Blood Lead Concentrations in Children and Method of Water Fluoridation in the United States, 1988–1994

The link between exposure to lead and children’s cognitive problems was implied in the earliest medical reports of frank lead poisoning of young children in Australia in the 1800s (Lin-Fu 1992). Children with acute severe toxicity of lead (Pb) are now rarely seen in the United States. However, millions of children may have subclinical neurobehavioral disorders associated with chronic low-level exposure to lead, representing a major public health concern (Bellinger 2008a). Lead is a nonessential metal that is recognized as a source of toxic exposure, with the developing nervous system particularly vulnerable. Because of this, U.S. regulations limiting the lead content of gasoline and household paint have led to a gradual reduction of the average blood lead concentration of Americans over the last three decades. Average blood lead levels of children in the United States dropped an estimated 78% from 1976 to 1991 (Brody et al. 1994; Caldwell et al. 2009). Despite these reductions in exposure to lead, new advances in research techniques have documented harmful consequences associated with lower blood lead levels. This raises the possibility that there is no threshold for occurrence of lead-induced toxicity. Bellinger (2008a) refers to “the silent pandemic of neurodevelopmental disorders resulting from children’s continuing exposure to low levels of lead.” The developing brain may be more sensitive to exposure to lead than the adult. Since the pioneering work of Needleman and colleagues (1979), a large scientific literature has documented the deleterious effects of pre- and neonatal exposure to lead. Decrements in IQ scores have proven to be among the most sensitive and consistent consequences of a child’s exposure to lead, but other cognitive and behavioral changes have been described as well, including attention-deficit hyperactivity disorder (ADHD). Among the important current sources of children’s exposure to lead is household dust (Dixon et al. 2009) the lead content in old water pipes, batteries, and from contamination by numerous industrial processes. Pre and postnatal exposure to cigarette smoke is a cofactor with lead exposure in children’s conduct disorders (Braun et al. 2008). Diagnosis of lead-induced disorders involves the determination of exposure to lead and the atomic absorption assay of lead in whole blood.

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Demographic and Socioeconomic Factors Associated with Blood Lead Levels among Mexican-American Children and Adolescents in the United States

Public Health Reports ◽

10.1177/003335490512000412 ◽

2005 ◽

Vol 120 (4) ◽

pp. 448-454 ◽

Cited By ~ 28

Author(s):

Leo S. Morales ◽

Peter Gutierrez ◽

Jose J. Escarce

Keyword(s):

United States ◽

Drinking Water ◽

Mexican American ◽

Family Income ◽

Blood Lead ◽

The United States ◽

Blood Lead Levels ◽

Mexican American Youth ◽

Lead Levels ◽

American Children

Objective. This study was designed to assess demographic and socioeconomic differences in blood lead levels (BLLs) among Mexican-American children and adolescents in the United States. Methods. We analyzed data from the Third National Health and Nutrition Examination Survey, 1988–1994, for 3,325 Mexican-American youth aged 1 to 17 years. The main study outcome measures included a continuous measure (μg/dL) of BLL and two dichotomous measures of BLL (⩾5 μg/dL and ⩾10 μg/dL). Results. The mean BLL among Mexican-American children in the United States was 3.45 μg/dL (95% confidence interval [CI] 3.07, 3.87); 20% had BLL ⩾5 μg/dL (95% CI 15%, 24%); and 4% had BLL ⩾10 μg/dL (95% CI 2%, 6%). In multivariate analyses, gender, age, generational status, home language, family income, education of head of household, age of housing, and source of drinking water were statistically significant independent predictors ( p<0.05) of having higher BLLs and of having BLL ⩾5 μg/dL, whereas age, family income, housing age, and source of drinking water were significant predictors ( p<0.05) of having BLL ⩾10 μg/dL. Conclusions. Significant differences in the risk of having elevated BLLs exist among Mexican-American youth. Those at greatest risk should be prioritized for lead screening and lead exposure abatement interventions.

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Declines in adult blood lead levels in New York City compared with the United States, 2004–2014

Environmental Research ◽

10.1016/j.envres.2018.01.049 ◽

2018 ◽

Vol 163 ◽

pp. 194-200 ◽

Cited By ~ 4

Author(s):

Alexis Feinberg ◽

Wendy McKelvey ◽

Paromita Hore ◽

Rania Kanchi ◽

Patrick J. Parsons ◽

...

Keyword(s):

United States ◽

New York ◽

New York City ◽

York City ◽

Blood Lead ◽

The United States ◽

Blood Lead Levels ◽

Lead Levels

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Housing Assistance and Blood Lead Levels: Children in the United States, 2005–2012

American Journal of Public Health ◽

10.2105/ajph.2016.303432 ◽

2016 ◽

Vol 106 (11) ◽

pp. 2049-2056 ◽

Cited By ~ 15

Author(s):

Katherine A. Ahrens ◽

Barbara A. Haley ◽

Lauren M. Rossen ◽

Patricia C. Lloyd ◽

Yutaka Aoki

Keyword(s):

United States ◽

Blood Lead ◽

The United States ◽

Blood Lead Levels ◽

Housing Assistance ◽

Lead Levels

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Emulation of Community Water Fluoridation Coverage Across US Counties

JDR Clinical & Translational Research ◽

10.1177/2380084419887696 ◽

2019 ◽

Vol 5 (4) ◽

pp. 376-384

Author(s):

J.A. Curiel ◽

A.E. Sanders ◽

G.D. Slade

Keyword(s):

United States ◽

Health Literacy ◽

Explanatory Power ◽

The United States ◽

County Level ◽

Water Fluoridation ◽

Community Water ◽

Percentage Points ◽

Us Counties ◽

Community Water Fluoridation

Introduction: Expansion of community water fluoridation has stalled in the United States, leaving 115 million Americans without fluoridated drinking water. Objective: This study used spatial regression methods to assess contributions of supply-side factors (neighboring counties’ fluoridation coverage) and demand-side factors (health literacy, education, and population density of the local county) in predicting the extent of fluoridation in US counties. Methods: For this cross-sectional ecological analysis, data from the 2014 Water Fluoridation Reporting System for all 3,135 US counties were merged with sociodemographic data from the 2014 American Community Survey and county-level estimates of health literacy based on the National Association of Adult Literacy Survey. We employed multilevel geographically weighted autoregressive models to predict fluoridation coverage of each county as a function of fluoridation coverage of neighboring counties and local-county covariates: either health literacy or sociodemographic characteristics. Akaike’s Information Criterion was used to distinguish the better model in terms of explanatory power and parsimony. Results: In the best-fit model, an increase from the first to third quartile of neighboring counties’ fluoridation coverage was associated with an increase of 27.76 percentage points (95% confidence limits [CI] = 27.71, 27.81) in a local county’s fluoridation coverage, while an increase from the first to third quartile of local county’s health literacy was associated with an increase of 2.8 percentage points (95% CL = 2.68, 2.89). The results are consistent with a process of emulation, in which counties implement fluoridation based upon their population’s health literacy and the extent of fluoridation practiced in neighboring counties. Conclusion: These results suggest that demand for community water fluoridation will increase as health literacy increases within a county. Furthermore, when considering expansion of fluoridation, non-fluoridated communities can benefit from precedents from nearby communities that are fluoridated. Knowledge Transfer Statement: Expanded coverage of community water fluoridation has stalled in the United States. The economic theory of diffusion describes how, over time and space, policy enacted in one community can influence public opinion in a neighboring community. This study applies geospatial analysis of county-level data and the theory of policy diffusion to demonstrate that fluoridated counties can promote the implementation of community water fluoridation in their neighboring, non-fluoridated communities.

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