Transcript Welcome and Overview

Childhood Lead Poisoning
Prevention in California
Presentation to the Border States Lead Issues
Meeting in El Paso
January 26, 2006
Joseph G. Courtney
California Department of Health Services
Childhood Lead Poisoning Prevention Branch
California Dept. of Health Services
Childhood Lead Poisoning Prev. Br.
CA Childhood Lead Poisoning
Prevention (CLPP) Program
• Established by legislation
beginning in late 1980s that
created program mandates and
created fee support.
• Fees are on industries that have
put lead into the environment
(motor vehicle fuel, paint, air
emitters)
California Dept. of Health Services
Childhood Lead Poisoning Prev. Br.
Program Mandates: State level
• Adopt regulations on evaluating and
screening children for lead poisoning
• Establish protocols for screening
• Ensure appropriate case management,
including environmental assessments and
educational activities to reduce a child’s
exposure to lead
• Collect and analyze information related to
these activities
California Dept. of Health Services
Childhood Lead Poisoning Prev. Br.
State CLPPB Partners
• Other State Agencies
 Food and Drug Branch
 Occupational Health Branch
 Environmental Health Laboratory
 Office of Binational Border Health
 Refugee Health
 Attorney General—Prop 65 enforcement
• Federal Agencies
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CDC: Cooperative Agreement (LA County also has one)
FDA
EPA
HUD
California Dept. of Health Services
Childhood Lead Poisoning Prev. Br.
CLPP Local Program Activities
46 Local programs have contracts with the State Branch
to carry out mandates of CLPP at local level:
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informing- outreach and education
promote screening
local surveillance
case management
environmental investigation
identify new lead hazards
California Dept. of Health Services
Childhood Lead Poisoning Prev. Br.
If High Lead Level Found in a
Child
• Interventions and services (usually by local
CLPPP)
referred for primary provider, as needed, for
medical assessment and treatment
program referrals (WIC, housing agencies)
environmental investigation for lead sources
and remediation steps are noted
nutritional guidance and prevention of
additional lead poisonings
California Dept. of Health Services
Childhood Lead Poisoning Prev. Br.
California Profile
• POPULATION:
Most populous state in the U.S.
Nearly 34 million residents in
2000
(12% of U.S. total)
14% increase since 1990
California Dept. of Health Services
Childhood Lead Poisoning Prev. Br.
California Child Population
10.7 million children under age 21 years
About 520,000 births per year
Over 1 million children age 1 and 2
California Dept. of Health Services
Childhood Lead Poisoning Prev. Br.
California Profile
• 58 counties with a huge range
of population:
Alpine Co. pop. 1,208
Los Angeles: 9.5 million
• 8 counties populations have
over one million people
• The most populous counties
(LA, Orange, San Diego) in
south
California Dept. of Health Services
Childhood Lead Poisoning Prev. Br.
California Population Served
MANY IN POVERTY:
• 46% of children live in
households with incomes less
than 200% of the Federal Poverty
Level (FPL)
• About 500,000 children age 1
and 2 years below 200% FPL
California Dept. of Health Services
Childhood Lead Poisoning Prev. Br.
California Population Served
ETHNIC DIVERSITY:
• In 2000, no group a majority:
32% Hispanic
11% Asian
6% African American
47% White
• Of children less than 18 years,
42% were Hispanic
California Dept. of Health Services
Childhood Lead Poisoning Prev. Br.
California Profile
• DIVERSITY:
30% of the U.S. foreign-born population
lives in California
33% of residents speak a language other
than English at home
Over 1/3 of school-age children speak a
language other than English at home
California Dept. of Health Services
Childhood Lead Poisoning Prev. Br.
California Housing Profile
• Ranks 3rd in U.S. for
largest number of old
housing units
• Over 2 million units
constructed before 1950
• 8.6 million units before
1980
California Dept. of Health Services
Childhood Lead Poisoning Prev. Br.
California Housing Profile
• Approximately 14% of
young children live in
pre-1950 housing
• Approximately 70% live
in pre-1980 housing
California Dept. of Health Services
Childhood Lead Poisoning Prev. Br.
Who is Routinely
Screened for Lead?
• Screening to identify children with
elevated blood lead levels is
focused on those considered most
at risk
Young children in government-assisted
programs: Medi-Cal (Medicaid), WIC,
EPSTD service providers
or Any child with other risk factors as
indicated
California Dept. of Health Services
Childhood Lead Poisoning Prev. Br.
Medical Provider
Requirements
Regulations mandate:
All children age 6 to 72 months receive
anticipatory guidance on lead hazards
Children in government-assisted health
programs receive blood lead tests age 12
and 24 months (to 72 months if not done)
Other children assessed for housing Pb
risk and tested if indicated
California Dept. of Health Services
Childhood Lead Poisoning Prev. Br.
Laboratory Reporting
MANDATES:
• universal reporting of all blood
lead test results (as of 1/1/03)
• electronic reporting (as of
1/1/05)
California Dept. of Health Services
Childhood Lead Poisoning Prev. Br.
Current Blood Lead Results
During FY 04-05
 Over 650,000 blood lead tests reported to CLPPB
 4,287 with elevated lead tests > 10mg/dL (0.6%)
 3,452 newly identified children with elevated
blood leads
 715 new lead poisoning “cases”
(BLL > 20mg/dL or persistent values > 15mg/dL )
 % children with elevated levels and # cases
decreasing
California Dept. of Health Services
Childhood Lead Poisoning Prev. Br.
Childhood Lead Poisoning Cases
California 1992-2004
1800
1600
1664
1499
1490
1400
1396
1200
1095
1000
950
890
800
833
769
797
600
736
687
657
2003
2004
400
200
0
1992
1993
1994
1995
1996
1997
1998 1999
2000
Year
California Dept. of Health Services
Childhood Lead Poisoning Prev. Br.
2001
2002
The Distribution of Lead Poisoning Cases
by Race/Ethnicity, 2001-2004
Latino
n= 1676, 87%
Non-Latino
Asian/Pacific
Islander
n=77, 4%
Non-Latino
White
n=80, 4%
Non-Latino
African
American n=90,
5%
California Dept. of Health Services
Childhood Lead Poisoning Prev. Br.
California Lead Poisoning Source
Analyses (cases with environmental
investigations 2000-2002)
• 69-90% had either a soil, paint, or dust
source (depending on the contamination
action level used)
• 36% had at least one non-soil/paint/dust
source
• 6-14% had ONLY a non soil/paint/dust
source
• 4-17% had NO source identified
California Dept. of Health Services
Childhood Lead Poisoning Prev. Br.
Most Common Non-Dust/Paint/Soil
Sources Found (cases with
environmental investigations 2000-02)
• Take-Home of Occupational Exposure:
12.5%
• Home remedy: 10.4%
• Hobby: 5.9%
• Pottery/Ceramics: 2.6%
• All “Other” non-d/p/s sources: 9% (includes
all candy and other food items, jewelry, etc.
California Dept. of Health Services
Childhood Lead Poisoning Prev. Br.
California BRFS
• 52% of those with young children living in
a pre-1978 home had undergone renovation
or repair in the prior 12 months
• 6% used Mexican ceramics to store, serve,
or prepare food
• 21% ate Mexican candy (37% of Latino
households)
California Dept. of Health Services
Childhood Lead Poisoning Prev. Br.
Alternative Sources 2005
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Jewelry
Indian silver foil
Cribs
Holiday mugs
Vinyl lunch boxes
Chinese kimchi
Tattoo ink
Chinese cured plums
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Ayurvedic remedies
Moroccan tajines
Litargirio
Children’s sunglasses
Mexican
candy/seasonings
• Turmeric
California Dept. of Health Services
Childhood Lead Poisoning Prev. Br.
New Lead in Candy Law (AB 121)
Became law Jan 1, 2006
 Requires CA DHS to ensure that candy does not
contain lead in excess of the naturally occurring
level. This level to be established by new regs
by 7/1/06.
DHS shall test candies for lead and establish
procedures for candy makers for testing and
certifying candy.
Imposes penalties on those who knowingly sell
lead-contaminated candy
California Dept. of Health Services
Childhood Lead Poisoning Prev. Br.
California Dept. of Health Services
Childhood Lead Poisoning Prev. Br.