Setting Priorities for Prevention of Childhood
Lead Poisoning in Providence

Christy Plumer

Despite six years of enhanced efforts to reduce lead contamination in homes and ensure that children live in safe and healthy environments, 21% of Providence children tested for lead in the first three quarters of 1998 had blood-lead levels above the Center for Disease Control's level of concern (10 mg/dl). In the spring of that year, at the request of the Mayor's Policy Office, the Environmental Studies 192 class at Brown University identified five indicators of poor housing quality -- Environmental Violations, Housing Code Violations, Section 8 status, Non-Owner Occupancy, and Assessed Building Value -- that could be used to identify problematic housing in the city. Case-control analyses of these indicators against addresses where Providence children resided when tested for lead in 1997 showed strong statistical significance for all indicators. Addresses cited for environmental violations in 1997 had the strongest correlation, with a child residing in a property with an environmental violation having a lead poisoning risk close to two times greater than a child who lived in a property without an environmental violation.

Based on more extensive indicator analyses, identifying properties with a history of lead poisoning, and determining whether funding should be directed towards low-income areas, I have proposed priority-setting options for the City's Housing and Urban Development Lead Hazard Control Program. The aim of my thesis is to prevent lead poisoning before it occurs, by providing the City with a means to target housing that poses the greatest risk to children. Beginning with further indicator analyses, I determined that correlations between blood-lead data for the years 1997 and 1998 (combined) and the five indicators continued to remain statistically significant. Again, environmental violations and code violations showed the strongest correlations, with Risk Ratios of 1.88 [95% Confidence Interval (CI): 1.64-2.16] and 2.24 [CI: 1.93-2.60], respectively. One available option for the City is to target addresses where children have not yet been poisoned but that have had both environmental and code violations in the past.

Other analyses suggested that targeting addresses with a history of multiple lead poisonings should be a priority. Two-percent (2%) of the residential addresses in the city housed 51% of the children with elevated blood-lead levels (EBLs - 15 mg/dl and above) and 32% of the addresses where a child resided in 1998 were addresses with a history of multiple poisonings in 1993-1997. This means that if the City had remediated all the houses where multiple poisonings had occurred, 930 addresses in total, a third of the 1998 poisonings would have been prevented. Targeting addresses where a poisoned child resided after an abatement is another available option. Of the 148 properties that had been abated in the past (according to DOH records), approximately half of these properties have had another lead-poisoned child residing there after the abatement. Socioeconomic analyses also provide support to the idea that resources would be more wisely directed towards targeting individual addresses rather than entire low-income neighborhoods.

Before the address lists necessary for implementation of the recommended priority-setting options can be released to the City, confidentiality concerns must be resolved.