Risk Factors and Refugees and Immigrants

Key points

  • Lead poisoning disproportionately impacts refugee and newcomer children resettled in the United States.
  • Factors like environmental exposure may put children who are resettled in the U.S. at a higher risk for lead exposure.
  • Individuals may receive lead testing as part of a comprehensive domestic medical examination within 90 days of arrival to the U.S.
Four smiling children


Refugee children arriving in the United States have higher blood lead levels (BLL) than U.S.-born children,12 though this varies among sub-populations.

Reports suggest that country of origin and country of last residence are strong predictors of BLLs among refugee children.32 Furthermore, in some circumstances these children may experience a rise in BLLs after arriving and resettling in the United States.

Causes and risk factors

Several risk factors put newcomer children who are resettled in the U.S. at a higher risk for lead exposure.

Environmental exposure

Newcomer children may be exposed to environmental lead hazards in their country of origin. These hazards include industrial emissions, lead-based paint, and the burning of waste containing lead.

Newcomer children may be exposed to environmental lead hazards from:

  • Living near or working in mines, ammunition manufacturing, smelters, or battery recycling facilities.
  • Lead-based paint and leaded gasoline have only been recently phased out in much of the world. Newcomer children may currently or have previously lived in areas where high lead levels remain in the soil even in areas where leaded gasoline is no longer widely used.
  • Resettling in pre-1978 housing containing lead-based paint after arriving to the U.S.

Cultural practices, traditional medicines, and consumer products

Some cultural practices, traditional medicines, and household and personal use items are associated with increased BLLs, before and after U.S. arrival.

Refugees and other newcomer populations may use or consume imported products contaminated with lead. This includes traditional remedies, herbal supplements, spices, candies with lead in the wrappers, cosmetics, jewelry, and amulets.

Some consumer products that may be a source of lead exposure include:

  • Car batteries used for household electricity outside the U.S.
  • Lead-glazed pottery
  • Pewter or brass utensils or cooking pots
  • Pressure cookers
  • Leaded crystal
  • chipped or cracked dishes1456

Other risk factors

Parents of newcomer children may not know about the risks posed by lead exposure. These parents may not recognize potential sources in their daily lives. Most children with lead in their blood may not have any obvious immediate symptoms. Newcomer children are also more likely to have compromised nutritional status. This includes chronic malnutrition and other moderate to severe health conditions that could increase lead absorption and possible neurological effects.

Some of the above information pertains specifically to refugees. However, many of these risk factors will be similar for all children arriving from the same countries or regions. These risk factors can occur regardless of visa type.

Lead screening recommendations

Refugees and eligible newcomers receive a range of benefits and services. This includes a comprehensive domestic medical examination within 90 days of arrival to the United States. The examination screens for a wide range of infectious diseases and non-communicable conditions. Healthcare providers might consider evaluating refugee and other eligible newcomer children and pregnant/lactating women for lead exposure. There may be follow-up testing for specific age groups.

For CDC's lead screening recommendations refer to Screening for Lead during the Domestic Medical Examination for Newly Arrived Refugees. This includes guidance for refugees and certain other newcomer infants, children, adolescents, and pregnant and lactating women and girls. This guidance was developed by the Immigrant, Refugee, and Migrant Health Branch. Guidance was developed in collaboration with its Centers of Excellence in Newcomer Health, and external experts in refugee health.

A woman and a child sit on a doctor's examine table in front of a doctor.
Talk to a medical provider if you are concerned about lead exposure.


Case studies

CDC resources

Other federal resources

  1. Geltman PL, Brown MJ, and Cochran J. Lead poisoning among refugee children resettled in Massachusetts, 1995 to 1999. Pediatrics. 2001; 108(1):158-62.
  2. Seifu S, Tanabe K, Hauck FR. The Prevalence of Elevated Blood Lead Levels in Foreign-Born Refugee Children Upon Arrival to the U.S. and the Adequacy of Follow-up Treatment.J Immigr Minor Health. 2019.
  3. Yun K, Matheson J, Payton C, et al. Health Profiles of Newly Arrived Refugee Children in the United States, 2006-2012.Am J Public Health. 2016; 106(1):128-35.
  4. Mitchell T, Jentes E, Ortega L, et al. Lead poisoning in United States-bound refugee children: Thailand-Burma border, 2009.Pediatrics. 2012; 129(2):e392-9.
  5. Minnesota Lead Poisoning Prevention Program. Biennial Report to the Legislature. [PDF – 4.16 MB] Minnesota Department of Health, Environmental Health Division; February 2007.
  6. Haefliger P, Mathieu-Nolf M, Lociciro S, et al. Mass lead intoxication from informal used lead-acid battery recycling in Dakar, Senegal. Environ Health Perspect. 2009; 117(10):1535-40.