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Children with Elevated Blood Lead Levels Attributed to Home Renovation and Remodeling Activities -- New York, 1993-1994

Renovation and remodeling activities that disturb lead-based paint can create substantial amounts of lead dust in the home; such dust can then be inhaled or ingested by children (1). In January 1995, the New York State Department of Health (NYSDOH) assessed lead exposure among children resulting from home renovation and remodeling during 1993-1994. This report summarizes findings of the study, which identified 320 children in New York state (excluding New York City) with blood lead levels (BLLs) greater than or equal to 20 ug/dL that were considered to be attributable to residential renovation and remodeling.

In December 1993, New York enacted a state law requiring that all children undergo blood lead screening at ages 1 and 2 years; however, some children are not screened. For children with confirmed elevated BLLs or evidence of high-dose lead exposures, BLL testing is required through age 6 years. For some children aged >6 years, BLLs are tested when there are symptoms of lead poisoning or when there is another reason to suspect lead exposure. All BLL results must be reported to NYSDOH by laboratories performing these tests, which provides results for children aged less than or equal to 14 years to respective local health departments. Local health departments then are responsible for environmental investigation and follow-up of children aged <6 years with BLLs greater than or equal to 20 ug/dL.

During 1993-1994, a total of 4608 children with venous BLLs greater than or equal to 20 ug/dL in New York were reported to local health departments. In January 1995, environmental health and nursing staff of the local health departments reviewed the case records of these children to identify those who within the previous year had been exposed to residential renovation or remodeling activities that involved disturbing lead-based paint and for whom another likely source of lead exposure could not be identified. Disturbed paint was presumed to have been lead-based if lead was found in similar paint that remained in the home. For each case, data abstracted included 1) child's birth date, 2) blood test date, 3) BLL, 4) address of the dwelling, 5) method used to remove old paint, and 6) identity of the person who performed the paint removal. Dwellings were classified as being in rural, suburban, or urban areas based on the average number of persons per square mile residing within the census block (rural: 0-2000 persons; suburban: 2001-15,000; and urban: greater than or equal to 15,001) (2).

Review of records for 1993-1994 identified 320 (6.9%) children in 258 households with elevated BLLs considered to be attributable to renovation and remodeling. Age was known for 289 children; of these, 29 (10%) were aged <1 year; 92 (32%), aged 1 year; 71 (25%), aged 2 years; 37 (13%), aged 3 years; 41 (14%), aged 4 years; 10 (3%), aged 5 years; and nine (3%), aged 6-10 years. BLLs were 20-24 ug/dL in 117 (37%) children, 25-29 ug/dL in 76 (24%), 30-39 ug/dL in 87 (27%), 40-59 ug/dL in 32 (10%), 60-79 in seven (2%), and greater than or equal to 80 ug/dL in one (<1%). Area of residence was known for 281 children; 120 (43%) resided in suburban areas, 101 (36%) in rural areas, and 60 (21%) in urban areas.

For 150 children, more than one type of paint removal activity was reported. Removal activities included scraping (150 reports), sanding (137), chemical stripping (62), using hand-held heat guns (28), using blow torches (nine), and blasting with either water or an abrasive material (six). There were 88 reports of complete removal of a painted component (e.g., wall, window, or stair). Information about who performed paint removal was known for 302 children; work was performed by a resident owner or tenant (187 {62%} children), by a nonresident owner (66 {22%} children), by a contractor (42 {14%} children), or by a nonprofessional employee (seven {2%} children).

Reported by: EM Franko, MS, WN Stasiuk, PhD, RW Svenson, MPA, New York State Dept of Health. Lead Poisoning Prevention Br, Div of Environmental Hazards and Health Effects, National Center for Environmental Health, CDC.

Editorial Note

Editorial Note: Childhood lead exposure is a preventable environmental health problem that usually occurs in residential settings (3). In the United States, an estimated 1.7 million children aged <6 years have BLLs greater than or equal to 10 ug/dL and approximately 200,000 have BLLs greater than or equal to 20 ug/dL (4). BLLs at least as low as 10 ug/dL are associated with adverse effects on children's behavior and development (3). CDC has recommended 1) nutritional and educational interventions for children identified with BLLs 10-19 ug/dL, 2) environmental evaluation to identify lead hazards for children with BLLs greater than or equal to 20 ug/dL or with BLLs that persist at greater than or equal to 15 ug/dL, and 3) medical evaluation and intervention for children with BLLs greater than or equal to 20 ug/dL (3).

The findings in this report suggest that home renovation and remodeling was an important source of lead exposure among children in New York during 1993-1994. Although some of the 320 children may have been exposed to sources of lead other than or in addition to renovation and remodeling, this assessment probably underestimates the burden of lead exposure associated with renovation and remodeling in New York for at least four reasons. First, children with elevated BLLs <20 ug/dL were not included in this study. Second, many children who were exposed to lead during home renovation or remodeling may not have had BLL testing both because universal screening was not a legal requirement until December 1993 and because screening rates were low among children aged>2 years and among those who did not live in urban areas. Third, some laboratories may have incompletely reported children with BLLs greater than or equal to 20 ug/dL. Finally, information on renovation and remodeling was not routinely collected during environmental investigations before this study; as a result, some children with these exposures may not have been identified in their case records.

In 1978, the Consumer Product Safety Commission banned manufacture and use of paint containing >0.06% lead by weight for interior and exterior residential surfaces, toys, and furniture. Because the concentration of lead in paint steadily declined before 1978 (5), older homes are more likely to have paint with higher concentrations of lead. The risk for lead exposure associated with this source is greatest in homes built before 1950 (6); in New York, both the number (3,401,416) and proportion (47%) of housing units built before 1950 are greater than in any other state (7).

Children can be exposed to lead-based paint in housing if the paint is in a form that can be inhaled or ingested (e.g., chipping, peeling, or pulverized to dust). Renovation and remodeling may generate lead dust and fumes. In this analysis, paint removal in most (86%) cases was performed by persons who were not professional contractors and who may have been unaware of lead hazards and protective measures for safely containing dust and paint chips. Their work primarily involved sanding and scraping, methods that are potentially hazardous but require no training and little financial investment (1).

Persons who remove lead-based paint from dwellings should follow the recommendations of the U.S. Department of Housing and Urban Development and the U.S. Environmental Protection Agency for minimizing lead exposure (1,8). These include 1) relocating occupants during paint removal and prohibiting children and pregnant women from entering the work area; 2) isolating areas where work is being performed from other areas of the house and avoiding practices that create lead dust or fumes; 3) performing a full clean-up after work is completed; and 4) considering the monitoring of BLLs in persons who live or work in the dwelling.

Although children residing in poverty and in urban areas are at the highest risk for lead exposure (4), 79% of the children identified in this study resided in suburban or rural settings. This finding underscores that in all communities with older housing, appropriate actions include public education about lead hazards, provider-based anticipatory guidance about lead hazards, and BLL screening of children.

As a result of this investigation, local health departments in New York now routinely collect information about renovation and remodeling when investigating the home environments of children with elevated BLLs. Information about this potential source of lead exposure will be reported to NYSDOH, which will use these data to monitor trends in causes of childhood lead poisoning and identify areas to be targeted for educational outreach activities.


  1. Office of Lead-Based Paint Abatement and Poisoning Prevention. Guidelines for the evaluation and control of lead-based paint hazards in housing. Washington, DC: US Department of Housing and Urban Development, Office of Lead-Based Paint Abatement and Poisoning Prevention, 1995.

  2. Bureau of the Census. 1990 Census of population and housing: summary tape file 1B. Washington, DC: US Department of Commerce, Economics and Statistics Administration, Bureau of the Census, 1991.

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

  4. Brody DJ, Pirkle JL, Kramer RA, et al. Blood lead levels in the U.S. population: phase 1 of the Third National Health and Nutrition Examination Survey (NHANES III, 1988 to 1991). JAMA 1994;272:277-83.

  5. Office of Policy Development and Research. Comprehensive and workable plan for the abatement of lead-based paint in privately owned housing: report to Congress. Washington, DC: US Department of Housing and Urban Development, Office of Policy Development and Research, 1991; report no. HUD-PDR-1295(1).

  6. Lead-Based Paint Hazard Reduction and Financing Task Force. Putting the pieces together: controlling lead hazards in the nation's housing. Washington, DC: US Department of Housing and Urban Development, Lead-Based Paint Hazard Reduction and Financing Task Force, 1995; report no. HUD-1547-LBP.

  7. Bureau of the Census. 1990 Census of housing: detailed housing characteristics, United States. 1990 CH-2-1. 1993. World-Wide Web site ATE, Table H-25. Accessed September 10, 1996.

  8. Office of Pollution Prevention and Toxics. Reducing lead hazards when remodeling your home. Washington, DC: US Environmental Protection Agency, Office of Pollution Prevention and Toxics, 1994; report no. EPA-747-R-94-002.

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