Lead poisoning: Yes, it’s still a problem
Many people, especially in the state of Washington, assume that lead poisoning is a problem of the past or exists only in other parts of the United States. In Washington, we see this perspective reflected in our low rates of blood lead level testing: in 2018, Washington providers tested only 4.2% of children under 72 months of age. This is significantly lower than the 17.6% national rate for the same year.
The prevalence of elevated blood lead levels in children has decreased substantially since the regulations banning lead from paint and gasoline in the late 1970s. However, there are still many sources of lead exposure that place children at risk of lead poisoning. We encourage all healthcare providers to learn about exposure sources, talk to their patients about lead exposure, and test blood lead levels in patients who may be at risk.
The following is not a comprehensive list of lead exposure sources. Visit the Washington Department of Health’s Common Sources of Lead Poisoning for more information.
Housing & other environmental sources
Lead-based paint is the most common source of lead exposure in Washington for children. Approximately 14% of our state’s housing stock has “elevated lead risk due to age,” meaning housing built prior to 1978, the year the federal government banned consumer uses of lead-based paint. Even if pre-1978 paint is hidden under newer, non-leaded paint, paint can wear away in areas of high friction (e.g., window and door frames). This causes an accumulation of lead-contaminated dust and paint chips, which children then inhale or ingest when the dust gets on their hands or toys.
The prevalence of housing-associated lead exposure risk differs vastly across our state. For example, northern and western areas of Spokane County have low to moderate risk, while areas around the city of Spokane and in southeastern Spokane County have high risk. See Figure 1 and explore your community’s housing-related lead risk with this map.
Although old paint is the most common lead exposure source, it is far from the only one. Soil can retain lead following continuous pollution. For example, an estimated 1,000 square miles of soil in the Puget Sound basin are contaminated with lead and other heavy metals due to a century of air pollution from the Asarco Company copper smelter in Tacoma. In addition to smelter plumes and smokestack emissions, other sources of soil contamination with lead include lead-arsenate pesticides in former orchard lands, slag (i.e., solid industrial waste containing hazardous materials) and liquid waste from metal smelting, and pollution nearby heavily trafficked roads.
Older water distribution lines can also contain lead. Leaching may occur if the water has low mineral content or is acidic, especially when running hot water. Washington state legislature now mandates lead testing of drinking water outlets in schools built prior to 2016 (see results here; schools have until 2026 to complete their initial round of testing). Testing does not regularly occur in homes, however. Lead in drinking water can stem from other sources, as well. Residents of Northport, Washington continue to deal with fallout from the Teck Cominco smelter in Trail, British Columbia. From 1906 to 1996, the smelter dumped a daily average of 450 tons of slag directly into the Columbia River. The slag concentrated where the river flows through Northport, subsequently exposing generations of residents to lead and other heavy metals.
Although cars and trucks haven’t used leaded gasoline since the 1970s, leaded fuel is still used in many small planes. As of 2021, airports are mandated by Congress to sell leaded aviation fuel. While old paint, soil, and water are larger contributors of lead poisoning, leaded aviation fuel is the leading airborne source of lead exposure. Residents who live near airports such as Boeing Field (King County International Airport) — which sells leaded fuel and houses small planes — are at an increased risk of lead exposure through the air.
Imported and unregulated items
Some imported and culturally significant items contain high levels of lead. For example, a recent study on aluminum cookware (pressure cookers, pots, and pans) popular with Afghan refugees in Washington found high levels of lead in many items that were brought to the United States, purchased from local stores, or online. Researchers noted one pot with a lead concentration of 66,374 ppm. In addition to cookware, lead is sometimes found in handmade or imported glazed ceramic ware and pottery.
An array of cosmetics may contain lead, especially those from the Middle East, India, and other parts of Asia. Dermal absorption of lead is minimal, but hand-to-mouth behaviors can expose individuals. Potential lead-containing cosmetics include surma, kohl, kajal, and sindoor.
Traditional or home remedies are an additional potential exposure source:
- Azarcon and Greta in Latinx communities, used to treat an upset stomach, constipation. These remedies may also be used on teething babies.
- Paylooah in Vietnamese and Hmong communities, used to treat rash or fever.
- Ghasard, Bali Goli, and Kandu in Asian Indian communities, used to treat an upset stomach.
- Diep Bao, a popular Vietnamese eczema cream.
Prevention strategies for individuals and families
Lead exposure is cumulative and most dangerous when it builds over time. Removing and avoiding potential sources of exposure are the most effective prevention strategies. However, doing so may be costly and not accessible to everyone. Exposure mitigation strategies include:
- Old paint: Regularly clean areas around windows and doors with damp washcloths or mops.
- Water: Flush pipes each morning by turning on water and running for at least 30 seconds. Only use cold water for cooking and drinking. Flush pipes again before drinking water or making a baby’s formula.
- Soil: Keep soil out of the home by removing shoes before coming indoors and immediately changing clothes, especially after any outdoor activities (e.g., gardening, working, or playing outdoors)
- Cosmetics: Wash hands after use and do not use on children
- Cookware & dishes: Do not eat off of glazed pottery. Replace aluminum cookware with stainless steel. If replacement is not an option, follow these tips to reduce potential exposure.
See additional prevention strategies here.
A call to action for healthcare providers
A blood lead level test is the only way to know if a child or adult has been exposed to lead. As a healthcare provider, you play a crucial role in asking about potential lead exposure sources, testing those who may be at risk, and connecting them to follow up services. Our next post will focus on recommendations for diagnosing, providing personalized guidance to reduce or mitigate exposure, and treating when necessary.
