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					Children & Lead, in the US, at the Border

               Mychal L. Anderson Thomas
    South Texas Environmental Education and Research
                   February 26, 2009

•   History of Childhood Lead Poisoning
•   Lead Effects in Children
•   Mechanisms for lead neurotoxicity
•   Is there a Threshold?
•   Consumer Product Safety Commission
•   Sources of Lead Poisoning
•   Solutions & Conclusions
      History of Childhood Lead Poisoning
• 1904 – Australian physician, Dr. Lockhard Gibson, links lead
  based paint to childhood lead poisoning. He urges “use of lead
  paint within the reach of children should be prohibited by law”

• 1914 – In Baltimore, Henry Thomas & Kenneth Blackfan
  detail the case of a boy who died of lead poisoning after eating
  white lead paint from his crib railing

• 1920’s, 1930’s – several countries, including Belgium, Cuba,
  Great Britain, Greece, Poland, Spain, Sweden, Tunisia,
  Yugoslavia ban/restrict lead paint use

• 1930 – Noted in the US that lead poisoning resulting from
  paint on toys, cradles and woodwork is increasing in children
      History of Childhood Lead Poisoning
• 1930’s – Lead industry publicly targets advertising to children,
  advocates for interior lead paint while internally
  acknowledging the danger lead paint poses to these children

• 1935 – researchers recommend prohibiting the use of lead-
  containing paints for “toys, children’s furniture and for interior

• 1952 – lead paint industry blames victims, says problem
  rooted in “slums” and “uneducable” parents

• 1970 – federal legislation prohibits use of lead paint, the
  following year NYC tests paints and finds them to have high
  lead levels
                        Lead Effects in Children

• “Clinical evaluations indicate that the victim of lead
  poisoning is brain damaged rather than simply a less
  intelligent child”*
• Neuropsychological impairments decrease academic
  potential and impair activities of daily living

• Different deficit patterns in different children

* Lidsky & Schneider, 2005
     Mechanisms for lead neurotoxicity

• Direct neurotoxic actions:
     influence on neurotransmitter storage and
     release processes,
     second messengers,
     cerebrovascular endothelial cells,
     astroglia & oligodentroglia
      Mechanisms for lead neurotoxicity

• Neurotoxicity is mediated by lead’s ability to
  substitute for Ca++

• Lead crosses Blood Brain Barrier by substituting for
  Ca++ ions

• Lead is taken up by excitable cells via interactions
  with Ca++ mediated cellular functions
                 Is there a Threshold?
• >10µg/dL is currently considered elevated blood lead level

• Subclinical lead poisoning – lead produces a spectrum of
  toxicity including subclinical counterparts, such as lowered
  intelligence, impaired renal tubule function, elevated
  erythrocyte protoporphyrin

• Cognitive deficits associated with BLL <5µg/dL

• There does not appear to be a detectable threshold for
  adverse effects of lead exposure on cognitive
  development/academic abilities
     Consumer Product Safety Commission
• Created by the 1972 Consumer Product Safety Act

• Independent regulatory agency administered by commissioners
  appointed by the president and confirmed by the senate

• Task of monitoring >15,000 types of consumer goods

• Has authority to ban hazardous consumer products, initiate
  recalls, establish mandatory performance standards and warning
  and instruction requirements

• Does not test products – this is left up to manufacturers,
  importers, retailers
            Glory and Decline of CPSC
• 1979: $44 million budget, 900 staff, 545 recalls

• 1981: Congress requires CPSC to wait for industry to write
  standards, then prove industry standards wrong before
  imposing any mandatory standards

• 1988: budget down 22%, staff cut almost in half, recalls <200

• 2007: $63 million budget (less than half of founding budget if
  corrected for inflation), 400 staff (including only 15 import
              Sources of Lead Poisoning

• Major source of childhood lead
  poisoning continues to be
  deteriorating lead-based paint
  ingested from paint chips, lead-
  laden dust, soil from pre-1978

• For years the Lead Industries
  Association (LIA) specifically
  promoted white lead paint for use
  in low-cost residential housing,
  especially in urban areas
            Lead in Toys from China 2007
• Toy Industry:
   –   Hasbro $161.6 million in profits, $1.14 billion in revenue 2006
   –   Mattel produces 800million toys yearly
   –   80% of the world’s toys made in China
   –   Lead makes paint brighter and more durable

• Federal Hazardous Substances Act (FHSA)
   – Household products exposing children to hazardous quantities of lead
     under reasonable foreseeable conditions of handling or use are
     “hazardous substances.” Household products not intended for children
     but which create risk of injury because they contain lead require
     precautionary labeling. A toy or other article intended for use by
     children which contains a hazardous amount of lead that is accessible
     for children to ingest is a banned hazardous substance.
          Lead in Toys from China 2007
“It has been all about price, and it is that very desire for lower
   prices that creates the problem” ~ Charles Hinnant, president,
   Charkit Chemical
• Large toy companies dependent on cheap Chinese production
   for most of their wares
• Limited regulatory environment in China, Quality control a
   significant issue, Chinese feel bullied by foreign companies to
   cut costs, thus squeezing their own suppliers
• Bargaining – “you get what you pay for”, price negotiation
   may implicitly negotiate quality
• Some companies had products more affected than others,
   depending on how stringent company testing and inspection
   policies were
  The US-Mexico Bi-National Community
       & Lead Risks for Children
• High risk
  – Ceramics
  – Tamarind & Other dulces
  – Chapulines
  – Folk Remedies (greta, azarcon)
          Ceramics – Study in Oaxaca City

• In Oaxaca state, small family businesses produce traditional lead-glazed
  ceramic-ware. Oaxaca city chosen to look at non-occupational exposures
  outside of Mexico City.

• Questionnaire administered & blood lead levels drawn on 220
  8-10 year olds
   – Mean blood lead level 10.5µg/dL

• Mean value for mothers was 13.4µg/dL

• Lead-glazed pottery was the most predictive questionnaire item of blood
  lead levels
                     Ceramics & Tamarind

• Lead glazed ceramic pots used to package some tamarind candy/jelly
• Tamarind candy is acidic, increasing lead leaching
• Chili, often in candies, can be lead contaminated through air or fuel assisted
• 1999 Oklahoma City-County Health Dept tested 2 types of tamarind suckers and
  their packaging for lead. >50% exceeded the FDA Level of Concern
• 1993 case in California
   – 6 year old boy identified via routine screening at well-child exam. BLL
      59µg/dL. He required 7 chelation therapy tx to reduce his BLL
   – 5 siblings, age 11-17, tested the same year and found BLL 35-46 ug/dL
   – BLLs coincided with return of maternal aunt from Mexico. She brought
      tamarind candy jam products in personal baggage

• Chapulines – toasted grasshoppers, popular snack, famous in Oaxaca

• Grasshoppers bioaccumulate

• 2000 – Seaside clinic, Monterey County, CA, excess elevated BLL cases
  noted, linked to imported chapulines sold locally

• 2003 – FDA warning issued against eating chapulines,
  found to contain as much as 2,300µg lead per gram
  of product (federal guidelines for children <6yo,
  6µg from all food sources)
   Traditional Remedies – tx for “empacho”
• greta and azarcon (lead tetroxide)
   – fine powders
   – total lead content 70% to > 90%.
   – large surface area for potential absorption
   – administered to infants and children

• 1982 case
   – 15 month old & 3 year old treated with multiple doses azarcon for
     chronic diarrhea refractory to ampicillin
   – Taken to San Diego hospital, 15 month old had BLL 124µg/dL, 3 year
     old expired with seizures, azarcon-induced lead encephalopathy
     suspected cause of death

• From Dec 1, 1991- Dec 31, 1992, CA Dept of Health Services received
  reports of 40 cases of BLL >= 20µg/dL in children who had received
  traditional ethnic remedies, 89% Hispanic
             Solutions and Conclusions

• Education – of families on both sides of the border

• Bi-National Cooperative Efforts – between US and Mexican
  government and health ministry

• Healthcare Providers – know what to ask, know risks

• Target producers – 2001 Dulmex tamarind candy roll recall

• Routine screening

• Role of the FDA – has banned some tamarind imports,
              Solutions and Conclusions

• CPSC needs teeth:
   – Readapt law code to allow for CPSC to more easily create mandatory
   – Funding for enforcement of standards
   – Increase staffing in import inspection role

• Companies working with international suppliers:
   – due diligence, including direct visits and reference checks
   – Evaluate quality through the 10th shipment (quality may decline after
     first few shipments)
   – Ultimate responsibility lies with the US company purchasing foreign
              Solutions and Conclusions

• Lead poisoning is a serious issue:
   – 12.8 million US children born from 1972-1988
     adversely affected by lead exposure (BLL>2.5µg/dL)
   – Nearly 1 million US children continue to have BLL at
     or > 10µg/dL, millions more have levels between 2.5
     and 10µg/dL

• The major concern is still lead paint in old houses
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