Screening housing to prevent lead toxicity in children.
OBJECTIVE
Screening children to identify those with blood lead levels > or = 10 microg/dl fails to protect children from lead-associated cognitive deficits and behavioral problems. To broaden our efforts at primary prevention, screening criteria are needed to identify lead-contaminated housing before children are unduly exposed. The purpose of this study was to identify and validate housing characteristics associated with children having elevated blood lead levels (> or = 10 microg/dl).


METHODS
Two existing studies were used to examine housing characteristics linked with undue lead exposure: a cross-sectional study of 205 children aged 12 to 31 months, and a random sample from a longitudinal study of 276 children followed from 6 to 24 months of age. Logistic regression analysis was conducted to examine the association of children's blood lead levels > or = 10 microg/dl.


RESULTS
The mean age of the 481 children was 17.8 months; 99 (20.6%) had a blood lead concentration of 10 microg/dl or higher. The following characteristics were associated with blood lead concentration > or = 10 microg/dl: floor lead loading > 15 microg/ft2 (odds ratio [OR]=2.2; 95% confidence interval [CI] 1.3, 3.8); rental housing (OR=3.2; 95% CI 1.3, 7.6); poor housing condition (OR=2.1; CI 1.2, 3.6); African American race (OR=3.3; CI 1.9, 6.1); paint chip ingestion (OR=5.8; CI 1.3, 26.5); and soil ingestion (OR=2.2; CI 1.1, 4.2). Housing characteristics including rental status, lead-contaminated floor dust, and housing condition had a range of sensitivity from 47% to 92%; specificity from 28% to 76%; a positive predictive value from 25% to 34%; and a negative predictive value of 85% to 93%.


CONCLUSIONS
Housing characteristics and floor dust lead levels can be used to screen housing to identify lead hazards prior to occupancy, before purchasing a home, or after renovation to prevent children's exposure to lead hazards.
Lanphear
Bruce P
BP
Cincinnati Children's Environmental Health Center, Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA. bruce.lanphear@chmcc.org
Hornung
Richard
R
Ho
Mona
M
D002669:Child Welfare; D002675:Child, Preschool; D004391:Dust / Q000032:analysis; D005191:Family Characteristics; D005260:Female; D005430:Floors and Floorcoverings; D006798:Housing / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007854:Lead / Q000097:blood*; D007855:Lead Poisoning / Q000175:diagnosis* / Q000208:ethnology / Q000209:etiology; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008403:Mass Screening; D009518:New York; D010150:Paint / Q000633:toxicity; D012307:Risk Factors; D012989:Soil Pollutants / Q000633:toxicity
D004391:Dust; D012989:Soil Pollutants; D007854:Lead