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childhood lead poisoning prevention branch

ā€‹ā€‹Sources of Lead Exposure for Full Cases, Fiscal Year 2019 to 2020

ā€‹Page contents:

Key Findings

  • In FY 2019-2020, there were 329 new children meeting full case criteria, however, only 248 children (75%) received full case management services (both PHN visit and on-site environmental investigation), mainly due to COVID. Of these 248 children, 82.3 percent were less than 6 years old, 52 percent were male, and 44.8 percent were Hispanic.
  • Major sources of lead exposure differed significantly by race/ethnicity.
    • Housing-related sources (paint, dust, soil, water) of lead were the main exposure sources among non-Hispanic Black children.
    • Non-housing sources of lead were the main exposure sources among non-Hispanic Asian children or non-Hispanic White children with Afghan origin.
    • Unlike non-Hispanic children, both housing and non-housing sources of lead were commonly identified among Hispanic children.
    • ā€‹Lead found in food, spice and drinks, cosmetic and spiritual products, pottery/utensils, and take-home/occupational were commonly identified non-housing exposures in racially and ethnically diverse populations.ā€‹

Introduction

The Childhood Lead Poisoning Prevention Branch (CLPPB) analyzed sources of lead exposure for children who were newly identified as full cases in FY 2019-2020 and consented to full case management, including environmental services. Every child meeting the full case definition is eligible to receive both public health nurse (PHN) case management services and an environmental investigation (EI) by an environmental professional (EP). During an EI, the EP assesses the child's environment for lead exposure sources in paint, dust, soil, and water, and documents the results. The PHN performs a visit to the family often at the same time as the EI, which includes collecting information to evaluate and coordinate the necessary services. Non-housing items may also be collected and sent for laboratory analysis. ā€œNon-housing sources" are sources of lead exposure other than housing-related paint, dust, soil, and water. In FY 2019-2020, due to the COVID-19 pandemic, an initial EI started as a remote exposure assessment by a structured questionnaire on the phone. The PHN visit and REA findings were reviewed and discussed at CLPPB, and EIs were done if the visit could not be deferred.

When housing-related lead sources are identified, EPs work with property owners to ensure the properties are remediated expediently. Properties remain open to follow up until the property passes a clearance inspection. A successful clearance inspection includes, at a minimum, a visual inspection to verify all required work was completed properly, as well as collection and analysis of dust wipe samples. For full cases where paint, dust, soil, and/or water were identified as a source, CLPPB reviewed whether the sources of lead exposure were removed, remediated, or abated. ā€‹

Methods

In this analysis, only children with blood lead levels (BLLs) meeting the full case criteria during FY 2019-2020 who received full case management, including an on-site environmental investigation, were included. As of July 1, 2016, children meet full case criteria with either a single venous blood lead level (BLL) at or above 14.5 micrograms per deciliter (Āµg/dL) or persistent levels at or above 9.5 Āµg/dL. Data on blood lead results were gathered from the Response and Surveillance System for Childhood Lead Exposures (RASSCLE) database.  

Exposure assessment data came from two sources:  
(1) EPs collected samples and information about housing-related sources of lead exposure, such as paint, dust, soil, and water as well as non-housing items.  The lead content in these samples (except water) were measured by X-Ray Fluorescence (XRF) screening by EPs, as well as quantitatively in the environmental health laboratories.  
(2) PHNs collected information about non-housing sources of lead exposure, such as the child's behavior, food, products used for cooking, and alternative medicines, using a structured questionnaire during the PHN visit.   

Race/ethnicity data were also collected by the PHN during the visit. CLPPB collects race/ethnicity data in a two-question format similar to the Federal Office of Management and Budget (OMB) race and Hispanic ethnicity categorizations. Race/ethnicity data collection was based on a parent's report of the child's identity with the ability to select all applicable races and one applicable ethnicity. Race category choices in the lead follow-up forms were:  

  • Native American/Alaskan 
  • Black/African American 
  • White 
  • Asian  
  • Pacific Islander 
  • Other 
  • Decline to state.  

If a parent identified the child as Asian or Pacific Islander, they were asked to further select from more detailed categories of Asian and Pacific Islander races. If the parent identified the child as ā€œOther" race, they were asked to specify. Ethnic background categories were:  

  • Not Hispanic/Spanish/Latino 
  • Yes, North American (Mexican, Mexican American) 
  • Yes, Central American 
  • Yes, South American 
  • Yes, other Spanish/Hispanic/Latino.  

ā€‹Answers to 'Country of birth' question were also used to help race/ethnicity categorization for data analysis when needed. CLPPB followed the California Department of Public Health vital statistics reporting categories for race/ethnicity for the data analysis: Mutually exclusive race/ethnicity categories were: 

  • Non-Hispanic Asian  
  • Non-Hispanic Black 
  • Non-Hispanic Hawaiian/Pacific islander  
  • Hispanic (single race)  
  • Multi-race (any ethnicity)  
  • Non-Hispanic Native American/Alaskan 
  • Non-Hispanic Other
  • Non-Hispanic White   
  • Declined or Unknown.   

ā€‹If a parent identified the child's race only as 'Other' and chose any of the 'Yes' Hispanic ethnicity options, then the child was categorized as Hispanic (single race). If multiple race categories were checked, then regardless of Hispanic ethnicity status, the child was categorized as Multiā€‘race (any ethnicity). For simplicity, Hispanic (single race) children will be described hereafter as Hispanic children, and non-Hispanic children will be described by their race category alone (e.g., non-Hispanic Asian children will be referred to as Asian children). In FY 2019-2020, there were 47 children with Afghan origin. They mostly identified themselves as 'White', 'Asian' or 'Other' and specified as Afghan. In this analysis, Afghan and all other Middle Eastern/North African children were categorized as 'White' following OMB guidelines. Of the 65 White children, 47 (72.3%) were Afghan, and sources of lead exposure differed by Afghan origin.  For this reason, the White race category was stratified as Afghan and non-Afghan.  Similarly, the Asian race category was stratified as Asian Indian and other Asian.

ā€‹ā€‹ā€‹CLPPB reviewed EI documentation to identify housing-related sources associated with full cases. For each investigation, CLPPB measured lead in deteriorated paint, dust, and bare soil. Results of first- and second-draw water samples from kitchen sinks were also recorded, as well as water draws from other frequent drinking water locations. Paint, dust, and soil were categorized as lead exposure sources based on regulatory levels found in Title 17, California Code of Regulations (CCR), beginning with Section 35001. The Los Angeles County local health jurisdiction also categorized housing-related sources with their own regulatory statutes (Los Angeles County Code Section 11.28.010). Water results were categorized as exposure sources based on the United States Environmental Protection Agency (US EPA) action level (40 Code of Federal Regulations [CFR] Section 141.80). EPs identified lead housing-related sources based on direct known exposure to lead-poisoned children, including media below current regulatory standards but found to be significant based on a child's specific behavior and activity (Table 1).

Table 1. Definitions of Housing-Related Sources of Lead Exposure 

Type of housing-related source Current Regulatory Level Lower ā€œActionable" Level 
Paint  
Deteriorated lead-based paint tested at the state regulatory level of greater than or equalā€‹ to 1.0 milligram of lead per square centimeter of surface area (ā‰„ 1.0 mg/cm2). In addition, full cases were attributed to paint at local regulatory level in Los Angeles at ā‰„ 0.7 mg/cm2. (17 CCR Sections 35022, 35033, 35037; Los Angeles County Code Section 11.28.010). 
Paint was considered a source in situations where paint was below the regulatory level but found to be nuisance that may result in persistent and quantifiable lead exposure (17 CCR Section 35037). 		Paint with lead ā‰„ 600 parts per million (ppm) was used. In 1978, the federal Consumer Product Safety Commission (CPSC) restricted lead in newly manufactured paint to 600 ppm. Additionally, 600 ppm is the level petitioners to the US EPA have been seeking to lower the federal definition of lead-based paint. Since there is incongruence of unit equivalency between ppm and mg/cm2, the level chosen for XRF instruments was 0.1 mg/cm2, which is the lowest level detectable to the tenths place in order to be most health protective.  
Dust Lead-contaminated at greater than or equal to 40 micrograms of lead per square foot of surface area (ā‰„ 40 mcg/ft2) for interior floor surfaces, ā‰„ 250 mcg/ft2 for interior horizontal surfaces, and ā‰„ 400 mcg/ft2 for exterior floor and exterior horizontal surfaces (17 CCR Sections 35035, 35037). Lead levels ā‰„ 10 mcg/ft2 for interior floor surfaces, and ā‰„ 100 mcg/ft2 for interior horizontal surfaces were selected to match changes in federal dust standards that took effect January 6, 2020 but were not in effect at the time when some of the cases received services. 
Soil Lead-contaminated at greater than or equal to 400 parts per million (ā‰„ 400 ppm) in children's play areas. 
Soil was considered a source in situations where soil was below the regulatory level but found to be a nuisance that may result in persistent and quantifiable lead exposure (17 CCR Section 35037). 		Bare soil with ā‰„ 80 ppm was used in order to match California Human Health Screening Levels (CHHSLs) proposed by the California Office of Environmental Health Hazard Assessment. The current CHHSL for lead in soil for residential property is 80 ppm. 
Water According to the US EPA Federal Lead and Copper Rule, greater than or equal to 0.015 milligrams of lead per liter of water (ā‰„ 0.015 mg/L) is above the action level (40 CFR Section 141.80). Drinking water ā‰„ 0.005 mg/L was selected for consistency with the goal for water to show non-detect levels of lead. Since this level was the laboratory reporting limit, results below this level would not be available from laboratory reports used in the sample of cases selected. ā€‹

Table 2. Categories and Examples of Non-housing Sources of Lead Exposure 

Category Examples  
Cosmetics/Spiritual Religious Products 
Black powder (e.g., kohl, surma, tiro), ceremonial powder, sindoor 
Food/Spices/Drink 
Dried grasshoppers (chapulines), turmeric, khmeli sunā€‹eli, lozenna, imported candy 
Take-home or Occupational Exposed through either personal or parental work or hobby 
Pottery & Utensils  Vintage/hand-made/imported pottery, leaded glassware, water dispenser/urn/samovar, food grinder 
Other  Fishing weight, jewelry/charm/amulet, painted object, metal object, lead ammunition, deteriorated vinyl/plastic, game meat/fish (from leaded bullets/sinkers), lead batteries, and lead solder 
Traditional Medicine/ Remedies  Azarcon, greta, ayurvedic remedy (e.g., Ghutti, Keasari Balguti), paylooah, traditional Chinese remedies 
Retained bullet   
Perinatal exposures Mother ate food high in lead during pregnancy, mother took remedy high in lead during pregnancy. 


Aā€‹ā€‹ny EI property found to have a lead housing-related source exceeding current regulatory levels must have it removed, remediated, or abated. Those properties remain open to EP follow-up until the completion of a clearance inspection. Passing a clearance inspection requires visual confirmation that lead housing-related sources have been corrected and quantifiable evidence through dust wipes that no lead-contaminated dust remains. CLPPB reviewed documentation from the corresponding EI properties to assess how many had passed clearance inspection. Acknowledging that children may still be exposed to lead below the current regulatory levels, CLPPB also analyzed housing-related lead exposure sources using lower ā€œactionable" levels (Table 1). These lower levels are based on recent changes in action levels and recommendations and proposals under consideration by regulatory agencies. Lead exposure source categories were then compared by current regulatory levels versus lower ā€œactionable" levels. 

Information reported to CLPPB about non-housing sources (Table 2) was reviewed by a CLPPB physician to determine whether each potential source was a probable source of lead exposure for the child. Determination was based on quantitative XRF and/or laboratory results; results of testing the item with a qualitative method (chemical test kit lead swab); amount, timing, and length of the child's access to the item; and whether there is a significant history of demonstrated high lead content for a given potential source. In addition, the physician considered information about whether removal of the item from the child's environment was associated with a decline in BLL. 

ā€‹ā€‹There may be several lead exposure sources identified for a child ā€‹ā€‹meeting full case criteria. When multiple exposure sources are identified, the exact contribution of each source to the child's initial BLL cannot be determined. CLPPB considered each possible exposure source separately for the child; for example, if both dust and paint levels are found above the regulatory levels, then both dust and paint were considered as possible lead exposure sources.  

ā€‹ā€‹ā€‹CLPPB performed descriptive analyses of demographic characteristics, BLLs, and exposure sources. In addition to identifying the sources of lead exposure, CLPPB analyzed how sources of lead exposure differed by race/ethnicity of the child. To compare the groups, CLPPB used a chi-square test. Statistical significance was defined as p ā‰¤ 0.05. Analyses were done using SAS software, version 9.4 (Copyright Ā© 2017, SAS Institute Inc., Cary, NC, USA). 

Results

ā€‹ā€‹In FY 2019-2020, there were 329 new children meeting full case criteria. Of those 329 new childhood lead cases, 309 children (93.9%) received a PHN visit, and 248 children (75.4%) received full case management services (both PHN visit and on-site environmental investigation). Two hundred and fifty unique properties went through an environmental investigation. In some cases, there were multiple children with case-making BLLs living at the same property. There were several reasons for incomplete PHN visits and/or EIs: persistent refusal (n=35) (of those who refused, 5 specifically stated because of COVID), remote exposure assessment (n=24), moved out of state (n=5), aged-out (n=4), administrative reasons (n=3), false positive (n=3), unable to locate family (n=2), lost-to follow-up (n=1), uncooperative family (n=1), or missing information (n= 3); these children are excluded from results.
The characteristics of children who received full case management services are described in Table 3. Most of the full cases were less than 6 years old (82.3 percent), male (52 percent), and either Hispanic-single race (44.8 percent) or Afghan White (19.0 percent). Of the 248 children who received full services, 5 (2 percent) had a BLL higher than 44.4 Āµg/dL, 172 (69.4 percent) had a BLL between 14.5 and 44.4 Āµg/dL, and 71 (28.6 percent) had a BLL between 9.5 and 14.4 Āµg/dL. 

Table 3. Demographic Characteristics of Full Cases1ā€‹, Fiscal Year 2019-20 (n=248)ā€‹ ā€‹ā€‹

Characteristic: Ageā€‹ā€‹ N=248 Percent (%) 
Less than 6 years 
204 82.3
Between 6 and up to 21 years 44  17.7
Characteristic: Sex N=248 Percent (%) 
Female 
 11948
Male  12952
Characteristic: Race/Ethnicity  N=248 Percent (%) 
Non-Hispanic Asian (n=48)2
[Separated below][Separated below]
ā€‹Asian Indian ā€‹ā€‹
31 12.5
Cambodian 
1  0.4
Chinese 
31.2
Indonesian 
10.4
Korean 
10.4
Laotian 
20.8
Pakistani 
52.0
Vietnamese 
10.4
Other Asian/Unspecified
31.2
Non-Hispanic Black 9  3.6
Non-Hispanic Hawaiian/Pacific Islander (n=1)3
[Separated below]
[Separated below]
Samoan, Tongan
 10.4 
Hispanic (Single race) 111 44.8 
Multi race (any Hispanic status)  93.6
Non-Hispanic Native American/Alaskan 10.4
Non-Hispanic Other Race (unspecified) 20.8
Non-Hispanic White (n=65)[Separated below]
[Separated below]
Afghan
4719.0
ā€‹Non-Afghan
187.3
Declined or Unknown  20.8

1 The definition of a case eligible for full case management services is either a single venous BLL at or above 14.5 micrograms (mcg)/deciliter (dL) or persistent 9.5 Āµg/dL. 
2 No full case was identified, specifically, as Bangladeshi, Filipino, Japanese, Korean, Malaysian, Sri Lankan, or Thai as an Asian sub-group within the Non-Hispanic Asian category. 
3 No full case was identified, specifically, as Hawaiian or Guamanian as a Pacific Islander sub-group within the Non-Hispanic Hawaiian/Pacific Islander category.  

Based on current regulatory levels, lead exposure source was unknown for 64 children (25.8 percent). Non-housing sources were identified in 116 children (46.8 percent) as the only source of lead exposure. The high occurrence of non-housing sources was mostly due to the high number of Afghan and Asian children. Housing-related sources were identified in 45 children (18.2 percent) as the only source of lead exposure. Both housing-related and non-housing sources of lead exposure were identified in 23 children (9.2 percent) (Table 4). Therefore, a total of 68 children (27.4 percent) had a housing-related source identified as a source of lead exposure. When lower ā€œactionable" levels were used, housing-related sources were identified in 50 children (20.2 percent) as the only source and both housing-related and non-housing sources of lead exposure were identified in 25 children (10.1 percent). Hence, a total of 75 children (30.3 percent) had a housing-related source identified as a source of lead exposure when the lower ā€œactionable" levels were applied. The difference in exposure patterns when identifying sources of lead exposure by current regulatory levels versus lower ā€œactionable" levels was statistically significant (p =0.001, Table 4). 

Table 4. Sources of Lead Exposure Among Full Cases, Fiscal Year 2019-20 (n=248)

Exposure source Current Regulatory Level1 
n (%) ā€‹
Lower ā€œActionable" Level2 
n (%) 
Only Housing source 45 (18.2%)50 (20.2%)
Both Housing and Non-Housing 23 (9.2%)25 (10.0%)
Only Non-Housing source 116 (46.8%)114 (46.0%)
Unknown 64 (25.8%)59 (23.8%)

1 Current regulatory level for housing-related sources of lead exposure:  

  • Paint is considered a source when the presence of deteriorated lead-based paint tested at the state regulatory level of ā‰„ 1.0 mg/cm2. In addition, full cases were attributed to paint at local regulatory levels in Los Angeles at ā‰„ 0.7 mg/cm2. (17 CCR Sections 35022, 35033, 35037; Los Angeles County Code Section 11.28.010) 
  • Dust is considered a source when it is lead contaminated at ā‰„ 40 mcg/ft2 for interior floor surfaces, ā‰„ 250 mcg/ft2 for interior horizontal surfaces, and ā‰„ 400 mcg/ft2 for exterior floor and exterior horizontal surfaces. (17 CCR Sections 35035, 35037) 
  • Soil is considered a source when it is lead contaminated at ā‰„ 400 ppm in children's play areas. 
  • Water levels are categorized by an action level; according to the US EPA Federal Lead and Copper Rule, ā‰„ 0.015 mg/L is above the action level (40 CFR Section141.80). Four water samples above the action level were found to be potential exposure sources to lead. One exterior faucet water sample was found above the action level; however, it was not found to be a potential exposure source to lead as it was not a primary drinking source. Follow-up steps were taken to prevent all possible exposure by removing the faucet and capping the pipe. Drinking water sources at this residence measured non-detect lead levels. 

2 Lower ā€œactionable" level for housing-related sources of lead exposure: ā€‹

  • Paint with lead ā‰„ 600 ppm was used. In 1978 the federal Consumer Product Safety Commission restricted lead in newly manufactured paint to 600 ppm. Additionally, 600 ppm is the level petitioners to the US EPA have been seeking to lower the federal definition of lead-based paint. Since there is incongruence of unit equivalency between ppm and mg/cm2, the level used for XRF instruments was 0.1 mg/cm2, which is the lowest level detectable to the tenths place in order to be most health protective. 
  • Dust lead levels ā‰„ 10 mcg/ft2 for interior floor surfaces, and ā‰„ 100 mcg/ft2 for interior horizontal surfaces were used in order to match changes in federal dust standards effective in 2020. 
  • Bare soil with ā‰„ 80 ppm was used in order to match California Human Health Screening Levels (CHHSL) proposed by the California Office of Environmental Health Hazard Assessment. The current CHHSL for lead in soil for residential property is 80 ppm. 
  • Drinking water ā‰„ 0.005 mg/L was selected considering the goal for water to show non-detect levels of lead. Since this level was the laboratory reporting limit, results below this level would not be available from laboratory reports used in the sample of cases selected. ā€‹ā€‹

The exposure source of lead differed by race/ethnicity (p <0.0001, Table 5). Housing-related sources of lead were identified as the most common source of lead exposure among Black children (55.6 percent) while non-housing sources of lead exposure were identified as the most common source among Asian Indian children (61.3 percent), and Afghan children (80.9 percent). Housing-related lead exposure was as common as non-housing sources among White children and Hispanic children (Table 5). 

The exposure source of lead did not differ by age group or identified sex at birth in FY2019-20 (Table 5). ā€‹

Table 5. Source of Lead Exposure at Current Regulatory Levels1 by Demographic Characteristics Among Full Cases, Fiscal Year 2019-20 (n=248) 

Characteristic: Age
p-value = 0.15		Only Housing (n=45)Both Housing and Non-Housing (n=23)Only Non-Housing (n=116)Unknown (n=64)
Less than 6 years (n=204)42 (20.6%)19 (9.3%)94 (46.1%)49 (24.0%)
Between 6 and 21 years (n=44)3 (6.8%)4 ā€‹(9.1%)ā€‹
22 (50.0%)15 (34.1%)
Characteristic: Sex
p-value = 0.07ā€‹

Only Housing (n=45)Both Housing and Non-Housing (n=23)Only Non-Housing (n=116)Unknown (n=64)
Female (n=119)18 (15.1%)
14 (11.8%)63 (52.9%)24 (20.2%)
Male (n=129)27 (20.9%)9 (7.0%)53 (41.1%)40 (31.0%)
Characteristic: Race/ethnicity
p-value = <0.001		Only Housing (n=45)Both Housing and Non-Housing (n=23)Only Non-Housing (n=116)Unknown (n=64)
Non-Hispanic Asian Indian (n=31)0 (0%)3  (9.7%)19 (61.3%)9 (29.0%)
Non-Hispanic All Other Asian (n=17)2 (11.8%)0 (0%)9 (52.9%)6 (35.3%)
Non-Hispanic Black (n=9)5 (55.6%)
1 (11.1%)0 (0%)3  (33.3%)
Non-Hispanic Hawaiian/ Pacific Islander (n=1)0 (0%)1 (100%)0 (0%)0 (0%)
Hispanic (Single race, n=111)25 (22.5%)18 (16.2%)38 (34.3%)ā€‹

30 (27.0%)
Non-Hispanic Native American/Alaskan (n=1)0 (0%)0 (0%)1 (100%)0 (0%)
Multi race (any Hispanic status, n=9)5  (55.6%)0 (0%)
3 (33.3%)1 (11.1%)
Non-Hispanic Other (n=2)
0 (0%)0 (0%)1 (50%)1 (50%)
Non-Hispanic White Afghan (n=47)1 (2.1%)0 (0%)38 (80.9%)8 (17.0%)
Non-Hispanic White Non-Afghan (n=18)6 (33.3%)0 (0%)6 (33.3%)6 (33.3%)
Declined or Unknown (n=2)1 (50%)0 (0%)1 (50%)0 (0%)ā€‹

1 Housing-related sources of lead exposure include:  

  • Paint is considered a source when the presence of deteriorated lead-based paint tested at the state regulatory level of ā‰„ 1.0 mg/cm2. In addition, full cases were attributed to paint at local regulatory levels in Los Angeles at ā‰„ 0.7 mg/cm2. (17 CCR Sections 35022, 35033, 35037; Los Angeles County Code Section 11.28.010) 
  • Dust is considered a source when it is lead contaminated at ā‰„ 40 mcg/ft2 for interior floor surfaces, ā‰„ 250 mcg/ft2 for interior horizontal surfaces, and ā‰„ 400 mcg/ft2 for exterior floor and exterior horizontal surfaces. (17 CCR Sections 35035, 35037)  
  • Soil is considered a source when it is lead contaminated at ā‰„ 400 ppm in children's play areas.  
  • Water was not identified as source of lead exposure in any case. Water levels are categorized by an action level; according to the US EPA Federal Lead and Copper Rule, ā‰„ 0.015 mg/L is above the action level (40 CFR Section141.80). One exterior faucet water sample was found above the action level; however, it was not found to be a potential exposure source to lead as it was not a primary drinking source. Follow-up steps were taken to prevent all possible exposure by removing the faucet and capping the pipe. Drinking water sources at this residence measured non-detect lead levels. ā€‹

Distribution of Housing-Related Sources of Lead Exposure 

Figure 1 shows the distribution of housing-related sources of lead exposure at current regulatory levels during FY 2019-20. Paint was the most common housing-related source of lead exposure, followed by soil, dust, and water. Table 6 depicts the distribution of housing-related lead exposure sources by race/ethnicity.

Figure 1. Total Occurrences1 of Housing-Related Sources of Lead Exposure2 Among Full Cases, Fiscal Year 2019-20 (n=68) 

Occurences of housing-related lead sources: paint=49, soil=35, dust=31, water=2
1A child may have more than one type of housing-related source of lead exposure and therefore, the total occurrences of housing-related sources will be greater than the number of children (n=68) identified with a housing-related source of lead exposure. 
2ā€‹Housing-related sources of lead exposure include:  

  • Paint is considered a source when the presence of deteriorated lead-based paint tested at the state regulatory level of ā‰„ 1.0 mg/cm2. In addition, full cases were attributed to paint at local regulatory levels in Los Angeles at ā‰„ 0.7 mg/cm2. (17 CCR Sections 35022, 35033, 35037; Los Angeles County Code Section 11.28.010) 
  • Dust is considered a source when it is lead contaminated at ā‰„ 40 mcg/ft2 for interior floor surfaces, ā‰„ 250 mcg/ft2 for interior horizontal surfaces, and ā‰„ 400 mcg/ft2 for exterior floor and exterior horizontal surfaces. (17 CCR Sections 35035, 35037)  
  • Soil is considered a source when it is lead contaminated at ā‰„ 400 ppm in children's play areas.  
  • Water was not identified as source of lead exposure in any case. Water levels are categorized by an action level; according to the US EPA Federal Lead and Copper Rule, ā‰„ 0.015 mg/L is above the action level (40 CFR Section141.80). One exterior faucet water sample was found above the action level; however, it was not found to be a potential exposure source to lead as it was not a primary drinking source. Follow-up steps were taken to prevent all possible exposure by removing the faucet and capping the pipe. Drinking water sources at this residence measured non-detect lead levels. ā€‹

Table 6. Total Occurrences1 of Housing-Related Sourā€‹ces of Lead Exposure2 by Race/Ethnicity Among Full Cases, Fiscal Year 2019-20 (n=69)

Housing-related Lead Sources

Non-Hispanic Asian Indian
ā€‹ā€‹n (row %)ā€‹

Non-Hispanic All Other Asian
n (row %)

Non-Hispanic
Black
n (row %)

Non-Hispanic Hawaiian/ Pacific Islander
n (row %)

Hispanic (Single race)
n (row %)

Multi race (any Hispanic status)
n (row %)

Non-Hispanic
Native American/
Alaskan
n (row %)

Non-Hispanic Other
n (row %)

Non-Hispanic White Afghanā€‹
n (row %)

Non-Hispanic White Non-Afghan
n (row %)

Declined or Unknown
n (row %)

Paint (n=49)1 (2.0%)2 (4.1%)5 (10.2%)
1 (2.0%)30 (61.2%4 (8.2%)0 (0%)0 (0%)0 (0%)5 (10.2%)1 (2.0%)
Soil (n=35)0 (0%)0 (0%)3 (8.6%)0 (0%)25 (71.4%)4 (11.4%)0 (0%)0 (0%)0 (0%)3 (8.6%)0 (0%)
Dust (n=31)2 (6.5%)1 (3.2%)2 (6.5%)0 (0%)17 (54.8%)4 (12.9%)0 (0%)0 (0%)1 (3.2%)3 (9.7%)1 (3.2%)
Water (n=2)0 (0%)0 (0%)0 (0%)0 (0%)2 (100%)0 (0%)0 (0%)0 (0%)0 (0%)0 (0%)0 (0%)
1 A child may have more than one type of housing-related source of lead exposure and therefore, the total occurrences of housing-related sources will be greater than the number of children (n=69) identified with a housing-related source of lead exposure. 
2 Housing-related sources of lead exposure include:  
  • Paint is considered a source when the presence of deteriorated lead-based paint tested at the state regulatory level of ā‰„ 1.0 mg/cm2. In addition, full cases were attributed to paint at local regulatory levels in Los Angeles at ā‰„ 0.7 mg/cm2. (17 CCR Sections 35022, 35033, 35037; Los Angeles County Code Section 11.28.010) 
  • Dust is considered a source when it is lead contaminated at ā‰„ 40 mcg/ft2 for interior floor surfaces, ā‰„ 250 mcg/ft2 for interior horizontal surfaces, and ā‰„ 400 mcg/ft2 for exterior floor and exterior horizontal surfaces. (17 CCR Sections 35035, 35037)  
  • Soil is considered a source when it is lead contaminated at ā‰„ 400 ppm in children's play areas.  
  • Water was not identified as source of lead exposure in any case. Water levels are categorized by an action level; according to the US EPA Federal Lead and Copper Rule, ā‰„ 0.015 mg/L is above the action level (40 CFR Section141.80). One exterior faucet water sample was found above the action level; however, it was not found to be a potential exposure source to lead as it was not a primary drinking source. Follow-up steps were taken to prevent all possible exposure by removing the faucet and capping the pipe. Drinking water sources at this residence measured non-detect lead levels. ā€‹

Removal, Remediation, or Abatement of Identified Housing-Related Sources of Lead Exposure 

Of the 248 full cases in our analysis, housing-related sources of lead exposure were identified at current regulatory levels in properties where 69 children lived. There were a total of 69 properties that needed housing-related sources of lead exposure removed, remediated, or abateā€‹d and required clearance. Multiple children may be living at the same property, and EIs are done in multiple properties for some children, so the number of properties do not exactly correspond to the number of cases. Of those 69 properties, 48 (69.6 percent) had their housing-related source of lead exposure removed, remediated, or abated while 21 properties (30.4 percent) are still in process. ā€‹ā€‹

Distribution of Non-Housing Sources of Lead Exposure 

For FY 2019-20, the main non-housing sources identified were 'food, spice and drink items' followed by 'cosmetics/spiritual products,' and 'take-home/occupational' exposures (Figure 2). Non-housing sources of lead exposure differed by race/ethnicity (p <0.0001, Table 7). Non-housing sources of lead were the main source of lead exposure among Asian children, specifically 'food, spice and drink items,' 'cosmetics and spiritual religious products,' and 'remedies.' The category of non-housing exposure source of lead between Asian Indian children and all other Asian children was different. Of the 18 Asian children of whom 'food, spice and drink' were identified as a source of lead exposure, 16 were Asian Indian (p=0.006, Fisher's exact test).Of the 11 Asian children where 'cosmetics/spiritual products' were identified as a source of lead exposure, 6 were Asian Indian, and 5 were other Asian (p=0.4). 'Take-home/Occupational' exposure was identified among 4 Asian children. Of those, only one was Asian Indian (p=0.8). Of the two newborns who received full case management services in FY 2019-20; one was Asian Indian.

Figure 2. Total Occurrences1 of Non-Housing Sources of Lead Exposure Among Full Cases, Fiscal Year 2019-20 (n=139) 

Total occurences of non-housing sources: food=50, cosmetics=46, occupational=41, pottery=16, other=13, remedies=7, maternal=2ā€‹ā€‹

ā€‹ā€‹1 A child may have more than one type of non-housing lead hazard and therefore, the total occurrences of non-housing lead hazards will be greater than the number of children (n=139) identified with a non-housing lead hazard.  ā€‹

Table 7. Total Occurrences1 of Non-Housing Sources of Lead Exposure by Race/Ethnicity Among Full Cases, Fiscal Year 2019-20 (n=139)

Non-Housing Exposure Source of LeadNon-Hispanic
Asian Indian
n (row%)
Non-Hispanic All Other Asian
n (row%)
Non-Hispanic Black
n (row%)
Non-Hispanic Hawaiian/ Pacific Islander
n (row%)
Hispanic (Single race)
n (row%)
Multi race (any Hispanic status)
n (row%)
Non-Hispanic Native American /Alaskan
n (row%)
Non-Hispanic Other
n (row%)
Non-Hispanic White Afghan
n (row%)
Non-Hispanic White Non-Afghan
n (row%)
Declined or Unknown
n (row%)
Food, Spice & Drink (n=50)16 (32%)2 (4%)0 (0%)0 (0%)9 (18%)1 (2%)0 (0%)0 (0%)19 (38%)3 (6%)0 (0%)
Cosmetics & Spiritual Products (n=46)6 (13%)5 (10.9%)0 (0%)0 (0%)0 (0%)0 (0%)0 (0%)0 (0%)34 (74%)1 (2%)
0 (0%)
Take-home/ Occupational (n=41)1 (2.4%)3 (7.4%)1 (2.4%)1 (2.4%)28 (68.3%)0 (0%)2 (4.9%)1 (2.4%)1 (2.4%)3 (7.4%)0 (0%)
Pottery & Utensils (n=16)1 (6.3%)1 (6.3%)0 (0%)0 (0%)14 (87.5%)0 (0%)0 (0%)0 (0%)0 (0%)0 (0%)
0 (0%)
Other Source (n=13)2 (15.4%)1 (7.7%)0 (0%)0 (0%)7 (53.8%)1 (7.7%)1 (7.7%)0 (0%)0 (0%)0 (0%)1 (7.7%)
Remedies (n=7)2 (28.6%)1 (14.3%)0 (0%)0 (0%)2 (28.5%)0 (0%)1 (14.3%)0 (0%)1 (14.3%)0 (0%)0 (0%)
Maternal exposure (n=2)1 (50%)0 (0%)0 (0%)0  (0%)1 (50%)
0 (0%)0 (0%)0 (0%)0 (0%)
0 (0%)0  (0%)
Retained Bullet (n=0)0 (0%)0 (0%)0 (0%)0 (0%)0 (0%)0 (0%)0 (0%)0 (0%)0 (0%)0 (0%)0 (0%)

1 A child may have more than one type of non-housing source of lead exposure and therefore, the total occurrences of non-housing sources will be greater than the number of children (n=139) identified with a non-housing source of lead exposure.ā€‹

'Take-home/occupational' exposure was the only non-housing source for three children. The non-housing sources of lead was identified as 'other lead sources' for the one Native American/Alaskan child who received full case management services. 

Both housing and non-housing sources of lead were found among Hispanic children. The most common non-housing exposure source for Hispanic children was 'Take-home/occupational' exposures (n=28), followed by pottery/utensils (n=14). Of the 16 children where 'pottery/utensils' were identified as a source of lead exposure, 14 (87.5 percent) were Hispanic children. 'Take-home/occupational' exposures were also common among Hispanic children. Of the 41 children where 'take-home/occupational' exposures were identified as sources of lead exposure, 28 (69 percent) were Hispanic. There were two newborns who received full case management services in FY 2019-20; one was Hispanic. While perinatal exposure was identified as the source of exposure for the newborns, the sources of exposure for their mothers were unknown. 

For multi-race children, 'take-home/occupational' exposures (n=2), 'other non-housing sources' (fishing, n=1), 'food/spice and drink' (n=1), and 'remedies' (n=1) were identified as non-housing sources of lead exposure. 

When aggregated, non-housing sources appeared to be the most common source of lead exposure among White children. However, when stratifying White children by having Afghan origin or not, for non-Afghan White children housing sources of exposure was as common as non-housing sources of lead. Among Afghan children, non-housing was the most common source of exposure (80.9%). The specific non-housing sources of lead exposure differed between the two populations. The major nonā€‘housing sources for children with Afghan origin were 'cosmetics and spiritual products' (n=34), and 'food, spice and drink' (n=19), while the major non-housing sources for White children without Afghan origin were 'take-home/occupational' exposures (n=3) as well as 'food, spice and drink' (n=3).

Non-housing sources of lead exposure were identified in only one child with unknown race/ethnicity. The source of lead exposure was 'other sources of lead'.  

Among the 41 take-home/occupational exposures, the most common sectors were construction (n=15), automobile (n=7), shooting/hunting/firearms (n=7), and fishing (n=5) (data not shown). 

Although unconfirmed, exposures from previous residence/travel outside of California were suspected in 118 children with the top countries where previous residence/travel outside of California included Afghanistan (n=48), Mexico (n=33), and India (n=23) (data not shown). ā€‹ā€‹

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