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Childhood Lead Poisoning in
Ohio
Objectives• Overview of childhood lead poisoning in
Ohio• Provide an overview of the Public Health
Lead Investigation Process• Bring awareness to funding resources for
lead hazard control
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State DataOhio is one of the top states in number of homes built pre-1980, and also in percent of
total homes built pre-1980Ohio has the third-highest percentage (5.0%) of
tested children under age 6 with elevated blood lead levels (CDC 2016)
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1.8 1.6 1.5 1.3 1.1 1 0.8 0.8 0.8 0.8 0.8 0.7
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1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
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Prevalence of Confirmed Elevated Blood Lead Levels ≥10 µg/dL Among Ohio Children, Less than Six Years of Age, 1999-2018
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Blood Lead Testing Statistics for Ohio Children, 2018
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5-9 µg/dL
10-44 µg/dL
≥45 µg/dL
Total ≥5 µg/dL
% Tested
≥5 µg/dL
Total ≥10
µg/dL
% Tested
≥10 µg/dL
2,737 1,100 19 3,856 2.29% 1,119 0.66%
5-9 µg/dL
≥10 µg/dL
1,135 208
Total Children Tested
0-4 µg/dL
168,352 163,153
Confirmed BLLs Only Unconfirmed
1. The table above contains data for children less than 72 months (6 years) of age at the time of test.
2. To be confirmed, a test must use a venous blood sample and not be analyzed on a point-of-care device. Capillary samples cannot be confirmed, regardless of how the blood is analyzed.
3. Blood lead levels above reflect the highest confirmed test if a confirmed test exists for the child, or the highest test for the year, otherwise.
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Lead Paint HazardsPeeling, chipping, chalking, or cracking
• Windows, windowsills, doors• Porches, stairs, railings• Antique furniture• Fences
Dust• Created when lead-based paint is scraped or
bumped• US EPA clearance level for floors: 40 µg/sq ft
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Other Sources of Lead• Older plumbing• Traditional cosmetics and
remedies (e.g. Azarcon, Greta, and Kohl)
• Pottery and ceramics• Toys
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High-Risk Zip Codes
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Blood Lead Testing Requirements
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Reduce Absorption: Nutrition• Eating a proper diet can help increase iron
intake and possibly decrease lead absorption.
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• Iron• Protein• Vitamin C
• Fiber• Zinc• Calcium
Public Health Lead Investigations• ODH covers 83 of 88 counties• 11 delegated boards of health• Total of 40 investigators statewide• When the Director becomes aware
that a child under 6 has a BLL of 10 micrograms/dL or higher, a lead investigation is performed
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Delegated Boards of Health
Cincinnati CityCleveland CityColumbus CityCuyahoga CountyFranklin CountyHamilton County
Lorain CountyMontgomery CountyMuskingum CountySummit CountyToledo City/Lucas County
Elevated Blood Lead Levels 5-9 μg/dL
• Children with confirmed tests of between 5 μg/dL and less than 10 μg/dL
• Telephone questionnaire• Send Public Health Lead Investigation Report• Provide educational materials by mail• Case closed in HHLPSS• Reimbursement for Medicaid enrolled children
Referral of case >10 μg/dL• Child is tested (physician’s office, WIC clinic)• Lab submits required data to ODH• Elevated level above ten(10) μg/dL• Surveillance system (HHLPSS)• Referred to ODH investigator or local board
of health• Referral contains child’s Medicaid number
Investigation
• Contact parent/guardian to administer questionnaire
• If unable to contact, collaborate with case manager, health care provider, Healthchekcoordinator, or others to obtain current contact information
Investigation (Cont’d)
Contact successful• Investigator
reviews the questionnaire
• Schedule the on-site investigation
• Sends educational material
No Contact (at least 6 attempts)
• Send certified letter• Receive no response• Close case in surveillance
system after 30 days
Source from property?Property is possible
source• Conduct lead risk
assessment• Issue lead hazard
control order• Compliance
Source is not related to the property
• Ceramic ware• Folk remedies• Painted furniture• Toys
Are there other sources?Investigate supplemental addresses:• Grandma’s house• Daycare facility• School• Neighbor’s property
Conducting the Onsite Lead Investigation
Centralized scheduling4.5 lead investigators on staffOnsite investigation components
• Visual assessment• Comprehensive Questionnaire• XRF analysis• Environmental Sampling
ChallengesLocating parents to scheduleNo showsTravel distanceEnvironmentSocial worker mentalityDistrust of government
Issuing the Lead Hazard Control Order• Issued to the property owner• Must control identified lead hazards• Must hire licensed lead abatement contractor• Given 90 days to comply• Extensions offered
• Lead poisoned child protected• Forward progress towards compliance
Compliance Achieved• Clearance examination performed• Licensed lead risk assessor or inspector• All hazards controlled• Ongoing monitoring for interim
controls• Annual Clearance examination
required• Compliance letter sent – order lifted
Noncompliance• Failure to comply by deadline• Issue order of noncompliance• 14 days to vacate property• Property placarded• Failure to vacate – civil or criminal action
**WARNING**ORDER TO VACATE
This property contains lead hazards and has been declared unsafe for human occupation especially for children under
six years of age and pregnant women as ordered by the Director of the [Name of health department]
Date _______ Issued by: ______________________
ORC 3742.40 OAC 3701-30-11
Ohio Revised Code Section 3742.99 - Removal of this sign is punishable by a fine and/or imprisonment. Each day of
violation is a separate offense. Please call [Telephone #] with questions or concerns.
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Funding Available• Three rounds of HUD funding for a total of
$7.7 million• Ohio Department of Medicaid SCHIP funding• $9 million total• Various local HUD grants across Ohio• Community Housing and Impact Preservation
(CHIP) funding
Partnership
For over 16 years ODH has partnered with the Ohio Department of Medicaid (ODM) to
address the needs of enrolled children with elevated blood lead levels
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Partnership• ODM has provided funding for public health
lead investigations to ODH and its local health department partners
• Rate has increased over the years from $475/investigation in FY ‘03 to $1,289/investigation in FY ’17
• Highest reimbursement rate in the nation• Actual cost methodology now implemented
Partnership Expansion• ODM and partnered to seek Centers for
Medicare and Medicaid (CMS) approval for lead hazard control funding
• State Children’s Health Insurance Plan (SCHIP) funds used
• Established a Health Services Initiative to protect children’s health
• State Plan Amendment (SPA) revision submitted to CMS—expansion of services
Medicaid Funded Lead Abatement
What is a health services initiative? States have the option to develop a state-designed Health Services Initiatives (HSI) to improve the health of low-income children.
Both direct services and public health initiatives are permitted.
Health Services Initiatives• CMS has approved 26 HSI state plan amendments (comprised
of 49 programs/projects) in 19 states• At least 3 states have current HSI’s for lead abatement
• Missouri – 2011 – $2.9 million to increase lead awareness and importance of blood lead screening
• Michigan- 2016- $24 million/year for 5 years for lead abatement including water service line replacement
• Maryland- 2017- $7.1 million- Lead abatement and asthma education and intervention
SCHIP Project• Request $10 million over 2 years for two
specific projects• Project 1 – Lead Abatement Activities• Project 2 – Lead-Safe Rental Registry• Required legislation approval for match
funding and language for rental registry• Approved in the state budget bill
Project 1 – Phase 1
• Conduct lead hazard control • A statewide project – all 88 counties included• Target properties with lead hazard control
orders
Eligibility• Specific requirements are under development. • Initial discussions include the following but have not yet
been approved by CMS: • The property owner shall demonstrate proof the
occupants’ income is at or below 206% of the federal poverty level (FPL)
• Consideration will be given to occupants whose income exceeds this threshold up to 250% FPL if no other financial resources are available to the family. Owner contribution is required in these cases.
Conditions of Enrollment• Constructed prior to 1978 as verified by the county
auditor’s records; • Covered by homeowners insurance with copies of the
policy submitted as proof;• Covered by flood insurance if the property is located in a
flood plain; • Current on all property taxes or have a tax payment plan
in place.
Lead Abatement Activities• Lead-based paint, dust, and soil remediation including
door and window treatments and replacement, floor treatments, paint removal, paint stabilization/repainting, encapsulation, enclosure, specialized cleaning, soil replacement or covering.
• When water is identified as a possible source of lead exposure a faucet water filter rated to effectively to remove lead will be provided.
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Project 1 – Phase 2 – Target Areas• Cleveland (Cuyahoga County)
Cincinnati (Hamilton County)Columbus (Franklin County)Akron (Summit County)Toledo (Lucas County)Youngstown (Mahoning County)
• The same procedures for enlisting a program into the project in Phase 1 will apply in Phase 2
Project 2 – Lead Safe Rental Registry• ODH finalized rules to operate registry• https://www.ohiohousinglocator.org/• Voluntary for rental property owners• Properties eligible for registration
• Built on or after Jan 1, 1978• Built before 1978
• Lead inspection conducted by a lead inspector or lead risk assessor shows no lead based paint
• Subject to a lead hazard control order with a passing clearance examination conducted within the past year (required)
• Completion of the prescribed visual assessment, rental maintenance practices and passage of a clearance inspection
HUD Grant #4• Cover 21 counties across the state• $3.1 million• $600,000 for healthy homes repairs• Will include Dayton and Springfield• In process of securing 3rd party vendor
HUD Grant Target Area
