Karla Armenti, ScD Occupational Health Surveillance Program Division of Public Health Services

1. Characterization of Adult Blood Lead Levels in the New Hampshire Adult Blood Lead Epidemiology and Surveillance Program (ABLES). Karla Armenti, ScD Occupational Health Surveillance Program Division of Public Health Services

2. Acknowledgements • Suzanne Allison, Public Health Nurse, and Paul Lakevicius, Analyst, Division of Public Health Services, Bureau of Public Health Protection, Childhood Lead Poisoning Prevention Program • Rosemary Caron, Associate Professor and Sarah DiStefano, Student, College of Health and Human Services, Department of Health Management and Policy, University of New Hampshire • Margaret Henning, Assistant Professor and Jesslyn Beaulieu, Student, Keene State College

3. Background • Lead adversely affects multiple organ systems and can cause permanent damage. • NH law requires that laboratories report all blood lead levels to the Division of Public Health Services, Bureau of Public Health Protection • The Childhood Lead Prevention Program receives all adult blood lead reports and provides data to NIOSH under ABLES for all BLLs above 25 µg/dL. BLLs over 40µg/dL are reported to OSHA.

4. Background • Until recently, a blood lead level (BLL) of 25 micrograms per deciliter (µg/dL) or greater for adults was considered “elevated,” and the Healthy People 2010 goal was to eliminate BLLs above this level. • However, adverse health effects have been found with cumulative exposure at BLLs lower than 25 µg/dL.* • CSTE and NIOSH have recommended changing the case definition for an elevated blood lead level (EBLL) in adults from 25 µg/dL to 10 µg/dL, thereby dramatically increasing the “caseload” in New Hampshire by almost 4 and half. • EPA’s Renovation, Repair and Painting Rule – What might we see in the data on contracter (home renovation) exposures? * Rosenman et al, “Occurrence of Lead-Related Symptoms Below the Current Occupational Safety and Health Act Allowable Blood Lead Levels, JOEM, Vol 45, Number 5, May 2003

5. Methods • We performed in-depth data analysis of the NH adult population with BLLs between 10 and 24 µg/dL and for those above 25 µg/dL for the year 2009 (n = 190). • In addition, we documented data by industry and occupation (to the best of our ability). • Analysis was made using a cross tabulation between gender, blood lead level, and by industry.

6. Methods - Survey Phone survey conducted for all cases above 10ug/dL, questions include:* • Reason for blood test (requested, Doctor’s advice, company program) • What type of work and where (employer name) • Why BLL was elevated (poor ventilation, no PPE) • Was PPE available? With training? • Hobbies (like shooting ranges) • Age of residence and any renovations done *Based on questionnaire developed by NY Heavy Metals Registry, NY State Bureau of Occupational Health

7. Process – Intern Support (~1 day per week for 8 months) • First attempt to gather information • Called providers/labs that ordered blood tests • Requested employer/occupation information • Attempted to code data using census industry codes by occupation and industry • Second attempt to gather information • Tried to get patient phone numbers from providers/labs • Many providers refused – we had to look them up (white pages) • Administered phone survey

8. Data Results

9. Data Results

10. Results of Survey • Out of 173 cases between 10 and 24 µg/dL, only 13 completed surveys • Type of work (of those confirmed to be work-related) – Foundry, maintenance, window restoration, contractor/building restoration • Non-occupational exposures were from old house restoration and firing ranges • Industry (only got employer name) and occupation – not able to code • Reason for exposure (work related cases) - not enough ventilation, no respirator available, on clothes, working without a respirator, not sure

11. Survey Results (cont’d) • Respirators available and required from employer? No = 1, Yes = 4, Only in certain areas = 1 • Other PPE – uniform, gloves, safety glasses, paper mask, eye and ear protection • Hobbies – Indoor shooting range, car restoration, house remodeling • House older than 1978 = 6 • Renovations – mostly painting (indoor) and upgrading tile

12. Limitations • Lead prevention staff (assigned to adult lead) include 3 people (1 public health nurse, 1 data entry clerk and 1 analyst), all working just a small percentage on adult lead (mostly assigned to childhood lead issues). • Occupational Health Surveillance Program is managed by one person. • Use of interns was the only way to complete this project.

13. Limitations • Information given by provider was too vague to make a conclusion on how to code each individual’s occupation or industry, so we couldn’t do it. • A lot of missing data • Difficult to draw quantitative conclusions • Difficulty finding telephone numbers – ended up with a lot of inoperative numbers • Survey mostly conducted during the day – staff limited by inability to stay late (only one night where staff could stay to conduct interviews, and only got 2 additional completed) • Survey sample size too small to produce statistical significance

14. Next Steps • New intern starting end of June through December • Collect data on all BLLs over 10µg/dL for 2010 including patient occupation, industry and phone number • Add 2010 data to 2009 data and analyze for various age groups, BLLs and industry • Survey (by phone) workers with BLLs over 10µg/dL • Review OSHA citations for violations of the lead standard for NH companies • Work with the Lead Prevention Program to develop “fact sheet” on Lead at Work to distribute to key stakeholders and facilities with workers at most risk.

15. Contact Information • Karla R. Armenti, ScD, Principal Investigator • Occupational Health Surveillance Program • Bureau of Public Health Statistics & Informatics • Division of Public Health Services • 29 Hazen Drive • Concord, NH 03301 • Phone (603) 271-8425 • www.dhhs.nh.gov/dphs/hsdm/ohs • karmenti@dhhs.state.nh.us