Implementation of the Lead Contamination Control Act of 1988

The U.S. Department of Health and Human Services has set as an objective the elimination of elevated blood lead levels (BLLs) in children in the United States by the year 2010 (1); an interim goal, specified as a national health objective for the year 2000, is to reduce BLLs greater than 15 ug/dL and greater than 25 ug/dL among children aged 6 months-5 years to no more than 500,000 and zero, respectively (objective 11.4) (2). The Lead Contamination Control Act of 1988 authorized CDC to make grants to state and local agencies for comprehensive programs designed to 1) screen infants and children for elevated BLLs, 2) ensure referral for medical and environmental intervention for lead-poisoned infants and children, and 3) provide education about childhood lead poisoning. This report summarizes efforts to implement the Lead Contamination Control Act.

Funds for this program were first appropriated in fiscal year 1990. In fiscal year 1991, these funds supported expansion of screening efforts and program development in 13 states and two cities. * Funded programs are required to report quarterly on the number of children screened, number identified with BLLs greater than or equal to 25 ug/dL, number of housing units receiving environmental inspections, and number of housing units in which hazard-reduction activities have been implemented. (Reporting requirements for grantees are being modified for consistency with guidelines that require individual follow-up in children with BLLs greater than or equal to 15 ug/dL (3)).

Cleveland, Ohio, is one example of an area with a lead identification and prevention program. In fiscal year 1991, among Cleveland children who were screened by health-care workers who went door-to-door in high-risk areas, the incidence of BLLs greater than or equal to 25 ug/dL was 3.4 times greater than that among children who were screened by the programs at fixed-site facilities (Table 1). In addition, door-to-door screening provided an introduction into the health-care system for many children, thereby facilitating receipt of benefits of other child health programs, such as vaccination programs.

Reported by: W Slota, Childhood Lead Poisoning Prevention Program, Cleveland Dept of Public Health; JF Quilty, Jr, MD, Div of Maternal and Child Health, TJ Halpin, MD, State Epidemiologist, Ohio Dept of Health. Lead Poisoning Prevention Br, Div of Environmental Hazards and Health Effects, National Center for Environmental Health and Injury Control, CDC.

Editorial Note

Editorial Note: Lead poisoning of children in their home environments was first reported in the 1890s in Australia (4). Although the problem was reported in subsequent decades in the United States, public health resources were not directed to the problem until the 1950s, when case-finding efforts began. During 1966, the first mass screening program was initiated in Chicago, followed by New York City and other cities (4).

During 1971, the Lead-Based Paint Poisoning Prevention Act initiated a national effort to identify children with lead poisoning and abate the sources of lead in their environments. CDC administered approximately $89 million in federal funds appropriated under this act; these funds enabled identification of more than 250,000 children with lead poisoning and facilitated referrals for environmental and medical intervention.

In 1981, when categorical programs, such as that for childhood lead poisoning prevention, were consolidated into the Maternal and Child Health (MCH) Services Block Grant Program, administrative responsibility for the Lead-Based Paint Poisoning Prevention Act was transferred to the Office of Maternal and Child Health (now the Maternal and Child Health Bureau) of the Health Resources and Services Administration. Under the provisions of the MCH Services Block Grant Act, each state decides how to use these federal funds. Until 1992, however, there was no federal requirement for reporting actual use of these funds for childhood lead poisoning prevention activities, and only limited emphasis had been placed on data collection and analysis by the state and local childhood lead poisoning prevention programs.

The Lead Contamination Control Act of 1988 again authorized a CDC grant program in childhood lead poisoning prevention. There are three fundamental differences between the current program and the childhood lead poisoning prevention program of the 1970s. First, the CDC program has increased emphasis on data collection and analysis by childhood lead poisoning prevention programs to evaluate completeness and timeliness of follow-up and effectiveness of screening activities. For example, special software (System for Tracking Elevated Lead Levels and Remediation (STELLAR)) has been developed to assist childhood lead poisoning prevention programs in case and data management. Second, increased emphasis has been placed on evaluating the impact of interventions. For example, although reduction of hazards from lead-based paint and lead paint-contaminated dust in the home is central to the treatment of a lead-poisoned child, the effect of these actions on the reduction of BLLs had not been well evaluated. Accordingly, CDC and state and local health departments are evaluating such lead paint and dust hazard reduction actions. Third, efforts have been increased to collect data on BLLs for all children who are screened -- not just those screened through lead poisoning prevention programs -- and CDC is funding an increased number of states to conduct surveillance for BLLs among children; this effort is being coordinated with efforts to conduct surveillance for elevated BLLs in workers.

Additional information about implementation of the Lead Contamination Control Act is available from CDC's Lead Poisoning Prevention Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health and Injury Control, Mailstop F-28, 1600 Clifton Road, NE, Atlanta, GA 30333.

References

1. CDC. Strategic plan for the elimination of childhood lead poisoning. Atlanta: US Department of Health and Human Services, Public Health Service, 1991.

2. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives -- full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.

3. CDC. Preventing lead poisoning in young children: a statement by the Centers for Disease Control--October 1991. Atlanta: US Department of Health and Human Services, Public Health Service, 1991.

4. Lin-Fu JS. Lead and children: a historical review. In: Needleman HL, ed. Low level lead exposure: the clinical implications of current research. New York: Raven Press, 1980:3-16.

• Connecticut, District of Columbia, Illinois, Indiana, Kentucky, Maryland, Massachusetts, New Jersey, New York City, New York State, Ohio, Pennsylvania, Rhode Island, South Carolina, and Wisconsin.

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