A coordinated relocation strategy for enhancing case management of lead poisoned children: outcomes and costs.

Controlling residential lead hazards is critical for case management of lead poisoned children. To attain this goal, permanent relocation of the family is sometimes necessary or advisable for many reasons, including poor housing conditions; extensive lead hazards; lack of abatement resources, landlord compliance and local enforcement capacity; and family eviction. During 1996-1998, the Kennedy Krieger Institute implemented a unique capitated program for case management of Baltimore City children with blood lead concentrations (PbB) >19 microg/dL. The Program provided financial, housing, and social work assistance to facilitate relocation as a means of providing safer housing. Nearly half of the Program families relocated with direct assistance, and 28% relocated on their own. The Program evaluation examined the costs and benefits of relocation. Average relocation cost per child was relatively inexpensive (<1,500 dollars). Average relocation time of 5 months (range <2 months to >12 months) was less than the 8-month average time to complete lead hazard control work in 14 city and state programs funded by U.S. HUD. Relocation was associated with (1) a statistically significant decrease in dust lead loadings on floors, windowsills and window troughs that persisted for one year, and (2) statistically significantly greater decreases in children's PbB compared to children who did not relocate from untreated homes. Children relocated to housing that met current Federal residential dust lead standards had statistically significant decreases in blood lead levels. Visual inspection did not consistently identify relocation houses with dust lead levels below current Federal standards, indicating that dust testing should be an essential component of future programs. This will require additional resources for dust testing and possibly cleaning and repairs but is expected to yield additional benefits for children. The findings support recent U.S. CDC case management recommendations suggesting that permanent relocation to safer housing is a viable means to reduce children's lead exposure. The benefits of relocation notwithstanding, 40% of families moved at least twice. Research is needed to better understand how to expedite relocation and encourage families to remain in safe housing. Relocation does not negate owners' and health authorities' responsibilities to address lead hazards in the child's original house in order to protect future occupants.

A study of urban housing demolitions as sources of lead in ambient dust: demolition practices and exterior dust fall.

Demolition of older housing for urban redevelopment purposes benefits communities by removing housing with lead paint and dust hazards and by creating spaces for lead paint-free housing and other community resources. This study was conducted to assess changes, if any, in ambient dust lead levels associated with demolition of blocks of older lead-containing row houses in Baltimore, Maryland (USA). In this article we present results based on dust-fall samples collected from fixed locations within 10 m of three demolition sites. In subsequent reports we will describe dust lead changes on streets, sidewalks, and residential floors within 100 m of the demolition sites. Geometric mean (GM) lead dust-fall rate increased by > 40-fold during demolition to 410 micro g Pb/m2/hr (2,700 micro g Pb/m2 per typical work day) and by > 6-fold during debris removal to 61 micro g Pb/m2/hr (440 micro g Pb/m2 per typical work day). Lead concentrations in dust fall also increased during demolition (GM, 2,600 mg/kg) and debris removal (GM, 1,500 mg/kg) compared with baseline (GM, 950 mg/kg). In the absence of dust-fall standards, the results were compared with the U.S. Environmental Protection Agency's (U.S. EPA's) dust-lead surface loading standard for interior residential floors (40 micro g/ft2, equivalent to 431 micro g/m2); daily lead dust fall during demolition exceeded the U.S. EPA floor standard by 6-fold on average and as much as 81-fold on an individual sample basis. Dust fall is of public health concern because it settles on surfaces and becomes a pathway of ambient lead exposure and a potential pathway of residential exposure via tracking and blowing of exterior dust. The findings highlight the need to minimize demolition lead deposition and to educate urban planners, contractors, health agencies, and the public about lead and other community concerns so that society can maximize the benefits of future demolition activities nationwide.