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Communities across the US face challenges from legacy lead contamination. In South Bend, Indiana, over 68,000 homes were built before 1978, and most contain leaded paint. When these homes are repainted, repaired, or renovated, failure to use lead-safe practices can contaminate the surrounding soil with lead paint flakes and dust. In this study, we used X-ray fluorescence (XRF) to measure soil lead levels surrounding a home with exterior leaded paint (about 10% Pb w/w) after it was repainted in fall of 2019. The painted wooden exterior was prepared for painting by dry scraping without the use of tarps or plastic barriers. A total of 220 soil samples were collected from the home and its immediate neighbors, and an additional 102 samples were collected from 34 homes in the same neighborhood. The median lead level in dripline soil samples across the neighborhood was 434 ppm, but in the recently repainted house, the median soil lead was 1808.9 ppm, and it was 1,346.4 ppm in the four neighboring homes. The repainted house and its four neighbors were mulched by covering all bare soil to a 4-6 inch depth with chipped wood mulch. Two months later, another 100 soil samples were collected and analyzed. The surface lead level around the target house dropped to 13.8 ppm, showing that mulching is an effective strategy for interim control of high soil lead levels.

Lead exposure is a major health hazard affecting children and their growth and is a concern in many urban areas around the world. One such city in the United States (US), South Bend Indiana, gained attention for its high levels of lead in blood and relatively low testing rates for children. We assessed current lead screening practices in South Bend and the surrounding St. Joseph County (SJC). The 2005-2015 lead screening data included 18,526 unique children. Lead screening rates ranged from 4.7 to 16.7%. More than 75% of children had 'elevated blood lead levels' (EBLL) ≥ 1 micrograms per deciliter (µg/Dl) and 9.7% had an EBLL ≥ 5 μg/dL. Over 65% of the census tracts in SJC had mean EBLL ≥ 5 μg/dL, suggesting widespread risk. Inconsistent lead screening rates, coupled with environmental and societal risk factors, put children in SJC at greater risk for harmful lead exposure than children living in states with provisions for universal screening. Indiana and other states should adhere to the US Centers for Disease Control's guideline and use universal lead testing to protect vulnerable populations.

Background: Legislation outlawing leaded paint in 1978 and tetraethyl lead from gasoline in 1992 effectively decreased blood lead levels (BLLs), but the effects of lead are still felt in the United States to this day. There is no safe level of lead in the body, and even low level lead exposure can lead to cognitive and developmental delays such as learning delay and disabilities; low IQ; and attention-deficit/hyperactivity disorder. The CDC has determined that a BLL of 5 μg/dL or higher is cause for environmental and educational intervention. Today, the EPA estimates that there are approximately 24 million housing units containing significant lead hazards, with 4 million being home to children. Many of the families that are faced with lead hazards in their homes are minorities and low socioeconomic status. To assist families with possible lead hazards in the home, interim controls of lead hazards may be paramount to reducing lead levels in the household in a simple, cost effective manner. Methods: To that end, our research had two aims (a) conduct a systematic literature review to learn about do-it-yourself (DIY) interim controls that are evidence-based and effective in reducing lead hazards in the home and (b) conduct interviews with key personnel at each state health department to learn more about their lead prevention programs and the DIY mitigation strategies recommended to families. Results: Our provisional findings suggest there is an inconsistent, wide range of mitigation strategies recommended by the state health departments that often lack empirical evidence. . While our literature review identified effective interim controls, the literature is outdated. Conclusion and Potential Impact: We recommend more studies are needed to identify cost effective interim controls and the standardization of health department DIY interim controls across the nation.

Background and Hypothesis: The CDC has declared that there is no safe blood lead level for a child, but still approximately 37 million homes are lead-contaminated of which 4 million are home to small children. Lead abatement is an expensive strategy to remove all lead hazards rendering a home lead-free. Many of these lead-contaminated homes are in lower socioeconomic areas which makes lead abatement nearly impossible. Given the expense of lead abatement, low-cost interim controls are needed to reduce lead exposure thus creating a lead-safe home. We hypothesize that updated lead mitigation strategies need pursued, and there is a large disparity of lead information disseminated between health departments. Project Methods: Using JSTOR and Boolean criteria, we conducted a systematic literature review on evidence-based, do-it-yourself (DIY) lead mitigation strategies for sources of lead contamination. Once the literature review was completed, QualtricsR was used to quantitatively and qualitatively evaluate the 50 state health department’s websites for lead policy, user friendliness, and recommended lead interim controls as compared to the literature review. Results: Results from the literature indicate that there is a lack of current information regarding new strategies for lead mitigation. Research prior to the year 2000 shows that cleaning flat surfaces by wet mopping, washing hands frequently, mulching, removing shoes before entering the home, and painting over deteriorating paint significantly reduces lead accumulation in the home. Preliminary results from the website review found that there is no baseline of uniform information being distributed, and evidence-based practices are not included for each state health department. Potential Impact: The lack of continuity nationwide for lead mitigation showcases that families are not receiving all of the information that research has to offer to help keep their homes safe. This research indicates that there is a need for national lead policies and recommendations, so each family in the U.S. is equally informed.

Background There is no safe level of lead in children's bodies. The US Centers for Disease Control and Prevention (CDC) estimate that more than half a million children under the age of 6 years are affected by low-level lead exposure in the USA. Low levels of lead can cause irreversible neurological and physiological damage in children. Currently, lead is investigated in the home and environment after a child has been identified as having elevated concentrations of lead in their blood; the source of lead exposure is then sought and removed. However, we seek to reverse this paradigm and allow families to engage in prevention by testing their home and environment before their child is exposed to lead. The aim of this study was to design and pilot a screening device to allow families to test their homes for lead. Methods We recruited participants for this blinded case-control study in Saint Joseph County, Indiana, USA, through community partnerships, a community lead testing event, and flyers. Participants were divided into three groups based on the age of their home: homes built before 1950; homes built between 1951 and 1978; and homes built after 1978. The post-1978 group acted as a control because lead paint was banned in 1978. Participants collected eight samples from their homes, including from soil, dust, and paint. The field team measured the concentration of lead levels in each of the eight samples at the site of collection using an X-ray fluorescence analyser. Samples were then tested at the laboratory where all identifying information was removed and workers were unaware of the age of the home the samples came from. Results from the field were then correlated with results from the laboratory using Bland-Altman plots, linear regression, and ROC curves. Informed consent was obtained and this study was approved by the University of Notre Dame Institutional Review Board. Findings We included results from 45 homes in the analysis: 17 from pre-1950 homes, 11 from 1951–78 homes; and 17 from post-1978 houses. Of the 17 pre-1950 homes, 94% had at least one finding of a lead concentration that exceeded the action level laid out by the US Environmental Protection Agency. Of the 11 1951–78 homes, 36% (4) had at least one elevated lead result, and none of the 1978 homes had an elevated lead result. Bland-Altman plot analysis showed good agreement between onsite and laboratory measurement with biases very close to zero. Correlation coefficients between field and laboratory measurements were 0·97, 0·89, and 0·92 for the soil, dust, and paint samples, respectively. The ROC curves show high sensitivity (87%), specificity (98%), and accuracy (96%). At the time of the study, the cost of the kit was approximately US$7.00, excluding laboratory fees. Interpretation This study lays the foundation for the creation of a lead sample collection kit model that can be implemented in homes, day-care centres, and schools. Although this model will not provide the participant with an in-depth lead risk assessment, it has the potential to be a tool to allow proactive screening of homes for environmental lead hazards. Our team will now work to scale up implementation with our community partners. Our goal is to distribute and test 500 kits in 2019. Funding A local private donor.