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Despite Progress, Lead Exposure Problems Persist in Twin States

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    Chad Dole, 42, sits on his Claremont, N.H. porch near the cracking evidence of lead paint on a window frame Friday, May 6, 2016. Dole has been working as a painter since age 16 and just started his own painting business in 2015. He took a renovation, repair and painting certification course for handling lead based paintslast summer and says he subscribes strictly to EPA rules. "It is kind of tedious," he said of requirements like changing his plastic drop cloths daily and changing his clothes in a plastic curtained booth before leaving a job site. "Following the law can cost you a lot of money, but if you don't follow it, you can end up spending a lot more," he said of potential fines and negative health effects. (Valley News - James M. Patterson) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com. Valley News — James M. Patterson

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    Chad Dole, 42, has been working as a painter since age 16 and just started his own painting business in 2015. He took a renovation, repair and painting certification course for handling lead based paintslast summer and says he subscribes strictly to EPA rules. "It is kind of tedious," he said of requirements like changing his plastic drop cloths daily and changing his clothes in a plastic curtained booth before leaving a job site. "Following the law can cost you a lot of money, but if you don't follow it, you can end up spending a lot more," he said of potential fines and negative health effects. (Valley News - James M. Patterson) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

Valley News Staff Writer
Published: 5/8/2016 12:12:45 AM
Modified: 5/8/2016 6:44:16 PM

Lebanon — Pediatrician James Sargent recalls the puzzlement when high levels of lead showed up in the blood of some young patients in Vermont and New Hampshire, where he was a lead-poisoning consultant to the state.

They didn’t seem to be ingesting or inhaling lead from flaking or peeling house paint, which is the most common source of such poisonous exposures. No other source was readily apparent.

Eventually, the mysteries were solved.

One case of lead exposure was traced back to solders in old boilers that had been used for maple sap, he said. While the sap wasn’t sufficiently acidic to leach out lead in those solders, the boilers had been used to sterilize apple juice, which was acidic. The unintended consequence was lead-laced apple juice.

Another case was traced back to a wood stove where ash had accumulated from the burning of boards from an old house covered with lead paint. That ash was spread on driveways and yards for de-icing, and another lead exposure occurred.

Solutions of these small mysteries have not pierced a bigger mystery, here and around the country: how to eliminate exposure to lead, especially among young children who are, typically, both more likely than their elders to ingest or inhale lead and more vulnerable to a wide range of health dangers.

And a lot of lead — which, until recently, was widely used to make paint and other products and as a gasoline additive — has been left behind.

The public health threat posed by lead is no mystery. “Exposure to lead can seriously harm a child’s health,” according to the U.S. Centers for Disease Control and Prevention. Lead raises a child’s risks for brain and nervous system damage, slows growth and development and causes problems with learning, behavior, hearing and speech, the CDC warns.

More than 1,000 children in the Twin States recently have been identified as having elevated lead blood levels.

In Vermont, statewide screening in 2015 identified 505 children under the age of 6 with lead blood levels above 5 micrograms per deciliter, which the CDC uses as a reference level to determine that children are “at risk and that public health actions should be initiated.” The testing found 73 children with more than twice that amount of lead in their blood.

In New Hampshire, where testing reaches a much smaller share of the state’s children, screening during 2014 identified 855 children under the age of 6 who had lead blood levels above 5 micrograms per deciliter, including 60 whose levels exceeded 10 micrograms, according to the state Health and Human Services Department’s annual lead exposure surveillance report.

Two children had lead blood levels above 45 micrograms, and one received chelation treatment at a Manchester hospital, according to HHS.

“Chelation is a chemical process in which a substance is delivered intravenously (through the veins) to bind atoms of metals or minerals, and hold them tightly so that they can be removed from the body,” according to the CDC. Chelation is recommended only for patients with especially high blood lead levels.

Nationally, the threat of lead poisoning has been reduced but not eliminated, according to the National Center for Healthy Housing. “The percentage of children who have been lead-exposed is much lower than it was in the 1980s,” according to the center’s website. “Yet lead exposure remains a threat for far too many people.”

Many of those at risk are children. “No safe blood lead level in children has been identified,” the CDC says. “Even low levels of lead in blood have been shown to affect IQ, ability to pay attention, and academic achievement. And effects of lead exposure cannot be corrected.”

Lead is an environmental legacy of the economic development. “Industry mined massive quantities of lead over the last century and put that lead into many products that went into our homes, including lead pipes and solder, paints and glazes, and other consumer products,” according to the National Center for Healthy Housing, a nonprofit advocacy organization funded by foundations, banks and government agencies.

“By the 1950s, lead — a dangerous neurotoxin once buried deep in the ground, far away from humans — had polluted the entire planet,” David Rosner, codirector of Columbia University’s Center for the History and Ethics of Public Health, wrote recently in the journal Health Affairs.

Lead has entered the environment through many portals. “Although lead was banned from new residential paint in 1978 and from new plumbing in 1986, residents may still be exposed to lead from products that remain in older homes,” according to the National Center. “Lead was also added to gasoline for on-road use until 1996.”

Recent revelations that elected officials and public health overseers sat on their hands after discovering high levels of lead in drinking water throughout Flint, Mich., and in public schools in Newark, N.J., produced a spike in public awareness of a long-standing health threat.

In April, the portion of Americans who considered drinking water contamination an “extremely serious” health problem rose to 35 percent.

Among those polled, the level of concern about water trailed only cancer (43 percent) and matched heroin abuse, according to the new survey by the Kaiser Family Foundation.

But drinking water doesn’t pose the main lead threat. Wrote Rosner: “Lead paint on the walls of virtually all buildings built before the 1950s is undoubtedly an even more pervasive hazard to children whose lead-tainted fingers end up in their mouths.”

Nationally, there are at least 4 million households where children are being exposed to high levels of lead, according to the CDC.

In New Hampshire, as many as 300,000 housing units contain lead hazards, and children under 6 live in 18,000 of those units, according to the state Health and Human Services Department.

In Vermont, 69 percent of the houses were built prior to the 1978 ban on the residential use of lead paint, according to the state Health Department.

Sargent, the pediatrician, said all rental housing should be subject to lead inspection, abatement and maintenance standards codified by the U.S. Department of Housing and Urban Development. Currently, those standards are binding only on the owners of about 3 million housing units that receive various HUD subsidies.

In the absence of universal federal standards, much of the work of removing lead from the environment has fallen to state and local governments.

Currently, 44 states have laws to regulate lead hazards, according to the National Conference of State Legislatures.

In Vermont, a law passed in 1996 and amended in 2008 requires owners of rental apartments and houses built before 1978 to notify tenants of the dangers of lead and complete annual inspections and cleanups.

But the law’s bark may be worse than its bite. Last week, Vermont Attorney General William Sorrell announced a pair of civil settlements, including $20,000 fines, with a private landlord in Rutland and a nonprofit housing organization in Bennington. Each landlord admitted to certifying inspections of properties where paint was deteriorating.

Each fine was reduced to $1,000 due to the property owner’s “demonstrated inability to pay the full penalty.”

So in a region with aging housing supplies, lead paint remains a fact of life, and advocates and public health experts have pushed for screening programs that look for lead in the blood of young children.

Screening programs generally rely on pediatricians to order tests. Parents can also request testing. Laboratories analyze blood samples, and send results to state regulators.

States can use the testing data to identify at-risk children and locations, spot new exposure sources, evaluate the effectiveness and timeliness of care and services to affected children and design education campaigns aimed at doctors who care for children, the CDC says.

But the reach of such programs continues to fall short of statutory and regulatory goals. In Vermont, where state law sets a goal of universal testing of all children under the age of 6, testing rates have peaked at about 80 percent. In New Hampshire, where the law mandates screening of designated populations of vulnerable children, testing rates remain much lower.

In the Twin States, testing has produced some evidence of progress. In Vermont, the percentage of 1- and 2-year-olds with blood lead levels above 10 micrograms per deciliter fell from about 2.5 percent in 2006 to just under 1 percent in 2014.

In New Hampshire, the number of children with blood lead levels over 5 micrograms per deciliter fell from 4,415 in 2009 to 855 in 2014, according to HHS.

But still, hundreds of children in each state have been harmed by lead exposures, and screening programs continue to miss many children.

That’s even true even in Vermont, where universal testing is written into statute and a recent Health Department report affirmed that “testing young children for lead in blood is a critical step in the process of reducing the incidence of elevated blood levels.”

Last year, 4,905 of the state’s 6,104 1-year-olds were tested, a rate of 80.4 percent, while the blood of 4,151 of the 6,101 2-year-olds was analyzed, a 68 percent rate, according to a report to the Legislature from the state Health Department.

Testing rates for 1-year-olds have fluctuated around 80 percent for the past decade, but increased for 2-year-olds, from about 44 percent a decade ago to a peak of 72 percent in 2014, the report said.

The state’s push for universal screening has been stymied by funding limitations, lack of insurance coverage, misconceptions about who should be tested and some “parental opposition,” the report said.

Screening reached an even smaller portion of the children in New Hampshire, which has a more limited goal of testing all children who live in 133 high-risk communities or are covered by Medicaid. Statewide, only 52.5 percent of 1-year-olds and 26.4 percent of 2-year-olds were tested in 2014, according to HHS. The total number of children tested declined from more than 15,000 in 2009 to under 13,700 in 2014.

Local lead testing rates were lower still. In Grafton County, only 37 percent of 1-year-olds and 20 percent of 2-year-olds were screened in 2014. Sullivan County tested 49 percent of 1-year-olds and 28 percent of 2-year-olds. Altogether, 646 Grafton and 478 Sullivan county children under the age of six were tested that year.

Two Upper Valley cities were on HHS’ list of eight “highest risk communities”: Newport, where only 43.3 percent of 1-year-olds and 22.4 percent of 2-year-olds were screened, and Claremont, where screening rates slightly exceeded the statewide average.

In Claremont, 28 children under the age of 6 had lead blood levels above 5 micrograms per deciliter, while there were nine in Newport.

In 2015, 19 of the 32 New Hampshire cities, towns and villages in the Upper Valley were designated as “high risk” for lead poisoning by HHS.

That designation is given to jurisdictions where more than 27 percent of the housing stock was built before 1950, when paint suppliers began to voluntarily reduce lead use.

A New Hampshire law passed in 2015 authorized the state Health Department to write rules that would require primary care doctors to screen and educate their patients.

The rules would take effect if screening rates fell short of 85 percent of children who live in high-risk communities or are covered by Medicaid or other government anti-poverty programs. The law also established a 19-member commission — including four landlords and three pediatric providers — to oversee blood testing of children and maintenance and abatement in old housing units.

William Storo, the president of the New Hampshire Pediatric Society and a member of the new commission, said the new law was “a step forward.”

“It’s really trying to look for ways to identify the lead sources and to abate them,” he said.

But in New Hampshire, as elsewhere in the fragmented and uneven nationwide battle against lead, progress has a stark measure. As Rosner noted, “The blood of exposed children is still officials’ primary means of identifying a dangerous home.”

So childhood screening shouldn’t be viewed as a final answer to lead dangers, Sargent said: “Rather than screening kids, we ought to be screening houses.”

Rick Jurgens can be reached at rjurgens@vnews.com or 603-727-3229.




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