Sunday, May 4, 2003

Spotty testing obscures toll
of lead poisoning

580 kids have elevated lead levels - and that may be just a fraction

By Tim Bonfield
The Cincinnati Enquirer

The public health system knows about children like Nick Holwadel, a 6-year-old Price Hill boy who was diagnosed with lead poisoning in 2001.

Nick Holwadel, with his mother Deb, suffers speech and behavior problems most likely from lead poisoning, apparently from paint in an apartment where his family used to live.
(Jeff Swinger photo)
| ZOOM |
The system knows that Nick was one of 580 children in Greater Cincinnati who were identified with unacceptable levels of lead in their blood. In fact, Nick was among the Tristate's 60 most-poisoned children, according to state statistics.

The system also knows that Nick has significant learning and behavior problems in school. Much of the damage he suffered is permanent.

What the public health system does not know is how many other Nicks are out there.

"We do not have a full handle on the extent of the problem," said Dr. Bruce Lanphear, a nationally prominent expert in childhood lead poisoning who is based at Cincinnati Children's Hospital Medical Center.

Lanphear and others say not enough children are tested for lead.

The vast majority of children in the region with elevated levels of lead in their blood - 517 of 580 - live in Hamilton County, which is where most of the tests are conducted.

Numbers of lead-poisoned children, by county
The federal Centers for Disease Control and Prevention recommends blood tests for all children under 6 in ZIP codes that meet a formula based on the amount of old housing, poverty and previous lead hazards detected in the area. Kentucky ZIP codes were not available.
Hamilton County: 45001, 45030, 45140, 45202, 45203, 45204, 45205, 45206, 45207, 45208, 45209, 45210, 45211, 45212, 45213, 45214, 45215, 45216, 45217, 45219, 45220, 45223, 45224, 45225, 45226, 45227, 45229, 45232, 45237, 45251
Butler County: 45003, 45011, 45013, 45015, 45030, 45044
Clermont County: 45120, 45140, 45176
Warren County: 45140, 45152
Source: ClearCorps, a unit of the Better Housing League of Greater Cincinnati
In 2001, 7,831 children were tested for possible lead poisoning in the county. Ninety-five of those tested in Hamilton County lived in the city of Cincinnati. In all, those tested reflect about 14 percent of the children ages 5 and younger in the county.

In Butler County, home to aging neighborhoods in Hamilton and Middletown, 887 children were tested in 2001. Eleven had elevated levels of lead.

And in Kenton County, where Covington, Ludlow and Bromley have many old houses and apartments, 71 tests were reported in 2001 by state health officials. Seventeen had elevated lead levels.

While experts in childhood lead poisoning say the full extent of the damage happening to Tristate children isn't reflected in official statistics, public health officials say their budgets can't be stretched to expand screening programs.

"It all boils down to the economy," said Dr. Omer Berger, director of the lead treatment clinic at Cincinnati Children's Hospital Medical Center. "If we wanted to find more kids with lead, we could go out and find them. Ten years ago we went out into areas and knocked on doors of likely sources."

Concerns about the health hazards of lead have re-emerged in Greater Cincinnati because 500 students at Heberle Elementary in Cincinnati's West End neighborhood were abruptly moved to another school after an inspection revealed extensive lead-paint hazards. It was the first time lead hazards had closed a city school.

Hundreds of Heberle families that accepted the Cincinnati Health Department's offer of free blood testing will spend the next week or so waiting for the results. And school administrators are bracing themselves for the repair bill that could follow inspections slated for 22 other old city schools.

Yet long before concern emerged about old schools, scientists, public health officials, policymakers, property owners, parents and others have been concerned about the far more common problem of children exposed to lead hazards at home.

Lead is a toxic metal that has been used by people for more than 8,000 years. It has been banned from gasoline and paint, but still affects children primarily through exposure to dust tainted with crushed lead paint chips.

Lead is most dangerous to children under age 6. It can interfere with growth and development in many ways, from damaging learning ability to stunting growth to triggering violent behavior.

Lead paint is a big concern in the Tristate because 36 percent of homes and apartments in Ohio were built before 1950 when lead paint was commonly used, along with 33 percent in Indiana and 24 percent in Kentucky, according to the federal Centers for Disease Control and Prevention.

Policy gridlock

While many agree that lead-paint hazards pose a significant urban environmental health concern, local efforts to prevent childhood lead poisoning have fallen into "gridlock," according to a December report from the Health Improvement Collaborative of Greater Cincinnati. Among the problems:

• Inconsistent and differing data about the scope of lead poisoning.

• Differing viewpoints about the amount of lead that is harmful to children.

• Differing views about routine screening of children.

• Differing views on the costs and benefits of lead abatement.

To get information about childhood lead poisoning:
• Call ClearCorps at 513-281-6850 or check the Better Housing League of Greater Cincinnati Web site at
• Call your city, county or state health department.
• Contact the National Center for Environmental Health at 1-888-232-6789 or; the National Lead Information Center at 1-800-424-LEAD or; the Office of Healthy Homes and Lead Hazard Control at (202) 708-1112 or
"One fundamental difference ... is that some of those interviewed believe that an appropriate mission is to reduce lead poisoning in Cincinnati to zero, while others believe that the cost of such an initiative is so high that it would impact negatively on other health priorities," the report states.

For years, thousands of children have been tested for lead in their blood. And each year, hundreds of children with problems are detected.

Tests can be ordered by private practice pediatricians, doctors in public health clinics, even doctors at Cincinnati Children's Hospital. However, the testing usually happens only when a child visits a medical office for some other reason.

Shocking results

In Nick's case, the family was visiting a doctor to sort out whether Nick had properly received a hepatitis vaccine.

The doctor, knowing the family lived in an old apartment building in a low-income neighborhood, recommended a lead test. The family, never asked before, agreed.

The results were shocking.

Nick had a blood lead level of 40.4 micrograms per deciliter - far higher than the 10 ug/dl action level set by the U.S. Environmental Protection Agency and well above the 15 ug/dl level that doctors call lead poisoning.

A follow-up inspection revealed that the apartment where the family lived for about six years had several lead-paint hazards. During a dispute over the repairs, the family was evicted and wound up moving to another house in Price Hill.

"Before that test, we had never even thought about it. He seemed normal," said Nick's mother, Deb Holwadel. "It's been nothing but pure hell ever since."

As Nick grew closer to school age, his speech and behavior problems became more obvious. More testing determined that Nick has an IQ of 75, well below the "normal" level of 100.

He has repeated his kindergarten year. He has so much trouble communicating that he gets speech therapy twice a week.

He goes to a lead treatment clinic as often as once a month, takes special vitamins, and follows a diet rich in iron and calcium to combat the lead. Chelation therapy - involving medications that can remove some of the lead from his body - has been tried once and may soon be tried again, Holwadel said.

"There were times when he was asking, 'Mommy will I die from this?' " she said. "He's not going to die from it, but he will have permanent mental retardation."

Gaps in screening

The system that found Nick by happenstance may be missing other children.

For example, Ohio Department of Health figures indicate that fewer than 7 percent of Hamilton County children who were tested actually had high lead levels.

But as many as 34 percent of the tests done in Avondale and Walnut Hills revealed elevated lead levels, according to a report from the Better Housing League of Greater Cincinnati. So were 20 percent of the tests done in the West End and Over-the-Rhine.

The federal Centers for Disease Control and Prevention recommends a more comprehensive screening effort than currently used in Greater Cincinnati. The CDC recommends that every child through age 6 be tested if they live in "high-risk" ZIP codes that have significant amounts of older housing and poverty.

In Hamilton County, 30 ZIP codes - nearly every part of Cincinnati and much of the county - meet the CDC formula, according to ClearCorps, a non-profit lead education and lead-cleaning service run by the Better Housing League of Greater Cincinnati.

Six ZIP codes in Butler County, three in Clermont County and two in Warren County also meet the CDC standards. Information about Northern Kentucky ZIP codes was not available.

Barbara Boylan, director of ClearCorps, said Greater Cincinnati should have a far more aggressive screening program and much more precise data about children with high lead levels.

"Why not go for a high screening rate in an old town like Cincinnati? Given that we have such old housing, we should have a better handle on this," Boylan said.

But some public health officials say their budgets can't handle the burden.

Blood testing for lead contamination is covered by Medicaid and private health plans and some other public programs. Inspecting buildings for lead hazards is paid through some government programs and by private owners. Repairing lead hazards is most frequently paid for by the property owner.

"We're not in favor of lead poisoning in children," said Dr. Judith Daniels, medical director for the Cincinnati Health Department. "But I think the issue needs to be looked at in perspective with the resources we have. If there were more money, we'd do more."

Nick's father, Larry, said he wishes he could go back in time to avoid the apartment with the lead hazards. He talks about his son's troubles now because he hopes other families can avoid similar situations.

"The public needs to know about lead paint. This is what they have to look out for," he said.


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