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March 7, 2022

Lead Hazards in U.S. Housing: The American Healthy Homes Survey II

Photo of a house with yellow caution tape blocking it off in the foreground and two orange signs on a post reading “warning lead work area poison no eating or smoking”.The American Healthy Homes Survey II revealed that 34.6 million homes (29.4 percent of all housing units) have lead-based paint somewhere in the building.

Joseph R. Downes discussed findings from the American Healthy Homes Survey

Introduction

HUD’s Office of Lead Hazard Control and Healthy Homes (OLHCHH) released findings on lead levels in American housing in an October 2021 report titled “American Healthy Homes Survey II Lead Findings.” The American Healthy Homes Survey II (AHHS II) measured levels of lead-based paint (LBP), LBP hazards, pesticides, formaldehyde, and mold in a sample of homes nationwide. AHHS II was developed from the first AHHS, conducted in 2005–2006, and the National Survey of Lead and Allergens in Housing, conducted in 1998–1999. From May 2018 to May 2019, two-person teams consisting of an interviewer and technician visited 703 randomly selected homes within 78 randomly selected areas across 37 states to determine how many American homes contain LBP and other potential health hazards. AHHS II revealed that 34.6 million homes (29.4% of all housing units) contain LBP. The survey also found that 18.2 million homes (15.4% of all housing units) have significantly deteriorated LBP, 21.9 million homes (18.6%) have dust lead hazards, and 2.4 million homes (2.0%) have soil lead hazards. Addressing these hazards is critical to ensuring that Americans, especially children, can have healthy, productive lives.

A Brief History of Lead

Lead is a heavy metal found naturally in the Earth’s crust that has been used for millennia for construction, plumbing, military, medicinal, dietary, and aesthetic purposes. Lead salts were a key component of the kohl eyeliner that ancient Egyptian royalty used. Kohl is still commonly used in Africa and the Middle East — often on children. The Romans famously lined their cookware with lead, used lead in their plumbing (the word “plumbing” derives from plumbum, the Latin word for lead), and even added lead acetate directly to their food and drink as a sweetener. Lead has been used since the Industrial Revolution as a major component in batteries, alloys, gasoline, paint, and radiation shielding as well other industrial products and processes. There is a problem, however: lead is extremely toxic, especially in young children.

Lead exposure is particularly associated with damage to the brain and nervous system, impaired growth, and learning and behavioral issues; it is fatal at higher exposure levels. In addition to nervous system effects, lead has cardiovascular, kidney, immune system, blood system, reproductive system and developmental effects, and is a likely carcinogen. Fetuses and young children are especially susceptible to the effects of high lead levels, with the latter at increased risk for lower IQ scores, impaired academic performance, and behavioral problems. Children with elevated blood lead levels (BLLs) are more likely to experience issues with cognition and self-control; multiple studies have found that, at the community level, lead exposure is associated with increased crime and homicide rates, as well as decreased income. Researchers and clinicians measure lead exposure by testing an individual’s BLL. The Centers for Disease Control and Prevention (CDC) and HUD currently use a blood lead reference value of 3.5 micrograms per deciliter (µg/dL) to identify children with elevated BLLs. Human knowledge of lead’s toxicity, however, considerably predates our capabilities in phlebotomy and laboratory diagnostics; scholars ranging from the Greek physician Pedanius Dioscorides in the 2nd century BCE to Benjamin Franklin in the 18th century recognized the negative health effects associated with lead exposure. Lead use peaked in the 19th century with the popularity of LBP; lead, when added to paint, improves durability, accelerates drying time, and provides an even color. As such, LBP became one of the most widespread lead-based products, with paint containing up to 70 percent lead commonly found in the homes, offices, and factories that were sprouting up across the United States and beyond.

At the dawn of the 20th century, governments and medical practitioners worldwide began to acknowledge the major problems that lead exposure caused. Although adding lead to paint improves its performance, LBP becomes hazardous when it deteriorates through chalking, peeling, flaking, or abrasion, which result in dust and paint chips that can be easily ingested. The risk of ingestion is especially dangerous for children, who can eat paint chips or ingest lead dust through normal hand-to-mouth contact and who are particularly susceptible to lead’s long-term negative health effects. In addition to LBP hazards, the introduction of tetraethyl lead gasoline in the early 1920s significantly increased ambient levels of lead in the atmosphere, in soil (after lead particulates settled to the ground), and, consequently, children’s mean BLLs. Numerous studies have confirmed that no safe level of lead exposure exists for children, and even minimal exposure can result in long-term negative effects. Recognizing the dangers of lead hazards and their effects on children, the federal government began limiting the amount of lead in common products beginning in the 1970s. In 1971, the Lead-Based Paint Poisoning Prevention Act required the Secretary of Health, Education, and Welfare (now Health and Human Services) to prohibit lead-based paint in residential structures constructed or rehabilitated by the federal government or with federal assistance. In 1978, under the Consumer Product Safety Act, the Consumer Product Safety Commission banned the residential use of lead-based paint that contained lead levels greater than or equal to 0.06 percent, or 600 parts per million. Further protections were instituted in the Safe Water Drinking Act, the Clean Water Act, the Clean Air Act, the Toxic Substances Control Act, and the Residential Lead-Based Paint Hazard Reduction Act to prevent the introduction of lead into the nation’s drinking water, atmosphere, and home environments. More than 50 years later, these combined actions have significantly reduced the amount of lead found in children’s blood: the CDC has lowered thresholds for what constitutes an elevated BLL several times in recent years, from 10 µg/dL to 5 µg/dL in 2012 and from 5 µg/dL to the current value of 3.5 µg/dL in May 2021. For reference, the first elevated BLL reference value that the CDC set in 1960 was 60 µg/dL, more than 17 times the current value.

Despite these protections, LBP is still commonly found in older housing. LBP often is addressed with interim controls, such as being repaired using lead-safe work practices by contractors trained in such work, which is less expensive and requires less labor and time than abatement. Without full abatement, however, lead hazards may reappear over time, especially during renovations, repairs, and painting. Surveys such as AHHS II are critical for social scientists, environmental advocates, health practitioners, and policymakers to understand the scope and characteristics of lead hazards in housing as well as provide an evidence base for effective policy solutions.

AHHS II: Key Findings

What does AHHS II say about lead hazards in America?

According to AHHS II, 34.6 million homes (29.4% of all housing units) contain at least some LBP, 18.2 million homes (15.4% of all housing units) have significantly deteriorated LBP, 21.9 million (18.6%) have dust lead hazards, and 2.4 million (2.0%) have soil lead hazards. Single-family dwellings, owner-occupied housing units, and housing units in metropolitan areas are more likely to have LBP than multifamily buildings, rental units, and rural housing units, respectively. The prevalence of LBP and LBP hazards increases with the age of the housing; more than 93 percent of all homes with LBP were built before 1978, and 85.4 percent of homes with LBP were built before 1940. The prevalence of LBP and LBP hazards differs by region; the highest prevalence is found in the Northeast and Midwest regions, where the housing stock generally is older than that in the South and West. Most concerningly, LBP is present in 28.5 percent of housing units nationally in which a child under age 6 resides.

In addition to these key findings, considerations of equity are central for an analysis of lead hazards in U.S. housing. Before the Consumer Product Safety Commission banned the new use of lead-containing paint in 1978, the lead industry sought to lay the blame for lead exposure at the feet of black and Hispanic parents who failed to stop their children’s “unnatural” hand-to-mouth activity, while public relations efforts simultaneously targeted children with coloring books and Halloween costumes from the Dutch Boy paint company intended to distract from lead’s toxicity. Analysis of the CDC’s National Health and Nutrition Examination Survey data in 2018 identified race/ethnicity of non-Hispanic Black, housing age, and household income at or below the federal poverty level as risk factors for elevated BLLs in children. In this regard, AHHS II found that 30.8 percent of White households live in housing with LBP compared with 25.2 percent of African-American households, 24.8 percent of households of other races, and 31.1 percent of Hispanic/Latino households. The prevalence of LBP and LBP hazards among African-American households decreased substantially between AHHS I and AHHS II. In addition, 22.3 percent of households in poverty live in housing with LBP compared with 30.9 percent of households with incomes above the federal poverty level. The prevalence of LBP and LBP hazards among households in poverty also decreased substantially between the two studies. Moreover, federal interventions have been relatively successful in addressing potential lead hazards in government-assisted housing. Housing units receiving government support have a significantly lower prevalence of LBP and LBP hazards than those not receiving government support. Studies have similarly found that children living in assisted housing had lower average BLLs than children living in unassisted housing when controlling for socioeconomic, demographic, and household characteristics. One topic that AHHS II cannot comment on, however, is the prevalence and geographic distribution of lead service lines for household water supply. Lead service lines, which run from water mains (typically under streets and sidewalks) to homes and other buildings and structures, may introduce lead into a household’s drinking water; an estimated 6 to 10 million lead service lines are in use throughout the United States, including those that serve approximately 400,000 schools and childcare facilities.

In sum, although AHHS II suggests that federal efforts over the past half century have dramatically reduced children’s BLLs and made progress toward removing lead in housing — especially for vulnerable populations — both the survey’s findings and the recent experiences of Flint and Benton Harbor, Michigan, highlight that more work must be done to remove lead from the nation’s environment.

What Is HUD Doing?

OLHCHH maintains two grant programs to address lead hazards in housing: the Lead Hazard Reduction Demonstration grant program (for older and larger jurisdictions) and the Lead-Based Paint Hazard Control program (for all jurisdictions). Eligible activities for both grant programs include blood lead testing; sampling and analysis of lead in paint, dust, and soil; interim controls; full abatement; data collection; hazard identification; resident and worker education; outreach; and capacity building. OLHCHH awarded nearly $95 million in lead hazard reduction grants in fiscal year 2021. Previous awards for fiscal years 2019 and 2020 included, among several grant categories, funding a demonstration targeting High Impact Neighborhoods, defined as areas of no more than four contiguous census tracts with high concentrations of both pre-1940 housing and low-income families with children and in which BLLs are elevated relative to the state average. The interventions funded by lead hazard reduction grants have proven to be effective: an evaluation of HUD’s Lead-Based Paint Hazard Control program completed in the early 2000s found that interventions funded through the program resulted in more than 76 percent of dwellings passing dust lead clearance standards on the first attempt. These interventions also remained effective multiple years after treatment and significantly lowered children’s BLLs.

Along with administering OLHCHH’s lead grant programs, HUD supports other agencies’ lead safety efforts. HUD, through OLHCHH, chairs the Department of Health and Human Services’ Lead Exposure and Prevention Advisory Committee, a federal – non-federal expert panel that reviews federal programs, services, and research on lead-exposed individuals and communities. HUD serves on the President’s Task Force on Environmental Health Risks and Safety Risks to Children alongside other federal agency partners. In addition, HUD, through OLHCHH, continues to co-chair the task force’s lead subcommittee that issued the Federal Lead Action Plan to Reduce Childhood Lead Exposures and Associated Health Impacts in December 2018. HUD also supports the U.S. Environmental Protection Agency (EPA) in its efforts to more rigorously assess and address lead hazards in American communities. For example, HUD has provided comments and support as EPA revises its Lead and Copper Rule, which regulates the concentrations of metals such as lead permitted in community water systems serving housing, schools, and childcare centers. Indeed, it was the tragic interaction of the decision to switch water systems; the presence of old, corroded pipes; and interrupted corrosion control measures that resulted in the 2014 water crisis in Flint, Michigan.

Despite government efforts over the past half century to remove lead from our nation’s air, water, housing, and blood, much work remains to remove lead from our communities, and the cost of inaction is massive. The National Center for Healthy Housing estimates that completely addressing all national lead hazards for the 2018 birth cohort could yield a maximum of $84 billion in net benefits, exclusive of implementation costs. In 2009, the Economic Policy Institute found that the costs of addressing lead hazards nationally range from $1.2 billion to $11 billion, and the benefits from reductions (medical, lost earnings, tax revenue, criminal activity, and education) total $192 billion to $270 billion, yielding a net benefit of $181 billion to $269 billion and a return of $17 to $221 for each dollar invested in lead hazard control. To begin addressing part of these overall needs, the Infrastructure Investment and Jobs Act of 2021 provided $15 billion for lead service line replacement, with up to an additional $11 billion potentially available. The act prioritizes lead service line replacement to, among other sectors, “landlords or property owners providing housing to low-income renters.” The $5 billion for lead hazard control and housing-related health and safety hazard mitigation included in the House-passed Build Back Better Act would make approximately 290,000 housing units occupied by lower-income families free of lead-based paint hazards.

In conclusion, the AHHS II is critical for both understanding lead-related hazards in the nation’s housing stock and providing an evidentiary basis for policy interventions. In an era in which scientific evidence is under increased scrutiny and our nation must face a long-overdue reckoning on socioeconomic equity, the AHHS II provides invaluable information upon which to assess, reflect upon, and ultimately improve our efforts to get the lead out and protect our nation’s most important resource: our children.

Source:

Science. 2010. “Egyptian Eyeliner May Have Warded Off Disease,” 8 January. doi: 10.1126/article.30976.

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Source:

Nick Farr and Cushing Dolbeare. 1996. “Childhood Lead Poisoning: Solving a Health and Housing Problem,” Cityscape 2:3, 167–81. National Toxicology Program. 2012. “NTP Monograph on Health Effects of Low-Level Lead,” NTP Monographs 1:xiii, xv–148.

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Office of Research and Development, U.S. Environmental Protection Agency. 2013. “Integrated Science Assessment for Lead.” Accessed 27 February 2022.

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Centers for Disease Control and Prevention. 2021a. “Health Effects of Lead Exposure.” Accessed 17 February 2022. National Toxicology Program 2012.

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Source:

James Feigenbaum and Chris Muller. 2016. “Lead Exposure and Violent Crime in the Early Twentieth Century,” Explorations in Economic History 62, 51–86. Hans Gronqvist, J. Peter Nilson, and Per-Olof Robling. 2020. “Understanding How Low Levels of Early Lead Exposure Affect Children’s Life Trajectories,” Journal of Political Economy 128:9; Jessica Reyes. 2007. “Environmental Policy as Social Policy? The Impact of Childhood Lead Exposure on Crime.” The B.E. Journal of Economic Analysis & Policy 7:1, Article 51.

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Source:

Centers for Disease Control and Prevention. 2021b. “Blood Lead Levels in Children.” Accessed 17 February 2016. Since 1999, when HUD issued its Lead Safe Housing Rule (24 CFR 35, subparts B through R), the Department has adopted the Centers for Disease Control and Prevention’s recommendations for BLL limits when conducting environmental investigations of young children’s lead exposure. For more information, see: https://www.federalregister.gov/d/99-23016, https://archives.hud.gov/news/2017/pr17-006.cfm and www.cdc.gov/mmwr/volumes/70/wr/pdfs/mm7043a4-H.pdf.

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Source:

A. Trevor Hodge. 1981. “Vitruvius, Lead Pipes, and Lead Poisoning,” American Journal of Archaeology 85:4, 486–91.

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H.M. Thomas and K.D. Blackfan. 1914. “Recurrent Meningitis, Due to Lead, in a Child of Five Years,” American Journal of Diseases of Children VIII:5, 377–80.

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Timothy Dignam et al. 2019. “Control of Lead Sources in the United States, 1970–2017: Public Health Progress and Current Challenges to Eliminating Lead Exposure,” Journal of Public Health Management and Practice 25: s13–s22.

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Source:

National Toxicology Program 2012; Centers for Disease Control and Prevention 2021a; Jianghong Lou et al. 2014. “Blood lead concentrations and children's behavioral and emotional problems: a cohort study,” JAMA Pediatrics 168:8, 737–45; Anne Evens et al. 2015. “The impact of low-level lead toxicity on school performance among children in the Chicago Public Schools: a population-based retrospective cohort study,” Environmental Health 14:21.

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Source:

Centers for Disease Control and Prevention 2021a. Steven Gilbert and Bernard Weiss. 2006. “A rationale for lowering the blood lead action level from 10 to 2 μg/dL,” Neurotoxicology 27:5, 693–701. See also: James Pirkle et al. 1994. “The Decline in Blood Lead Levels in the United States,” Journal of the American Medical Association 272:4, 284–91.

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Unless otherwise noted, all findings from: U.S. Department of Housing and Urban Development. 2021. “American Healthy Homes Survey II Lead Findings.”

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The U.S. Environmental Protection Agency’s standard for dust lead hazards changed in 2019. Under the previous standard, adopted in 2001, 10.6 million homes (9.0% of all housing units) have dust lead hazards. Under the current, more stringent 2019 standard, 21.9 million homes (18.6% of all housing units) have dust lead hazards.

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Source:

David Rosner and Gerald Markowitz. 2013. “Why It Took Decades of Blaming Parents Before We Banned Lead Paint,” The Atlantic, 22 April.

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President’s Task Force on Environmental Health Risks and Safety Risks to Children. 2018. “Federal Action Plan To Reduce Childhood Lead Exposures and Associated Health Impacts.” Accessed 17 February 2022.

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A 2016 study by the Centers for Disease Control and Prevention and HUD found that the BLL of children living in assisted housing averaged 1.44 µg/dL compared with 1.79 µg/dL for children living in unassisted housing. Katherine Ahrens et al. 2016. “Housing Assistance and Blood Lead Levels: Children in the United States, 2005–2012,” American Journal of Public Health 106:11, 2049–56. A 2019 study found that children who lived in private housing in New York City had higher mean BLLs than children living in New York City Housing Authority housing (2.10 μg/dL and 1.92 μg/dL, respectively) as well as a higher prevalence of BLLs of 5 μg/dL or above (2.76% and 0.25%, respectively). Jacqueline Chiofolo et al. 2019. “Pediatric Blood Lead Levels Within New York City Public Versus Private Housing, 2003–2017,” American Journal of Public Health 109:6, 906–11.

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Source:

Office of Water, U.S. Environmental Protection Agency. 2020. “Economic Analysis for the Final Lead and Copper Rule Revisions.”

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National Center for Healthy Housing and University of Cincinnati Department of Environmental Health. 2004. “Evaluation of the HUD Lead-Based Paint Hazard Control Grant Program,” U.S. Department of Housing and Urban Development. Accessed 17 February 2022.

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Kelsey Pieper, Min Tang, and Marc Edwards. 2017. “Flint Water Crisis Caused By Interrupted Corrosion Control: Investigating “Ground Zero” Home,” Environmental Science & Technology 51: 2007–14.

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Health Impact Project. 2017. “10 Policies to Prevent and Respond to Childhood Lead Exposure.” Accessed 27 February 2022.

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Elise Gould. 2009. “Childhood Lead Poisoning: Conservative Estimates of the Social and Economic Benefits of Lead Hazard Control,” Environmental Health Perspectives 117:7, 1162–7.

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Source:

117th Congress. 2021. Infrastructure Investment and Jobs Act, HR 3684, 23 USC 101. See esp.: §50105, Reducing lead in drinking water.

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