Characterization of Adult Blood Lead Levels in the

Characterization of Adult Blood Lead Levels in the New Hampshire Adult Blood Lead Epidemiology and Surveillance Program (ABLES). Karla Armenti, Sc. D Occupational Health Surveillance Program Division of Public Health Services 1

Acknowledgements • Suzanne Allison, Public Health Nurse, and Paul Lakevicius, Analyst, Division of Public Health Services, Bureau of Public Health Protection, Childhood Lead Poisoning Prevention Program • Rosemary Caron, Associate Professor and Sarah Di. Stefano, Student, College of Health and Human Services, Department of Health Management and Policy, University of New Hampshire • Margaret Henning, Assistant Professor and Jesslyn Beaulieu, Student, Keene State College 2

Background • Lead adversely affects multiple organ systems and can cause permanent damage. • NH law requires that laboratories report all blood lead levels to the Division of Public Health Services, Bureau of Public Health Protection • The Childhood Lead Prevention Program receives all adult blood lead reports and provides data to NIOSH under ABLES for all BLLs above 25 µg/d. L. BLLs over 40µg/d. L are reported to OSHA. 3

Background • Until recently, a blood lead level (BLL) of 25 micrograms per deciliter (µg/d. L) or greater for adults was considered “elevated, ” and the Healthy People 2010 goal was to eliminate BLLs above this level. • However, adverse health effects have been found with cumulative exposure at BLLs lower than 25 µg/d. L. * • CSTE and NIOSH have recommended changing the case definition for an elevated blood lead level (EBLL) in adults from 25 µg/d. L to 10 µg/d. L, thereby dramatically increasing the “caseload” in New Hampshire by almost 4 and half. • EPA’s Renovation, Repair and Painting Rule – What might we see in the data on contracter (home renovation) exposures? * Rosenman et al, “Occurrence of Lead-Related Symptoms Below the Current Occupational Safety and Health Act Allowable Blood Lead Levels, JOEM, Vol 45, Number 5, May 2003 4

Methods • We performed in-depth data analysis of the NH adult population with BLLs between 10 and 24 µg/d. L and for those above 25 µg/d. L for the year 2009 (n = 190). • In addition, we documented data by industry and occupation (to the best of our ability). • Analysis was made using a cross tabulation between gender, blood lead level, and by industry. 5

Methods - Survey Phone survey conducted for all cases above 10 ug/d. L, questions include: * – Reason for blood test (requested, Doctor’s advice, company program) – What type of work and where (employer name) – Why BLL was elevated (poor ventilation, no PPE) – Was PPE available? With training? – Hobbies (like shooting ranges) – Age of residence and any renovations done *Based on questionnaire developed by NY Heavy Metals Registry, NY State Bureau of Occupational Health 6

Process – Intern Support (~1 day per week for 8 months) • First attempt to gather information • Called providers/labs that ordered blood tests • Requested employer/occupation information • Attempted to code data using census industry codes by occupation and industry • Second attempt to gather information • Tried to get patient phone numbers from providers/labs • Many providers refused – we had to look them up (white pages) • Administered phone survey 7

Data Results Lead Test Result by age Group 2009 ABLES Data Lead Level µg/d. L Age Group 10 to 24 25 and up Grand Total 1 Under 20 2 2 4 21 to 30 23 1 24 31 to 40 39 3 42 41 to 50 33 3 36 51 to 60 55 6 61 61 and up 21 2 23 17 190 Grand Total 8

Data Results Lead Test Result by Industry Sic Code Description Automotive Repair Firearms General Contractors - Residential Blood Lead µg/d. L 10 to 24 Grand Total > 25 2 12 2 1 3 13 3 Non-ferrous foundry and machine shop 14 5 19 Painting Bridge/House 22 3 25 Special Trades: deleading, ornamental iron work/other 6 6 Valves 25 2 27 BLANK 89 6 95 173 17 190 Grand Total 9

Results of Survey • Out of 173 cases between 10 and 24 µg/d. L, only 13 completed surveys • Type of work (of those confirmed to be work-related) – Foundry, maintenance, window restoration, contractor/building restoration • Non-occupational exposures were from old house restoration and firing ranges • Industry (only got employer name) and occupation – not able to code • Reason for exposure (work related cases) - not enough ventilation, no respirator available, on clothes, working without a respirator, not sure 10

Survey Results (cont’d) • Respirators available and required from employer? No = 1, Yes = 4, Only in certain areas = 1 • Other PPE – uniform, gloves, safety glasses, paper mask, eye and ear protection • Hobbies – Indoor shooting range, car restoration, house remodeling • House older than 1978 = 6 • Renovations – mostly painting (indoor) and upgrading tile 11

Limitations • Lead prevention staff (assigned to adult lead) include 3 people (1 public health nurse, 1 data entry clerk and 1 analyst), all working just a small percentage on adult lead (mostly assigned to childhood lead issues). • Occupational Health Surveillance Program is managed by one person. • Use of interns was the only way to complete this project. 12

Limitations • Information given by provider was too vague to make a conclusion on how to code each individual’s occupation or industry, so we couldn’t do it. • A lot of missing data – Difficult to draw quantitative conclusions • Difficulty finding telephone numbers – ended up with a lot of inoperative numbers • Survey mostly conducted during the day – staff limited by inability to stay late (only one night where staff could stay to conduct interviews, and only got 2 additional completed) • Survey sample size too small to produce statistical significance 13

Next Steps • New intern starting end of June through December • Collect data on all BLLs over 10µg/d. L for 2010 including patient occupation, industry and phone number • Add 2010 data to 2009 data and analyze for various age groups, BLLs and industry • Survey (by phone) workers with BLLs over 10µg/d. L • Review OSHA citations for violations of the lead standard for NH companies • Work with the Lead Prevention Program to develop “fact sheet” on Lead at Work to distribute to key stakeholders and facilities with workers at most risk. 14

Contact Information • • Karla R. Armenti, Sc. D, Principal Investigator Occupational Health Surveillance Program Bureau of Public Health Statistics & Informatics Division of Public Health Services 29 Hazen Drive Concord, NH 03301 Phone (603) 271 -8425 www. dhhs. nh. gov/dphs/hsdm/ohs • karmenti@dhhs. state. nh. us 15