible • Ubiquitous in environment • Urban poor and minorities disproportionately affected

  12. NHANES blood lead levels among children aged 1-5 years, United States, 1976-2000 Source: CDC MMWR 2003;52:SS10

  13. Prevalence of lead poisoning by housing age • Nationwide 2.2 % of 1-5 year-olds • Housing • 8.6% Pre-1946 • 4.6% 1946-73 • 1.6% Post-1973 Source: CDC, 1999-2000 NHANES

  14. Prevalence of lead poisoning by race/ethnicity and income among those in pre-1946 housing • Differs by race/ethnicity • 22% black • 13% Mexican American • 6% white • Differs by income • 16% low • 4% middle • 1% high Source: CDC, 1999-2000 NHANES

  15. Childhood lead poisoning in Miami-Dade County • Prevalence • Florida: 3.2% (Hopkins, et al, J Fla Med Assoc. 1995) • Miami-Dade • Countywide: unknown • Central urban area: estimated 8% • Surveillance: average 431 cases a year among children (1998-2002) • Underscreening • Florida 17% (GAO Report) • Miami-Dade 23% (analysis of Medicaid data)

  16. Lead poisoning cases by gender, Miami-Dade County – 2002 Source: Miami-Dade County Health Department, Vital and Morbidity Statistics 2002

  17. Population < 6 years, 2000, and reported lead poisoning cases by race and ethnicity, 1999-2001, Miami-Dade County Population Cases Source: 2000 US Census and Miami-Dade County Health Department

  18. Sources of lead hazards based on environmental home inspections • 188 inspections • 89 (47%) inspections found no hazards (55 of these inspections in imported cases) • ‘Other sources’: fishing weights, parental occupations, hobbies, water, objects/statues Source: Miami-Dade County Health Department Childhood Lead Poisoning Prevention Program 2003

  19. Risk factors for lead poisoning in Miami-Dade County • Living in a home built prior to 1950 • Living in central urban area • Low socio-economic status • Living in a recently remodeled home • Sibling or playmate with lead poisoning • Refugee status

  20. Lead poisoning prevalence among children screened at the Refugee Health Assessment Center*,July 1, 2001 to June 30, 2002

  21. Childhood Lead Poisoning Prevention Program • Screening • Surveillance • Follow-up • Public and professional education • Primary prevention • Evaluation

  22. Relevance to students’ lives • May live in neighborhoods with soil lead hazards and may have younger siblings at risk • May become parents and will need to know about preventing lead poisoning in their own children • May be exposed in workplace or during hobbies in future

  23. What we still don’t know • How to remove lead from soil • How to cover soil to prevent exposure • If there is a safe lead level • Extent of behavioral effects • How to bring about lead abatement • Risk factors among immigrant children

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