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Evaluating the Effects of Lead Mitigation Policy on Childhood Lead Exposure in Rhode Island
Alyssa Sylvaria & Ryan KellyThe Providence Plan - Information Group
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Outline
1. Background2. Data and Methods3. Compliance4. Childhood Lead Exposure
– Compliance– Exemption – Foreclosure
5. Implications
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BACKGROUND
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Childhood Lead Exposure
5 µg/dL CDC reference level for elevated blood lead levels (EBLL) as of 2012
Rhode Island
2002 Incidence 25%2012 Incidence 5%
Sources: ACCLPP. (2012). Low Level Lead Exposure Harms Children: A Renewed Call for Primary Prevention. Centers for Disease Control and Prevention.Childhood Lead Poisoning Prevention Program. (2014). Childhood Lead Poisoning. Rhode Island Department of Health. http://www.health.ri.gov/data/childhoodleadpoisoning/
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Federal Primary Prevention Efforts
• Title X: Lead Disclosure Rule• HUD Lead Safe Housing Rule• EPA Renovation, Repair, and Painting• OSHA Interim Lead in Construction Standard
Sources: HUD Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing. (2012). http://portal.hud.gov/hudportal/HUD?src=/program_offices/healthy_homes/lbp/hudguidelines
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RI Primary Prevention Efforts
• As of 2005, most rental property owners need to obtain a compliance certificate
• Exemptions:–1978 or later Built after lead was banned in paint
–Owner-occupied properties with <4 units
–≤100 days a year Temporary or seasonal units
–Age 62+ Designated elderly housing
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RI’s Lead Law
Certificates of Conformance require that property owners1. Attend a Lead Hazard Awareness Class2. Visually assess the property 3. Get an Independent Clearance Inspection 4. Fix lead hazards 5. Use lead-safe work practices in any maintenance projects6. Give tenants an Inspection Report and lead hazard info7. Respond to tenants' concerns about any lead hazards
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DATA AND METHODS
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Population of Properties
• Residential properties– 1 to 5 family properties– Apartments (6+ units)– Mixed use (commercial + residential)
• Core cities in Rhode Island– Central Falls– Pawtucket– Providence– Woonsocket
• Built before 1978 – For both exempt and non-exempt
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Data
• Property-Level Data• Compliance certificates• Tax Assessor Data
– Current as of…• Providence, 2009• Woonsocket, 2009• Pawtucket, 2010• Central Falls, 2011
• Master Look-Up Tables– Verifies the property associated with each
address
• Child-Level Data• Blood Lead Levels (BLLs)
– Confirmed blood lead test results– Children living at addresses in the
core cities– Ages 0-72 months
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Linking Method
2. Standardize Address Data to Properties and Match
1. Aggregate Lead Test Results to Properties
Lead-exposed children
Lead Compliance
Propertydescriptives
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RESULTS 1: COMPLIANCE
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Focus: Rates of compliance with the Lead Hazard Mitigation Act
Population:
15,678 non-exempt properties – Did or did not have any children with blood lead tests (all
non-exempt residential properties in our linked dataset)– 2005-2012
Compliance
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Properties with “Any Compliance”
• Had a Certificate of Conformance or Lead Safe Lead Free Certificate –At least one unit on the property (if multi-family)
–Complied at any point between 2005 and 2012
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Any Compliance & Lead Exposure
• Any compliance includes properties that did not comply until after a child had an elevated blood lead level (EBLL) from 2005-2012
Not Compliant Until After
EBLL
ComplianceBefore EBLL or No EBLL
NO COMPLIANCE
Compliance & Lead Exposure at Property
ANY COMPLIANCE
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Compliance Results
2005 2006 2007 2008 2009 2010 2011 20120%
10%20%30%40%50%60%70%80%90%
100%
Compliance over Time
% o
f Pro
perti
es
30.4% of properties had ANY
compliance
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Compliance Results
69.6
9.0
21.4 Non-Compliant
Compliant after EBLL
Compliant before or No EBLL
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Compliance Results
Mixed U
se
Apartments
1 Family
2-5 Family
Total0%
10%20%30%40%50%60%70%80%90%
100%
Compliant before or No EBLLCompliant after EBLLNon-Compliant
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Compliance Summary
• Most non-exempt properties did not comply from 2005 to 2012, regardless of how broadly we defined compliance
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RESULTS 2: CHILDHOOD LEAD EXPOSURE
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Lead Exposure & Compliance
Population 9,127 non-exempt properties with at least one child tested for lead (2005-2012)
Question Did compliant properties have lower rates of lead exposure than non-compliant properties?
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Lead Exposure By Compliance Status
Non-Compliant Any Compliance Total0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
42.8%
52.9%47.0%
Properties with One or More EBLL 5+
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Any Compliance EBLL Timing
No BLL 5+; 47.1%
BEFORE com-pliance; 25.0%
BEFORE & AFTER
compli-ance; 12.0%
AFTER compli-
ance; 15.9%
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Any Compliance EBLL Timing
No BLL 5+
BEFORE co
mpliance
AFTER co
mpliance
BEFORE &
AFTER co
mpliance
0.0%20.0%40.0%60.0%80.0%
48.1%69.5% 63.8%
84.1%EBLL 5+ Before the Law (pre-2005)
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Lead Exposure & Compliance Summary
• Properties with any compliance had higher rates of lead-exposed children than non-compliant properties.
• Most of the compliant properties with lead-exposed children in 2005-2012 were multi-families and had lead-exposed children before 2005.
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Lead Exposure & Exemption
Population 20,974 properties with at least one child tested for lead (2005-2012)
Question Do exempt properties still have lead-exposed children?
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Lead Exposure & Exemption
56.5% of properties are exempt from the law
Non-exempt Exempt Total0.0%5.0%
10.0%15.0%20.0%25.0%30.0%35.0%40.0%45.0%50.0% 47.0%
33.7%39.5%
One or More EBLL
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Lead Exposure & Exemption
Mixed Use Apartments One Families 2-5 Families Total
44.1%
52.9%
33.1%
48.9% 47.0%
0.32258064516129
0.228332337118948
0.417381022760863
0.336794125094961
Properties with One or More EBLL 5+
Non-exempt Exempt
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Lead Exposure & Exemption
Non-exempt Exempt Total0
100020003000400050006000700080009000
4,291 3,990
8,281
One or More EBLL
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Lead Exposure & Exemption Summary
• Over half of the properties with children tested for lead are not subject to the law.
• Non-exempt properties had higher rates of EBLLs on the property, but the non-exempt and exempt categories had similar numbers of properties with EBLLs
• 4,291 non-exempt compared to 3,990 exempt
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Lead Exposure & Foreclosure
Population 39,903 children with blood lead test results
Question Do foreclosed properties increase the likelihood of lead-exposed children?
Context Housing market issues and home maintenance
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• 5% of children lived in a property that foreclosed within 18 months of their lead test date
(Adjusted for residence type, owner-occupancy, city of residence, year property built (pre-1950 vs. 1950-1977), and child’s age at time of test).
Lead Exposure & Foreclosure Key Results
Foreclosure within 18 months of test No: Yes: Difference
Estimated BLL Estimated BLL (p-value)
All children 3.17 3.37 -0.20 (-0.1715)
Children in owner-occupied properties 3.37 3.33 0.05 (-0.8586)
Children in non-owner-occupied properties 3.71 4.36 -0.64 (-0.0468)
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Lead Exposure & Foreclosure Summary
Children living in foreclosed rented properties had significantly higher estimated BLLs once we controlled for other variables.
Relationship was not significant for owner-occupied properties.
Foreclosure is likely one important factor out of many that can contribute to lead exposure.
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Data Limitations
• Analysis is not unit-based
• Compliance does not account for expired certificates
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Takeaways
• Enforcement is key to primary prevention
• Owner-occupied properties not less likely to have lead-exposed children
• Housing market issues can complicate efforts to reduce environmental health conditions
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Implications & Next Steps
• Emphasize connection with healthy housing–Asthma–Energy usage–Inspections
• Local outreach around compliance and implications for child health
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