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Egan KB, Dignam T, Brown MJ, Bayleyegn T, Blanton C. Using Small Area Prevalence Survey Methods to Conduct Blood Lead Assessments among Children. Int J Environ Res Public Health 2022; 19:ijerph19106151. [PMID: 35627688 PMCID: PMC9141915 DOI: 10.3390/ijerph19106151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 12/04/2022]
Abstract
Introduction: Prevalence surveys conducted in geographically small areas such as towns, zip codes, neighborhoods or census tracts are a valuable tool for estimating the extent to which environmental risks contribute to children’s blood lead levels (BLLs). Population-based, cross-sectional small area prevalence surveys assessing BLLs can be used to establish a baseline lead exposure prevalence for a specific geographic region. Materials and Methods: The required statistical methods, biological and environmental sampling, supportive data, and fieldwork considerations necessary for public health organizations to rapidly conduct child blood lead prevalence surveys at low cost using small area, cluster sampling methodology are described. Results: Comprehensive small area prevalence surveys include partner identification, background data collection, review of the assessment area, resource availability determinations, sample size calculations, obtaining the consent of survey participants, survey administration, blood lead analysis, environmental sampling, educational outreach, follow-up and referral, data entry/analysis, and report production. Discussion: Survey results can be used to estimate the geographic distribution of elevated BLLs and to investigate inequitable lead exposures and risk factors of interest. Conclusions: Public health officials who wish to assess child and household-level blood lead data can quickly apply the data collection methodologies using this standardized protocol here to target resources and obtain assistance with these complex procedures. The standardized methods allow for comparisons across geographic areas and over time.
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Affiliation(s)
- Kathryn B. Egan
- Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA;
- Office of Community Health and Hazard Assessment, Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
- Correspondence: ; Tel.: +404-718-5778
| | - Timothy Dignam
- Office of the Director, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA;
| | - Mary Jean Brown
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
| | - Tesfaye Bayleyegn
- Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA;
| | - Curtis Blanton
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA;
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Dignam T, Kaufmann RB, LeStourgeon L, Brown MJ. Control of Lead Sources in the United States, 1970-2017: Public Health Progress and Current Challenges to Eliminating Lead Exposure. J Public Health Manag Pract 2020; 25 Suppl 1, Lead Poisoning Prevention:S13-S22. [PMID: 30507765 PMCID: PMC6522252 DOI: 10.1097/phh.0000000000000889] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
CONTEXT During the past 45 years, exposure to lead has declined dramatically in the United States. This sustained decline is measured by blood and environmental lead levels and achieved through control of lead sources, emission reductions, federal regulations, and applied public health efforts. OBJECTIVE Explore regulatory factors that contributed to the decrease in exposure to lead among the US population since 1970. DESIGN/SETTING We present historical information about the control of lead sources and the reduction of emissions through regulatory and selected applied public health efforts, which have contributed to decreases in lead exposure in the United States. Sources of lead exposure, exposure pathways, blood lead measurements, and special populations at risk are described. RESULTS From 1976-1980 to 2015-2016, the geometric mean blood lead level (BLL) of the US population aged 1 to 74 years dropped from 12.8 to 0.82 μg/dL, a decline of 93.6%. Yet, an estimated 500 000 children aged 1 to 5 years have BLLs at or above the blood lead reference value of 5 μg/dL established by the Centers for Disease Control and Prevention. Low levels of exposure can lead to adverse health effects. There is no safe level of lead exposure, and child BLLs less than 10 μg/dL are known to adversely affect IQ and behavior. When the exposure source is known, approximately 95% of BLLs of 25 μg/dL or higher are work-related among US adults. Despite much progress in reducing exposure to lead in the United States, there are challenges to eliminating exposure. CONCLUSIONS There are future challenges, particularly from the inequitable distribution of lead hazards among some communities. Maintaining federal, state, and local capacity to identify and respond to populations at high risk can help eliminate lead exposure as a public health problem. The results of this review show that the use of strong evidence-based programs and practices, as well as regulatory authority, can help control or eliminate lead hazards before children and adults are exposed.
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Affiliation(s)
- Timothy Dignam
- Lead Poisoning Prevention and Environmental Health Tracking Branch (Dr Dignam) and National Center for Chronic Disease Prevention and Health Promotion (Dr Kaufmann), Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia (Ms LeStourgeon); and Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Cambridge, Massachusetts (Dr Brown)
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Abstract
In 2017, Puerto Rico sustained extensive damage from Hurricane Maria, increasing the risk of fires and carbon monoxide (CO) poisonings. Using a population-based, in-person survey of households with children less than 6 years old in Puerto Rico, we collected data in 2010 concerning the presence of smoke alarms and CO alarms in these households. We generated national estimates by extrapolating the number of households in each stratum using data from the 2010 Census. We determined which household characteristics predicted the presence of these alarms. Of 355 households analyzed, 31% had functional smoke alarms, or an estimated 109,773 households territory wide. The presence of smoke alarms was associated with living in multifamily housing and no child in the household receiving government medical insurance. Public housing or publicly subsidized housing, as compared to owner-occupied housing and unsubsidized rental housing, was associated with having a functional smoke alarm in households with children aged less than 6 years. Based on only six houses having CO alarms, we estimated only 7685 (2%) households had CO alarms. The low prevalence of functional smoke or CO alarms 7 years before Hurricane Maria is unfortunate and should be remedied by ensuring that such alarms are widely installed in current rebuilding activities.
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Affiliation(s)
- Jessica Chen
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Timothy Dignam
- Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, Atlanta, GA, 30341, USA.
| | - Fuyuen Yip
- Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, Atlanta, GA, 30341, USA
| | - Brenda Rivera García
- Office of Epidemiology and Research, Puerto Rico Department of Health, San Juan, PR, USA
| | - Curtis Blanton
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mary Jean Brown
- Division of Emergency and Environmental Health Services, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kanta Sircar
- Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, Atlanta, GA, 30341, USA
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Dai D, Neal FB, Diem J, Deocampo DM, Stauber C, Dignam T. Confluent impact of housing and geology on indoor radon concentrations in Atlanta, Georgia, United States. Sci Total Environ 2019; 668:500-511. [PMID: 30852225 PMCID: PMC6456363 DOI: 10.1016/j.scitotenv.2019.02.257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/10/2019] [Accepted: 02/16/2019] [Indexed: 05/03/2023]
Abstract
Radon is a naturally released radioactive carcinogenic gas. To estimate radon exposure, studies have examined various risk factors, but limited information exists pertaining to the confluent impact of housing characteristics and geology. This study evaluated the efficacy of housing and geological characteristics to predict radon risk in DeKalb County, Georgia, USA. Four major types of data were used: (1) three databases of indoor radon concentrations (n = 6757); (2) geologic maps of rock types and fault zones; (3) a database of 402 in situ measurements of gamma emissions, and (4) two databases of housing characteristics. The Getis-Ord method was used to delineate hot spots of radon concentrations. Empirical Bayesian Kriging was used to predict gamma radiation at each radon test site. Chi-square tests, bivariate correlation coefficients, and logistic regression were used to examine the impact of geological and housing factors on radon. The results showed that indoor radon levels were more likely to exceed the action level-4 pCi/L (148 Bq/m3) designated by the U.S. Environmental Protection Agency-in fault zones, were significantly positively correlated to gamma readings, but significantly negatively related to the presence of a crawlspace foundation and its combination with a slab. The findings suggest that fault mapping and in situ gamma ray measurements, coupled with analysis of foundation types and delineation of hot spots, may be used to prioritize areas for radon screening.
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Affiliation(s)
- Dajun Dai
- Department of Geosciences, Georgia State University, 38 Peachtree Center Avenue, Atlanta, GA 30303, United States of America.
| | - Fredrick B Neal
- Department of Geosciences, Georgia State University, 38 Peachtree Center Avenue, Atlanta, GA 30303, United States of America; Critigen LLC, 7555 East Hampden Avenue, Suite 415, Denver, CO 80231, United States of America
| | - Jeremy Diem
- Department of Geosciences, Georgia State University, 38 Peachtree Center Avenue, Atlanta, GA 30303, United States of America
| | - Daniel M Deocampo
- Department of Geosciences, Georgia State University, 38 Peachtree Center Avenue, Atlanta, GA 30303, United States of America
| | - Christine Stauber
- School of Public Health, Georgia State University, 140 Decatur Street, Atlanta, GA 30303, United States of America
| | - Timothy Dignam
- Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, 30341, United States of America
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Prihartono NA, Djuwita R, Mahmud PB, Haryanto B, Helda H, Wahyono TYM, Dignam T. Prevalence of Blood Lead among Children Living in Battery Recycling Communities in Greater Jakarta, Indonesia. Int J Environ Res Public Health 2019; 16:E1276. [PMID: 30974753 PMCID: PMC6480953 DOI: 10.3390/ijerph16071276] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/04/2019] [Accepted: 04/07/2019] [Indexed: 11/16/2022]
Abstract
This study aimed to assess the prevalence of blood lead levels (BLLs) among children 1 to 5 years old who reside near and distant to informally used lead-acid battery (ULAB) recycling locations and examine risk factors for elevated BLLs. A cross-sectional study was conducted in three greater Jakarta neighborhoods where informal ULAB recycling occurs. Venous BLLs among 279 children were analyzed using portable blood lead testing machines. Demographic, child activities, and sources of lead exposure inside and outside homes were assessed. Multivariate analysis was performed to evaluate factors associated with the prevalence of BLLs. Forty-seven percent of children had BLLs ≥ 5 µg/dL and 9% had BLLs ≥ 10 µg/dL. No differences in geometric mean BLLs were observed between children who lived near and distant to ULAB locations. Older child age groups [Prevalence Ratio (PR) 2.14, 95% Confidence Interval (CI) 1.16, 4.18) and low household income (PR 1.58, 95% CI 1.03, 2.40) were associated with BLLs 5-9 µg/dL. Low educational attainment of the child's father (PR 3.17, 95% CI 1.23, 8.16) and frequent outdoor child activity (PR 4.93, 95% CI 1.09, 22.21) were predictors of BLLs ≥ 10 µg/dL. This study shows the association between lead exposure among children and environmental sources. Public health officials can consider expanded surveillance, health care provider education, and development of strategies to reduce lead exposure.
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Affiliation(s)
- Nurhayati A Prihartono
- Department of Epidemiology, Faculty of Public Health, Universitas of Indonesia, Depok 16424, Indonesia.
| | - Ratna Djuwita
- Department of Epidemiology, Faculty of Public Health, Universitas of Indonesia, Depok 16424, Indonesia.
| | - Putri B Mahmud
- Department of Epidemiology, Faculty of Public Health, Universitas of Indonesia, Depok 16424, Indonesia.
| | - Budi Haryanto
- Department of Environmental Health, Faculty of Public Health, Universitas of Indonesia, Depok 16424, Indonesia.
| | - Helda Helda
- Department of Epidemiology, Faculty of Public Health, Universitas of Indonesia, Depok 16424, Indonesia.
| | - Tri Yunis Miko Wahyono
- Department of Epidemiology, Faculty of Public Health, Universitas of Indonesia, Depok 16424, Indonesia.
| | - Timothy Dignam
- Division of Environmental Health Science and Practice, National Center for Environmental Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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Kennedy C, Yard E, Dignam T, Buchanan S, Condon S, Brown MJ, Raymond J, Rogers HS, Sarisky J, de Castro R, Arias I, Breysse P. Blood Lead Levels Among Children Aged <6 Years - Flint, Michigan, 2013-2016. MMWR Morb Mortal Wkly Rep 2016; 65:650-4. [PMID: 27359350 DOI: 10.15585/mmwr.mm6525e1] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
During April 25, 2014-October 15, 2015, approximately 99,000 residents of Flint, Michigan, were affected by changes in drinking water quality after their water source was switched from the Detroit Water Authority (DWA), sourced from Lake Huron, to the Flint Water System (FWS), sourced from the Flint River.* Because corrosion control was not used at the FWS water treatment plant, the levels of lead in Flint tap water increased over time. Adverse health effects are associated with lead exposure (1). On January 2, 2015, a water advisory was issued because of detection of high levels of trihalomethanes, byproducts of disinfectants.(†)(,)(§) Studies conducted by local and national investigators detected an increase in the prevalence of blood lead levels (BLLs) ≥5 µg/dL (the CDC reference level) among children aged <5 years living in Flint (2) and an increase in water lead levels after the water source switch (3). On October 16, 2015, the Flint water source was switched back to DWA, and residents were instructed to use filtered tap water for cooking and drinking. During that time, pregnant and breastfeeding women and children aged <6 years were advised to consume bottled water.(¶) To assess the impact on BLLs of consuming contaminated drinking water, CDC examined the distribution of BLLs ≥5 µg/dL among children aged <6 years before, during, and after the switch in water source. This analysis enabled determination of whether the odds of having BLLs ≥5 µg/dL before the switch differed from the odds during the switch to FWS (before and after the January 2, 2015, water advisory was issued), and after the switch back to DWA. Overall, among 9,422 blood lead tests in children aged <6 years, 284 (3.0%) BLLs were ≥5 µg/dL during April 25, 2013-March 16, 2016. The adjusted probability of having BLLs ≥5 µg/dL was 46% higher during the period after the switch from DWA to FWS (and before the January 2, 2015, water advisory) than during the period before the water switch to FWS. Although unrelated to lead in the water, the water advisory likely reduced tap water consumption and increased consumption of bottled water. Characterizing exposure to lead contaminated drinking water among children aged <6 years living in Flint can help guide appropriate interventions.
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Brown MJ, McWeeney G, Kim R, Tahirukaj A, Bulat P, Syla S, Savic Z, Amitai Y, Dignam T, Kaluski DN. Lead poisoning among internally displaced Roma, Ashkali and Egyptian children in the United Nations-Administered Province of Kosovo. Eur J Public Health 2009; 20:288-92. [PMID: 19897587 DOI: 10.1093/eurpub/ckp164] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This study assessed the association between lead poisoning prevention activities and blood lead levels (BLLs) among children living in lead-contaminated camps for internally displaced persons in the United Nations-Administered Province of Kosovo. METHODS We conducted a population-based study to examine the relationship among geometric mean BLLs in children (i) born before any lead poisoning prevention activities were instituted, (ii) born when specific interim interventions were instituted and (iii) born after relocation and medical therapy were available. The study population consisted of 145 of the 186 children born in the camps between December 1999 and July 2007. RESULTS Lower mean BLLs were found in children born following implementation of the interventions as compared with the children born before the interventions. However, this decrease in mean BLLs was attenuated in children born into families suspected of informal lead smelting. CONCLUSION Despite lower BLLs following interventions, children living in these camps have BLLs that remain unacceptably high. Further efforts are urgently needed to control or eliminate lead exposure in this population. Continued blood lead monitoring of the population is also warranted.
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Affiliation(s)
- Mary Jean Brown
- Lead Poisoning Prevention Branch, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30348, USA.
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Plotinsky RN, Straetemans M, Wong LY, Brown MJ, Dignam T, Dana Flanders W, Tehan M, Azziz-Baumgartner E, Dipentima R, Talbot EA. Risk factors for elevated blood lead levels among African refugee children in New Hampshire, 2004. Environ Res 2008; 108:404-412. [PMID: 18834979 DOI: 10.1016/j.envres.2008.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Revised: 07/29/2008] [Accepted: 08/01/2008] [Indexed: 05/26/2023]
Abstract
OBJECTIVES Surveillance blood lead screening of refugee children resettled in Manchester, NH, in 2004 revealed that 39 (42%) of 92 children had elevated levels (>or=10 microg/dL) after resettlement. Furthermore, 27/92 children (29%) had nonelevated screening blood lead levels on arrival (BLL1) but had elevated follow-up blood lead levels 3-6 months after settlement (BLL2). The main objective was to identify risk factors for increasing lead levels among refugee children after resettlement in Manchester in 2004. PATIENTS AND METHODS We conducted a cohort study, with completion of household interviews and home assessments for refugee families who had resettled in 2004 in Manchester, NH. Blood lead level (BLL) data were abstracted from the New Hampshire (NH) Childhood Lead Poisoning Prevention Program. To assess acute and chronic malnutrition among refugees, we used anthropometric data from International Organization of Migration documents to calculate nutritional indices. RESULTS AND DISCUSSION Of the 93 African refugee children in 42 families who participated, 60 (65%) had been born in a refugee camp. Median age was 5.5 years at the time of BLL2 measurement. Thirty-six (39%) of the refugee children had BLL2 >or= 10 microg/dL. Liberians and those born in refugee camps had higher geometric mean BLL2 than those not Liberian or not born in camps. Younger children and children with nutritional wasting before immigrating to the United States had a greater increase in geometric mean from BLL1 to BLL2, compared to older children and those without nutritional wasting. Follow-up blood lead testing of refugee children, particularly those resettled in areas with older housing stock, as in Manchester, is important for identifying lead exposure occurring after resettlement. Increased attention to improve nutritional status of children in refugee camps and after arrival in the United States and awareness of children who were born in refugee camps should be incorporated into lead-poisoning prevention strategies.
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Affiliation(s)
- Rachel N Plotinsky
- Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Albalak R, McElroy RH, Noonan G, Buchanan S, Jones RL, Flanders WD, Gotway-Crawford C, Kim D, Dignam T, Daley WR, Jarrett J, Eduardo E, McGeehin MA. Blood lead levels and risk factors for lead poisoning among children in a Mexican smelting community. Arch Environ Health 2003; 58:172-83. [PMID: 14535578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
The authors evaluated mean blood lead levels (BLLs) and the prevalence of elevated BLLs in children 1-6 yr of age living in Torreón, Mexico, and assessed risk factors for lead exposure in these children. The study involved a simple random sample of households in the area around a local smelter, as well as a 2-stage cluster sample of neighborhoods and households in the remainder of Torreón. The geometric mean BLL of children in this study (N = 367) was 6.0 microg/dl (95% confidence interval [CI] = 5.2, 6.8) (0.29 microM/l [95% CI = 0.25, 0.33]). Twenty percent of the children had BLLs > or = 10 microg/dl (0.48 microM/l), and 5% had BLLs > or = 20 microg/dl (0.97 microM/l). In multivariate analyses, distance from the smelter, amount of income, and education level of the primary caregiver predicted BLLs. In the environmental risk factor subsample (n = 124), dust and soil lead levels were associated with BLLs and distance from the smelter. BLLs in this study were moderately high, but the levels were lower than those in other smelting communities prior to remediation.
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Affiliation(s)
- Rachel Albalak
- Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
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