Lead in the Americas: A Call for Action (1996)

Alameda County Lead Poisoning Prevention Program (ACLPPP ): Community Education and the Role of Community Health Outreach Workers. Rebecca Carrillo and Dario Hunter⁽¹⁾. ⁽¹⁾Oakland, California, U.S.A.. Alameda County is both ethnically and economically diverse, requiring a multifaceted approach to the prevention of childhood lead poisoning. ACLPPP's outreach and education focuses on paint, dust, and soil as primary sources of lead toxicity in children. Ceramics fired at low temperatures and home remedies in the Latino community are also focal points. The outreach component of the program is dedicated to increased community awareness of lead hazards, potential dangers of lead poisoning, and increased screening for children. This is accomplished, in part, by providing outreach both to and through several subcommunities, including the local medical community; local schools (K-12); day care centers; renovators; and targeted neighborhoods based on exterior conditions of homes.

Strategies for reaching families include, but are not limited to, educational home visits or phone contact for children with elevated blood lead levels, door-to-door campaigns, informational booths, health fairs, public service announcements, community presentations, informational potlucks, an informational line, and promotional items.

Alliance to End Childhood Lead Poisoning: International Action Plan for Preventing Lead Poisoning. Maria Rapuano⁽¹⁾, K.W. Rochow⁽¹⁾. ⁽¹⁾Washington, D.C., U.S.A. The Alliance to End Childhood Lead Poisoning, a nonprofit interest organization formed in October 1990, focuses exclusively on eliminating lead poisoning. Its mission is to frame the agenda, formulate innovative approaches, and bring critical resources to bear –scientific and technical knowledge, public policy, economic forces, other organizations, and community leaders– to prevent lead poisoning. In 1994 the Alliance convened The Global Dimensions of

Lead Poisoning: The First International Prevention Conference in Washington, D.C., bringing together over 250 advocates, officials, and experts from every continent, with substantial representation from developing countries. The conference used for discussion The Global Dimensions of Lead Poisoning: An Initial Analysis prepared by the Alliance and the Environmental Defense Fund. In April 1995, the Alliance released its most recent report, International Action Plan for Preventing Lead Poisoning, providing a framework for taking the actions needed to reduce and eliminate lead poisoning. Phasing lead out of gasoline is one of the single most effective steps that can be taken to prevent lead poisoning. The phaseout campaign, conducted by the Alliance in concert with other nongovernmental organizations (NGOs), is based on the framework for lead poisoning prevention embodied in the International Action Plan.

Blood Lead Levels According to Branch of Industrial Activity: September 1992-September 1994. Carmen Yris Delgado Pantaleón⁽¹⁾, Angel Danilo Moquete⁽¹⁾. ⁽¹⁾Pan American Health Organization, Santo Domingo, Dominican Republic . We analyzed the occupational exposure and the blood lead levels of workers exposed to lead in various industries in the Dominican Republic. We looked at the workers most directly affected by lead who had clinical manifestations of lead poisoning, a history of exposure, and a confirmation of exposure from laboratory results. Of the 1,429 workers studied, 348 had blood lead levels that exceeded the acceptable limits set by the World Health Organization (40 µg/dl).

Lead levels were lowered through the implementation of recommendations given to the industries to control the lead exposure. In addition, a diagnostic approximation of the principal sources of lead exposure in the formal sector and their effects on the health of the exposed population were obtained.

Blood Lead Levels of Workers Exposed to Leaded Gasolines and Combustion Products in Trinidad. Ivan Chang-Yen⁽¹⁾, Neela Pooransing⁽¹⁾, David Bratt⁽²⁾, Anthony Parkinson⁽²⁾, Leverson Boodlal⁽³⁾. ⁽¹⁾The University of West Indies Chemistry Dept., ⁽²⁾University of West Indies Medical School, ⁽³⁾Ministry of Workers and Transport, Trinidad. Studies of blood lead levels of motor vehicle mechanics, exhaust repair workers, and road maintenance personnel were carried out in Trinidad. The mean blood lead level of a local control population over a similar age range was simultaneously determined for comparison. Persons in

the former groups had mean blood lead levels two to three times higher than that of the control population. Of particular interest was the finding that persons residing in close proximity to motor vehicle repair sites also had mean blood lead levels significantly higher than that of the controls. Work habits, the use of leaded gasolines in Trinidad, and air and roadside dust concentrations are used to explain the results obtained in the groups studied. The need for strategies to minimize such exposures was also discussed.

Childhood Lead Poisoning Prevention: Yesterday, Today, and Tomorrow in the Far West. L. Rex Ehling⁽¹⁾, Alvaro Garza⁽¹⁾. ⁽¹⁾California Department of Health Services, Childhood Lead Poisoning Prevention Branch, Emeryville, California, U.S.A.. This poster offers reflective and prospective views of childhood lead poisoning and its prevention in the United States, specifically in California. The display reviews what we have learned about the effects of lead on various organ systems; the accumulation of lead hazards in the environment; a review of regulatory efforts both nationwide and in California; epidemiology of the disease in California; and California 's plan to eliminate childhood lead poisoning based upon primary, secondary, and tertiary prevention models.

Community Action and the Reduction of Lead Exposure: The Trail Experience. Terry Oke⁽¹⁾. ⁽¹⁾Trail Lead Program, Trail, Canada. Trail, a small city of 9,000 people in the province of British Columbia, Canada, has a lead/zinc smelter, active since the turn of the century. Contamination from stack and fugitive emissions has resulted in a significant health concern for young children. A health study in 1989 found that the geometric mean blood lead level of Trail area children was 13.1 µg/dl. The Trail Community Lead Task Force has responsibility for reducing children's blood lead levels and producing a remedial strategy for the community. Trail uses community input as an approach to remedial decisionmaking. Since 1990, comprehensive programs of blood lead screening, community education, and case management, as well as investigations of lead exposure pathways and intervention, have assisted the Task Force in achieving its mandate.

Controlling Lead Exposure due to “Backyard” Battery Repair Shops in Jamaica. J. Peter Figueroa⁽¹⁾, Thomas Matte⁽¹⁾, Stephanie Ostrowski⁽¹⁾, et al. ⁽¹⁾Jamaican Ministry of Health Epidemiology Unit, Kingston, Jamaica. Reports of Jamaican children being admitted to hospitals with severe

lead poisoning led to an investigation of the problem in the mid-1980s. Three surveys were undertaken: (1) 58 households were studied in the Red Pond community in which an established lead smelter and several cottage lead smelters were located; (2) 3 battery manufacturers and 10 battery repair shops were surveyed and 69 workers tested; (3) 24 households in Kingston with exposure to “backyard” battery repair shops (BBRS) were surveyed.

Soil lead levels in Red Pond exceeded 500 parts per million (ppm) in 24 percent of households, and 44 percent of children under 6 years of age had blood lead levels exceeding or equal to 25 µg/dl. Proximity to backyard smelters and to the conventional smelter were independent predictors of soil lead, which was the strongest predictor of lead in children under 12 years of age. Sixty-five percent of “backyard ” battery repair shop workers and 28 percent of battery manufacture workers had lead levels above 60 µg/dl. The majority of households (84 percent) with exposure to BBRS had soil lead levels above 500 ppm, and 43 percent of children under 12 years of age in these households had lead levels greater than 70 µg/dl.

The findings of the three surveys were used to mobilize efforts to reduce the high lead exposure levels in the different settings. Persons with abnormally high lead levels were removed from exposure points and treated. The media highlighted the serious nature of the problem, and the findings were shared with the management and the workers of the battery repair shops and the community and the household members. An educational program was put into place, specific control measures identified, and inspection visits increased. The conventional smelter in Red Pond closed down and clean-up was undertaken. The control measures have resulted in a significant decrease in pediatric admissions for lead poisoning. Additional measures are needed to further reduce lead exposure arising from backyard battery repair shops (Matte et al., 1989a, 1991).

The Development of A Statewide Database on Lead-Safe Housing and Identifying Communities with High Risk of Lead Poisoning. Robert Haug⁽¹⁾, Joan Cook Luckhardt⁽²⁾. ⁽¹⁾New Jersey Department of Community Affairs, ⁽²⁾University of Medicine and Dentistry of New Jersey, New Jersey, U.S.A.. The United States permitted lead in residential paint until 1978; as a result, over five million metric tons of lead remain on dwellings throughout the country. The Department of Community Affairs, Lead-based Paint Abatement Program and Division on Codes and Standards, and Lead Poisoning Prevention Education and Training Program at the

University of Medicine and Dentistry of New Jersey SOM have been developing a pilot registry of lead-safe housing using Geographic Information Systems to identify areas with high risk of lead exposure and cataloguing lead-safe dwelling units. The registry will provide citizens with information to help them avoid renting or buying homes with unacceptable lead hazards. Information from all municipal building permits on all lead abatement activities and gut rehabilitation projects and other publicly funded programs requiring lead removal will be entered to create the lead-safe housing registry. Other state demographic and geographical databases also are used. Addresses of lead-safe houses will help tenants seeking lead-safe housing and agencies placing lead-burdened children with minimal disruption.

Educational Interventions to Change Head Start Parents' Behavior to Prevent Lead Poisoning Among Young Children. Cecile Dickey⁽¹⁾, J. C. Luckhardt⁽²⁾, Fred Patterson⁽³⁾, Frank Torpey⁽⁴⁾. ⁽¹⁾St. Peters College, Jersey City, New Jersey, ⁽²⁾New Jersey Head Start Assoc. and University of Medicine and Dentistry of New Jersey, ⁽³⁾Fred Patterson Assoc. and Johnson & Johnson Co., New Jersey, ⁽⁴⁾Ethicon Corporation, New Jersey. The Johnson and Johnson Corporation and the New Jersey Head Start Association are designing educational materials and interventions to educate about the dangers of lead poisoning and are developing ways to better prevent lead poisoning in 2,000 Head Start Children in four New Jersey cities using control and experimental groups. The modes of intervention include outreach workers educating individual families, use of broadcast media and print materials, and small group instruction. The effectiveness of the various modes of education will be assessed by an independent research institute with interviews conducted before, during, and after the program. Blood lead levels of the children in the experimental and control groups will be measured before and after the educational intervention.

Effect of a Nutritional Intervention to Reduce Lead Exposure in Infants . M. Hernández-Avila⁽¹⁾, I. Romieu⁽²⁾, E. Palazuelos-Rendón⁽³⁾, E. Fishbein⁽¹⁾, L. H. Sanin⁽¹⁾, S. Treviño⁽¹⁾. ⁽¹⁾National Institute of Public Health, Cuernavaca, Mexico, ⁽²⁾Pan American Center for Human Ecology and Health, Mexico, ⁽³⁾Federal District Department, Minister of the Environment, Mexico. The effect of a nutritional intervention to reduce lead exposure in infants is currently being studied in Mexico City. This double-blind, placebo-controlled study will assess whether a supplement

of 1,200 mg of calcium given to lactating mothers with elevated lead levels in breast milk will reduce lead absorption in their nursing infants. Recruitment for the study is conducted antepartum, but the study begins immediately postpartum. Mothers are randomly placed in either treatment or placebo groups according to blood lead levels (high or low).

The mothers are contacted for follow-up on three separate occasions. The first contact is one month after delivery in the hospital ABC investigation center, where biological samples of mother's blood, urine, milk, and bone, and samples of the baby's blood (if the mother allows) and hair are taken. Information on the mother's socioeconomic status, daily practices leading to potential lead exposure (for example, ceramicware use), anthropometric data, and daily dietary calcium intake are gathered during interviews. The first dose of calcium or placebo is given at this time. The second contact is made at the mother's home four months after delivery, and the same biologic samples (excluding bone and the baby's blood) are taken. The second and final dose of calcium or placebo is given at this time. Seven months after delivery, a final contact is made. Biologic samples (excluding the baby's blood) are taken, and diet is reassessed. A parallel intervention designed to educate mothers about lead poisoning prevention and breastfeeding advantages was also conducted monthly with approximately 50 percent of the mothers. The promotion project started in November 1994 and will end in June 1995.

Because the study is still under way, conclusions and findings are not available. The study will examine the relationships between maternal calcium intake and lead levels in nursing infants and between maternal lead levels and the following factors: use of glazed ceramics, living in high-density traffic zones in Mexico City, length of time residing in Mexico City, type of water used for drinking, kind of paint used in the home, partner's and mother's job, mother's usual smoking habits, and mother's education and socioeconomic level.

Epidemiological Analysis of Lead Exposure in Four Different Occupations. Nancy Patiño Reyes⁽¹⁾. ⁽¹⁾District Secretary of Health, Bogota, Colombia. Workers exposed to lead from four different occupations were identified and their blood lead levels assessed in the city of Santafé de Bogota. The occupational groups were (1) service station attendants, (2) printers, (3) painters, and (4) battery factory workers. The analyses were conducted with a hematoflurometer to determine zinc protoporphyrin (ZPP) as a method of screening, verifying some samples with atomic absorption spectrophometry (AAS) equipped with a graphite furnace to

test the accuracy and reliability of this method. The results showed that the battery workers had the highest blood lead levels of the four occupational groups.

Families Exposed to Lead: A Public Health Problem. Nancy Patiño Reyes⁽¹⁾. ⁽¹⁾District Secretary of Health, Bogota, Colombia. Children of workers who live near battery factories are at risk of being exposed to residual lead brought home by the workers. A 2-year-old girl, whose parents worked in a battery factory, died in May 1993 from lead poisoning. This death, and several other cases of extremely poisoned children in the same population, precipitated the need to study the syndrome of “fouling the nest.” Arrangements are under way for such studies.

There are other families in the region exposed to lead from the religious elements and images they make and sell. Blood lead levels in these individuals have been reported to be as high as 900 µg/dl. Programs of intervention have been targeted to these families.

Fouling the Nest with Lead: The Santo Amaro Case Study. Fernando M. Carvalho⁽¹⁾, Annibal M. Silvany-Neto⁽¹⁾, Tania M. Tavares⁽¹⁾. ⁽¹⁾Federal University of Bahia, Bahia, Brazil. From 1960 to December 1993, a primary lead smelter, a branch of a multinational company producing 11,000 to 32,000 tons of lead a year, polluted Santo Amaro City, State of Bahia, Brazil. Average blood lead levels of the 642 children living within 900 meters of the industry were 59.1 µg/dl in 1980, decreasing to 36 µg/dl in 1985 after abatement measures were taken. About 22 percent of the study population were children of smelter workers. Smelter dross was freely donated by the industry to local populations, who often used it to pave the backyards and orchards of their homes. Geometric mean of zinc protoporphyrin (ZZP) in children living in homes where dross was present was 78.8 µg/dl, whereas this concentration was 70.3 µg/dl for children in dwellings without dross. The enterprise, a branch of a multinational company, has moved to another state of Brazil because it could not cope with the health and environmental penalties levied against it. Their legacy now includes 230 unemployed workers, some with health problems; an unknown number of people poisoned by lead; and about 500,000 tons of smelter dross containing 1-3 percent lead scattered around the former smelter area. This episode illustrates the poor compliance with environmental and occupational regulations by the industry and the lax enforcement of these laws by the state authorities.

Lead Content in Tropical Vegetables and Fruits Grown Around a Smelter. M. Bereta⁽¹⁾, V. P. Campos⁽¹⁾, T. Tavares⁽¹⁾. ⁽¹⁾Department of Analytical Chemistry, Federal University of Bahia, Brazil. Levels of lead in 25 varieties of consumer vegetables and fruits at various distances upwind and downwind from a smelter, within a 12-kilometer radius, were determined. Lead content in soil where crop plants were grown and in atmospheric particles was also measured. Plant samples were pretreated in the manner customary in the local consumer population, and lead was then extracted with concentrated nitric acid in Teflon-lined pressure vessels for 15 hours. Atmospheric particles were collected and fractionated by size with a 6-stage Berner impactor, then extracted with nitric acid in an ultrasonic bath. Analysis was conducted by atomic absorption spectrophometry with a graphite furnace. Highest levels (µg/g-dry weight basis) were found in green vegetables: mint (23-1,109), coriander (11-436), lettuce (17-406), green cole (5-394), and okra (22-12). Based on local eating habits, however, PTWI will most probably be exceeded because of consumption of homemade mint tea or of local dishes based on okra and green cole. These higher lead levels are associated more with fugitive emissions from the smelter than chimney emissions or soil lead content.

Lead-free Glazes in Ceramic Production. Mario Lugardo Covarrubias Perez⁽¹⁾. ⁽¹⁾Naucalpan, State of Mexico, Mexico. The use of nonleaded glazes in Santa Maria Canchesda, Municipality of Temascalzingo, Mexico, was implemented. The following are highlights of the program:

• Nonlead enamels, their application, and use in traditional pottery for holding food and beverages were instituted.

• Ceramic colors without lead were applied, controlled, and used in pottery.

• The use of energetic fusings to lower the fusion temperature of the nonlead ceramic glazes was initiated.

• The use of frits—a fused or partially fused material used as a basis for glazes or enamels—began.

• New production methods for raising the pottery production were used.

• Alternative decoration methods in pottery production were tried.

• Government institutions interested in the development of new ways to solve the problem of lead in the pottery were consulted.

• Technical, administrative, and countable training was begun.

National Lead Information Center. Janet Phoenix⁽¹⁾. ⁽¹⁾Washington, D.C., U.S.A. In 1992 the Environmental Health Center of the National Safety Council established the National Lead Information Center under a cooperative agreement with the U.S. Environmental Protection Agency (EPA) and with support from four federal agencies—EPA, Department of Housing and Urban Development, Centers for Disease Control and Prevention, and the Department of Defense. The National Safety Council/National Lead Information Center's lead-related activities include co-sponsorship, with EPA, of a national education campaign intended to raise public awareness about lead poisoning. The National Lead Information Center has three primary activities: a national toll-free hotline (1-800-LEAD-FYI); an information clearinghouse (1-800-424-LEAD); and focused education and outreach activities. The hotline, which opened in November 1992, provides callers with a packet of easy-to-understand materials about lead poisoning prevention. The clearinghouse provides information on how to most effectively manage, avoid, and, if necessary, mitigate potential lead-related health risks.

Occupational Blood Lead Trends in Manitoba, 1979 through 1994: Assessing the Effectiveness of Regulation and Surveillance. Annalee Yassi⁽¹⁾, Ted Redekop⁽²⁾, Norma Alberg⁽²⁾, Mary Cheang^{(1). (1)}University of Manitoba, ⁽²⁾Manitoba Department of Labor, Manitoba, Canada. Between 1979 and 1994, as part of regulated occupational surveillance, an analysis was conducted of 16,199 blood lead samples from employees of 9 high-risk workplaces in Manitoba, Canada. Results from workers in radiator shops were also analyzed beginning in 1986. A significant decrease in blood lead concentrations was observed overall, as well as for each of the high-risk companies. Longitudinal analyses by individual worker suggested that companies were complying through use of administrative controls—that is, removing workers to lower-lead areas until blood lead levels had fallen, then returning them to high-lead areas. In 1987 an order was issued requiring removal of the worker at blood lead levels of 2.42 µmol/L (50 µg/dl) or higher, as well as limiting environmental exposure to 50 µg/m3. This resulted in a significant reduction in the number of workers with blood lead levels exceeding 50 µg/dl. Focusing on blood lead as the sole criterion for compliance proved ineffective. Regulations must specifically require environmental monitoring and controls, with biological surveillance serving as “back-up” to ensure effectiveness of these efforts.

Occupational Exposure to Lead According to Altitude. René Córdova Cardozo⁽¹⁾. ⁽¹⁾National Department of Occupational Medicine, La Paz, Bolivia. A clinical survey was undertaken of 29 workers exposed to lead, of whom 13 were treated with the chelation d-penicillamine, and 16 were not chelated. These workers were employees of a metallurgical factory located between 3,800 and 4,000 meters above sea level. Lead-exposed workers showed the following signs of intoxication: “lead lines” in teeth and gums (n= 23); reduced muscle strength in upper arms and legs (14); intestinal colic (11); dizziness and loss of memory (11); and decreased libido (8). In accordance with industrial exposure classifications, these workers were labeled “dangerously exposed.”

It was observed that in 30 percent of the workers there were signs of anemia, porphyrinurea, and nephrotoxicity, which were correlated with blood and urine lead concentrations. In these workers, it is important to consider the interactions of nutritional status with prolonged lead exposure.

It is possible that lead exposure at high altitudes may have different effects than at sea level because of differences in respiratory parameters. If this is the case, exposure standards may need to be reevaluated.

Protection Against Consumption of Lead During Pregnancy Through the Consumption of Milk and Orange Juice: The Case of Mexico City. L. H. Sanin⁽¹⁾, M. Hernández-Avila⁽¹⁾, I. Romieu⁽³⁾, F. G. Olaíz⁽²⁾, E. Palazuelos-Rendón⁽⁴⁾, R. Tapia⁽¹⁾. ⁽¹⁾Center for Public Health Research, National Institute of Public Health, Mexico, ⁽²⁾Director General of Environmental Health, Mexico, ⁽³⁾Pan American Center for Human Ecology and Health, Mexico, ⁽⁴⁾Federal District Department, Minister of the Environment, Mexico. A total of 1,849 binomials (mother and child) were studied to assess if there is protection offered by the consumption of milk and orange juice on blood lead levels in the mother-child binomial. The maternal mean age was 25 years. Blood samples were taken at the moment of childbirth in nine gynecogenic/obstetrics hospitals of Mexico City between 1992 and 1993. The study included only women with normal pregnancies and childbirths. The lead content in the maternal venous blood and umbilical cord was measured, and questions assessing exposure to the most widely acknowledged sources of lead in Mexico City were asked of the mothers. Maternal blood lead levels (MBL) ranged between 0.5 and 58.3 µg/dl, with a geometric mean of 10.63. No important variation by social class, age group, or marital status was found. The umbilical cord blood lead values varied between 0.40 and 55.2 µg/dl, with a geometric mean of 10.17. Regression analysis of umbilical cord lead

and MBL produced a B value= 0.7363, the correlation between both values was r= 0.743. The main predictor of maternal blood lead was the use of glazed earthenware; MBL was inversely correlated with consumption of milk and orange juice. It is the first time that the protectiveness of foodstuffs rich in calcium and in which calcium has great bioavailability is proved with empirical data from such a population group.

Reducing Sources of Lead Exposure Through Community Education. Joan Cook Luckhardt⁽¹⁾, Stacey Kenyon⁽¹⁾. ⁽¹⁾University of Medicine and Dentistry of New Jersey, Stratford, New Jersey, U.S.A.. In 1991, 1,110,000 tons of the 1,250,000 tons of lead consumed in the United States were used to make rechargeable lead-acid batteries (such as car batteries). Each car battery contains about 18 pounds of lead. Improper disposal of lead-acid batteries can result in incineration or dispersal of lead on the surface of the earth. Local and state government and industry developed a comprehensive recycling program for batteries. To increase consumer recycling of all spent rechargeable batteries, the University of Medicine and Dentistry of New Jersey, in cooperation with the New Jersey Department of Environmental Protection, has designed a battery recycling campaign and a pre- and postcampaign survey of public knowledge and behavior. The public information campaign includes public service announcements, posters, flyers, training videos, mailings to all vehicle owners in the state, training manuals for hazardous waste and recycling coordinators, and community-based educational programs in each county. Each county's hazardous waste coordinators are responsible for separation and proper storage and transport of batteries to approved and monitored secondary smelters. Educational materials were developed with focus groups. The pre- and postcampaign survey tested public knowledge about lead and citizen responsibility for environmental protection. The project is a model of how to link various levels of government and form private-public partnerships to reduce toxins in the environment.

Regulation and the Reduction of Lead in California: Proposition 65. David Roe⁽¹⁾. ⁽¹⁾Environmental Defense Fund, Oakland, California, U.S.A.. Remarkable progress in reducing the amount of exposure to lead from a variety of consumer products has been made in California. Examples include removing leaded glazes and leaded paints from a full range of commercial ceramicware in thousands of patterns manufactured in numerous countries; ceasing the use of leaded brass and leaded bronze in the manufacture of submersible well pumps throughout the United

States; advancing the use of lead-leaching barriers in the manufacture of fine and medium-range crystalware (for example, decanters and wine glasses); and adding warnings and use instructions to the use of home lead casting equipment (such as lead-melting pots and molds for the casting of bullets, lead sinkers) through an innovative law known as Proposition 65.

Regulation and the Reduction of Lead in Gasoline in the United States. Judith MacGregor⁽¹⁾, Howard Mielke⁽²⁾. ⁽¹⁾San Diego State University, California, ⁽²⁾Xavier University, Louisiana, U.S.A.. The addition of leaded additives to gasoline as antiknock agents and octane enhancers grew steadily as the use of automobiles increased in the United States from 1923 to its peak in the late 1960s, when more than 450 million pounds (205 million kilograms) of lead were used in gasoline additives annually. Even though it was estimated that 85 percent of the lead in air in the United States was derived from gasoline combustion, the use of leaded fuels continued. In order to achieve the emission goals for hydrocarbons and carbon monoxide in the Clean Air Act, catalytic converters were required on new automotive exhaust systems in 1973, and unleaded gasoline was essential to avoid fouling the emission equipment. The decline in blood lead levels measured in a national survey of the general population paralleled the decline in the use of leaded fuels. Lead reservoirs still exist from past use. Lead levels in the urban soils parallel the density of automotive use, and contaminated soil persists, continuing as a source of lead exposure. In addition, lead stored in bone deposits will take many years to deplete, with 40–70 percent of current blood lead levels derived from bone stores.

Relationship Between Blood Lead in Children and Lead Mining Activities. Ana Maria Murgueytio⁽¹⁾, R. Gregory Evans⁽¹⁾. ⁽¹⁾St. Louis University School of Public Health, St. Louis, Missouri, U.S.A.. We evaluated blood lead levels in children living in southwestern Missouri, in one of the world's largest lead-zinc mining areas. The 240-square-mile site is on the United States Environmental Protection Agency list of priority hazardous waste sites. Data indicate that 14 percent of 243 children between 6 and 71 months of age living in the area of lead mine exposure had blood lead levels greater than 10 µg/dl. None of the 138 children living in a comparison area had elevated levels. Soil lead levels were six times higher and dust lead levels three times higher in the exposed compared with the comparison area, 599 ppm compared with 91 ppm for soil, and 609 ppm compared with 209 ppm for dust. The study concluded that soil lead levels were primarily responsible

for the difference in blood lead levels between the two groups. A number of behavioral and socioeconomic factors were also associated with elevated blood lead levels.

Risk Factors Associated with High Blood Lead Levels in Mexico City Schoolchildren. F. G. Olaíz⁽¹⁾, M. R. Rojas, T. I. Fortoul⁽²⁾, C. R. Tapia, M. Doyer⁽³⁾, E. Palazuelos-Rendón⁽⁴⁾. ⁽¹⁾Director General of Environmental Health, Mexico City, ⁽²⁾Professor, UNAM, ⁽³⁾Director General of Epidemiology, ⁽⁴⁾Federal District Department, Minister of the Environment, Mexico City, Mexico. Between April 1991 and May 1992, blood lead concentrations were analyzed in 1,583 schoolchildren who resided in five areas: two with historically high blood lead concentrations (Xalostoc and Tialnepantla) and three with historically low concentrations of the metal in the air (Pedregal, Centro, and Iztapalapa). The selected schools were located less than 5 kilometers from the RAMA monitors. A questionnaire including information about lead exposure risk factors was presented to the parents. Bivariate and multilogistic analyses were conducted to evaluate the strength of the association and identify the most accurate model to explain the variability of the blood lead sample concentrations. The highest values were found in children who lived in Xalostoc and Tialnepantla (16.7 and 16.4 µg/dl respectively), and the lowest values were observed in children living in Iztapalapa (9.26 µg/dl). The most significant predictive variables were: place of residence (p = 0.001), the use of glazed pottery for cooking meals (p = 0.003), chewing playdough (p= 0.005), eating paint chips from the walls (p = 0.003), and failing school years since the beginning of the primary school (p = 0.02). There was no correlation of either age or gender with blood lead concentrations.

Substitution of Leadless Ceramic Glazes. Michael McCann⁽¹⁾. ⁽¹⁾Center for Safety in the Arts, New York, New York, U.S.A.. The use of lead-containing ceramic glazes has resulted in lead poisoning of both potters and their families, and of people eating and drinking from ceramicware. In the United States and Canada, substitution of leadless ceramic glazes using boric oxide, alkaline, and alkaline earth fluxes has become common. This trend has been accelerated by strict laws regulating how much lead can leach from ceramicware used for eating and drinking containers.

There are several problems involved in the substitution of leadless glazes. Tradition has to be overcome, because leadless glazes often do not give the effect expected by potters. Lead-free glazes require different and more careful firing conditions. Active communication among potters has

been a major factor. There is also an environmental problem with the potential lead-contamination of kilns and the cost of substitute materials compared with lead batteries and other easily available materials currently in use. Factors that can help overcome these problems will include increased awareness of the lead poisoning issue among potters and their families and the economic incentive of a larger market in the United States and elsewhere for leadless ceramicware.

United Parents Against Lead: Parents United to Educate A Nation United We Can Save A Rainbow of Children. Maurci Jackson⁽¹⁾. ⁽¹⁾Chicago, Illinois, U.S.A.. United Parents Against Lead (UPAL) is a national organization of and for parents of lead-poisoned children. It works to end the continuing threat of lead poisoning through education, advocacy, resource referral, and legislative action. Founded in 1994, UPAL is committed first and foremost to ensuring the basic right of all children to live in a safe and healthy environment.

Our members come from diverse backgrounds, reflective of the broad range of communities affected by lead, but we are united by our unique experience and commitment. We know firsthand the effects of lead poisoning and the irreparable damage and suffering caused by this preventable epidemic. As parents, we have a responsibility to bring our children's voices and experiences to the national dialogue and to remind participants that children's health and safety are fundamentally everyone's responsibility.

UPAL assists parents in organizing chapters in states and local communities and is committed to assisting affected families. Members are kept informed of local, state, and national developments through the publication of our national newsletter. Accurate information is a crucial element in the campaign to eliminate this disease. UPAL promotes proactive steps to prevent children's exposure instead of parents “learning after the fact.” We want to ensure that other families do not needlessly repeat our experiences. Whether a family is African-American, white, Asian, or Hispanic, whether they live in the suburbs, inner cities, or in rural areas, parents need information that will empower them to make informed decisions. We aim to provide that information.

Using Benefit-Cost Analysis to Build Alliances in Preventing Lead Poisoning: A Canadian Drinking Water Case Study. Jerry Speigel⁽¹⁾. ⁽¹⁾Manitoba Department of Environment, Department of Community Health Sciences, University of Manitoba, Canada. The objective was to determine

how the nonhealth benefits identified in a comprehensive benefit-cost analysis can influence decisionmaking interventions to prevent lead poisoning and to help realize health benefits that may otherwise not be pursued. A case study investigation with different decisionmaking protocols for reducing health risks in drinking water was applied in Winnipeg, Canada. Different decisionmaking protocols were applied to consider risk management options, including the effect of applying a comprehensive benefit-cost analysis considering nonhealth benefits. The benefit-cost ratio identified when nonhealth benefits were considered sufficient to prompt municipal decisionmakers to pursue preventive actions in reducing lead exposure. Without consideration of these nonhealth factors, uncertainties associated with the estimation of health benefits and their valuation had prompted officials to resist intervention. In assessing policy options, it is always critical to apply a comprehensive benefit-cost approach. In this way, decisionmakers can take into account both health and nonhealth benefits. Given the uncertainties associated with the valuation of the health benefits of lead poisoning prevention, consideration of nonhealth benefits can help to overcome resistance to pursuing preventive measures.

Worker Training on Lead: The AFSCME Experience. Carlos Eduardo Siquiera⁽¹⁾. ⁽¹⁾American Federation of State, County and Municipal Employees Washington, D.C., U.S.A. Effective worker training has been shown, and is widely believed, to be an important tool in reducing lead exposures in the workplace. This poster discusses some of the critical issues faced by the American Federation of State, County and Municipal Employees ' Health and Safety Training Program over the last 12 years. We looked at political and financial issues, legislative challenges, and, over the last three years, some highly effective joint labor-management training efforts across the United States, and the applicability of the experience to Latin America.