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Childhood Lead Poisoning Prevention Branch
Sources of Lead Exposure Data 2020-2021

Childhood lead poisoning prevention branch

Sources of Lead Exposure for Full Cases Fiscal Year (FY) 2020 to 2021

Extracted from the 2024 Biennial Report (PDF). Please refer to References section of the 2024 Biennial Report for in-text citations made on this page.

Page Contents:

7) Sources of Lead Exposure
Methods

Table 8. Definitions of Housing-Related Sources of Lead Exposure
Table 9. Categories and Examples of Non-Housing Sources of lead Exposure

Results

Table 10. Demographic Characteristics of Dull Cases, Fiscal Year 2020-21 (n=175)
Table 11. Sources of Lead Exposure Among Full Cases, Fiscal Year 2020-21 (n=175)
Table 12. Source of Lead Exposure at Current Regulatory Levels by Demographic Characteristics Among Full Cases, Fiscal Year 202-21 (n=175)

Distribution of Housing-Related Sources of Lead Exposure

Figure 2. Total Occurrences of Housing-Related Sources of Lead Exposure Among Full Cases, Fiscal Year 2020-21 (n=175)
Table 13. Total Occurrences of Housing-Related Sources of Lead Exposure by Race/Ethnicity Among Full Cases, Fiscal Year 2020-21 (n=120)

Removal, Remediation, or Abatement of Identified Housing-Related Sources of Lead Exposure
Distribution of Non-Housing Sources of Lead Exposure

Figure 3. Total Occurrences of Non-Housing Sources of Lead Exposure Among Full Cases, Fiscal Year 2020-21 (n=99)
Table 14. Total Occurrences of Non-Housing Sources of Lead Exposure by Race/Ethnicity Among Full Cases, Fiscal Year 2020-21 (n=99)

7) Sources of Lead Exposure

CLPPB analyzed sources of lead exposure for children who were newly identified as full cases in FY 2020-2021 and consented to full case management, including environmental services. Every child meeting the full case definition is eligible to receive both PHN case management services and an EI by an EP. During an EI, the EP assesses the child's environment for lead exposure sources in paint, dust, soil, and water, and documents the results. The PHN performs a home visit often at the same time as the EI, which includes collecting information to evaluate and coordinate the necessary services. The EP, with assistance from the PHN, identifies suspect non-housing items and may submit these items for laboratory analysis. “Non-housing sources" are sources of lead exposure other than housing-related paint, dust, soil, and water, for example food items, cosmetics, or potteries (Table 9).

In FY 2020-2021, initial EI started as a remote exposure assessment by a structured questionnaire on the phone due to COVID-19 pandemic, then, based on family's consent, an on-site EI was completed. When housing-related lead sources are identified, EPs work with property owners to remediate them expediently. Properties remain open to follow up until the property passes a clearance inspection. A successful clearance inspection includes, at a minimum, a visual inspection to verify all required work was completed properly, as well as collection and analysis of dust wipe samples. For full cases where paint, dust, soil, and/or water were identified as a source, CLPPB reviewed whether the sources of lead exposure were removed, remediated, or abated.

Methods

In this analysis, only children with BLLs meeting the full case criteria during FY 2020-2021 who received full case management, including environmental services, were included. As of July 1, 2016, children meet full case criteria with either a single venous BLL at or above 14.5 µg/dL or persistent levels at or above 9.5 µg/dL. Data on blood lead results were gathered from the RASSCLE database.

Exposure assessment data came from two sources:

EPs collected samples and information about housing-related sources of lead exposure, such as paint, dust, soil, and water as well as non-housing items. The lead content in these samples were measured by X-Ray Fluorescence (XRF) screening by EPs, as well as quantitatively in the environmental health laboratories.
PHNs collected information about non-housing sources of lead exposure, such as the child's behavior, food, products used for cooking, and alternative medicines, using a structured questionnaire during the home visit.

Race/ethnicity data were also collected by the PHN during the home visit. CLPPB collects race/ethnicity data in a two-question format similar to the Federal Office of Management and Budget (OMB) race and Hispanic ethnicity categorization. Race/ethnicity data collection was based on a parent's report of the child's identity with the ability to select all applicable races and one applicable ethnicity. Race category choices in the lead follow-up forms were:

Native American/Alaskan
Black/African American
White
Asian
Pacific Islander
Other
Decline to state.

If a parent identified the child as Asian or Pacific Islander, they were asked to further select from more detailed categories of Asian and Pacific Islander races. If the parent identified the child as “Other" race, they were asked to specify. Ethnic background categories were:

Not Hispanic/Spanish/Latino
Yes, North American (Mexican, Mexican American)
Yes, Central American
Yes, South American
Yes, Other Spanish/Hispanic/Latino.

Answers to 'Country of birth' question were also used to help race/ethnicity categorization for data analysis when needed. CLPPB followed the California Department of Public Health vital statistics reporting categories for race/ethnicity for the data analysis. Mutually exclusive race/ethnicity categories were:

Non-Hispanic Asian
Non-Hispanic Black
Non-Hispanic Hawaiian/Pacific islander
Hispanic (single race)
Multi-race (any ethnicity)
Non-Hispanic Native American/Alaskan
Non-Hispanic Other
Non-Hispanic White
Declined or Unknown

If a parent identified the child's race only as 'Other' and chose any of the 'Yes' Hispanic ethnicity options, then the child was categorized as Hispanic (single race). If multiple race categories were checked, then regardless of Hispanic ethnicity status, the child was categorized as Multirace (any ethnicity). For simplicity, Hispanic (single race) children will be described hereafter as Hispanic children, and non-Hispanic children will be described by their race category alone (e.g., non-Hispanic Asian children will be referred to as Asian children). OMB made changes in their race/ethnicity categorizations in 2020, which affected our grouping for children of Afghan origin. Afghans mostly identified themselves as 'White', 'Asian' or 'Other' and specified as Afghan. Previously, Afghan children were categorized as 'White' in accordance with OMB recommendations. In 2020, OMB category for Afghans changed to 'Asian - Central Asian'. In our FY2020-21 analysis, Afghans are counted within the Asian category.

CLPPB reviewed EI documentation to identify housing-related sources associated with full cases. For each investigation, CLPPB measured lead in deteriorated paint, dust, and bare soil. Results of first- and second-draw water samples from kitchen sinks were also recorded, as well as water draws from other frequent drinking water locations. Paint, dust, and soil were categorized as lead exposure sources based on regulatory levels found in Title 17, California Code of Regulations (CCR), beginning with Section 35001. The Los Angeles County local health jurisdiction also categorized housing-related sources with their own regulatory statutes (Los Angeles County Code Section 11.28.010). Water results were categorized as exposure sources based on the United States Environmental Protection Agency (US EPA) action level (40 Code of Federal Regulations [CFR] Section 141.80). EPs identified lead housing-related sources based on direct known exposure to lead-poisoned children, including media below current regulatory standards but found to be significant based on a child's specific behavior and activity (Table 8).

Table 8. Definitions of Housing-Related Sources of Lead Exposure

Type of housing-related source	Current Regulatory Level	Lower “Actionable" Level
Paint	Deteriorated lead-based paint tested at the state regulatory level of greater than or equal to 1.0 milligram of lead per square centimeter of surface area (≥ 1.0 mg/cm²). In addition, full cases were attributed to paint at local regulatory level in Los Angeles at ≥ 0.7 mg/cm². (17 CCR Sections 35022, 35033, 35037; Los Angeles County Code Section 11.28.010) Paint was considered a source in situations where paint was below the regulatory level but found to be nuisance that may result in persistent and quantifiable lead exposure (17 CCR Section 35037).	Paint with lead ≥ 600 parts per million (ppm) was used. In 1978, the federal Consumer Product Safety Commission (CPSC) restricted lead in newly manufactured paint to 600 ppm. Additionally, 600 ppm is the level petitioners to the US EPA have been seeking to lower the federal definition of lead-based paint. Since there is incongruence of unit equivalency between ppm and mg/cm², the level chosen for XRF instruments was 0.1 mg/cm², which is the lowest level detectable to the tenths place to be most health protective.
Dust	Lead-contaminated at greater than or equal to 40 micrograms of lead per square foot of surface area (≥ 40 µg/ft²) for interior floor surfaces, ≥ 250 µg/ft² for interior horizontal surfaces, and ≥ 400 µg/ft² for exterior floor and exterior horizontal surfaces. (17 CCR Sections 35035, 35037)	Lead levels ≥ 10 µg/ft² for interior floor surfaces, and ≥ 100 µg/ft² for interior horizontal surfaces were selected to match changes in federal dust standards that took effect January 6, 2020 but were not in effect at the time of when the cases received services.
Soil	Lead-contaminated at greater than or equal to 400 parts per million (≥ 400 ppm) in children's play areas. Soil was considered a source in situations where soil was below the regulatory level but found to be a nuisance that may result in persistent and quantifiable lead exposure (17 CCR Section 35037).	Bare soil with ≥ 80 ppm was used to match California Human Health Screening Levels (CHHSLs) proposed by the California Office of Environmental Health Hazard Assessment. The current CHHSL for lead in soil for residential property is 80 ppm.
Water	According to the US EPA Federal Lead and Copper Rule, greater than or equal to 0.015 milligrams of lead per liter of water (≥ 0.015 mg/L) is above the action level. (40 CFR Section 141.80)	Drinking water ≥ 0.005 mg/L was selected in light of the goal for water to show non-detect levels of lead. Since this level was the laboratory reporting limit, results below this level would not be available from laboratory reports used in the sample of cases selected.

Table 9. Categories and Examples of Non-Housing Sources of Lead Exposure

Category	Examples
Cosmetics/ Spiritual Religious Products	Black powder (e.g., kohl, surma, tiro), ceremonial powder, sindoor
Food/Spices/Drink	Dried grasshoppers (chapulines), turmeric, khmeli suneli, lozenna, imported candy
Take-home or Occupational	Exposed through either personal or parental work or hobby
Pottery & Utensils	Vintage/hand-made/imported pottery, leaded glassware, water dispenser/urn/samovar, food grinder
Other	Fishing weight, jewelry/charm/amulet, painted object, metal object, lead ammunition, deteriorated vinyl/plastic, game meat/fish (from leaded bullets/sinkers), lead batteries, and lead solder
Traditional Medicine/ Remedies	Azarcon, greta, ayurvedic remedy (e.g., Ghutti, Keasari Balguti), paylooah, traditional Chinese remedies
Retained bullet	No data
Perinatal exposures	Mother ate food high in lead content during pregnancy, mother took remedy high in lead during pregnancy

Any EI property found to have a lead housing-related source exceeding current regulatory levels must have it removed, remediated, or abated. Those properties remain open to EP follow-up until the completion of a clearance inspection. Passing a clearance inspection requires visual confirmation that lead housing-related sources have been corrected and quantifiable evidence through dust wipes that no lead-contaminated dust remains. CLPPB reviewed documentation from the corresponding EI properties to assess how many had passed clearance inspection. Acknowledging that children may still be exposed to lead below the current regulatory levels, CLPPB also analyzed housing-related lead exposure sources using lower “actionable" levels (Table 8). These lower levels are based on recent changes in action levels and recommendations and proposals under consideration by regulatory agencies. Lead exposure source categories were then compared by current regulatory levels versus lower “actionable" levels.

Information reported to CLPPB about non-housing sources (Table 9) was reviewed by a CLPPB physician to determine whether each potential source was a probable source of lead exposure for the child. Determination was based on quantitative XRF and/or laboratory results; results of testing the item with a qualitative method (chemical test kit lead swab); amount, timing, and length of the child's access to the item; and whether there is a significant history of demonstrated high lead content for a given potential source. In addition, the physician considered information about whether removal of the item from the child's environment was associated with a decline in BLL.

There may be several lead exposure sources identified for a child meeting full case criteria. When multiple exposure sources are identified, the exact contribution of each source to the child's initial BLL cannot be verified. CLPPB counted each possible exposure source separately for the child; for example, if both dust and paint levels are found above the regulatory levels, then both dust and paint were counted as possible lead exposure sources.

CLPPB performed descriptive analyses of demographic characteristics, BLLs, and exposure sources. In addition to identifying the sources of lead exposure, CLPPB analyzed how sources of lead exposure differed by race and ethnicity of the child. To compare the groups, CLPPB used a chi-square test. Statistical significance was defined as p ≤ 0.05. Analyses were done using SAS software, version 9.4 (Copyright © 2017, SAS Institute Inc., Cary, NC, USA).

Results

In FY 2020-2021, there were 269 new children meeting full case criteria. Of those 269 new childhood lead cases, 175 (65.1%) received full case management services (both home visit and on-site environmental investigation) and 168 unique properties went through an environmental investigation. In some cases, there were multiple children with case-making BLLs living in the same property; in other cases, family moved and a second EI was done in the new house (n=20).There were several reasons for incomplete home visits and/or EIs: persistent refusal (n=46), remote exposure assessment (n=24), uncooperative family (n=7), other administrative reasons (n=6), moved away (n=3), aged-out (n=1), or missing information (n=7); these children are excluded from results.

The characteristics of children who received full case management services are described in Table 10. Most of the full cases were less than 6 years old (90.9 percent), female (50.3 percent), Hispanic-single race (57.7 percent). Of the 175 children who received full services, five (2.9 percent) had a BLL higher than 44.4 µg/dL, 120 (68.6 percent) had a BLL between 14.5 and 44.4 µg/dL, and 50 (28.5 percent) had a BLL between 9.5 and 14.4 µg/dL.

Table 10. Demographic Characteristics of Full Cases¹, Fiscal Year 2020-21 (n=175)

Characteristic: Age	n=175	Percent (%)
Less than 6 years	159	90.9
Between 6 and 21 years	16	9.1

Characteristic: Sex	n=175	Percent (%)
Female	88	50.3
Male	87	49.7

Characteristic: Race/Ethnicity	n=175	Percent (%)
Non-Hispanic Asian (n=50)²	[Separated below]	[Separated below]
Afghan	17	9.7
Asian Indian	22	12.5
Cambodian	2	1.2
Chinese	2	1.2
Filipino	1	0.6
Japanese	1	0.6
Pakistani	4	2.2
Tibetan	1	0.6
Unspecified	1	0.6
Non-Hispanic Black	5	2.8
Non-Hispanic Hawaiian/ Pacific Islander³	0	0
Hispanic (Single race)	101	57.7
Multi race (any Hispanic status)	1	0.6
Non-Hispanic Native American/Alaskan	0	0
Non-Hispanic Other Race (unspecified)	1	0.6
Non-Hispanic White	13	7.4
Declined or unknown	4	2.3

¹ As of July 1, 2016, the definition of a case eligible for full case management services is either a single venous BLL at or above 14.5 micrograms (µg)/deciliter (dL) or persistent 9.5 µg/dL.

²No full case was identified, specifically, as Bangladeshi, Burmese, Hmong, Indonesian, Korean, Laotian, Malaysian, Sri Lankan, Taiwanese, Thai, or Vietnamese as an Asian sub-group within the Non-Hispanic Asian category.
³ No full case was identified, specifically, as Fijian, Hawaiian, Guamanian or Chamorro, Marshaleese, Native Hawaiian, Samoan, or Tongan as a Pacific Islander sub-group within the Non-Hispanic Hawaiian/Pacific Islander category.

Based on current regulatory levels, lead exposure source was unknown for 51 children (29.1 percent). Non-housing sources were identified in 56 children (32.0 percent) as the only source of lead exposure. The high occurrence of non-housing sources was driven mostly by Asian children which accounted for 57% of non-housing sources. Housing-related sources were identified in 43 children (24.6 percent) as the only source of lead exposure. Both housing-related and non-housing sources of lead exposure were identified in 25 children (14.3 percent) (Table 11). Therefore, a total of 68 children (38.9 percent) had a housing-related source identified as a source of lead exposure. When lower “actionable" levels were used, housing-related sources were identified in 45 children (25.7 percent) as the only source and both housing-related and non-housing sources of lead exposure were identified in 34 children (19.4 percent). Hence, a total of 79 children (45.1 percent) had a housing-related source identified as a source of lead exposure when the lower “actionable" levels were applied. The difference in identifying sources of lead exposure by current regulatory levels versus lower “actionable" levels was statistically significant (p =0.001, Table 11).

Table 11. Sources of Lead Exposure Among Full Cases, Fiscal Year 2020-21 (n=175)

Exposure source	Current Regulatory Level¹	Lower “Actionable" Level²
Only Housing source	43 (24.6%)	45 (25.7%)
Both Housing and Non-Housing	25 (14.3%)	34 (19.4%)
Only Non-Housing source	56 (32.0%)	47 (26.9%)
Unknown	51 (29.1%)	49 (28.0%)

¹Current regulatory level for housing-related sources of lead exposure:

Paint is considered a source when the presence of deteriorated lead-based paint tested at the state regulatory level of ≥ 1.0 mg/cm². In addition, full cases were attributed to paint at local regulatory levels in Los Angeles at ≥ 0.7 mg/cm². (17 CCR Sections 35022, 35033, 35037; Los Angeles County Code Section 11.28.010)
Dust is considered a source when it is lead contaminated at ≥ 40 µg/ft² for interior floor surfaces, ≥ 250 µg/ft² for interior horizontal surfaces, and ≥ 400 µg/ft² for exterior floor and exterior horizontal surfaces. (17 CCR Sections 35035, 35037)
Soil is considered a source when it is lead contaminated at ≥ 400 ppm in children's play areas.

Water levels are categorized by an action level; according to the US EPA Federal Lead and Copper Rule, ≥ 0.015 mg/L is above the action level (40 CFR Section141.80). Four water samples above the action level were found to be potential exposure sources to lead. One exterior faucet water sample was found above the action level; however, it was not found to be a potential exposure source to lead as it was not a primary drinking source. Follow-up steps were taken to prevent all possible exposure by removing the faucet and capping the pipe. Drinking water sources at this residence measured non-detect lead levels.
² Lower “actionable" level for housing-related sources of lead exposure:

Paint with lead ≥ 600 ppm was used. In 1978 the federal Consumer Product Safety Commission restricted lead in newly manufactured paint to 600 ppm. Additionally, 600 ppm is the level petitioners to the US EPA have been seeking to lower the federal definition of lead-based paint. Since there is incongruence of unit equivalency between ppm and mg/cm², the level used for XRF instruments was 0.1 mg/cm², which is the lowest level detectable to the tenths place in order to be most health protective.
Dust lead levels ≥ 10 µg/ft² for interior floor surfaces, and ≥ 100 µg/ft² for interior horizontal surfaces were used in order to match changes in federal dust standards effective in 2020.
Bare soil with ≥ 80 ppm was used in order to match California Human Health Screening Levels (CHHSL) proposed by the California Office of Environmental Health Hazard Assessment. The current CHHSL for lead in soil for residential property is 80 ppm.
Drinking water ≥ 0.005 mg/L was selected considering the goal for water to show non-detect levels of lead. Since this level was the laboratory reporting limit, results below this level would not be available from laboratory reports used in the sample of cases selected.

The exposure source of lead differed by race/ethnicity (p <0.0001, Table 12). Housing-related sources of lead were identified as a common source of lead exposure among Black (40 percent) and Hispanic children (36.6 percent) while non-housing sources of lead exposure were identified as the most common source among Asian Indian children (63.6 percent), and Afghan children (76.5 percent, Table 12). The exposure source of lead did not differ by age group or identified sex at birth in FY2020-21 (p=0.0543, Table 12).

Table 12. Source of Lead Exposure at Current Regulatory Levels¹ by Demographic Characteristics Among Full Cases, Fiscal Year 2020-21 (n=175)

Characteristic: Age p-value: 0.054	Only Housing (n=43)	Both Housing and Non-Housing (n=25)	Only Non-Housing (n=56)	Unknown (n=51)
Less than 6 years (n=159)	43 (27.0%)	21 (13.2%)	48 (30.2%)	47 (29.6%)
Between 6 and 21 years (n=16)	0 (0.0%)	4 (25.0%)	8 (50.0%)	4 (25.0%)

Characteristic: Sex p-value: 0.36	Only Housing (n=43)	Both Housing and Non-Housing (n=25)	Only Non-Housing (n=56)	Unknown (n=51)
Female (n=88)	24 (27.3%)	10 (11.4%)	25 (28.4%)	29 (32.9%)
Male (n=87)	19 (21.8%)	15 (17.2%)	31 (35.6%)	22 (25.3%)

Characteristic: Race/Ethnicity p-value: <0.001	Only Housing (n=43)	Both Housing and Non-Housing (n=25)	Only Non-Housing (n=56)	Unknown (n=51)
Non-Hispanic Asian Afghan (n=17)	0 (0.0%)	1 (5.9%)	13 (76.5%)	3 (17.6%)
Non-Hispanic Asian Asian Indian (n=22)	1 (4.7%)	0 (0.0%)	14 (66.7%)	6 (28.6%)
Non-Hispanic Asian All Other Asian (n=11)	1 (9.1%)	0 (0.0%)	5 (45.4%)	5 (45.4%)
Non-Hispanic Black (n=5)	2 (40.0%)	0 (0.0%)	0 (0.0%)	3 (60.0%)
Non-Hispanic Hawaiian/ Pacific Islander (n=0)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)
Hispanic (Single race, n=101)	37 (36.6%)	17 (16.8%)	18 (17.8%)	29 (28.7%)
Non-Hispanic Native American/Alaskan (n=0)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)
Multi race (any Hispanic status, n=1)	1 (100.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)
Non-Hispanic Other (n=1)	0 (0.0%)	0 (0.0%)	1 (100.0%)	0 (0.0%)
Non-Hispanic White (n=13)	0 (0.0%)	6 (46.1%)	4 (30.8%)	3 (23.1%)
Declined or Unknown (n=4)	1 (25.0%)	1 (25.0%)	0 (0.0%)	2 (50.0%)

1 Housing-related sources of lead exposure include:

Paint is considered a source when the presence of deteriorated lead-based paint tested at the state regulatory level of ≥ 1.0 mg/cm2. In addition, full cases were attributed to paint at local regulatory levels in Los Angeles at ≥ 0.7 mg/cm2. (17 CCR Sections 35022, 35033, 35037; Los Angeles County Code Section 11.28.010)
Dust is considered a source when it is lead contaminated at ≥ 40 µg/ft2 for interior floor surfaces, ≥ 250 µg/ft2 for interior horizontal surfaces, and ≥ 400 µg/ft2 for exterior floor and exterior horizontal surfaces. (17 CCR Sections 35035, 35037)
Soil is considered a source when it is lead contaminated at ≥ 400 ppm in children's play areas.
Water was not identified as source of lead exposure in any case. Water levels are categorized by an action level; according to the US EPA Federal Lead and Copper Rule, ≥ 0.015 mg/L is above the action level (40 CFR Section141.80). One exterior faucet water sample was found above the action level; however, it was not found to be a potential exposure source to lead as it was not a primary drinking source. Follow-up steps were taken to prevent all possible exposure by removing the faucet and capping the pipe. Drinking water sources at this residence measured non-detect lead levels.

Distribution of Housing-Related Sources of Lead Exposure

Figure 2 shows the distribution of housing-related sources of lead exposure at current regulatory levels during FY 2020-21. Paint was the most common housing-related source of lead exposure, followed by dust, soil and water. Table 13 depicts the distribution of housing-related lead exposure sources by race/ethnicity and the pattern of paint being the most common housing-related source of lead exposure persisted over the years.

Figure 2. Total Occurrences¹ of Housing-Related Sources of Lead Exposure²Among Full Cases, Fiscal Year 2020-21 (n=120)

Housing sources of lead exposure: Paint 61, Dust 33, Soil 26, Water 0

¹A child may have more than one type of housing-related source of lead exposure and therefore, the total occurrences of housing-related sources will be greater than the number of children (n=68) identified with a housing-related source of lead exposure.
²Housing-related sources of lead exposure include:

Paint is considered a source when the presence of deteriorated lead-based paint tested at the state regulatory level of ≥ 1.0 mg/cm². In addition, full cases were attributed to paint at local regulatory levels in Los Angeles at ≥ 0.7 mg/cm². (17 CCR Sections 35022, 35033, 35037; Los Angeles County Code Section 11.28.010)
Dust is considered a source when it is lead contaminated at ≥ 40 µg/ft² for interior floor surfaces, ≥ 250 µg/ft² for interior horizontal surfaces, and ≥ 400 µg/ft² for exterior floor and exterior horizontal surfaces. (17 CCR Sections 35035, 35037)
Soil is considered a source when it is lead contaminated at ≥ 400 ppm in children's play areas.
Water was not identified as source of lead exposure in any case. Water levels are categorized by an action level; according to the US EPA Federal Lead and Copper Rule, ≥ 0.015 mg/L is above the action level (40 CFR Section141.80). One exterior faucet water sample was found above the action level; however, it was not found to be a potential exposure source to lead as it was not a primary drinking source. Follow-up steps were taken to prevent all possible exposure by removing the faucet and capping the pipe. Drinking water sources at this residence measured non-detectable lead levels.

Table 13. Total Occurrences¹ of Housing-Related Sources of Lead Exposure² by Race/Ethnicity Among Full Cases, Fiscal Year 2020-21 (n=120)

Housing-related Lead Sources	Non-Hispanic Asian - Afghan	Non-Hispanic Asian - Indian	Non-Hispanic Asian - Other	Non-Hispanic Black	Hispanic (Single race)	Multi race (any Hispanic status)	Non-Hispanic White	Declined or Unknown
Paint (n=61)	0 (0.0%)	1 (1.6%)	0 (0.0%)	2 (3.3%)	50 (82.0%)	1 (1.6%)	5 (8.2%)	2 (3.3%)
Dust (n=33)	1 (3.0%)	0 (0.0%)	1 (3.0%)	1 (3.0%)	25 (75.8%)	1 (3.0%)	4 (12.1%)	0 (0.0%)
Soil (n=26)	1 (3.9%)	0 (0.0%)	0 (0.0%)	1 (3.9%)	20 (76.9%)	0 (0.0%)	4 (15.3%)	0 (0.0%)
Water (n=0)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)

Paint is considered a source when the presence of deteriorated lead-based paint tested at the state regulatory level of ≥ 1.0 mg/cm2. In addition, full cases were attributed to paint at local regulatory levels in Los Angeles at ≥ 0.7 mg/cm2. (17 CCR Sections 35022, 35033, 35037; Los Angeles County Code Section 11.28.010)
Dust is considered a source when it is lead contaminated at ≥ 40 µg/ft2 for interior floor surfaces, ≥ 250 µg/ft2 for interior horizontal surfaces, and ≥ 400 µg/ft2 for exterior floor and exterior horizontal surfaces. (17 CCR Sections 35035, 35037)
Soil is considered a source when it is lead contaminated at ≥ 400 ppm in children's play areas.
Water was not identified as source of lead exposure in any case. Water levels are categorized by an action level; according to the US EPA Federal Lead and Copper Rule, ≥ 0.015 mg/L is above the action level (40 CFR Section 141.80). One exterior faucet water sample was found above the action level; however, it was not found to be a potential exposure source to lead as it was not a primary drinking source. Follow-up steps were taken to prevent all possible exposure by removing the faucet and capping the pipe. Drinking water sources at this residence measured non‑detect lead levels.

Removal, Remediation, or Abatement of Identified Housing-Related Sources of Lead Exposure

Of the 175 full cases in our analysis, housing-related sources of lead exposure were identified at current regulatory levels in 70 properties. There were a total of 70 properties that needed housing-related sources of lead exposure removed, remediated, or abated and required clearance. Keep in mind that multiple children may be living at the same property as well as EI done in multiple properties for some children, number of properties are independent from the number of cases. Of those 70 properties, 55 (78.6 percent) had their housing-related source of lead exposure removed, remediated, or abated while 15 properties (21.4 percent) are still in process.

Distribution of Non-Housing Sources of Lead Exposure

For FY 2020-21, the main non-housing sources identified were 'take-home/occupational' exposures' followed by 'food, spice and drink items', and 'cosmetics/spiritual products' (Figure 3).

Figure 3. Total Occurrences¹ of Non-Housing Sources of Lead Exposure Among Full Cases, Fiscal Year 2020-21 (n=99)

Non-housing lead exposure sources: Occupational 37, food/drink 28, cosmetics 21, other 9, pottery 3, remedies 1, bullet & matern

¹A child may have more than one type of non-housing lead hazard and therefore, the total occurrences of non-housing lead hazards will be greater than the number of children (n=81) identified with a non-housing lead hazard.

Lead exposure through 'Take-home/occupational exposure' differed by race/ethnicity (p=0.005). Of the 37 children where 'Take-home/occupational exposure' was identified as the lead source, 26 were Hispanics (70 percent), 7 were Whites (18.9 percent), 3 were Asian (8.1 percent) and 1 was Unknown race (2.7 percent, Table 14).

Table 14. Total Occurrences¹ of Non-Housing Sources of Lead Exposure by Race/Ethnicity Among Full Cases, Fiscal Year 2020-21 (n=99)

Non-Housing Exposure Source of Lead	Non-Hispanic Asian- Afghan	Non-Hispanic Asian- Indian	Non-Hispanic Asian- Other	Hispanic (Single race)	Non-Hispanic Other	Non-Hispanic White
Take-Home/ Occupational (n=37)	0 (0.0%)	0 (0.0%)	3 (8.1%)	26 (70.3%)	0 (0.0%)	7 (18.9%)
Food and Drink (n=28)	8 (28.6%)	10 (35.7%)	2 (7.1%)	6 (21.4%)	1 (3.6%)	1 (3.6%)
Cosmetics and Spiritual Products (n=21)	13 (61.9%)	5 (23.8%)	2 (9.5%)	0 (0.0%)	0 (0.0%)	1 (4.8%)
Other Lead Sources (n=9)	0 (0.0%)	0 (0.0%)	2 (22.2%)	6 (66.7%)	0 (0.0%)	1 (11.1%)
Pottery (n=3)	0 (0.0%)	0 (0.0%)	0 (0.0%)	3 (100.0%)	0 (0.0%)	0 (0.0%)
Remedies (n=1)	0 (0.0%)	1 (100.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)
Maternal Exposure (n=0)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)

¹A child may have more than one type of non-housing source of lead exposure and therefore, the total occurrences of non-housing sources will be greater than the number of children (n=81) identified with a non-housing source of lead exposure.

Lead exposure through food, spice and drinks differed by race/ethnicity (p <0.0001, Table 14). Of the 28 children, where “food, spices and drinks' were identified as the source of exposure, 20 were Asian (71.4 percent), 6 were Hispanics (21.4 percent) and 1 was White (3.6 percent) and 1 was Other race (3.6 percent, Table 14). Of the 20 Asian children where 'food, spices and drinks' was a source of lead exposure, 10 were Asian Indians, 8 were Afghans.

Lead exposure through cosmetics and spiritual items differed by race/ethnicity (p <0.0001, Table 14). Of the 21 children where cosmetics and spiritual items were identified as the source of lead exposure, 20 were Asians (95.2 percent). Of the 20 Asian children, 13 were Afghans, 5 were Asian Indians (Table 14).

Lead exposure though 'other sources of lead' were identified among 9 children. Six of them were Hispanics (66.7%), two were Asians (22.2%), and one was White (11.1%, p-value=0.9). Pottery was identified as a source of lead exposure among three children. They were all Hispanics (p=0.9, Table 14). Remedies were identified as a source of lead exposure in only one Asian child (Table 14). Non-housing sources of lead exposure were not identified among Black and Multi-race children (Table 14).

Among the 37 take-home/occupational exposures, the most common sectors were construction (n= 15), fishing (n= 5), painting (n=4, data not shown). Although unconfirmed, exposures from previous residence/travel outside of California were suspected in 45 children with the top countries where previous residence/travel outside of California included Afghanistan (n= 16), Mexico (n= 15), and India (n= 10) (data not shown).

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