Invited Perspective: Identifying Childhood Lead Exposure Hotspots for Action.

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Date: July 2022
From: Environmental Health Perspectives(Vol. 130, Issue 7)
Publisher: National Institute of Environmental Health Sciences
Document Type: Guest commentary
Length: 2,687 words
Lexile Measure: 2020L

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Lead poisoning and its long-term impacts are largely preventable, yet millions of children worldwide remain at risk for exposure to persistent lead hazards in the environment. (1) In the United States, federal and state regulatory policies aimed at controlling environmental sources of lead--including in residential paint, automotive gasoline, plumbing solder, food packaging, and some consumer products--have been instrumental in decreasing population exposures over time. (2) Despite the numerous successes in childhood lead poisoning prevention, lead exposure remains a "wicked problem," denoting its complex nature and resistance to resolution. (3)

Recent estimates indicate that over 250,000 U.S. children 1-5 years of age have blood lead levels (BLLs) [greater than or equal to]5 [micro]g/dL (4) and 2.5% of U.S. children 1-5 years of age have BLLs [greater than or equal to]3.5 [micro]g/dL, the recently updated Centers for Disease Control and Prevention (CDC) blood lead reference value in children. (5) These estimates do not include older or younger children, occupationally exposed adults who can bring lead hazards home, or the approximately 500,000 women of childbearing age with BLLs [greater than or equal to]5 [micro]g/dL who could pass lead to the developing child during pregnancy and breastfeeding. (6) Meanwhile, the evidence has mounted for adverse health effects at lower exposure levels, and it is now recognized that there is no safe BLL for children. (7)

Childhood lead exposure is associated with well-established risk factors at the population level, including race/ethnicity, low socioeconomic status, and housing age. (4,8-12) However, these risk factors are not uniformly or consistently distributed across the United States, and significant inequities in lead exposure sources and pathways exist. (13) According to the Federal Lead Action Plan, identifying children and communities at increased risk of lead exposure is an important priority for local, state, and federal health agencies, as well as for health care providers and families with young children. (14)

Xue et al. (15) present "a systematic approach to help identify high lead exposure locations" using state-based childhood blood lead surveillance data collected over an 11-year period (2006-2016) by the Michigan Department of Health and Human Services (MDHHS). The authors identified census tracts where children were identified with elevated BLLs (EBLLs) of [greater than or equal to]3.5, [greater than or equal to]5, or [greater than or equal to]10 [micro]g/dL. "High %EBLL locations" were defined as "%EBLL exceedance rate" (the number of children tested in the census tract with EBLL divided by the total number of children tested in the census tract times 100) and as "population-adjusted %EBLL" (the number of children tested in the census tract with EBLL divided by the total population in the census tract times 100). Two statistical methods for identifying small geographic areas where children are at increased risk for lead exposure ("hot-spots") were used: those locations with %EBLLs in the highest 20th percentile and those locations that were clustered statistically. The authors then compared the hotspot locations identified by these two methods to a) each other, b) annual state BLL reports, and c) three existing lead...

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Gale Document Number: GALE|A712308610