ORIGINAL ARTICLES Lead Levels Among Children Who Live in Public Housing Felicia A. Rabito, 1 Charles Shorter, 2 and LuAnn E. White 2 Background. Exposure to lead hazards is a serious health concern for inner-city children. In the United States, the greatest contributor to an elevated lead level is lead exposure in the home. There are federal regulations to protect children in public housing developments from exposure to lead paint. The efficacy of these regulations has not been examined. Methods. We assessed the association between residence in a public housing development and the risk of an elevated blood lead level among high-risk children in New Orleans. We did so by conducting a case-control study among 7121 children age 6 to 71 months who received a screening blood lead test from New Orleans public health clinics in 1998. Results. We found elevated blood lead levels for 29% of children who were screened. Children residing in New Orleans housing developments had lead levels no different from those residing in nondevelopment housing when controlling for housing age, and child’s sex and age (odds ratio = 0.93; 95% confidence interval = 0.77–1.1). Conclusions. Despite legislative efforts, public housing does not appear to protect children from elevated lead levels, calling into question the efficacy of existing regulations. (EPIDEMIOLOGY 2003;14:263–268) Key words: ;ead poisoning, blood lead level, children, environmental health, lead, health policy. A lthough much progress has been made in reduc- ing the prevalence of lead poisoning in U.S. children, lead remains an important problem for poor, inner-city, minority children. Nationwide it is estimated that 4.4% of children age 1 to 5 years have an elevated blood lead level. 1 African-American children are 5 times as likely to have an elevated blood lead level as white children, and approximately one-quarter of low-income minority children residing in older housing have levels considered unsafe. 1 Recent research findings indicate that the effects of lead may be more deleterious than currently thought. A recent study of children and adolescents indicates that the threshold for neurocogni- tive effects may be substantially lower than the level currently assumed to provide protection, 2,3 and a recent clinical trial has suggested that the neurotoxic effects of lead are irreversible, even for those receiving treatment. 4 Given that lead poisoning is a preventable condition, these findings add urgency to the call for effective im- plementation of governmental policies that help to pre- vent lead poisoning. It is well known that the greatest contributor to an elevated lead level in a child is lead hazards in the home. 1,5 Lead contamination of paint and dust is a particular problem in housing built before 1950, before the lead content in paint was regulated. 5 Since 1971, with the passage of the Lead-Paint Poisoning Prevention Act, federal legislation has been in place to protect children in public housing developments from exposure to lead paint. The Act mandated development of pro- cedures to eliminate the hazards of lead-based paint in federally assisted housing. Further, under the Housing and Community Development Act of 1987, the U.S. Department of Housing and Urban Development (HUD) was ordered to identify lead-based paint in pub- lic housing. The 1987 Act implemented a housing-based approach to the reduction of lead poisoning, replacing Editors’ note: An invited commentary on this article ap- pears on page 257. From the 1 Department of Epidemiology, and 2 Department of Environmental Health Sciences, Center for Applied Environmental Health, Environmental Diseases Prevention Research Center, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA. Address correspondence to: Felicia A. Rabito, Center for Applied Environmen- tal Public Health, Tulane University SPHTM – TW43, 1430 Tulane Ave, New Orleans, LA 70112; rabito@tulane.edu. This study was supported by the Centers for Disease Control and Prevention, Prevention Research Center: U48CCI6157844 and Louisiana Office of Public Health’s CDC Childhood Lead Poisoning Prevention Grant Project and Coop- erative Agreement: H64/CCH615525. Submitted 6 May 2002; final version accepted 23 January 2003. Copyright © 2003 by Lippincott Williams & Wilkins, Inc. 263