Assessment of a lead management program for inner-city children

Lead poisoning is a significant health problem among some children living i n inner-city homes in Toledo, Ohio, and elsewhere. The Department of Housin g and Urban Development (HUD) provided a three-year grant to the city of To ledo for an environmental lead remediation program. This study retrospectiv ely reviewed records of houses contaminated with lead and blood-lead levels (BLLs) in children for the period January 1995 to August 1998. The authors then evaluated the sources of lead exposure and the influence of chelation therapy and parent lead education on children's BLLs. The children who participated in this study lived in the inner city and wer e from low-income families. They occupied pre-1950 houses with lead based p aint concentrations that in some areas were greater than 9.9 milligrams per square centimeter (mg/cm(2)), well exceeding the HUD guideline of 1.0 mg/c m(2). Levels of lead dust in soil and on surfaces in homes also were greate r than the respective HUD guidelines of 400 micrograms per gram (mug/g) and 100 to 800 microgram per square foot (mug.ft(2)). About 88 percent of the 165 children evaluated had elevated BLLs-that is, BLLs greater than or equa l to 10 micrograms per deciliter (mug/dL). Among children who received chel ation therapy, the postchelation mean BLL was statistically lower (p < .001 ) than the prechelation mean BLL, but it remained elevated. Among nonchelat ed children, the mean BLL at the final screening was statistically,higher ( p < .001) than the mean BLL at initial screenings, These results suggest th at chelation alone was not sufficient to lower the concentration of lead in children's blood to an acceptable level (less than 10 mug/dL) and that the single visit a health care worker made to each home to educate the parents about lead was inadequate. Both chelated and nonchelated children continue d to occupy lead-contaminated homes through the duration of the study. Acco rdingly the authors draw three conclusions: Chelation therapy and parent education about lead do not always adequately lower children's BLLs if exposure continues. Parents should receive more frequent and more comprehensive education about lead. Residence in lead-free homes remains the most effective option to control c hildren's BLLs.