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Why Should You Care?

Lead Poisoning can happen to anyone anywhere in the US. Lead can cause permanent damage to childrenespecially unborn children, infants, toddlers, and children under six years old. It can damage the brain and other parts of the nervous system and can cause long-term behavior and learning problems Lead poisoning is one of the greatest environmental threats to children. Lead absorption is 5 to 8 times greater in children than in adults. Approximately 11% of ingested lead will reach the adult digestive tract, as compared to 30 to 70% in children. In addition, children absorb up to 50 % of inhaled lead The problems that lead causes remain long after childhood. In comparison with children who have not been exposed to excessive levels of lead, children who have been exposed are much more likely to have

Reading difficulties Poor vocabulary Attention problems More school absences Lower class ranking Greater chance of dropping out of high school
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Occurrence
The majority of household lead exposure comes from window sills and other painted surfaces. The risk of exposure is heightened in older houses and apartments, many of which received several coats of lead paint before the toxin was banned from paint in 1978. It is important to determine the construction year of the house or the dwelling where your child may spend a large amount of time (e.g., grandparents or daycare). In housing built before 1978, assume that the paint has lead unless tests show otherwise Opening and closing windows in the home causes lead paint to breakdown into dust which then travels into a childs system and into their blood. Children get lead paint dust or chips on their hands from playing near windows. Anyone with a toddler or preschooler knows that young children love to put everything in their mouths, especially their hands. . Outside the home, lead can come from toxic waste sites. Shortly after lead gets into your body, it travels in the blood to the "soft tissues" and organs (such as the liver, kidneys, lungs, brain, spleen, muscles, and heart). After several weeks, most of the lead moves into your bones and teeth. In adults, about 94% of the total amount of lead in the body is contained in the bones and teeth. About 73% of the lead in childrens bodies is stored in their bones. Some of the lead can stay in your bones for decades; however, some lead can leave your bones and reenter your blood and organs under certain circumstances (e.g., during pregnancy and periods of breast feeding, after a bone is broken, and during advancing age). Today, more than 300,000 children in the United States, particularly in urban areas, suffer from lead poisoning, and uncounted more have unhealthy levels of lead in their blood. Specifically, about 250,000 U.S. children aged 1-5 years have blood lead levels greater than 10 micrograms of lead per deciliter of blood, the level at which CDC recommends public health actions be initiated.

Symptoms
Lead exposure results from either inhaling or ingesting lead. Low levels of exposure (up to 10 g/dl) are associated with anemia , headaches, general weakness, fatigue , learning disabilities, impaired development of the nervous system , and delayed growth, while greater levels of exposure (70 g/dl) include symptoms such as decreased appetite, vomiting, abdominal pain, constipation , and drowsiness. If blood lead levels exceed 70 g/dl, coma, seizures, bizarre behavior, impaired muscular coordination, and even death can occur. Children with lead poisoning may not look or act sick. Even if the children do show some signs of lead poisoning, these symptoms can often be mistaken for other illnesses, such as the flu. Some of these symptoms may make the parents, guardians, or caregivers feel annoyed or resentful and therefore less affectionate toward the child. They may feel like talking less and spending less time with that child. Understanding that these problems are caused by lead poisoning may help the adults to handle the children more effectively. Studies on the effects of lead in children have demonstrated a relationship between exposure to lead and a variety of adverse health effects. These effects include impaired mental and physical development, decreased heme biosynthesis, elevated hearing threshold, and decreased serum levels of vitamin D. The neurotoxicity of lead is of particular concern, because evidence from prospective longitudinal studies has shown that neurobehavioral effects, such as impaired academic performance and deficits in motor skills, may persist even after PbB levels have returned to normal. Although no threshold level for these effects has been established, the available evidence suggests that lead toxicity may occur at PbB levels of 10-15 mcg/dl or possibly less (ATSDR 1988).

Acute

In adults, symptoms may include: Fatigue Headache Irritability, anxiety, or depression Dizziness, weakness, numbness Reproductive problems: loss of sex drive, infertility, impotence High blood pressure Anemia Digestive disorders: nausea, vomiting, constipation, diarrhea, abdominal pain Nervous system problems Hearing loss Difficulty with memory and concentration Muscle and joint pain or soreness
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Children with lead poisoning may: Be tired, restless, irritable, or weak Have headaches, poor appetite, stomachache and cramps, constipation, or vomiting Have trouble sleeping Be more clumsy Lose skills already learned Be anemic

Elementary School Children Perform poorly in school Disrupt their classes Have difficulty staying seated Have problems learning Are easily distracted Cannot tolerate frustration Have problems with other children

Preschoolers Seem excessively active, fidgety, squirmy Are very uncooperative, refusing to follow requests or directions Have difficulty following directions Act impulsively Are easily distracted Talk excessively and interrupt others frequently Have difficulty in toilet training

Infants and Toddlers Cry, whine, or fuss excessively Have feeding problems Have sleep problems Seem very sensitive to, and unhappy about, touch, tastes, noises, smells, or sounds Seem irritable, cranky, uncooperative, difficult to care for Are difficult or impossible to soothe or comfort Seem to be late in babbling and saying first words

Unborn children - Lead in the mother's blood can pass to the unborn child. Lead poisoning in unborn children can cause: Stillbirth and miscarriage Premature birth Low birth weight Brain and nerve damage Learning disabilities Behavioral problems

Pregnancy -A French study reports that higher lead levels measured in women halfway through their pregnancy are associated with pregnancy-induced high blood pressure. A recent study links higher blood lead levels with high blood pressure in pregnant women, suggesting that lead exposure may increase the risk of developing hypertension during pregnancy. All of the women in the study had blood levels below the level considered acceptable by most health agencies. The association suggests that the level 10 micrograms per deciliter (g/dL) may need to be lowered

Chronic

Lead poisoning can affect nearly every system in the body. Because lead poisoning often occurs with no obvious symptoms, it frequently goes unrecognized. The effects of lead are the same whether it enters the body through breathing or swallowing. The main target for lead toxicity is the nervous system, both in adults and children. Long-term exposure of adults to lead at work has resulted in decreased performance in some tests that measure functions of the nervous system. Lead exposure may also cause weakness in fingers, wrists, or ankles. Lead exposure also causes small increases in blood pressure, particularly in middle-aged and older people. Lead exposure may also cause anemia. At high levels of exposure, lead can severely damage the brain and kidneys in adults or children and ultimately cause death. In pregnant women, high levels of exposure to lead may cause miscarriage. High-level exposure in men can damage the organs responsible for sperm production.

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As Blood Lead levels rise in both children and adults so do the severity of the symptoms.(see chart above)

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Lead and Intelligence IQ Changes in adult intelligence quotients IQs is a way to measure effects of lead and other neurotoxic substances. According to the NRDC, even small amounts of lead in children, have been proven to lower IQ levels. High blood levels are also associated with delayed puberty in girls New evidence (Mazumdar et al 2011) suggests childhood lead exposure may have a persistent and irreversible effect on IQ during the adult years. A 30 year follow-up study in Boston found that even low level exposure to lead during childhood that is, at or below the U.S. level of concern of 10 g/dL may impair adult cognitive function enough to lower IQ scores. Even small decreases in IQ can increase the number of people in society who need extra help in school or who may have difficulty finding work. Lead has been shown many times to permanently reduce the cognitive capacity of children at extremely low levels of exposure. Fetuses exposed to lead in the womb, because their mothers had a lot of lead in their bodies, may be born prematurely and have lower weights at birth. Exposure in the womb, in infancy, or in early childhood also may slow mental development and cause lower intelligence later in childhood.

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In Detroit Michigan, another study has also shown a relationship between IQ and lead exposure at lead levels below those considered safe by EPA. Scores on standard aptitude tests in schools were influenced by very slight changes in Blood lead level. All of these levels are above the EPA current level of concern.

Appearance

Lead is a heavy, low melting, bluish-gray metal that occurs naturally in the Earth's crust. However, it is rarely found naturally as a metal. It is usually found combined with two or more other elements to form lead compounds. Metallic lead is resistant to corrosion (i.e., not easily attacked by air or water). When exposed to air or water, thin films of lead compounds are formed that protect the metal from further attack. Lead is easily molded and shaped. Lead can be combined with other metals to form alloys. Lead and lead alloys are commonly
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found in pipes, storage batteries, weights, shot and ammunition, cable covers, and sheets used to shield us from radiation. The largest use for lead is in storage batteries in cars and other vehicles. Lead compounds are used as a pigment in paints, dyes, and ceramic glazes and in caulk. The amount of lead used in these products has been reduced in recent years to minimize leads harmful effect on people and animals. Tetraethyl lead and tetramethyl lead were once used in the United States as gasoline additives to increase octane rating. However, their use was phased out in the United States in the 1980s, and lead was banned for use in gasoline for motor vehicles beginning January 1, 1996. Tetraethyl lead may still be used in gasoline for offroad vehicles and airplanes. It is also still used in a number of developing countries. Lead used in ammunition, which is the largest non-battery enduse, has remained fairly constant in recent years. However, even the use of lead in bullets and shot as well as in fishing sinkers is being reduced because of its harm to the environment. Most lead used by industry comes from mined ores ("primary") or from recycled scrap metal or batteries ("secondary"). Lead is mined in the United States, primarily in Alaska and Missouri. However, most lead today is secondary lead obtained from lead-acid batteries. It is reported that 97% of these batteries are recycled.

Diagnosis

Lead poisoning is rarely obvious, and people who are lead poisoned often show no symptoms. If you suspect that children or adults may be lead poisoned, they should be tested immediately. They should not wait for symptoms to appear. The only way to detect lead poisoning is through a simple blood test. Testing Blood tests can determine a person's lead level. There are two ways to collect blood for testing: The first, a fingerstick, screens for the presence of lead. The person's finger is pricked to obtain a blood sample, which is sent to a laboratory for analysis. If the lead level is high, the results must be checked with a second test, called a venipuncture, which involves taking blood from a vein. This second sample is also sent to a laboratory for analysis.

Lead can be measured in teeth or bones by x-ray techniques, but these methods are not widely available. These tests show long-term exposures to lead. The primary screening method is measurement of blood lead. Exposure to lead also can be evaluated by measuring erythrocyte protoporphyrin (EP) in blood samples. EP is a part of red
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blood cells known to increase when the amount of lead in the blood is high. However, the EP level is not sensitive enough to identify children with elevated blood lead levels below about 25 micrograms per deciliter (g/dL). These tests usually require special analytical equipment that is not available in a doctors office. However, your doctor can draw blood samples and send them to appropriate laboratories for analysis.

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Treatments
Typically, persons diagnosed with blood lead levels greater than 45 g/dl will receive chelation therapy, which uses chemical agents that bind to lead in the body and cause it to be excreted in the urine or feces. This treatment is often done in the hospital and usually is given as a series of shots. Some people with lead poisoning need several types of treatment and several months of careful follow-up. High blood lead levels are considered a medical emergency requiring immediate attention, since the chances of serious complications rise as lead accumulates in the blood.

Prevention
Regular hand and face washing to remove lead dusts and soil, especially before meals, can lower the possibility that lead on the skin is accidentally swallowed while eating Talk to your state or local health department about testing paint and dust from your home for lead. Make sure your child does not have access to peeling paint or chewable surfaces painted with lead-based paint. Pregnant women and children should not be present in housing built before 1978 that is undergoing renovation. They should not participate in activities that disturb old paint or in cleaning up paint debris after work is completed. Create barriers between living/play areas and lead sources. Regularly wash childrens hands and toys. Hands and toys can become contaminated from household dust or exterior soil.

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Regularly wet-mop floors and wet-wipe window components. Because household dust is a major source of lead, parents should wet-mop floors and wet-wipe horizontal surfaces every 2-3 weeks. Prevent children from playing in bare soil containing lead; if possible, provide them with sandboxes. Parents should plant grass on areas of bare soil or cover the soil with grass seed, mulch, or wood chips, if possible. Families whose members are exposed to lead dusts at work can keep these dusts out of reach of children by showering and changing clothes before leaving work, and bagging their work clothes before they are brought into the home for cleaning. Proper ventilation and cleaningduring and after hobby activities, home or auto repair activities, and hair coloring with products that contain leadwill decrease the possibility of exposure. Lead-containing dust may be deposited on plant surfaces and lead may be taken up in certain edible plants from the soil by the roots; therefore, home gardening may also contribute to exposure if the produce is grown in soils that have high lead concentrations. Vegetables should be well washed before eating to remove surface deposits. Certain hobbies and home or car repair activities like radiator repair can add lead to the home as well. These include soldering glass or metal, making bullets or slugs, or glazing pottery. Some types of paints and pigments that are used as facial make-up or hair coloring contain lead. Cosmetics that contain lead include surma and kohl, which are popular in certain Asian countries. Read the labels on hair coloring products, and keep hair dyes that contain lead acetate away from children. Do not allow children to touch hair that has been colored with lead-containing dyes or any surfaces that the compounds can rub off onto their hands and be transferred to their mouths. Community prevention activities should be triggered by PbB levels > or = 10 mcg/dl, (1) screening and surveillance determining populations at risk and the locations of the worst exposures;

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(2) risk assessment and integrated prevention planning analyzing all available data to assess sources of lead, exposure patterns, and high-risk populations; developing prevention plans; (3) outreach and education informing health-care providers, parents, property owners, and other key people about lead poisoning prevention; (4) infrastructure development finding the resources needed for a successful program of risk reduction; (5) hazard reduction reducing the hazards of lead-based paint and lead in dust and soil, particularly in high-risk buildings and neighborhoods. It is important that children have proper nutrition and eat a balanced diet of foods that supply adequate amounts of vitamins and minerals. Good nutrition lowers the amount of swallowed lead that passes to the bloodstream and also may lower some of the toxic effects of lead. children of low socioeconomic status are at a nutritional disadvantage, for they often do not consume enough food to keep their stomachs full enough to slow absorption, and because they usually do not have enough iron and calcium in their diets . In the body, calcium binds to lead and inhibits its absorption; therefore, dietary calcium interferes with the absorption of lead through the intestinal mucosa. Among high-risk populations, calcium supplements or the addition of milk and yogurt to meals and snacks is recommended. Research has also demonstrated a link between iron deficiency and lead poisoning. Recognition of this link is important, since iron deficiency is the most common childhood nutritional problem worldwide. Iron supplementation, or consuming foods rich in iron, such as fortified cereals, prunes, beef, and calves liver, can interfere with lead accumulating in the body.
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Risks
Probable Carcinogens

The Department of Health and Human Services (DHHS) has determined that lead and lead compounds are reasonably anticipated to be human carcinogens based on limited evidence from studies in humans and sufficient evidence from animal studies, and the EPA has determined that lead is a probable human carcinogen. The International Agency for Research on Cancer (IARC) has determined that inorganic lead is probably carcinogenic to humans All children under the age of 6 years old are at risk because they are growing so rapidly and because they tend to put their hands or other objects, which may be contaminated with lead dust, into their mouths. However, children living at or below the poverty line who live in older housing are at greatest risk. Additionally, children of some racial and ethnic groups and those living in older housing are disproportionately affected by lead. As of 2007, 310,000 kids in the United States are still hurt by lead poisoning every year. Even worse, the dangerous exposure to lead often comes from inside the home.

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Sources

Sources of lead in dust and soil include lead that falls to the ground from the air, and weathering and chipping of lead-based paint from buildings, bridges, and other structures. Landfills may contain waste from lead ore mining, ammunition manufacturing, or other industrial activities such as battery production. Disposal of leadcontaining products contribute to lead in municipal landfills. Past uses of lead such as its use in gasoline are a major contributor to lead in soil, and higher levels of lead in soil are found near roadways. Most of the lead in inner city soils comes from old houses with paint containing lead and previous automotive exhaust emitted when gasoline contained lead. A child's environment is full of lead. Children are exposed to lead from different sources (such as paint, gasoline, solder, and consumer products) and through different pathways (such as air, food, water, dust, and soil). Soil and dust act as pathways to children for lead deposited by primary lead sources such as lead paint, leaded gasoline, and industrial or occupational sources of lead Because lead does not dissipate, biodegrade, or decay, the lead deposited into dust and soil becomes a long-term source of lead exposure for children. For example, although lead emissions from gasoline have largely been eliminated, an estimated 4-5 million metric tons of lead previously used in gasoline remain in dust and soil, and children continue to be exposed to it
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Although all there are numerous lead exposure sources, Lead-based paint and lead contaminated dust are the main sources of exposure for lead in U.S. children. Lead-based paints were banned for use in housing in 1978. All houses built before 1978 are likely to contain some lead-based paint. However, it is the deterioration of this paint that causes a problem. Approximately 24 million housing units have deteriorated leaded paint and elevated levels of lead-contaminated house dust. More than 4 million of these dwellings are homes to one or more young children. This lead may still be on walls, floors, ceilings, and window sills, or on the outside walls of the house. The paint may have been scraped off by a previous owner, but paint chips and lead-containing dust may still be in the yard soil.

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LEAD IN HOMES

Lead dust is likely to be found in places where lead is mined or smelted, where car batteries are made or recycled, where electric cable sheathing is made, where fine crystal glass is made, or where certain types of ceramic pottery are made. Pets can also bring lead into the home in dust or dirt on their fur or feet if they spend time in places that have high levels of lead in the soil.

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NOTE: Potential hot spots of lead hazards in housing are identified based on indicators, not lead monitoring data. Because local data on lead contamination are generally unavailable, it relies on housing and demographic indicators to identify areas with housing that has a high risk of lead hazards. Scientific studies have
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demonstrated that housing built prior to 1950 and households with income below the poverty threshold have an elevated risk of lead contamination. Data is from the 2000 U.S. Census and estimates both of these risk factors to estimate potential lead hazards in housing.Actual lead poisoning incidence by state may vary considerably from these at- risk-housing estimates.
Ohio Ohio utilizes the % of children actually poisoned by lead in each county.

% Children in Ohio Poisoned by Lead (darker colors = greater percentage)


New Hampshire New Hampshire combines actual lead poisoning cases with remaining houses with required lead clean-up to determine housing risk.

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New Hampshire Lead Poisoning Cases (darker colors = higher number of cases)

Pennsylvania

In Philadelphia, Lead Poisoning Risk Analysis maps combine housing and socio-economic data with known cases of childhood lead poisoning.

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Wisconsin - Data published by the Centers for Disease Control and Prevention through 2006 indicates that the rate of confirmed (venous) lead poisoning in Wisconsin is more than twice the national rate of lead poisoning. 2.5% of Wisconsin children who were tested had confirmed lead poisoning compared to 1.2% of all other children in the U.S.1 Connecticut - According to the Connecticut Department of Public Health, 2500 children with blood lead levels of concern and 600 children with elevated blood lead levels were identified in 1998. Although lead poisoning can and does affect people of all races, ethnicities, and socioeconomic statuses, children in low-income families and families of color who live in urban areas or older housing are at greatest risk. Nationwide, African-American children are five times more likely be to lead poisoned than white children. Children from poor families are eight times more likely to be poisoned than are those from higherincome families. In Eastern Connecticut, most children hospitalized for lead poisoning are between the ages of one and two, non-Hispanic, black, and poor.

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Connecticut Lead Poisoning Incidence (darker colors = higher rate)

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Hartford Connecticut- Density of Households Below Poverty

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Hot Spots of Housing with High Risk of Lead Hazards Rank 1 3 2 4 5 7 8 6 9 10 County KINGS, NY LOS ANGELES, CA COOK, IL PHILADELPHIA, PA NEW YORK, NY BRONX, NY QUEENS, NY WAYNE, MI SUFFOLK, MA BALTIMORE (CITY), MD # High Risk Units 130,000 120,000 93,000 75,000 68,000 59,000 56,000 43,000 31,000 31,000

Rank states, counties or census tracts by housing with high risk of lead hazards Counties in the United States with the Greatest Number of High Risk Housing Units The standard used by EPA and HUD is that paint with a lead concentration equal to or greater than 1.0 milligram per square centimeter (mg/cm2) of surface area should be removed or otherwise treated
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Lead in AIR OSHA regulations limit the concentration of lead in workroom air to 50 g/m3 for an 8-hour workday. If a worker has a blood lead level of 50 g/dL or higher, then OSHA requires that the worker be removed from the workroom where lead exposure is occurring. Hot Spots of Lead Air Quality Hazards

Rank 1. 2. 3. 4. 5.

County DEKALB, GA PIKE, AL JEFFERSON, MO WILLIAMSON, TN IRON, MO

Quarterly Average Concentration (ug/m3) 5.96 1.92 1.49 .99 .88

Rank counties by concentrations of lead in ambient air

Counties in the United States with the Highest Ambient Air Concentrations of Lead:

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Rank 1. 2. 3. 4. 5.

County PITTSBURG, OK MARSHALL, KS MACON, IL WOODFORD, KY SMITH, TX

Pounds 31,024 16,113 12,413 9,013 8,595

Counties in the United States with the Greatest Reported Releases of Lead to Air:

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Counties in the United States with the Greatest Reported Releases of Lead Compounds to Air: Rank 1. 2. County JEFFERSON, MO IRON, MO Pounds 118,277 98,093

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3. 4. 5.

REYNOLDS, MO CLARK, NV GILA, AZ

70,629 55,132 34,342

Rank counties by reported releases of lead or lead compounds to air

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LEAD IN WATER
Small amounts of lead may enter rivers, lakes, and streams when soil particles are moved by rainwater. Small amounts of lead from lead pipe or solder may be released into water when the water is acidic or soft. Lead (Pb) exposure through drinking water accounts on average for 20% of total lead exposure in the United States (US) (US EPA, 2005). Recent instances of blood lead poisoning were linked to the water (Triantafyllidou et al., 2007; Recent cases of childhood lead poisoning, in Washington DC, Greenville North Carolina and Durham North Carolina were tied to lead particles in tap water. Particulate lead was identified in faucet aerators and in the water, at lead-poisoned childrens homes. The particulate lead mostly originated from solder or lead corrosion by-products (e.g., lead rust), which detached from the plumbing and contaminated the water supply. The only way to know whether your tap water contains lead is to have it tested. You cannot see, taste, or smell lead in drinking water. Therefore, you must ask your water provider whether your water has lead in it. For homes served by public water systems, data on lead in tap water may be available on the Internet from your local water authority. If your water provider does not post this information, you should call and find out. High levels of lead in tap water can cause health effects if the lead in the water enters the bloodstream and causes an elevated blood lead level

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Where lead is suspected, drink or cook only with water that comes out of the tap cold. Water that comes out of the tap warm or hot can contain much higher levels of lead. Boiling this water will NOT reduce the amount of lead in your water. You can also reduce or eliminate your exposure to lead in drinking water by consuming only bottled water or water from a filtration system that has been certified by an independent testing organization to reduce or eliminate lead.

LEAD PARTICLES TRAPPED ON FAUCET AERATOR SCREEN Lead (Pb) particles that detach from the plumbing and contaminate drinking water can pose a significant health threat, which is often underestimated. WASHINGTON DC CASE STUDY A case in point is the Washington DC Lead in Drinking Water Crises of the last decade. This case was described in detail by S.Triantafyllidou et al.in 2009 and a portion of their report

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Lead (Pb) Exposure Through Drinking Water: Lessons To Be Learned From Recent U.S. Experience is extracted below: In November 2000, Washington DC switched its disinfection treatment from free chlorine to chloramine in order to comply with national regulations for the reduction of disinfection byproducts in US drinking water. Approximately two years later, the local drinking water utility (Washington DC Water and Sewer AuthorityWASA) reported to the EPA, which regulates and oversees Washington DCs drinking water, that about half of the DC homes it tested in 2001-2002 had levels of lead exceeding EPAs action level of 15 ug l-1. The EPA initially characterized these findings as a serious public health issue and ordered the gradual replacement of residential lead pipes in the system (Leonnig and Nakamura, 2004). At the same time, however, Washington DC residents in homes with contaminated drinking water were not informed about the extent of the contamination, and the public at large was not clearly instructed on simple steps to minimize potential exposure to elevated levels of lead in water. Follow up testing in 2003 revealed that in some homes lead levels were in the hundreds and even thousands of ug l-1 (Reel and Cohen, 2004). These news did not reach the public until January 2004, when a front page article in the Washington Post (Nakamura, 2004) alerted City residents to the severity of the contamination. Until recently, for example, the DC Department of Health routinely failed to sample the water consumed by children with lead poisoning based on the erroneous assumption that when compared to deteriorated lead paint, dust, and soil, Washington DCs drinking water poses an insignificant health concern. This assumption has been proven false because during 2001-2004 drinking water was the sole source of lead identified for several lead poisoned children In addition, some children with lead poisoning did not have identified lead paint or dust hazards in their homes

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77% of schools had at least one tap with lead levels above the EPA action level for home taps. Moreover, ten percent of schools produced water samples with over 700 ppb lead a disturbing fact given that an equivalent amount of lead detected in toys would trigger recalls because of concern over acute health effects in children who might possibly ingest the contaminated items. They concluded: When present in tap water, lead particles might pose a significant public health threat. This is because the presence of chloride, warm temperature, low pH and mild agitation inside the human stomach may render a significant fraction of particulate lead bioavailable once ingested.

LEAD IN SOIL
Once lead falls onto soil, it sticks strongly to soil particles and remains in the upper layer of soil. Lead may remain stuck to soil particles or sediment in water for many years. Movement of lead from soil particles into groundwater is unlikely unless the rain falling on the soil is acidic or "soft". That is why past uses of lead such as lead in gasoline, house paint, and pesticides are so important in the amount of lead found in soil.
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Reagan and Silbergeld (1989) argue "that the literature as a whole supports a low soil lead standard of 100 mcg/g or so." The results of occupational studies indicate that increased exposures to lead are followed by elevations in PbB levels, which reach a new level in 60-120 days (Tola et al. 1973). Also, PbB levels may be higher in children during the summer months presumably as the result of increased opportunity for exposures through outdoor play. Public health impact of exposure to lead-contaminated soil. A strong positive correlation is found between exposure to lead-contaminated soils and PbB levels. Generally, PbB levels rise 3-7 mcg/dl for every 1000ppm increase in soil or dust lead concentrations (CDC, 1991). This range reflects different sources of lead, different exposure conditions, and different exposed populations. Even if PbB levels are not elevated, the site should not be dismissed as posing no potential public health hazard. Potential seasonal variation of exposure conditions; the half-life of lead in the blood stream; and limitations of any screening methods used, especially study design (power and representativeness of blood and soil samples), should be evaluated Lead left in the environment as hazardous waste is a matter of great public health concern to ATSDR. Preschool-age children and fetuses are usually the most vulnerable segments of the population for exposures to lead. Among children, those in the 2-3 year-old age bracket may be most at risk for exposure to lead-contaminated soil. OTHER SOURCES OF LEAD Imported Vinyl blinds The U.S. Consumer Product Safety Commission (CPSC) found that older, imported vinyl (plastic) mini blinds contain high amounts of lead which
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can be hazardous to young children. These blinds were manufactured before mid-1997 and imported from China, Indonesia, Taiwan and Mexico. Manufacturers used lead in blinds to stabilize the vinyl and make it less brittle. Lead dust forms on the blinds, particularly when the they are exposed to heat and sun. Children get lead by mouthing the blinds or by touching the blinds and then putting theirfingers in their mouth. Children under the age of six are especially vulnerable to lead, which can cause problems with learning, behavior, growth, and hearing.Imported vinyl blinds on windows contain lead in the plastic which leaches to the surface and is spread as lead dust. Some blinds had enough lead that a child ingesting dust from less than one square inch of the miniblind daily, for about 15 to 30 days, could have a blood lead level above the level of concern for children These blinds are extremely common and more than 50 million have been imported per year from Asia and Mexico. Make certain that these blinds are not present where your children are spending time such as schools, daycare or relatives. Washing the blinds has no effect and they must be replaced taking care not to spread the lead dust to furniture, walls or carpets

Artificial Turf o In 2008, reports indicated there may be health hazards linked to lead in the artificial turf currently installed in schools, parks, and stadiums nationwide. The problem arises from the fact that pigment containing lead chromate is used in some surfaces to make the grass green and to enable the turf to maintain its color under the fading effects of sunlight. In 2009, AstroTurf agreed to reformulate its products, replace lead-tainted fields and playground surfaces installed over the last five years in California and pay thousands in fines. California claimed the company knowingly and intentionally

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exposed individuals within the State of California to lead" and AstroTurf agreed to the settlement without admitting liability. The settlement does not apply to the rest of the country.

Cosmetics o In 2007, tests of 33 brand-name lipsticks, including some popular brands showed that "61 percent had detectable lead levels of 0.03 to 0.65 parts per million (ppm)." One-third of the lipsticks tested had levels higher than 0.1 ppm, the FDA's safety limit for lead in candy. In 2009 FDA tests of 20 samples of red lipstick, FDA found lead levels ranging from 0.09 to 3.06 parts per million. The highest lead level found by FDA was more than four times higher than the highest lead level found by the 2007 study (0.65 ppm). The FDA states that the lead found in lipstick samples by the agency is not a safety concern.
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Folk Medicine o Non-Western folk remedies used to treat diarrhea or other ailments may contain substantial amounts of lead. Examples of these include: Alarcon, Ghasard, Alkohl, Greta, Azarcon, Liga, Bali Goli, Pay-loo-ah, Coral, and Rueda. There are also risks of elevated blood lead levels caused by folk remedies which each can containup to 95% lead.[ Toys and Toy Jewelry o In 2007, millions of toys made in China were recalled from multiple countries owing to safety hazards including lead paint. Sindoor Alert o There are confirmed child and adult cases of lead poisoning related to ingesting a product generically called sindoor. Though it is not intended to be food, sindoor nevertheless might be
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used by some as a food additive. It is more typically used as a cosmetic and in certain religious ceremonies. Traditionally, Hindu, and some Sikh, married women wear sindoor, a red powder, in the parting of their hair to indicate marital status. The Food and Drug Administration (FDA) issued an alert on Dec. 17, 2007, warning consumers not to use the Swad brand sindoor product because testing conducted by the Illinois Department of Public Health indicated this product contained very high levels of lead, sometimes as high as 87%. In January 2008, Raja Foods, importer of Swad products into the United States, issued a nationwide recall of sindoor and several other Swad products due to their high lead content.

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LEAD POLLUTION DISTRIBUTION IN THE US


The Environmental Protection Agency (EPA) identifies the most serious hazardous waste sites in the nation. These sites are then placed on the National Priorities List (NPL), also called Superfund sites, and are targeted for long-term federal clean-up activities. Lead has been found in at least 1,272 of the 1,684 current or former Superfund sites. In addition lead is currently being released at more than 2200 sites in the Toxic Release Inventory with 150 of these sites having released more than 1000 pounds of lead in 2009. Some lead compounds are changed into other forms of lead by sunlight, air, and water. However, elemental lead cannot be broken down.

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. US Map of Major Superfund Sites Releasing Lead in 2009

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US Map of Toxic Release Sites in 2009 (> 1000 pounds)

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Southern Region Map of Toxic Release Sites in 2009 (> 1000 pounds) And Major Superfund Sites

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Rocky Mtn. Region Map of Toxic Release Sites in 2009 (> 1000 pounds) And Major Superfund Sites

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LEAD IN AIR

Very little lead in the air comes from gasoline now because EPA has banned its use in gasoline for motor vehicles. Other sources of lead in the air include releases to the air from industries involved in iron and steel production, lead-acid-battery manufacturing, and nonferrous (brass and bronze) foundries. Lead released into air may also come from burning of solid waste that contains lead,

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windblown dust, volcanoes, exhaust from workroom air, burning or weathering of lead painted surfaces, fumes and exhaust from leaded gasoline, and cigarette smoke. For 30 years, the U.S. Environmental Protection Agency maintained an air-quality standard that allowed 1.5 micrograms of lead per cubic meter of air -- a standard put in place when scientists understood far less about lead and its risks than they do today. In fall 2008, a new EPA standard of 0.15 micrograms per cubic meter was implemented which falls within the limit recommended by scientists and

researchers The most recent U.S. EPA inventory (2002) lists 16,600 facilities that emit lead into the nation's air. About 7,000 of these are relatively small, reported to release less than one pound of lead per year. The remaining
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9,600 facilities release significant amounts of lead each year, from one pound to more than 10,000 pounds -- the largest being 117,392 pounds from a lead smelter in Missouri. (see location map below)

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According to the EPA's inventory, sources of airborne lead emissions can be found in every U.S. county. In some counties more than 10,000 pounds of lead are emitted into the air each year. The EPA monitoring stations responsible for testing for lead in the air (marked with black stars on the maps) are not located throughout the country and are totally absent from some areas where lead emissions may be the highest. These industrial facilities are found across the country, including power plants, smelters and cement kilns, which emit lead into the air, where it eventually settles into soil and dust. The lead remains there indefinitely, to be tracked into homes or ingested by children as they play outdoors and put their hands in their mouths. Less than 200 air-lead monitors are deployed nationwide, making it impossible to measure the risk in many communities.

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LEAD IN BLOOD

Blood Lead Levels in Children under 6 in the United States Kids with Blood Lead Levels >= 10 ug/dL sort 2,774 18,681 18,905 14,998 11,853 7,676 % Kids with Blood Lead Levels >= 10 ug/dL sort .86 % 2.53 % 3.97 % 4.22 % 3.6 % 3.81 %

Age Group sort 0-1 1-2 2-3 3-4 4-5 5-6

* (ug/dL) = micrograms per deciliter The above estimates present a snapshot of current lead exposure for children under 6 by age group, based on 2001 data.

The chart below shows the relationship between elevated blood lead levels in the states and pre-1950 housing.

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Case Studies Leadville CO Superfund Site


Mining in the Leadville area began in 1859 with the discovery of placer gold in California Gulch followed by silver and lead finds in the 1870's. Area mines produced significant quantities of zinc, lead, and copper through World War II, but mining activity has since virtually ceased. However, over 120 years of mining, ore processing and smelting have resulted in approximately 2,000 waste piles (shown below) at the California Gulch site.

The site was placed on the list of Superfund sites in September 1983 The primary health concern is exposure to lead in soils by children age six or younger. Also, elevated metals concentrations in the Arkansas River have impacted aquatic life. In 1986, EPA extended public water supply system lines to residences using private wells. Remediation began in 1988 to minimize the flow of acidic water from the Yak Tunnel. Cleanup consists of a surge pond, water treatment plant and a groundwater monitoring network

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2011 Satellite View of Leadville Colorado Tailings Piles In 2009, the EPA announced that its original remediation plan was not working. Dye tracer tests have shown that not all the 300 to 500 million gallons of contaminated water generated each year actually makes it to the plant. Depending on the day, the plant recovers somewhere between 12 percent and 75 percent of the contaminated water. No one is sure where the rest of the water goes. The EPA now proposes to cap the mine waste with Shotcrete which can be sprayed on and colored and carved to resemble the historic mine waste piles.

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Tar Creek Superfund Site -OK

The Tar Creek Superfund Site is part of the Tri-State Mining District, which includes northeastern Oklahoma, southeastern Kansas, and southwestern Missouri. Specifically, the Site includes the Old Picher Field lead and zinc mining area located in northeastern Ottawa County.

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Map of Tar Creek Superfund Site

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Watershed and Drainage Map of Tar Creek

The Site consists of five mining cities, Picher, Cardin, Quapaw, Commerce, and North Miami, and other areas within Ottawa County. Chat piles are located throughout the communities. Approximately 19,556 people lived in the surrounding area.

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Large capacity pumps were used during active mining to control ground water inflow and flooding. When mining activities ceased in the mid-1960s, the pumps were removed from the mines. By 1979, the majority of the underground mines were completely flooded. Acid mine drainage began to discharge via abandoned or partially plugged mine shaft openings and boreholes. Studies found no fish and only a few benthic macroinvertebrates were surviving in Tar Creek. The Creek was used for recreational purposes, including swimming. Several communities in Ottawa County had experienced ground water quality problems related to the mines Lead-contaminated soils and chat piles are now the principal source of exposure to the population, especially to young children. An October 2004, Report To Congress by the Agency for Toxic Substances and Disease Registry (ATSDR). showed children between the ages of 1 and 5 living at the Tar Creek site had a blood lead level in excess of the 10ug/dL level decreased from 31.2% in 1996 to 2.8% in 2003. More than 2,295 residential yards and public areas have been remediated since the inception of cleanup in Quapaw, Cardin, Picher, Commerce, and North Miami. Work on the final 119 properties in Commerce began in December of 2005 and was completed in October 2007.
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EPA was provided more than $35 million in Recovery Act resources for the Tar Creek site. The projected cost of the remedy is $167 million. This funding is being used to continue the ongoing voluntary relocation efforts and start the implementation of the Remedial Action which consists of removal of chat from remote areas of the site and from area streams People living near hazardous waste sites may be exposed to lead and chemicals that contain lead by breathing air, drinking water, eating foods, or swallowing dust or dirt that contain lead

Picher Ghost Town

Location Map and Satellite Image of Picher

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Picher is a ghost town and former city in Ottawa County, Oklahoma. It was formerly a center of lead and zinc mining. In 1983, the Environmental Protection Agency declared Picher to be at the center of a 40-square-mile Superfund site, one of the most toxic places in America, initially because of the mine waste contaminating the water. In the mid-1990s, studies showed that about a third of children in the area had elevated lead levels in their blood, which can cause cognitive and learning issues.

Picher Sink Hole and Mine Tunnel Collapse In 2006 Discoveries of ground contamination and the possibility of a cave-in of mines under the city have prompted its population to evacuate. The city is within the boundaries of the Tar Creek Superfund site. The Picher area became the most productive lead-zinc mining field in the Tri-State district producing over $20 billion worth of ore between 1917 and 1947. More than fifty percent of the lead and zinc metal used during World War I were produced by the Picher district. At its peak over 14,000 miners worked the mines and another 4,000 worked in mining services.

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Picher Chat Pile and Contaminated Stream On May 10, 2008, Picher was struck by a F4 tornado. There were eight confirmed deaths, possibly including one child, and many other injuries. Twenty blocks of the city suffered extensive damage with houses and businesses destroyed or flattened. The damage in Picher was rated at "EF4". At least 150 others were injured in Picher alone. The federal government also decided that there would be no aid given to rebuild homes, but the buyouts would continue as previously scheduled and people will be assisted in relocation. As of November 2010, it was reported that Picher still had "one business and six occupied houses The people of the adjacent city of Treece, Kansas, would like to see the government carry out a similar relocation program in their city, too. The State of Kansas conducted several health surveys that indicated a high incidence of tuberculosis and lung cancer among area residents.On October 29, 2009, Congress voted to allow the EPA to fund the relocation of the remaining citizens of Treece.
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2011 Satellite Image of Picher OK and Lead Contaminated Chat Piles In Feb. 2011, almost all remaining commercial structures were demolished.

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Missouri Lead Emissions Map

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Doe Run Lead Smelter Herculaneum, MO


In 2010 The Environmental Protection Agency announced that St. Louis-based Doe Run -- North America's largest lead producer -has agreed to spend approximately $65 million to correct violations of environmental laws at ten of its lead mining, milling and smelting facilities in Missouri. The settlement also requires the company to pay a $7 million civil penalty. It has also spent US$10.4 million on buying up to 160 residential properties close to the smelter that are contaminated and is to clean up contaminated soils. Most important, for residents near St. Louis, was the news that Doe Run plans to close its Herculaneum smelter, in Jefferson County by the end of 2013 instead of trying to bring the only US primary lead smelter into compliance with environmental regulations. The closing of the Herculaneum smelter is expected to result in significant benefits to public health and the environment by annually reducing air emissions of at least 101,000 tons of carbon dioxide, 42,000 tons of sulfur dioxide, 30 tons of lead, 23 tons of particulate matter, 22 tons of carbon monoxide, 13.5 tons of nitrogen oxides, and 2.5 tons of volatile organic chemicals. These reductions will result in significant health and environmental benefits to the Herculaneum and St. Louis areas, which are currently exceeding federal air standards for lead, ozone and particulate matter.

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The 2,800 residents of Herculaneum, the home of the nation's biggest lead smelter, were first told in 2001 by Doe Run Officials that lead contamination was far worse than they believed as follows: 1. They shouldn't walk on certain residential streets because of dust that's spilled from trucks hauling lead concentrate. 2. About 22 percent of the children under the age of 6 had high blood-lead levels (the state average is 8 percent); that even with an accelerated cleanup program, it will be years before some Herculaneum children stop being poisoned. 3. At least 510 of the town's 530 residential yards located east of Highway 61-67 are so contaminated with lead that they'll have to be replaced. That includes yards whose topsoil had been replaced just a few years ago. 4. Half of the dust samples from the town's elementary, middle and high schools exceeded federal guidelines for lead. 5. The number of people in the town afflicted with amyotrophic lateral sclerosis (Lou Gehrig's disease) and multiple sclerosis, neurological diseases linked to heavymetal exposure, is unusually high - there
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may be as many as six cases of ALS in Herculaneum In May 2011, sixteen people who were children and babies when they lived next door to the lead smelter in Herculaneum went to trial with claims its owner did little to prevent dust from poisoning them and later causing issues like depression, learning problems and asthma. On July 28 2011, a jury awarded 16 plaintiffs $38.5 million in compensatory damages for lead poisoning they sustained living next to a Herculaneum smelter. The following day the St. Louis jury awarded $320 million in punitive damages in the lawsuit against the former owners of a lead smelter in the eastern Missouri town of Herculaneum Another Doe Run Smelter facility at Boss, MO also became a Superfund site.
The recycling smelter handles old batteries, scrap lead and lead-bearing hazardous waste This area had been identified as a recharge area for the underlying aquifer. There were private drinking water wells within a one-mile radius of the facility and slag metals were found in the groundwater. A total of about 480,000 tons of Lead slag had been placed in the slag disposal area over nearly 20 years of primary smelter operation. The piled slag covered about 5 acres at its base with a thickness of 20 to 55 feet. The slag pile was generally unvegetated and fully exposed to the weather.

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Monitoring well data from 1988 showed that cadmium, lead, and zinc concentrations in the ground water below the slag disposal area exceeded drinking water standards. These data showed that contamination of the ground water below the slag disposal area had occurred, though it was unclear if this contamination was attributable to the slag pile directly or to two adjacent impoundments that contained water from the slag storage area. Several independent laboratories analyzed subsamples of each sample to derive a mean value. Mean cadmium levels ranged up to 0.67 mg/L (67 times the MCL); lead ranged up to 0.6 mg/L (12 times the previous MCL); and one mean value for zinc contained 7.4 mg/L (1.5 times the MCL). These levels are 60 times the current level acceptable lead.

Things to Avoid!
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Lead poisoning is almost entirely preventable. The key is stopping children from coming into contact with lead and treating children who have been poisoned by lead. The goal is to prevent lead exposure to children before they are harmed. There are many ways parents can reduce a childs exposure to lead. The key is stopping children from coming into contact with lead. Lead hazards in a childs environment must be identified and controlled or removed safely. To further reduce a childs exposure from non -residential paint sources: avoid using traditional home remedies and cosmetics that may contain lead; avoid eating candies imported from Mexico; avoid using containers, cookware, or tableware to store or cook foods or liquids that are not shown to be lead free; remove recalled toys and toy jewelry immediately from children. Check Lead Recalls lists. use only cold water from the tap for drinking, cooking, and for making baby formula (Hot water is more likely to contain higher levels of lead. Most of the lead in household water usually comes from the plumbing in your house, not from the local water supply.); shower and change clothes after finishing a task that involves working with lead-based products such as stain glass work, bullet making, or using a firing range Children are particularly vulnerable to lead poisoning. Follow these guidelines to help keep kids safe.
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Avoid direct contact with soil if you live near a lead polluter, in an urban area or near a highway. Touching soil with bare hands and getting it into the mouth can be hazardous.

Keep kids on grassy areas or pavement when they play outside, and avoid playing in the dirt. Wash hands as soon as you get home.

Save food and snacks for indoors, after you've washed up. Lead lingers in soil and dust, and can get ingested when kids put their hands in their mouths.

Take shoes off at the door to avoid tracking contaminated dust or soil into the house.

Vacuum carpets frequently -- a HEPA vacuum cleaner is best. Also use a damp rag to clean windowsills, surfaces and moldings. A damp mop is the best way to clean up lead dust particles from hard floors. Use gloves when you're gardening, and if you want to grow food, have the soil tested for heavy metals first. Alternatively, dig out the area of the garden bed, down to a depth of six inches or more, and replace the soil with clean topsoil. Root and vegetable crops, such as carrots and lettuce, tend to pick up more lead. Choose fruit crops such as corn, beans, squash, tomatoes or strawberries to minimize the risk of lead contamination. Check for peeling or flaking paint, especially around windows, doorframes and molding, if your house was built before 1978. Get the paint tested. The do-it yourself kits available at most hardware stores aren't always completely reliable, but they're a reasonable first step. Before having any renovations done, have the paint
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professionally tested. If there is lead in the paint, make sure a certified lead remediation contractor does the renovation work. Test imported dishware or pottery with a lead swab, available at most hardware stores, before cooking or serving food in it. Lead paints and glazes are still used outside the United States and Europe, and contaminated dishware and pottery -- particularly from Mexico and China -- has been found on store shelves in the United States. Watch out for toys imported from China, cheap kids' costume jewelry and candy made in Mexico -- these products could be contaminated with lead and pose a risk to children. Let tap water run a couple of minutes in the morning before you drink it, to make sure any water that has been standing in the pipes has run through -- you can collect it for watering your plants. Or use an NSF-certified water filter, available at most stores, for your drinking water. Charcoal filters (including filter pitchers) are effective at removing lead. Avoid drinking regularly from leaded crystal if you're pregnant.

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Recommendations
Initially it may seem as though lead is everywhere and there is not much we can do about it. However, since many of the sources in the environment are known, we know exactly where to look.

We must begin by checking the sources of our drinking water. If you don't already know the lead content and variability in your drinking water you must have your water tested or inquire from your public water provider. Remember, it is not sufficient to know the quality of the waters you're drinking today, you must also determine the quality of the water consumed for extended periods in the past. Regarding the risks of encountering lead paint; assume any house you lived in built before 1978 was lead contaminated. Also you may want to inquire from real estate agents in the area whether your previous residences have been sold with the lead certification or if they have been refurbished to remove lead paint.

For lead in soil assessments, it is necessary to know the distance from the residences to the nearest superfund sites and toxic release inventory sites. If the residences are near to the sources of lead contamination or tailings piles, it may be advisable to have the soil tested.

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To determine the levels of lead in the air, the EPA provides detailed maps of ambient lead emissions. These maps should be monitored for lead variability and wind direction. It is also important to know the distance to the closest air quality monitors to evaluate the reliability of the estimates.

Of course, the top priority would be to remove the sources of lead in the home including imported vinyl mini blinds and any imported plastic toys, jewelry or cosmetics which might have high lead content. The primary concern must always be the availability of lead sources to children with special attention paid to children under 6 years old.

If any of these investigations reveal the potential for high lead exposure then consideration should be given for

a blood lead level determination. In all cases of suspected lead exposure, you should discuss the implications with your doctor and ascertain whether additional tests or treatments are warranted.

Only a complete toxic profile of previous, current and potential exposures to lead in the environment can minimize acute symptoms and chronic disease complications. Exposure to lead may decrease lifespan and have health effects in the long term. Death rates from a variety of causes have been found to be higher in people with elevated blood lead levels; these include cancer, stroke, and heart disease, and general death rates from all causes. Early testing and detection can maximize the opportunities for a correct diagnosis and provide your doctor with more treatment options. Ultimately, this is the best way to reduce the impacts of chronic diseases from lead exposure and improve chances for favorable outcomes.

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