The State of Rhode Island received $500,000 through cooperative agreement EH21-2102 from the Centers for Disease Control and Prevention (CDC) in FY 2022. The funds address childhood lead poisoning prevention and surveillance programmatic activities being conducted from September 30, 2022 to September 29, 2023.
The strategies focus on
- Ensuring blood lead testing and reporting
- Enhancing blood lead surveillance
- Improving linkages to recommended services
To learn more about these efforts in Rhode Island, contact the program below.
Rhode Island Department of Health
3 Capitol Hill
Providence, RI 02908
Lead Safe Housing Requirements as Primary Prevention in Rhode Island
Rhode Island designates cities with a child poverty rate greater than 25% as “Core Cities.” Central Falls, which has the highest rate of children living below the poverty level in Rhode Island (39.4%), is one of these Core Cities. The 2021 statewide incidence rate of children under the age of six years with a first-time blood lead level (BLL) >5 µg/dL was 2.8% in the Core Cities. In comparison the levels were 1.7% statewide and 0.9% statewide excluding Core Cities. The incidence rate in Central Falls in 2021 was 2.7%.
Improving compliance with Rhode Island’s lead hazard mitigation regulations is one of the most effective primary prevention tools for increasing lead-safe housing and reducing lead exposure. At least 82% of renter-occupied homes in Rhode Island and 94% of rental homes in the Core Cities were built before the 1978 ban on lead in residential paint. Through its lead hazard mitigation program, Rhode Island requires most rental properties to maintain a valid Certificate of Lead Conformance (CLC). The CLC documents that the rental housing is lead-safe. The Rhode Island Department of Health (RIDOH) assumed the authority to implement this program in 2019. Compliance with this regulation is low. Rhode Island strives to increase the number of CLCs to ensure lead-safe housing in Rhode Island.
RI CLPPP established a systematic, data-driven approach to increasing the number of CLCs. The intervention was piloted in Central Falls. RI CLPPP analyzed and integrated new data into its surveillance system to identify non-compliant property owners. RIDOH hired an external vendor to analyze Central Fall’s Tax Assessor information cross-referenced with RI CLPPP’s database. This resulted in identifying 964 non-compliant property owners to RI’s Lead Hazard Mitigation Act. These landlords were renting units and single-family homes built before 1978 without having them evaluated by a Lead Inspector. Central Fall’s Code Enforcement officials are performing site visits. Their staff capacity allows them to issue a citation for not having a Certificate of Lead Conformance. This ongoing project has brought 897 units into compliance since the list was shared in January 2020.
RI CLPPP partnered with local officials to contact and educate non-compliant property owners and provide access to lead abatement resources. The RI CLPPP took the following steps:
- RI CLPPP maintained and expanded the Central Falls Lead Poisoning Prevention Coordination Group, including community partners, building and code officials, municipal leadership, and the attorney general’s office, as part of the statewide advisory committee.
- They held monthly subcommittee meetings to discuss policy development, implementation, and networking and to brainstorm new ideas.
- They connected local tax assessor data, including address and plot of property, year built, type of structure, and owner’s name and mailing address, to RIDOH’s lead surveillance system, which increased interoperability.
- RI CLPPP used the updated surveillance system to identify non-compliant property owners.
- They conducted education, outreach, and enforcement to non-compliant property owners through multiple communications channels. They also automated referrals of non-compliant property owners to lead abatement programs funded by the U.S. Department of Housing and Urban Development’s Office of Lead Hazard Control and Healthy Housing for funding assistance.
Out of 1,262 non-exempt properties, 76.4% (964) of properties in Central Falls were missing the required CLC. Non-compliant property owners were sent an educational postcard informing them of their legal obligations to obtain a CLC and to maintain lead-safe housing for their tenants. RI Housing conducted outreach to enroll each non-compliant property in its Lead-Safe Housing Program, which provides financial assistance for lead abatement. Central Falls’ subcommittee issued notices of violation to all non-compliant property owners. If property owners did not comply within 30 days, Central Falls issued a summons to Municipal Housing Court.
The partnership between RI CLPPP and the Central Falls Lead Poisoning Prevention Coordination Group has increased lead-safe housing. From January 1, 2022, to September 29, 2022, Central Falls issued a total of 156 (16.2%) notices of violations to non-compliant property owners. Central Falls issued 74 (47.4%) second notices of violations to property owners who did not comply. Central Falls summoned 27 (17.3%) property owners to housing court. As a result of the notices of violation, owners of 268 units at 79 properties obtained the required CLC. This represents a 23.4% increase in lead-safe rental housing in Central Falls.
The success of this intervention stems from the partnership’s strength, incorporating new data into RI CLPPP’s comprehensive surveillance system, and the ability to replicate the approach. Under their new policy, Central Falls now proactively issues notices of violations on an ongoing basis for all non-compliant property owners before a child is exposed to lead and before a housing code inspection occurs. This pilot is serving as a foundation for Providence and Woonsocket, two other Core Cities, to integrate the policy into their housing code department.
Funding for this work was made possible in part by CDC-RFA-EH21-2102 from the Centers for Disease Control and Prevention (CDC). The views expressed in this material do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.
Lowering Blood Lead Level Rates in Core Cities in Rhode Island
Rhode Island’s main source of childhood lead exposure is lead paint in older housing, as 80% of Rhode Island’s housing stock was built before 1978. The state designates cities with a child poverty rate greater than 25% as Core Cities. These Core Cities also have the oldest housing stock in the state, with 94% of residences built before 1978 and 61% of residences built prior to 1940. The percentage of pre-1940 housing in the Core Cities is approximately twice the statewide rate, and the 2016 statewide proportion of children under the age of 6 with a first-time blood lead level (BLL) > 5 µg/dL was 3.6% (834 children).
The Core Cities in Rhode Island have historically had higher rates of elevated child BLLs. From 2013–2016, the rate in Rhode Island (and Core Cities) remained stagnant.
The Rhode Island Childhood Lead Poisoning Prevention Program (RI CLPPP) and the Childhood Lead Action Project (RI CLAP) worked with the Core Cities of Providence and Pawtucket to address the issue. Since 1992, RI CLAP has worked to eliminate childhood lead poisoning through education, parental support, and advocacy. They have come to be recognized as a leading education and information resource by Rhode Island communities and a catalyst for social change.
RI CLPPP and RI CLAP assisted these Core Cities in crafting policy to enforce the standards of Rhode Island’s Renovation, Repair, and Painting Rule more aggressively. This rule requires contractors, painters, and other workers doing renovation, repair, or painting on pre-1978 homes or childcare facilities (including day cares, preschools, and elementary schools) to be employed by licensed Lead Hazard Control Firms. The policy’s goal is to decrease exposures due to unsafe lead work practices in older homes and buildings.
Additionally, both Providence and Pawtucket are now rigorously enforcing lead-related minimum housing standards by requiring a lead certificate of conformance to resolve all housing-related complaints and open violations. Previously, cases were closed once a violation was fixed.
In 2017, Rhode Island’s elevated BLL prevalence dropped to 2.9%, meaning that 158 fewer cases of child BLLs ≥5 µg/dL were reported in 2017 than in 2016. Although the incidence in many of the state’s Core Cities continued to be approximately twice as high as in the rest of the state, the rate in the two Core Cities that implemented the renovation policy changes, Providence and Pawtucket, saw the most notable improvement, accounting for 87 fewer cases in 2017 than in 2016.
RI CLPPP and RI CLAP will continue to meet and partner with the Providence and Pawtucket municipalities to develop and review additional policies for combating childhood lead exposure in older housing. Pending additional funding, the state plans to expand these policies and procedures statewide, with the collaboration between RI CLPPP and RI CLAP leading the way.
Funding for this work was made possible in part by EH14-1408 from the Centers for Disease Control and Prevention (CDC). The views expressed in this material do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.