The American Public Health Association,
Recognizing that lead is pervasive throughout the human environment as a result of industrial pollution, and that abnormal high blood levels of lead is one of the most prevalent and preventable health problems in the United States today;1-3 and
Realizing that new epidemiologic, clinical, and experimental evidence suggests that lead is toxic at levels previously thought to be nontoxic and that lead toxicity is a widespread problem that is neither unique to the inner city nor limited to one area of the country;2-3 and
Noting that the Centers for Disease Control has lowered its definition of an elevated blood level for lead from 30 to 25 ug/dl in whole blood and for lead toxicity to an elevated blood lead level with an erythrocyte protoporphyrin (EP) level in whole blood of 35 ug/dl or greater;2 and
Noting that the US Environmental Protection Agency has called for the elimination of leaded gasoline within three years; and
Acknowledging that numerous clinical and pathological effects of lead in humans and animals have been identified affecting the blood, central nervous system, kidneys, skeleton, gastro-intestinal tract, cardiovascular system, endocrine system, reproductive system, and the peripheral neuro-muscular system;4-7 and
Realizing that all members of the population experience exposures to man-made sources of lead from the air, drinking water, and foods,8,9 and that current lead levels in Americans are between 100 and 1,000 times higher than in pre-technological humans;1,2,10,11 and
Recognizing that many drinking water supplies are conveyed through plumbing systems containing lead-based solder, which produce excessive lead levels in the water,23,24 and that these levels may threaten health;24 and
Observing that young children have been identified as being at greatest risk of lead exposure and toxicity through exposure to leaded paint, soil, dust, food, folk medicines, water, and air;1,12-18 and
Noting that environmental levels alone may not account for some children developing elevated blood lead levels and that a number of sociodemographic variables (e.g., parental education, income, supervision) are often associated with elevated blood lead levels;19-20 and
Considering that lead in gasoline is a major source of elevated blood lead levels in both children and adults;21,22 therefore
- Recommends that researchers continue to undertake prospective epidemiologic studies to ascertain the effects of low-level lead exposures on humans, especially children;
- Recommends that the use of lead-based solders should be prohibited and that control measures be instituted to minimize the presence of lead in drinking water due to the leaching of the lead;
- Suggests that each state review its state and local housing codes to assure that they reduce lead hazards in existing residential dwellings. State/local procedures for enforcement of such standards should be reviewed and improved as necessary;
- Recommends development of childhood lead poisoning prevention programs which incorporate the following: a screening program that enrolls the maximum number of children of high-risk populations, ensures a comprehensive diagnostic evalua-tion of every child with a positive screening test, thoroughly identifies all possible sources (e.g., paint, soil, dust, food, water, air, and folk medicines) and addresses the sources of the exposure, and monitors the adequacy of the treatment and the follow-up of each lead toxicity case, including abatement of the environmental problem, and that these programs be made available to all children at high risk;
- Encourages continued efforts by the Environmental Protection Agency to reduce and rapidly eliminate the lead added to gasoline;
- Recommends further research on quantitative assessment of social, demographic, and family risk factors related to elevated blood lead levels in order to identify high-risk target populations and to facilitate development of prevention strategies to protect those populations from environmental lead hazards; and
- Recommends the dissemination of information to and education of the public, especially high-risk populations, health professionals, and public officials, with regard to the sources of lead exposure, the potential health effects of lead, and the means of reducing exposures, and encourages professional and community action to reduce lead exposure.
- Minnesota Department of Health, Division of Maternal and Child Health: Lead Exposure and the Health Effects on Children. Minneapolis: Minnesota Department of Health, February 1984.
- Centers for Disease Control: Preventing lead poisoning in young children: A statement by the Centers for Disease Control. Atlanta: CDC, January 1985.
- Mahaffey KR, Annest JL, Roberts MS, Murphy RS: National estimates of blood levels: United States, 1976-1980. N Engl J Med 1982;307:573-579.
- National Academy of Sciences, Committee on Lead in the Human Environment: Lead in the Human Environment. Washington, DC: National Academy Press, 1980.
- Tsuchinya K: Lead. In: Friberg L, et al (eds): Handbook on the Toxicology of Metals. New York: Elsevier/North-Holland Biomedical Press, 1979.
- Gerber G, Leonard A, Jacquet P: Toxicity, mutogenicity and teratogenicity of lead. Mutation Res 1980;76:115-141.
- Singhal R, Thomas J (eds): Lead Toxicity. Baltimore: Urban and Schwarzenberg, 1980.
- Beloian A: Use of a food consumption model to estimate human contaminant intake. Proceeding of the International Workshop on Exposure Monitoring. Las Vegas, NV, October 19-22, 1981. Environ Monit Assess 1982;2:115-128.
- Wolnik KA, Fricke KL, Caspar SG, et al: Elements in major raw agricultural crops in the United States. I. cadmium and lead in lettuce, peanuts, soybeans, sweet corn and wheat. J Agric Food Chem 1983;31:1240-1244.
- Annest JL, Mahaffey KR, Cox DH, Roberts J: Blood lead levels for persons 6 months-74 years of age: United States, 1976-80. NCHS Advance Data. Vital and Health Statistics, DHHS Pub. No. 82-1250. Hyattsville, MD: Health Research, Statistics and Technology, 1982.
- Annest JL, Pirkle JL, Makuc D, et al: Chrono- logical trend in blood lead levels between 1976 and 1980. N Engl J Med 1983;308:1373-1377.
- Lin-Fu JS: The evolution of childhood lead poisoning as a public health problem. In: Chisolm JJ, O'Hara D (eds): Lead Absorption in Children. Baltimore, Urban and Schwarzenberg, 1982.
- Chan H, et al: Lead poisoning from ingestion of Chinese herbal medicine. Clin Toxicol 1977;10:273-281.
- Lightfoot J, Blair J, Cohen J: Lead intoxication in an adult caused by Chinese herbal medication. JAMA 1977;238:1539.
- Mielke HW, Anderson JC, Berry KJ, et al: Lead concentrations in inner-city soils as a factor in the child lead problem. Am J Public Health 1983;73:1366-1369.
- Needleman HL, Gunnoe C, Leviton A, et al: Deficits in psychologic and classroom performance of children with elevated dentine lead levels. N Engl J Med 1979;300:689-695.
- Lin-Fu JS: Preventing lead poisoning in children: children today. DHEW Pub. No. (HSM) 73-5113. Rockville, MD: Maternal and Child Health Service, 1973.
- Chisolm JJ Jr: Lead poisoning. Sci Am 1971;224:15-23.
- Stark AD, Quah RF, Meigs JW, Delouise ER: Relationship of sociodemographic factors to blood lead concentrations in New Haven children. J Epidemiol Community Health 1982;36:133-139.
- National Academy of Sciences, Committee on Toxicology: Recommendations for the Prevention of Lead Poisoning in Children. Washington, DC: National Academy Press, July 1976.
- Billick IH, Curran AS, Shier DR: Relation of pediatric blood lead levels to lead in gasoline. Environ Health Perspect 1980;34:213-217.
- Billick IH: Sources of lead in the environment. In: Rutter M, Jones R (eds): Lead Versus Health. New York: John Wiley, 1983.
- Lassovszky P: Effects on water quality from lead and nonlead solders in piping. Heating/Piping/ Air Conditioning 1984;56:51-58.
- Richards WN, Moore MR: Lead hazard controlled in Scottish water systems. J Am Water Works Assoc 1984;76:60-67.
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