A Randomized Trial of the Effect of Dust Control on Children's Blood Lead Levels. † 627

Lanphear, Bruce P.; Winter, Nancy L.; Apetz, L; Eberly, Shirley; Weitzman, Michael

doi:10.1203/00006450-199604001-00649

Cited by 19 publications

(26 citation statements)

References 10 publications

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“…Consistent with other studies, 16,19,20 our findings suggest a minimal effect of education. In the homes of families who did not relocate, significant reductions in dust lead loadings were only found for troughs and only at 12 months after initial education.…”

Section: Discussionsupporting

confidence: 93%

A Coordinated Relocation Strategy for Enhancing Case Management of Lead Poisoned Children: Outcomes and Costs

McLaine¹,

Shields

Farfel

et al. 2006

J Urban Health

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Controlling residential lead hazards is critical for case management of lead poisoned children. To attain this goal, permanent relocation of the family is sometimes necessary or advisable for many reasons, including poor housing conditions; extensive lead hazards; lack of abatement resources, landlord compliance and local enforcement capacity; and family eviction. During 1996-1998, the Kennedy Krieger Institute implemented a unique capitated Program for case management of Baltimore City children with blood lead concentrations (PbB) 919 2g/dL. The Program provided financial, housing, and social work assistance to facilitate relocation as a means of providing safer housing. Nearly half of the Program families relocated with direct assistance, and 28% relocated on their own. The Program evaluation examined the costs and benefits of relocation. Average relocation cost per child was relatively inexpensive (G$1,500). Average relocation time of 5 months (range G2 months to 912 months) was less than the 8-month average time to complete lead hazard control work in 14 city and state programs funded by U.S. HUD. Relocation was associated with (1) a statistically significant decrease in dust lead loadings on floors, windowsills and window troughs that persisted for one year, and (2) statistically significantly greater decreases in children_s PbB compared to children who did not relocate from untreated homes. Children relocated to housing that met current Federal residential dust lead standards had statistically significant decreases in blood lead levels. Visual inspection did not consistently identify relocation houses with dust lead levels below current Federal standards, indicating that dust testing should be an essential component of future programs. This will require additional resources for dust testing and possibly cleaning and repairs but is expected to yield additional benefits for children. The findings support recent U.S. CDC case management recommendations suggesting that permanent relocation to safer housing is a viable means to reduce children_s lead exposure. The benefits of relocation notwithstanding, 40% of families moved at least twice. Research is needed to better understand how to expedite relocation and encourage families to remain in safe housing. Relocation does not negate owners_ and health authorities' responsibilities to address lead hazards in the child's original house in order to protect future occupants.

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Section: Discussionsupporting

confidence: 93%

A Coordinated Relocation Strategy for Enhancing Case Management of Lead Poisoned Children: Outcomes and Costs

McLaine¹,

Shields

Farfel

et al. 2006

J Urban Health

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“…The literature search returned 405 articles. Of these, nine lead hazard control trials were identified (11,(13)(14)(15)(16)19,(30)(31)(32), and five fulfilled the inclusion criteria (13)(14)(15)30,31). One trial was published twice: once following the 24-month follow-up of children and again following the 48-month follow-up (14,31).…”

Section: Resultsmentioning

confidence: 99%

“…Three studies included parental education (13,15,31), two studies provided the families with cleaning supplies or equipment (15,31), two provided professional cleaning (13,30), and one made minor housing repairs (30). The length of follow-up ranged from 6 to 48 months.…”

Section: Resultsmentioning

confidence: 99%

“…For the vast majority of children, educational efforts-such as dust control, hand washing, and reducing children's mouthing behaviors-represent the major strategy to reduce lead exposure, ingestion, and absorption (9,10). One professional dust intervention trial led to significant reductions in highly exposed children (11), but it is clear that education alone is not adequate to prevent children's exposure to lead, as measured by blood lead concentration (12)(13)(14)(15)(16). Moreover, despite considerable evidence that higher dietary calcium intake is associated with lower blood lead concentration, the beneficial effects of calcium supplementation on children's blood lead concentration remains uncertain (17).…”

mentioning

confidence: 99%

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The effect of interior lead hazard controls on children's blood lead concentrations: a systematic evaluation.

Haynes

Lanphear

Tohn

et al. 2002

Environ Health Perspect

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Dust control is often recommended to prevent children's exposure to residential lead hazards, but the effect of these controls on children's blood lead concentrations is uncertain. We conducted a systematic review of randomized, controlled trials of low-cost, lead hazard control interventions to determine the effect of lead hazard control on children's blood lead concentration. Four trials met the inclusion criteria. We examined mean blood lead concentration and elevated blood lead concentrations (> or = 10 microg/dL, > or = 15 microg/dL, and > or = 20 microg/dL) and found no significant differences in mean change in blood lead concentration for children by random group assignment (children assigned to the intervention group compared with those assigned to the control group). We found no significant difference between the intervention and control groups in the percentage of children with blood lead > or = 10 microg/dL, 29% versus 32% [odds ratio (OR), 0.85; 95% confidence interval (CI), 0.56-1.3], but there was a significant difference in the percentage of children with blood lead > or = 15 microg/dL between the intervention and control groups, 6% versus 14% (OR, 0.40; 95% CI, 0.21-0.80) and in the percentage of children with blood lead > or = 20 microg/dL between the intervention and control groups, 2% versus 6% (OR, 0.29; 95% CI, 0.10-0.85). We conclude that although low-cost, interior lead hazard control was associated with 50% or greater reduction in the proportion of children who had blood lead concentrations exceeding 15 microg/dL and > or = 20 microg/dL, there was no substantial effect on mean blood lead concentration.

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“…In a randomized trial in toddlers with mean blood lead of 12 µg/dL, Rhoads et al (3), using data from the same study, showed that maternal education and these biweekly cleanings produced a 17% decline in blood lead on average, compared to no change in control children. Other trials examining cleaning effectiveness that showed no significant decrease in blood lead levels after cleaning either only provided cleaning supplies and educational materials and did not guarantee that cleaning occurred (9,10) or were done in an active smelter community with more modern housing (11). The studies that have provided actual cleaning of urban homes suggest that not only does regular cleaning reduce dust lead levels, but it also directly reduces blood lead levels.…”

mentioning

confidence: 99%

Comparison of home lead dust reduction techniques on hard surfaces: the New Jersey assessment of cleaning techniques trial.

Rich

Rhoads

Yiin

et al. 2002

Environ Health Perspect

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High efficiency particulate air filter (HEPA) vacuums, which collect particles > 0.3 micro m, and trisodium phosphate (TSP), a detergent claimed to selectively remove lead, have been included in the HUD Guidelines for the Evaluation and Control of Lead Based Paint Hazards in Housing without systematic validation of their effectiveness. At the time the study was initiated, both HEPA vacuums and TSP were relatively expensive, they were not readily found in urban retail centers, and there were environmental concerns about the use and disposal of high-phosphate detergents. A randomized, controlled trial was conducted in urban high-risk homes in northern New Jersey to determine whether a more readily available and less expensive low-phosphate, non-TSP detergent and non-HEPA vacuum could perform as well as TSP and a HEPA vacuum in a cleaning protocol. Homes were randomized to one of three cleaning methods: TSP/HEPA vacuum, TSP/non-HEPA vacuum, or non-TSP/non-HEPA vacuum. Change in log-transformed lead loading was used in mixed models to compare the efficacy of the three cleaning techniques separately for uncarpeted floors, window sills, and window troughs. After we adjusted for baseline lead loading, the non-HEPA vacuum produced larger reductions on hard floors [19%; 95% confidence interval (CI), 3-38%], but the HEPA vacuum produced larger reductions on window sills (22%; 95% CI, 11-32%) and larger reductions on window troughs (16%; 95% CI, -4 to 33%). The non-TSP produced larger reductions on window troughs (21%; 95% CI, -2 to 50%), but TSP produced larger reductions on hard floors (5%; 95% CI, -12 to 19%) and window sills (8%; 95% CI, -5 to 20%). TSP/HEPA produced larger reductions on window sills (28%; 95% CI, 18-37%) and larger reductions on window troughs (2%; 95% CI, -24 to 23%), whereas the non-TSP/non-HEPA method produced larger reductions on hard floors (13%; 95% CI, -5 to 34%). Because neither vacuum nor detergent produced consistent results across surface types, the use of low-phosphate detergents and non-HEPA vacuums in a temporary control measure is supported.

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A Randomized Trial of the Effect of Dust Control on Children's Blood Lead Levels. † 627

Cited by 19 publications

References 10 publications

A Coordinated Relocation Strategy for Enhancing Case Management of Lead Poisoned Children: Outcomes and Costs

A Coordinated Relocation Strategy for Enhancing Case Management of Lead Poisoned Children: Outcomes and Costs

The effect of interior lead hazard controls on children's blood lead concentrations: a systematic evaluation.

Comparison of home lead dust reduction techniques on hard surfaces: the New Jersey assessment of cleaning techniques trial.

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