Effects of HUD-supported lead hazard control interventions in housing on children's blood lead

The Evaluation of the US Department of Housing and Urban Development Lead-Based Paint Hazard Control Grant Program studied the effectiveness of the housing intervention performed in reducing the blood lead of children at four post-intervention times (6-months, 1-year, 2-years, and 3-years). A repeat measures analysis showed that blood lead levels declined up to three-years post-intervention. The results at each successive collection time were significantly lower than at the previous post-intervention time except for the difference between the levels at two and three years. At two-years post-intervention, geometric mean blood lead levels were approximately 37% lower than at pre-intervention. Children with pre-intervention blood lead levels as low as 10 μg/dL experienced substantial declines in blood lead levels. Previous studies have found substantial improvements only if a child's pre-intervention blood lead level was above 20 μg/dL. Individual interior lead hazard control treatments as grouped by Interior Strategy were not a significant predictor of post-intervention blood lead levels. However, children living in dwellings where exterior lead hazard control interventions were done had lower blood lead levels at one-year post-intervention than those living in dwellings without the exterior interventions (all other factors being equal), but those differences were only significant when the mean exterior paint lead loading at pre-intervention was about the 90th percentile (7.0 mg/cm²). This observation suggests that exterior lead hazard control can be an important component of a lead hazard control plan. Children who were six to eleven months of age at pre-intervention had a significant increase in blood lead at one-year post-intervention, probably due to other exposures.     

Residential lead-based-paint hazard remediation and soil lead abatement: their impact among children with mildly elevated blood lead levels.

OBJECTIVES: This prospective study describes the impact of residential lead-based-paint hazard remediations on children with mildly elevated blood lead levels. METHODS: Changes in blood lead levels were observed following paint hazard remediation alone and in combination with soil abatement. RESULTS: After adjustment for the confounding variables paint hazard remediation alone was associated with a blood lead increase of 6.5 micrograms/dL (P = 0.5), and paint hazard remediation combined with soil abatement was associated with an increase of 0.9 microgram/dL (P = 36). CONCLUSIONS: Lead-based-paint hazard remediation as performed in this study, is not an effective secondary prevention strategy among children with mildly elevated blood lead levels.     

Lead dust in Broken Hill homes: effect of remediation on indoor lead levels

This study was undertaken to determine whether home remediation effectively reduced indoor lead levels in Broken Hill, a long-established silver-lead-zinc mining town in outback Australia. A before-after study of the effect of home remediation on indoor lead levels was embedded into a randomized controlled trial of the effectiveness of remediation for reducing elevated blood lead levels in young children. Moist towelettes were used to measure lead loading (microg/m2) on internal windowsills and internal and entry floors of 98 homes; samples were collected before, immediately after, and 2, 4, 6, 8, and 10 months after remediation. Data were log(10) transformed for the analysis. Remediation reduced average indoor lead levels by approximately 50%, and lead levels remained low for the duration of the follow-up period (10 months). The greatest gains were made in homes with the highest initial lead levels; homes with low preremediation lead levels showed little or no benefit. Before remediation, homes located in areas with high soil lead levels or with "poor" dust proofing had higher lead levels than those in areas with lower soil lead levels or with "medium" or "good" dust proofing; these relative differences remained after remediation. There was no evidence that lead loading was reduced by an increased opportunity to become aware of lead issues. We conclude that remediation is an effective strategy for reducing the lead exposure of children living in homes with high indoor lead levels.     

Lead poisoning among young children in Russia: concurrent evaluation of childhood lead exposure in Ekaterinburg,Krasnouralsk, and Volgograd

The Gore-Chernomyrdin Commission encouraged a binational collaboration to evaluate pediatric lead poisoning in Russia. The study evaluated children in three Russian cities: Krasnouralsk, a small city with minimal traffic centered around a copper smelter; and Ekaterinburg and Volgograd, both of which are large cities with multiple factories and heavy vehicular traffic. This project was the first international use of portable blood lead analysis instruments. In each city, at least 90% of children attending selected neighborhood kindergartens participated. We selected kindergartens on the basis of their proximity to industrial areas and major traffic corridors. We obtained capillary blood samples and analyzed for lead content and hemoglobin (Hgb) levels in the field, and collected environmental samples (i.e., indoor dust, tap water, play area soil, and interior and exterior paint) and analyzed for each participating school and in the homes of about 10% of the children who had elevated blood lead levels (BLLs; greater than or equal to 10 microg/dL). We calculated all age-, sex-, and city-specific geometric means using generalized estimating equations to account for covariance within kindergartens, and used multivariate logistic regression models to identify variables predictive of elevated BLLs. Overall, 23% of study children had elevated BLLs and 2% were anemic, defined as Hgb < 11 g/dL. Krasnouralsk had the highest geometric mean BLL (10.7 microg/dL), the highest percentage of children (60%) with elevated BLLs, and the highest percentage of anemic children (4%). All soil samples in Krasnouralsk had detectable lead levels. Volgograd was the only city that had paint samples with elevated lead levels. We found apparent city-specific differences in the percentages of children with elevated BLLs. Lead-contaminated soil and dust, which can result from lead-based automotive fuel and from lead-related industrial emissions, appear to be the most important routes of lead exposure of those evaluated in this study. Elevated lead levels found in paint samples from Volgograd may indicate old undercoats of lead-based paint that could represent a regionally rather than nationally important source of exposure.     

A preliminary study of residential paint lead concentrations in Johannesburg

While efforts are underway to phase out the use of leaded petrol in South Africa, relatively little attention has been devoted to the potential for childhood exposure to lead used in paint. This is one of the first studies undertaken on the African continent to report on the presence of lead-based paint. In South Africa, there is a dearth of information available on the extent of past and current use of lead-based paint. Recent studies demonstrate that large numbers of young South African children continue to be at risk of elevated blood lead concentrations. To investigate the prevalence of lead-based paint in Johannesburg dwellings, the South African Medical Research Council recently undertook a preliminary study in which samples of residential paint were collected from homes in 60 randomly selected suburbs across the city. The results indicate that 17% of all of the samples collected were lead-based paint (paint that contains lead levels equal to or greater than 0.5% by weight). The percentage of lead by weight in the samples ranged from 0.01% to 29.00%. Lead-based residential paint was found in 20% of the sampled homes, located in both new and old suburbs, and in suburbs from a variety of different socioeconomic backgrounds. These results, in conjunction with those emanating from other studies of childhood lead exposure currently being conducted by the Medical Research Council, indicate that weathering, peeling, or chipping lead-based paint may play an important role in childhood lead exposure in South Africa. Children who have a pica tendency may be at particular risk.     

The effect of soil abatement on blood lead levels in children living near a former smelting and milling operation

OBJECTIVE: To evaluate the effect of soil abatement on children's blood lead concentrations and on environmental levels of lead and arsenic. METHODS: Two cross-sectional surveys were conducted. The first (1989) was of a random sample of 6- to 72-month-old children (n=112). The second (1998) included all 6- to 72-month-old children whose parents agreed to participate in the survey (n=215). From 1993 to 1996, soil abatement was conducted around homes with average soil lead concentration >500 parts per million (ppm). Venipuncture blood samples were taken, interviews were conducted, and samples of house dust, soil, water, and paint were tested for lead and arsenic, using identical protocols in both surveys. The expected decline in blood lead concentrations were calculated for children who lived in houses that were abated, compared with children who lived in houses that were not abated. RESULTS: Lead and arsenic in soil and interior dust in homes that underwent soil abatement declined significantly compared to unabated homes (p<.05). After adjustment for potential confounders, the blood lead concentration in children ages 6 to 72 months who lived in soil-abated housing declined 42.8% faster than children who lived in unabated housing (p=0.14). In children ages 6 to 36 months, the decline was 45.4% faster (p=0.03). The estimated reduction in blood lead for children ages 6 to 36 months was 3.5 micro g/dL for every 1,000 ppm reduction in soil lead concentration (95% confidence interval [CI]=2.4 micro g/dL, 4.6 micro g/dL). CONCLUSION: Soil abatement was associated with a significant decline in children's blood lead and indoor environmental levels of lead and arsenic.     

Fecal lead excretion in young children as related to sources of lead in their environments

Summary Fecal lead excretion (PbF) was studied in young children with elevated lead exposure. PbB was generally 40–70 g/dl. The children's home environments were classified as to lead-base paint hazard and traffic density. There was a significant correlation between paint hazard classification and PbF but not between traffic density and PbF. There also was a correlation of PbB with paint hazard classification. Long-term fecal collections were instituted using 10 children who lived in high hazard homes and three children with low PbB's, whose PbF's were considered normal. Among the children living in high hazard homes, median fecal lead excretion generally was only moderately elevated. Grossly elevated amounts of lead were found only occasionally and only in a few of the children. Movement of two children from a high hazard home to a low hazard home resulted in prompt and substantial reduction in PbF. By contrast, PbB fell only very slowly.This study was supported by a grant from the US National Science Foundation—RANN Program, Grant 77-22186     

Association between children's blood lead levels, lead service lines, and water disinfection, Washington, DC, 1998-2006

Objective

Evaluate the effect of changes in the water disinfection process, and presence of lead service lines (LSLs), on children’s blood lead levels (BLLs) in Washington, DC.

Methods

Three cross-sectional analyses examined the relationship of LSL and changes in water disinfectant with BLLs in children <6 years of age. The study population was derived from the DC Childhood Lead Poisoning Prevention Program blood lead surveillance system of children who were tested and whose blood lead test results were reported to the DC Health Department. The Washington, DC Water and Sewer Authority (WASA) provided information on LSLs. The final study population consisted of 63,854 children with validated addresses.

Results

Controlling for age of housing, LSL was an independent risk factor for BLLs ≥10 μg/dL, and ≥5 μg/dL even during time periods when water levels met the US Environmental Protection Agency (EPA) action level of 15 parts per billion (ppb). When chloramine alone was used to disinfect water, the risk for BLL in the highest quartile among children in homes with LSL was greater than when either chlorine or chloramine with orthophosphate was used. For children tested after LSLs in their houses were replaced, those with partially replaced LSL were >3 times as likely to have BLLs ≥10 μg/dL versus children who never had LSLs.

Conclusions

LSLs were a risk factor for elevated BLLs even when WASA met the EPA water action level. Changes in water disinfection can enhance the effect of LSLs and increase lead exposure. Partially replacing LSLs may not decrease the risk of elevated BLLs associated with LSL exposure.     

Occurrence and determinants of increases in blood lead levels in children shortly after lead hazard control activities

This study is an examination of the effect of lead hazard control strategies on children's blood lead levels immediately after an intervention was conducted as part of the US Department of Housing and Urban Development's Lead-Based Paint Hazard Control Grant Program. Fourteen state and local government grantees participated in the evaluation. The findings indicated an overall average reduction in the blood lead levels of 869 children soon after the implementation of lead hazard controls. However, 9.3% of these children (n = 81) had blood lead increases of 5 microg/dL or more. Data routinely collected as part of the evaluation, as well as additional information supplied by the individual programs, were used to determine potential reasons for these observed increases in blood lead. A logistic regression analysis indicated that three principal factors were associated with the blood lead increases: the number of exterior deteriorations present in the child's home (prior to intervention), the educational level of the female parent or guardian of the child, and the child's age. The statistical analysis did not find evidence that children living in households that either did not relocate or relocated for less than the full work period were significantly more likely to have a blood lead increase equal to or greater than 5 microg/dL than children living in households that fully relocated. Statistical analyses also did not reveal any single interior strategy to be more or less likely than others to be associated with a blood lead increase of 5 microg/dL or more.     

Blood lead in children and its determinants in Nagpur, India

In a community-based cross-sectional study of 297 children aged 6 months to 6 years in an Indian city, the authors assessed the prevalence of elevated (> or = 10 microg/dL) blood lead (PbB) levels, their risk factors, and the lead contents in potential environmental sources. Mean PbB was 18.4 microg/dL +/- 16.5. The prevalence of elevated PbB was 67%. Anticipated risk factors for elevated PbB were living in houses painted with lead-based paint, odds ratio (OR) 6.42 (1.75, 23.6; p = 0.005), recent exposures to lead-based paint, OR 2.61 (1.07, 6.66; p = 0.03), and the use of the eye cosmetic ma," OR 2.63 (1.24, 5.56; p = 0.01). Unanticipated results were effect of upper caste as a risk factor, OR (adjusted) 1.85 (95% CI = 0.96, 3.57; p = 0.06), and the lack of effect of traffic, parental occupational exposure, or nutritional status. Analysis of various environmental sources such as paint, pencils, crayons, and clay revealed high lead levels. These results demonstrate the existence of a major environmental health problem in Indian children, with risk factors that differ from those in other countries.     

Evaluation of the HUD lead hazard control grant program: early overall findings.

This study evaluates the effectiveness of lead hazard control methods used in the Lead Hazard Control (LHC) grant program of U.S. Department of Housing and Urban Development. The LHC Program awards funds to local jurisdictions to address lead hazards in privately owned, low-income dwellings. Grantees in 14 cities, states, or counties collected environmental data in over 2600-treated dwellings making this the largest study of residential lead hazard control ever undertaken. Grantees employed a range of treatments, the most common being replacement of windows and repair of deteriorated lead-based paint. In this paper, dust lead loading levels and blood lead levels of children (6 months-6 years, if present) were observed at four periods of time (preintervention, immediate, and 6- and 12-months postintervention) in 1212 dwellings. Dust lead loading levels were also observed in a subset of these dwellings at 24- and 36-months postintervention. The geometric mean floor and window dust lead loadings declined at least 50 and 88% (P<0.0001), respectively, immediately postintervention. Three years later, floor dust lead loadings remained at or below the immediate postintervention levels. Window dust lead loadings had moderate increases, but remained substantially reduced from preintervention levels and below clearance standards. At 1 year after intervention, geometric mean age-adjusted blood lead levels had declined from 11.0 to 8.2 microg/dL, a 26% decline (P<0.0001). The LHC Program interventions produced blood lead declines similar to or greater than the percentage changes reported in earlier 1-year lead intervention studies.     

A randomized trial of education to prevent lead burden in children at high risk for lead exposure: efficacy as measured by blood lead monitoring

In this article we report on the effectiveness of a community-based, culture-specific, controlled trial of intensive peer education aimed at preventing lead burden in children 0-36 months of age within a neighborhood with high risk for lead exposure. Mothers (n = 594) were randomly assigned to control or intervention groups. Offspring blood lead levels were assessed every 4 months. All participants received brochures on basic lead prevention strategies. Intervention participants were offered 20 bi-weekly educational sessions by same-ethnicity peer educators over the course of 1 year, and quarterly booster sessions for 2 years afterward. The intervention group's educational curriculum included information on lead sources (e.g., paint, dust, water, soil, and risks from home repairs and remodeling), health consequences of lead burden, and strategies to reduce lead exposure, including household cleaning, hygiene, safe use of water, and nutritional recommendations. Results indicated that of the 378 children contributing sufficient blood data for analysis, 23% had blood lead levels > 10 micro g/dL before 3 years of age. Intervention participants were more likely to maintain blood lead levels < 10 micro g/dL than were controls (81% vs. 73%; p = 0.08). Multivariate analyses demonstrated that the intervention reduced the risk of blood lead levels > 10 micro g/dL by approximately 34%. We conclude that although intensive education resulted in a lower proportion of children with elevated lead levels, education alone cannot be relied upon to prevent lead burden.     

Validation of a 20-year forecast of US childhood lead poisoning: Updated prospects for 2010

We forecast childhood lead poisoning and residential lead paint hazard prevalence for 1990-2010, based on a previously unvalidated model that combines national blood lead data with three different housing data sets. The housing data sets, which describe trends in housing demolition, rehabilitation, window replacement, and lead paint, are the American Housing Survey, the Residential Energy Consumption Survey, and the National Lead Paint Survey. Blood lead data are principally from the National Health and Nutrition Examination Survey. New data now make it possible to validate the midpoint of the forecast time period. For the year 2000, the model predicted 23.3 million pre-1960 housing units with lead paint hazards, compared to an empirical HUD estimate of 20.6 million units. Further, the model predicted 498,000 children with elevated blood lead levels (EBL) in 2000, compared to a CDC empirical estimate of 434,000. The model predictions were well within 95% confidence intervals of empirical estimates for both residential lead paint hazard and blood lead outcome measures. The model shows that window replacement explains a large part of the dramatic reduction in lead poisoning that occurred from 1990 to 2000. Here, the construction of the model is described and updated through 2010 using new data. Further declines in childhood lead poisoning are achievable, but the goal of eliminating children's blood lead levels > or =10 microg/dL by 2010 is unlikely to be achieved without additional action. A window replacement policy will yield multiple benefits of lead poisoning prevention, increased home energy efficiency, decreased power plant emissions, improved housing affordability, and other previously unrecognized benefits. Finally, combining housing and health data could be applied to forecasting other housing-related diseases and injuries.     

Low-cost household paint abatement to reduce children's blood lead levels

The purpose was to examine the effectiveness of low-cost abatement on children's blood lead levels. Blood lead was analyzed before and after abatement in 37 homes of children under 7 years old with initial blood lead levels of 25-44 microgram/dL. Ninety-five percent of homes were built before 1950. Abatement methods used were wet-scraping and repainting deteriorated surfaces and wrapping window wells with aluminum or vinyl. A control group was retrospectively selected. Control children were under 7 years old, had initial blood lead levels of 25-44 microgram/dL and a follow-up level at least 28 days afterward, and did not have abatements performed in their homes between blood lead levels. After abatement, statistically significant declines occurred in the intervention children's blood lead levels. The mean decline was 22%, 1 to 6 months after treatment. After adjustment for seasonality and child's age, the mean decline was 6.0 microgram/dL, or 18%. The control children's blood levels did not decline significantly. There was a mean decline of 0.25 microgram/dL, or 0.39%. After adjustment for seasonality and age, the mean decline for control children was 1.6 microgram/dL, or 1.8%. Low-cost abatement and education are effective short-term interim controls.     

The influence of common area lead hazards and lead hazard control on dust lead loadings in multiunit buildings

Owners of multiunit buildings built before 1978 that have interior common areas, and who receive certain forms of federal assistance are generally required to address lead-based paint hazards in those common areas. This study examines the relationships between common area paint and dust lead levels and the floor dust lead loadings in associated dwelling units, as well as the effects of lead hazard control treatments in common areas. This article presents data from common areas in 145 low-income, mostly pre-1940, multiunit buildings with 342 associated dwellings in the U.S. Department of Housing and Urban Development Lead Hazard Control Grant Program at preintervention, clearance, and 1-year postintervention. Interior common areas in these multiunit buildings were not as well maintained as the dwellings in the buildings. At preintervention, a higher percent of the interior common areas had non-intact, lead-based paint on windows, doors and trim, and other interior components than in associated dwellings (95% versus 85%; 78% versus 67%; and 85% versus 62%). Common areas had preintervention entry and interior (i.e., nonentry) floor dust lead loadings more than four times higher than in dwelling units (128 versus 30 micro g/ft(2); 130 versus 28 micro g/ft(2)) while 1-year postintervention common area dust lead loadings are four to six times that of dwelling dust lead loadings (41 versus 11 micro g/ft(2); 44 versus 8 micro g/ft(2)). Windowsill dust lead loadings in common areas were twice the loadings in dwelling units at preintervention and 1-year postintervention (756 versus 383 mu g/ft(2); 154 versus 68 micro g/ft(2)). Interior common area treatments reduced geometric mean common entry dust lead loadings 71% from preintervention to clearance, and maintained those reduced levels from clearance to 1-year postintervention. Higher level interventions were not more effective than low-level interventions in reducing preintervention levels to clearance or 1-year postintervention. This study demonstrates that interior common areas in the multiunit buildings examined contain substantial amounts of deteriorated lead-based paint and dust. Remediation of common areas can effectively reduce those hazards.     

Status of children's blood lead levels in Pakistan: implications for research and policy

OBJECTIVES: Data on blood lead levels, sources of lead and health effects were reviewed among children in Pakistan. METHODS: A systematic review was conducted of published studies found through PubMed, an index of Pakistani medical journals PakMediNet and unpublished reports from governmental and non-governmental agencies in Pakistan. RESULTS: With the exception of a few studies that had adequate sample sizes and population-based samples, most studies were small and used convenience sampling methods to select study subjects. Overall, blood lead levels declined from 38 microg/dl in 1989 to 15 microg/dl in 2002. The major sources of lead that directly or indirectly resulted in lead exposure of children included: leaded petrol; father's occupation in lead-based industry; leaded paint; traditional cosmetics; and remedies. Apart from leaded petrol, there was no information regarding the level of lead in other sources such as paints and the household environment. Very little information was available regarding the adverse health effects of lead among children. CONCLUSION: The phasing out of leaded petrol was a commendable mitigation measure undertaken in July 2001 in Pakistan. A comprehensive assessment is now needed urgently to explore other sources of lead contributing to adverse health effects, and to plan intervention options with the ultimate goal of reducing the burden of disease due to lead exposure.     

Reductions in blood lead levels among school children following the introduction of unleaded petrol in South Africa

Epidemiological studies have indicated that in the 1980s and early 1990s (a period in which petrol lead concentrations in South Africa ranged from 0.836 to 0.4 g/L), large proportions of urban South African children were at risk of excessive exposure to environmental lead. In 1991, when the maximum permissible petrol lead concentration in the country equaled 0.4 g/L, a study determined that the mean blood lead level among children attending inner city schools in the Cape Peninsula equaled 16 microg/dL, with well over 90% of children having blood lead levels equaling or exceeding the internationally accepted guideline level of 10 microg/dL. Socio economic status, housing conditions, and proximity of children's schools and homes to heavily trafficked roads were among the factors significantly associated with blood lead concentrations. In 1996, unleaded petrol was introduced in South Africa. A study undertaken in 2002 (at the same schools as in 1991), when unleaded petrol constituted around 30% of the market share of petrol in the country, has shown significant reductions in the mean blood lead concentration among Cape Peninsula inner city children and in the proportion of children with elevated blood lead levels. The mean blood lead level for the total sample (n = 429) of children whose mean age equaled 7 years (range: 5-11 years) was 6.4 microg/dL (range: 1.0-24.5 microg/dL) and 10% of children had blood lead levels equalling or exceeding 10 microg/dL. The mean blood lead levels among children attending schools in an inner city and in a less heavily trafficked periurban suburb were 6.9 and 4.8 microg/dL, respectively.     

Declining blood lead levels in Victorian children

Abstract: To investigate the distribution of blood lead levels in a sample of Victorian children, and to compare current levels with those from a similar survey in 1979, blood was tested for lead in 252 children (123 under five years) attending Royal Children's Hospital as outpatients and having venepuncture blood samples for medical reasons. Blood lead levels were determined by graphite furnace atomic absorption spectrophotometer. The mean blood lead level was 0.26 μmol/L (5.4 μg/dL). In the under-five age group, the mean was 0.28 μmol/L (5.7 μg/dL). Only 1.6 per cent of this group exceeded the National Health and Medical Research Council action level of 0.72 μmol/L (15 μg/dL). Levels in this age group have declined significantly since 1979, when the mean was 0.54 μmol/L (11.1 μg/dL) and 12.9 per cent exceeded 0.72 μmol/L (15 μg/dL). Average blood lead levels have halved since 1979, with likely contributing factors being reduced exposure from lead in diet, reduced access to lead in paint and reduced lead in ambient air. Children with elevated levels had identifiable risk factors such as pica or exposure to lead-based paint, suggesting the need for ongoing public health action to prevent exposure in these groups.     

Childhood Lead Poisoning in Russia: A Site-specific Pediatric Blood Lead Evaluation

Abstract

Lead poisoning in children is an international concern. Health effects vary according to a child's blood lead level. Historically, the problem of lead poisoning in Russia had been defined by analysis of hair samples. In Saratov, Russia, during the spring of 1996, the authors conducted the first evaluation of blood lead levels among Russian children. The mean blood lead level of 579 samples analyzed at the Centers for Disease Control and Prevention was 7.7 μg/dL (range 3.0 to 35.7 μg/dL). The sensitivity of hair analysis in identifying blood lead levels above 10 μg/dL was 50% . Most of the environmental samples evaluated (including water, dust, paint, and soil) were within acceptable U.S. remediation standards. Almost one-fourth of the Russian children evaluated during this site-specific investigation had blood lead levels capable of causing adverse health effects in children. Hair analysis is not an adequate method for identifying these children. Additional investigations in other Russian cities are necessary in order to determine the extent of lead poisoning in Russia's children.     

Childhood lead poisoning associated with tamarind candy and folk remedies--California, 1999-2000

Lead poisoning affects children adversely worldwide. In the United States, elevated blood lead levels (BLLs) (>10 microg/dL) result primarily from exposure to lead-based paint or from associated lead-contaminated dust and soil; however, other sources of lead exposure, including folk remedies, Mexican terra cotta pottery, and certain imported candies, also have been associated with elevated BLLs in children. This report describes five cases in California of lead poisoning from atypical sources. Health-care providers should be aware of the potential hazards of certain food products, and community members should be educated about potential sources of lead poisoning for children.