Lead paint abatement programs eliminate lead-based paint and contaminated dust by removing or encapsulating lead paint or removing lead painted fixtures and surfaces1. Approximately 24 million housing units contain serious lead hazards such as peeling lead paint and lead contaminated dust2; lead-based paint is the most widespread source of high-dose lead exposure for young children3. As of 2012, scientists indicate no safe blood lead level (BLL). The Centers for Disease Control and Prevention (CDC) blood lead reference level for initiating public health actions to prevent further exposure and mitigate health effects is 5 micrograms per deciliter (µg/dL); it is estimated that over 500,000 children have BLLs at or above this level4, 5, 6.
Expected Beneficial Outcomes (Rated)
Reduced lead exposure
Other Potential Beneficial Outcomes
Reduced blood lead levels
Improved health outcomes
Improved child behavior
Improved youth behavior
Reduced health care costs
Evidence of Effectiveness
There is strong evidence that lead paint abatement programs reduce lead dust exposure when removal of the lead source is confirmed7, 8, 9, 10, 11, 12, 13, 14. Additional evidence is needed to confirm effects on blood lead levels, especially over the long-term7, 14.
Lead abatement can improve health outcomes for children and adults by reducing developmental disorders, attention deficit hyperactivity disorder-related behaviors (ADHD), anemia, hypertension, and kidney and brain damage7, 14, 15. Newborn infants are especially vulnerable to effects of lead exposure16; a St. Louis-based study suggests prenatal screening and proactive lead hazard remediation can prevent exposure among some newborns15.
Childhood lead exposure is associated with an increased likelihood that children and teenagers engage in adverse behaviors such as aggression, crime17, and risky sexual activity18. Higher prenatal and childhood blood lead levels have been associated with increased adult arrest rates and arrests for violent offenses19. Reduced lead exposure may be linked to reductions in violent crime levels roughly twenty years after exposure would have occurred20, 21.
Local lead laws are associated with reduced lead hazards for children, especially in rental properties22, 23, and local housing laws can support rehabilitation of older homes contaminated with lead24. A Philadelphia court that enforces lead hazard laws appears to increase property remediation rates25. Public-private sector partnerships can increase efficiency in remediation, prevention, and support of early interventions for children exposed to lead5. Abatement and childhood lead screening programs that focus on communities with homes built before 1978, when lead paint was commonly used, may most effectively identify and reduce lead poisoning4.
Childhood lead poisoning occurs at higher rates among families with lower incomes, those living in older homes, and those residing in urban areas than their counterparts4, 24, 26, 5. On average, black children from low income families have higher blood lead levels than white or Hispanic children from low income families4.
Cost benefit analysis finds positive net benefits and a high rate of return for lead abatement programs overall27, 28. Economic modeling suggests that future earnings and decreased medical costs for children who benefit from these programs range from 2-20 times the estimated costs of lead abatement29.
Impact on Disparities
As of 2016, 44 states have adopted laws to address lead hazards, primarily lead paint and lead dust30. In Maryland, Massachusetts, Rhode Island, and Washington DC, laws focus on identifying and fixing lead paint hazards before children are exposed24. Some cities also have lead hazard reduction laws. Rochester, NY, for example, adopted a Lead-Based Paint Poisoning Prevention Ordinance in 2006 that requires lead paint inspections for rental units within the city limits31. Burlington, VT32; New York City33; Philadelphia, PA34; and Washington DC35 are additional examples of cities with ordinances regarding assessment of lead hazards in rental units.
Many states also support lead hazard reduction. The New York State Department of Health, for example, supports regional lead resource centers in New York City, Syracuse, and Buffalo that work to improve lead testing, education, and prevention activities through partnerships with local medical providers and departments of health36.
The Centers for Disease Control and Prevention (CDC) Childhood lead poisoning prevention program provides funding for population-based lead poisoning prevention programs around the country, supporting programs in 29 states, Washington DC and 5 other cities for 3 years as of 201437. The 10 regional offices of the US Environmental Protection Agency (EPA) each have a designated Regional Lead Coordinator who oversees lead-poisoning prevention, training, and enforcement efforts in the region38.
US EPA-Protect your family - US Environmental Protection Agency (US EPA), US Consumer Product Safety Commission, US Department of Housing and Urban Development (US HUD). Protect your family from lead in your home. Washington, DC: US Environmental Protection Agency (EPA); 2012.
US EPA-LAF - US Environmental Protection Agency (US EPA). Locate certified inspection, risk assessment, and lead abatement firms (LAF) for assistance with lead removal.
US EPA-Lead hotline - US Environmental Protection Agency (US EPA). Lead hotline: The national lead information center.
NCHH-Lead 2014 - National Center for Healthy Housing (NCHH). Preventing lead exposure in US children: A blueprint for action. 2014.
CDC-Lead facts - Centers for Disease Control and Prevention (CDC). Lead: Facts, tips, tools, training, and resources for childhood lead poisoning prevention.
US HUD-Lead 2012 - US Department of Housing and Urban Development (US HUD), Office of Healthy Homes and Lead Hazard Control. Guidelines for the evaluation and control of lead based paint. 2012.
NYS DOH-Lead paint 2013 - New York State Department of Health (NYS DOH). What home owners need to know about removing lead-based paint. 2013.
EPHDT-WI Lead - Environmental Public Health Data Tracker (EPHDT): Wisconsin Environmental Public Health Tracking Program. Childhood lead poisoning: filterable map of lead poisoning in Wisconsin.
ME DEH-Lead - Maine Center for Disease Control and Prevention Division of Environmental Health (ME DEH). Childhood lead poisoning: Prevention resources and information.
GREE-Lead exposure - Glennon Real Estate Experts (GREE). Lead in your home: How to safely identify issues and avoid exposure.
LHS-COVID-19 response - Local Housing Solutions (LHS), NYU Furman Center, Abt Associates. COVID-19 Housing response plans.
* Journal subscription may be required for access.
1 US HUD-Lead 2012 - US Department of Housing and Urban Development (US HUD), Office of Healthy Homes and Lead Hazard Control. Guidelines for the evaluation and control of lead based paint. 2012.
2 CDC-Lead prevention - Centers for Disease Control and Prevention (CDC). Lead: Prevention tips.
3 CDC-Lead info for parents - Centers for Disease Control and Prevention (CDC). Lead information for parents: Prevent children’s exposure to lead.
4 White 2015 - White BM, Bonilha HS, Ellis C. Racial/ethnic differences in childhood blood lead levels among children <72 months of age in the United States: A systematic review of the literature. Journal of Racial and Ethnic Health Disparities. 2015:1-9.
5 NCHH-Lead 2014 - National Center for Healthy Housing (NCHH). Preventing lead exposure in US children: A blueprint for action. 2014.
6 CDC-Lead facts - Centers for Disease Control and Prevention (CDC). Lead: Facts, tips, tools, training, and resources for childhood lead poisoning prevention.
7 NCHH-Jacobs 2009 - Jacobs DE, Baeder A. Housing interventions and health: A review of the evidence. Columbia: National Center for Healthy Housing (NCHH); 2009.
8 Levin 2008 - Levin R, Brown MJ, Kashtock ME, et al. Lead exposures in U.S. children, 2008: Implications for prevention. Environmental Health Perspectives. 2008;116(10):1285-93.
9 Breysse 2007* - Breysse J, Anderson J, Dixon S, Galke W, Wilson J. Immediate and one-year post-intervention effectiveness of Maryland's lead law treatments. Environmental Research. 2007;105(2):267-275.
10 Dixon 2005* - Dixon SL, Wilson JW, Clark CS, et al. Effectiveness of lead-hazard control interventions on dust lead loadings: Findings from the evaluation of the HUD Lead-Based Paint Hazard Control Grant Program. Environmental Research. 2005;98(3):303–14.
11 Dixon 2012* - Dixon SL, Jacobs DE, Wilson JW, et al. Window replacement and residential lead paint hazard control 12 years later. Environmental Research. 2012;113:14-20.
12 Wilson 2006* - Wilson J, Pivetz T, Ashley P et al. Evaluation of HUD-funded lead hazard control treatments at 6 years post-intervention. Environmental Research. 2006;102(2):237-48.
13 Wilson 2015* - Wilson J, Dixon SL, Jacobs DE, et al. An investigation into porch dust lead levels. Environmental Research. 2015;137:129-135.
14 Armstrong 2014 - Armstrong R, Anderson L, Synnot A, et al. Evaluation of evidence related to exposure to lead. Canberra: National Health and Medical Research Council; 2014.
15 Berg 2012* - Berg DR, Eckstein ET, Steiner MS, Gavard JA, Gross GA. Childhood lead poisoning prevention through prenatal housing inspection and remediation in St. Louis, MO. American Journal of Obstetrics and Gynecology. 2012;206(3):199.e1-199.e4.
16 Vigeh 2014* - Vigeh M, Yokoyama K, Matsukawa T, Shinohara A, Ohtani K. Low level prenatal blood lead adversely affects early childhood mental development. Journal of Child Neurology. 2014;29(10):1305-1311.
17 Needleman 2002 - Needleman HL, McFarland C, Ness RB, Fienberg SE, Tobin MJ. Bone lead levels in adjudicated delinquents. Neurotoxicology and Teratology. 2002;24(6):711-717.
18 Wolpaw Reyes 2015* - Wolpaw Reyes J. Lead exposure and behavior: Effects on antisocial and risky behavior among children and adolescents. Economic Inquiry. 2015;53(3):1580-1605.
19 Wright 2008 - Wright JP, Dietrich KN, Ris MD, et al. Association of prenatal and childhood blood lead concentrations with criminal arrests in early adulthood. PLoS Medicine. 2008;5(5):e101.
20 NBER-Wolpaw Reyes 2007 - Wolpaw Reyes J. Environmental policy as social policy? The impact of childhood lead exposure on crime. National Bureau of Economic Research (NBER). 2007. Working Paper 13097.
21 Feigenbaum 2015 - Feigenbaum JJ, Muller C. Lead exposure and violent crime in the early twentieth city. Cambridge: Harvard University; 2015.
22 Korfmacher 2013* - Korfmacher KS, Hanley ML. Are local laws the key to ending childhood lead poisoning? Journal of Health Politics, Policy and Law. 2013;38(4):757-813.
23 Korfmacher 2012 - Korfmacher KS, Ayoob M, Morley R. Rochester’s lead law: Evaluation of a local environmental health policy innovation. Environmental Health Perspectives. 2012;120(2):309-315.
24 Korfmacher 2014 - Korfmacher KS, Malone J, Jacobs D. Local housing policy approaches to preventing childhood lead poisoning. Public Health Law Research: Making the Case for Laws that Improve Health. 2014.
25 Campbell 2013a* - Campbell C, Gracely E, Pan S, et al. Public health and law collaboration: The Philadelphia Lead Court study. American Journal of Public Health. 2013;103(7):1271-1277.
26 Reed 2011a* - Reed W. Preventing childhood lead poisoning. In: Lemelle AJ, Reed W, Taylor S, eds. Handbook of African American Health: Social and Behavioral Interventions. New York: Springer; 2011:103-11.
27 Cochrane-Nussbaumer-Streit 2016* - Nussbaumer-Streit B, Yeoh B, Griebler U, et al. Household interventions for preventing domestic lead exposure in children. Cochrane Database of Systematic Reviews. 2016;(12):CD006047.
28 Gould 2009 - Gould E. Childhood lead poisoning: Conservative estimates of the social and economic benefits of lead hazard control. Environmental Health Perspectives. 2009;117(7):1162-7.
29 Jones 2012* - Jones DJ. Primary prevention and health outcomes: Treatment of residential lead-based paint hazards and the prevalence of childhood lead poisoning. Journal of Urban Economics. 2012;71(1):151-164.
30 NCSL-Lead hazards 2016 - National Conference of State Legislatures (NCSL). Lead hazards project: State efforts to address lead in housing. 2016.
31 Rochester-Lead paint - City of Rochester, NY. The Rochester lead law: A lead-based paint poisoning prevention ordinance.
32 Burlington-Lead paint - Burlington, Vermont. Code of Ordinances Chapter 18, Housing Article III, Minimum standards section 18-112: Lead-based paint.
33 NYC-Lead paint - New York City, NYC.gov. Housing preservation & development: Lead-based paint.
34 Philadelphia-Lead paint - City of Philadelphia, Public Health. Lead paint disclosure and certification law.
35 DC-Lead paint - Washington DC, DC.gov, Department of Energy & Environment. All about lead.
36 NYS DOH-RLRCs - New York State Department of Health (NYS DOH). Regional Lead Resource Centers (RLRCs) work to improve lead testing, education, and prevention activities through partnerships with local medical providers and departments of health.
37 CDC-PPHF lead - Centers for Disease Control and Prevention (CDC). Prevention and Public Health Funds (PPHF) 2014: Lead poisoning prevention- Childhood lead poisoning prevention.
38 US EPA-Lead contacts - US Environmental Protection Agency (US EPA). Lead: EPA regional lead contacts.
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