Advancing Knowledge on the Environment and Its Impact on Health, and Meeting the Challenges of Global Environmental Change

ImportanceElevated blood lead levels in children are associated with neurologic effects such as behavioral and learning problems, lower IQ, hyperactivity, hearing problems, and impaired growth. In pregnant women, lead exposure can impair organ systems such as the hematopoietic, hepatic, renal, and nervous systems, and increase the risk of preeclampsia and adverse perinatal outcomes. Many of the adverse health effects of lead exposure are irreversible.ObjectiveTo update the 2006 US Preventive Services Task Force (USPSTF) recommendation on screening for elevated blood lead levels in children and pregnant women.Evidence ReviewThe USPSTF reviewed the evidence on the benefits and harms of screening for and treatment of elevated blood lead levels. In this update, an elevated blood lead level was defined according to the Centers for Disease Control and Prevention reference level of 5 μg/dL.FindingsThe USPSTF found adequate evidence that questionnaires and other clinical prediction tools to identify asymptomatic children with elevated blood lead levels are inaccurate. The USPSTF found adequate evidence that capillary blood testing accurately identifies children with elevated blood lead levels. The USPSTF found inadequate evidence on the effectiveness of treatment of elevated blood lead levels in asymptomatic children 5 years and younger and in pregnant women. The USPSTF found inadequate evidence regarding the accuracy of questionnaires and other clinical prediction tools to identify asymptomatic pregnant women with elevated blood lead levels. The USPSTF found inadequate evidence on the harms of screening for or treatment of elevated blood lead levels in asymptomatic children and pregnant women. The USPSTF concluded that the current evidence is insufficient, and that the balance of benefits and harms of screening for elevated blood lead levels in asymptomatic children 5 years and younger and in pregnant women cannot be determined.Conclusions and RecommendationThe USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for elevated blood lead levels in asymptomatic children. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for elevated blood lead levels in asymptomatic pregnant persons. (I statement)

A workshop titled "Using Sentinel Species Data to Address the Potential Human Health Effects of Chemicals in the Environment," sponsored by the U.S. Army Center for Environmental Health Research, the National Center for Environmental Assessment of the EPA, and the Agency for Toxic Substances and Disease Registry, was held to consider the use of sentinel and surrogate animal species data for evaluating the potential human health effects of chemicals in the environment. The workshop took a broad view of the sentinel species concept, and included mammalian and nonmammalian species, companion animals, food animals, fish, amphibians, and other wildlife. Sentinel species data included observations of wild animals in field situations as well as experimental animal data. Workshop participants identified potential applications for sentinel species data derived from monitoring programs or serendipitous observations and explored the potential use of such information in human health hazard and risk assessments and for evaluating causes or mechanisms of effect. Although it is unlikely that sentinel species data will be used as the sole determinative factor in evaluating human health concerns, such data can be useful as for additional weight of evidence in a risk assessment, for providing early warning of situations requiring further study, or for monitoring the course of remedial activities. Attention was given to the factors impeding the application of sentinel species approaches and their acceptance in the scientific and regulatory communities. Workshop participants identified a number of critical research needs and opportunities for interagency collaboration that could help advance the use of sentinel species approaches.

Blood Lead Levels in Children

Over the years, Environmental Health Perspectives (EHP) has emerged as one of the leading journals in the environmental health sciences. It can be argued that one reason for EHP’s standing in the field of environmental health is its credibility as an unbiased source of news and research. With the National Institute of Environmental Health Sciences (NIEHS)—the journal’s parent agency—under new direction, we felt it was important to assure our readership that we greatly value the journal’s trustworthy reputation and that we are committed to maintaining its credibility as a high-quality, independent, peer-reviewed publication. The mission of EHP is to serve as a forum for the discussion of the interrelationships between the environment and human health by publishing in a balanced and objective manner the best peer-reviewed research and the most current and credible news in the field. EHP does this by maintaining a strict separation from advocacy and nonprofit groups, industry, and government agencies, including the NIEHS. In reference to the ability of the journal to report scientific findings independent of influence from some segments of the industrial sector, U.S. Representative Dennis Kucinich remarked in a congressional hearing (House Oversight and Government Reform Subcommittee on Domestic Policy 2007) that “EHP alone is a pillar of truth.” In June 2007, a roundtable meeting (Listening Session and Roundtable Discussion on Environmental Health Perspectives) was held in Bethesda, Maryland, to consider the future of the journal. Participants included representatives from the environmental health sciences, journal subscribers, academics, and publishers. As part of the discussion, the participants were asked to identify threats that could weaken the journal in the future. One of these threats was the potential for the director of the NIEHS to influence, or be perceived to influence, the journal content. Because EHP receives considerable support for personnel and publication costs from the institute and because the journal and its staff are subject to the same organizational rules and regulations as other federal employees, it is logical to be concerned that the NIEHS director might exercise control over journal operations and publication decisions. The roundtable participants further noted that the potential problem for EHP is not so much that of biased editorializing, but of editorial self-censorship—that is, trying not to offend the powers that be, especially among staff who have been long-term government employees. In the minds of the participants, editors working within a government context may be less likely to act and write provocatively, even though it is the role of editorials, news, and research papers to provoke thought and stimulate discussion. In fact, the NIEHS director makes no attempt to sway editors or writers, or to influence the peer-review process. In our view, editorial independence is an absolute necessity for producing a successful scientific journal. An EHP editorial published in January 2008 noted that the content, scope, and direction of the journal would not be influenced by NIEHS leadership and that the editor-in-chief would be given full responsibility for directing and managing all aspects of the publication process (Tilson 2008). Accordingly, editorial decisions about which papers are accepted or rejected, the layout of the publication, and content of the news and editorials would not be subject to approval by NIEHS management. This policy still stands. We acknowledge and believe it is in the best interest of the NIEHS to support a prominent journal dedicated to stimulating new ideas and publishing research that sustains and develops themes relevant to the mission of the institute but that is not influenced by the institute. It is in the best interest of the institute to ensure that the message of the journal is viewed as fair and balanced to all sides of a question and that the journal is dedicated to publishing the best peer-review work in the discipline of environmental health sciences. At issue are the credibility and scientific integrity of both EHP and the NIEHS. A high degree of credibility and scientific integrity is necessary to maintain the trust of Congress and the public, which are the ultimate consumers and supporters of environmental health science research.

Human Exposure Estimates for Phthalates

St Louis City has been demolishing vacant buildings at an increasing rate. Demolition can cause lead dust spread, and childhood lead exposure can have negative effects on cognition, growth, and development. Previous studies show an association between exposure to multiple demolitions and elevated blood lead levels (EBLLs) in children, but St Louis City does not monitor the effects of demolitions on children's blood lead levels. The purpose of this study was to measure the association between exposure to demolitions and EBLLs in children younger than 6 years in St Louis City from 2017 to 2020. We analyzed blood lead testing data for children 0 to 72 months of age (n = 22 192) and proximity to demolitions. Exposure was the presence of demolitions within 400 ft of a child's address in the 33 days before their first lead test. We used logistic regression to test the association between proximity to demolition and EBLLs (≥5 µg/dL). The percentage of children living in proximity to 1 or more demolitions was slightly higher among those with EBLLs (n = 21; 1.3%) than among those without EBLLs (n = 250; 1.2%). However, after adjusting for age, sex, year home was built, season, neighborhood socioeconomic percentile, and neighborhood racial composition, the odds of EBLLs were not significantly different for children exposed to 1 or more demolitions (OR = 0.82; 95% CI, 0.5-1.25) compared with exposed to zero demolitions. Although this study found no association between exposure to demolitions and EBLLs, results should be interpreted with caution, given numerous limitations. Given the consequences of childhood lead exposure, it is recommended that St Louis City conduct a similar analysis on demolitions conducted after 2020 using systematically collected demolition dates. Targeted testing or soil and air monitoring could also be informative.

To investigate the blood lead levels (BLLs) in children after 10-year use of unleaded gasoline in Guangzhou and evaluate the effect of this measure. Through stratified random sampling method, 4 kindergartens and 4 elementary schools were selected from each of three districts among 12 districts of Guangzhou. Totally 2373 children were recruited into this survey and 1-2 ml blood was sampled from each child through vein. The lead concentration in blood samples was determined with Inductively Coupled Plasma Mass Spectrometry (ICP-MS) after diluted with 0.1% Triton X-100 and 0.1% HNO(3) in the ratio of 1:20. Among 2373 children, the highest BLL was 330 microg/L, while the lowest was 10 microg/L. Geometric mean (GM) of BLL was 58.28 microg/L with 61.11 microg/L of male and 55.37 microg/L of female (t=8.671, P=0.000). Sixty (2.51%) children were identified as elevated BLLs (>or=100 microg/L), including 36 (2.90%) male and 24 (2.09%) female (chi2=1.594, P=0.207). Compared to the surveys conducted in China 10-year ago, the children with elevated BLLs decreased 96.28% and the GM of BLLs reduced 58.37%. BLLs in suburb children (60.33 microg/L) were higher than those in downtown (58.09 microg/L) or in countryside (56.72 microg/L). The BLLs in children and the ratio for children with elevated BLLs, had declined dramatically after 10-year implement of unleaded gasoline in Guangzhou.

Moving from awareness to action on preventing patient exposure to toxic environmental chemicals

After implementing measures to control lead pollution in many countries, blood lead levels (BLLs) in children have been declined. The phase-out of leaded petrol began in Lucknow, the capital of most populated state, Uttar Pradesh in India on April 1, 2000. We evaluated the mean BLL and associated risk factors for lead exposure in Lucknow children (3-12 years) after petrol lead phase-out activity. The mean BLL of the 200 children was 9.3 microg/dL (range: 1.0-27.9 microg/dL). Seventy-four children (37%) had BLL above the Centre for Disease Control and Prevention's (CDC) level of concern (10 microg/dL). When these data were compared with BLLs determined by the George Foundation among the children of Mumbai, Bangalore, Kolkata, Chennai, Hyderabad, and Delhi during the year 1997 when leaded petrol was in use, where 62%, 62%, 87%, 96%, 43%, and 95%, respectively, then exceeded the CDC intervention level. Further, BLL of present study was very close to Mumbai children (age < or =12 years) estimated following the introduction of unleaded petrol, and 33% children had BLL above the CDC concern level with an average 8.4 microg/dL. Low socioeconomic status, proximity of home to traffic density, and mother's illiteracy were the factors associated with elevated BLLs in Lucknow children (P < 0.05). Overall, results indicate a declining trend of BLL in Lucknow children when compared with those reported from other cities of India when leaded petrol was in practice. A national population-based study is recommended to determine the prevalence of elevated BLLs after the phase-out of leaded-petrol. In addition, future studies on other sources of lead exposure in Lucknow are warranted for public health purposes.

e-Junk explosion.

DESPITE DRAMATIC REDUCTIONS IN POPULATION LEAD exposure over the past 2 decades, nearly 900 000 US children younger than 6 years still have elevated blood lead levels ($0.483 μmol/L [$10 μg/dL]). The problem disproportionately affects lowincome children living in older dwellings. Available data suggest that subtle health effects, such as lower IQ scores in children, may extend to blood lead levels well below the 0.483-μmol/L (10-μg/dL) threshold. While not as well studied, an association between blood lead levels in this range and cognitive function of middle-aged and elderly men has also been reported. Further research may continue to redefine what constitutes an entirely “safe” level. Much of the reduction in lead exposure to date has come from eliminating uses of lead, such as in gasoline, soldered cans, and housepaint, that were causing widespread, ongoing exposures. The opportunity for such relatively simple but powerful interventions has waned as the most hazardous uses of lead have been largely phased out in the United States (although not, unfortunately, in many developing nations). The remaining challenge is far more complex: to address the large reservoirs of lead in paint and exterior soil and dust contaminated from past uses. Some further declines in exposure may occur with turnover in the housing stock and dilution of existing soil and dust contamination. However, without additional efforts to reduce lead hazards at the level of individual homes and neighborhoods, such changes will come too slowly to avoid harm to many cohorts of children. Consequently, as the distribution of blood lead levels has shifted downward, policy makers and researchers continue to address 2 questions: (1) what impact do blood lead levels prevailing in the population today have on human health; and (2) what interventions can further reduce the risk of lead toxicity, especially among those at highest risk? Two reports in this issue of THE JOURNAL address aspects of these questions. Moss and colleagues add data on dental caries to other findings supporting health effects of lead at levels common in the general population, including lower IQ scores and reductions in stature. Based on data from the Third National Health and Nutrition Examination Survey (NHANES III), the authors report a direct relation of blood lead levels in children to the prevalence and extent of dental caries, even for levels well below 0.24 μmol/L (5 μg/dL). The authors estimate that variation in lead exposure could account for perhaps 20% or more of the prevalence of dental caries among older children. In addition to the usual limitations of cross-sectional data, at least 2 caveats should be kept in mind when interpreting these findings. First, it is not clear whether other nutritional or behavioral factors might confound the observed association between lead and caries. The roles of iron and ascorbic acid, for example, can and should be assessed with data available in NHANES III. In addition, the authors are perhaps too quick to minimize the possibility of potential confounding of their findings by exposure to fluoridated drinking water. Lead exposure is influenced by both individual-level factors and community characteristics (such as urbanization). If lead exposure and lack of fluoridation are correlated at the community level, this could explain some of the dental caries risk gradient reported by Moss et al. Despite these limitations, the strength of the relationship reported by Moss et al, its consistency across age groups, and supporting animal data bolster a causal explanation. The study by Simon and Hudes concerns the second question of potential interventions to reduce the risk of lead toxic effects. The authors report an inverse relationship of serum ascorbic acid levels to blood lead levels in both children and adults. As in the study by Moss et al, Simon and Hudes used NHANES III data to examine in the general population an association suggested by animal and limited human data. The association of both high blood lead levels and low dietary ascorbic acid intake (in adults) with poverty raises the possibility of confounding by socioeconomic status. Since the authors largely addressed this possibility, their results imply that the impact of increasing ascorbic acid intake on blood lead levels could be greatest in the highestrisk populations. Ascorbic acid intake is but 1 of several nutritional factors that may influence lead toxicity through an influence

<i>EHP</i> Update

Vol. 115, No. 1 PerspectivesOpen AccessFarewell and Best Wishes James G. Burkhart James G. Burkhart Search for more papers by this author Published:1 January 2007https://doi.org/10.1289/ehp.115-a12aAboutSectionsPDF ToolsDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InReddit With publication of this issue, I have reached a long-planned retirement from the NIEHS and Environmental Health Perspectives (EHP). The mission of EHP is to serve as a forum for the discussion of the interrelationships between the environment and human health by publishing in a balanced and objective manner the best peer-reviewed research and most current and credible news of the field. I feel privileged to have been a part of this effort. From the time I began as science editor of EHP in March 2002, my goal was to engage as directly as possible with the environmental science community so that EHP could best serve as a focal point for the dissemination of relevant research. Through the combined dedication and efforts of the EHP staff and editorial boards, the journal has progressed in both science and outreach. Our impact factor now places EHP at the top of two categories of science journals: environmental science and environmental, occupational, and public health. We are privileged to be part of a changing view of environmental health science, one that recognizes that improved environmental health requires creative integration across previously classically defined disciplines: environment, exposures, and individual/population health cannot be separated from genetic and societal contexts. The articles published in EHP over the last few years provide many examples of this understanding, and I hope that your future contributions to the journal will continue to reflect these ideas.Believing that credible science information is a powerful means to improved health, I have been particularly proud to be a part of efforts to facilitate communication of environmental health sciences in two areas: to and within developing countries and to high school students. EHP ’s programs to disseminate environmental science worldwide, including our policy of open access, have provided much-needed access to vital information at a time of critical global development. Similarly, our student edition program engages the next generation of scientists in the compelling world of environmental health at a critical time in their academic development. The response by the worldwide science and education communities to these programs has been terrific. I hope that these unique efforts continue to provide a successful model for how research journals can serve to inform, educate, and improve the lives of people around the world.Concurrent with my retirement, a search for a new editor-in-chief is being conducted. I invite you to become involved by bringing forth highly qualified candidates dedicated to environmental health and the future of EHP. In the meantime, Kenneth Korach, director of the Environmental Diseases and Medicine Program of the NIEHS, will serve as interim editor-in-chief. I will assist with various aspects of transition before beginning an eagerly anticipated extended road adventure, after which I will explore new avenues for involvement in global environmental health issues.The passion and engagement of EHP ’s readers, combined with the excitement and dedication of our staff, have made the years of my tenure here the best for me to remember. On behalf of all the staff of EHP, I thank you for your tenacious support. Its impact on our morale and feelings about what we have tried to accomplish cannot be overstated. I leave with the deep conviction that the environmental health community is making a real difference in global health and that EHP will continue to be at the vanguard of these efforts. My best wishes for the coming year and all the ones to follow.FiguresReferencesRelatedDetails Vol. 115, No. 1 January 2007Metrics About Article Metrics Publication History Originally published1 January 2007Published in print1 January 2007 Financial disclosuresPDF download License information EHP is an open-access journal published with support from the National Institute of Environmental Health Sciences, National Institutes of Health. All content is public domain unless otherwise noted. Note to readers with disabilities EHP strives to ensure that all journal content is accessible to all readers. However, some figures and Supplemental Material published in EHP articles may not conform to 508 standards due to the complexity of the information being presented. If you need assistance accessing journal content, please contact [email protected]. Our staff will work with you to assess and meet your accessibility needs within 3 working days.

Blood lead levels in young children: US, 2009-2015

The Conquest of Lead Poisoning: A Pyrrhic Victory