2014 Childhood Blood Lead Research Study Philadelphia PA National Center for Environmental Health Agency for Toxic Substances & Disease Registry U.S. Environmental Protection Agency Philadelphia Department of Public Health Community Meeting: The Urban Worship Center 17 September 2015 National Center for Environmental Health Division of Emergency and Environmental Health Services Historical lead emitting industry in Philadelphia, Pennsylvania USA TODAY December 2012 Map: Nations Online Project, Wikimedia Commons Historical lead emitting industry in Phildelphia, ?5 . 43'? :i V52: ?r c? f??g?gw [n 9) JT Lewis Community Site Child Blood Lead Study Epi Aid 2014-0064  Collaboration • • • • • •  National Center for Environmental Health (NCEH) Agency for Toxic Substances and Disease Registry (ATSDR) Environmental Protection Agency (EPA) Philadelphia Department of Public Health Pennsylvania Department of Health Epidemic Intelligence Service Program To determine blood lead levels and identify risk factors for elevated lead status among children 9 to 71 months of age living around the John T Lewis site Environmental Sources of Childhood Lead Exposure ?1 II. 4' LEADIN . no tam-51c n-c Lag ah?? PIPES .gL I v3 73' 1 7/3 l'l LEAD .?ring, ll" W7 (a My: Where do lead hazards come from? • Most lead hazards come from lead paint chips that have been ground into tiny bits • These tiny bits of lead become part of the dust and soil in and around our homes. Child enrollment • • • Residences randomly selected up to 2.7 km from John T Lewis site Field work conducted from July 15 to 31, 2014 Eligibility criteria:  Child 9 to 71 mo with a consenting legal guardian present  Child lived in residence at least 3 days a week for at least 6 months Data collection and result dissemination Legal guardian questionnaires:  Household  Healthy homes  Child  Environmental Data collection and result dissemination Legal guardian questionnaires:  Household  Healthy homes  Child  Environmental Child:  Venous blood Data collection and result dissemination Legal guardian questionnaires:  Household  Healthy homes  Child  Environmental Child:  Venous blood Household:  Tap water  Dust on window sill near child’s bed  Dust from play area  Dust near front door  Soil where child plays Data collection and result dissemination Legal guardian questionnaires:  Household  Healthy homes  Child  Environmental • • Child:  Venous blood Household:  Tap water  Dust on window sill near child’s bed  Dust from play area  Dust near front door  Soil where child plays Participants informed of sample results Philadelphia Department of Public Health followed-up with children based on established protocol Participants Children 9 through 71 months enrolled n=151 from 105 households Refused blood sample collection, n=53 Missing information, n=3 Children 9 through 71 months with available BLL data n=95 from 66 households Blood Lead Level (BLL) results  Blood lead results of 126 children included in the study • Maximum blood lead results was 11 ug/dL • Mean blood lead result was 1.96 ug/dL  CDC/ATSDR uses a reference value of 5 µg/dL to identify children with an elevated blood lead result. • Approximately 11% of children from the study had a blood lead result of 5 µg/dL or above. • At the national level, approximately 2.5% children have a blood lead level equal to or above 5 µg/dL. Soil Results   Soil samples were collected from child’s play area Levels of lead in soil were considered elevated if above 400 parts per million (ppm) Number of Number of elevated samples soil lead results Minimum and maximum concentrations detected Mean 72 40 – 7,700 ppm 774 ppm 51 (71%) *Elevated soil and dust wipe sample results are defined as results exceeding EPA’s standards under the Lead Renovation, Repair and Painting rule Dust Wipes Results   Dust wipe samples were collected from the floor in the house entryway, the floor in child’s play area and window sill. Lead dust wipe results were considered elevated if above 40 micrograms per square foot (µg/ft2) on child play area or if above 250 μg/ft2 on window sills Sample location Number of samples Number of elevated dust wipe results (%) minimum and maximum levels detected Mean Dust Floor (Front Door) 119 26 (22%) Non-detect – 2,300 µg/ft² 56 µg/ft² Dust Floor (Child Play Area) 116 21 (18%) Non-detect – 630 µg/ft² 33 µg/ft² Dust Window (Child Room) 106 13 (12%) Non-detect – 18,000 µg/ft² 356 µg/ft² Drinking Water Results   Tap water samples were collected from the kitchen sink spigot in each participating household. EPA’s action level for lead in public drinking water (15 micrograms per liter (μg/L)) was used to assess the water sample results. Number of samples Number of elevated water sample results 120 0 Minimum and maximum concentrations detected Mean Non-detect – 3.9 µg/L N/A Public health significance    We found a 13.7% prevalence of elevated BLLs among children 9 to 71 months of age living around the John T Lewis site Elevated lead in environmental samples increase odds of elevated BLL Providers and parents of children less than 6 years old should make sure the children are tested for BLL regularly Spatial distribution of BLLs above the reference value BLL: <5 µg/dL ≥5 µg/dL Map: Randall Young, CDC GRASP Public health significance  Older housing is associated with higher blood lead levels in children in the study. The highest blood lead levels in children in the study area are seen with children living in pre-1900 housing. # of Homes Housing Age <1900 1900-1919 1920-1939 1940-1959 >1959 Total: Mean BLL 42 25 87 7 2.83 2.16 2.57 1.15 Median BLL 2.85 2.02 1.73 1.1 7 1.86 2 168 Public health significance  Higher levels of lead in soils are associated with higher blood lead levels in children  When categorizing distance from the former JT Lewis site into natural quartiles, we do not see a relationship between blood lead levels in children in the study and where they live relative to the former site; however, we are continuing to study this further in different ways  Having a single elevated dust result is not associated with higher children’s blood lead levels Fish 0 Lt Girard Ave '2 49 /?epK Miles Blood-lead Visualization Lowest BL measurement 0 micrograms per deciliter 5 micrograms per deciliter 11 micrograms per deciliter Highest BL measurement This map uses a kernel density method to visualize106 blood-lead measurements taken during the study. Measurements that were geographically near each other were aggregated and smoothed. or? 51mm? b. ?is. [Znahzt {?Moore Ave 4- . 5:4 .- Age of house I Pre-1950 ?Soil lead samples . 1950 - 1978 Girard Ave i ?we a? PPM A Post- 1978 i . . - I le??a 40 99 Blood-lead Visualization Lowest BL measurement 100 399 0 micrograms per deciliter 4 4-. 0400-999 I 5 micrograms per deciliter a 1? a ,3 ?1000 - 2499 1 I 11 micrograms per deciliter 2500 - 7700 Highest BL measurement This map uses a kernel density method to visualize106 blood-lead measurements taken during the study. Measurements 3 that were geographically near each other Miles were aggregated and smoothed. ?nick I. ?4 ?I'm Strengths and limitations  Strengths • Population • Environmental and blood samples collected at same time • Applied a formal sample strategy to cover an important area around the site  Limitations • Utilized incomplete tax assessor data during randomized selection of residential plots • Not powered to look at all outcomes of interest • Not able to assess possible differences between children who did and did not participate in the study. No safe level of lead exposure      Lead exposure can result in physical, cognitive and neurobehavioral consequences1 No known safe blood lead level1 Contributes to 600 000 new cases of children with intellectual disabilities every year2 Children are more sensitive to health effects3 Most important exposure sources in US occur in residential environment3 1 ACCLPP 2012 2 WHO 2013, Bouftini 2014 (Morocco), Dabrera 2015 (London), Kennedy 2014 (USA), Caravanos 2014 (Zambia), Ajumobi 2014 (Nigeria) 3 ATSDR 2007 .Individuals with an IQ score between 50-70 are classilied as moderately retarded IQ Score Individuals with an IQ score betwe?m 125-14 a 9 class ?Ie av qr ?ed Highly nih v? 150 175 ?Normal Distribution ?Shift in Average of 5 IO points Shift in Average of 10 IQ points gnu}, ll "b mg Percentage of Children with Blood Lead Levels Above 10 pg/dL, 2003-2012, Philadelphia, PA Elevated lead levels per 1,000 child rm years 15.? 15.5 16': 2009 3010 1011 r\ {m ?a Philadelphia Lead Screening and Lead Poisoning of Children Children Screened At least One Time for Blood Lead, Philadelphia, PA (≤ 6 years of age)* Calendar Year Children Tested, # Census Population Tested, % 2010 89,500 74.8 2011 94,868 79.3 2012 98,889 82.7 *Testing and child age as of December 31 for year shown. Includes tests performed in previous years (PA NEDSS 4/11/14) Children with confirmed blood lead levels ≥ 10 µg/dL, Philadelphia, PA (≤ 6 yrs) Calendar Year 2010 2011 2012 2013 Children, # 981 648 601 552 Children Tested, % 6.2 3.9 2.9 2.9 Next Steps PDPH and CDC/ATSDR will continue to  Help residents understand the health risks associated with lead and the steps they can take to protect themselves  Provide scientific assistance to EPA and the local and state health departments to further evaluate the results from this study  Work with health care providers to make sure young children living near the site routinely have blood lead tests  Provide healthy homes referral services to eligible families PDPH follows up on all children in the City with elevated blood lead results Next Steps EPA will continue to  Conduct experiments to identify how much of the lead found in soil has the potential to be absorbed once it is inside the body. • This will allow scientists to better assess the potential impact of people’s exposure to lead in soil.  Partner with health agencies and community organizations in outreach activities For more information please contact: Ana Pomales, ATSDR, Region III (located in Philadelphia) 215-814-5716 or APomales@cdc.gov Palak Raval-Nelson, Philadelphia Department of Public Health at 215-685-7489 or Palak.Raval-Nelson@phila.gov Disclaimer: The findings and conclusions in this presentation are those of the author(s) and do not necessarily represent the views of the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry. National Center for Environmental Health Division of Emergency and Environmental Health Services