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Assessment of Child Lead Exposure in a Philadelphia Community, 2014

Dignam, Timothy, PhD, MPH; Pomales, Ana, MS; Werner, Lora, MPH; Newbern, E. Claire, PhD, MPH; Hodge, James, JD, MPH; Nielsen, Jay, MPA, BSEH; Grober, Aaron, MPH; Scruton, Karen, MS; Young, Rand, MA; Kelly, Jack, MS; Brown, Mary Jean, ScD, RN

Journal of Public Health Management and Practice: January/February 2019 - Volume 25 - Issue 1 - p 53–61
doi: 10.1097/PHH.0000000000000711
Research Reports: Research Full Report

Introduction: Several urban neighborhoods in Philadelphia, Pennsylvania, have a history of soil, household lead paint, and potential lead-emitting industry contamination.

Objectives: To (1) describe blood lead levels (BLLs) in target neighborhoods, (2) identify risk factors and sources of lead exposure, (3) describe household environmental lead levels, and (4) compare results with existing data.

Methods: A simple, random, cross-sectional sampling strategy was used to enroll children 8 years or younger living in selected Philadelphia neighborhoods with a history of lead-emitting industry during July 2014. Geometric mean of child BLLs and prevalence of BLLs of 5 μg/dL or more were calculated. Linear and logistic regression analyses were used to ascertain risk factors for elevated BLLs.

Results: Among 104 children tested for blood lead, 13 (12.4%; 95% confidence interval [CI], 7.5-20.2) had BLLs of 5 μg/dL or more. The geometric mean BLL was 2.0 μg/dL (95% CI, 1.7-2.3 μg/dL). Higher geometric mean BLLs were significantly associated with front door entryway dust lead content, residence built prior to 1900, and a child currently or ever receiving Medicaid. Seventy-one percent of households exceeded the screening level for soil, 25% had an elevated front door floor dust lead level, 28% had an elevated child play area floor dust lead level, and 14% had an elevated interior window dust lead level. Children in households with 2 to 3 elevated environmental lead samples were more likely to have BLLs of 5 μg/dL or more. A spatial relationship between household proximity to historic lead-emitting facilities and child BLL was not identified.

Conclusion: Entryway floor dust lead levels were strongly associated with blood lead levels in participants. Results underscore the importance to make housing lead safe by addressing all lead hazards in and around the home. Reduction of child lead exposure is crucial, and continued blood lead surveillance, testing, and inspection of homes of children with BLLs of 5 μg/dL or more to identify and control lead sources are recommended. Pediatric health care providers can be especially vigilant screening Medicaid-eligible/enrolled children and children living in very old housing.

Divisions of Environmental Hazards and Health Effects (Dr Dignam) and Emergency and Environmental Health Services (Messrs Hodge and Nielsen and Dr Brown), National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Region 3 (Mss Pomales and Werner), Division of Community Health Investigations (Mr Grober and Ms Scruton), and Division of Toxicology and Human Health Studies (Mr Young), Agency for Toxic Substances and Disease Registry, Atlanta, Georgia; Philadelphia Department of Public Health, Philadelphia, Pennsylvania (Dr Newbern); and Region 3, Environmental Protection Agency, Philadelphia, Pennsylvania (Mr Kelly).

Correspondence: Timothy Dignam, PhD, MPH, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, Mailstop F-60, Atlanta, GA 30341 (

The authors acknowledge the following persons for their contributions in planning and conducting this study. Without all of their effort, this endeavor would not have been possible: Kevin Chatham-Stevens, Rebecca D. Merrill, Oluwatosin Olaiya, Palak Raval-Nelson, Paulette Smith, Jennifer Van Skiver, Martha Stefaniak, Kimberly Brinker, Natasha Bagwe, Jonathan Cruz, Kerry Buchs, and Weston Solution Inc staff.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry or the Environmental Protection Agency.

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