Residential Hazards in Children A Neglected Public Health Problem

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Residential Hazards in ChildrenA Neglected
Public Health Problem
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The connection between health and the dwelling
of the population is one of the most important
that exists. Florence Nightingale
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Residential Hazards

• Lead Toxicity
• Asthma and Indoor Allergens
• Hazards of Tobacco Smoke
• Housing Deaths and Injuries

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Lead Toxicity
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Sequela of Childhood Lead Poisoning
Perlstein MA, Attala R. Clinical Pediatrics
19665282-298.
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Mental Health Problems in Children by Tooth Lead
Concentration
Needleman HL, et al. NEJM 1979301163.
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Blood Lead Levels Considered Elevated by the
Centers for Disease Control
Blood Lead Level (mg/dL)
Year
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Percent of Preschool Children Exceeding Selected
Blood Lead Levels, NHANES II - III
Pirkle JL, et al. Environ Health Perspect
1998106745-50.
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Lead Toxicity - Still A Major Public Health
Problem

• Lead toxicity remains epidemic in many parts of
  United States.
• Major environmental justice problem.
• Evidence of adverse effects below 10 ?g/dL.
• Systemic toxicant associated with numerous
  adverse conditions and diseases in humans.

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Blood Lead Levels gt 10 µg/dL among Children in
Rochester, 1995
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Distribution of Blood Lead Levels among Black and
White Children
Percent
Blood Lead Levels (?g/dL)
Lanphear BP. AJPH 1996 861460-1463.
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Blood Lead Concentration by Reading Scores in
U.S. children
Reading Score
Blood Lead (?g/dL)
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Canfield R, et al. NEJM 20033481517-1526.
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Body Burdens of Lead in Ancient Peoples, Typical
American and Overt Lead Poisoning
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Association of Blood Lead Levels and Delinquency
in Adolescents
Dietrich KN. Neurotoxicology Teratology
200123511-518.
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Relationship of Lead Exposure and Murder Rate
(/100,000) in the U.S.
Nevin R. Environmental Research 2000831-22
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Asthma
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The Prevalence of Asthma in US Children
Akinbami, et al. AJE 200315899-104.
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Asthma Mortality Rate (per 10,000) by Race of
Child, United States 1995
Mortality Rate (/10,000)
Age (years)
Anderson RN. Monthly Vital Statistics
Report4511 (supplement 2).
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Indoor Allergens and Asthma
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Causal Relation of Allergens and Asthma The IOM
Report
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Residential Risk Factors for Asthma in U.S.
Children and Adolescents
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Hospitalization for Asthma by Exposure to
Cockroach and Sensitization
Hospitalization in Past Year
Rosenstreich DL. NEJM 19973361356-1363.
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Factors associated with Der p 1 Concentration
(?g/g) on Bedroom Floor
Carpeted Floors
Ratio of Geometric Mean
Wickens K. Clin Exp Allergy 1997271077-1085.

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Carpet Production in the US
Millions of Square Yards
Introduction of Synthetic Fibers
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Tobacco Exposure in Children
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Asthma Exacerbations in the prior 12 months by
Urine Cotinine
No. of exacerbations
Chilmonczyk NEJM 19933281665-1669.
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Residential Risk Factors for Asthma in U.S.
Children
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Lifetime Exposure to Environmental Tobacco Smoke
and Behavioral Problems
Mean Problem Score
Behaviors
Fergusson DM. Pediatrics 199392815-822.
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Risk of Premature Birth by Exposure to
Environmental Tobacco Smoke
Adjusted Odds Ratio
Hair Nicotine (?g/g)
Jaakkola JJK. Env Health Persp
2001109557-561.
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ResidentialInjuries in Children
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Fatal Injuries by place of occurrence in US
children lt 19 years, 1985-1997
Home 62
Other 26
Unspecified 12
Nagaraja J, et al. (submitted)
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Percent of Injury-related Deaths that occur in
the Home by Childs Age
p value for trend lt 0.01
Percent Deaths in Home
Age of Children (years)
Nagaraja J, et al. (submitted)
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Fatal Residential Injuries among U.S. Children,
1985 to 1997
Mortality Rate (/100,000)
Year
Nagaraja J et al. (in progress).
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Fatal Residential Injuries among U.S. Children by
Race, 1985 to 1997
Mortality Rate (/100,000)
Year
Nagaraja J et al. (in progress).
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Children Cant Fly
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Injuries from Window FallsNew York City,
1973-1990
Window Guard Regulation
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Until effective standards for the domestic
environment are devised, it is likely that
children will continue to be employed as
biological indicators of substandard housing.

• Donald Barltrop, 1974