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Childhood Lead Poisoning: Conservative Estimates of the Social and Economic Benefits of Lead Hazard Control

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This study is a cost-benefit analysis that quantifies the social and economic benefits to household lead paint hazard control compared with the investments needed to minimize exposure to these hazards. This research updates estimates of elevated blood lead levels among a cohort of children < or = 6 years of age and compiles recent research to determine a range of the costs of lead paint hazard control ($1-$11 billion) and the benefits of reduction attributed to each cohort for health care ($11-$53 billion), lifetime earnings ($165-$233 billion), tax revenue ($25-$35 billion), special education ($30-$146 million), attention deficit-hyperactivity disorder ($267 million), and the direct costs of crime ($1.7 billion). Each dollar invested in lead paint hazard control results in a return of $17-$221 or a net savings of $181-269 billion. There are substantial returns to investing in lead hazard control, particularly targeted at early intervention in communities most likely at risk. Given the high societal costs of inaction, lead hazard control appears to be well worth the price.
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... The Centers for Disease Control and Prevention reports that over 500,000 children under the age of 6 have elevated blood lead levels of ≥5 μg/dL [1]. Symptoms of lead exposure, such as attention deficits, cognitive impairments, and aggression are not always obvious and, if present, are often irreversible [2,3] and have lasting adverse health, economic and social implications [4]. Lead exposures include lead-based paint dust, soils, food and herbal remedies, water, and some recreational activities [5][6][7]. ...
... The association between lead exposure and negative health impacts is well described in the literature [2][3][4] and hence having a control group receiving a placebo or no information would be considered unethical. The flyer contained the same information that would typically be shared with the public when marketing the availability of the RLR funds and hence we consider the flyer to be equivalent to the 'usual care'. ...
... Furthermore, future studies should calculate and interpret the cost of engaging community members to apply for RLR funds in context of the social and economic benefits of remediation. A study by Gould estimates that for every dollar invested in lead hazard control results in $17 -$221 in return over the life course [4]. ...
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Objective To examine the efficacy of direct mailing using four types of messaging on promoting the uptake of residential lead remediation (RLR) funds in Lancaster, PA, USA. Study design We designed a quasi-experiment to assess the effect of 4 RLR messages sent to. households in Lancaster, PA by direct mail between September and December 2020: a brief flyer (F); a detailed brochure + the flyer (BF); a health infographic + the flyer (IF); and an application form + the flyer (AFF). Methods Mailers were sent to addresses in four census tracts; each census tract received a different message. Both English and Spanish versions were sent. The outcomes were the event rate defined as the number of phone call inquiries received, and the number of applications received. The association between type of messaging and household type (owner-vs renter-occupied) was assessed using a chi square test. Results The event rates for the renter-occupied households were lower than for owner-occupied households, regardless of treatment. The event rates for renter-occupied households in the F, BF, IF and AFF groups were 0.00%, 0.35%, 0.12% and 0.18% respectively compared to 0.93%, 0.45%, 0.86% and 1.32% for homeowners. More applications were received from homeowners, and the event rate of the owner-occupied households was significantly different from that of renter-occupied homes (p-value = 0.001). Conclusions Event rates and applications received were higher for owner-occupied households than they were for renter-occupied households. Direct mailing of RLR information is feasible especially if households at high risk for lead poisoning are targeted.
... [4][5][6] Elimination of lead exposure, the most preventable environmental hazard facing young children, can potentially generate $84 to $269 billion in long-term savings per birth cohort. 7,8 Eliminating lead from children's environments is the subject of policy and agency initiatives, and responses to petitions, public comment, public reports, 8 We describe actions taken nationally by the CDC, the EPA, the FDA, and HUD, the primary agencies on the federal action plan to eliminate lead poisoning, 9 to develop and enforce updated standards and guidance for dust, soil, paint, water, food, and air. We further discuss actions taken by these agencies locally, including remediation, enforcement, outreach, and education focused on reducing exposure and exposure disparities, working together with state, tribal, and local governments; nongovernmental organizations; and industry stakeholders. ...
... including neurological damage, slowed growth, and learning and behavior issues into adulthood (Gould, 2009;Reyes, 2007). While there is no safe level of lead contamination in blood, the United States Centers for Disease Control and Prevention (CDC) (2020a, b) estimates that there are at least four million households in which children are exposed to dangerous levels of lead; this is likely a considerable underestimate due to underreporting and gaps in testing for at-risk children. ...
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Conducting a neurodevelopmental screening without considering ecological factors is insufficient and may underestimate the actual risk to development for children living in poverty. This article describes ecological risk factors among a nationwide sample (n = 231) of young children experiencing homelessness. Researchers examined rates of health care access and continuity, food insecurity, lead exposure, ACEs, and access to safe places to play using a new ecological screening tool developed for the population. Children in the sample experienced high rates of food insecurity, faced significant challenges to health care access, and significant exposure to adverse childhood events. Children experiencing homelessness and poverty experience more barriers to health care access and significantly more food insecurity and hunger. A third of caregivers reported that their child had some exposure to lead, primary due to substandard housing. And the majority were enduring long periods of homelessness with over half (56%) being between 1–6 months. Findings are discussed within a social determinants of health perspective.
... Around 10-15% of childbirths are reportedly affected by the development of neurobehavioral disorder every year, while other neurological disorders, including attention-deficit/hyperactivity disorder (ADHD), dyslexia, autism spectrum disorder (ASD), and several additional cognitive disabilities, are skyrocketing globally [9,19,20]. These dysfunctions have grave impacts on behaviors (such as predator escape response, mating and feeding mannerisms/reactions), academic accomplishment, population growth, wellbeing, ecosystems, and all aspects of life in society [3,9,21,22]. Despite the numerous reported studies on the impact of neurotoxicants on humans in the literature, to the best of our knowledge, a report documenting the quantity of research in the field is lacking and thus, the present study becomes imperative. ...
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Neurotoxicants are detrimental to the mammalian nervous system at higher concentrations after exposure, and could result in several neurological abnormalities, especially on the nervous and reproductive systems, and sometimes death. The present study, therefore, aimed to evaluate the research growth on neurotoxicants and their effects on humans and the environment over the last decade from 2011 to 2020. Data on this subject were obtained from the SCI-Expanded of Web of Science, and analyses were performed on the retrieved data in RStudio. The number of published documents fluctuated over the studied years, with an annual growth rate of 4.46%, and the highest number of publications were recorded in 2020 (n = 40). Single authored documents, documents per author, authors per documents, and collaboration index were 24, 0.219, 4.57, and 4.87, respectively. Networks of collaboration in this study were noticeable among authors, institutions, and countries; thus, making efforts to strengthen networking globally would be a good idea. Results from this study also show that the growing trend of research in the field is quite encouraging, thus providing future directions to upcoming researchers, and contributes immensely to reducing the exposure and several disorders linked to these neurotoxicants globally.
... Lead (Pb) is a heavy metal widely used in diverse industries, including printing, construction, automobile manufacturing, rechargeable batteries, and others. Along with its widespread use, Pb has been released and is accumulated in environmental systems and is considered a risk for human health (Hernberg, 2000;Gould, 2009). It had been also reported that lead induces toxic stress in plants, resulting in the inhibition of seed germination and growth (Shu et al., 2012;Hadi and Aziz, 2015). ...
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Bacterial cell-based biosensors have been widely developed for detecting environmental toxic materials. The znt-operon in Escherichia coli is a Zn(II)-responsive genetic system and is employed in Zn(II), Cd(II), and Hg(II)-sensing biosensors. In this study, point mutations were introduced in the regulatory protein ZntR to modulate its target selectivity, and metal ion-exporting genes, such as copA and zntA, in host cells were deleted to increase cellular metal ion levels and enhance specificity. Thus, the overall responses of the E. coli cell-based biosensors toward metal(loid) ions were increased, and their selectivity, which was originally for Cd(II) and Hg(II), was shifted to Pb(II). The gene encoding ZntA, known as the Zn(II)-translocating P-type ATPase, showed an impact on the ability of E. coli to export Pb(II), whereas copA deletion showed no significant impact. Noteworthily, the newly generated biosensors employing ZntR Cys115Ile showed the capacity to detect under 5 nM Pb(II) in solution, without response to other tested metal ions within 0–100 nM. To understand the marked effect of single point mutations on ZntR, computational modeling was employed. Although it did not provide clear answers, changes in the sequences of the metal-binding loops of ZntR modulated its transcriptional strength and target selectivity. In summary, the approaches proposed in this study can be valuable to generate new target-sensing biosensors with superior selectivity and specificity, which can in turn broaden the applicability of cell-based biosensors to monitor Pb(II) in environmental systems.
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Housing-based lead paint dust is the most common source of lead exposure for US-born children. Although year of housing construction is a critical indicator of the lead hazard to US children, not all housing of the same age poses the same risk to children. Additional information about housing condition is required to differentiate the housing-based lead risk at the parcel level. This study aimed to identify and assess a method for gathering and using observations of exterior housing conditions to identify active housing-based lead hazards at the parcel level. We used a dataset of pediatric blood lead observations (sample years 2000–2013, ages 6–72 months, n = 6589) to assess associations between observations of exterior housing conditions and housing-based lead risk. We used graphical and Lasso regression methods to estimate the likelihood of an elevated blood lead observations (≥3.5 μg/dL). Our methods estimate a monotonic increase in likelihood of an elevated blood lead observation as housing conditions deteriorate with the largest changes associated with homes in the greatest disrepair. Additionally we estimate that age of home construction works in consort with housing conditions to amplify risks among those houses built before 1952. Our analysis indicates that a survey of external housing conditions can be used in combination with age of housing in the identification process, at the parcel level, of homes that pose a housing-based lead hazard to children.
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OBJECTIVE Lead is a neurotoxicant that negatively affects health. Reducing lead exposure and early detection among children are important public health goals. Our objective with this study was to determine if the September 2015 lead advisory in Flint, Michigan affected lead testing among children when possible exposure was widely publicized. METHOD This study included 206 001 children born in Michigan from 2013 to 2015 and enrolled in Medicaid, using 2013 to 2017 claims data to determine if and at what age an individual received a lead test. Difference-in-differences regression models were used to compare the receipt of lead tests among children in Flint with other cities in Michigan before and after September 2015, when a lead advisory was issued for the city warning about potential exposure to lead in publicly supplied water. RESULTS Before the lead advisory, approximately 50% of children in Flint received a lead test by 12 months of age and nearly 75% received a lead test by 24 months of age. After the September 2015 advisory, the receipt of lead tests among children in Flint increased 10 percentage points by 12 months compared with other cities. Effects by 10-month cohorts, as of 2016, revealed a 20-percentage-point increase for children in Flint compared with other cities. CONCLUSIONS Despite a highly publicized lead advisory, children in Flint enrolled in Medicaid received lead tests earlier, but the proportion of Medicaid-eligible children who were tested did not change. This suggests that increasing lead testing is a difficult policy goal to achieve and, therefore, supports recent efforts focusing on primary prevention to reduce lead exposure.
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By 1995 Congress had appropriated hundreds of millions of dollars for lead paint remediation, but most of it remained unspent due to a lack of scientific expertise at the US Department of Housing and Urban Development (HUD) and inadequate local capacity. HUD hired a wave of scientists and embarked on efforts to expand the local workforce, which accelerated the number of remediated houses. The focus on science was reflected in the new HUD guidelines on technical inspection, risk assessment, remediation and other procedures that were later adopted in local, state, and federal regulations. They focused on lead dust and both long- and short-term remediation. A new task force was formed to address liability, insurance, and other issues that Title X had not resolved in 1992. New research on lead dust sampling and standards enabled HUD to promulgate them in 1999 and EPA in 2001. Each agency adopted different scientific modeling approaches due to differences in units of measure, practicality, detection limits, correlation with blood lead level, and applicability to housing and hazardous waste sites and other matters; yet the two agencies adopted numerically consistent lead dust standards. A Congressionally mandated scientific study of HUD’s lead hazard control grant program, covering over 3000 housing units in 14 jurisdictions showed the new lead paint identification and remediation methods resulted in a 37% improvement in children's blood lead levels and a 66%–95% improvement in lead dust, producing greater confidence that the new approach was working. A later study found the interventions remained durable for at least 12 years. This research led to the reform of virtually all federally assisted housing lead paint regulations in 1999, despite last-minute political interference from Congress and the HUD Secretary at the time. New paint lead measurement technologies appeared, stimulated by new government quality control programs, covering both field and laboratory methods. The first federal enforcement actions of the lead paint disclosure law appeared in the late 1990s, resulting in widespread inspection and remediation.
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The author examines criminal behaviour from birth to adulthood in a sample of nearly 1,000 subjects in order to determine the biological and sociological influences on violence. Over 100 predictors of violent behaviour found to be significant in past biological and sociological studies of crime are analysed. The results indicate that both biological and environmental factors produce strong, and independent, effects on both delinquency and adult crime and violence among both males and females. Powerful influences on violence include behavioural disorder during youth, low school achievement, hyperactivity, lead poisoning, and low levels of parental education. The results do not confirm the findings of previous studies that indicate direct relationships between delinquency and early intelligence, mental retardation, socioeconomic status, or early central nervous system dysfunction. The author concludes that many of the factors contributing to criminal and violent behaviour can be prevented because they have clear environmental origins that can be eliminated.
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In Reply. —Dr Sachs and Dr Sayres are skeptical; they have treated lead-poisoned children but have not observed antisocial behavior. Both relied on personal behavioral observation in a clinic setting; we used structured behavioral inventories from 3 separate informants, all of whom had the benefit of prolonged, close-up observation. Sachs notes that 69 subjects she treated with extreme elevations in blood lead levels (>4.83 μmol/L [>100 μg/dL]) seemed to be doing well on follow-up. She actually treated 105 children with lead levels in this dangerous range, but she ignores 36 subjects who were not located. Subjects not located after treatment generally have worse outcomes than those who are located. It is reasonable to ask how many of her missing lead-poisoned subjects are in special schools, are homeless, are in prison, or are dead.Dr Ernhart criticizes our report because the CBCL delinquency clusters did not reach statistical significance when classified
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Objective. —To evaluate the association between body lead burden and social adjustment.
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Lead is a component of tobacco and tobacco smoke, and smokers have higher blood lead levels than do nonsmokers. We examined the relation between second-hand smoke exposure and blood lead levels in a nationally representative sample of 5592 U.S. children, age 4-16 years, who participated in the Third National Health and Nutrition Examination Survey (1988-1994). Linear and logistic regression modeling was used to adjust for known covariates. Geometric mean blood lead levels were 1.5 mug/dL, 1.9 mug/dL, and 2.6 mug/dL for children with low, intermediate, and high cotinine levels, respectively. The adjusted linear regression model showed that geometric mean blood lead levels were 38% higher (95% confidence interval [CI] = 25-52%) in children with high cotinine levels compared with children who had low cotinine levels. The logistic regression models showed that children with high cotinine levels were more likely to have blood lead levels >/=10 mug/dL than were children with low cotinine levels (odds ratio [OR] = 4.4; CI = 1.9-10.5). Second-hand smoke could be associated with increased blood lead levels in U.S. children aged 4-16 years.