Objective: We review the sources of lead in U. S. children's environments, their contributions to children's blood lead levels (BLLs), source elimination and control efforts, and existing federal authorities. Our context is the U. S. public health goal to eliminate pediatric elevated blood lead levels (EBLs) by 2010. Data Sources: National, state and local exposure assessments over the past half century have identified risk factors for EBLs among U.S. children, including age, race, income, age and location of housing, parental occupation, and season. Data Extraction and Synthesis: Recent national policies have greatly reduced lead exposure among US children but even very low exposure levels compromise children's later intellectual development and lifetime achievement. No threshold for these effects has been demonstrated. While lead paint and dust may still account for up to 70% of EBLs in U.S. children, CDC estimates that 30% or more of current EBLs do not have an immediate lead-paint source, and numerous studies indicate that lead exposures result from multiple sources. EBLs and even deaths have been associated with inadequately controlled sources including ethnic remedies and goods, consumer products, and food-related items including ceramics. Lead in public drinking water and in older urban centers remain exposure sources in many areas. Conclusions: Achieving the 2010 goal requires maintaining current efforts, especially programs addressing lead paint, while developing interventions that prevent exposure before children are poisoned. Achieving the 2010 goal requires active collaboration across all levels of government to identify and control all potential sources of lead exposure. Achieving the 2010 goal requires primary prevention.
Ronnie Levin, U.S. EPA SEP, One Congress St, Boston MA 02114