ca childhood lead poisoning prevention (clpp) program

California Dept. of Health Services Childhood Lead Poisoning Prev. Br.

Childhood Lead Poisoning Prevention in California

Presentation to the Border States Lead Issues Meeting in El Paso

January 26, 2006

Joseph G. CourtneyCalifornia Department of Health Services

Childhood Lead Poisoning Prevention Branch


CA Childhood Lead Poisoning Prevention (CLPP) Program

• Established by legislation beginning in late 1980s that created program mandates and created fee support.

• Fees are on industries that have put lead into the environment (motor vehicle fuel, paint, air emitters)


Program Mandates: State level• Adopt regulations on evaluating and

screening children for lead poisoning

• Establish protocols for screening

• Ensure appropriate case management, including environmental assessments and educational activities to reduce a child’s exposure to lead

• Collect and analyze information related to these activities


State CLPPB Partners• Other State Agencies

Food and Drug BranchOccupational Health BranchEnvironmental Health LaboratoryOffice of Binational Border HealthRefugee HealthAttorney General—Prop 65 enforcement

• Federal Agencies– CDC: Cooperative Agreement (LA County also has one)– FDA– EPA– HUD


CLPP Local Program Activities

46 Local programs have contracts with the State Branch to carry out mandates of CLPP at local level:

• informing- outreach and education• promote screening• local surveillance• case management• environmental investigation• identify new lead hazards


If High Lead Level Found in a Child

• Interventions and services (usually by local CLPPP)referred for primary provider, as needed, for

medical assessment and treatmentprogram referrals (WIC, housing agencies)environmental investigation for lead sources

and remediation steps are notednutritional guidance and prevention of

additional lead poisonings


California Profile

• POPULATION:

Most populous state in the U.S.

Nearly 34 million residents in 2000

(12% of U.S. total)

14% increase since 1990


California Child Population 10.7 million children under age 21 years

About 520,000 births per year

Over 1 million children age 1 and 2


California Profile

• 58 counties with a huge range of population:

Alpine Co. pop. 1,208

Los Angeles: 9.5 million

• 8 counties populations have over one million people

• The most populous counties (LA, Orange, San Diego) in south


California Population Served

MANY IN POVERTY:

• 46% of children live in households with incomes less than 200% of the Federal Poverty Level (FPL)

• About 500,000 children age 1 and 2 years below 200% FPL


California Population Served

ETHNIC DIVERSITY:

• In 2000, no group a majority:

32% Hispanic

11% Asian

6% African American

47% White

• Of children less than 18 years, 42% were Hispanic


California Profile

• DIVERSITY:

30% of the U.S. foreign-born population lives in California

33% of residents speak a language other

than English at home

Over 1/3 of school-age children speak a

language other than English at home


California Housing Profile

• Ranks 3rd in U.S. for largest number of old housing units

• Over 2 million units constructed before 1950

• 8.6 million units before 1980


California Housing Profile

• Approximately 14% of young children live in pre-1950 housing

• Approximately 70% live in pre-1980 housing


Who is Routinely Screened for Lead?

• Screening to identify children with elevated blood lead levels is focused on those considered most at risk

Young children in government-assisted programs: Medi-Cal (Medicaid), WIC, EPSTD service providersor Any child with other risk factors as indicated


Medical Provider Requirements

Regulations mandate:All children age 6 to 72 months receive

anticipatory guidance on lead hazardsChildren in government-assisted health

programs receive blood lead tests age 12 and 24 months (to 72 months if not done)

Other children assessed for housing Pb risk and tested if indicated


Laboratory Reporting

MANDATES:

• universal reporting of all blood lead test results (as of 1/1/03)

• electronic reporting (as of 1/1/05)


Current Blood Lead ResultsDuring FY 04-05 Over 650,000 blood lead tests reported to CLPPB 4,287 with elevated lead tests > 10g/dL (0.6%) 3,452 newly identified children with elevated

blood leads 715 new lead poisoning “cases”

(BLL > 20g/dL or persistent values > 15g/dL ) % children with elevated levels and # cases

decreasing


Childhood Lead Poisoning CasesCalifornia 1992-2004

950

1490

1664

13961499

1095

890833

769 797736

687 657

0

200

400

600

800

1000

1200

1400

1600

1800

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

Year


The Distribution of Lead Poisoning Cases by Race/Ethnicity, 2001-2004

Latinon= 1676, 87%

Non-Latino White

n=80, 4%Non-Latino Asian/Pacific

Islandern=77, 4%

Non-Latino African

American n=90, 5%


California Lead Poisoning Source Analyses (cases with environmental

investigations 2000-2002)• 69-90% had either a soil, paint, or dust

source (depending on the contamination action level used)

• 36% had at least one non-soil/paint/dust source

• 6-14% had ONLY a non soil/paint/dust source

• 4-17% had NO source identified


Most Common Non-Dust/Paint/Soil Sources Found (cases with

environmental investigations 2000-02)

• Take-Home of Occupational Exposure: 12.5%

• Home remedy: 10.4%

• Hobby: 5.9%

• Pottery/Ceramics: 2.6%

• All “Other” non-d/p/s sources: 9% (includes all candy and other food items, jewelry, etc.


California BRFS

• 52% of those with young children living in a pre-1978 home had undergone renovation or repair in the prior 12 months

• 6% used Mexican ceramics to store, serve, or prepare food

• 21% ate Mexican candy (37% of Latino households)


Alternative Sources 2005

• Jewelry• Indian silver foil• Cribs• Holiday mugs• Vinyl lunch boxes• Chinese kimchi• Tattoo ink• Chinese cured plums

• Ayurvedic remedies• Moroccan tajines• Litargirio• Children’s sunglasses• Mexican

candy/seasonings• Turmeric


New Lead in Candy Law (AB 121) Became law Jan 1, 2006 Requires CA DHS to ensure that candy does not

contain lead in excess of the naturally occurring level. This level to be established by new regs by 7/1/06.

DHS shall test candies for lead and establish procedures for candy makers for testing and certifying candy.

Imposes penalties on those who knowingly sell lead-contaminated candy

ca childhood lead poisoning prevention (clpp) program

Documents

lead sources

high lead level

new lead hazardscalifornia

california presentation

south california

california profilepopulation

california child population

california profile58