Adult Blood Lead Epidemiology and Surveillance (ABLES)
ABLES is a state-based surveillance program of laboratory-reported adult blood lead levels. In 2009, the ABLES program updated its case definition for an Elevated Blood Lead Level for surveillance purposes as a blood lead concentration >= 10 µg/dl. The public health objective of the ABLES program is objective 20.7 in Healthy People 2010, which is to reduce the rate of adults(age 16 or older) who have blood lead levels of 25 micrograms per deciliter (µg/dL) or greater. The ABLES program aims to accomplish this objective by building state capacity to initiate or improve adult blood lead surveillance programs which can accurately measure trends in adult blood lead levels and which can effectively intervene to prevent lead over-exposures.
Elevated blood lead levels (BLL's) in adults can damage the nervous, hematologic, reproductive, renal, cardiovascular, and gastrointestinal systems. The majority of cases are workplace-related. U.S. Department of Health and Human Services recommends that BLLs among all adults be reduced to <25 µg/dL. The highest BLL acceptable by standards of the U.S. Occupational Safety and Health Administration is 40 µg/dL. The geometric mean BLL of all adults in the United States is <3 µg/dL.
ABLES state interventions to prevent lead over-exposures include:
- conducting follow-up interviews with
- physicians, employers, and workers
- investigating work sites
- providing technical assistance
- providing referrals for consultation and/or enforcement
- developing and disseminating educational materials and outreach programs
ABLES states are required to have a mandatory state requirement that laboratories report blood lead level results to the state health department or designee. The lowest blood lead level to be reported varies from state to state. However, the reporting of all blood lead levels, elevated or not, is extremely useful for the analysis of these data and is recommended for any state planning to either initiate or change their reporting requirements.
ABLES states are encouraged to develop effective working relationships with childhood lead poisoning prevention programs within their state. Lead may be taken home from the workplace on clothes or in cars thus potentially exposing spouses and children. Children who come in contact with lead-exposed workers should be targeted for blood lead screening.
ABLES states are also encouraged to develop effective working relationships with other federal and State agencies involved in preventing lead over exposure including:
NIOSH is currently the only federal supporter of occupational surveillance for lead. In 2007, the ABLES program is collecting data from 40 funded states. NIOSH seeks to ensure the future funding of state based adult lead surveillance by creating Federal partnerships.
To facilitate adult lead communications the ABLES program maintains a listserv, and meets once a year in conjunction with the Annual Conference of the Council of State and Territorial Epidemiologists.
Besides the interventions of the 40 ABLES States, ABLES partners in achieving the Healthy People 2010 adult lead objective include:
- OSHA--Safety and Health Topics - LEAD
- Center to Protect Workers' Rights--lead research and training programs
- Council of State and Territorial Epidemiologists--lead surveillance initiatives
- National Institute for Occupational Safety and Health (NIOSH)
- Centers for Disease Control and Prevention
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