Pathways and sources of lead exposure: Michigan Children's Lead Determination (the MI CHILD study).

There has been little research on childhood lead exposure pathways since the 1990s. New data from Michigan in 2017-2021 for 429 children in 345 homes included lead in blood, paint, dust, soil, water, and other housing, demographic, and behavioral metrics. Fifty-three percent of these children had blood lead (BPb) ≥5 µg/dL. A repeated measures pathway model that accounted for multiple children in the same home was constructed using weighted least squares mean estimation and included variance-covariance model multiple imputation. Results showed that children's BPb was directly predicted by lead in settled floor house dust, child's age, season, and mouthing behavior and indirectly predicted by window sill and trough dust lead (DPb), bare soil lead (SPb), proportion of floors with carpets, and exterior building deteriorations. Paint lead (PPb) was also an indirect predictor of BPb through the soil and settled dust pathways. Water lead (WPb), water consumption and other lead sources/pathways were not significant predictors of BPb in this cohort. Although risk factors for individual children are highly variable and worthy of investigation to pinpoint their exposures, this study shows that the main direct and indirect pathways of lead exposure for most children in older housing remain paint and the contaminated dust and soil it generates. Pathway analyses in other jurisdictions using current data should be performed to confirm these results. This study suggests both DPb and BPb in high-risk homes may have declined since the 1990s and that lead in dust, soil, and paint all should be measured to predict risk and target remediation. Because most homes still have not been assessed for lead hazards and remediated, too many children remain at needless risk.

Evaluating and Assessing Radon Testing in Multifamily Housing.

CONTEXT: To determine if radon mitigation is needed to protect occupants of multifamily housing, reliable testing procedures are needed. Yet, protocols on how many ground-contact housing units must be tested vary from 10% to 25% to 100%. OBJECTIVES: To estimate the probability of failing to identify a building containing at least one unit with elevated radon level when all ground-contact units are not tested. DESIGN: Retrospective analysis of previously collected data from licensed (ie, certified) radon measurement professionals using hypergeometric and Monte Carlo statistical methods to estimate the confidence that there are no units with radon levels of 4 picoCuries/liter of air (pCi/L) or more based on various testing percentages. SETTING: Testing data were obtained from 29 US states for 7892 ground-contact units in 687 multifamily buildings, primarily 5 to 20 units per building. MAIN OUTCOME MEASURE: Probability of failing to identify elevated radon levels in untested units. RESULTS: About 15% (n = 1163) of the units had radon levels of more than 4 pCi/L (the EPA action level); 59 units had more than 20 pCi/L (maximum of 96 pCi/L). For building sizes of 5 to 20 ground-contact units, the 2018 federal testing protocols that currently require testing of 10% and 25% of ground-contact units in each building failed to identify 47%-69% and 32%-46% of the units, respectively, depending on building size. CONCLUSIONS: Measurement of 90% of the ground-contact units in buildings with 5 to 20 ground-contact units results in up to 4% of the units with elevated radon levels being missed. To achieve 95% confidence that no units in the building have radon levels of 4 pCi/L or more in buildings up to 20 units, 100% sampling is required. For the vast majority of multifamily buildings, all ground-contact units in multifamily buildings should be tested for radon.

Radon and moisture impacts from interventions integrated with housing energy retrofits.

Energy retrofits can reduce air exchange, raising the concern of whether indoor radon and moisture levels could increase. This pre/post-intervention study explored whether simple radon interventions implemented in conjunction with energy retrofits can prevent increases in radon and moisture levels. Treatment homes (n = 98) were matched with control (no energy retrofits or radon intervention) homes (n = 12). Control homes were matched by geographic location and foundation type. t-tests were used to determine whether post-energy retrofit radon and moisture level changes in treatment homes significantly differed from those in control homes. The radon interventions succeeded in preventing statistically significant increases in first floor radon using arithmetic (p = 0.749) and geometric means (p = 0.120). In basements, arithmetic (p = 0.060) and geometric (p = 0.092) mean radon levels statistically significantly increased, consistent with previous studies which found that basement radon levels may increase even if first floor levels remain unchanged. Changes in infiltration were related to changes in radon (p = 0.057 in basements; p = 0.066 on first floors). Only 58% of the change in infiltration was due to air sealing, with the rest due to weather changes. There was no statistically significant association between air sealing itself and radon levels on the first floor (p = 0.664). Moisture levels also did not significantly increase.

The New York State Healthy Neighborhoods Program: Findings From an Evaluation of a Large-Scale, Multisite, State-Funded Healthy Homes Program.

CONTEXT: A growing evidence base suggests that a comprehensive healthy homes approach may be an effective strategy for improving housing hazards that affect health, but questions remain about the feasibility of large-scale implementation. OBJECTIVE: To evaluate the impact of a large-scale, multisite, state-funded healthy homes program. SETTING: Homes in high-risk neighborhoods of 13 counties funded under the New York State Healthy Neighborhoods Program (NYS HNP) from 2008 to 2012. PARTICIPANTS: A total of 28 491 homes received an initial visit and 6436 dwellings received a revisit (follow-up assessment 3 to 6 months after the intervention). A majority of residents are low-income renters living in buildings built prior to 1950. INTERVENTION: The NYS HNP is a low-intensity healthy homes program. Participating homes undergo a visual assessment to identify potential environmental health and safety hazards, and interventions (education, referrals, and products) are provided to address any hazards identified during the visit. MAIN OUTCOME MEASURES: The proportion of homes affected by several types of housing hazards, improvement in hazards among revisited homes, and the change in the overall number of hazards per home were assessed. RESULTS: Among the homes that were revisited, there were significant improvements in the conditions assessed for tobacco control, fire safety, lead poisoning prevention, indoor air quality, and other hazards (including pests and mold). There was a significant reduction in the number of hazards per home (2.8 to 1.5; P < .001), but homes were not hazard-free at the revisit. CONCLUSION: This evaluation suggests that a comprehensive, low-intensity healthy housing approach can produce short-term impacts with public health significance. This evaluation provides information about hazards that are common, easily assessed, and easily corrected or improved, which may be of use to a variety of programs that already provide in-home services and are seeking to expand the scope of their visits or to inform the development of new programs.

An Evaluation of a State-Funded Healthy Homes Intervention on Asthma Outcomes in Adults and Children.

CONTEXT: Reducing exposure to environmental triggers is a critical part of asthma management. OBJECTIVE: To evaluate the impact of a healthy homes intervention on asthma outcomes and assess the impact of different targeting strategies. SETTING: The New York State (NYS) Healthy Neighborhoods Program (HNP) operates in select communities with a higher burden of housing-related illness and associated risk factors. PARTICIPANTS: Residents with asthma were recruited through 3 mechanisms: door-to-door canvassing (CANVASSED), 752 residents in 457 dwellings; referrals from community partners (REFERRED), 573 residents in 307 dwellings; referrals of Medicaid enrollees with poorly controlled asthma (TARGETED), 140 residents in 140 dwellings. INTERVENTION: The NYS HNP provides visual assessments and low-cost interventions to identify and address asthma triggers and trigger-promoting conditions in the home environment. Conditions are reassessed during a revisit conducted 3 to 6 months after the initial visit. MAIN OUTCOME MEASURE(S): The analysis compares improvements across the 3 groups for measures of asthma self-management, health care access, morbidity, and environmental conditions. An asthma trigger score characterizing the extent of multiple triggers in a dwelling was also calculated. RESULTS: Among 1465 adults and children, there were significant improvements in environmental conditions and self-reported self-management, health care access, and asthma morbidity outcomes for each group. The improvement was greatest in the TARGETED group for most outcomes, but selected measures of self-management and health care access were greater in the other groups. The mean improvement was significantly greater in the TARGETED group. CONCLUSION: Targeting the intervention to people with poorly controlled asthma maximizes improvements in trigger avoidance and asthma morbidity; however, other recruitment strategies are effective for impacting endpoints related to health care access and self-management. This evaluation demonstrates that a low-intensity home-based environmental intervention is effective as well as practical and feasible. Health care payers, state and local health departments, and others should consider investing in these home-based services as part of a comprehensive asthma care package.

A Cost-Benefit Analysis of a State-Funded Healthy Homes Program for Residents With Asthma: Findings From the New York State Healthy Neighborhoods Program.

CONTEXT: Despite considerable evidence that the economic and other benefits of asthma home visits far exceed their cost, few health care payers reimburse or provide coverage for these services. OBJECTIVE: To evaluate the cost and savings of the asthma intervention of a state-funded healthy homes program. DESIGN: Pre- versus postintervention comparisons of asthma outcomes for visits conducted during 2008-2012. SETTING: The New York State Healthy Neighborhoods Program operates in select communities with a higher burden of housing-related illness and associated risk factors. PARTICIPANTS: One thousand households with 550 children and 731 adults with active asthma; 791 households with 448 children and 551 adults with asthma events in the previous year. INTERVENTION: The program provides home environmental assessments and low-cost interventions to address asthma trigger-promoting conditions and asthma self-management. Conditions are reassessed 3 to 6 months after the initial visit. MAIN OUTCOME MEASURES: Program costs and estimated benefits from changes in asthma medication use, visits to the doctor for asthma, emergency department visits, and hospitalizations over a 12-month follow-up period. RESULTS: For the asthma event group, the per person savings for all medical encounters and medications filled was $1083 per in-home asthma visit, and the average cost of the visit was $302, for a benefit to program cost ratio of 3.58 and net benefit of $781 per asthma visit. For the active asthma group, per person savings was $613 per asthma visit, with a benefit to program cost ratio of 2.03 and net benefit of $311. CONCLUSION: Low-intensity, home-based, environmental interventions for people with asthma decrease the cost of health care utilization. Greater reductions are realized when services are targeted toward people with more poorly controlled asthma. While low-intensity approaches may produce more modest benefits, they may also be more feasible to implement on a large scale. Health care payers, and public payers in particular, should consider expanding coverage, at least for patients with poorly controlled asthma or who may be at risk for poor asthma control, to include services that address triggers in the home environment.

Replacing Windows Reduces Childhood Lead Exposure: Results From a State-Funded Program.

CONTEXT: Despite considerable evidence that window replacement reduces childhood lead exposure and improves energy conservation and market value, federal policies in childhood lead poisoning, home improvement, and weatherization programs all tend to discourage it. OBJECTIVE AND INTERVENTION: To evaluate a state bond-financed pilot program that replaced old lead-contaminated windows with new lead-free energy efficient ones. DESIGN AND SETTING: Pre-/post evaluation in 1 urban and 1 rural jurisdiction. PARTICIPANTS: Low-income households (n = 96). MAIN OUTCOME MEASURES: Dust wipe sampling, visual assessment, and physical and mental self-reported health at baseline and 1 year. RESULTS: Geometric mean lead dust (PbD) from baseline to 1 year for interior floors, interior sills, and exterior troughs declined by 44%, 88%, and 98%, respectively (P < .001); 1 year later, levels remained well below baseline but rose slightly compared with clearance sampling just after intervention. PbD declined significantly on both sills and troughs in both the urban and rural jurisdictions from baseline to 1 year. On interior floors, PbD significantly declined by 58% (P = .003) in the rural area and 25% (P = .38) in the urban area, where the decline did not reach statistical significance. Households reported improvements in uncomfortable indoor temperatures (P < .001) and certain health outcomes. Economic benefits were estimated at $5 912 219 compared with a cost of $3 451 841, resulting in a net monetary benefit of $2 460 378. Residents reported that they were "very satisfied" with the window replacement work (87%). CONCLUSION: Local and state governments should fund and operate window replacement programs to eliminate a major source of childhood lead exposure, improve energy bills, increase home market value, and create local construction and industrial jobs. Federal agencies should encourage (not discourage) replacement of old windows contaminated with lead. In budget climates such as Illinois with reduced public expenditures, making wise investments such as lead-safe window replacement is more important than ever.

Self-reported health outcomes associated with green-renovated public housing among primarily elderly residents.

OBJECTIVES: Assess the benefits of green renovation on self-reported health of primarily elderly residents of a low-income public housing apartment building. DESIGN AND SETTING: Using questions from the Medicare Health Outcomes Survey, we interviewed residents at baseline and 1 year after green renovation of their 101-unit building in Mankato, Minnesota, comparing self-reported mental and physical health outcomes of 2 sets of residents (all-ages: median, 66 years, n = 40; elder: median, 72 years, n = 22) with outcomes for 2 same-aged low-income Minnesota comparison groups taken from Medicare Health Outcomes Survey participants (n = 40 and 572, respectively). STUDY GROUP: Mankato apartment building residents. INTERVENTIONS: Green renovation including building envelope restoration; new heating, electrical, and ventilation systems; air sealing; new insulation and exterior cladding; window replacement; Energy-Star fixtures and appliances; asbestos and mold abatement; apartment gut retrofits; low volatile organic chemical and moisture-resistant materials; exercise enhancements; and indoor no-smoking policy. MAIN OUTCOME MEASURES: Self-reported health status including Activities of Daily Living and Veteran's Rand 12 (VR-12) survey results; housing condition visual assessment; indoor environmental sampling; and building performance testing. RESULTS: The all-ages study group's mental health improved significantly more than the comparison group's mental health on the basis of mean number of good mental health days in the past month (P = .026) and mean VR-12 mental component score (P = .023). Sixteen percent fewer all-ages study group people versus 8% more comparison group people reported falls (P = .055). The elder study group's 9% improvement in general physical health was not statistically significantly better than the elder comparison group's decline (6%) (P = 0.094). Significantly fewer people in the all-ages group reported smoke in their apartments because of tobacco products (20% vs 0%, P = .005), likely reflecting the new no-smoking policy. CONCLUSIONS: Green healthy housing renovation may result in improved mental and general physical health, prevented falls, and reduced exposure to tobacco smoke.

An investigation into porch dust lead levels.

Lead in porch dust can expose children through direct contact or track-in to the home, but has not been adequately evaluated. At homes undergoing lead hazard control in Rochester, NY, we sampled settled dust lead on exterior porch floors at baseline, immediately post-lead hazard control and one-year post-work (n=79 homes with complete data) via wipe sampling and collected housing, neighborhood and soil data. Baseline GM porch floor dust lead loading (PbPD) was 68 µg/ft(2), almost four times more than baseline GM interior floor dust lead (18 µg/ft(2)). Immediate post-work PbPD declined 55% after porch floor replacement and 53% after porch floor paint stabilization (p=0.009 and p=0.041, respectively). When no porch floor work was conducted but lead hazard control was conducted elsewhere, immediate post-work PbPD increased 97% (p=0.008). At one-year, GM PbPD continued to decline for porch replacement (77% below baseline) and paint stabilization (72% below baseline), but where no porch floor work was done, GM PbPD was not significantly different than baseline (p<0.001, p=0.028 and p=0.504, respectively). Modeling determined that porch floor replacement had significantly lower one-year PbPD than stabilization when baseline PbPD levels were higher than 148 µg/ft(2) (the 77th percentile) but not at lower levels. Treatment of porches with lead paint results in substantial declines in PbPD levels. It is of concern that PbPD levels increased significantly at immediate post-work when lead hazard control was not conducted on the porch but was conducted elsewhere. Standards for porch lead dust should be adopted to protect children from inadequate clean-up after lead hazard control.

Moving into green healthy housing.

BACKGROUND: Green building systems have proliferated but health outcomes and associated costs and benefits remain poorly understood. OBJECTIVE: To compare health before and after families moved into new green healthy housing with a control group in traditionally repaired housing. DESIGN AND SETTING: Mixed methods study in 3 Chicago housing developments. PARTICIPANTS: Public housing and low-income subsidized households (n = 325 apartments with 803 individuals). MAIN OUTCOME MEASURES: Self-reported health status, visual assessment of housing condition, indoor air sampling, and Medicaid expenditure and diagnostic data. Medicaid expenditures and International Classification of Diseases, Ninth Revision codes were modeled using a generalized linear model with γ distribution and log-link. RESULTS: Housing conditions and self-reported physical and mental health improved significantly in the green healthy housing study group compared with both the control group and the dilapidated public housing from which the residents moved, as did hay fever, headaches, sinusitis, angina, and respiratory allergy. Asthma severity measured by self-reported lost school/work days, disturbed sleep, and symptoms improved significantly, as did sadness, nervousness, restlessness, and child behavior. Medicaid data in this exploratory study were inconclusive and inconsistent with self-reported health outcomes and visual assessment data on housing quality but hold promise for future investigation. Possible sources of bias in the Medicaid data include older age in the study group, changes in Medicaid eligibility over time, controlling for Medicaid costs in an urban area, and the increased stress associated with moving, even if the move is into better housing. CONCLUSION: The mixed method approach employed here describes the complex relationships among self-reported health, housing conditions, environmental measures, and clinical data. Housing conditions and self-reported physical and mental health improved in green healthy housing. Health care cost savings in Medicaid due to improved housing could not be quantified here but hold promise for future investigations with larger cohorts over a longer follow-up period.

A side-by-side comparison of three allergen sampling methods in settled house dust.

Understanding allergen exposure and potential relationships with asthma requires allergen sampling methods, but methods have yet to be standardized. We compared allergen measurements from dust collected from 200 households with asthmatics and conducted a side-by-side vacuum sampling of settled dust in each home's kitchen, living room and subject's bedroom by three methods (EMM, HVS4 and AIHA). Each sample was analyzed for dust mite, cockroach, mouse, rat, cat and dog allergens. The number of samples with sufficient dust mass for allergen analysis was significantly higher for Eureka Mighty Mite (EMM) and high volume small surface sampler (HVS4) compared with American Industrial Hygiene Association (AIHA) in all rooms and surfaces tested (all P<0.05). The allergen concentration (weight of allergen divided by total weight of dust sampled) measured by the EMM and HVS4 methods was higher than that measured by the AIHA. Allergen loadings (weight of allergen divided by surface area sampled) were significantly higher for HVS4 than for AIHA and EMM. Cockroach and rat allergens were rarely detected via any method. The EMM method is most likely to collect sufficient dust from surfaces in the home and is relatively practical and easy. The AIHA and HVS4 methods suffer from insufficient dust collection and/or difficulty in use.

Health and housing outcomes from green renovation of low-income housing in Washington, DC.

Green building systems have proliferated recently, but studies are limited of associated health and housing outcomes. The authors measured self-reported resident physical and mental health, allergens, and building conditions at baseline and one-year follow-up in a low-income housing development being renovated in accordance with green healthy housing improvements (Enterprise Green Communities standards and Leadership in Energy & Environmental Design [LEED] gold certification). Self-reported general health in adults significantly improved from 59% to 67% (p = .026), with large statistically significant improvements in water/ dampness problems, cockroaches and rodents, and reduced pesticide use. Median cockroach (Bla g1) and mouse (Mus m1) allergen dust loadings showed large and statistically significant reductions from baseline to three months postintervention and were sustained at one year (both p < .05). Energy and water cost savings were 16% and 54%, respectively. Incorporating Enterprise Green Communities and LEED standards in low-income housing renovation improves health and housing conditions and can help to reduce disparities. All green housing standards should include health-related requirements.

Lead and other heavy metals in dust fall from single-family housing demolition.

OBJECTIVE: We measured lead and other heavy metals in dust during older housing demolition and effectiveness of dust suppression. METHODS: We used American Public Housing Association Method 502 and U.S. Environmental Protection Agency Methods SW3050B and SW6020 at 97 single-family housing demolition events with intermittent (or no) use of water to suppress dust at perimeter, non-perimeter, and locations without demolition, with nested mixed modeling and tobit modeling with left censoring. RESULTS: The geometric mean (GM) lead dust fall during demolition was 6.01 micrograms of lead per square foot per hour (µg Pb/ft(2)/hour). GM lead dust fall was 14.18 µg Pb/ft(2)/hour without dust suppression, but declined to 5.48 µg Pb/ft(2)/hour (p=0.057) when buildings and debris were wetted. Significant predictors included distance, wind direction, and main street location. At 400 feet, lead dust fall was not significantly different from background. GM lead concentration at demolition (2,406 parts per million [ppm]) was significantly greater than background (GM=579 ppm, p=0.05). Arsenic, chromium, copper, iron, and manganese demolition dust fall was significantly higher than background (p<0.001). Demolition of approximately 400 old housing units elsewhere with more dust suppression was only 0.25 µg Pb/ft(2)/hour. CONCLUSIONS: Lead dust suppression is feasible and important in single-family housing demolition where distances between houses are smaller and community exposures are higher. Neighbor notification should be expanded to at least 400 feet away from single-family housing demolition, not just adjacent properties. Further research is needed on effects of distance, potential water contamination, occupational exposures, and water application.

Window replacement and residential lead paint hazard control 12 years later.

Window replacement is a key method of reducing childhood lead exposure, but the long-term effectiveness has not been previously evaluated. Windows have the highest levels of interior lead paint and dust compared to other building components. Our objective was to conduct a follow-up study of residential window replacement and lead hazard control 12 years after homes were enrolled in an evaluation of the HUD Lead Hazard Control Grant Program, sampling settled lead dust in housing in four cities (n=189 homes). Previous work evaluated lead hazard controls up to 6 years after intervention using dust lead measurements and two years after intervention using both dust and blood lead data. But the earlier work could not examine the effect of window replacement over the longer time period examined here: 12 years. The individual homes were assigned to one of three categories, based on how many windows had been replaced: all replacement, some replacement, or non-replacement. Windows that were not replaced were repaired. We controlled for covariates such as site, housing condition, presence of lead paint, and season using longitudinal regression modeling. Adjusted floor and sill dust lead geometric mean dust lead loadings declined at least 85% from pre-intervention to 12 years after the intervention for homes with all replacement windows, some windows replaced and no windows replaced. Twelve years after intervention, homes with all replacement windows had 41% lower interior floor dust lead, compared to non-replacement homes (1.4 versus 2.4 µg/ft2, p<0.001), and window sill dust lead was 51% lower (25 versus 52 µg/ft2, p=0.006) while controlling for covariates. Homes with some windows replaced had interior floor and window sill dust lead loadings that were 28% (1.7 versus 2.4 µg/ft2, p=0.19) and 37% (33 versus 52 µg/ft2, p=0.07) lower, respectively, compared to non-replacement homes. The net economic benefit of window replacement compared to window repair (non-replacement) is $1700-$2000 per housing unit. Homes in which all windows were replaced had significantly lower lead dust. New windows are also likely to reduce energy use and improve home value. Lead-safe window replacement is an important element of lead hazard control, weatherization, renovation and housing investment strategies and should be implemented broadly to protect children.

Housing and allergens: a pooled analysis of nine US studies.

BACKGROUND: Housing conditions can contribute to allergen exposures that are linked to asthma, but little is known about which of those conditions are most likely to predict high levels of allergens in settled house dust. METHODS: We pooled allergen, housing condition, occupant behavior, demographic, and other data from nine asthma studies (n=950 homes in 6 US cities). Dust mite (Der f 1 or Der p 1), cockroach (Bla g 1 or Bla g 2), mouse (Mus m 1), cat (Fel d 1) and dog (Can f 1) allergens were measured in settled dust from kitchens or bedrooms, and concentrations were categorized according to previously published asthma symptom thresholds. We calculated odds ratios (OR) using logistic regression to identify those housing conditions and occupant behaviors that were associated with clinically significant allergen levels, after adjusting for numerous confounding variables. RESULTS: The adjusted results show that high cockroach allergen was associated with cracks or holes in walls (OR=2.1), high dust mite allergen was associated with mold odor (OR=2.5), housing built before 1951 (OR=2.1), and single-family home with slab on grade (OR=1.9); and mouse allergen was associated with rodent control or signs of rodents (OR=3.62) and inversely associated with presence of a cat (OR=0.20). Water leaks and below average housekeeping had unadjusted high odds ratios for high cockroach allergen. CONCLUSION: We have identified a number of housing conditions that are consistently associated with increased allergen dust concentrations. This study indicates that screening for housing-based asthma triggers should include presence of cats, dogs, cockroaches, or rodents; water leaks; mold or mold odor; holes or cracks in walls; and below average housekeeping. Single family houses that have basements or crawl spaces or are built before 1951 are also important predictors for increased allergens in housing.

The relationship of housing and population health: a 30-year retrospective analysis.

OBJECTIVE: We analyzed the relationship between health status and housing quality over time. METHODS: We combined data from two nationally representative longitudinal surveys of the U.S. population and its housing, the National Health and Nutrition Examination Survey and the American Housing Survey, respectively. We identified housing and health trends from approximately 1970 to 2000, after excluding those trends for which data were missing or where we found no plausible association or change in trend. RESULTS: Changes in housing include construction type, proportion of rental versus home ownership, age, density, size, moisture, pests, broken windows, ventilation and air conditioning, and water leaks. Changes in health measures include asthma, respiratory illness, obesity and diabetes, and lead poisoning, among others. The results suggest ecologic trends in childhood lead poisoning follow housing age, water leaks, and ventilation; asthma follows ventilation, windows, and age; overweight trends follow ventilation; blood pressure trends follow community measures; and health disparities have not changed greatly. CONCLUSIONS: Housing trends are consistent with certain health trends over time. Future national longitudinal surveys should include health, housing, and community metrics within a single integrated design, instead of separate surveys, in order to develop reliable indicators of how housing changes affect population health and how to best target resources. Little progress has been made in reducing the health and housing disparities of disadvantaged groups, with the notable exception of childhood lead poisoning caused by exposure to lead-based paint hazards. Use of these and other data sets to create reliable integrated indicators of health and housing quality are needed.

Exposure of U.S. children to residential dust lead, 1999-2004: I. Housing and demographic factors.

BACKGROUND: Lead-contaminated house dust is a major source of lead exposure for children in the United States. In 1999-2004, the National Health and Nutrition Examination Survey (NHANES) collected dust lead (PbD) loading samples from the homes of children 12-60 months of age. OBJECTIVES: In this study we aimed to compare national PbD levels with existing health-based standards and to identify housing and demographic factors associated with floor and windowsill PbD. METHODS: We used NHANES PbD data (n=2,065 from floors and n=1,618 from windowsills) and covariates to construct linear and logistic regression models. RESULTS: The population-weighted geometric mean floor and windowsill PbD were 0.5 microg/ft2 [geometric standard error (GSE)=1.0] and 7.6 microg/ft2 (GSE=1.0), respectively. Only 0.16% of the floors and 4.0% of the sills had PbD at or above current federal standards of 40 and 250 microg/ft2, respectively. Income, race/ethnicity, floor surface/condition, windowsill PbD, year of construction, recent renovation, smoking, and survey year were significant predictors of floor PbD [the proportion of variability in the dependent variable accounted for by the model (R2)=35%]. A similar set of predictors plus the presence of large areas of exterior deteriorated paint in pre-1950 homes and the presence of interior deteriorated paint explained 20% of the variability in sill PbD. A companion article [Dixon et al. Environ Health Perspect 117:468-474 (2009)] describes the relationship between children's blood lead and PbD. CONCLUSION: Most houses with children have PbD levels that comply with federal standards but may put children at risk. Factors associated with PbD in our population-based models are primarily the same as factors identified in smaller at-risk cohorts. PbD on floors and windowsills should be kept as low as possible to protect children.

Exposure of U.S. children to residential dust lead, 1999-2004: II. The contribution of lead-contaminated dust to children's blood lead levels.

BACKGROUND: The U.S. Centers for Disease Control and Prevention collected health, housing, and environmental data in a single integrated national survey for the first time in the United States in 1999-2004. OBJECTIVES: We aimed to determine how floor dust lead (PbD) loadings and other housing factors influence childhood blood lead (PbB) levels and lead poisoning. METHODS: We analyzed data from the 1999-2004 National Health and Nutrition Examination Survey (NHANES), including 2,155 children 12-60 months of age with PbB and PbD measurements. We used linear and logistic regression models to predict log-transformed PbB and the odds that PbB was >or=5 and >or=10 microg/dL at a range of floor PbD. RESULTS: The population-weighted geometric mean (GM) PbB was 2.0 microg/dL (geometric standard error=1.0). Age of child, race/ethnicity, serum cotinine concentration, poverty-to-income ratio, country of birth, year of building construction, floor PbD by floor surface and condition, windowsill PbD, presence of deteriorated paint, home-apartment type, smoking in the home, and recent renovation were significant predictors in either the linear model [the proportion of variability in the dependent variable accounted for by the model (R2)=40%] or logistic model for 10 microg/dL (R2=5%). At floor PbD=12 microg/ft2, the models predict that 4.6% of children living in homes constructed before 1978 have PbB>or=10 microg/dL, 27% have PbB>or=5 microg/dL, and the GM PbB is 3.9 microg/dL. CONCLUSIONS: Lowering the floor PbD standard below the current standard of 40 microg/ft2 would protect more children from elevated PbB.

An examination of interventions to reduce respiratory health and injury hazards in homes of low-income families.

We evaluated whether combining asthma trigger reduction with housing structural repairs, device disbursement and education in low-income households with children would improve self-reported respiratory health and reduce housing-related respiratory health and injury hazards (convenience sample of n=67 homes with 63 asthmatic and 121 non-asthmatic children). At baseline, a visual assessment of the home environment and a structured occupant interview were used to examine 29 potential injury hazards and 7 potential respiratory health hazards. A home-specific intervention was designed to provide the children's parents or caretakers with the knowledge, skills, motivation, supplies, equipment, and minimum housing conditions necessary for a healthy and safe home. The enrolled households were primarily Hispanic and owned their homes. On average, 8 injury hazards were observed in the homes at baseline. Four months following intervention, the average declined to 2.2 hazards per home (p<0.001), with 97% of the parents reporting that their homes were safer following the interventions. An average of 3.3 respiratory health hazards were observed in the homes at baseline. Four months following intervention, the average declined to 0.9 hazards per home (p<0.001), with 96% of parents reporting that the respiratory health of their asthmatic children improved. A tailored healthy homes improvement package significantly improves self-reported respiratory health and safety, reduces respiratory health and injury hazards, and can be implemented in concert with a mobile clinical setting.

The effectiveness of low-cost soil treatments to reduce soil and dust lead hazards: The Boston lead safe yards low cost lead in soil treatment, demonstration and evaluation.

The Boston lead safe yards low cost lead in soil treatment, demonstration, and evaluation was developed to explore the viability and effectiveness of low-cost soil interventions to reduce exposure to soil lead hazards. Buildings that had been abated for lead to Massachusetts's deleading standards in the previous 5 yrs and met other program requirements were recruited for the evaluation. Following individual property assessments, yards were treated with application of ground coverings and ground barriers in 2000-2001 and followed up at 1 yr. The treatment cost ranged from 1095 dollars to 5643 dollars with an average of 2798 dollars. Soil lead levels at the building dripline, measured with a field-portable X-ray fluorescence analyzer (Niton Model 702 Spectrum Analyzer), dropped from 2021 PPM at baseline to 206 PPM at 1-yr follow-up. Most of the barrier treatments continued to block access to the lead-contaminated soil at 1yr. At the follow-up, few properties with grass treatment had areas that were completely bare, but 28% had more than a small amount of treated areas bare. Treatments were effective in reducing entryway dust lead in the rear of the building if the residents reported they had maintained the yard treatments. Each additional yard work activity reported was predicted to lower 1-yr floor dust lead loading at the rear common/main and dwelling unit entries by about 20%. Each additional 100 ft2 of yard treated was predicted to lower 1-yr floor dust loading at the rear dwelling unit entry by 19%. Treatments did not show a dust lead effect at 1 yr in the front entryway of the building, but the investigators believe that this may be due to the effect of resident cleaning overshadowing the treatment effect.