lead poisoning prevention: a guide for legislators · lead poisoning prevention: a guide for...

Lead Poisoning Prevention: A Guide for Legislators i

LEAD POISONING PREVENTION:A GUIDE FOR LEGISLATORS

by Doug FarquharSenior Policy Specialist

State Issues and Policy Analysis Program

National Conference of State Legislaturesin cooperation with the

U.S. Environmental Protection Agency

National Conference of State LegislaturesWilliam T. Pound, Executive Director

1560 Broadway, Suite 700Denver, Colorado 80202-5140

303/830-2200

444 North Capitol Street, N.W., Suite 515Washington, D.C. 20001

202/624-5400

August 1994

Lead Poisoning Prevention: A Guide for Legislators iii

CONTENTS

LIST OF TABLES AND FIGURES .............................................................................................. v

ACKNOWLEDGMENTS............................................................................................................. v i

EXECUTIVE SUMMARY ........................................................................................................... vi i

1 . NATURE AND EXTENT OF LEAD POISONING ......................................................... 1Characteristics of the Metal .................................................................................................................... 1Effects on Children and Pregnant Women ...................................................................................... 2Sources and Reduction of Exposure ................................................................................................... 2

Lead-based paint ................................................................................................................................ 2Lead in soil and dust ......................................................................................................................... 5Lead in drinking water .................................................................................................................... 7

2. THE STATE ROLE IN REDUCING LEAD EXPOSURE ................................................ 8History of the State Role .......................................................................................................................... 8Title X: The Residential Lead-Based Paint Hazard Reduction Act of 1992 ........................ 8

Effect on state programs .................................................................................................................. 9Comprehensive State Programs for Lead Poisoning ................................................................. 11

Surveillance ......................................................................................................................................... 11Screening programs ........................................................................................................................ 12Reporting requirements/state registry ................................................................................... 13Public outreach and education ................................................................................................... 14Medical and environmental case management programs .............................................. 15Inspections/risk assessments ..................................................................................................... 16Remediation or abatement of lead hazards ........................................................................... 16Disclosure of lead hazards ............................................................................................................ 16

3. TRAINING, CERTIFICATION, AND ACCREDITATION......................................... 17Training Programs ................................................................................................................................... 17Elements of a Lead Inspection, Assessment, and Abatement Training Program .......... 18State Training, Certification, and Accreditation Programs ...................................................... 19Section 402—Lead-Based Paint Activities Training and Certification................................. 20Inspection, Risk Assessment, and Abatement Requirements Under Section 402 .......... 21State Implementation of Section 402 ................................................................................................. 21State Authority Over Federal Facilities and Properties ............................................................. 22Training and Certification for Renovators and Remodelers ................................................... 22Fees for Training, Certification, and Accreditation Programs ................................................ 22

4. FUNDING OPTIONS FOR STATE LEAD POISONINGPREVENTION PROGRAMS............................................................................................ 23Fees and Taxes ........................................................................................................................................... 24State Loans to Finance Abatements .................................................................................................. 25Bonds to Finance Lead Poisoning Prevention .............................................................................. 26Federal Resources to Finance State Programs .............................................................................. 27

iv Lead Poisoning Prevention: A Guide for Legislators

APPENDIXESA . Federal Statutes ............................................................................................................................................ 29

Lead-Based Paint Poisoning Prevention Act .............................................................................. 29Lead Contamination Control Act of 1988 .................................................................................... 29Residential Lead-Based Paint Hazards Reduction Act of 1992 ........................................... 30

B. State Statutes Regarding Prevention of Lead-Based Paint Poisoning .................................... 32C . Resources for Further Information ....................................................................................................... 38

NOTES .......................................................................................................................................... 39

ACRONYMS AND ABBREVIATIONS ................................................................................... 43

BIBLIOGRAPHY ......................................................................................................................... 44

ABOUT THE AUTHOR.............................................................................................................. 47

Lead Poisoning Prevention: A Guide for Legislators v

LIST OF TABLES AND FIGURES

Tables1. Status of State Lead Hazard Reduction Programs ........................................................................... x i

2. Number of Owner-Occupied Properties and Single-Family Rental Properties .................... 4

3. States With Comprehensive Programs ................................................................................................ 11

4. CDC’s Recommended Responses to Various Blood Lead Levels in Children .................... 15

5. Estimated Average Cost of Abatement per Dwelling Unit ......................................................... 23

6. Percentage of all Housing With Lead-Based Paint by Estimated Abatement Cost ........... 23

7. Estimated Annual Number of Units to be Tested orAbated and the Estimated Annual Costs ........................................................................................... 24

Figures1. Lead Levels In Blood That Cause Certain Effects in Children ..................................................... 1

2. Number of Children Exposed to Lead via Various Media ............................................................ 2

3. Number and Age of U.S. Homes ............................................................................................................. 3

4. States With Lead Screening Programs ................................................................................................. 13

5. States With Lead Training, Certification, and Accreditation Statutes in 1994 ..................... 20

vi Lead Poisoning Prevention: A Guide for Legislators

ACKNOWLEDGMENTS

Lead Poisoning Prevention: A Guide for Legislators presents a comprehensive overview of theissues and policies surrounding lead poisoning prevention and lead hazard reduction.Data for this publication came from documents and reports prepared by the U.S. Departmentof Health and Human Services, the U.S. Department of Housing and Urban Development, andthe U.S. Environmental Protection Agency; from research into state and federal statutes andregulations; from information collected from contacts in state governments; and from legisla-tive staff.

This document is part of a project to assist states in identifying and reducing lead hazards.This project is funded through a cooperative agreement between NCSL and the U.S. Environ-mental Protection Agency. The EPA project officer for this publication was John Heisler,Environmental Protection Specialist. We gratefully acknowledge his and the agency's assis-tance with this project.

State agency personnel reviewed our state sidebar sections and deserve special recognition:Norman Petersen, Arizona Office of Health Services; Jennifer Flattery, California Departmentof Health Services; Beverly Gammage, Maryland Department of the Environment; Roy Petre,Massachusetts Department of Public Health; and Daryl Roberts, Missouri Department ofHealth. Dr. Carol Pertowski from the Center of Disease Control (CDC) deserves special recog-nition for her assistance with the medical terminology. Special assistance and insight into stateprograms came from participants in the Forum on State and Tribal Toxics Action (FOSTTA)Lead Project: Jim Brownlee, New Jersey Department of Health; Conner Byestewa, ColoradoRiver Indian Tribes; Representative Karen Clark, Minnesota House of Representatives; BarbaraConrad, Maryland Department of the Environment; Brad Prenney, Massachusetts Departmentof Health; Paul Schur, Connecticut Department of Health Services; Bob Schlag, CaliforniaDepartment of Health Services; William R. Schmidt, Missouri Department of Health; James O.White, Washington Office of Toxic Substances; and the many other state personnel who partici-pated in the Lead Project. We appreciate and acknowledge the time and effort given by everyperson who assisted in this project.

Staff support for this project was provided by Linda Gaer. Karen Fisher edited the publication,and Rena Roybal provided computer support. The cover was designed by Bruce Holdeman.We gratefully acknowledge their assistance.

NCSL greatly appreciates any additional information or comments regarding this document orthe project. Please write or call:

Lead Hazards ProjectNational Conference of State Legislatures

1560 Broadway, Suite 700Denver, Colorado 80202

303/830-2200

Lead Poisoning Prevention: A Guide for Legislators vii

Each section highlights innovative ap-proaches undertaken by states or presentscommon problems states face regarding leadpoisoning. Chapters 3 and 4 emphasize twoissues most pressing to states in the nearfuture because of recently enacted federallaws and regulations. The appendixes pro-vide a comprehensive reference to state andfederal laws. Also included is a bibliographyof relevant publications and a reference guidefor further information.

The Nature and Extentof Lead Poisoning

Almost 9 percent of children in this countryare believed to have elevated blood leadlevels. Fifty-seven million homes have lead-based paint, posing a risk to as many as 9.9million children.2 Thirty percent of elevatedblood lead levels in children can be attributedto lead in soils and dust, and 30 millionpeople use drinking water systems contain-ing lead in excess of federal standards.3

Though the sources of lead have been identi-fied and remedies acknowledged, childrencontinue to be poisoned because of theenormity of the problem. Lead, as an ele-ment and a highly toxic metal, existsthroughout the United States. Almost fivemillion tons of lead were used in residentialpaint; 7.3 million tons were used for leadedgas.4 Massive amounts of lead were alsoused in plumbing and numerous otherconsumer and industrial goods. Although itscurrent uses and production have beengreatly reduced, lead remains a threat be-cause it persists indefinitely in the environ-ment.

When absorbed by humans, lead disturbsvirtually every bodily system, most severelythe brain and central nervous system. Ex-treme lead poisoning causes convulsions,

EXECUTIVE SUMMARY

Lead poisoning is considered the foremostenvironmental threat facing children today.According to the U.S. Centers for DiseaseControl and Prevention, 1.7 million childrenin this country has levels of lead in his or herblood exceeding the amount recognized assafe by the federal government. Childrenfrom every geographic region, race, andsocioeconomic level have been found withelevated blood lead levels, making leadpoisoning the most pervasive childhoodenvironmental disease in the U.S. today. It isalso completely preventable.

In the past states and the federal governmentadopted strict regulations to control or limitexposure to lead, which significantly reducedthe overall levels of lead in humans. How-ever, studies tracking blood lead levels inchildren over an extended period proved thateven minimal levels can cause severe irre-versible health effects.1 These studiesprompted the federal Centers for DiseaseControl and Prevention (CDC) to furtherlower the level of concern for lead in theblood from 25 µg/dL to 10 µg/dL, therebygreatly expanding the number of childrenwith blood lead levels warranting concern.

This publication surveys the issue of leadpoisoning and presents methods used bystates and the federal government to reduceand prevent lead poisoning. The guide isdivided into five sections:

• The nature and extent of lead poisoning• State role in reducing lead hazards• The training, certification and accredita-

tion of lead inspection, risk assessment,and abatement professionals

• Sources and approaches to funding stateprograms

• Appendixes of federal and state leadpoisoning prevention laws, a bibliogra-phy and reference section

viii Lead Poisoning Prevention: A Guide for Legislators

mental retardation, seizures, and sometimesdeath; low levels of poisoning reduce intelli-gence, delay cognitive growth, and impairphysical development. In children, infants,and fetuses, lead is particularly harmfulbecause it damages the developing brain andcentral nervous system permanently.5

State Role in Reducing Lead Hazards

Although the federal government looks to thestates to implement policies to reduce leadhazards and 24 states have enacted lawsregarding some aspect of lead poisoningprevention, few have enacted comprehensivelead hazard reduction programs (see table 1for a summary of state lead hazard reductionprograms). In 1992, Congress passed theResidential Lead-Based Paint Hazard Reduc-tion Act, also known as Title X, which de-pends upon states adopting training andcertification programs for risk assessment,inspection, and abatement professionals andbuilds an infrastructure that states can use tocontrol the hazards that cause lead poisoning.

Comprehensive state programs encompassboth primary and secondary prevention.Secondary prevention identifies lead-poi-soned children and then removes or controlsthe lead hazard causing the poisoning.Primary prevention identifies and remediatesthe sources of lead exposure before a child isharmed.6 States enacting comprehensiveprograms have seen significant reductions incases of elevated blood lead levels. In otherstates, screening data has not identified manylead-poisoned children.

Surveillance helps states assess the sources oflead in communities, determine exposurepatterns, and identify high-risk populations.Screening children provides the most accu-rate determination of the extent of elevatedblood lead levels, though few states requireuniversal screening.7 Thirty-eight states usereporting of lead poisoning to determine the

number of children with lead poisoning.8

Public outreach programs to educate thepublic about lead poisoning prevention areconducted in 38 states.9 Medical case man-agement provides parents with educationalmaterials and coordinates with other supportservices to ensure that the child receivesproper attention through the lengthy recov-ery period. Environmental case manage-ment, or follow-up, allows for the discoveryand remediation of the sources of a child’sexposure. Inspection and risk assessmentsidentify lead hazards and make recommen-dations for remediation, and abatementprograms reduce the hazards found. Certifi-cation of inspection and abatement profes-sionals is required in 20 states and soon willbe required nationwide under Title X. Title Xalso requires disclosure of known lead-basedpaint hazards upon the sale or lease of hous-ing built before 1978.

State policies and programs in two areas areof special importance at this stage of thenation’s response to lead poisoning: thetraining, certification, and accreditation ofprofessionals in lead risk assessment, abate-ment, and inspection; and funding of stateprograms for lead poisoning prevention.

Training, Certification, and Accreditation

With 57 million homes having lead-basedpaint and 20 million needing remediation,training and certification of professionals toperform lead risk assessment, abatement, andinspection activities and the accreditation oftraining programs are crucial to ensure thatremediation effectively reduces lead hazards.Incorrect inspections can identify hazardswhere there are none; improper abatementscan increase, rather than diminish, exposureto lead in a home. Though many states aremoving toward implementing training andcertification programs, property owners, thereal estate community, and other businessesinvolved with older housing are concerned

Lead Poisoning Prevention: A Guide for Legislators ix

States usually place the financial burden ofprograms directly on the main beneficiariesor participants: direct fees on training provid-ers and the accredited workforce, taxes onindustries that historically have used lead,and fees on owners of dwelling units withlead-based paint. Such financing fluctuateswith the number of participants and theirability to pay and cannot guarantee sufficientfunding for a state’s program.

Federal Statutes

The federal government regulates leadpoisoning and lead hazard reduction throughthree main statutes and their implementingregulations: the Lead-Based Paint PoisoningPrevention Act; the Lead ContaminationControl Act; and the Residential Lead-BasedPaint Hazard Reduction Act (Title X). Therecently passed Residential Lead-Based PaintHazard Reduction Act, or Title X of theHousing and Community Development Act,focuses primarily on prevention in residentialhousing, but also covers public and commer-cial buildings and steel structures. In addi-tion to primary prevention, Title X addressestraining and certification of risk assessment,abatement, inspection professionals, andaccreditation of training programs. It alsoprovides funding for abatement; directs EPAto develop health-based standards for haz-ardous levels of lead in paint, dust and soils;directs HUD to inspect and abate certaingovernment-owned and -financed housing;provides for public outreach programs; anddirects EPA, HUD, and the OccupationalSafety and Health Administration (OSHA) topromulgate implementing regulations.

State Statutes

Several states have programs addressing leadpoisoning. Massachusetts has the mostcomprehensive long-standing program, andMaryland’s program has been in existence

that these programs are burdensome andcostly.

Twenty states in 1994 require training andcertification of lead inspection, risk assess-ment, abatement professionals, and accredittraining programs. The Lead-Based PaintHazard Reduction Act of 1992 (Title X) directsthe U.S. Environmental Protection Agency(EPA) to develop a national training, certifica-tion, and accreditation program that requiresthat training programs be accredited andprofessionals be certified before performingrisk assessment, inspection, and abatementactivities in housing built before 1978; inpublic or commercial buildings; or on steelstructures.10 EPA is developing the programat the federal level with the intent that it willbe adopted by states.

Funding of State Programs

Removal of lead-based paint is expected tocost $49.9 billion over the next 10 years, andthe encapsulation of lead contaminated areasapproximately $36.3 billion.11 CDC estimatesthat $974.3 million is needed to eliminatechildhood lead poisoning from both publicand private sources. Lack of adequate fundsis the main obstacle to states implementingcomprehensive lead poisoning preventionprograms. States with lead poisoning pre-vention programs use some general appro-priations, but the majority of support comesfrom fees, direct taxes, bonds, and federalgrants and loans. CDC currently funds moststate screening programs (though these fundsare seen as start-up funds, rather than acontinuing source of money), and the U.S.Department of Housing and Urban Develop-ment (HUD) has begun to provide grants forprivate residential abatement projects. Title Xalso authorizes HUD and EPA to providegrants to states to establish training, certifica-tion, and accreditation programs.

x Lead Poisoning Prevention: A Guide for Legislators

since 1974. Arkansas, California, Connecti-cut, Georgia, Illinois, Louisiana, Maine,Minnesota, Missouri, New Hampshire,New Jersey, Ohio, Rhode Island,Virginia,Vermont, and Wisconsin havepassed legislation to implement comprehen-

sive programs that should meet the stan-dards of the recent federal mandates. Arizo-na, Delaware, Iowa, Kentucky, New York,North Carolina, Oklahoma, and SouthCarolina have statutes that in some manneraddress lead poisoning.

Lead Poisoning Prevention: A Guide for Legislators xi

State LeadPoisoningPrevention

StatuteScreeningProgram

ReportingRequirements/State Registry

PublicOutreach

andEducation

Medical andEnvironmental

Case ManagementPrograms

Inspections/Risk

Assessments

RequiredAbatement

of LeadHazards

TrainingCertification

andAccreditation

RequiredDisclosure of

Lead HazardsAL ! ! ! ! AK ! AZ ! !AR ! ! ! ! ! ! !CA ! ! ! ! ! ! ! ! !

CO ! !CT ! ! ! ! ! ! !DE ! ! ! !FL ! ! ! !

GA ! ! ! ! !

HI ! !IDIL ! ! ! ! ! ! !IN ! !IA ! ! ! ! ! ! !

KS !KY ! ! ! ! ! ! !LA ! ! ! ! ! ! !ME ! ! ! ! ! ! ! ! MD ! ! ! ! ! ! ! ! !

MA ! ! ! ! ! ! ! ! !MI ! ! !

MN ! ! ! ! ! ! ! !MS ! !MO ! ! ! ! ! ! ! !

MT !NE ! ! !NV ! !NH ! ! ! ! ! ! ! !NJ ! ! ! ! ! ! !

NM ! ! !NY ! ! ! ! ! !NC ! ! ! ! ! !ND ! !OH ! ! ! ! ! ! !

OK ! ! !OR ! ! !PA ! ! ! !RI ! ! ! ! ! ! ! ! !SC ! ! ! ! ! !

SD !TN ! ! !TX ! ! !UT !VT ! ! ! ! ! ! ! !

VA ! ! ! ! ! ! !WA ! ! !WI ! ! ! ! ! ! ! !WV ! ! !WY ! !

Table 1. Status of State Lead Hazard Reduction Programs

Lead Poisoning Prevention: A Guide for Legislators 1

↑ Immediate medical and environmentalinterventions

← Medical and environmental interventions

← Medical evaluation and environmentalintervention

← Individual case management andenvironmental investigation ifcondition persists

← Community prevention activities andfrequent rescreening

↓ Not considered lead poisoned

Death →

Encephalopathy--adverse effects tothe brain; can cause coma →Nephropathy--harmful to kidneysand their functions →Anemia--occurs in low blood cell count →

Colic →Hemoglobin Synthesis--body's ability toproduce hemoglobin is decreased ↓ →

Vitamin D Metabolism--body's ability toprocess vitamin D is affected ↓ →

Nerve Conduction Velocity--nervoussystem adversley affected ↓ →

Erythrocyte Protoporphyrin--indicates abody's inability to produce hemoglobin ↑ →

Developmental ToxicityDecreased IQ ↓Hearing impaired ↓ →Growth affected ↓

Transplacental Transfer →

Figure 1Lead Levels in Blood That Cause Certain Effects in Children*

*Note: The levels in this diagram do not necessarily indicate the lowest levels at which lead can have aneffect. These are the levels at which studies have adequately demonstrated an effect.

Source: ATSDR, The Story of Lead (Washington, DC, 1990), p. 32.

150

100

40

30

20

10

50

70

µµµµµg/dLEffect Medical Response

1 . THE NATURE AND EXTENT OF LEAD POISONING

Lead is a highly toxic metal that exists inpaints, dust, and soils in and around homesin the United States. If ingested by humanslead disturbs virtually every system in thebody and provides no physiological benefit.The most comprehensive study of blood leadlevels, the Third National Health and Nutri-tion Examination Survey (NHANES), esti-mates 1.7 million children have blood leadlevels at least 10 µg/dL or above.12

Characteristics of the Metal

Lead has unique properties that increase theseverity of the problem. As an element,inorganic lead cannot be processed or de-

stroyed, nor can its chemical structure bechanged. Lead also accumulates in theenvironment. Once released from its naturalstate it remains indefinitely, continuallyposing a threat for which there are no naturaldefenses.13

Before the industrial age, exposure to leadwas rare. Industrialization, however, re-leased massive amounts of lead into theenvironment. Lead was used extensively inpaints and gasoline, emitted from smeltersand factories, used in pipes and plumbing forwater systems, as well as other consumer andindustrial applications. Large amounts oflead remain in old paint and drinking water

2 Lead Poisoning Prevention: A Guide for Legislators

systems. Dust and soil contain the residuesfrom all these major sources, and naturalforces widely disperse dust contaminated bylead. No socioeconomic group, geographicarea, or racial or ethnic population is freefrom lead.

Effects on Children and Pregnant Women

When absorbed into the body, lead usuallyaffects the central nervous system mostseverely (see figure 1). It is, therefore, partic-ularly harmful even at low-levels to thedeveloping brain and nervous system ofyoung children, infants and fetuses.14 Chil-dren and infants are more likely than adultsto be poisoned by lead because they havemore hand-to-mouth activities and therebyingest more lead-contaminated dusts andpaints. Their bodies also are more likely toabsorb the lead once ingested.15

Lead affects pregnant women by causingpremature deliveries and lower birthweightand, in extreme cases, causing miscarriagesand stillbirth. Research has indicated thatlow levels of lead in the blood harm a fetus’central nervous system, and the Centers forDisease Control and Prevention (CDC)believes it may have an adverse effect.16

Lead poisoning is measured by blood leadcontent: the number of micrograms of lead ina deciliter of blood (µg/dL). A microgramper deciliter is equivalent to four grains ofsalt placed in a swimming pool. Extremelevels in children, above 80 µg/dL, can causecomas, convulsions, and death if not treated.Lower levels, between 25 µg/dL and 60 µg/dL, cause adverse effects on the centralnervous system, the kidneys, and blood-forming organs. At levels nearing 10 µg/dL,lead decreases intelligence and impairsneurobehavioral development. Other effectslinked to low blood lead levels includedecreased height, impaired hearing, and aninability to stand upright.17

Paint Gasoline Smelters Soil** DrinkingWater

0

2

4

6

8

10

12

14

16

Number at Risk Number Exposed

Paint Gasoline Smelters Soil* Drinking Water

16

14

12

10

*the number at risk unknown

Figure 2Number of Children Exposed to Leadvia Various Media

Source: Agency for Toxic Substances and Disease Control (1988)

Sources and Reduction of Exposure

The three major sources of lead are lead-basedpaint, lead particles in dust and soils (mostlycontaminated by lead in paints and gasoline),and lead in drinking water. Lead from smelt-ers and other stationary sources, municipalwaste and sewage sludge incinerators, andconsumer products also contribute to leadinto the environment (see figure 2).19

Lead-based paint. Lead in household paintsis the most frequent cause of lead poisoning.20

Although the sale and use of lead-based paintwas banned in 1978,21 4.9 million tons of leadwere used in paints, and more than 57 millionhomes have lead-based paint.22 Nearly 10million of these homes are occupied by fami-lies with children under seven, and almostfour million of these homes have chippingand peeling paint that poses an immediaterisk to children.23 Many children from upper-and middle-income families are being ex-posed to lead paint and dust from home

Number at Risk


before 1960

1961-1978

1979-1991

Total

0 20 40 60 80 100 120

millions

before 1960

1961-1978

1979-1991

0 2 4 6 8 10 12 14 16

million

before 1960

1961-1978

1979-1991

0 2 4 6 8 10 12 14 16

millions

before 1960

1961-1978

1979-1991

0 2 4 6 8 10 12 14 16

million

1979-1991

1961-1978

before 1960

Source: American Housing Survey 1991, Feb. 1993

SouthNortheast

1979-1991

1961-1978

before 1960

0 2 4 6 8 10 12 14 16

All Areas

Figure 3Number and Age of U.S. Homes

North Central: IL, IN, IA, KS, MI, MN, MO, NE, ND, OH, SD, WI

before 1960

1961-1978

1979-1991

0 2 4 6 8 10 12 14 16

million

0 2 4 6 8 10 12 14 16

1979-1991

1961-1978

before 1960

North Central

1979-1991

1961-1978

before 1960

0 2 4 6 8 10 12 14 16

West

millionsmillions

West: AK, AZ, CA, CO, HI, ID, MT, NM, NV, OR, WA, WY

South: AL, AK, DE, DC, FL, GA, KY, LA, MD, MS, NC, OK, SC,TN, TX, VA, WV

0 20 40 60 80 100 120millions

Northeast: CT, ME, MA, NH, NJ, NY, PA, RI, VT

millions0 2 4 6 8 10 12 14 16

millions

Total

1979-1991

1961-1978

before 1960


Table 2Number of Owner-Occupied Properties and Single-Family Rental Properties

Owner Occupied PropertiesHouseholds Children under 6 Households Children under 6

p re-1950 16,225,000 2,140,0001950-1959 8,982,000 1,103,000 City 14,422,000 2,286,0001960-1969 9,570,000 1,193,000 Suburb 30,461,000 5,069,0001970-1978 11,251,000 1,563,000 Rura l 14,913,000 2,024,000post-1978 13,768,000 3,380,000Tota l 59,796,000 9,379,000 59,796,000 9,379,000

Single-Family Rental PropertiesHouseholds Children under 6 Households Children under 6

p re-1950 11,508,000 2,507,0001950-1959 3,530,000 838,000 City 15,265,000 3,255,0001960-1969 4,953,000 1,130,000 Suburb 12,575,000 2,660,0001970-1978 6,340,000 1,396,000 Rura l 5,511,000 1,332,000post-1978 7,020,000 1,376,000Tota l 33,351,000 7,247,000 33,351,000 7,247,000

Source: American Housing Survey, 1991

renovation projects and lead-contaminatedsoil around homes, playgrounds, and schools(see table 2).

The older the home, the greater the amount oflead-based paint. Of the 4.9 million tons ofwhite lead pigment used between 1910 and1989, 92 percent was used prior to 1950, mostof it between 1910 and 1939.24 The greatestconcentration of older homes is in the North-east and upper Midwest (see figure 3).

Children ingest lead paint mostly fromgetting lead particulates on their hands theninto their mouths, though some do eat paintchips. These particulates come from deterio-rated or damaged paint or from paint dustreleased during a renovation into carpeting,floors, and window sills.

Reduction and abatement of lead-basedpaint. To lessen exposures to lead-basedpaint requires either making the paint inac-cessible or removing it completely. Encapsu-

lation or enclosure of the paint preventsaccess and is an acceptable abatement meth-od in Illinois, Kentucky, Louisiana, Massa-chusetts, Minnesota, and Wisconsin. Encap-sulation involves covering paint with amaterial that bonds to the surface, such asacrylic or epoxy coatings, or with flexiblewall coverings. Enclosure requires use ofapproved wallboards or paneling that ad-equately covers the contaminated surface.25

Enclosure and encapsulation, however, doesnot remove the paint.

Removal also is an accepted method; how-ever, lead-contaminated dust can be gener-ated unless proper procedures are followed.Removal requires the complete stripping orremoval of contaminated surfaces and re-placement with lead-safe components.Physical removal can be done by wet scrap-ing with mechanical removal methods, withchemical paint removers, or by hand-scrap-ing using a heat gun at recommended levels.On-site removal of lead-based paint requires

-


worker safeguards, including protectiveclothing, respirators, personal hygiene proto-cols, and periodic blood lead testing. Thework area also must be isolated in most casesto prevent release of contaminants into otherparts of the building and the environment.26

Removal costs 30 percent to 50 percent morethan enclosure or encapsulation.27

Title X directs EPA to establish health-basedstandards to determine when a dwelling issafe from lead hazards, though not necessar-ily free from lead. These standards permitinterim controls.28 Interim controls are de-signed to temporarily reduce exposure tolead hazards and may remain in place as longas periodic monitoring of the hazards indi-cate the controls are still effective. Clearancetesting can make interim controls acceptableand effective and can delay, perhaps perma-nently, the cost of doing an abatement.Interim controls are a strategy used in Mary-land, Massachusetts, and Rhode Island.

Lead in soil and dust. Lead-contaminatedsoil and dust have been identified as thesecond most likely source of exposure. Upto 30 percent of elevated blood lead levelsmay be due to soil and dust, with householddust being the most common source of low-level poisoning of children.29 ATSDR esti-mates that between 5.9 million to 11.7 millionchildren have been exposed to lead from dustand soil, but the agency has no accurateestimates of its effects on the children’s bloodlead levels.30

Soil and dust are often described as pathwaysfor exposure to lead rather than directsources, because they become contaminatedfrom other sources. Soil and dust becomecontaminated through the weathering andchipping of lead-based paint; from scraping,sanding, or renovation activities that breaksurfaces painted with lead-based paint; fromemissions from factories and cars fueled byleaded gas; from solid wastes from indus-

Arizona’s Response to Lead in Soil

Because so little blood lead testing has beendone, Arizona cannot determine whetherlead in paint is a significant problem. How-ever, lead in the soil of smelter communitiesis a recognized problem. Historically, 52communities in the state had smelting opera-tions releasing lead into the environment.Since the natural soil lead levels are less than50 milligrams per kilogram (mg/kg), reportsof up to 13,600 mg/kg of soil samples insmelter towns caused alarm.

The state studied three communities withpast smelter operations. A representativesample of children under five were screenedand soil samples taken. Soil lead levels in thetowns of Douglas, where a large smelteroperated until 1986, and Bisbee, which hadnumerous small smelters until 1908, were 254mg/kg and 337 mg/kg, respectively; soillead levels were 35 mg/kg in Safford, whichclosed its small smelting operations before1900. Corresponding to the soil samples, thechildren in Douglas and Bisbee had signifi-cantly higher blood lead levels than childrenin the town of Safford. Soil lead and bloodlead levels in Bisbee were higher the closerthe children lived to the old smelter sites.

The dry climate and desert flora of Arizonaalso contribute to the problem. Withoutmuch precipitation to dilute the lead or lushvegetation to cover the lead-contaminatedsoil, children come into direct contact withthe contaminated soil.

The state responded to this situation byimplementing a voluntary screening programfor these communities, but because there islittle research on the effectiveness of abatinglead-contaminated soil in dry climates, thestate has been unable to provide much otherassistance. It has proved, though, thatsmelter towns have a higher incidence of leadpoisoning caused by lead in soil.


Missouri’s Lead Mines and Smelters Study

Because Missouri produces more lead than any other state, the state has been very con-cerned about the effects mining and smelting have on their population. The state studiedthree communities: Jasper County in the southern part of the state; near Herculaneum, justsouth of St. Louis; and a smelting operation in Glover. All the towns had mining or smelt-ing operations.

The studies done by the Department of Health determined that lead mining per se does notcause elevated blood lead levels, but smelters do significantly contribute. In Jasper, thestate studied people living on mine tailings and near smelter sites; these lead levels werecompared with those for people who live outside any historical mining or smelting activity.The study, which focused on lead poisoning from soil (as opposed to paint), found that 12percent to 13 percent of children six years old and younger living near the sites had bloodleads above 10 µg/dL.

The Herculaneum study looked at a smelter that has been in operation more than 100years. Soil within a half mile radius of the smelter had lead levels ranging from 1100 ppmto 2800 ppm. Though the smelter meets EPA ambient air standards, children screenedwithin the half mile radius had a 20 percent incidence of elevated blood lead levels.

The Glover smelter site did not meet EPA’s ambient air standards. Lead soil levels withintwo miles of the site reached 8500 ppm, and the smelter had been known to emit pollutants10 times the level allowed by EPA. Not many children live near the smelter, and, therefore,few were found with elevated blood lead levels. However, the nature of the operationraises concerns for the state.

tries; and from dust and dirt carried into thehome from contaminated sources.31

Leaded gasoline emitted from cars is viewedas the foremost source of soil contamination,since 7.9 million tons of lead were used ingas. However, EPA’s residential soil studyshowed the highest concentrations of leadparticles in the soil nearest houses, conclud-ing that lead from paint is the greatest con-taminant.32

Reduction or abatement of lead-contaminat-ed soils and dust. Less is known about howto reduce or abate the lead in soils and dustthan is known about reducing lead in paint ordrinking water, and EPA acknowledges thatmore information is needed to better charac-terize the problem, determine pathways of

exposure, and determine effectiveremediation methods.33 HUD has set guide-lines for clearance testing for lead dust: 200mg/ft2 of dust lead on floors and 500 mg/ft2

of dust lead on windowsills.34

States with soil abatement standards gener-ally regard soil with more than 500 ppmcontaminated, though some demand actionfor levels as low as 100 ppm.35 These statesrecommend that contaminated soil be re-moved or covered with either asphalt, ce-ment, mulch or grass, or other materials toprevent access to the lead. The planting ofshrubs or bushes to limit access to the soil bychildren also is recommended in somestates.36

Other states, such as Maryland and NewYork, address lead in soil on a case by case


basis. Remediation through soil covering orplanting is usually required only if levels areabove 1000 ppm-1500 ppm and there is anindication that the affected children actuallyhave direct contact with the contaminatedsoil. These states have not found removal ofsoil less than 1000 ppm to have a significanteffect.

Though household dust can be reduced bythorough cleaning of the dwelling and con-tinued maintenance, research sponsored byHUD has shown that the lead-contaminateddust and soil in carpeting and furniturecannot be adequately cleaned, and recom-mends replacement.37

Lead in drinking water. Lead contaminatesdrinking water from two sources: at thesource of the supply (contaminated by falloutfrom air or solid waste) and from corrosion oflead pipes or brass or solder plumbingmaterials in the water distribution system.Most contamination is from corrosion by-products and is found in older urban areaswith lead service lines and mains, lead solder,and brass fixtures.38

The body absorbs lead from drinking watermore completely than from food or othersubstances; and, given the amount of water a

body consumes, even a small concentrationof lead can cause adverse affects. An esti-mated 1.8 million children under the age offive are potentially exposed, and approxi-mately 241,000 children under six have bloodlead levels above 15 µg/dL from water.39

Reduction and remediation of lead in drink-ing water. EPA has aggressively dealt withlead in drinking water by promulgatingregulations limiting the amount of leadallowed in drinking water, banning the use oflead in solder and plumbing components,and requiring the replacement of lead pipesin water systems if they fail to meet a speci-fied testing standard of 15 parts of lead perbillion parts of water.40 Through the SafeDrinking Water Act (SDWA) and the LeadContamination Control Act (LCCA) and theirimplementing regulations, EPA has effec-tively worked with states and localities toreduce lead in drinking water through regu-latory enforcement and non-regulatorystrategies, such as outreach programs toeducate consumers and technical assistanceto manufacturers.41 However, lead in drink-ing water remains a problem; and to meetcurrent and future drinking water standards,states and EPA must increase their efforts toeliminate lead.


For most of the eighties, lead was not seen asa serious concern. The ban on lead in gaso-line and paints significantly reduced overallblood lead levels, from an average of 15 µg/dL in 1976 to around 5 µg/dL in 1991. How-ever, research published in the late 1980sproved that minor levels of lead, even levelsas low as 10 µg/dL, could severely harmchildren under six.45 This sparked renewedconcern about lead poisoning.

In 1988, Congress passed the Lead Contami-nation Control Act, which authorized CDC toprovide grants to states to administer child-hood lead poisoning prevention for fiscalyears 1990 and 1991. This law also addressedlead in drinking water by requiring states toestablish programs to test and eliminate leadin water from schools and day care centers byJuly 1989 and provide for public notificationof drinking water analysis.46

Title X: The Residential Lead-Based PaintHazard Reduction Act of 1992

The Residential Lead-Based Paint Hazard Reduc-tion Act of 1992, Title X of the Housing andCommunity Development Act, was enactedinto law on October 28, 1992.47 Title X, as it iscommonly known, redirects the federalgovernment’s approach to lead poisoning byfocusing on lead-based paint, soils and dustin residences, public and commercial build-ings, and steel structures. Working mainlythrough HUD, EPA, and the OccupationalSafety and Health Administration (OSHA),Title X establishes a new framework for leadhazard reduction. It imposes specific require-ments on federally owned, insured, andassisted housing; authorizes resources tostates and local governments to abate lead inhomes; mandates requirements for certifyingand training contractors and workers, pro-

2. THE STATE ROLE IN REDUCING LEAD EXPOSURE

History of the State Role

Legislatures have focused on lead poisoningprevention several times since 1971. Thepassage in 1971 of the Lead-Based PaintPoisoning Prevention Act marked the initialfederal push to address lead hazards.42 Theact primarily established protocols for dealingwith lead-based paint in public housing andrequired the Centers for Disease Control andPrevention (CDC) to establish standards.During this time states began to recognize theseriousness of lead poisoning and twostates—Massachusetts and Maryland—initiated comprehensive programs to addresslead poisoning prevention.

As more became known about lead, thefederal government, mostly through CDC,encouraged states to undertake screeningprograms for children in “high-risk” areas(cities with older homes and young families).It also banned lead in gasoline and newresidential paints, which significantly re-duced the overall release of lead into theenvironment.43 Prompted by CDC funding,several states enacted lead paint poisoningand control acts, which granted authority,usually to their health departments, to screen,diagnose, and treat lead poisoning.44 Thesestatutes allowed states to provide secondaryprevention, that is, respond to childrenalready poisoned by lead and provide someremediation. However, they gave littleauthority to states to prevent poisoning.Screening and remediation legislation waspassed in California, Connecticut, Illinois,Kentucky, Louisiana, Maine, Maryland,Massachusetts, New Hampshire, NewJersey, New York, Rhode Island, SouthCarolina, and Wisconsin. These programsflourished until CDC eliminated funding in1981.


tecting workers, certifying laboratories, andaccrediting training programs; and raises thepublic’s awareness of the seriousness of leadpoisoning.48

Effect on state programs. Title X effectsstates both directly and indirectly. Directly,Title X requires states (and metropolitanareas) receiving federal housing and commu-nity development funds to consider lead-based paint hazards in their ComprehensiveHousing Affordability Strategies. States mustoutline the actions being proposed or taken toevaluate and reduce lead-based paint anddescribe how lead-based paint hazard reduc-tion will be integrated into housing policiesand programs.49 Indirectly, Title X authorizesgrant money to HUD and EPA to encouragestates to adopt training, certification, andaccreditation programs “at least as protec-tive” as the federal program. EPA mustdevelop a model state program for statesseeking to adopt a training and certificationprogram. States without a program twoyears after EPA promulgates its model stateplan will be subject to an EPA-imposedprogram.

In addition, Congress authorized under TitleX close to $400 million in grants and loans tostates and local governments for lead hazardreduction.50 To receive the funding statesmust comply with federal lead hazard reduc-tion guidelines, which include a training,certification, and accreditation program.

For 1993, HUD’s criteria for Lead-Based PaintHazard Reduction grants (58 FR 31848)require states to enact a comprehensive leadprogram before receiving funds. HUD andEPA defined the minimum set of basic ele-ments that must be contained in a state'senabling legislation:

• Agency. Establish an agency or agenciesor designate an existing state agency oragencies to implement the state program.

• Certification. Authorize and direct theagency to promulgate regulations requir-ing the certification of contractors whooffer to detect or reduce lead hazards.

• Worker training. Authorize and directthe agency to promulgate regulationssetting training requirements for workers,inspectors, and other persons directly andsubstantially involved in lead-based paintactivities. The regulations must establishminimum acceptable levels of trainingand periodic refresher training for eachclass of workers and require that trainingbe provided by accredited training pro-viders.

• Accreditation of training providers.Authorize and direct the agency to pro-mulgate regulations to establish theaccreditation of training programs, in-cluding the following:- Minimum requirements for the accredi-tation of training providers- Minimum training curriculum require-ments- Minimum training hour requirements- Minimum hands-on training require-ments- Minimum trainee competency andproficiency requirements- Minimum requirements for trainingprogram quality control

• Standards. Authorize and direct theagency to promulgate regulations estab-lishing standards for performing lead-based paint activities, taking into accountreliability, effectiveness, and safety.

• Compliance. Authorize and direct theagency to promulgate regulations thatwill require any activity involving leadhazard detection or reduction proceduresto comply with agency regulations and touse certified and accredited personnel.

• Enforcement. Authorize and direct theagency to promulgate regulations thatprovide for the enforcement of the StateCertification Program and that establishsuitable sanctions for those who fail to


Massachusetts’ Childhood Lead Poisoning Prevention Program

Massachusetts’ comprehensive program began in 1974, three years following the enactment oftheir Childhood Lead Poisoning Prevention Act, which gave the Department of Health theauthority to “establish a statewide program for the prevention, screening, diagnosis, andtreatment of lead poisoning.”62 Since that time the Childhood Lead Poisoning PreventionProgram (CLPPP) has become the nation's most comprehensive program addressing leadpoisoning prevention.

CLPPP requires annual screening of all children under six by physicians and health care facili-ties. Children considered at high risk are screened more frequently. Physicians, health careproviders, and laboratories report cases of elevated blood lead levels in children to the directorof CLPPP.

Upon receipt of a confirmed case, the program must conduct an inspection of the child’s home,determine whether the home has dangerous levels of lead, and, if dangerous levels are found,require the property be abated. An abatement makes lead-contaminated paint, plaster, or othermaterials inaccessible to children under six by either removing, replacing, or covering thecontaminated surface. Preventive abatement is required whenever a child under six resides onthe premises, but CLPPP can order abatements if a child under six who is at significant riskspends time at a dwelling or if someone with elevated blood lead affecting his or her cognitivedevelopment resides there.

Abatements and inspections must be done by certified professionals who are specially trainedin the procedures mandated by the state. Follow-up inspections will be conducted to ensurethat lead levels remain low.

Results of this aggressive approach are encouraging. Overall blood lead levels have fallen, andeven with the lowering of the blood lead standards and the advent of universal screening, thestate’s caseload of poisoned children has declined. The program continues to address thedifficult issue of preventive abatement of lead hazards and is furthering its educational out-reach efforts.

may from time to time be promulgated byEPA, HUD, and such other federal agen-cies as may have jurisdiction over leadhazards.

• Reciprocity. Authorize the agency toestablish liaison with other states havinga State Certification Program to assure themaximum consistency of program re-quirements, in order to facilitate reciproc-ity of certification and accreditationamong the several states.51

comply with program requirements. Theregulations shall include provisions forthe decertification and deaccreditation ofprograms and personnel.

• Federal funding eligibility. Authorizeand direct the agency to revise its regula-tions and procedures from time to time toassure that state lead hazard activitiescontinue to be eligible for federal funding,by meeting the state certification programstandards and other requirements that


Comprehensive State Programs for LeadPoisoning

Elements of a comprehensive programgenerally include surveillance, screening,reporting, public outreach, and medical andenvironmental case management, whichencompasses inspections, risk assessments,remediation or abatement of lead hazards,and disclosure of lead hazards. By establish-ing a comprehensive program, states canremediate the sources of lead exposure aswell as identify and treat children withelevated blood lead levels.52 California,Connecticut, Georgia, Illinois, Louisiana,Maine, Maryland, Massachusetts, Minneso-ta, Missouri, New Hampshire, New Jersey,Ohio, Rhode Island, Vermont, Virginia, andWisconsin have enacted comprehensive leadpoisoning prevention programs addressingmost of the elements listed above (see table3).

Earlier state and federal laws focused onhealth-based, or secondary prevention ratherthan hazard abatement or primary preven-tion.53 Secondary prevention is reactive;programs are triggered and hazardsremediated after a child has been poisoned.Primary prevention is proactive, requiringhomeowners and landlords to remediatehazards before a child is poisoned. Primaryprevention programs are encouraged by TitleX and CDC, but require administration andenforcement by the state and shift the finan-cial burdens onto property owners,homeowners, and others involved with theresidential housing community.

Surveillance. States identify the extent oflead poisoning from 1) screening data ofblood lead levels, 2) environmental surveysdesigned to identify common sources of leadexposure, and 3) demographic data identify-ing common factors that indicate elevated

Table 3States With Comprehensive Programs

Surveillance Screening ReportingPublic

Outreach

Medical &Environmental

CaseManagement

Training,Certification,Accreditation

Ca lifornia ✔ ✔ ✔ ✔ ✔ ✔

Connec ticut ✔ ✔ ✔ ✔ ✔

Georg ia ✔ ✔ ✔

Illino is ✔ ✔ ✔ ✔ ✔ ✔

Lousia na ✔ ✔ ✔

Ma ine ✔ ✔ ✔ ✔ ✔ ✔

Ma ryla nd ✔ ✔ ✔ ✔ ✔ ✔

Ma ssa chusetts ✔ ✔ ✔ ✔ ✔ ✔

Minnesota ✔ ✔ ✔

Missouri ✔ ✔ ✔ ✔ ✔

New Ha mp shire ✔ ✔ ✔ ✔ ✔ ✔

New Jersey ✔ ✔ ✔ ✔ ✔ ✔

Ohio ✔ ✔ ✔ ✔ ✔

Rhod e Isla nd ✔ ✔ ✔ ✔ ✔ ✔

Vermont ✔ ✔ ✔ ✔

Virg inia ✔ ✔ ✔ ✔ ✔

Wisconsin ✔ ✔ ✔ ✔ ✔ ✔

Source: NCSL 1994 Survey of State Programs


California’s Lead Screening Programs

As part of a settlement to a lawsuit brought against the state, routine screening is now requiredfor all children under the Child Health and Disability Prevention program (CHDP), whichcovers approximately two million children under the age of six, and in the state’s Early Period-ic Screening, Diagnostic, and Treatment (EPSDT) program under Medicaid.

In the first six months of this directive, more than 82,000 blood lead tests were conducted.These numbers continue to grow dramatically each month as more providers implement thenew guidelines and recommendations. The number of screenings now reach 12,000 - 15,000tests per month.

The results show the breadth of the problem. In 1992, the state identified more than 550 newcases of serious childhood lead poisoning above 25 µg/dL, whereas in the past only 40 casesper year were discovered. Twelve percent of the children identified had blood lead levelsbetween 45 µg/dL and 69 µg/dL, and 2 percent had levels above 70 µg/dL. These resultsindicate severe lead poisoning and usually require hospitalization and urgent medical treat-ment.

tal surveys and demographic data provide areasonable alternative, neither can match theaccuracy of direct, universal screening.

Screening programs. Individual screening ofchildren documents blood lead levels mostaccurately. CDC recommends that all chil-dren under six be tested at least once andmore often if they are considered a high riskbecause they 1) live in old, decaying housingbuilt before 1960, 2) live in high-densityurban areas or near major roadways, or 3)live near smelters or other industrial com-plexes that use or process lead.58 To meetCDC’s recommendations, 16.4 million pediat-ric tests will have to be performed yearly.59

The preferred screening method is directblood lead measurement.60 Formerly, physi-cians measured erythrocyte protoporphyrin(EP) to determine the level of lead in blood.However, EP is not sensitive enough to detectlevels below 25 µg/dL and often fails todetect blood lead even at higher levels. Themore precise direct testing of blood leadrequires detailed procedures and laboratoryanalysis that better ensure the accuracy of thetest.61

blood lead levels.54 All three are necessary toprovide a complete portrait of lead poison-ing .

Screening can provide the most accurateportrayal of blood lead levels, but mostscreening is limited to target areas andpopulations, and universal screening of allchildren is rare. Environmental surveysdetermine common sources of lead exposure,such as lead-based paint, lead in dust andsoils, and lead in drinking water, to estimatethe number of poisoned children.55 Statesbase their estimates on the concentration oflead in a particular source, the amount oflead that source releases, and the number ofchildren who come into contact with thereleased lead.56

Demographic data also are used to defineareas with a high likelihood of lead poison-ing, or “high-risk areas.” Relevant factorsthat indicate a high-risk area include: the ageof the housing, income levels, socioeconomicstatus, ethnicity of the residents, population,and the number or density of preschool-agedchildren in the area.57 Although environmen-


risk communities and to identify blood leadlevels as low as 10 µg/dL, an approach thatwill command more extensive resources todiscover low-level lead poisoning.

Reporting requirements/state registry. Leadpoisoning is a reportable disease in 38 states.Reporting of lead poisoning assists states indetermining the extent of the problem, thoughoften the data collected identify only a portionof the total number poisoned since a majorityof states rely on voluntary screening forreporting purposes.

Two groups are required to report: physiciansand laboratories. Physicians can report bloodlead levels above 25 µg/dL using the EP test,but must wait for results from a lab if testingfor levels below 25 µg/dL using the direct

Twenty-nine states have some sort of screen-ing program (see figure 4).63 Seventeenstates statutorily mandate screening ofchildren either in high-risk areas, beforeentering day care, or by pediatricians.

State screening programs began in 1971 andwere supported by federal funds under theLead-Based Paint Poisoning Prevention Act.Screening done pursuant to federal man-dates focused on children considered at highrisk with a likelihood of elevated blood leadat a level warranting medical attention, atleast above 25 µg/dL. This method waseffective in finding the children most severe-ly harmed by lead.

Current screening programs are broadeningtheir focus to screen children outside of high

Figure 4States with Lead Screening Programs


Maryland’s Lead Registry

Maryland established its Childhood Lead Registry (CLR) in 1986 requiring medical laboratoriesto report all blood lead tests for lead screening of Maryland’s children between one year and 18years of age. Since 1990, when the CLR was computerized, there have been 218,979 reportedscreening tests.

The CLR is an in-house, PC-based computer system that receives reports both electronically(from three private labs and the state lab) and on hard copy (from other private labs). Reportsof elevated blood lead levels are phoned or faxed to the CLR to facilitate public health casemanagement by the community health nurses housed in local health departments and whoserve as case managers for children with blood lead levels equal to or greater than 20 µg/dL.

Lead screening is required for Early Periodic Screening, Diagnostic, and Treatment (EPSDT)children and recommended for all others, though a majority of children between birth and 6years have not been tested. However, because of public awareness screening reports havebeen multiplying, from 60,109 in 1990 to an estimated 112,000 in 1993. The state is preparingfor a 100 percent reporting increase in the coming years.

Because more than half the children screened in 1990 were discovered to have lead levels inexcess of 10 µg/dL, Maryland has found the CLR essential for tracking lead poisoning andfacilitating medical management.

and state and federal programs, and theNational Lead Information Center has aclearinghouse and a hotline to answer ques-tions on lead: 1/800/LEADFYI [1(800)532-5323-394] for the hotline, 1(800)424-LEAD[1(800)424-5323] for the clearinghouse (seeappendix E).

Thirty-six state agencies responsible forpublic health have information regardinglead and ways to prevent poisoning. Distri-bution, however, is often limited to specifichealth care clinics, and the informationsometimes fails to reach the people mostlikely to have lead-poisoned children.

CDC recommends that outreach and educa-tion programs target local officials, healthcareproviders, parents, property owners, day careproviders, and early childhood educatorsthrough pamphlets and written materials,media outlets, public meetings, school pro-grams, and social service agencies.66

blood lead method. Laboratories can providemore precise blood lead tests and are seen asan easier community to regulate to ensureaccurate reporting. Twenty-six states requireboth physicians and laboratories to report,eight require only lab reporting.

Public outreach and education. One of themost critical and commonly practiced compo-nents of states’ lead poisoning preventionprograms is public outreach.64 Title X re-quires EPA to publish a lead hazard informa-tion pamphlet designed to inform the publicon the health risks associated with leadexposures, the presence of lead in target andfederally assisted housing, and the risksinvolved in renovating or remodeling adwelling.65 EPA has already printed anddistributed Lead Poisoning and Your Children,which discusses general problems with leadin residences, and Lead Based Paint: ProtectYour Family. CDC, HUD, and EPA also havemany other summaries and pamphletsdescribing different aspects of lead poisoning


Medical and environmental case manage-ment programs. When a child is identifiedwith an elevated blood lead level or as livingin a high risk area, the state may track thatchild and provide case management. Casemanagement encompasses medical follow-up(health education and making certain that thechild is properly treated for the lead) andenvironmental activities (reducing exposureto the sources of lead poisoning).

Medical case management programs pre-scribe specific treatment for poisoned chil-dren to reduce lead levels based on a child’sblood lead concentration (see table 4). Treat-ment involves pediatric evaluations, contin-ued monitoring of blood lead levels, anddietary supplements to reduce lead exposureand lessen the effects of poisoning.67 Mostimportant, it provides the necessary interven-tion for children to reduce their blood leadlevels.

Public health case management is publiclyfinanced programs in which nurses go tohomes to educate parents about the sources,effects, and prevention of lead poisoning, andprovide continued oversight and support toensure that lead hazards are remediated andpoisoning does not reoccur.

Most medical management programs areprovided at the local level but rely on stateand federal funding. Medicaid’s Early and

Periodic Screening, Diagnostic, and Treat-ment (EPSDT) program provides screeningfor lead and treatment for poisoning tochildren it covers, but states or the privatesector must handle treatment for the remain-der of children. State health budgets oftenare not in a position to provide for extensivetreatment programs.

If elevated blood lead levels persist,healthcare providers may recommend, orrequire if they have the authority, that envi-ronmental case management be undertaken.Environmental case management, also calledenvironmental follow-up, investigates achild’s environment, meaning home, playareas, and school, to discover the source ofthe lead exposure. Environmental casemanagement allows states to investigate thechild’s environment, usually the home, todetermine areas or surfaces releasing unac-ceptable amounts of lead, take emergencyand long-term action to reduce lead expo-sures, and evaluate the efficacy of the inter-vention.68 This can include everything fromtesting for lead-based paint in the home tostudies of soils in playgrounds. Often casemanagement is limited to a simple inspectionof the child’s home to identify obvioussources of exposure, such as chipped paint,painted windows or door jambs, or drinkingwater. CDC, however, recommends thor-ough and immediate investigation and

Lead Level R e c ommenda t i o n(mcg/dL)

Up to 9 Not considered lead-poisoned10-14 Community prevention activities and frequent rescreening15-19 Individual case management, and environmental investigation if condition persists20-44 Medical evaluation and environmental intervention45-69 Medical and environmental interventions70 plus Immediate medical and environmental interventions

Source: U.S. Centers for Disease Control and Prevention, “Preventing Lead Poisoning in Young Children” (October 1991).

Table 4CDC’s Recommended Responses to Various Blood Lead Levels in Children


remediation of the environment, especially ifthe poisoning is severe.69

Inspections/risk assessments. Case manage-ment limits inspections to residences withpoisoned children, but states with preventiveprograms expand inspection requirements tocover child care facilities, property beingrented or leased to persons with youngchildren, or private property upon sale.These inspections identify the presence oflead-based paint, soils, and dusts. Somestates, and Title X, provide for risk assess-ments to determine the severity of the leadexposure hazard.

“Risk assessment,” as defined by Title X,means “an on-site investigation to determineand report the existence, nature, severity, andlocation of lead-based paint hazards indwellings,” including information regardingthe age and history of the housing andoccupancy by children under six, a visualinspection, limited wipe or other environ-mental sampling techniques, and a reportexplaining the results of the investigation.70

Title X recommends risk assessments oftarget housing (housing built before 1978)and in public buildings and encourages statesadopting the EPA program to provide forrisk assessments as well.

Remediation or abatement of lead hazards.Results of the risk assessments and inspec-tions usually determine the recommendedresponse, either interim control or abatement.Preventive programs require owners toremediate lead hazards (using certifiedprofessionals) or be subject to penalty. Mas-sachusetts imposes strict liability on residen-tial owners refusing to abate.71

Abatement standards are not universalamong state programs. Abatement technolo-gies are continually evolving, and EPA isworking to establish performance standardsfor lead-based paint activities.72 In the paststates have had to struggle to identify whatconstitutes proper “abatement” or “interimcontrol,” leaving the public uncertain about

whether their state’s guidelines are sufficientto make their dwelling lead-safe. For federalpublic housing, “abatement” means theremoval of all lead-based paint; under Title X,“abatement” encompasses measures de-signed to permanently eliminate lead-basedpaint hazards, including removal, replace-ment, and encapsulation controls to limithazards. “Interim controls” under Title X aremeasures “designed to reduce temporarilyhuman exposure or likely exposure to lead-based paint hazards,” including cleaning,repairs, maintenance, and ongoing monitor-ing of lead hazards (see appendix A). Moststates are looking to EPA to set the finalstandard.

Disclosure of lead hazards. Disclosure ofknown lead hazards in housing assists stateand local governments, investors, mortgagecompanies, potential buyers, and the realestate community when working with aproperty. A registry of homes with knownlead hazards facilitates a state’s poisoningprevention efforts, and several states (andTitle X, section 1018 after the promulgation offinal regulations)73 require reporting of theresults of lead inspections. Disclosure notonly provides owners, occupants, mortgag-ees, and lienholders with an understandingof the hazards that exist, but also puts themon notice regarding potential liability frominvesting in a building with lead hazards.

Under Title X, all lead-based hazards must bedisclosed upon the sale or lease of any targethousing and the purchaser or lessee must begiven a lead hazard information pamphlet.The purchaser must also have the option ofconducting a risk assessment or inspection todetermine the presence of any lead-basedhazards before becoming obligated under acontract to purchase the house.


Maryland’s and Massachusetts’ Accreditation Program

Both Maryland and Massachusetts pioneered programs to accredit lead abatement contractorsand inspectors. Massachusetts began the accreditation process in 1989 and has the most expe-rience in lead-related training and certification. Administration of its program is conducted bytwo agencies: the Department of Health, which accredits inspectors, and the Department ofLabor and Industries, which accredits contractors and workers.

Massachusetts' inspector training lasts a minimum of 2 1/2 days, followed by an one-hourexam. Upon successful completion of the course, a person must complete an apprenticeship toa master inspector. After the apprenticeship the person may apply for an inspector’s licenseand become certified to inspect for lead.

Abatement workers and contractors also must undergo training and an exam but do not needto become apprentices before licensure.

Maryland established training requirements in 1988 within the provisions of the state’s lead-based paint abatement regulations for residential and child care structures. Under these regu-lations, the Maryland Department of the Environment (MDE) reviews and approves trainingprograms, and certifies workers, inspectors, and contractors; MDE also trains and certifies stateand local agency employees as abatement inspectors.

Maryland’s Occupational Safety and Health Lead in Construction regulations, effective in 1986,include training provisions. To satisfy requirements under Title X, Maryland’s new law re-quires that persons exposed to lead while working on structural steel also meet more stringenttraining and accreditation requirements.

government will require all persons doinglead abatements, risk assessments, or inspec-tions to be trained by an accredited trainingprovider and certified by a state or EPA.74

Certification confirms licensure on individu-als to perform lead abatements, risk assess-ment, or inspection within a state. Trainingby an accredited training provider is a neces-sary precursor to certification.

Training Programs

In a report to Congress, HUD concluded thatuntrained abatement contractors increase,rather than diminish, the danger from leadexposure and recommended training for all

Training and certification programs ensurethat only qualified professionals inspect,assess, and remediate homes, residences,and other structures with lead-based haz-ards. Accreditation of training programsensures that these professionals are trainedin qualified courses. Certification, an officialrecognition that a person has been adequate-ly trained and has fulfilled state (or federal)requirements to work in a profession, pro-vides an assurance of competency to per-form inspection and abatement activities.Currently, 20 states mandate training andcertification of all lead abatement contractorsand inspectors. Two years following pro-mulgation of the final regulations the federal

3. TRAINING, CERTIFICATION, AND ACCREDITATION


persons directly involved with testing andabatement, including architects, engineers,abatement contractors, abatement workers,and lead inspectors. Others HUD has identi-fied as benefiting from lead training includegovernment administrators, property ownersand managers.75 Congress reacted by man-dating under Title X that persons who in-spect, assess risks, or are directly involvedwith abatement activities be trained andcertified.76

Lead inspection, assessment, and abatementtraining courses have operated for severalyears. Programs specializing in certifyingcontractors for work in Massachusetts andMaryland have been in existence since themid-1980s, and general training programshave been teaching safe practices in leadabatement and inspection in many parts ofthe country.

Yet new technology and new theories haveraised questions about current trainingprograms. Lead inspection and abatement isan evolving science, and discrepancies haveemerged between training courses regardingthe proper method. Questions about theeffectiveness of encapsulation versus re-moval, use of sodium sulfide rather than anX-ray fluorescence (XRF) analyzer to detectlead, and the use of new technologies haveleft training providers and state administra-tors struggling to determine the best tech-niques to present.

In response, EPA initiated development ofmodel courses that standardize curricula fortraining lead identification and control pro-fessionals. EPA has developed model curric-ula for supervisors, contractors, and inspec-tors. A course for abatement workers iscomplete and will be available for distribu-tion shortly. Additionally, a course for riskassessors will be started soon. EPA sponsorsfive regional lead training centers (RLTCs).The RLTCs established consortial links withother universities and community colleges,

state lead programs, labor organizations, andnonprofit organizations to provide leadabatement training that is accepted, thoughnot approved, by EPA at sites throughout thecountry.77 The model curriculum is availablethrough the HUD user service (see appendixC).

Elements of a Lead Inspection, Assessment,and Abatement Training Program

HUD identified what it considers to be thebasic components necessary for training oflead inspection and abatement professionalsto work in HUD housing. HUD requirestraining in:

• Possible routes of exposure to lead—knowledge of how fetuses, children, andadults become exposed and the types andmeaning of tests to determine lead poi-soning and other exposures.

• Known health effects associated withexposure—the types of tests to determinelead exposure, the adverse health effectslead may cause, corresponding blood leadlevels, symptoms of lead poisoning,medical reaction to lead poisoning, andthe conditions requiring medical treat-ment.

• Importance of good personal hygieneduring lead hazards reduction—refrainfrom eating, drinking, smoking, andapplying cosmetics; use of showers andthorough washing; and other practices toprevent the transfer of lead to the work-er’s home, car, or environment.

• Specific methods of abatement to beused—the relevance and effectiveness ofvarious abatement methods; the appro-priateness of using different technologieson various surface conditions.

• Proper use and maintenance of protec-tive clothing and equipment—the properprocedures for dressing and undressingto prevent contamination; respiratoryprotection covering fit-testing and main-


tenance; and employers ultimate respon-sibility for the proper use and mainte-nance of their workers’ protective cloth-ing and equipment.

• Correct use of engineering controls andimplementation of good work prac-tices—the importance of good workpractices such as measures for control-ling and containing debris and otherhousekeeping measures.

• Other health and safety consider-ations—a review of all health and safetyprecautions, including working withlocal building and housing codes toavoid standards that may conflict.78

Training following the HUD guidelines forsupervisors and planners is more stringentthan training for workers, and personstrained in asbestos abatement are not seen asautomatically qualified to perform leadremoval. HUD notes that classroom instruc-tion should not be seen as a replacement foron-the-job training, but rather as a supple-ment to it.79

State Training, Certification,and Accreditation Programs

States pioneered programs to accredit pro-fessionals who inspect or abate homes withlead-based paint. Massachusetts beganlicensing inspectors and “deleaders” (abate-ment professionals) in 1989. Previously,noncertified contractors could abate leadhazards from a dwelling; the state had nocontrol over techniques used during theabatement. Since household dust is a pri-mary contributor to lead poisoning, manyunits were found more dangerous after theabatement than before. Such concernsprompted the state legislature to pass thelicensing requirements.

Maryland also requires certification ofpeople who inspect or perform abatements.

The state accredits training providers, abate-ment workers, and inspectors. These require-ments were effected in response to the largenumber of residences being abated (especiallyin Baltimore) without the proper oversightand controls necessary to properly reduce thelead hazards. Education and specializedtraining were the only way to limit the num-ber of inadequately performed projects.

California’s Department of Health Servicesestablished a training and certification pro-gram in 1993. The state requires seven hoursof lead-awareness training for all accrediteddisciplines, in addition to specific training.Currently, accreditation is voluntary, but thestate may make it mandatory in the future.Connecticut passed legislation in 1987 butwas unable to promulgate the regulationsuntil September 1992, one month beforeCongress enacted Title X. The Legislaturerevised its law in 1994 to come into compli-ance with Title X.

Rhode Island enacted and implementeddetailed training and accreditation require-ments for contractors, site supervisors, work-ers, and inspectors. Arkansas, Georgia,Louisiana, Maine, Missouri, New Hamp-shire, New Jersey, Ohio, Vermont, Virginia,and Wisconsin enacted legislation and areimplementing programs; Michigan, NewYork, North Carolina, and Pennsylvaniamust pass and implement training and certifi-cation requirements to meet the criteria oftheir HUD lead-abatement grant.80 Oklahomarequires certification of individuals workingstate- or federally assisted housing, and NewMexico passed a memorial resolution recom-mending a certification program. Minnesotarequires only licensed contractors and certi-fied workers may conduct residential leadabatement, and Illinois requires accreditationof inspectors, contractors and workers. (Seeappendix B for more information.)


Figure 5States with Lead Training, Certification, and Accreditation Statutes in 1994

The act specifically requires EPA to establish:

• Minimum requirements for the accredita-tion of training providers

• Minimum training curriculum require-ments

• Minimum training hour requirements• Minimum hands-on training require-

ments• Minimum training competency and

proficiency requirements• Minimum requirements for training

program quality control82

These regulations also will include standardsfor performing lead-based paint activities,taking into account reliability, effectiveness,and safety.83 The regulations must specifyrequirements for accrediting training pro-

Section 402—Lead-Based Paint ActivitiesTraining and Certification

The passage of Title X made training andcertification of lead inspection and abatementprofessionals a national concern (see figure5). Title X mandates EPA to promulgateregulations regarding the accreditation oftraining programs and certification for work-ers, supervisors, inspectors, planners, andother individuals involved with lead-basedpaint activities. As stated in section 402(a) ofTitle X, EPA must:

Promulgate final regulations gov-erning lead-based paint activities toensure that individuals engaged insuch activities are properly trained;that training programs are accred-ited; and that contractors engaged insuch activities are certified.81


Title X’s inspections and abatement require-ments also cover target housing receivingmore than $5,000 in project-based assistanceunder any federal housing or communitydevelopment program. Units being sold bythe Resolution Trust Corporation are subjectto inspection and abatement requirements.All federal facilities, including housingowned by the Department of Defense andother federal agencies, are subject to Title X’smandates.

State Implementation of Section 402

Section 404(d) directs EPA to develop amodel state program that states may adopt toadminister and enforce the standards, regula-tions, and requirements of section 402.86

To receive authorization, states must submittheir proposed program to EPA for review. Ifthe state program is “at least as protective ofhuman health and the environment as theFederal program… and such state programprovides adequate enforcement,” then a stateis eligible to apply for EPA approval of itsprogram.87 Congress used this terminologyto allow states more flexibility in developingtheir programs. Upon approval, the statereceives the authority to administer andenforce the training, certification, and accredi-tation provisions of Title X. Any state with-out an approved program two years afterfinal promulgation of these regulations willbe subject to an EPA-administered and-enforced training, certification, and accredi-tation program.88

EPA has compelling reasons to want states toadminister training, certification, and accredi-tation programs. Congress intended thetraining and certification portions of Title X tobe administered by states.89 EPA cannotrealistically administer a program that is bestsuited to be implemented at the state level.

grams for workers, supervisors, inspectors,risk assessors, and planners/project design-ers; establish requirements for certifyingcontractors; and ensure that all risk assess-ments, inspections, and abatement activitiesin target housing are performed by certifiedcontractors.

Inspection, Risk Assessment, and Abate-ment Requirements Under Section 402

Congress sought to build a trained workforcenationally by requiring that certain federallyowned housing or housing receiving federalassistance be inspected and abated by certi-fied workers, and provided funding to in-spect, assess, and abate private residences.

Congress identified two types of structuressubject to Title X requirements:

• Target housing (any housingconstructed before 1978, excepthousing for the elderly or personswith disabilities or any zero-bedroom dwelling), which issubject to risk assessments, in-spections and abatements;84 and

• Public buildings constructedbefore 1978, commercial build-ings, bridges, or other structuresor superstructures, which aresubject to regulations coveringidentification of lead-based paintand materials containing lead-based paint, deleading, removal oflead from bridges, and demoli-tion.85

Federally owned target housing that is soldby any federal agency, rehabilitated withfederal funds, or assisted with a project-basedsubsidy are subject to inspection and abate-ment requirements. Public housing must beinspected and, if necessary, abated of all lead-based paint in the course of modernization.


States can develop rules that reflect localgeographic and economic concerns, incorpo-rate the interests and specific needs of theirpopulation, and provide effective responsesto specific concerns raised by training pro-grams, the workforce, and their citizens.They are in a better position to monitortraining, inspect lead abatement operations toensure proper techniques are applied, andprovide effective enforcement against un-qualified individuals or improperly per-formed abatements.90

HUD has the responsibility for ensuring thatpublic housing authorities follow the federallead-based paint guidelines (currently underrevision as required by Title X). Publichousing authorities are required to under-stand and comply with state and local regula-tions regarding testing, abatement, workerprotection, and disposal of the waste. En-forcement by states of federal standardsassists in coordinating efforts to reduce leadhazards in federal housing. State regulationsalso may apply to state-supported or privatehousing in the state.91

State Authority Over Federal Facilities andProperties

Congress specifically addressed whetherstate and local training and certificationrequirements apply to federal facilities inTitle X. Title X states:

Each department, agency, andinstrumentality of executive, legisla-tive and judicial branches of theFederal Government (1) havingjurisdiction over any property orfacility, or (2) engaged in any activ-ity resulting, or which may result, ina lead-based paint hazard, and eachofficer, agent, or employee thereof,shall be subject to, and comply with,all Federal, State, interstate, andlocal requirements, both substantiveand procedural, (including anyrequirement for certification [and]licensing).92

Any reasonable licensing and certificationfees may be assessed on persons or agenciesworking on or for a federal facility or prop-erty. This section also waives any immunity“otherwise applicable to the United States”with respect to any substantive or proceduralrequirements.

Training and Certification of Renovatorsand Remodelers

Section 402(c) requires EPA to promulgateguidelines for renovators and remodelers tolimit exposure from lead created by theiractivities. EPA is to disseminate these guide-lines through state and local agencies, hard-ware and paint stores, employee organiza-tions, and trade groups.93

EPA is also required to study the extent oflead exposure caused by renovations andremodeling and determine whether suchactivities should be subject to training andcertification requirements. Revisions to theirregulations incorporating these finding aredue by 1997. States will likely be requestedto revise their training and certificationrequirements to meet EPA’s renovation andremodeling requirements. Therefore, statesmay seek authority to address renovationand remodeling activities in their enablinglegislation.

Fees for Training, Certification,and Accreditation Programs

Title X requires EPA or any authorized stateto impose fees on persons operating accred-ited training programs and contractorscertified to perform lead-based paint activi-ties. The amount must cover the cost ofadministering and enforcing the standardsand regulations applicable to such programsand contractors. The act, however, forbidsfees being imposed on any state, local gov-ernment, or nonprofit training organization.Fees may be waived against contractors withtheir own accredited training program train-ing their own employees.94


4. FUNDING OPTIONS FOR STATE LEAD POISONINGPREVENTION PROGRAMS

Effective lead poisoning prevention programsneed sustainable and sufficient resources foroperation and enforcement. Federal fundssupport a majority of state screening andmedical follow-up programs; only half thestates use any state funds for either program.In contrast, most states use their own fundsfor environmental investigations, and lessthan half have federal support for this activi-ty. For abatement activities, local and othersources, including private financing, providemost of the money, although Title X increasesfederal funding substantially for lead-basedpaint abatement.95

The cost of reducing lead poisoning is enor-mous. HUD estimates the average cost toabate a home is $2,500; more than $10,000 isnecessary for units with serious lead-basedpaint hazards (see tables 5, 6, and 7). Theaverage cost of testing alone for lead-basedpaint is $375 per unit.96 To implement CDC’srecommended childhood lead poisoningprevention activities, which include screen-ing, educational materials, and outreach andinfrastructure development, will cost states,local government, and the federal govern-ment an estimated $913 million over the nextfive years.97

This section presents alternative fundingmechanisms used or proposed by states to

finance lead poisoning prevention programs,provide assistance to private homeowners forabatement, and assist local governments withtheir lead poisoning prevention activities.Four funding activities are discussed: statefees and taxes, state loans and grants, bonds,and federal loans and grants. These methodssupport the operation of programs indepen-dent of general appropriation funding, andthey can generate revenue beyond the cost ofthe programs. Most states use such methodsto support their lead poisoning preventionprograms.98

Table 6Percentage of all Housing With Lead-Based

Paint by Estimated Abatement Cost

Table 5Estimated Average Cost of Abatement per Dwelling Unit

Source: HUD, Comprehensive and Workable Plan for the Abatement of Lead-Based Paint in Privately Owned Housing (Washington, D.C., 1990)

Source: HUD, Comprehensive and Workable Plan for the Abatement of Lead-Based Paint inPrivately Owned Housing, (Washington, D.C., 1990).

Cost Range Encapsulation Removal

$0 - $2,499 54.4% 54.7%$2,500 - $4,999 13.3 11.8$5,000 - $9,999 13.9 5.6

$10,000 - $14,999 8.2 8.9$15,000 - $19,999 3.5 8.4$20,000 - $24,999 1.9 1.4$25,000 and over 4.7 9.2

A batem ent Strategy

U nits With Exterior Lead-

Based Paint O nly

U nits With Interior Lead-

Based Paint Only

U nits With Both Exterior and

Interior Lead-Based Paint

A ll U nits With Lead-Based Paint

Encap su lation $2,841 $1,798 $8,447 $5,453Rem oval $4,791 $1,808 $11,720 $7,704


Table 7Estimated Annual Number of Units to be Tested or Abated and the Estimated Annual Costs

Fees and Taxes

Special fees or taxes beyond the state’s gen-eral revenues provide independent supportfor programs and are the most popular formof alternative financing.99 Fees, which imposea flat rate as a condition of doing business oroperating an agency, place the costs of theprogram directly upon the immediate benefi-ciaries. Taxes are a compulsory levy basedon a per unit calculation and provide nodirect service to the payer. These distinctionsare important because taxes are often subjectto legislative or regulatory restrictions thatfees are not.

States often establish fees for specific regula-tory actions (e.g., inspections, permit review,licensing) to place the cost of administrationon the affected communities. Many statesallow fees to be administratively imposedwithout legislative approval. Most requirethat fees not exceed the cost of providing theservice and the ability of the affected commu-nity to pay. Fees may be placed in a generalfund, with specific programs supported bythe amount, or earmarked specifically for

lead poisoning prevention activities.100 Be-cause revenues from fees are based on aspecific regulated community, fees are effec-tive only if the community can support theprogram.

Taxes are independent of services and mustbe levied equally upon all persons subject tothem. Tax revenues generally go into thegeneral fund unless specifically earmarkedfor certain programs, and they can be usedfor a wider variety of activities than feesbecause they are not tied to a service. Inmost jurisdictions, new taxes require legisla-tive approval.101

California’s lead poisoning case managementprogram is funded by a fee assessed onindustries responsible for lead contaminationbased on their market-share in the “stream ofcommerce” (see sidebar). The legislature triedto pass a bill to place a 50 cents per gallon taxon all paint sold at retail, but it was foundunconstitutional. The state did pass anoccupational lead poisoning preventionprogram supported by fees paid by employ-

Lead Hazard Criterion for Abatement

No. of Units to be Tested

(millions)

No. of Units to be Abated

(millions)

Annual Testing Cost ($ billions)

Annual Abatement Cost ($ billions)

Total Annual Cost Inspections and Abatement

($ billions)Encapsulation Removal Encapsulation Removal

Lead in paint 82.3 60.8 $3.1 $33.2 $46.8 $36.3 $49.9

Lead in paint andeither lead dust or 82.3 21.2 3.1 18.8 25.2 21.9 28.3nonintact paint

Lead in paint and child p resent 30.5 21.7 1.1 11.8 16.7 12.9 17.8

Lead in paint andeither lead dust or 27.2 7.5 1 6.6 8.9 7.6 9.9nonintact paint andchild p resent

Source: HUD, Comprehensive and Workforce Plan, (Washington, D.C. 1990), p. 4-20.


California’s Fee-Based Program

In 1991, the California Legislature enacted the Childhood Lead Poisoning Prevention Act,which, among other things, required the state Department of Health Services to impose a feeon the manufacturers and other persons engaged in the “stream of commerce of lead orproducts containing lead . . . which have significantly contributed . . . to environmental leadcontamination.”107

This language gave the Department of Health Services the difficult task of determining whichmanufacturers this fee applies to and how much to charge. The agency responded to thisdilemma by researching U.S. Bureau of Mines reports which indicate those industries thatconsumed lead historically. According to this data, gas and oil companies used approximate-ly 85 percent of all lead consumed in the state, and paint manufacturers consumed the re-maining 15 percent. Fees of $20,000 were assessed against companies who continue to releaselead into the air, based on the Toxic Release Inventory under SARA III.

The second dilemma, how much to charge, forced the agency to calculate the budget tooperate the program. For fiscal year 1993 - 1994, the state budget for case managementactivities came to approximately $12 million. By using the data on historical consumptionand applying them against the operating budget, the calculation resulted in a .07 cent fee oneach gallon of gas sold in the state and two cents a gallon on paint. For every pound of leadreleased into the air, about $1 was assessed.

This fee went into effect on April 1, 1993, and, because it is a fee based on the department’soperating budget, it must be reassessed yearly. The funds generated will completely supportthe state’s case management program.

ers involved in industries that present apotential source of occupational lead expo-sure.

Maryland charges fees to approve trainingcourses and certify abatement workers,contractors, and inspectors. In 1992 theLegislature established the Lead Paint Poi-soning Commission to investigate the feasi-bility of an alternative compensation systemfor lead poisoning that would decreaseliability for rental property owners if theyperform maintenance that prevents leadpoisoning.

Massachusett’s licensing program imposesannual fees of $300 on inspectors anddeleaders (abatement workers) and $600 oncontractors. These fees go into the general

fund, and the program is supported througha general appropriation. A $1,500 tax credithas been established for private propertyowners doing lead-based paint abatement foreach unit abated, which may be appliedagainst a resident’s general tax obligation. Abill to provide a $10 surtax on all propertytransfers to finance educational outreachprograms failed in the Legislature.

Illinois assesses a fee on laboratories per-forming blood lead analysis to support itsprogram.

State Loans to Finance Abatements

State loan programs provide capital forspecific activities at a subsidized rate. Often,states limit the offer of loans to certain parties


the state appropriated more than $5.7 millionfor lead abatement loans.

Loans of up to $15,000 per unit may be usedin single family and multifamily propertiesserving low-income occupants, with aninterest rate of 0 percent- 7 percent. If theborrower has an income below 50 percent ofthe area’s median income or the affectedhousehold makes 80 percent of the median,the loan is forgiven. Owners of buildingshousing services for children (e.g., day careproviders) may receive loans for abatement at7 percent interest. Properties receiving loansmust meet the state’s post-abatement clear-ance standard.104

Bonds to Finance Lead PoisoningPrevention

Bonds are a written promise to repay bor-rowed money on a definite schedule andusually at a fixed rate of interest for the life ofthe bond. States use bonds to finance capitalexpenditures and repay the debt with taxes,fees, or other sources of governmental rev-enue. Though bonds cannot be used foroperating agencies on an annual basis, theydo account for approximately 60 percent ofthe capital financing for environmentalinfrastructures, such as loan or grant pro-grams.105 State and local governments havegreat flexibility in structuring bonds to meetspecific needs.106

Since most governmental bonds are tax-exempt, bondholders are generally willing toaccept a correspondingly lower rate of returnon their investment than they would expecton a comparable commercial bond, and thusprovide state governments with low-interestcapital.

There are many types of bonds used tofinance environmental programs. Three thatare most relevant to lead poisoning preven-tion include the following:

meeting established criteria. Loans generallydo not require voter approval or have statu-tory restrictions; however, loans do not havea specified revenue source to generate thecapital.102 The cost of abating lead has per-suaded Massachusetts and Maryland toestablish loan programs to assist privatehomeowners.

Massachusett’s Housing Finance Agency(MHFA) has begun the “Get the Lead Out”program to provide low- and no-interestloans for owner-occupied residential units toabate lead paint. MHFA sold tax-exemptbonds to finance the program, which pro-vides loans with 5 percent to 8.5 percentinterest to moderate-income owners needingto abate and no-interest loans to owners withlead poisoned children currently residing in aunit. As loans are repaid, the funds can bereused for additional low-interest loans.Since fall 1992, $500,000 has been loaned to 50owner/occupiers.

MHFA also administers the Home Improve-ment Loan Program, which provides loans at3 percent to 8 percent interest for rehabilita-tion and improvements of owner-occupiedresidences; the money can be used for leadabatement.103

Massachusetts’ Housing Partnership initiateda loan guarantee program in fall 1993 toencourage private lending institutions toprovide loans for the abatement of investor-owned housing, with $1 million dedicated tothe loan guarantee fund.

Maryland’s Community DevelopmentAgency (CDA) has the authority to provideloans for lead-based paint abatement inresidential properties. The program operatesthrough local governments, which administerthe funds. Special projects, such as theevaluation of alternative lead abatementstrategies, may receive special allocation offunds. For 1994 the Legislature appropriated$450,000 for the loan program. Since 1986,


financial assistance to owners needing toperform abatement. A five-year forgivableloan is offered for the first $5,000 worth ofwork, with additional amounts of up to$15,000 per unit available through a deferredloan. Loan amounts in excess of $5,000 arerepaid at the time of sale or transfer of theproperty.

Federal Resources to Finance State Pro-grams

The federal government has several fundingmechanisms for states to use to administerand enforce lead poisoning preventionprograms. Title X requires EPA or anyauthorized state to impose fees on personsoperating accredited training programs andcontractors certified to perform lead-basedpaint activities (see previous section).111 Con-gress also authorized EPA under Title X toprovide grants to states to develop andadminister authorized programs.112

The Department of Housing and UrbanDevelopment (HUD) distributed $44.4million in grants to state and local govern-ments in 1992 for lead-based paint abatementprograms. Congress appropriated another$90 million for 1993 and authorized $150million in 1994 for states and local govern-ments to remediate lead-based paint hazardsin moderate- and low-income housing. Thegovernments receiving the grants in 1992pledged an additional $95 million to abate atotal of 5,783 units of privately owned hous-ing .

Grantees receiving the funds have eitherestablished or promised to establish a statecertification program within one year ofreceiving the grant. Grantees also mustdemonstrate a capability to identify housingwith lead hazards and to oversee the conductof the abatement work.113

Other HUD grant programs include theCommunity Development Block Grant

• General obligation bonds, guaranteedby the issuing government, which uses itstaxing power to repay the bond. There aretwo primary types: unlimited and limited advalorem tax debt. With unlimited, the gov-ernment pledges its full faith and credit withno limitation on possible property tax rate.Limited general obligation bonds have capson possible property tax rates to repay thebond. Limited bonds are less secure thanunlimited bonds because the tax limits couldconceivably be reached within the term of thebond or other tax revenues may not beavailable for debt service.108

• Revenue bonds, backed by user fees orservice charges paid by users of the govern-ment service. These bonds may be used tofinance a long-term abatement program, withlicense and permit fees repaying the obli-gated amount.109

• Mandate bonds, created by the federalgovernment to provide relief from federalrestrictions on tax-exempt financing, underthe belief that facilities built, acquired, reno-vated, or rehabilitated because of a require-ment in a federal statute or regulation shouldreceive the same tax treatment as a govern-ment bond. Mandate bonds reduce indi-vidual or corporate taxes assessed on interestearned, allow financial institutions to deduct80 percent of the cost of purchasing andcarrying, and they do not apply the “dispro-portionate use” test. These bonds could beused by state governments to finance federal-ly mandated renovation and rehabilitation(and, theoretically, lead-paint abatement) inhousing or other structures.110

The Rhode Island Housing Mortgage Fi-nance Corporation is using tax-exempt bondsto finance a program of deferred and forgiv-able loans for lead-based paint hazard reduc-tion. Since the state requires an inspection ofall units with lead-poisoned children, theowners of these units must remediate thelead hazards, if any. This program offers


(CDBG), Public Housing Operating Subsi-dies, and the HOME program of the Na-tional Affordable Housing Act of 1990.CDBG allocates funds to cities and urbancounties with populations over 50,000. Re-cipient governments may use a portion oftheir funding for administration. Granteesmay spend their funds for a wide variety ofactivities, including physical improvementsto neighborhoods, economic development,public works construction, code enforcement,and housing rehabilitation.114

At least 75 percent of a recipient’s residentialrehabilitation activities must benefit low- andmoderate-income households, and the recipi-ent may grant or loan CDBG funds to privatehouseholds, neighborhood-based organiza-tions, or investors in housing who carry outeligible activities, which includes lead-basedpaint abatement if written into the adminis-trative plan. CDBG recipients have usedthese funds to provide abatement grants andloans and to purchase lead paint testingequipment.

HUD’s Office of Public Housing, AssistedHousing, which oversees public housingoperation and financial management, pro-vides operating subsidies to public housingauthorities to fund any differences betweenallowed and statutorily restricted rents. Thesubsidy is determined by previous year’soperating costs and other adjustment factors.Congress usually appropriates $2 billion peryear for the program.115

Public housing authorities may use operatingreserves to finance lead-based paint testingand abatement, but such funds may berestricted to emergency situations because oftheir limited availability. Operating funds,however, could be used for small-scaleactivities to reduce lead-based paint hazards,such as lead dust cleanup, removal of minorlead-based painted surfaces, or temporaryrelocation of families. Some money may beused for resident education programs as atenant service expenditure.116

HUD’s HOME program provides blockgrants to states and local governments thatencourage the design and implementation ofhousing programs tailored to local needs.The program specifically promotes housingrehabilitation and replaces several otherrehabilitation programs, including Section312 and the rental rehabilitation program.Funding lead-based paint abatement activi-ties is likely since abatement can be mostefficiently and economically done duringrehabilitation. Congress authorized $2.086billion in 1992 for this program.117

The Department of Health and HumanServices (HHS) also provides grants to states,but for screening and health-related pro-grams solely. HHS’s categorical grant pro-gram of Grants to States for Childhood LeadPoisoning Prevention funds primarilyscreening to identify children with elevatedblood lead levels, but also provides informa-tion on the extent of lead poisoning withinspecific communities.118

HHS’s Maternal and Child Health BlockGrant, the State Preventative Health andHealth Services Block Grant, and Grants forCommunity Health Centers may be used tofund state screening programs. The Maternaland Child Health grant provides funds toeach state for a broad range of health servic-es, including preventive and primary care forchildren. States and cities may use fundsavailable to them for screening for leadpoisoning and other prevention activities if itis an important health problem in theircommunities. Some states use the preventa-tive health and health service grant for leadscreening activities. The community healthcenters grant can also be used to fund leadpoisoning prevention activities; it providesessential health care services to underservedpopulations, including low-income, inner cityhouseholds whose children are most at riskof lead poisoning.119


APPENDIX A: Federal Statutes

Lead-Based Paint Poisoning Prevention Act,42 U.S.C. 4822 (1971)

The passage of the Lead-Based Paint Poison-ing Prevention Act (LPPPA) marked the firstfederal effort to identify lead-poisoned chil-dren and reduce environmental exposurefrom lead. The act initiated programs toscreen children and begin the elimination oflead-based paint in residential housing.

LPPPA directed the Department of Healthand Human Services to:

• Prohibit the use of lead-based paint inresidential structures constructed orrehabilitated by the federal governmentor with federal assistance in any form

• Establish a national program to encour-age and assist states and cities to conductmass screenings

• Identify children with elevated blood leadlevels and make sure they receive medicaltreatment

• Investigate the child’s residences forsources of lead

• Order abatement of the residences ifnecessary

The Centers for Disease Control and Preven-tion administered the program from itsinception until 1981, when the program wasincorporated into Maternal and Child HealthServices Block Grant. Under the grant, statesmay use these funds for childhood leadpoisoning prevention, but they are notrequired to.

LPPPA defined lead-based paint as “paintcontaining more than 1 percent lead byweight”; this was amended in 1976 to 0.06percent lead by weight, which remains thestandard today. However, there is no univer-sal definition of lead-based paint.

The Department of Housing and UrbanDevelopment (HUD), responding to theLPPPA, promulgated regulations prohibitingthe use of lead-based paint in HUD-assistedhousing. The 1973 amendments to the actrequired that HUD eliminate lead-basedpaint poisoning hazards in housing builtbefore 1950 (later amended to pre-1978housing) covered by housing subsidies andapplications for mortgage insurance and inall federally owned housing prior to sale.

Congress amended the LPPPA again in 1988to direct HUD to change its lead-based paintrequirements for public housing to include“intact paint” in its definition of immediatehazards. Congress also directed HUD tobegin an extensive research and demonstra-tion program that provided the data for moreextensive programs to eliminate or reducelead in residential housing. The reportsproduced from this research covered testingtechnology for detecting lead-based paint; anestimate of the hazards from lead-based paintbased on region, amount, and paint charac-teristics; a lead-based paint abatement dem-onstration project; and an in-place manage-ment or interim containment program.120

Lead Contamination Control Act of 1988, 42U.S.C. 201

The Lead Contamination Control Act (LCCA)authorized CDC to provide grants to states toadminister a program for preventing child-hood lead poisoning for fiscal years 1990 and1991. Under this grant money, states were to:

• Screen infants and children for lead• Refer cases of elevated blood lead levels

to the state for treatment and provideenvironmental case management

• Provide for education to communitieswith the highest risk for EBL (above 25µg/dL)


LCCA also addressed lead in drinking water(42 U.S.C. 300j-21 et. seq.). States were toestablish programs to test and eliminate leadin water from schools and day care centers byJuly 1989 and provide for public notificationof drinking water analyses. EPA distributedgrants to states to assist local educationagencies in meeting the requirements of theact.

Residential Lead-Based Paint Hazard Reduc-tion Act of 1992 (Public Law 102-550)

Congress passed the most comprehensivefederal lead poisoning prevention legislationin 1992 as part of the Housing and Commu-nity Development Act. The act, entitled theResidential Lead-Based Paint Hazard Reduc-tion Act, better known as Title X, redefinesthe federal response to lead poisoning bydirecting several federal agencies to establisha coordinated effort to reduce lead hazards.The main agencies responsible for Title X arethe Department of Housing and UrbanDevelopment (HUD), the EnvironmentalProtection Agency (EPA), and the Depart-ment of Labor.

HUD requirements. Title X expands HUD’scoverage of federally owned and assistedhousing subject to lead-based paint reductionactivities. All public housing built before1978 must be inspected, and housing builtbefore 1960 must be abated of all lead-basedpaint. Housing under the Resolution TrustCorporation, Federal Insurance DepositCorporation, Department of Defense, andIndian Housing are subject to Title X’s in-spection and abatement requirements uponsale. States and local governments mustevaluate and propose how to integrate lead-based paint hazards reduction into theirhousing policies and programs. HUD mustalso issue guidelines for the conduct offederally supported risk assessments, inspec-tions, interim controls, and abatement oflead-based paint hazards.

Title X imposes disclosure requirements onpersons selling or leasing target housing withlead-based paint hazards. Besides disclosure,sellers or lessors must provide a pamphlet onlead hazards (produced by EPA) and allowrisk assessment or inspection for the presenceof lead-based paint hazards.

More important to states, Title X authorizesHUD to distribute close to $400 million ingrants to states and local governments toreduce lead based paint hazards in priorityhousing that is not federally assisted orowned property. Funding under Title X isavailable for states to establish training,certification, and accreditation programs tomeet the requirements of Section 402.121

Subtitle D of Title X requires HUD to conductresearch on strategies to reduce the risk oflead exposure from other sources, includingexterior soil and interior lead dust in carpets,furniture, and forced-air ducts. Subtitle Erequires HUD to submit to Congress anannual report assessing the progress inimplementing the programs authorized byTitle X.

EPA requirements (TSCA Title IV): Leadexposure reduction. Title X amends theToxic Substance Control Act (TSCA) byadding a fourth title: Lead Exposure Reduc-tion. TSCA gives EPA the authority toaddress lead in residential housing, publicand commercial buildings, and steel struc-tures.

Under this title EPA must promulgate regula-tions ensuring that “individuals engaged (inlead-based paint activities) are properlytrained, that training programs are accred-ited, and that contractors engaged in suchactivities are certified.”122 EPA also mustdevelop standards for reducing lead hazards,taking into account reliability, effectiveness,and safety, and require that all “risk assess-ment, inspection, and abatement activities in


target housing (housing built before 1978)…be done by certified contractors.”123 Certifica-tion also applies to persons who identifylead-based paint, remove or abate lead, or dodemolitions on any commercial building orpublic building built before 1978, on anybridge, or on any other structure or super-structure.

States seeking to administer and enforce theirown training, certification, and accreditationprograms may apply for authorization fromEPA. Title X requires EPA to approve a stateprogram if it is “at least as protective ofhuman health and the environment as theFederal program” and “such state providesadequate enforcement.”124 To assist states inadopting such programs, EPA must developa model state program. The program isintended to facilitate states in developingtheir programs by using existing state certifi-cation and accreditation programs whileencouraging reciprocity among all states.Any state without an authorized programtwo years after the promulgation of theseregulations will be subject to an EPA-admin-istered and -enforced program.

Renovation and remodeling activities intarget housing and public and commercialbuildings will be regulated to reduce the riskof exposure from lead-based paint, and

studies will be done to determine whetherpersons engaged in various renovation andremodeling activities significantly contributeto elevated blood lead levels and should becertified. Persons performing renovationwork in target housing must provide to theowner and occupant of that housing an EPA-produced pamphlet about lead hazards.

EPA will determine dangerous levels of leadin paints, soil, and dust to be used as health-based standards for Title X activities. EPAmust also sponsor public education andoutreach activities, develop practical con-sumer information for retail distribution onhazards of renovation and remodeling, andestablish a national clearinghouse on child-hood lead poisoning. It will also publish alead hazard information pamphlet.

U.S. Department of Labor. The U.S. Depart-ment of Labor focuses on worker protection.By April 1994 the department must issueinterim final regulations regulating occupa-tional exposure to lead in the constructionindustry. The department also must coordi-nate between EPA and OSHA for enforce-ment and make grants for training andeducation of workers and supervisors.


APPENDIX B: State Statutes Regarding Prevention of Lead-Based PaintPoisoning

Arizona

1. Lead-Based PaintARIZ. REV. STAT. ANN. § 36-1671 to 36-1676(1986)

Prohibits certain uses of lead-based paint andauthorizes the department of health to de-velop and conduct programs to prevent,detect, and treat lead-based paint poisoning.

Arkansas

1. Lead Poisoning PreventionARK. STAT. ANN. § 20-27-601 to 20-27-608(Michie 1987)

Provides for the prevention, screening,diagnosis, and treatment of lead poisoningincluding elimination of the sources of thepoisoning through research, education,epidemiological, and clinical activities.

2. ARK. STAT. ANN. § 20-27-1001 to 1007(Michie 1994)

Adopts a training, certification, and accredita-tion program for lead abatement work.

California

1. Childhood Lead Poisoning Prevention ActCAL. HEALTH AND SAFETY CODE 309.7, 372 etseq, 1367.3-1367.5 (West 1990)

Establishes the Childhood Lead PoisoningPrevention Program within the Departmentof Health Services and requires them tocompile information, identify target areas,and analyze information to design andimplement a program of medical follow-upand environmental abatement to reducechildhood lead exposure.

2. Childhood Lead Poisoning Prevention ActCAL HEALTH AND SAFETY CODE § 50710.5 (WestSupp. 1989)

Provides that housing authorities acting ingood faith will not be liable for any injurycaused by the presence of LBP prior to Jan. 1,1989.

3. Disclosure RequirementsCAL. CIV. CODE § 1102.6; § 2079.7 (West Supp.1992)

Requires the disclosure upon sale of a prop-erty any lead based paint that may be ahazard.

4. Lead-Safe Schools Protection ActCAL. EDUC. § 32230 to 32245 (West Supp. 1992)

Provides for a sample survey to predict leadcontamination in public schools and deter-mines response.

5. Occupational safety and health: leadrelated construction work.CAL HEALTH AND SAFETY CODE 429.13 to 429.15

Instructs California Department of HealthServices to develop a program that willcomply with the Residential Lead-BasedPaint Hazard Reduction Act of 1992 and topromulgate regulations to establish an autho-rized state program pursuant to TSCA TitleIV.

Connecticut

1. Financial assistance for removal of lead-based paint and asbestosCONN. GEN. STAT. ANN. § 8-219e (West 1989)

Provides for loans up to two-thirds of the cost


based paint, and it directs the commissionerto establish certification criteria and proce-dures for lead inspectors and lead abatementand removal contractors.

5. Use of paint in tenements and municipallyowned buildingsCONN. GEN. STAT. ANN. 21a-82 (West 1985)

Prohibits the use of lead-based paint intenements or municipally-owned buildingunless it is done in compliance with state andfederal LBP guidelines.

6. Paint not conforming to standards rendersproperty unfitCONN. GEN. STAT. ANN. § 47a-8 (West Supp.1991)

Mandates a property being deemed unfit ifpaint does not conform with federal stan-dards or is cracked, chipped, blistered,flaking, loose, or peeling if property is in-tended for human habitation.

Delaware

1. Restrictions on lead based paintDEL. CODE ANN. tit. 31 § 4114 (Michie 1985)

Prohibits the use of paint with more than 0.5percent lead on any surfaces of a dwelling ordwelling unit, including fences and outbuild-ings.

Georgia

1. Lead Poisoning PreventionGA. CODE ANN. 31-40-1 (1994)

Provides for the promulgation of regulationsregarding training, licensing, and certificationof individuals performing lead hazard reduc-tion activities; sets standards for performingsuch activities; provides for reciprocity; andprovides for fees, among other purposes.

of the abatement to persons seeking to re-move lead based paint.

2. Testing for elevated blood lead levelsCONN. GEN. STAT. ANN. § 10-206; 10-206b(West 1989)

Demands the local or regional boards ofeducation to require each pupil to have ahealth assessment that may include testingfor elevated blood lead levels.

3. Department designated as lead agency forchild day care facilitiesCONN. GEN. STAT. ANN. § 17-585 (West Supp.1991)

Designates the Department of Human Re-sources as the lead agency for day carecenters. Requires the department to inspectday care centers for any evident sources oflead poisoning prior to their being registeredwith the state.

4. Report of lead poisoning. Investigation.Preventive measures. Relocation of families.Reports. Regulations.CONN. GEN. STAT. ANN. § 19a-110 and § 19a-111a, b, c, and d (West Supp. 1990)

Requires physicians and private labs toreport to the commissioner of health servicespeople with lead levels of .025 milligramsper 100 grams of blood or more.

Upon receipt of report, commissioner shallinvestigate the source of the lead and reportthe results to the local building officials.Local building officials will require action betaken by the persons responsible for thecondition and, if necessary, relocate theoccupants of the building.

The statute also provides for the establish-ment of a lead poisoning prevention pro-gram, an education and early diagnosisprogram, provisions for the removal of lead-


Illinois

1. Lead Poisoning Prevention ActILL. ANN. STAT. ch. 111 1/2 p. 1301 to 1308.2(Smith-Hurd 1980)

Provides for the establishment of a leadpoisoning prevention program encompassingscreening, reporting, lab analysis, licensure ofinspectors, inspection, and abatement re-quirements under the Department of PublicHealth and directs the department to performthese and other activities. The statute alsoprohibits or regulates the use of lead-bearingsubstances.

Iowa

1. Lead Abatement ProgramIOWA CODE § 135.100 to 105 (West 1989)

Establishes a lead abatement program withinthe Department of Public Health. The statuterequires the department to implement andreview programs designed to eliminate orreduce dangerous levels of lead in children.

Kentucky

1. Lead Poisoning PreventionKY. REV. STAT. ANN. § 211.900 to 211.905(Michie 1982, Supp. 1990)

Provides the authority for the secretary forhuman resources to establish a lead poison-ing prevention program, including thescreening, diagnosis, and treatment of leadpoisoning.

Louisiana

1. Lead paint poisoning prevention andcontrol actLA. REV. STAT. ANN. § 40:1299:26 to 40:1299:29(West Supp. 1990)

This act establishes a comprehensive lead

poisoning control program and encompassesthe sale and use of lead-based paint, theremoval or repainting of surfaces that havelead based paint, and the enforcement ofsuch provisions.

2. Lead Hazard Reduction, Licensure andCertificationLA. STAT. ANN. § 30:2001 et seq. (1994)

This bill amends Chapter 15-A of Title 30 toprovide for lead hazard reduction. Includedin the bill is licensure and certification re-quirements for lead abatement and inspectionprofessionals, abatement provisions, author-ity to promulgate regulations relating to leadhazard reduction, and funding for suchprograms.

Maine

1. Lead Poisoning Control ActME. REV. STAT. ANN. tit. 22 § 1314 to 1326(West 1980 and Supp. 1990)

Enacts a lead poisoning control program thatencompasses the restriction of sale and use oflead-based products, an early diagnosisprogram, educational outreach, reportingrequirements, inspections by public healthofficials, notice to remove hazards, enforce-ment provisions, licensure of inspectors andabaters, and certification of training programsand labs; also grants the Department ofHuman Services the authority to implementthese activities.

Maryland

1. Lead-based paintMD. ENV. CODE ANN. § 6-301 to 6-303 and 6-601 to 6-608; 6-1001 to 1-1005 (Michie 1994 )

Prohibits the use of lead-based paint on anyinterior surface, on any exterior surfacecommonly accessible to children, or anyarticle that is intended for household use.


The act also requires physicians to reportpersons with elevated blood lead levels andcreates an advisory council to explore theproblem of lead poisoning.

Provides for the accreditation of trainingproviders and the certification and licensureof lead abatement professionals.

2. Reduction of Lead Risk in HousingMD. ENV. CODE ANN. § 6-801 to 6-852 (Michie1994)

Establishes risk reduction standards foraffected properties; requires owners of affect-ed properties to register those properties andperform risk reduction activities. Providesfor immunity from liability under certaincircumstances, specifies insurance require-ments for certain insurors and owners,includes other provisions.

3. Failure of lessor to remove lead-basedpaint; rent escrowMD. REAL PROP. CODE ANN. § 8-211.1 (Michie1988)

Provides for a lessee of a rental propertywhich the lessor has failed to remove lead-based paint within 20 days of notice to depos-it rent with the District Court where it will beheld until the lessor has remedied the situa-tion. The tenant may not be evicted or besubject to an increase in rent for exercisingthis remedy.

Massachusetts

1. Lead Poisoning Prevention and ControlMASS. GEN. L. ch. 111 § 190 to 199A (West1990, West Supp. 1993)

Establishes a comprehensive lead poisoningprevention program. The act directs theprogram to promulgate regulations regardinguniversal screening of children under sixyears, guidelines for medical follow-up, and

procedures for reporting elevated bloodlevels. The act also provides for an educa-tional and publicity program to inform thegeneral public, the establishment of a leadpoisoning laboratory, and disclosure of leadhazards upon sale of a property.

The act grants authority to the department ofhealth to require the inspection and abate-ment of residences and require the licensingof inspectors and deleaders (abaters).

2. Lead Removal Assistance ProgramMASS. GEN. L. CH. 23B § 28 (WEST SUPP. 1993)

Establishes a grant and loan program toassist residential property owners in financ-ing lead abatements.

Minnesota

1. Lead abatement and standardsMINN. STAT. § 144.871 to 144.878 (1990)

Provides for a task force to evaluate costs ofproviding assistance for abatement programs;provides for education, reporting require-ments, abatement procedures, relocation ofresidents, residential lead assessment guide,registration of abatement contractors, andregulations to carry out these provisions.

Missouri

1. Lead Poisoning PreventionMO. STAT. ANN. 701.300 et seq. (West 1994)

Provides for the establishment of a leadpoisoning prevention program and commis-sion. The department of health will setstandards for blood lead levels, residentialabatement, inspections, and training; providefor the licensure and accreditation leadabatement and inspection professionals; andestablishes enforcement authority. The actalso provides for educational and outreachprograms.


New Hampshire

1. Lead paint poisoning preventionN.H. REV. STAT. ANN. § 130-A:1 to 130 A:17(West 1990)

Provides for inspections, notice and removal;prohibits certain acts; and grants authority tothe director of public health to promulgateregulations regarding lead poisoning preven-tion. Authorizes the Division of PublicHealth Services the authority to license leadabatement training providers, contractors,workers, supervisors, inspectors, and riskassessors. The statute also covers state-ordered abatements, relocation of tenants,reciprocity with other states, and funding tocover the costs of the program.

The law applies to landlords, day care cen-ters, and rental property owners. Personswith four or fewer dwelling units are exemptfrom licensing but must take the training andfollow rules for abatement.

New Jersey

1. Lead poisoning preventionN.J. REV. STAT. ANN. § 26:2-130 to 26:2-137(West 1992)

Promulgates regulations for lead poisoningprevention through the AdministrativeProcedures Act. The statute requires thecommissioner of the department of health topromulgate regulations to identify sources oflead within dwellings; to establish testingprocedures to detect lead in persons; tostimulate professional and public educationconcerning the need to test, detect, andcontrol lead poisoning; and to abate identi-fied lead hazards.

2. Paint containing leadN.J. REV. STAT. ANN. § 24:14A-1 to 24:14A-11(West Supp. 1991)

Prohibits the use of LBP on certain products,and on the interior or exterior of any buildingreadily accessible by children; provides forabatement procedures, notification; andenforcement penalties.

New York

1. Control of lead poisoningN.Y. PUB. HEALTH LAW § 1370 to 1376-a(McKinney 1971 and Supp. 1990)

Provides for the prohibition of sale of certainproducts containing lead-based paint, theabatement of lead poisoning conditions, andthe enforcement for these rules and regula-tions.

North Carolina

1. Lead Poisoning in ChildrenN.C. GEN. STAT. 130A-131.5 (Michie 1992)

Requires the Commission of Health Servicesto adopt rules for the prevention and controlof lead poisoning in children. Laboratoriesmust report elevated blood lead levels ofchildren under six years; the departmentmust determine a maximum standard forelevated levels of blood lead; and the depart-ment must conduct investigations to deter-mine the sources of elevated blood leadlevels.

Ohio

1. Childhood Lead Poisoning PreventionOHIO REV. CODE ch. 3701.25 et seq.; 4725 etseq. (1994)

Provides for the licensure of an individualperforming lead abatement work; the ap-proval of environmental lead laboratories;directs the implementation of a lead poison-ing prevention program; and to create theLead Program Fund; among other purposes.


Rhode Island

1. Lead Poisoning Prevention ActR.I. GEN. LAWS § 23-24.6-1 to 23-24.6-26 (1991)

Expands the childhood lead screening anddiagnosis program, and the environmentalmanagement and primary prevention pro-gram, and provides mechanisms for funding.

2. General requirements relating to the safeand sanitary maintenance of parts of dwell-ings and dwelling units relative to lead-basedpaint.R.I. GEN. LAWS § 45-24.3-10 (1989)

Prohibits the use of lead based paint indwellings with surfaces accessible to childrenunder six years, and provides for inspectionand abatement procedures for emergencysituations. Specifics of the statute include adefinition of “lead-based substance” asmaterials containing lead in excess of 0.5percent of lead by weight and provisions foremergency abatements if child occupying theproperty is suffering lead poisoning.

South Carolina

1. Lead Poisoning Prevention and ControlActS.C. CODE ANN. § 44-53-1310 to 44-53-1480(1985 and Supp. 1989)

Comprehensive act that prohibits the use oflead in certain items, requires reporting oflead poisoning followed by an inspection,and specifies notification procedures forinforming owners/occupants of lead hazards.

Vermont

1. Childhood Lead Poisoning, Screening, andLead Abatement Act38 V.S.A. § 1751 - 1757 (1993)

This act establishes a training and certifica-tion program for lead hazard abatementworkers within the Department of Health.The act also provides for blood lead screeningupon request, inspection and testing for childcare facilities, and disclosure of lead-basedhazards prior to sale or lease of housing builtbefore 1978.

Virginia

1. Asbestos and Lead Contractors andWorkersVA. CODE § 54.1-500 et. seq. (1994)

Relates to certification of lead contractors,professionals, and workers. Provides thatlead hazard reduction activities meet therequirements of the federal program. Aprogram will be implemented by January 1,1995.

Wisconsin

1. Lead Poisoning PreventionWIS. STAT § 151.01. to 151.13. (West 1989)

Comprehensive act relating to lead poisoningprevention. Prohibits certain uses of lead;provides for reporting requirements, inspec-tion; and abatement procedures; grantsauthority to the Department of Health andSocial Services; to perform screening andmedical case management, adopt inspectionand risk assessment requirements, abatementstandards, training and licensure require-ments, and provide for enforcement of theseprovisions.


APPENDIX C: Resources for Further InformationEnvironmental Defense Fund202/387-35001875 Connecticut Avenue, N.W.Suite 1016Washington, D.C. 20009

National Center for Lead-Safe Housing410/992-0712205 American City BuildingColumbia, Maryland 21044

National Conference of State Legislatures303/830-2200Lead Hazards Project1560 Broadway, Suite 700Denver, Colorado 80202

National Lead Information Center1019 19th Street, N.W.Suite 401Washington, D.C. 20036

Lead Hotline800/LEAD-FYIClearinghouse800/424-LEAD

HUD User800/245-2691P.O. Box 6091301/251-5154Rockville, Maryland 20850

University of Massachusetts at Amherst413/545-5201

University of Cincinnati513/558-1730

University of Maryland at Baltimore410/706-1849

Georgia Institute of Technology404/894-3806

University of Kansas913/897-8500

University of California at San Diego619/534-6157

FEDERAL RESOURCES

Department of Housingand Urban Development (HUD)

Office of Lead-Based Paint Abatement andPoisoning Prevention202/755-1810451 7th Street, S.W.Washington, D.C. 20410

Centers for Disease Controland Prevention (CDC)

Lead Poisoning Prevention Branch404/488-73304770 Buford Highway, N.E.Building 101, Mail Stop 742Atlanta, Georgia 30341

Environmental Protection Agency

Office of Pollution Prevention and Toxics202/554-1404401 M Street, S.W.Washington, D.C. 20460

Office of Drinking Water800/426-4791401 M Street, S.W.Washington, D.C. 20460

OTHER RESOURCES

Alliance to End Childhood Lead Poisoning202/543-1147227 Massachusetts Avenue, N.E.Suite 200Washington, D.C. 20002

Association of State and Territorial HealthOfficials202/546-5400415 Second Street, N.E.Suite 200Washington, D.C. 20002

Conservation Law Foundation617/350-099062 Summer StreetBoston, Massachusetts 02110


15. Ibid, p. 11.16. Ibid, p. 9.17. Ibid.18. Agency for Toxic Substances and Disease

Control (ATSDR), NHANES II survey (1988).19. U.S. EPA, Strategy for Reducing Lead

Exposure, p. 1.20. Agency for Toxic Substances and Disease

Control, NHANES II survey (1988).21. In 1978, the federal government, through

the Consumer Products Safety Council, bannedlead in paints for residential purposes.

22. Statistics provided by U.S. Housing andUrban Development (HUD) survey (1990).

23. Statistics provided by U.S. Housing andUrban Development (HUD) survey (1990), andthe American Housing Survey 1991.

24. Weaver, J.C., “A White Paper on Lead,”ASTM Standardization News, April 1989, pp. 34-38.

25. HUD, Comprehensive Workable Plan, p. 4-4,4-5.

26. Ibid.27. Ibid., p. 4-11.28. Title X defines interim controls as any set

of measures designed to reduce temporarilyhuman exposure to lead-based paint hazards,including specialized cleaning, repairs, mainte-nance, painting, temporary containment, ongoingmonitoring of lead-based paint hazards or poten-tial hazards, and the establishment and operationof management and resident education programs.

29. EPA, Strategy for Reducing Lead Exposure,p. 19.

30. NHANES II survey, 1988. The surveywas unable to determine the number of childrenpoisoned from lead in dust and soil.

31. HUD, Comprehensive Workable Plan, p. 2-15.

32. U.S. EPA, Three City Soil Study, (Washing-ton, D.C., 1992).

33. U.S. EPA, Strategy for Reducing LeadExposure, p. 20.


35. States with soil standards: California,Hawaii, Illinois, Louisiana, Maine, Maryland,Michigan, Minnesota, North Carolina, NewMexico, Ohio, Oregon, Tennessee, Utah, Wash-ington, Wisconsin. Information from a survey ofstate lead contacts, NCSL 1993.

36. Rhode Island, Maine, Connecticut,Minnesota, and Vermont recommend thesepolicies.

NOTES

EXECUTIVE SUMMARY

1. See H. Needleman, A. Schell, D. Bellinger,A. Leviton, and E. Allred, “The Long-TermEffects of Exposure to Low Doses of Lead inChildhood: An 11-Year Follow-up Report,” TheNew England Journal of Medicine 322 no. 2 (Jan. 11,1990): 83; A. McMichael, et al., “Port Pirie CohortStudy: Environmental Exposure to Lead andChildren’s Abilities at the Age of Four Years,”New England Journal of Medicine, 319 no. 8 (Aug.25, 1988): 468.

2. Department of Housing and UrbanDevelopment (HUD), Office of Policy Develop-ment and Research, Comprehensive Workable Planfor the Abatement of Lead-based Paint in PrivatelyOwned Housing, (Washington, D.C., Dec. 1990), p.xvi i .

3. U.S. Environmental Protection Agency(EPA), Strategy for Reducing Lead Exposure (Wash-ington, D.C., Feb. 1991), p. 1.

4. Weaver, J.C., “A White Paper on WhiteLead,” ASTM Standardization News (April 1989):34-38.

5. Centers for Disease Control and Preven-tion (CDC), Preventing Lead Poisoning in YoungChildren (Atlanta, Ga., Oct. 1991), p. 7.

6. Ibid, p. 36.7. Ibid, p. 35.8. Based on information reported to NCSL

in a survey of state lead poisoning preventioncontacts in March 1994.

9. Information from the NCSL survey ofstate contacts.

10. Section 402 of Title X—Residential Lead-Based Paint Hazard Reduction Act of 1992,Housing and Community Development Act of1992, PL 102-550 (Oct. 28, 1992).


1 . NATURE AND EXTENT OF LEADPOISONING

12. Phase 1 of the Third National Health andNutrition Examination Survey (NHANES III,1988-1991).

13. U.S. Environmental Protection Agency(EPA), Strategy for Reducing Lead Exposure (Wash-ington, D.C., Feb. 1991), p. 1.

14. Centers for Disease Control and Preven-tion, Preventing Lead Poisoning in Young Children,p. 7.


highest priority. CDC, Preventing Lead Poisoningin Young Children, p. 2.

53. ATSDR, The Nature and Extent of LeadPoisoning in Children in the United States, IX-20(Atlanta, Ga., 1988), p. IX -20.

54. CDC, Preventing Lead Poisoning in YoungChildren, p. 76, 77.

55. CDC, Preventing Lead Poisoning in YoungChildren, p. 76.

56. See the National Health and NutritionExamination Survey (NHANES II), Agency forToxic Substances and Disease Registry, U.S. Dept.of Health and Human Services, (1984).



59. According to estimates given to theAssociation of State and Territorial Public HealthLaboratory Directors at their October 1991meeting.


61. Ibid.62. Lead Poisoning Prevention and Control,

MASS. GEN. LAWS ANN. Ch. 111 s. 190.63. Alliance to End Childhood Lead Poison-

ing, Childhood Lead Poisoning Prevention; A Re-source Directory, (Washington, D.C., 1991), p. 67.

64. Public outreach is practiced in 41 states.For more information see HUD, Comprehensiveand Workable Plan, p. 5-2; CDC, Preventing LeadPoisoning in Young Children, p. 78, 79.

65. Title X sec. 406.66. CDC, Preventing Lead Poisoning in Young

Children, p. 78.67. Recommendations offered by CDC to

reduce lead levels include: Making sure thatchildren do not have access to peeling paint orchewable surfaces painted with lead-based paint;paying special attention to windows, windowsills, and wells; wet mopping houses built before1960 with hard surface floors once a week with ahigh phosphate solution (other hard surfaces,such as window sills and baseboards should bewiped); washing children’s hands and face andtheir toys and pacifiers frequently; planting grassor shrubs over open soil if near house withexterior lead-based paint; flushing water fordrinking and cooking in areas where the leadcontent in water exceeds the drinking waterstandards; making sure that take-home exposuresare not occurring from parental occupations orhobbies. CDC, Preventing Lead Poisoning in YoungChildren, p. 30-31.


38. 56 Federal Register 26460, 26463 (June 7,1991); EPA, Strategy for Reducing Lead Exposure, p.22.

39. NHANES II survey, 1988.40. 40 C.F.R. 141.80 to 141.89.41. U.S. EPA, Strategy for Reducing Lead

Exposure, p. 24-25; for more information contactthe U.S. EPA Safe Drinking Water Hotline,1(800)426-4791.

2. STATE ROLE IN REDUCING LEADEXPOSURES

42. Lead-Based Paint Poisoning PreventionAct, 42 U.S.C. 4822 (1971).

43. In 1978, the the federal government,through the Consumer Product Safety Commis-sion, banned the addition of lead to new residen-tial paint. CDC, Preventing Lead Poisoning inYoung Children, p. 3.


45. See H. Needleman, et al., “The Long-TermEffects of Exposure to Low Doses of Lead inChildhood,” A. McMichael, et al, “Port PirieCohort Study.”

46. Lead Contamination Control Act of 1988,42 U.S.C. 201 (1988).

47. Residential Lead-Based Paint HazardReduction Act of 1992 (Public Law 102-550)

48. Alliance to End Childhood Lead Poison-ing, Understanding Title X: A Practical Guide to theResidential Lead-Based Paint Hazard Reduction Act of1992, (Washington, D.C., 1993), p. 2.

49. Section 1014 of Title X.50. Section 1011 of Title X.51. HUD, NOFA for Lead-Based Paint

Hazard Reduction in Priority Housing, 58 FR31847, 31866 (June 4, 1993).

52. CDC recommends a multitiered approachfor lead poisoning prevention programs. Forblood lead levels of 10 µg/dL or greater, commu-nity prevention activities should begin. At levelsabove 20 µg/dL, medical evaluation and environ-mental investigations should be done. At levelsabove 15 µg/dL, children should receive indi-vidual medical management, including nutri-tional and educational interventions and morefrequent screening. If resources are available,environmental investigations and remediationsshould be done if a child’s blood lead levelremains at 15 µg/dL to 19 µg/dL. Children withthe highest blood lead levels should receive the


68. CDC, Preventing Lead Poisoning in YoungChildren, p. 66-67.


70. Title X, Section 401(16).71. Lead Poisoning Prevention and Control,

Mass. Gen. Laws Ann. Ch. III S. 197.72. Title X requires EPA to promulgate

abatement standards.73. Title X, Section 404(h).

3. TRAINING, CERTIFICATION ANDACCREDITATION

74. Title X, Section 404(h).75. HUD, Comprehensive and Workable Plan, p.

6-14.76. Title X, Section 402.77. The five centers are based at the following

universities: University of Massachusetts atAmherst; University of Maryland and Universityof Cincinnati (joint program); Georgia Institute ofTechnology; University of Kansas; University ofCalifornia at San Diego.

78. Lead-Based Paint: Interim Guidelines forHazard Identification and Abatement in Publicand Indian Housing, 55 Federal Register 14556,14581 (April 18, 1990).

79. Ibid, 14582.80. HUD awarded $44 million for lead-based

paint abatement programs in 1992 to California,Massachusetts, Minnesota, New Jersey, RhodeIsland, and Wisconsin; the cities of Baltimore,Boston, and Cleveland; and Alameda County,California. For 1993, HUD awarded $91 millionto Maryland, Michigan, North Carolina, Ohio,Pennsylvania, Vermont, and Virginia; the cities ofChicago, Cincinnati, New Haven, New York City,Philedelphia, San Francisco, Springfield, Mass;and the counties of Allegeny, Pa., Los Angeles,Calif., Prince George, Md., and Shelby County,Tenn.

81. Section 402 of Title X—Residential Lead-Based Paint Hazard Reduction Act of 1992,Housing and Community Development Act of1992, PL 102-550 (Oct. 28, 1992).

82. Ibid.83. U.S. EPA, Action Plan for Priority Activities

(for Title X), (Washington, D.C., 1993), p. 3.84. Title X, section 402 (a)(2).85. Title X, section 402 (6)(2).86. States may adopt the implementing

regulations of 402. Title X, section 404. For moreinformation see 138 Congressional RecORD H11465to H11476 (daily ed. October 5, 1992).

87. Section 404 (b)(1)(2) of Title X.88. Section 404 of Title X.89. See 138 Congressional RecORD H11465 to

H11476 (daily ed. October 5, 1992).90. Based on conversations with state and

federal administrators during meetings held todiscuss implementation of Title X. These meet-ings, part of the Forum on State and Tribal ToxicsAction, have brought together staff from EPA’sOffice of Pesticides, Prevention, and Toxic Sub-stances and state agency and legislative personnelto discuss common problems regarding leadpoisoning prevention.

91. 55 Federal Register 14582.92. Title X, Section 408.93. Title X, Section 402(c)(1).94. Title X, section 402(a)(3).

4. FUNDING OPTIONS FOR STATE LEADPOISONING PREVENTION PROGRAMS

95. Based on information from a survey ofstate health officials for CDC’s 1991 Statement onPreventing Lead Poisoning in Young Children:Assessing Its Impact on State Health Agencies,Association of State and Territorial HealthOfficials, (Washington, D.C., Dec. 1992), p. 10, 11.

96. HUD, Comprehensive and Workable Plan, p.4-11, 4-22.

97. Centers for Disease Control, StrategicPlan for the Elimination of Childhood Lead Poisoning,(Washington, D.C., Feb. 1991), p. 45, 47.

98. States generally use alternative fundingmechanisms to support most of their environmen-tal programs. For more information see U.S.Environmental Protection Agency, State CapacityTask Force, A Compendium of Alternative FinancingMechanisms for Environmental Programs, (Washing-ton, D.C., July 1992).

99. Association of State and TerritorialHealth Officials, CDC’s 1991 Statement on Prevent-ing Lead Poisoning in Young Children, (Washington,D.C., Dec. 1992), p. 10.

100. U.S. EPA, A Compendium of AlternativeFinancing Mechanisms for Environmental Programs,p. 4.

101. U.S. EPA, A Compendium of AlternativeFinancing Mechanisms for Environmental Programs,p. 3.

102. U.S. EPA, A Compendium of AlternativeFinancing Mechanisms for Environmental Programs,p. 5, 71.

103. For more information see Alliance to EndChildhood Lead Poisoning, Resource Guide for


Financing Lead-Based Paint Cleanup, (Washington,D.C. 1991).

104. For more information see Alliance to EndChildhood Lead Poisoning, Resource Guide forFinancing Lead-Based Paint Cleanup, (Washington,D.C., 1991).

105. U.S. EPA, A Compendium of AlternativeFinancing Mechanisms for Environmental Programs,p. 4, 62.

106. Ibid, p. 5.107. Cal. Health and Safety Code 372.7 (West

Supp. 1992).108. Ibid, pp. 62-70.109. For more information see EPA, A Compen-

dium of Alternative Financing Mechanisms forEnvironmental Programs, pp. 62-70.

110. For more information see EPA, A Compen-dium of Alternative Financing Mechanisms forEnvironmental Programs, pp. 62-70.

111. Title X, section 402(a)(3).112. Title X, section 404(g).113. See “Notice of Funds Available for Lead-

Based Paint Abatement in Low- and Moderate-

Income Private Housing,” 57 Fed. Reg. 29,774(1991)

114. HUD, Comprehensive and Workable Plan, p.6-18.

115. Alliance to End Childhood Lead Poison-ing, Resource Guide, p. 8.

116. For more information see the Alliance’sResource Guide and Comprehensive and WorkablePlan, p. 6-17 to 6-22.

117. HUD, Comprehensive and Workable Plan, p.6-20

118. IBID, p. 6-20.119. IBID, p. 6-19.

5. APPENDIXES

120. For more information see Comprehensiveand Workable Plan, p. 1-3.

121. Title X, sec. 1011(g)(1).122. Title X, sec. 402.123. Title X, sec. 402.124. Title X, sec. 402(b)(1)(2).


ACRONYMS AND ABBREVIATIONS

ATSDR Agency for Toxic Substances andDisease Registry

CDC Centers for Disease Control andPrevention

CERCLA Comprehensive EnvironmentalResponse, Compensation, andLiability Act

CHAS Comprehensive HousingAffordability Strategy

EBL Elevated Blood LeadEP Extraction Procedure TestEPA U.S. Environmental Protection

AgencyEPSDT Early and Periodic Screening,

Diagnostic, and Treatment Pro-g r a m

HUD U.S. Department of Housing andUrban Development

LBP Lead-Based PaintLPPPA Lead-Based Paint Poisoning

Prevention ActLCCA Lead Contamination Control ActNIOSH National Institute for Occupational

Safety and HealthNESHAP National Emission Standards for

Hazardous Air PollutantsOSHA Occupational Safety and Health

AdministrationRCRA Resource Conservation and Re-

covery ActTC Toxicity Characteristic TestTSCA Toxic Substances Control Actµg/dL microgram of lead per deciliter of

bloodµg/kg milligrams of lead per kilogram of

soil


BIBLIOGRAPHY

Alliance to End Childhood Lead Poisoning. AFramework for Action to Make PrivateHousing Lead-Safe. Washington, D.C.,June 1993.

A detailed proposal is summarized tomake private U.S. housing units lead-safe. Specific requirements for propertyowners, a workable schedule, and mech-anisms that reinforce and reward respon-sible action are discussed (47 pages).

Alliance to End Childhood Lead Poisoning.Making the Most of Medicaid: State Progressin Childhood Lead Poisoning Prevention.Washington, D.C., 1993.

Examines state Medicaid policies, provid-ing a status report on state conformity,current practices, recommendations andMedicaid program polices. Containsrecommendations for key policy changesat the national and state levels to maxi-mize Medicaid’s contribution to prevent-ing childhood poisoning (87 pages).

Alliance to End Childhood Lead Poisoning.National Action Plan for Preventing Child-hood Lead Poisoning. Washington, D.C.,1993.

Provides specific recommendations forfederal, state, and local governments toreduce children’s exposure to lead (62pages) .

Alliance to End Childhood Lead Poisoning.Understanding Title X: A Practical Guide tothe Residential Lead-Based Paint HazardReduction Act of 1992. Washington, D.C.,January 1993.

Provides a summary and analysis of TitleX’s changes, its impact, and its implica-tions (19 pages).

Alliance to End Childhood Lead Poisoningand Conservation Law Foundation.Model State Law. Washington, D.C., 1993.

Model state legislation designed tomandate a comprehensive childhood leadpoisoning prevention program at thestate, and local levels. Includes annota-tions and “talking points” (100 pages).

Centers for Disease Control and Prevention.“State Activities for Prevention of LeadPoisoning Among Children-UnitedStates, 1992.” Journal of the AmericanMedical Association 269, no. 13 (April 7,1993): 1614, 1616.

Summarizes the findings of the June 1992lead prevention survey conducted by theAssociation of State and TerritorialHealth Officials (ASTHO) in regards tothe implementation of the recommenda-tions made in the revised 1991 CDCChildhood Lead Poisoning PreventionPolicy Statement (i.e.,. screening, fund-ing, and follow-up of children withelevated blood lead levels) (2 pages).

Brody, et al. “Blood Lead Levels in the U.S.Population.” Journal of the AmericanMedical Association 272, no. 4 (July 27,1994): 277-283.

Presents the results of Phase 1 of theThird National Health and NutritionExamination Survey.

Farquhar, D., and Gaer, L. Lead PoisoningPrevention: Directory of State Contacts 1993.National Conference of State Legisla-tures, Denver, Colo., 1993.

Profiles state programs to reduce leadhazards, provides brief descriptions ofthe specific activities, and lists the peoplewho administer them (141 pages).

Florini, K.; Krumbhaar, G.; and Silbergeld, E.Legacy of Lead: America’s ContinuingEpidemic of Childhood Lead Poisoning.Washington, D.C., Environmental De-fense Fund, 1990.


Presents a public policy report andproposal for legislative action. Containstables with estimates of local prevalenceof childhood lead poisoning in thiscountry (46 pages).

Freuer, Elizabeth, and Florini, Karen. At ACrossroads: State and Local Lead PoisoningPrevention Programs in Transition. Wash-ington, D.C.: Environmental DefenseFund, June 1992.

Reviews seven states’ attempts to imple-ment recommendations made in theCDC’s 1991 policy statement “PreventingLead Poisoning in Young Children” (46pages) .

National Academy Press. Measuring LeadExposure in Infants, Children, and OtherSensitive Populations. Washington, D.C.,1993.

Report prepared by the National Re-search Councils Committee on Measur-ing Lead Exposure in Critical Popula-tions. The committee concurred withCDC's selection of 10 µg/dL as the leadconcentration of concern.

National Association of Home Builders. LeadExposure Prevention Manual. Washington,D.C., 1992.

Reports on state lead prevention pro-grams and abatement measures requiredand on strategies for lead hazard reduc-tion in both the public and private sectors(102 pages).

National Center for Lead-Safe Housing. Lead-Based Paint Hazards and the ComprehensiveHousing Affordability Strategy: How toRespond to Title X. Columbia, Md., 1993.

This technical assistance bulletin wasdeveloped in close consultation withHUD to enable people who are unfamil-iar with lead-based paint issues to inte-grate lead into the development of theirComprehensive Housing AffordabilityStrategy.

Pirkle, et al. "The Decline in Blood LeadLevels in the United States." Journal of theAmerican Medical Association 272, no. 4(July 27, 1994): 284-291.

Discusses trends in blood levels for theU.S. population from 1976 to 1991.

Ruff, H.; Bijur, P.; Ma, Y.; Makowitz, M.; andRosen, J. “Declining Blood Lead Levelsand Cognitive Changes in ModeratelyLead-Poisoned Children.” Journal of theAmerican Medical Association 269, no. 13(April 7, 1993): 1641-46.

Study to determine the associationbetween lead exposure and intellectualperformance in children. Examines theimpact of changes in blood lead level onthe cognitive index of lead-poisonedchildren (6 pages).

U.S. Department of Housing and UrbanDevelopment. Office of Policy Develop-ment and Research. Comprehensive andWorkable Plan for the Abatement of Lead-Based Paint in Privately Owned Housing.Washington, D.C., 1990.

HUD’s comprehensive report to Congresson the problems of lead-based painthazards in U.S. housing, abatementstrategies, and actions undertaken byfederal, state, local, and private agenciesto reduce and eliminate lead-based painthazards.

U.S. Environmental Protection Agency. Officeof Pollution Prevention and Toxics.Applicability of RCRA Disposal Require-ments to Lead-Based Paint AbatementWastes. Washington, D.C., 1993

Reports on the study's findings regardingwastes from lead-based paint abate-ments. Discusses the situations in whichlead-based paint abatement wastes werefound hazardous and reports on itsconclusions (43 pages).

U.S. Environmental Protection Agency. Office


of Toxic Substances. Detailed DesignDocument for the Comprehensive AbatementPerformance Study. Washington, D.C.,1992.

EPA’s comprehensive abatement perfor-mance study directed at the identificationand abatement of lead-based paint haz-ards in privately owned and publichousing. Discusses research programsconducted in 10 cities to assess the costsof both short- and long-term efficacy ofalternative methods of lead-based paintabatement (57 pages).

U.S. Department of Health and HumanServices, Centers for Disease Control,Preventing Lead Poisoning In Young Chil-dren. Atlanta, Ga., 1991.

Presents CDC’s statement on the natureand extent of lead and lead poisoning,recommends actions to remediate sourcesof lead, provides information on medicaltreatment of lead poisoning, and discuss-es public policy actions to reduce leadpoisoning (107 pages).

U.S. Department of Health and HumanServices, Centers for Disease Control.Strategic Plan for the Elimination of Child-hood Lead Poisoning. Atlanta, Ga., 1991.

Discusses CDC’s strategy to increasepublic health awareness of childhoodlead poisoning for long-term preventionand elimination of the problem (93pages) .

U.S. Department of Health and HumanServices, Public Health Service. Natureand Extent of Lead Poisoning in Children inthe United States: A Report to Congress.Atlanta, Ga., 1988.

Provides an comprehensive overview ofthe problem of lead poisoning in the U.S.;sources of lead in the environment andthe means by which humans are at risk;the estimated number of children at riskof lead’s toxic effects by race, familyincome, and urban location; and thecontribution of lead-based paints to leadpoisoning (495 pages).

U.S. Department of Housing and UrbanDevelopment. The HUD Lead-Based PaintAbatement Demonstration (FHA). Washing-ton, D.C., 1991.

Presents HUD’s demonstration programto compare alternative abatement meth-ods, including their costs, effectiveness,and safety, of lead-based paint hazards inHUD-owned, vacant and single-familyproperties (110 pages).

U.S. Department of Labor. OccupationalSafety and Health Administration. LeadExposure in Construction; Interim FinalRule. 58 Federal Register 26590, (May 4,1993).

Presents the interim final rule amendingOSHA’s standards for lead exposure inthe construction workplace (60 pages).

Weitzman, M.; Aschengrau, A.; Bellinger, D.;Jones, R.; Hamlin, J.; and Beiser, A.“Lead-Contaminated Soil Abatement andUrban Children’s Blood Lead Levels.”Journal of the American Medical Association269, no. 13 (April 7, 1993): 1647-54.

Study to determine the effectiveness ofremoving lead-contaminated soil inreducing the blood lead level of urbanchildren with multiple sources of leadexposure (8 pages).


ABOUT THE AUTHOR

Doug Farquhar is a senior policy specialist responsible for the Lead Hazards and Asbestos HazardsManagement Projects in the State Issues and Policy Analysis Program at the National Conference of StateLegislatures. The projects provide support to state legislatures, their staffs, and state agency personnelregarding lead hazard reduction and asbestos policies, statutes, and regulations and assist the U.S. Environ-mental Protection Agency in its work with states. While at NCSL he has written State Asbestos Programs,two editions of Lead Poisoning Prevention: Directory of State Contacts, and several reports and articleson state lead and asbestos policies.

Before coming to NCSL, Mr. Farquhar worked in the CERCLA (Superfund) Litigation Section of theColorado Attorney General’s Office, as a staffer for the Texas House of Representatives, and in theWashington, D.C., office of Colorado Congressman Dan Schaefer.

Mr. Farquhar has a B.A. in government from the University of Texas and a law degree from the Universityof Denver.

lead poisoning prevention: a guide for legislators · lead poisoning prevention: a guide for...

Documents