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childhood lead poisoning prevention branch
ā€‹Sources of Lead Exposure for Full Cases Fiscal Year (FY) 2018 to 2019

Extracted from the 2022 Biennial Report (PDF). Please refer to References section of the 2022 Biennial Report for in-text citations made on this page.

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7. Sources of Lead Exposure

CLPPB analyzed sources of lead exposure for children who were newly identified as full cases in FY 2018-19 and consented to full case management, including environmental services. Every child meeting the full case definition is eligible to receive both public health nurse (PHN) case management services and an environmental investigation (EI) by an environmental professional (EP). During an EI, the EP assesses the child's environment for lead exposure sources in paint, dust, soil, and water, and documents the results. The PHN performs a home visit often at the same time as the EI, which includes collecting information to evaluate and coordinate the necessary services. The EP, with assistance from the PHN, identifies suspect non-housing items and may submit these items for laboratory analysis. "Non-housing sources" are sources of lead exposure other than housing-related paint, dust, soil, and water.

When housing-related lead sources are identified, EPs work with property owners to remediate them expediently. Properties remain open to follow up until the property passes a clearance inspection. A successful clearance inspection includes, at a minimum, a visual inspection to verify all required work was completed properly, as well as collection and analysis of dust wipe samples. For full cases where paint, dust, soil, and/or water were identified as a source, CLPPB reviewed whether the sources of lead exposure were removed, remediated, or abated.

Methods

In this analysis, only children with BLLs meeting the full case criteria who received full case management, including environmental services, were included during FY 2018-2019. As of July 1, 2016, children meet full case criteria with either a single venous BLL at or above 14.5 micrograms/deciliter (Āµg/dL) or persistent levels at or above 9.5 Āµg/dL. Data on blood lead test results were gathered from the Response and Surveillance System for Childhood Lead Exposures database. 

Exposure assessment data came from two sources:

  1. EPs collected samples and information about housing-related sources of lead exposure, such as paint, dust, soil, and water, as well as non-housing items. X-Ray Fluorescence (XRF) screening by EPs, and environmental health laboratories provided quantitative results.
  2. PHNs collected information about non-housing sources of lead exposure, such as the child's behavior, food, products used for cooking, and alternative medicines, using a structured questionnaire during the home visit. 

Race/ethnicity data were also collected by the PHN during the home visit. CLPPB collects race/ethnicity data in a two-question format similar to the Federal Office of Management and Budget (OMB) race and Hispanic ethnicity categorization. Race/ethnicity data collection was based on a parent's report of the child's identity with the ability to select all applicable races and one applicable ethnicity. Race category choices were:

  • Native American/Alaskan
  • Black/African American
  • White
  • Asian
  • Pacific Islander
  • Other
  • Decline to state

If a parent identified the child as Asian or Pacific Islander, they were asked to further select from more detailed categories of Asian and Pacific Islander races. If the parent identified the child as "Other" race, they were asked to specify. Ethnic background categories were:

  • Not Hispanic/Spanish/Latino
  • Yes, North American (Mexican, Mexican American)
  • Yes, Central American
  • Yes, South American
  • Yes, other Spanish/Hispanic/Latino

Answers to 'Country of birth' question were also used to help race/ethnicity categorization for data analysis when needed. CLPPB followed the CDPH vital statistics reporting categories for race/ethnicity for the data analysis: Mutually exclusive race/ethnicity categories were:

  • Non-Hispanic White 
  • Non-Hispanic Black
  • Non-Hispanic Asian
  • Non-Hispanic Hawaiian/Pacific islander
  • Non-Hispanic Native American/Alaskan
  • Multi-race (any ethnicity)
  • Hispanic (single race)
  • Declined or Unknow

If a parent identified the child's race only as 'Other' and chose any of the 'Yes' Hispanic ethnicity options, then the child was categorized as Hispanic (single race). If multiple race categories were checked, then regardless of Hispanic ethnicity status, the child was categorized as Multiā€‘race (any ethnicity). For simplicity, Hispanic (single race) children will be described hereafter as Hispanic children, and non-Hispanic children will be described by their race category alone (e.g., non-Hispanic Asian children will be referred to as Asian children). In FY 2018-19, there were 40 children with Afghan origin. They mostly identified themselves as 'White' or 'Other' and specified as Afghan. In this analysis, Afghan and all other Middle Eastern/North African children were categorized as 'White' as OMB recommends. Of the 84 White children, 40 (47.6 percent) were Afghan, and the sources of lead exposure differed by Afghan origin. For this reason, the White race category was stratified as Afghan and nonā€‘Afghan. Similarly, the Asian race category was stratified as Asian Indian and other Asian.

CLPPB reviewed EI documentation to identify housing-related sources associated with full cases. For each investigation, CLPPB measured lead in deteriorated paint, dust, and bare soil. Results of first- and second-draw water samples from kitchen sinks were also recorded, as well as water draws from other frequent drinking water locations. Paint, dust, and soil were categorized as lead exposure sources based on regulatory levels found in Title 17, California Code of Regulations (CCR), beginning with Section 35001. The Los Angeles County local health jurisdiction also categorized housing-related sources with their own regulatory statutes (Los Angeles County Code Section 11.28.010). Water results were categorized as exposure sources based on the United States Environmental Protection Agency (US EPA) action level (40 Code of Federal Regulations [CFR] Section 141.80) (Table 9). EPs identified lead housing-related sources based on direct known exposure to lead-poisoned children, including media below current regulatory standards but found to be significant based on a child's specific behavior and activity (Table 10). 

Table 9. Definitions of Housing-Related Sources of Lead Exposure 

Type of housing-related source Current Regulatory LevelLower "Actionable" Level
  
Paint  Deteriorated lead-based paint tested at the state regulatory level of greater than or equal to 1.0 milligram of lead per square centimeter of surface area (ā‰„ 1.0 mg/cm2). In addition, full cases were attributed to paint at local regulatory level in Los Angeles at ā‰„ 0.7 mg/cm2. (17 CCR Sections 35022, 35033, 35037; Los Angeles County Code Section 11.28.010)
Paint was considered a source in situations where paint was below the regulatory level but found to be nuisance that may result in persistent and quantifiable lead exposure (17 CCR Section 35037). 		Paint with lead ā‰„ 600 parts per million (ppm) was used. In 1978, the federal Consumer Product Safety Commission (CPSC) restricted lead in newly manufactured paint to 600 ppm. Additionally, 600 ppm is the level petitioners to the US EPA have been seeking to lower the federal definition of lead-based paint. Since there is incongruence of unit equivalency between ppm and mg/cm2, the level chosen for XRF instruments was 0.1 mg/cm2, which is the lowest level detectable to the tenths place to be most health protective. 
Dust Lead-contaminated at greater than or equal to 40 micrograms of lead per square foot of surface area (ā‰„ 40 Āµg/ft2) for interior floor surfaces, ā‰„ 250 Āµg/ft2 for interior horizontal surfaces, and ā‰„ 400 Āµg/ft2 for exterior floor and exterior horizontal surfaces. (17 CCR Sections 35035, 35037) Lead levels ā‰„ 10 Āµg/ft2 for interior floor surfaces, and ā‰„ 100 Āµg/ft2 for interior horizontal surfaces were selected to match changes in federal dust standards that took effect January 6, 2020 but were not in effect at the time of when the cases received services.
Soil Lead-contaminated at greater than or equal to 400 parts per million (ā‰„ 400 ppm) in children's play areas.
Soil was considered a source in situations where soil was below the regulatory level but found to be a nuisance that may result in persistent and quantifiable lead exposure (17 CCR Section 35037). 		Bare soil with ā‰„ 80 ppm was used to match California Human Health Screening Levels (CHHSLs) proposed by the California Office of Environmental Health Hazard Assessment. The current CHHSL for lead in soil for residential property is 80 ppm.
Water According to the US EPA Federal Lead and Copper Rule, greater than or equal to 0.015 milligrams of lead per liter of water (ā‰„ 0.015 mg/L) is above the action level. (40 CFR Section 141.80) Drinking water ā‰„ 0.005 mg/L was selected in light of the goal for water to show non-detect levels of lead. Since this level was the laboratory reporting limit, results below this level would not be available from laboratory reports used in the sample of cases selected.

Table 10. Categories and Examples of Non-housing Sources of Lead Exposure 

Category Examples  
Cosmetics/ Spiritual Religious Products Black powder (e.g., kohl, surma, tiro), ceremonial powder, sindoor
Food/Spices/Drink Dried grasshoppers (chapulines), turmeric, khmeli suneli, lozenna, imported candy
Take-home or Occupational Exposed through either personal or parental work or hobby
Pottery & Utensils  Vintage/hand-made/imported pottery, leaded glassware, water dispenser/urn/samovar, food grinder
Other  Fishing weight, jewelry/charm/amulet, painted object, metal object, lead ammunition, deteriorated vinyl/plastic, game meat/fish (from leaded bullets/sinkers), lead batteries, lead solder
Traditional Medicine/ Remedies  Azarcon, greta, ayurvedic remedy (e.g., Ghutti, Keasari Balguti), paylooah, traditional Chinese remedies
Retained bullet  No data
Perinatal exposuresMother ate food high in lead content during pregnancy, mother took remedy high in lead during pregnancy

Any EI property found to have a lead housing-related source exceeding current regulatory levels must have it removed, remediated, or abated. Those properties remain open to EP follow-up until the completion of a clearance inspection. Passing a clearance inspection requires visual confirmation that lead housing-related sources have been corrected and quantifiable evidence through dust wipes that no lead-contaminated dust remains. CLPPB reviewed documentation from the corresponding EI properties to assess how many had passed clearance inspection. Acknowledging that children may still be exposed to lead below the current regulatory levels, CLPPB also analyzed housing-related lead exposure sources using lower "actionable" levels (Table 8). These lower levels reflect recommendations and proposals under consideration by regulatory agencies based on more stringent understanding of lead hazards and safety standards. Lead exposure source categories were then compared by current regulatory levels versus lower "actionable" levels.

Information reported to CLPPB about non-housing sources (Table 9) was reviewed by a CLPPB physician to determine whether each potential source was a probable source of lead exposure for the child. Determination was based on quantitative XRF and/or laboratory results; results of testing the item with a qualitative method (chemical test kit lead swab); amount, timing, and length of the child's access to the item; and whether there is a significant history of demonstrated high lead content for a given potential source. In addition, the physician considered information about whether removal of the item from the child's environment was associated with a decline in BLL.

There may be several lead exposure sources identified for a child meeting full case criteria. When multiple exposure sources are identified, the exact contribution of each source to the child's initial BLL cannot be verified. CLPPB counted each possible exposure source separately for the child; for example, if both dust and paint levels are found above the regulatory levels, then both dust and paint were counted as possible lead exposure sources.

CLPPB performed descriptive analyses of demographic characteristics, BLLs, and exposure sources. In addition to identifying the sources of lead exposure, CLPPB analyzed how sources of lead exposure differed by race and ethnicity of the child. To compare the groups, CLPPB used a chi-square test. Statistical significance was defined as p ā‰¤ 0.05. Analyses were done using SAS software, version 9.4 (Copyright Ā© 2017, SAS Institute Inc., Cary, NC, USA).

Results

In FY 2018-2019, there were 406 new children meeting full case criteria. Of those 406 new childhood lead cases, 364 received full case management services and 382 unique properties went through an EI. In some cases, there were multiple children with case-making BLLs living in the same property. In some cases, an EI was done on multiple properties because the case(s) spent considerable time in another property (e.g., grandparents, or daycare) or family moved to another property. There were several reasons for incomplete home visits and/or EIs: persistent refusal (n=27), unable to locate family (n= 3), moved out of state (n= 2), late BLL reporting (n= 1) or missing information (n= 8); these children are excluded from results. 

The characteristics of children who received full case management services are described in Table 11. Most of the full cases were less than 6 years old (86 percent), male (52.8 percent), and Hispanic (50.8 percent) or Afghan (9.9 percent). Of the 364 children who received full services, 7 (1.9 percent) had a BLL higher than 44.4 Āµg/dL, 246 (67.6 percent) had a BLL between 14.5 and 44.4 Āµg/dL, and 111 (30.5 percent) had a BLL between 9.5 and 14.4 Āµg/dL. 

Table 11. Demographic Characteristics of Full Cases[1], Fiscal Year 2018-19 (n=364) 

Characteristic: Age N=364 Percent (%)
Less than 6 years 313 86.0
Between 6 and 21 years 51 14.0
Characteristic: Sex N=364 Percent (%)
Female 172 47.2
Male 192 52.8
Characteristic: Race/Ethnicity N=364Percent (%)
Non-Hispanic White (n=75) No dataNo data
Afghan 36 9.9
Non-Afghan 39 10.7
Non-Hispanic Black 12 3.3
Non-Hispanic Native American/Alaskan 1 0.3
Non-Hispanic Asian (n=76)2 No dataNo data
Asian Indian 58 15.9
Cambodian 2 0.5
Chinese 1 0.3
Hmong 2 0.5
Laotian 1 0.3
Malaysian 1 0.3
Nepalese 1 0.3
Pakistani 5 1.4
Vietnamese 1 0.3
Unspecified/Other Asian 4 1.1
Non-Hispanic Hawaiian/ Pacific Islander (n=1)3 No dataNo data
Marshallese 1 0.3
Multi race (any Hispanic status) 7 1.9
Hispanic (Single race) 185 50.8
Declined, Unknown, or Non-Hispanic other 7 1.9

1 As of July 1, 2016, the definition of a case eligible for full case management services is either a single venous BLL at or above 14.5 micrograms (Āµg)/deciliter (dL) or persistent 9.5 Āµg/dL.

2 No full case was identified, specifically, as Bangladeshi, Filipino, Indonesian, Japanese, Korean, Sri Lankan, or Thai as an Asian sub-group within the Non-Hispanic Asian category.

3 No full case was identified, specifically, as Hawaiian, Guamanian, Samoan, or Tongan as a Pacific Islander subā€‘group within the Non-Hispanic Hawaiian/Pacific Islander category.

Based on current regulatory levels, 87 children (23.9 percent) had an unknown exposure. Nonā€‘housing sources were identified in 135 children (37.1 percent) as the only source of lead exposure. Housing-related sources were identified in 103 children (28.3 percent) as the only source of lead exposure. Both housing-related and non-housing sources of lead exposure were identified in 39 children (10.7 percent) (Table 12). Therefore, a total of 142 children (39 percent) had a housing-related source identified as a source of lead exposure. When lower "actionable" levels were used, housing-related sources were identified in 143 children (39.3 percent) as the only source and both housing-related and non-housing sources of lead exposure were identified in 81 children (22.3 percent). Hence, a total of 224 children (61.6 percent) had a housing-related source identified as a source of lead exposure when the lower "actionable" levels were applied. The difference in identifying sources of lead exposure by current regulatory levels versus lower "actionable" levels was statistically significant (p <0.001, Table 12). 

Table 12. Sources of Lead Exposure Among Full Cases, Fiscal Year 2018-19 (n=364)

Exposure source Current Regulatory Level1
n (%) 		Lower "Actionable" Level2
n (%)
Only Housing source 103 (28.3%) 143 (39.3%)
Both Housing and Non-Housing 39 (10.7%) 81 (22.2%)
Only Non-Housing source 135 (37.1%) 93 (25.6%)
Unknown 87 (23.9%) 47 (12.9%)

1Current regulatory level for housing-related sources of lead exposure:

  • Paint is considered a source when the presence of deteriorated lead-based paint tested at the state regulatory level of ā‰„ 1.0 mg/cm2. In addition, full cases were attributed to paint at local regulatory levels in Los Angeles at ā‰„ 0.7 mg/cm2. (17 CCR Sections 35022, 35033, 35037; Los Angeles County Code Section 11.28.010)
  • Dust is considered a source when it is lead contaminated at ā‰„ 40 Āµg/ft2 for interior floor surfaces, ā‰„ 250 Āµg/ft2 for interior horizontal surfaces, and ā‰„ 400 Āµg/ft2 for exterior floor and exterior horizontal surfaces. (17 CCR Sections 35035, 35037)
  • Soil is considered a source when it is lead contaminated at ā‰„ 400 ppm in children's play areas.
  • Water levels are categorized by an action level; according to the US EPA Federal Lead and Copper Rule, ā‰„ 0.015 mg/L is above the action level (40 CFR Section141.80). Four water samples above the action level were found to be potential exposure sources to lead. One exterior faucet water sample was found above the action level; however, it was not found to be a potential exposure source to lead as it was not a primary drinking source. Follow-up steps were taken to prevent all possible exposure by removing the faucet and capping the pipe. Drinking water sources at this residence measured non-detect lead levels.

2 Lower "actionable" level for housing-related sources of lead exposure:

  • Paint with lead ā‰„ 600 ppm was used. In 1978 the federal Consumer Product Safety Commission restricted lead in newly manufactured paint to 600 ppm. Additionally, 600 ppm is the level petitioners to the US EPA have been seeking to lower the federal definition of lead-based paint. Since there is incongruence of unit equivalency between ppm and mg/cm2, the level used for XRF instruments was 0.1 mg/cm2, which is the lowest level detectable to the tenths place in order to be most health protective.
  • Dust lead levels ā‰„ 10 Āµg/ft2 for interior floor surfaces, and ā‰„ 100 Āµg/ft2 for interior horizontal surfaces were used in order to match changes in federal dust standards effective in 2020.
  • Bare soil with ā‰„ 80 ppm was used in order to match California Human Health Screening Levels (CHHSL) proposed by the California Office of Environmental Health Hazard Assessment. The current CHHSL for lead in soil for residential property is 80 ppm.
  • Drinking water ā‰„ 0.005 mg/L was selected considering the goal for water to show non-detect levels of lead. Since this level was the laboratory reporting limit, results below this level would not be available from laboratory reports used in the sample of cases selected.

The exposure source of lead differed by race/ethnicity (p <0.001, Table 13). Housing-related sources of lead were identified as the most common source of lead exposure among multi-race children (85.7 percent), race/ethnicity unknown children (57.1 percent) and Hispanic children (36.8 percent) and while non-housing sources of lead exposure were identified as the most common source among Asian children (64.5 percent), and Afghan children (69.4 percent). Similarly, the exposure source of lead differed by age group with housing-related exposure more common among children less than six years compared to children ages between 6 to 21 years (p = 0.0001, Table 13).

Table 13. Source of Lead Exposure at Current Regulatory Levels[1] by Demographic Characteristics Among Full Cases, Fiscal Year 2018-19 (n=364) 

Characteristic: Age            P-value: <0.001 

Only Housing (n=104)Both Housing and Non-Housing (n=39)Only Non-Housing (n=135)Unknown (n=86)
Less than 6 years (n=74) 102 (32.6%) 30 (9.6%) 107 (34.2%) 74 (23.6%)
Between 6 and 21 years (n=12) 2 (3.9%) 9 (17.7%) 28 (54.9%) 12 (23.5%)
Characteristic: Sex
P-value: 0.2		Only Housing (n=104)Both Housing and Non-Housing (n=39)Only Non-Housing (n=135)Unknown (n=86)
Female (n=172) 42 (24.4%) 17 (9.9%) 72 (41.9%) 41 (23.8%)
Male (n=192) 62 (32.3%) 22 (11.5%) 63 (32.8%) 45 (23.4%)
Characteristic: Race/Ethnicity
P-value: <0.001		Only Housing (n=104)Both Housing and Non-Housing (n=39)Only Non-Housing (n=135)Unknown (n=86)
Non-Hispanic White (n=75)No DataNo DataNo DataNo Data
Afghan (n=36)2 (5.6%) 0 (0.0%) 25 (69.4%) 9 (25.0%)
Non-Afghan (n=39)13 (33.3%) 4 (10.3%) 12 (30.8%) 10 (25.6%)
Non-Hispanic Black (n=12)4 (33.3%) 0 (0.0%) 3 (25.0%) 5 (41.7%)
Non-Hispanic Native American/Alaskan (n=1)1 (100%) 0 (0.0%) 0 (0.0%) 0 (0.0%)
Non-Hispanic Asian (n=76)No DataNo DataNo DataNo Data
Asian Indian (n=58) 2 (3.5%) 6 (10.3%) 39 (67.2%) 11 (19.0%)
All Other Asian (n=18) 3 (16.6%) 0 (0.0%) 10 (55.6%) 5 (27.8%)
Non-Hispanic Hawaiian/ Pacific Islander (n=1)0 (0.0%) 0 (0.0%) 0 (0.0%) 1 (100%)
Multi race (any Hispanic status, n=7)6 (85.7%)  0 (0.0%) 1 (14.3%) 0 (0.0%)
Hispanic (Single race, n=185)68 (36.8%) 28 (15.1%) 45 (24.3%) 44 (23.8%)
Declined or Unknown (n=7) 4 (57.1%) 1 (14.3%) 0 (0.0%) 2 (28.6%)

1 Housing-related sources of lead exposure include:

  • Paint is considered a source when the presence of deteriorated lead-based paint tested at the state regulatory level of ā‰„ 1.0 mg/cm2. In addition, full cases were attributed to paint at local regulatory levels in Los Angeles at ā‰„ 0.7 mg/cm2. (17 CCR Sections 35022, 35033, 35037; Los Angeles County Code Section 11.28.010)
  • Dust is considered a source when it is lead contaminated at ā‰„ 40 Āµg/ft2 for interior floor surfaces, ā‰„ 250 Āµg/ft2 for interior horizontal surfaces, and ā‰„ 400 Āµg/ft2 for exterior floor and exterior horizontal surfaces. (17 CCR Sections 35035, 35037)
  • Soil is considered a source when it is lead contaminated at ā‰„ 400 ppm in children's play areas.
  • Water was not identified as source of lead exposure in any case. Water levels are categorized by an action level; according to the US EPA Federal Lead and Copper Rule, ā‰„ 0.015 mg/L is above the action level (40 CFR Section141.80). One exterior faucet water sample was found above the action level; however, it was not found to be a potential exposure source to lead as it was not a primary drinking source. Follow-up steps were taken to prevent all possible exposure by removing the faucet and capping the pipe. Drinking water sources at this residence measured non-detect lead levels.

Distribution of Housing-Related Sources of Lead Exposure

Figure 3 shows the distribution of housing-related sources of lead exposure at current regulatory levels during FY 2018-19. Paint was the most common housing-related source of lead exposure, followed by soil, dust, and water. Table 14 depicts the distribution of housing-related lead exposure sources by race/ethnicity and the pattern of paint being the most common housing-related source of lead exposure persisted. The main source of lead exposure was housing-related among Hispanic, Black, and multi-race children.

Figure 3. Total Occurrences[1] of Housing-Related Sources of Lead Exposure[2] Among Full Cases, Fiscal Year 2018-19 (n=142)

Paint=119; Soil==58; Dust=39; Water=5








1A child may have more than one type of housing-related source of lead exposure and therefore, the total occurrences of housing-related sources will be greater than the number of children (n=142) identified with a housing-related source of lead exposure.
2Housing-related sources of lead exposure include:

  • Paint is considered a source when the presence of deteriorated lead-based paint tested at the state regulatory level of ā‰„ 1.0 mg/cm2. In addition, full cases were attributed to paint at local regulatory levels in Los Angeles at ā‰„ 0.7 mg/cm2. (17 CCR Sections 35022, 35033, 35037; Los Angeles County Code Section 11.28.010)
  • Dust is considered a source when it is lead contaminated at ā‰„ 40 Āµg/ft2 for interior floor surfaces, ā‰„ 250 Āµg/ft2 for interior horizontal surfaces, and ā‰„ 400 Āµg/ft2 for exterior floor and exterior horizontal surfaces. (17 CCR Sections 35035, 35037)
  • Soil is considered a source when it is lead contaminated at ā‰„ 400 ppm in children's play areas.
  • Water was not identified as source of lead exposure in any case. Water levels are categorized by an action level; according to the US EPA Federal Lead and Copper Rule, ā‰„ 0.015 mg/L is above the action level (40 CFR Section141.80). One exterior faucet water sample was found above the action level; however, it was not found to be a potential exposure source to lead as it was not a primary drinking source. Follow-up steps were taken to prevent all possible exposure by removing the faucet and capping the pipe. Drinking water sources at this residence measured non-detectable lead levels.

Table 14. Total Occurrences[1] of Housing-Related Sources of Lead Exposure[2] by Race/Ethnicity Among Full Cases, Fiscal Year 2018-19 (n=142) 

Housing-related Lead SourcesNon-Hispanic White  AfghanNon-Hispanic White  Non-AfghanNon-Hispanic  BlackNon-Hispanic Native American /AlaskanNon-Hispanic Asian IndianNon-Hispanic All Other AsianNon-Hispanic Hawaiian/ Pacific IslanderMulti race (any Hispanic status)Hispanic (Single race)Declined or Unknown
Paint (n=129)1 (0.8%) 14 (11.7%) 4 (3.4%) 1 (0.8%) 4 (3.4%) 2 (1.7%) 0 (0%)  4 (3.4%) 84 (70.6%) 5 (4.2%)
Soil (n=58)1 (1.7%)  8 (13.8%)  1 (1.7%) 0 (0.0%) 3 (5.2%)  1 (1.7%) 0 (0%) 4 (7%) 38(65.5%) 2 (3.4)
Dust (n=39)0 (0%) 4 (10.3%) 4 (10.3%) 0 (0%) 2 (5.1%) 2 (5.1%)  0 (0%) 3 (7.6%) 20 (51.3%) 4 (10.3%)
Water (n=5)0 (0%) 0 (0%) 1 (20) 0 (0%) 2 (40%) 0 (0%) 0 (0%) 0 (0%) 2 (40%) 0 (0%)

1A child may have more than one type of housing-related source of lead exposure and therefore, the total occurrences of housing-related sources will be greater than the number of children (n=142) identified with a housing-related source of lead exposure.
2Housing-related sources of lead exposure include: 

  • Paint is considered a source when the presence of deteriorated lead-based paint tested at the state regulatory level of ā‰„ 1.0 mg/cm2. In addition, full cases were attributed to paint at local regulatory levels in Los Angeles at ā‰„ 0.7 mg/cm2. (17 CCR Sections 35022, 35033, 35037; Los Angeles County Code Section 11.28.010)
  • Dust is considered a source when it is lead contaminated at ā‰„ 40 Āµg/ft2 for interior floor surfaces, ā‰„ 250 Āµg/ft2 for interior horizontal surfaces, and ā‰„ 400 Āµg/ft2 for exterior floor and exterior horizontal surfaces. (17 CCR Sections 35035, 35037) 
  • Soil is considered a source when it is lead contaminated at ā‰„ 400 ppm in children's play areas. 
  • Water was not identified as source of lead exposure in any case. Water levels are categorized by an action level; according to the US EPA Federal Lead and Copper Rule, ā‰„ 0.015 mg/L is above the action level (40 CFR Section 141.80). One exterior faucet water sample was found above the action level; however, it was not found to be a potential exposure source to lead as it was not a primary drinking source. Follow-up steps were taken to prevent all possible exposure by removing the faucet and capping the pipe. Drinking water sources at this residence measured nonā€‘detect lead levels.

Removal, Remediation, or Abatement of Identified Housing-Related Sources of Lead Exposure

Of the 364 full cases in our analysis, housing-related sources of lead exposure were identified at current regulatory levels in properties of 142 children. Since multiple children may be living at the same property, there were a total of 140 properties that needed housing-related sources of lead exposure removed, remediated, or abated and required clearance. Of those 140 properties, 100 (71.4 percent) had their housing-related source of lead exposure removed, remediated, or abated while 40 properties (28.6 percent) are still in process.

Distribution of Non-Housing Sources of Lead Exposure

For FY 2018-19, the main non-housing sources identified were 'cosmetics/ spiritual products,' followed by 'food, spice, and drink items' and 'take-home/occupational' exposures (Figure 4).  

Figure 4. Total Occurrences[1] of Non-Housing Sources of Lead Exposure Among Full Cases, Fiscal Year 2018-19 (n=174)

cosmetics & spiritual products 56; food, spice, & drink 52; take-home 40; pottery 29; other 22; remedies 12; retained bullet 3

1A child may have more than one type of non-housing lead hazard and therefore, the total occurrences of non-housing lead hazards will be greater than the number of children (n=174) identified with a nonā€‘housing lead hazard.

Non-housing sources of lead exposure differed by race/ethnicity (p < 0.0001, Table 14). When aggregated, non-housing sources appeared to be the most common source of lead exposure among White children. However, when stratifying White children by having Afghan origin or not, major sources of lead exposure differed between the two. The major exposure sources for children with Afghan origin were nonā€‘housing while the major exposure sources for White children without Afghan origin were housing related. The major nonā€‘housing sources for White children with Afghan origin were 'cosmetics and spiritual products,' 'food, spice and drink', and 'remedies.' For White children without Afghan origin, 'other sources of lead', and 'take-home/occupational' were among the major non-housing sources in addition to 'cosmetics and spiritual products.' 

Table 15. Total Occurrences[1] of Non-Housing Sources of Lead Exposure by Race/Ethnicity Among Full Cases, Fiscal Year 2018-19 (n=174)

Non-Housing Exposure Source of LeadNon-Hispanic White
Afghan		Non-Hispanic White
Non-Afghan		Non-Hispanic BlackNon-Hispanic Native American /AlaskanNon-Hispanic Asian IndianNon-Hispanic All Other AsianNon-Hispanic Hawaiian/ Pacific IslanderMulti race (any Hispanic status)Hispanic (Single race)Declined or Unknown
Cosmetics & Spiritual Products (n=56)20 (35.7%) 7 (12.5%) 0 (0%) 0 (0%) 22 (39.3%) 5 (8.9%)  0 (0%) 0 (0%) 2 (3.6%) 0 (0%)
Food, Spice & Drink (n=52) 9 (17.3%) 4 (7.7%) 0 (0%) 0 (0%) 25 (48.1%) 1 (1.9%) 0 (0%) 0 (0%) 13 (25%) 0 (0%)
Take-home/ Occupational (n=40)0 (0%) 2 (5%)  1 (2.5%) 0 (0%)  0 (0%)  3 (7.5%) 0 (0%) 1 (2.5%) 32 (80%) 1 (2.5%)
Pottery & Utensils (n=29)1 (3.4%) 1 (3.4%) 0 (0%) 0 (0%)  4 (13.8%) 0 (0%) 0 (0%) 1 (3.4%) 22 (76%) 0 (0%)
Other Source (n=22)0 (0%) 3 (13.6%) 1 (4.5%) 0 (0%) 6 (27.3%) 2 (9.1%) 0 (0%) 0 (0%) 10 (45.5%) 0 (0%)
Remedies (n=12)2 (16.7%) 1 (8.3%) 0 (0%) 0 (0%) 7 (58.4%)  1 (8.3%) 0 (0%) 0 (0%)  1 (8.3%) 0 (0%)
Retained Bullet (n=3)0 (0%) 0 (0%) 1 (33.3%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 2 (66.7%)  0 (0%)

1A child may have more than one type of non-housing source of lead exposure and therefore, the total occurrences of non-housing sources will be greater than the number of children (n=174) identified with a non-housing source of lead exposure.

Non-housing sources of lead, specifically 'food, spice, and drink', and 'cosmetics and spiritual religious products' were the main source of lead exposure among Asian children. However, when stratifying Asian children as 'Asian Indian (n=58)' and 'Other Asian (n=18)', major sources of non-housing source differed between the two groups. Of the 26 Asian children where 'food, spice, and drink' were identified as source of lead exposure, 25 were Asian Indian. 'Cosmetics and spiritual religious products' were significant non-housing source for both groups. 'Takeā€‘home/occupational' exposures were identified only among 'other Asian' children (16.7 percent vs. 0 percent).

Non-housing sources of lead were identified among 3 of the 12 Black children (25 percent). Major non-housing sources of lead exposure for Black children were 'retained bullet', 'takeā€‘home/occupational', and other sources of lead. 

No non-housing source of lead was identified for the one Native American/Alaskan child who received full case management services (n= 1). Similarly, for the one Hawaiian/Pacific Islander child who received full case management services, no non-housing source of lead was identified.

 Non-housing source of lead was identified in only one of the seven multi-race children. 'Pottery and utensils' as well as 'take-home/occupational' exposures were identified as a source for the child.

Of the 29 children where 'pottery/utensils' were identified as source of lead exposure, 22 (75.9 percent) were Hispanic children. 'Take-home/occupational' exposures were also common among Hispanic children. Of the 40 children where 'take-home/occupational' exposures were identified as sources of lead exposure, 32 (80 percent) were Hispanic. Of the three children where 'retained bullet' was identified as source of exposure, 2 (66.7 percent) were Hispanic (Table 15).  

Non-housing sources of lead exposure were identified in one child with unknown race/ethnicity, and the source of lead exposure was 'take-home/occupational' exposure.

Among the 40 take-home/occupational exposures, the most common sectors were fishing/hunting (n=8), auto repair (n= 7), metal work/soldering (n= 7), and construction (n= 6), (data not shown).

Although unconfirmed, exposures from previous residence/travel outside of California were suspected in 15 children with the top countries where previous residence/travel outside of California included Afghanistan (n= 3), Mexico (n= 7), and India (n= 2) (data not shown).

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