differences in sources of lead exposure for hispanic and non-hispanic childhood lead poisoning cases...
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Differences in sources of lead exposure for Hispanic and Non-Hispanic childhood
lead poisoning cases in California
Amy G. Cantor, MHS1, Lynn Goldman, MD, MPH2, Joseph G. Courtney, PhD3, and David Kattari3. (1) University of Texas Health Science Center, San Antonio (2) Johns Hopkins University School of Public Health (3) Childhood Lead Poisoning
Prevention Branch, California Department of Health Services
Lead Poisoning: A Brief History
• Lead recognized as a threat to human health since 1920’s
• Early cases linked to lead paint — acute exposures
• Scientific evidence and litigation → new requirements for paint, lead screening, housing regulations
Why are cases of lead poisoning still being documented?
Childhood Lead Poisoning in California
• 1999-2000: A disproportionate number of cases are Hispanic
• Minorities are at a higher risk
• Differences in exposure sources for these groups have not been thoroughly assessed
Research Questions
• Are there ethnic disparities in lead exposure?
• Are certain identifiable risk factors linked to cultural practices?
Study Design
• RASSCLE: Response And Surveillance System for Childhood Lead Exposures
• Specific risks for childhood lead poisoning
• Folk remedies and other culturally related sources of lead exposure (imported candies and pottery)
• Ethnic differences in identified exposure sources
• Evaluation based on ethnic group categories consistent with US census data
Study Population
• Data source – all cases reported from 1999 & 2000
• Case definition
• California law – report BLL > 25 ug/dL
• Most children reported if BLL > 10 ug/dL
Sources of Lead Exposure
Traditional – Lead-based paint
chips– Old window glaze – Soil, dust, and debris
from building renovation
– Household dust
Non-traditional– Foreign
manufactured items– Leaded pots and
pans– Cosmetics– Traditional
medicines– Ceramics– Leaded crystal
Paint: A Modern Problem
Why are Children at Risk?
• Lower body weight
• Lower overall tolerance to toxic substances
• Increased hand to mouth activity
Chronic Effects
• Central nervous system damage
• Permanent learning impairment
• Attention span, growth, behavior deficits
Hispanic Children – at Increased Risk?
• Poorly maintained, older housing
• Deteriorating paint
• Lead dust particles in soil
• High lead levels in urban areas
• Limited access to health care
• Culturally linked exposures
Mexican Candy
Ceramics and Home Remedies
Ethnic Disparities in Lead Exposure
• 1621 cases between 1999-2000
• 81.3% of cases (n = 1317) are Hispanic
• Cultural Sources:– Identified in 22% of all cases– Only source of exposure in 5% of cases (n = 81)
• 43% of California’s population < 21 years old are Hispanic
Paint-related exposures predominateamong cases of lead poisoning
for children in California
“Paint-related” and “culturally linked” sources of lead poisoning for Hispanic
and Non-Hispanic casesRelative % of cases identified with a source of lead poisoning
0
10
20
30
40
50
60
70
80
90
Paint/Dus t/Soil Hom e Rem edy Pottery
Exposure Source
Re
lati
ve
% o
f C
as
es
Hispanic Non-Hispanic
Lead poisoning in 2003: Are we protecting our children?
“Lead exposures to Mexican candy, home remedies and pottery are culturally linked sources that are causing great harm to Hispanic children in California”
- Amy Cantor, New York Times letter to the editor, October 6, 2003
Future Directions
• Culturally sensitive prevention strategies
• Lead screening
• Policy
Acknowledgments
• Joseph Courtney and David Kattari, California Childhood Lead Poisoning Prevention Branch
• Lynn Goldman, Johns Hopkins University, Bloomberg School of Public Health
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