Refugees and Other Newcomer Persons Resettled to the United States

Group of happy Burmese children

Lead poisoning disproportionately impacts refugee and other newcomer children resettled in the United States. Refugee children arriving in the United States have higher blood lead levels (BLL) than U.S.-born children [1,8], though this varies among sub-populations.

Reports suggest that country of origin and country of last residence are strong predictors of elevated BLLs among refugee children [7,8]. 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 elevated blood lead levels.  These include:

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, such as traditional remedies, herbal supplements, spices, candies with lead in the wrappers, cosmetics, jewelry, and amulets.
  • Car batteries used for household electricity outside the U.S., lead-glazed pottery, pewter or brass utensils or cooking pots, pressure cookers, leaded crystal, and chipped or cracked dishes may also be sources of lead exposure [1, 9-11].

For more information on imported items known to contain lead, see Lead in Foods, Cosmetics, and Medicines and Lead and Consumer Products.

Other risk factors. Parents of newcomer children may not know about the risks posed by lead exposure and may not recognize potential sources in their daily lives. Most children with elevated BLLs 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.

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

Lead Screening Recommendations
Mother And Daughter At The Doctor's office.

Refugees and eligible newcomers receive a range of benefits and servicesexternal icon such as a comprehensive domestic medical examination within 90 days of arrival to the United States that screens for a wide range of infectious diseases and non-communicable conditions. As part of the domestic medical screeningexternal icon, healthcare providers might consider evaluating refugee and other eligible newcomer children and pregnant/lactating women for lead exposure, with follow-up testing for specific age groups.

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