Home
Programs
Center for Healthy Communities
Division of Environmental and Occupational Disease Control
Childhood Lead Poisoning Prevention Branch
Sources of Lead Exposure Data 2021-2022

childhood lead poisoning prevention branch

Sources of Lead Exposure for Full Cases Fiscal Year (FY) 2021 to 2022

Page Contents:

Key Findings
Introduction
Methods

Table 1. Definitions of Housing-Related Sources of Lead Exposure
Table 2. Categories and Examples of Non-housing Sources of Lead Exposure

Results

Table 3. Demographic Characteristics of Full Cases, Fiscal Year 2021–22 (n=217)
Table 4. Sources of Lead Exposure Among Full Cases, Fiscal Year 2021–22 (n=217)
Table 5. Source of Lead Exposure at Current Regulatory Levels by Demographic Characteristics Among Full Cases, Fiscal Year 2021–22 (n=217)

Distribution of Housing-Related Sources of Lead Exposure

Figure 1. Total Occurrences of Housing-Related Sources of Lead Exposure Among Full Cases, Fiscal Year 2021–22 (n=73)
Table 6. Total Occurrences of Housing-Related Sources of Lead Exposure by Race/Ethnicity Among Full Cases, Fiscal Year 2021–22 (n=73)

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

Figure 2. Total Occurrences of Non-Housing Sources of Lead Exposure Among Full Cases, Fiscal Year 2021–22 (n=87)
Table 7. Total Occurrences of Non-Housing Sources of Lead Exposure by Race/Ethnicity Among Full Cases, Fiscal Year 2021–22 (n=87)

Distribution of Unknown Sources of Lead Exposure

Key Findings

271 new children met full case criteria in fiscal year (FY) 2021–22. Of those, 217 (80.1 percent) received full case management services, including home visits by public health nurse and environmental investigations.
Of the 217 children with blood lead levels meeting the full case criteria and who received full case management services, 83.4 percent were less than 6 years old, 50.2 percent were male.
A significant proportion (45.6 percent) of children were Hispanic (single race), highlighting ethnic disparities in lead exposure.
The major source of lead exposure was not identified in 38.3 percent of cases who received full services at current regulatory levels. Housing-related lead exposure was identified in 33.6 percent of children, and non-housing sources were found in 28.1 percent. Both sources were identified in 12 percent of children.
Applying lower “actionable” levels increased the identification of housing-related sources of lead exposure from 33.6 percent to 37.8 percent. This significantly increased identification of lead exposure sources by using lower “actionable” levels, emphasizes the potential for more effective early intervention and prevention strategies.
Paint was the most common source of housing-related lead exposure, followed by dust, soil, and water. This pattern of exposure from housing-related sources persisted across years.
Major sources of lead exposure differed significantly by race/ethnicity.

Housing-related exposures were most common among Black, multi-race, and Hispanic children, while non-housing sources (e.g., food, spices, cosmetics, and ceremonial items) were more prevalent among Asian children. Afghan children were disproportionately represented in cases where the lead source could not be identified.
Take-home/occupational exposures were predominantly seen among Hispanic children, with certain industries like construction and automotive being high-risk.
88.9 percent of children where pottery and utensils were identified as a source of lead exposure were Hispanic (single race) children.
Food, drink and spices were significant exposure sources especially among those of Asian Indian descent while cosmetics and ceremonial items were identified more commonly among Afghan children.

There was a notable increase in exposures from suspected non-housing items, especially among children with recent exposure to foreign products known for high lead content. Lead exposure was suspected to be linked to living abroad or travel, particularly to countries like Afghanistan, Mexico, and India.
A comprehensive approach, including cultural sensitivity, targeted interventions for non-housing sources, and the use of lower action levels, is crucial for effective early detection and prevention of lead exposure among children.

The Childhood Lead Poisoning Prevention Branch (CLPPB) analyzed sources of lead exposure for children who were newly identified as full cases in FY 2021–22 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 home visit often at the same time as the EI, which includes collecting information to evaluate and coordinate the necessary services. The EP, with assistance from the PHN, identifies suspect non-housing items and may submit these items for laboratory analysis. “Non-housing sources” are sources of lead exposure other than housing-related paint, dust, soil, and water.

When housing-related lead sources are identified, EPs work with property owners to remediate them 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.

Methods

In this analysis, only children with blood lead levels (BLLs) meeting the full case criteria during FY 2021–22 who received full case management, including environmental services, 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/deciliter (mcg/dL) or persistent levels at or above 9.5 mcg/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:

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 were measured by X-Ray Fluorescence (XRF) screening by EPs, as well as quantitatively in the environmental health laboratories.
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 home visit.

Race/ethnicity data were also collected by the PHN during the home visit. CLPPB collects race/ethnicity data in a two-question format. 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:

American American/Alaskan Native
Asian
Black/African American
Pacific Islander
White
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 “Other” 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.

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:

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

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 Multi‑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 2021–22, there were 42 children with Afghan origin. They mostly identified themselves as ‘White,’ ‘Asian’ or ‘Other’ and specified as Afghan. In this analysis, Afghan were categorized as ‘Asian’ as OMB recommended. Of the 81 Asian children, 42 (51.9 percent) were Afghan, and sources of lead exposure differed by Afghan origin.

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).

Any EI property found to have a lead housing-related source exceeding current regulatory levels must have the lead 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 housing-related lead 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 “actionable” 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 “actionable” levels.

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

Type of housing-related source	Current Regulatory Level	Lower “Actionable” Level
Paint	Deteriorated lead-based paint tested at the state regulatory level of greater than or equal to 1.0 milligram of lead per square centimeter of surface area (≥ 1.0 mg/cm²). In addition, full cases were attributed to paint at local regulatory level in Los Angeles at ≥ 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 ≥ 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 10 micrograms of lead per square foot of surface area (≥ 10 mcg/ft²) for interior floor surfaces, ≥ 100 mcg/ft² for interior horizontal surfaces, and ≥ 400 mcg/ft² for exterior floor and exterior horizontal surfaces. (17 CCR Sections 35035, 35037) The new standard went into effect on February 3, 2022.	Lead levels ≥ 10 mcg/ft² for interior floor surfaces, and ≥ 100 mcg/ft² for interior horizontal surfaces were selected to match changes in federal dust standards that took effect January 6, 2020.
Soil	Lead-contaminated at greater than or equal to 400 parts per million (≥ 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 ≥ 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 (≥ 0.015 mg/L) is above the action level. (40 CFR Section 141.80)	Drinking water ≥ 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.

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.

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 suneli, 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, Balguti Kesaria), paylooah, traditional Chinese remedies
Retained bullet	No data
Perinatal exposures	Mother ate food high in lead during pregnancy, mother took remedy high in lead during pregnancy.

There may be several lead exposure sources identified for a child meeting full case criteria. When multiple exposure sources are identified, the exact contribution of each source to the child’s initial BLL cannot be verified. CLPPB counted 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 counted as possible lead exposure sources.

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 and ethnicity of the child. To compare the groups, CLPPB used a chi-square test. Statistical significance was defined as p ≤ 0.05. Analyses were done using SAS software, version 9.4 (Copyright © 2023, SAS Institute Inc., Cary, NC, USA).

Results

In FY 2021-2022, there were 271 new children meeting full case criteria. Of those 271 new childhood lead cases, 217 (80.1 percent) received full case management services (both home visit and on-site EI) and 206 unique properties went through an EI. In some cases, there were multiple children with case-making BLLs living in the same property while EIs are done in multiple different properties for some children. There were several reasons for incomplete home visits and/or EIs: persistent refusal (n=28), administrative reasons (n=4), not a state case (n=1), unable to locate family (n=1), uncooperative family (n=4), case was in juvenile hall (n=3) or missing information (n= 13); 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 (83.4 percent), male (50.2 percent), Hispanic-single race (45.6 percent). Of the 217 children who received full services, 158 (72.8 percent) had a BLL between 14.5 and 44.4 mcg/dL, 56 (25.8 percent) had a BLL between 9.5 and 14.4 mcg/dL, and 3 (1.4 percent) had a BLL higher than 44.4 mcg/dL

Table 3. Demographic Characteristics of Full Cases¹, Fiscal Year 2021-22 (n=217)

Characteristic: Age	N=217	Percent (%)
Less than 6 years	181	83.4
Between 6 and 21 years	36	16.6

Characteristic: Sex at Birth	N=217	Percent (%)
Female	108	49.8
Male	109	50.2

Characteristic: Race/Ethnicity	N=217	Percent (%)
Hispanic (Single race)	99	45.6
North American	74	34.1
Central American	15	6.9
South American	0	0.0
North American and Central American	2	0.9
Unspecified	8	3.7
Multi race (any Hispanic status)	9	4.2
Non-Hispanic American Indian/ Native Alaskan	0	0.0
Non-Hispanic Asian²	81	37.3
Afghan	42	19.4
Asian Indian	27	12.4
Cambodian	1	0.5
Chinese	2	0.9
Filipino	1	0.5
Hmong	2	0.9
Laotian	1	0.5
Nepali	2	0.9
Pakistani	1	0.5
Tajik	1	0.5
Vietnamese	1	0.5
Non-Hispanic Black	2	0.9
Non-Hispanic Native Hawaiian/ Pacific Islander³	0	0.0
Non-Hispanic Other Race (unspecified)	2	0.9
Non-Hispanic White	17	7.8
Declined or Unknown	7	3.2

¹ As of July 1, 2016, 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 mcg/dL.
²No full case was identified, specifically, as Bangladeshi, Indonesian, 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, Guamanian, or Samoan 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 83 children (38.3 percent). Housing-related sources were identified in 47 children (21.7 percent) as the only source of lead exposure. Non‑housing sources were identified in 61 children (28.1 percent) as the only source of lead exposure. Both housing-related and non-housing sources of lead exposure were identified in 26 children (12 percent) (Table 4). Therefore, a total of 73 children (33.6 percent) had a housing-related source identified as a source of lead exposure. When lower “actionable” levels were used, housing-related sources were identified in 52 children (24 percent) as the only source and in 30 children (13.8 percent) both housing-related and non-housing sources of lead exposure were identified. By applying a lower “actionable” level for identifying lead exposure from housing sources, nine more children were identified as having exposure from their living environment. The percentage of children with housing-related lead exposure increased from 33.6 percent to 37.8 percent (p <0.0001, Table 4). This increase demonstrates that the standard approach using higher lead thresholds might have missed cases that could benefit from intervention. The lower actionable levels allow for earlier detection of lead exposure, potentially leading to more effective intervention and prevention strategies. This change reflects a proactive approach to protecting children’s health.

Table 4. Sources of Lead Exposure Among Full Cases, Fiscal Year 2021-22 (n=217)

Exposure source	Current Regulatory Level¹ n (%)	Lower “Actionable” Level² n (%)
Only Housing source	47 (21.7%)	52 (24.0%)
Both Housing and Non-Housing	26 (12.0%)	30 (13.8%)
Only Non-Housing source	61 (28.1%)	57 (26.3%)
Unknown	83 (38.3%)	78 (35.9%)

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 ≥ 1.0 mg/cm². In addition, full cases were attributed to paint at local regulatory levels in Los Angeles at ≥ 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 ≥ 10 mcg/ft² for interior floor surfaces, ≥ 100 mcg/ft2 for interior horizontal surfaces, and ≥ 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 ≥ 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, ≥ 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.

²Lower “actionable” level for housing-related sources of lead exposure:

Paint with lead ≥ 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 ≥ 10 mcg/ft² for interior floor surfaces, and ≥ 100 mcg/ft² for interior horizontal surfaces were used in order to match changes in federal dust standards effective in 2020.
Bare soil with ≥ 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 ≥ 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.

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 multi-race children (55.6 percent), among Black children (50 percent) and Hispanic children (31.3 percent) while non-housing sources of lead exposure were identified as the most common source among Asian Indian children (55.6 percent). Housing-related lead exposure was as common as non-housing sources among White children (Table 5).

Table 5. Source of Lead Exposure at Current Regulatory Levels1 by Demographic Characteristics Among Full Cases, Fiscal Year 2021-22 (n=217)

Characteristic: Age p-value=0.17	Only Housing (n=47) n (row %)	Both Housing and Non-Housing (n=25) n (row %)	Only Non-Housing (n=61) n (row %)	Unknown (n=83) n (row %)
Less than 6 years (n=181)	40 (22.1%)	25 (13.8%)	47 (26.0%)	69 (38.1%)
Between 6 and 21 years (n=36)	7 (19.4%)	1 (2.8%)	14 (38.9%)	14 (38.9%)

Characteristic: Sex at Birth p-value =0.02	Only Housing (n=47)	Both Housing and Non-Housing (n=25)	Only Non-Housing (n=61)	Unknown (n=83)
Female (n=108)	16 (14.8%)	15 (13.9%)	38 (35.2%)	39 (36.1%)
Male (n=109)	31 (28.4%)	11 (10.1%)	23 (21.1%)	44 (40.4%)

Characteristic: Race/Ethnicity p-value <0.001	Only Housing (n=47)	Both Housing and Non-Housing (n=25)	Only Non-Housing (n=61)	Unknown (n=83)
Hispanic (Single race, n=99)0.14	31 (31.3%)	16 (16.2%)	23 (23.2%)	29 (29.3%)
Central American (n=15)	3 (20.0%)	2 (13.3%)	3 (20.0%)	7 (46.7%)
North American (n=74)	24 (32.4%)	13 (17.6%)	19 (25.7%)	18 (24.3%)
Central American and North American (n=2)	1 (50.0%)	1 (50.0%)	0 (0.0%)	0 (0.0%)
Unspecified (n=8)	3 (37.5%)	0 (0.0%)	1 (12.5%)	4 (50.0%)
Non-Hispanic Asian (n=81)	4 (4.9%)	5 (6.2%)	29 (35.8%)	43 (53.1%)
Afghan (n=42)	0 (0.0%)	2 (4.8%)	11 (26.2%)	29 (69.0%)
Asian Indian (n=27)	1 (3.7%)	1 (3.7%)	15 (55.6%)	10 (37.0%)
Cambodian (n=1)	0 (0.0%)	0 (0.0%)	0 (0.0%)	1 (100.0%)
Chinese (n=2)	1 (50.0%)	1 (50.0%)	0 (0.0%)	0 (0.0%)
Filipino (n=1)	1 (100.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)
Hmong (n=2)	0 (0.0%)	0 (0.0%)	1 (50.0%)	1 (50.0%)
Laotian (n=1)	1 (100.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)
Nepali (n=2)	0 (0.0%)	1 (50.0%)	1 (50.0%)	0 (0.0%)
Pakistani (n=1)	0 (0.0%)	0 (0.0%)	0 (0.0%)	1 (100.0%)
Tajik (n=1)	0 (0.0%)	0 (0.0%)	0 (0.0%)	1 (100.0%)
Vietnamese (n=1)	0 (0.0%)	0 (0.0%)	1 (100.0%)	0 (0.0%)
Non-Hispanic Black (n=2)	1 (50.0%)	1 (50.0%)	0 (0.0%)	0 (0.0%)
Non-Hispanic Hawaiian/ Pacific Islander (n=0)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)
Non-Hispanic Native American/Alaskan (n=0)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)
Non-Hispanic Another Race – unspecified (n=2)	0 (0.0%)	2 (100.0%)	0 (0.0%)	0 (0.0%)
Non-Hispanic White (n=17)	5 (29.4%)	1 (5.9%)	5 (29.4%)	6 (35.3%)
Multi race (any Hispanic status, n=9)	5 (55.6%)	0 (0.0%)	2 (22.2%)	2 (22.2%)
Declined or Unknown (n=7)	1 (14.3%)	1 (14.3%)	2 (28.5%)	3 (42.9%)

¹Housing-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 ≥ 1.0 mg/cm². In addition, full cases were attributed to paint at local regulatory levels in Los Angeles at ≥ 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 ≥ 10 mcg/ft² for interior floor surfaces, ≥ 100 mcg/ft² for interior horizontal surfaces, and ≥ 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 ≥ 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, ≥ 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.

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 2021-22. Paint was the most common housing-related source of lead exposure, followed by dust, soil and water. Table 6 depicts the distribution of housing-related lead exposure sources by race/ethnicity and the pattern of paint being the most common housing-related source of lead exposure persisted over the years.

Figure 1. Total Occurrences¹ of Housing-Related Sources of Lead Exposure² Among Full Cases, Fiscal Year 2021-22 (n=73)

Housing sources of lead exposure: paint 63, dust 36, soil 26, water 1

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=73) identified with a housing-related source of lead exposure.
²Housing-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 ≥ 1.0 mg/cm². In addition, full cases were attributed to paint at local regulatory levels in Los Angeles at ≥ 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 ≥ 40 mcg/ft2 for interior floor surfaces, ≥ 250 mcg/ft2 for interior horizontal surfaces, and ≥ 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 ≥ 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, ≥ 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.

Table 6. Total Occurrences¹ of Housing-Related Sources of Lead Exposure² by Race/Ethnicity Among Full Cases, Fiscal Year 2021-22 (n=73)

Housing-related Lead Sources	Hispanic (Single race) n = 99 (row %)	Non-Hispanic Asian n = 81 (row %)	Non-Hispanic Black n = 2 (row %)	Non-Hispanic Another Race - Unspecified n = 2 (row %)	Non-Hispanic White n = 17 (row %)	Multi race (any Hispanic status) n = 9 (row %)	Declined or Unknown n =7 (row %)
Paint (n=63)	41 (65.1%)	8 (12.7%)	2 (3.2%)	1 (1.6%)	5 (7.9%)	5 (7.9%)	1 (1.6%)
Dust (n=36)	20 (55.6%)	4 (11.1%)	1 (2.8%)	2 (5.5%)	3 (8.3%)	4 (11.1%)	2 (5.5%)
Soil (n=26)	18 (69.2%)	2 (7.7%)	2 (7.7%)	1 (3.9%)	2 (7.7%)	1 (3.9%)	0 (0.0%)
Water (n=1)	1 (100.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)

Paint is considered a source when the presence of deteriorated lead-based paint tested at the state regulatory level of ≥ 1.0 mg/cm². In addition, full cases were attributed to paint at local regulatory levels in Los Angeles at ≥ 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 ≥ 10 mcg/ft² for interior floor surfaces, ≥ 100 mcg/ft2 for interior horizontal surfaces, and ≥ 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 ≥ 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, ≥ 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

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

Of the 217 full cases in our analysis, housing-related sources of lead exposure were identified at current regulatory levels in properties of 73 children. There were total of 71 properties that needed housing-related sources of lead exposure removed, remediated, or abated and required clearance. Keep in mind that multiple children may be living at the same property as well as EI done in multiple properties for some children, number of properties are independent from the number of cases. Of those 71 properties, 46 (64.8 percent) had their housing-related source of lead exposure removed, remediated, or abated while 25 properties (35.2 percent) are still in process.

Distribution of Non-Housing Sources of Lead Exposure

For FY 2021-22, the main non-housing sources identified were ‘take-home/occupational’ exposures,’ followed by ‘food, spice and drink items’ and ‘cosmetics and ceremonial items’ (Figure 2). Non-housing sources of lead exposure differed by race/ethnicity (p <0.0001, Table 7). The non-housing exposure source of lead also differed among different Asian sub-groups.

Figure 2. Total Occurrences¹ of Non-Housing Sources of Lead Exposure Among Full Cases, Fiscal Year 2021-22 (n=87)

Non-housing lead exposure sources: occupational 36, Food 32, cosmetic 15, other 10, pottery 9, perinatal 3, remedies 2

¹A 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=87) identified with a non-housing lead hazard.

Table 7. Total Occurrences¹ of Non-Housing Sources of Lead Exposure by Race/Ethnicity Among Full Cases, Fiscal Year 2021-22 (n=87)

Non-Housing-related Lead Sources	Hispanic (Single race) n (row %)	Non-Hispanic Asian n (row %)	Non-Hispanic Black n (row %)	Non-Hispanic Another Race-unspecified n (row %)	Non-Hispanic White n (row %)	Multi race (any Hispanic status) n (row %)	Declined or Unknown n (row %)
Take-Home/ Occupational (n=36)	23 (63.9%)	3 (8.3%)	1 (2.8%)	2 (5.6%)	4 (11.1%)	2 (5.6%)	1 (2.7%)
Food and Drink (n=32)	13 (40.6%)	16 (50.0%)	0 (0.0%)	0 (0.0%)	1 (3.1%)	0 (0.0%)	2 (6.3%)
Cosmetics and Spiritual Products (n=15)	0 (0.0%)	13 (86.6%)	0 (0.0%)	0 (0.0%)	1 (6.7%)	0 (0.0%)	1 (6.7%)
Other Lead Sources (n=10)	2 (20.0%)	4 (40.0%)	0 (0.0%)	1 (10.0%)	2 (20.0%)	0 (0.0%)	1 (10.0%)
Pottery and Utensils (n=9)	8 (88.9%)	1 (11.1%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)
Perinatal Exposure (n=3)	3 (100%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)
Remedies (n=2)	1 (50.0%)	1 (50.0%)	0 (0.0%)	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%)

¹A 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=85) identified with a non-housing source of lead exposure.

Take-home/Occupational exposure was identified among 36 children; 23 (63.9 percent) of those children were Hispanic (single race). ‘Take-home/occupational’ exposure was the only non-housing source of lead for Black children (n=1), and multi-race children (n=2).

Among the 36 take-home/occupational exposures, the most common sectors were construction (n= 7), metal work (soldering/welding/iron work, etc., n=6), automotive (n= 6), fishing/hunting (n= 4), painting (n=4), firearms (n= 3), and other (battery work, manufacturing, electronics, carpentry, landscaping, pottery, n=6, data not shown).

Lead exposure through food, drink, and spices was identified among 32 children. Of those, 16 (50 percent) were Asian and 13 (40.6 percent) were Hispanic (single race). Of the 16 Asian children where ‘food, spice and drink’ were identified as source of lead exposure, 12 (75 percent) were Asian Indian.

Lead exposure through cosmetics and ceremonial items were identified among 15 children. Of those, 13 (86.6 percent) were Asian. Of the 13 Asian children where ‘cosmetics/spiritual products’ were identified as source of lead exposure, 10 (76.9 percent) were Afghan children.

Other sources of lead exposure, such as jewelry, fishing weighs, ammunition, etc. were identified as the source of lead among ten children. Of those, four (40 percent) were Asian, two (20 percent) were White, two (20 percent) were Hispanic (single race), one (10 percent) was unspecified another race, and one (10 percent) was unknown race.

Pottery and utensils were identified as the source of lead exposure among nine children; of those, eight (88.9 percent) were Hispanic (single race), and 1 child was Asian (11.1 percent).

There were three newborns that received full case management services in FY 2021-22; all were Hispanic (single race) children.

Of the two children where remedies were identified as source of lead exposure, one was Asian, and the other one was Hispanic.

Distribution of Unknown Sources of Lead Exposure

In FY 2021-22, 83 children (38.3 percent) did not have an identified source of lead exposure at current regulatory levels (Table 4). Among these 83 children, 51.8 percent (n=43) were Asian while only 37.3 percent of all full-service cases were Asian children (n=81). A closer look at the 43 Asian children with unidentified lead sources shows that 67.4 percent (29 children) were Afghan. While Afghan children represented only 19.4 percent of all full-service cases, they accounted for 34.9 percent of those whose lead exposure source could not be identified.

When lower "actionable” levels were applied, an additional five children with only housing source were identified.

When we expanded our investigation for 78 children without an identified lead source even at the lower actionable levels, assuming the children’s lead exposure could be attributed to products they interacted with or consumed, in addition to living environments. There were an additional 28 children, Public Health Nurses (PHNs) suspected that they might be at risk due to recent exposure to non-housing items or products, particularly those came from foreign countries known for having high lead content. In some cases, individual items from these non-housing categories had lead levels below the typical clinical concern threshold, but when multiple such items were present, they could still contribute to elevated lead levels. This pattern suggests a cumulative risk from multiple sources. The suspected non-housing exposures were due to any combination of cosmetics and ceremonials items (n=13), food, spices and drink (n=9), and other sources of lead (n=5).

This information underscores the importance of considering cultural and ethnic backgrounds when addressing lead exposure risks, as certain communities may be more affected due to specific sources of lead in products.

Page Last Updated :