Housing With Lead Risk in Hawaii

Hawaii

Lead, a naturally occurring heavy metal, is highly toxic in large amounts, especially for young children and pregnant people. Harmful amounts of lead can be found in many places, including water pipes, soil and homes built before 1978. Exposure can occur through inhalation, ingestion or skin contact. Once lead enters the body, it is absorbed into the bloodstream and spread throughout the rest of the body, where it can affect other organs and tissues.

There is no known safe level of lead exposure. In 2021, the Centers for Disease Control and Prevention lowered the threshold for identifying unsafe levels of lead in the blood to 3.5 µg/dL. Studies found that even low levels of lead, far below the previous threshold of 10 µg/dL, are detrimental to cognitive development in children and can negatively impact intellectual function, attention-related behaviors and academic and cognitive skills well into adolescence and adulthood. 

High blood lead levels during pregnancy can be passed onto the developing fetus, which may cause miscarriages, low birth weight infants, preterm births or other health problems. 

Housing built before 1978 carries an elevated risk of lead exposure, and housing built before 1950 poses the highest risk. Due to a 1978 ban on lead-based paint, housing built after this year poses minimal risk. Around 29 million houses in the United States have lead-based paint hazards, of which 2.6 million are homes to young children. A study of children ages 6 months to 2 years found that interior renovation of older homes — which often includes painting, sanding, scraping or other activities that might release lead dust into the air — further increases the risk of lead poisoning. 

It is estimated that investing in lead paint hazard control in high-risk communities could return $17 to $221 in societal and health costs for each dollar spent.

Populations most vulnerable to environmental lead exposure include:

• Children younger than age 6, who tend to put their hands on objects that may be contaminated with lead dust.
• Low-income households. Children living in households with incomes below 130% of the federal poverty line have higher levels of lead exposure than children in higher-income households.
• Those who live in the Northeast and Midwest, where housing stock is older with higher levels of lead-based paint and associated hazards than housing in the South and West.

The only way to stop lead poisoning is to prevent exposure in the first place, since the health effects of lead are permanent. Strategies to reduce the negative consequences of lead exposure include:

• Reducing lead hazards or permanently eliminating them through lead abatement. 
• Providing lead exposure education for parents of young children during routine doctor’s appointments and well-child check-ups. Parents should be taught about sources of lead exposure and best practices for reducing harm and risk, including keeping children away from peeling paint and frequently washing their hands, toys and other items that they may place in or near their mouths. 
• Screening children at higher risk of exposure via blood lead test. Federal law mandates screening all children covered by Medicaid. 
• Removing leaded drinking water pipelines from homes.
• Eliminating lead from airplane fuel.
• Increasing compliance with lead safety regulations from the Environmental Protection Agency (EPA). 
• Using EPA-recognized lead test kits to assess if lead-based paint is present in housing and child-occupied facilities.

The Association of Maternal and Child Health Programs maintains a lead poisoning prevention toolkit and resource index for agencies working to prevent lead exposure.

Healthy People 2030 has objectives to reduce blood lead levels in children ages 1-5 and reduce lead exposure among the general population.

Bellinger, David C. “Very Low Lead Exposures and Children’s Neurodevelopment.” Current Opinion in Pediatrics 20, no. 2 (April 2008): 172–77. https://doi.org/10.1097/MOP.0b013e3282f4f97b.

Garrison, Veronica E. H., and Peter J. Ashley. “Identifying Jurisdictions at Risk of Containing Housing Units With Deteriorated Paint: Results and Targeting Implications for the US Department of Housing and Urban Development.” Journal of Public Health Management & Practice 27, no. 6 (November 2021): 546–57. https://doi.org/10.1097/PHH.0000000000001191.

Gould, Elise. “Childhood Lead Poisoning: Conservative Estimates of the Social and Economic Benefits of Lead Hazard Control.” Environmental Health Perspectives 117, no. 7 (July 2009): 1162–67. https://pmc.ncbi.nlm.nih.gov/articles/PMC2717145/. 

Jordan, Catherine M., Becky L. Yust, Leslie L. Robison, Peter Hannan, and Amos S. Deinard. “A Randomized Trial of Education to Prevent Lead Burden in Children at High Risk for Lead Exposure: Efficacy as Measured by Blood Lead Monitoring.” Environmental Health Perspectives 111, no. 16 (December 2003): 1947–51. https://pmc.ncbi.nlm.nih.gov/articles/PMC1241771/.

Lanphear, Bruce P., Kim Dietrich, Peggy Auinger, and Christopher Cox. “Cognitive Deficits Associated with Blood Lead Concentrations <10 Pg/dL in US Children and Adolescents.” Public Health Reports 115, no. 6 (2000): 521–29. https://doi.org/10.1093/phr/115.6.521.

Lanphear, Bruce P., Richard Hornung, Jane Khoury, Kimberly Yolton, Peter Baghurst, David C. Bellinger, Richard L. Canfield, et al. “Low-Level Environmental Lead Exposure and Children’s Intellectual Function: An International Pooled Analysis.” Environmental Health Perspectives 113, no. 7 (July 2005): 894–99. https://pmc.ncbi.nlm.nih.gov/articles/PMC1257652/ 

Roberts, David J., Sally M. Bradberry, Frances Butcher, and Araceli Busby. “Lead Exposure in Children.” BMJ 377 (April 7, 2022): e063950. https://doi.org/10.1136/bmj-2020-063950.

Ruckart, Perri Zeitz, Robert L. Jones, Joseph G. Courtney, Tanya Telfair LeBlanc, Wilma Jackson, Mateusz P. Karwowski, Po-Yung Cheng, Paul Allwood, Erik R. Svendsen, and Patrick N. Breysse. “Update of the Blood Lead Reference Value — United States, 2021.” MMWR. Morbidity and Mortality Weekly Report 70, no. 43 (October 29, 2021): 1509–12. https://doi.org/10.15585/mmwr.mm7043a4.

Spanier, Adam J., Stephen Wilson, Mona Ho, Richard Hornung, and Bruce P. Lanphear. “The Contribution of Housing Renovation to Children’s Blood Lead Levels: A Cohort Study.” Environmental Health 12 (August 27, 2013): 72.https://doi.org/10.1186/1476-069X-12-72.