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Determination of numbers of lead-exposed American children as a function of lead source: integrated summary of a report to the U.S. Congress on childhood lead poisoning.

In 1986, the U.S. Congress [Section 118(f), Superfund Amendments and Reauthorization Act (SARA)] directed the Agency for Toxic Substances and Disease Registry to provide to it a quantitative assessment of the contributions of various sources of lead to childhood exposure. We provided both a quantitative response to the mandate and a critique of low-level lead sources for U.S. population segments. We also present here an integrated assessment of major and low-level lead sources. Significant sources of lead in childhood exposure include lead in paint, dust, soil, and drinking water. Approximately 6 million U.S. children less than 7 years old reside in the oldest housing, with highest exposure risk due to leaded paint. About 2 million in deteriorated units are at particularly high risk for exposure with ca. 1.2 million children in oldest, deteriorated housing estimated to have blood lead (PbB) levels above 15 micrograms/dl. Soil and dust lead are potential sources of exposure for 6-12 million children. Residential tap water lead is a measurable source for ca. 3.8 million children, of whom the U.S. EPA estimates ca. 240,000 have water-specific exposures at toxic levels. Leaded gasoline combustion mainly in past years has produced, and will continue to produce into the 1990s, significant numbers of exposed children with toxicologically elevated PbBs. For 1990, 1.25 million children will have their PbBs fall below 15 micrograms/dl. Food lead can cause significant exposure in certain cases.

Child↗

Role of the U.S. Congress in setting goals and priorities for research on nutrition and aging.

The U.S. Congress plays an important role in setting the broad research agenda for research agencies. It often does so by articulating major goals for federally-supported activities. Goals, longer-term objectives that agencies should work towards, should not be confused with priorities, near-term resource allocations designed to support efforts to achieve goals. Typically, federal research priorities are established by individual departments, agencies, and other organizations within the executive branch; however, when the funding levels are particularly large or public concern about an issue is particularly intense, Congress may become involved in the process of setting specific priorities. Congress influences the directions of research on aging primarily through the activities of authorization, appropriations, and special or select committees. The Special Committee on Aging in the Senate, and the Select Committee on Aging in the House of Representatives focus their attention exclusively on elderly Americans. Periodically, the activities of these committees are directed to research issues. Congress indirectly influences the directions of research on aging and nutrition through laws that establish science-based regulatory programs such as the Food, Drug, and Cosmetic Act, and the Toxic Substances Control Act. In setting priorities Congress relies on information, analysis, and advice from the four congressional support agencies, particularly the Office of Technology Assessment (OTA). OTA has undertaken a number of studies in recent years which address aging and nutrition issues. It is useful to try to devise mechanisms to encourage the establishment of national and international long-range goals and near-term priorities for research on aging and nutrition.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

Adolescent health: a report to the U.S. Congress.

This article reports findings from an assessment by the Office of Technology Assessment (OTA), an analytical arm of the U.S. Congress. In brief, OTA found the conventional wisdom that American adolescents as a group are so healthy that they do not require health and related services is not justified. Even more disturbing, U.S. adolescents often face formidable barriers in trying to obtain health care. OTA suggested that Congress could act to 1) increase adolescents' access to health care, most effectively by supporting school- or community-based comprehensive health services specifically for adolescents, 2) restructure and reinvigorate the federal role in adolescent health, most visibly by creating an office of adolescent health in the U.S. Executive branch, and 3) improve adolescents' social environments, by providing more support to the families of adolescents, limiting adolescents' access to firearms, supporting the expansion of recreational opportunities for adolescents, and further supporting opportunities for community service. Congressional actions taken since the release of OTA's report are summarized.

Adolescent↗

Methods for reducing lead exposure in young children and other risk groups: an integrated summary of a report to the U.S. Congress on childhood lead poisoning.

As part of a Congressionally mandated report on U.S. childhood lead poisoning prepared by the Federal government (U.S. Agency for Toxic Substances and Disease Registry [ATSDR]), the authors have analyzed the relative effectiveness of measures to reduce source-specific lead exposure of U.S. children. An integrated overview of this analysis is presented in this article. Two national actions, the Federally mandated phasedown of lead in gasoline by the U.S. Environmental Protection Agency and the voluntary phasedown of lead use in domestic food can production, are examples of centrally directed initiatives that have been relatively successful in limiting childhood lead exposure in the U.S. Efforts to abate lead-based paint exposure of children have largely failed. This is especially true for the nation's 21 million residential units with the highest lead content paint. Similarly, abatement of lead exposure from contaminated dusts and soils has generally been unsuccessful. Comprehensive measures to reduce lead exposure from drinking water in residences and public facilities, e.g., elementary schools, are only now being promulgated or implemented. The full extent of their effectiveness remains to be demonstrated. There are many miscellaneous but potentially severe exposure sources that are difficult to control but require attention, such as poorly glazed foodware and ethno-specific preparations.

Air Pollution↗

Determination of numbers of lead-exposed women of childbearing age and pregnant women: an integrated summary of a report to the U.S. Congress on childhood lead poisoning.

In a Congressionally mandated study carried out under the aegis of the U.S. Agency for Toxic Substances and Disease Registry (ATSDR) and summarized in this article, the authors have provided estimates of the numbers of American women of childbearing age and the numbers of American pregnant women whose lead exposure is sufficiently elevated to pose an intrauterine toxicity risk. Exposures associated with such risk were defined as blood lead (PbB) levels greater than 10, greater than 15, greater than 20, and greater than 25 micrograms/dL. Using PbB prevalence projection techniques based on the Second National Health and Nutrition Examination Survey (NHANES II), we first generated projected 1984 prevalences of these PbB levels in white and black women of childbearing age, ages 15 to 19 and 20 to 44. White women in the two age bands had rates of PbBs greater than 10 micrograms/dL of 9.2 and 9.7%, respectively. For black women, the corresponding rates were 8.2 and 19.7%, respectively. Combining these rates with standard metropolitan statistical areas (SMSAs) based 1980 Census and other population enumerations show, for example, that 4.4 million U.S. women of childbearing age are estimated to have had PbBs greater than 10 micrograms/dL. Pregnant black and white women in U.S. SMSAs are approximately 9% of the U.S. black and white childbearing age total, i.e. 3.6 million out of a 41.3 million SMSA total. Of these, 403,200 pregnant women were estimated to have PbB levels greater than 10 micrograms/dL.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Adolescent Health. Reflections on a report to the U.S. Congress.

The Office of Technology Assessment (OTA) found that the conventional wisdom that American adolescents are so healthy that they do not require health and related services is not justified; U.S. adolescents often face formidable barriers to obtaining needed health care, and relatively little appropriate attention has been paid to adolescents by the federal government. OTA suggested that Congress could act to (a) increase adolescents' access to health care by supporting comprehensive health services specifically for adolescents, (b) restructure the federal role in adolescent health by creating an office of adolescent health in the U.S. Executive Branch, and (c) improve adolescents' social environments by providing more support to families of adolescents, limiting adolescents' access to firearms, supporting the expansion of their recreational opportunities, and further increasing opportunities for community service. Federal actions taken since OTA's report are summarized.

Adolescent↗

Determination of numbers of lead-exposed U.S. children by areas of the United States: an integrated summary of a report to the U.S. Congress on childhood lead poisoning.

In response to Congressional mandate and under the aegis of the Federal Agency for Toxic Substances and Disease Registry (ATSDR), a comprehensive report to Congress on childhood lead poisoning in the United States was prepared. We have examined numbers of lead-exposed U.S. children by socioeconomic/demographic strata for children 0.5 to 5 years of age; by children in U.S. lead-screening programs; and by enumerations of children 0.5 to 5 years old in the oldest (i.e., highest paint lead and lead plumbing) housing. Using blood lead (PbB) prevalence projection modeling and data of the Second National Health and Nutrition Examination Surgery (NHANES II), it is estimated for 1984 that 2.4 million black and white children 0.5 to 5 years old in metropolitan U.S. had PbB levels greater than 15 micrograms/dL. For all races and the entire nation, we estimate 3 to 4 million children will have PbB levels greater than 15 micrograms/dL. Inner-city, low-income children have the highest prevalences of PbB levels above this criterion level, but sizable numbers of all strata of children have elevated PbB levels when considering both base populations and prevalences for the specific strata (total of 30 strata). Lead screening programs indicate much lower numbers of exposed children compared to NHANES II-based projections, for various reasons that allow programs to underestimate true prevalences. Analysis of 1980 U.S. Census Bureau housing data for 318 standard metropolitan statistical areas show that 4.4 million children 0.5 to 5 years old live in the oldest U.S. housing (pre-1950). Of these, most are actually in the more affluent socioeconomic strata.

Child, Preschool↗

Prenatal and postnatal effects of low-level lead exposure: integrated summary of a report to the U.S. Congress on childhood lead poisoning.

This article provides an integrated summary of a report to Congress from the Federal government (ATSDR) on childhood lead poisoning in the United States, with particular reference to low-level lead exposure and its effects on the fetus and the preschool child. As mandated by Section 118(f)(1)(C) of the 1986 Superfund Amendments and Reauthorization Act (SARA), ATSDR has examined the full spectrum of human in utero and postnatal lead toxicity, with emphasis on low-level neurotoxicity and adverse impacts on growth indices in risk populations. Especially important has been assessment of the relative persistence of these effects in later life as discernible from a number of longitudinal studies now under way around the world. Included in the Congressional report were discussions of dose-effect and dose-response relationships using blood lead levels as the indicator of lead dose.

Child, Preschool↗