DOCUMENT RESUME ED 324 135 PS 019 125 TITLE The Nature and Extent of Lead Poisoning in Children in tLe United States: A Report to Congress. INSTITUTION Agency for Toxic Substaaces and Disease Registry (DHHS/PHS), Atlanta, GA. PUB CATE Jul 88 NOTr' 603p. PUB TYPE Reports Research/Technical (143) EDRS PRICE MF03/PC25 Plus Postage. DESCRIPTORS At Risk Persons; *Child Health; Females; Hazardous Materials; *Incidence; Intervention; *Lead Poisoning; *Metabolism; National Surveys; *Pollution; *Pregnancy; Public Health; Regional Characteristics; Research Methodology; Research Needs; Tables (Data); Toxicology; Wastes ICENTIFIERS Pollutant Concentrations; *Pollutants; Screening Programs; Soil Restoration ABcTRAC- This national study on lead poisoning in children is organized in three parts. Part 1 provides an executive summary. Part 2 presents background information, an overview, findings, and conclusions. Part 3, which constitut.as the bulk of the report, discusses terms, issues, and findings concerning lead metabolism, its relationship tc lead exposure and adverse effects of lead, and adver..e health effects of lead in relationship to public health rick and societal well-being. Also discussed are the number of children exposed to lead in the United States; numbers of children exposed to lead according to lead source; numbers of women of child bearing age and pregnant women exposed to lead; low-level lead sources and children's aggregate exp-sure to lead; methods and alternatives for reducing environmental exposure to lead for young children and related risk groups; environmental releases of lead as evaluated under the Superfund Amendments and Reauthorization Act of 1966; and exposure to lead and toxicity in children and other related groups. Information gaps, research needs, and recommendations are discussed. Appendices provide numerous tables of data, a draft report on lead-contaminated soil cleanup, the final and proposed national priorities list of waste sites with lead as a contaminant, and methodological details of blood-lead prevalence projections from the National Health and Nutrition Examination Survey II data. References number 255.(RH) * * * * * * * * * * ** * * * * * * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * * lc * * * * * * * * * * * * * * * * * lc * * * Reproductions supplied by EDRS are the 'oest that can be made * from the original document. * kk,c,c.****************************************************************** U & DEPARTMENT OF EDUCATION Office d Educat.0.111rifseamt. and Impontenent EoucanoNAL RESOURCES INFORMATION CENTER !ERIC) Xnus clocumintMa bean 400400uCe0 ,eCenni0 hewn the 004son 04 orgarnshon Onmat.eq C k4.04 Cha4Vos face Octc nude to wnorove ,I104000ebo Quithty 004 nt 01 rte.* C4 0044400a SIlI.dn !Ns 0Car men! 00 not heCeseardy represent OlCtil Cr.. Of RI 00Sthue 04 pattcy CrD ir4 immanimmaiiiimmummestematim CliT4 The Nature and Extent of Lead Poisoning inChildren in the United States: A Report to Congress 'PERMISSION TO REPRODUCE THIS MATERIAL HAS BEEN GRANTED BY TO THE EDUCATIONAL RESOURCES INFORMATION CENTER (ERIC)- THE NATURE AND EXTENT OF LEADPOISONING IN CHILDREN INTHE UNITED STATES: A REPORT TOCONGRESS Agency for Toxic Substances and DiseaseRegistry Public HealthService U.S. Department of Health andHuman Services July 1988 : DISCLAIMER ckes not constitute Mention of the name of anycompany or product Disease Registry. endorsement by the Agencyfor Toxic Substances and 4 i i .7-. PREFACE Section 118(f) of the Superfwld Amendments and Reauthorization Act (SARA) of 1986 (42 U.S.C. 9618(0) required the Agency for Toxic Substances and Disease Registry (ATSDR) of the U.S. Public Health Service to prepare a study of lead poisoning in children. Congress specifically requested that the following issues be addressed, as stated in SARA Section 118(f): (f) Study of Lead Poisoning in Children-- (1) The Administrator of the Agency for Toxic Substances and Disease Registry shall, in consultation with the Administrator of the Environmental Protec- tion Agency and other officials as appropriate, not later than March 1, 1987, submit to the Congress, a report on the nature and extent of lead poisoning in children from environmentalsources. Such report shall include, at a minimum, the following information-- (A) an estimate of the total number of children, arrayed according to Standard Metropolitan Statistical Area or other appropriate geographic unit, exposed to environmental sources of lead At concentrations sufficient to cause adverse health effects; (B) an estimate of the total number of children exposed to environ- mentalsources of lead arrayed according to source or source types; (C) a statement of the long term consequences for public health of unabated exposures to environmental sources of lead and including but not limited to, diminution in intelligence, increases in morbidity and mortality; and (0) methodsand alternatives availablefor reducing exposures of children to environmental sources of lead. (2) Such reportshall also score and evaluate specific sites at which children are known to be exposed to environmental sources cf lead due to releases, utilizing the Hazard Ranking System of the National Priorities List. !11 (3) The costs of preparing and submitting the report required by this secticn shall be borne by the Hazardous Substance Superfund established under sub- chapter A of chapter 98 Internal Revenue Code of 1954. Since much of the data needed for this report was not readily available in an appropriate format in the peer-reviewed literature, but was developed specifically for this report, a postponement of the original deadline (March 1, 1987) was granted to ATSDR. The report has undergone extensive peer review by external peer reviewers' and a Federal ad hoc pane1.2 The ATSDR appreciates the efforts of the consultant aLthors and peer reviewers in developing this report; the final document, as a culmination of this process,is the sole responsibility of ATSDR in fulfillment of its Congressional mandate (see Acknowledgments, page xix). The ATSDR considers this report to be a significant milestone in the public's understanding of the widespread distribution and effects of childhood lead poisoning. As with all reports to Congress, the recommendations within this report-must be weighed against other competing priorities. 'External peer reviewers are listed on pages xx-xxi. 2Members of the Federal ad hoc panel are listed on pages xxii-xxiii. i v IMMIGIAJ CONTENTS Page TABLES xi FIGURES xvi AUTHORS AND CONTRIBUTORS xvii ACKNOWLEDGMENTS xix NONFEDERAL PEER REVIEWERS xx FEDERAL AD HOC ADVISORY COMMITTEE xxii PART 1 EXECUTIVE SUMMARY 3. A. RESPONSE TO DIRECTIVES OF SECTION 118(f)OF SARA 3 1. Section 118(f)(1)(A) 3 2. SectiGn 118(f)(1)(B) 6 3. SeLtion 118(0(1)(f) 9 4. Section 118(f)(1)(D) 11 5. Section 118(0(2) 13 B. SUMMARY OF REPORT RECOMMENDATIONS 13 C. ISSUES, DIRECTIONS, AND THE FUTUREOF THE LEAD PROBLEM 15 1. Issues 15 2. Directions and Foture of the Lead Problem 16 PART 2 CHAPTER I. REPORT FINDINGS, CONCLUSIONS, AND OVERVIEW I-1 A. BACKGROUND INFORMATION TO THE REPORT 1-2 1. Historical Perspectives and Discussion of Important Issues 1-2 2. Lead Metabolism and its Relationshipto Exposure, Risk Population Identification andAdverse Health Effects 1-3 3. Adverse Prenatal and Postnatal Effects ofLead in Children: Relationship to PublicHealth Risk and Their Relative Persistence 1-6 B. MAIN REPORT: QUANTITATIVE EXAMINATION OF LEAD EXPOSURE AND TOXICITY RISK IN CHILDREN AND PREGNANTWOMEN AND STRATEGIES FOR ABATEMENT 1-8 1. Ranking of Lezd-Exposed Children by GeographicArea I-10 2. Numbers of Lead-Exposed Children by Lead Source 1-15 3. Number of Women of Childbearing Age and Pregnant Women 1-21 4. The Issue of Low-Level Lead Sources and AggregateLead Exposure of Children in the United States 1-23 5. Lead Exposure Abatement Strategies and Alternatives 1-24 Lead in Paint 1-25 Lead in Ambient Air 1-27 Lead in Dust and Soil 1-27 Lead in Drinking Water 1-28 Lead in Food 1-29 Nutritional Measures in Primary Prevention ofLead Exposure 1-30 CONTENTS (continued) Page Secondary Exposure Prevention Measures 1-31 Secondary Nutritional Measures 1-34 Extra-Environmental Prevention Measures 1-34 of Lead Under 6. A Review of Environmental Releases 1-34 Superfund Recommendations 1-36 7. Information Gaps, Research Needs, and 1-37 Information Gaps 1-38 Research Needs 1-39 Recommendations 1-39 1. Lead in the Environment ofChildren 1-41 2. Lead in the Qodies of Children 1-42 C. CONCLUSIONS AND OVERVIEW 1-42 1. Lead as a Public Health Issue 1-43 2. Lead in the Environment ofChildren 1-45 3. Lead in the Bodies of Children Children in the 4. The Extent of Lead Poisoning in 1-46 United States The Extent of 5. The Problem If In Utero LeadToxicity: Fetal Leau Exposure in the UnitedStates 1-48 6. Removal or Reduction of Lead in theChild's 1-49 Environment Public Health Problem 1-50 7. Future Directions of Lead as a PART 3 AND ISSUES CHAPTER II INTRODUCTION AND DISCUSSION OF TERMS A. INTRODUCTION B. DISCUSSION OF TERMS AND ISSUES at Greatest Risk for 1. Young Children and Other Groups Lead Exposure and AdverseHealth Effects Children and Other 2. Monitoring Lead Exposure in Young Risk Populations United States with 3. Environmental Sources of Lead in the Reference to Young Children andOther Risk Groups in Young Children and 4. Adverse Heallh Effects of Lead Other Risk Groups and Their Rolein Health Risk Assessment LEAD METABOLISM AND ITSRELATIONSHIP TO LEAD EXPOSURE CHAPTER III. III-1 AND ADVERSE EFFECTS OF LEAD III-1 A. LEAD ABSORPTION IN HUMANPOPULATIONS Human Populations III-1 1. Respiratory Absorption of Lead in Gastrointes.:.inal (GI) Absorption ofLead in Human 2. 111-2 Populations in Human Populations ... 111-4 3. Percutaneous Absorption of Lead Transplacental Transfer and FetalUptake of Lead in 4. 111-4 Pregnant Women 111-5 DISTRIBUTION OF ABSORBED LEAD IN THEHUMAN BODY B. 111-6 Lead Uptake in Soft Tissue 1. 111-7 2. Lead Uptake in MineralizingTissue vi CONTENTS (continued) C. LEAD EXCRETION AND RETENTION IN HOMAN POPULATIONS 111-7 D. METABOLIC INTERACTIONS OF LEAD WITH NUTRIENTS ANDOTHER ACTIVE FACTORS IN HUMAN POPULATIONS 111-9 E.