Housing With Lead Risk in North Carolina

North Carolina

Lead, a naturally occurring heavy metal, is highly toxic in large amounts, especially for young children and pregnant women. Lead exposure can occur through inhalation, ingestion or skin contact and is found in many places, including in older homes, water pipes and soil. Once lead has been introduced to the human body, it is absorbed by the bloodstream and spread throughout the rest of the body, where it can affect other organs and tissues.

There is no known safe level of lead exposure. In 2021, the Centers for Disease Control and Prevention (CDC) lowered the blood lead reference value — the threshold for identifying unsafe levels of lead in the blood — to 3.5 μg/dL. Studies found that even low levels of lead, far below the previous threshold of 10 µg/dL, are detrimental to cognitive development in children and can negatively impact intellectual function, attention-related behaviors and academic and cognitive skills well into adolescence and adulthood. 

High blood lead levels during pregnancy can be passed onto the developing fetus, which may cause miscarriages, low birth weight infants, preterm births and other congenital disabilities. 

Housing built before 1978 carries an elevated risk for lead exposure, and housing built before 1950 has the highest risk of lead exposure. Due to a ban on lead-based paint in 1978, housing built after this year carries minimal risk. The United States Department of Housing and Urban Development estimated that 89% of the 34.6 million homes with lead paint were built before 1978.

A study of young children ages 6 months to 2 years found that interior renovation of older homes — which often includes painting, sanding, scraping or other activities that might release lead dust into the air — further increased risk of lead poisoning. Over 3 million homes with children younger than age 6 had one or more lead-based paint hazards in 2021, 2.1 million of which were low-income households. Investing in lead paint hazard control for communities at high risk could provide a return of $17-$221 in societal and health costs for each $1 spent.

Populations most vulnerable to environmental lead exposure include:

• Children younger than age 6, who tend to put their hands on objects that may be contaminated with lead dust.
• Low-income households. Among low income households, those without government housing assistance have a higher prevalence of lead-based paint hazards than those receiving housing assistance.
• Those who live in the Northeast and Midwest regions, where the housing is older and has significantly higher levels of lead-based paint and lead-based paint hazards.

Strategies to reduce the negative consequences of lead exposure include:

• Reducing lead hazards (or permanently eliminating them through lead abatement). Because the adverse health effects of lead exposure are permanent, primary prevention is the only effective way to prevent lead toxicity in children.
• Providing lead exposure education for parents of young children during routine check-ups. This education should include sources of lead exposure and best practices for harm and risk reduction, including keeping children away from peeling paint and frequently washing hands, toys, and other items children place in or near their mouths. 
• Screening children for exposure via blood lead test at 12 and 24 months of age. Federal law mandates screening all children covered by Medicaid. For those not covered by Medicaid, the CDC recommends concentrating efforts on high-risk populations at the state and local level. 
• Removing leaded drinking water pipelines from homes.
• Eliminating lead from airplane fuel.
• Increasing compliance with the EPA’s lead-safe initiative. 

The Association of Maternal and Child Health Programs maintains a Lead Poisoning Prevention Toolkit for agencies working to prevent lead exposure.

Healthy People 2030 has two objectives related to reducing lead exposure:

• Reducing blood lead levels in children ages 1-5.
• Reducing lead exposure among the population.

Bellinger, David C. “Very Low Lead Exposures and Children’s Neurodevelopment.” Current Opinion in Pediatrics 20, no. 2 (April 2008): 172–77. https://doi.org/10.1097/MOP.0b013e3282f4f97b.

Cox, David C., Gary Dewalt, Robert O’Haver, Jonathan Bielli, Peter J. Ashley, Warren Friedman, and Eugene A. Pinzer. “American Healthy Homes Survey II: Lead Findings.” Washington, D.C.: U.S. Department of Housing and Urban Development, Office of Lead Hazard Control and Healthy Homes, October 29, 2021. https://www.hud.gov/sites/dfiles/HH/documents/AHHS%20II_Lead_Findings_Report_Final_29oct21.pdf.

Gould, Elise. “Childhood Lead Poisoning: Conservative Estimates of the Social and Economic Benefits of Lead Hazard Control.” Environmental Health Perspectives 117, no. 7 (July 2009): 1162–67. https://doi.org/10.1289/ehp.0800408.

Jordan, Catherine M., Becky L. Yust, Leslie L. Robison, Peter Hannan, and Amos S. Deinard. “A Randomized Trial of Education to Prevent Lead Burden in Children at High Risk for Lead Exposure: Efficacy as Measured by Blood Lead Monitoring.” Environmental Health Perspectives 111, no. 16 (December 2003): 1947–51. https://doi.org/10.1289/ehp.6352.

Lanphear, Bruce P., Kim Dietrich, Peggy Auinger, and Christopher Cox. “Cognitive Deficits Associated with Blood Lead Concentrations <10 Pg/dL in US Children and Adolescents.” Public Health Reports 115, no. 6 (2000): 521–29. https://doi.org/10.1093/phr/115.6.521.

Lanphear, Bruce P., Richard Hornung, Jane Khoury, Kimberly Yolton, Peter Baghurst, David C. Bellinger, Richard L. Canfield, et al. “Low-Level Environmental Lead Exposure and Children’s Intellectual Function: An International Pooled Analysis.” Environmental Health Perspectives 113, no. 7 (July 2005): 894–99. https://doi.org/10.1289/ehp.7688.

Roberts, David J., Sally M. Bradberry, Frances Butcher, and Araceli Busby. “Lead Exposure in Children.” BMJ 377 (April 7, 2022): e063950. https://doi.org/10.1136/bmj-2020-063950.

Ruckart, Perri Zeitz, Robert L. Jones, Joseph G. Courtney, Tanya Telfair LeBlanc, Wilma Jackson, Mateusz P. Karwowski, Po-Yung Cheng, Paul Allwood, Erik R. Svendsen, and Patrick N. Breysse. “Update of the Blood Lead Reference Value — United States, 2021.” MMWR. Morbidity and Mortality Weekly Report 70, no. 43 (October 29, 2021): 1509–12. https://doi.org/10.15585/mmwr.mm7043a4.

Spanier, Adam J., Stephen Wilson, Mona Ho, Richard Hornung, and Bruce P. Lanphear. “The Contribution of Housing Renovation to Children’s Blood Lead Levels: A Cohort Study.” Environmental Health 12 (August 27, 2013): 72. https://doi.org/10.1186/1476-069X-12-72.

Washington State Department of Health. “A Targeted Approach to Blood Lead Screening in Children, Washington State: 2015 Expert Panel Recommendations.” Washington State Department of Health, Division of Environmental Public Health, Office of Environmental Public Health Sciences, Environmental Epidemiology Section; Childhood Lead Poisoning Prevention Program, May 2016. https://doh.wa.gov/sites/default/files/legacy/Documents/Pubs//334-383.pdf.

Wengrovitz, Anne M., and Mary Jean Brown. “Recommendations for Blood Lead Screening of Medicaid-Eligible Children Aged 1--5 Years: An Updated Approach to Targeting a Group at High Risk.” MMWR. Recommendations and Reports 58, no. RR-9 (August 7, 2009): 1–11. https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5809a1.htm.