Table of Contents

ABSTRACT

Although US policies to limit lead (Pb) release into the environment have substantially decreased children’s blood Pb concentrations over the past four decades, more than a million children are still exposed to harmful Pb levels. A social-ecological model (SEM) of childhood Pb exposure may help public health professionals and government officials prevent these exposures by identifying the combinations of individual and social environmental factors that have resisted previous Pb exposure control policies and programs. To develop such an SEM, we conducted a systematic review of studies of children’s blood Pb in the United States published since 2005. Information on risk factors for Pb exposure was extracted from each article. Identified risk factors were then grouped into the five levels of an SEM: intrapersonal, interpersonal, institutional, community, and public policy. In total, the review identified 75 peer-reviewed studies of children’s Pb exposure in the United States since 2005. The review revealed that while child blood Pb levels have declined over time, inequities of Pb exposure persist among Non-Hispanic Black, migrant, and low-income children. Mixed effects were reported for Hispanic/Latinx/Mexican-American populations, with some studies finding these groups were at higher risk and others showing lower risks. Surprisingly, some studies found higher blood Pb in children over age 5 than in younger children, though the reverse was generally true. Findings reveal new opportunities to target exposure prevention programs at the intrapersonal, institutional, community, and policy levels. Well-controlled studies of the effectiveness of interventions at each level are needed to guide future policymaking.

Keywords: Childhood, children, lead exposure, lead poisoning, risk factors, United States