摘要：Objectives. We examined the effects of changes in Rhode Island’s Lead Hazard Mitigation Law in 2005 on children’s blood lead levels. Methods. We used 2005 to 2009 data from Rhode Island’s Lead Elimination Surveillance System; city tax assessor records in Central Falls, Pawtucket, Providence, and Woonsocket, Rhode Island; and records of conformance to the state’s lead hazard mitigation law, to assess the extent to which legislation changes resulted in minimizing children’s exposure to lead. Results. During the 5-year study, the proportion of properties that complied with the new law increased for properties that housed young children. However, the majority of rental properties did not comply with the law. Children’s lead levels declined by approximately 1 microgram per deciliter on average in properties that did comply, demonstrating that the law could have a protective effect for children. Conclusions. Legislation changes increased the proportion of properties that were certified as nonhazardous, leading to decreased blood lead levels for children living in these properties. However, legislation cannot be a highly effective primary prevention strategy if it does not cover all properties where children live and is not strictly enforced. The prevention of childhood lead poisoning has been named one of the 10 great public health achievements in the United States for 2001 to 2010. 1 The impact of prevention programs has been dramatic. In the 1976 to 1980 National Health and Nutrition Examination Surveys of preschool children, 88.2% of preschool children had blood lead levels (BLLs) greater than or equal to 10 micrograms per deciliter. This percentage dropped to 0.9% in the 2003 to 2008 surveys. 1 Public health efforts have been highly successful, but the work remains incomplete. Recognizing that, even at very low blood levels, lead can have a lifelong negative impact, the Advisory Committee on Childhood Lead Poisoning Prevention (ACCLPP) of the Centers for Disease Control and Prevention (CDC) has made a “Renewed Call for Primary Prevention,” stating that, “Screening children for elevated BLLs and dealing with their housing only when their BLL is already elevated should no longer be acceptable practice.” 2 Although children can be exposed to lead from many sources (including lead pipes, ceramic dishes, and even the air they breathe), the most prevalent source of exposure is from lead-based paint. 3 One of the specific primary prevention approaches recommended by the ACCLPP was for local and state governments to “develop and enforce preventive lead-safe housing standards for rental and owner-occupied housing.” To provide insight into the potential impact of this recommendation, we examined the experience of Rhode Island, a state that has long-established lead-safe housing requirements. In 2002, Rhode Island enacted sweeping changes to the state’s lead hazard regulations as part of a comprehensive strategy to reduce lead poisoning incidence rates. 3 Starting in November 2005, Rhode Island’s new law required landlords of non–owner-occupied rental properties to attend a 3-hour lead hazard awareness class, assess and fix lead hazards on the property, perform ongoing lead-safe home maintenance practices learned in the class, and obtain a lead hazard conformance certificate from a Certified Environmental Lead Inspector. Alternatively, rental property owners could meet higher standards for all of the rental units they owned by obtaining the Rhode Island Department of Health (RIDOH) lead safe certification (issued to properties after a more extensive inspection confirmed that all painted surfaces, water, or soil might contain lead, but all painted surfaces were intact or fully covered, or the lead present was at environmental levels permissible under RIDOH standards), or lead-free certification (issued to properties after a more extensive inspection confirmed that all painted surfaces, water, or soil contained no lead, or contained lead in amounts not sufficient to pose a health risk to children younger than 6 years). We examined the effect of changes implemented as part of the Rhode Island Lead Hazard Mitigation Act on children’s BLLs. Our broader study goal was to use Rhode Island’s experience to help inform state and local governments that are considering establishing housing regulations in response to the CDC Advisory Council’s recommendations, which seek to protect children from lead exposure. To reach these objectives, we first assessed the proportion of properties that complied with the new legislation in the first 5 years following the instituted changes. Next, we evaluated the overall effect of lead hazard conformance certification by comparing lead screening results before and after obtaining certification. Finally, to explore the potential impact of expanding the scope or level of enforcement of the regulations, we assessed the lead burden (i.e., average BLLs, rates of elevated BLLs, and rates of lead poisoning) in properties that were either not in compliance or were exempt from the legislation.
