Healthy Homes and Lead Poisoning Prevention

What is lead?

Lead is a heavy metal found in the earth's crust. It can combine with other chemicals to form lead compounds or salts. Lead is a natural element that does not break down in the environment and is very hard to clean up.

CDC Fact Sheet on Blood Lead Levels in Children

How is lead used?
Lead is most often used to produce batteries and ammunition. It's also used in sheet lead, solder, some brass and bronze products, pipes, and ceramic glazes.

Lead was added to gasoline to raise the octane level. In 1996, the federal government banned the sale of gasoline with lead. Lead was also added to paint so that it would last longer and stick to surfaces better. In 1978, the federal government banned lead in residential paints.

Lead is still used in some cosmetics and hair dyes, medical supplies, commercial paints, scientific equipment, and military equipment.

What is lead poisoning?
It's an illness that occurs when someone swallows or inhales lead. The Centers for Disease Control and Prevention (CDC) defines childhood lead poisoning as 3.5 ug/dl (micrograms per deciliter) or more of lead within the body at the time of screening.

How does lead affect your health?
Lead can be harmful to anyone. However, children under the age of six are at the greatest risk of being harmed by lead. Their bodies easily absorb lead, which can be bad for the developing brain and other organs and systems. Children also tend to put things in their mouths. When children put items in their mouth that have no nutritional value, such as dirt or flaking paint, this is called pica.

For children, low levels of lead in their bodies can be just as harmful as high levels of lead.

Low levels of lead (<10ug/dL) can result in:

• Speech, language, and behavioral and problems
• Lower IQ
• Learning disabilities and attention deficit disorder
• Nervous system damage

Higher levels of lead (>10ug/dL) can result in:

• Coma
• Convulsions
• Mental retardation
• Seizures
• Death

Unborn babies are also at risk for lead poisoning. A pregnant woman can pass lead on to her unborn child in the womb. This exposure can cause premature birth, low birth weight and small size, and miscarriage and stillbirth. A mother with an increased blood lead level (BLL) who breast-feeds can expose her child to lead.

Although children are at a greater risk of being harmed by lead, it's still harmful for adults too. In adults, high BLLs can cause increased blood pressure, reproductive health problems, anemia, nerve disorders, and memory and concentration problems.

What are the symptoms of lead poisoning?
There are no clear symptoms of lead poisoning. This makes the illness hard to detect. Sometimes the symptoms are the same as those of more common illnesses.

Where is lead found?

• Lead-based paint - Many children get lead poisoning when they eat paint chips or inhale dust from peeling lead-based paint, in or outside the house. Houses built before 1978 are more likely to contain lead paint than houses built after 1978. Lead-based paint may also be found on toys and furniture.
• Soil - Soil can get lead in it when paint on the outside of houses, buildings, or other structures flakes or peels. Lead can also be found in soil around old playground equipment.
• Drinking water - Drinking water can become contaminated with lead when it passes through older lead pipes, newer brass pipes, or copper pipes that are joined with lead solder. Over time water can corrode the pipes, letting lead into the water.
• Jobs and hobbies - Working parents may bring lead home on their hands, clothing, and shoes. Jobs that expose people to lead include painting, construction or home remodeling, radiator repair, battery or scrap metal recycling, pottery manufacturing, working with guns and ammunition, industries using lead solder, roadwork, and shipbuilding.

  Dust and fumes from hobbies (such as stained-glass production, pottery, refinishing furniture, making fishing weights, jewelry, etc.) can be a source of lead too.

• Air - Before the Environmental Protection Agency (EPA) banned leaded gasoline, most lead released into the environment came from car exhaust. Other sources of lead released into the air include burning fuel, such as coal or oil, industrial processes, and burning solid waste.
• Lead-glazed ceramic ware, pottery, and leaded crystal - Food and liquids can become contaminated when put in pottery, dishes, and crystal that contain lead.
• Traditional folk medicines and cosmetics such as Greta, azarcon, paylooah, surma and kohl may contain high levels of lead.
• Moonshine - Some parts, such as automobile radiators or lead pipes, used in the distillation process to make moonshine may have contaminated the alcohol with lead.
• Mini or Venetian blinds - Mini-blinds that are made outside of the United States may contain lead. Over time, sunlight and heat cause lead dust to form on the surface of these mini-blinds. Children could inhale this lead dust.

How do you protect your family from lead?

• Have your child's blood tested for lead poisoning.
• Be sure your child washes his/her hands often, especially after being outside, before eating, and before bedtime.
• Wash toys, stuffed animals, and pacifiers often.
• Do not allow your child to eat or chew on things that may contain lead.
• Mop floors and wash windowsills with a wet cloth and warm soapy water. Use a wet sponge or rag to wipe up paint chips.
• When outside, make sure your child plays on grass or in a sandbox - not in the dirt.
• Do not store food in old or imported pottery or glassware.
• Run water from the tap for 1-2 minutes before drinking or cooking with it. Use only cold water from the faucet for cooking, drinking, or making baby formula.
• If lead is used where you work, change your clothes and shoes before entering your house. Always wash your hands too.
• Make sure you and your family eats a well-balanced diet that is low in fat and high in calcium, iron, and Vitamin D.
• Do not remove lead paint yourself. Hire a certified contractor to remove lead paint from your home.
• If you rent property, tell the landlord about peeling or flaking paint.

Is there a test for lead?

• For your child - A simple blood test is used to measure the level of lead in one's body. Contact your child's doctor for additional information and/or to request a test. You can also contact your local health department to inquire about screening. The only way to know for sure if your child has been exposed to lead is to have the test done.
• For your home - Home test kits are sold at local hardware stores. They are used to detect lead in paint, soil, and dust. Some kits can test dishes, glasses, and ceramics. The Federal Government DOES NOT currently advise using home test kits to detect lead. These kits are not always reliable. f you would like to have your home checked for lead, contact a lead inspector or lead risk assessor. To find professionals in your area, contact the Department of Natural Resources (DNR).
• For water - Contact your  local health department  or water supplier to find out about testing your water for lead.

The Georgia Department of Natural Resources (DNR) Environmental Protection Division creates and enforces rules based on Georgia (Official Code of Georgia Annotated) Statutes. The agency's rules for lead-based paint abatement, certification, and accreditation are in accordance with The Georgia Lead Poisoning Prevention Act of 1994. These rules form DNR Chapter 391-3-24.

Lead Abatement Activities

Abatement refers to any activity that gets rid of lead-based paint or lead-based paint hazards. DNR states that abatement includes, but is not limited to:

• The permanent containment or encapsulation of lead-based paint,
• The replacement of lead-painted surfaces or fixtures,
• The removal or covering of lead contaminated soil; and
• All preparation, cleanup, disposal, and post abatement clearance testing activities associated with such measures.

For more information on abatement activities as they pertain to Georgia's law, refer to DNR Chapter 391-3-24.

If you want to find a certified contractor who does lead-based paint abatement, contact DNR.

Finding a Lead Inspector or Lead Risk Assessor

The health department conducts home investigations to find lead sources in the home. These investigations are done when a child has a confirmed elevated blood lead level (>3.5 ug/dL). The health department does not do home investigations under other circumstances. If you would like to have your home checked for lead, contact a lead inspector or lead risk assessor. To find professionals in your area, contact DNR.

Becoming a Certified Lead-Training Program, Lead Risk Assessor, or Lead Inspector

Under the Georgia Lead Poisoning Prevention Act of 1994, all persons who conduct or claim they are trained to conduct any lead-based paint activities must have the correct licensure or certification as decided by the Board of Natural Resources. If you would like to become a certified lead-training program, lead risk assessor, or lead inspector, contact DNR. They provide the forms needed to apply for certification.

The Georgia Healthy Homes and Lead Poisoning Prevention surveillance program collects and analyzes data that is used to help plan, implement, and evaluate Georgia's lead poisoning prevention activities.

Lead screening data are entered into the Stellar database that was created by the CDC. The Georgia Stellar database contains data for 1998 through 2003 for children less than 16 years of age. Analyses are done using SAS statistical analysis software. The lead screening data are address matched and analyzed by location with ArcGis mapping software. The maps on the Web site were produced by using ArcView 8.3. The data available on the website summarize surveillance information that has been reviewed and accepted by the CDC.

You can contact GHHLPPP to request more detailed or more recently collected data.

Data Notes:

• A child can only be screened once initially within a specified period of time (ex. 1999). All other tests are confirmatory and/or follow-up tests. Elevated blood lead data are based on the highest test result (capillary or venous) within that period of time.
• Records for which the child's date of birth is unknown or incorrect are dropped.
• Age is based on the child's age when the blood specimen with the highest test result was collected.
• The data represent all records reported to the GHHLPPP during the year.
• 0 to 4 case of elevated blood lead levels are reported as <5 to preserve confidentiality.
• County is county of residence of the child at the time of the screen.

Childhood Lead Screening Data in Georgia
These tables provide data on the number of blood lead screens and elevated blood lead levels among children (<6 years old) in Georgia, by county, Public Health District, age, race, gender and year.

ARCHIVE FILES

*For older data, please email [email protected]

Yearly Data, 2013
Yearly Data, 2014
Yearly Data, 2015
Yearly Data, 2016
Yearly Data, 2017
Yearly Data, 2018
Yearly Data, 2019
Yearly Data, 2020
Yearly Data, 2021
Yearly Data, 2022
Yearly Data, 2023

Home investigations are done by trained people who try to locate sources of lead in the home, buildings, or other structures. The state health department conducts investigations when a child has a confirmed blood lead level of >= 3.5 ug/dL. Otherwise, if you want your home tested, contact a lead inspector or lead risk assessor.

When a home investigation is done, the hand held XRF machine is used to locate lead sources in the home. The machine uses X-ray technology and must be used with care to prevent exposure to harmful radiation. This is why investigators are always trained professionals. Sometimes dust and paint chip samples are collected and sent to a lab for testing. When the results come back, the investigator gives the homeowner a detailed report of the findings. Recommendations are also given on ways to get rid of the lead hazard.

Abatement

Any activity that gets rid of lead-based paint and lead-based paint hazards. The four types of abatement methods are removal, enclosure, encapsulation, and replacement.

Anticipatory guidance

Information that is given to a parent or guardian to help reduce a child's risk of exposure to lead and to prevent childhood lead poisoning. A health care professional usually provides this information.

Blood lead level (BLL)

A measurement of how much lead is in the blood.

Capillary blood test

A test for which blood is obtained by pricking the skin of the finger, heel, or other areas (capillary blood). A drop (or a few drops) of blood is put on a test strip or into a small container.

Chelation therapy

The drug treatment given to someone that has very high lead levels.

Home investigation (environmental investigation)

An investigation done by certified people who try to locate sources of lead in the home, buildings, or other structures. Sometimes dust and paint chip samples are gathered and sent to a lab for testing. When the results come back, the homeowner is given a detailed report of the findings and recommendations on ways to get rid of lead hazards.

Lead Inspector

A person who has completed training from an EPA approved program and has been licensed or certified by the proper local, tribal, state or Federal agency to perform a lead-based inspection.

Lead Inspection

An on-site investigation to detect if lead-based paint is present in a home and where it's found. This investigation does not provide information on whether it's a hazard or how to take care of it.

Lead-based paint

Any paint, varnish, shellac, or other coating that contains lead equal to or greater to 1.0 milligram per square centimeter or 0.5 percent lead by weight.

Lead hazard

Unsafe conditions that cause lead exposure at levels that could be harmful to a person.

Lead hazard control

Activities to control and get rid of lead hazards. They include short-term controls and abatement.

Lead risk assessment

An on-site investigation to detect if lead hazards are present and how they can be controlled.

Lead risk assessor

A person who has completed training with an accredited training program and has been certified by the proper local, tribal, state, and Federal agency to perform a risk assessment.

Pica

The compulsive eating of nonnutritive items such as dirt or flaking paint.

Title X (Lead-Based Paint Hazard Reduction Act of 1992)

This law directs Federal agencies to create regulations to strengthen and redirect national lead poisoning prevention efforts.

ug/dL

Micrograms per deciliter; the measurement used to express how much lead is in someone's blood.

Venous blood test

A test for which blood is drawn from a vein, usually in the arm. This is the ONLY way to know for sure if a child has lead poisoning.

XRF machine

A devise used to detect sources of lead in the home. The machine uses X-ray technology and must be used with care by a certified professional to prevent exposure to harmful radiation.

The Federal Law: Renting, Buying, or Renovating pre-1978 Housing

Federal law (Title X, Section 1018) requires landlords, sellers, and renovators to give information on lead based paint and lead based paint hazards before the sale or lease of target housing. Target housing includes most private housing, public housing, housing receiving federal assistance, and federally owned housing built before 1978. 

This law does not affect some housing. Housing that is not affected includes:

• Housing built after 1977.
• Zero bedroom dwellings, such as lofts, efficiencies, and studios.
• Leases of dwelling units of 100 days or fewer, such as vacation homes or short-term rentals.
• Housing for the elderly and the handicapped (unless children live there).
• Rental housing that has been inspected by a certified inspector and is found to be free of lead-based paint.
• Foreclosure sales.

Selling a House

If you're selling target housing, you must:

• Provide information and any existing reports on all known lead-based paint and lead-based paint hazards in the housing.
• Give buyers the Protect Your Family from Lead in Your Home.
• Give buyers a 10-day time period to test the housing for lead.
• Include certain disclosure and acknowledgement language in the sales contracts.

Renting a House

If you're renting target housing, you must:

• Provide information and any existing reports on all known lead-based paint and lead-based paint hazards in the housing.
• Give renters the Protect Your Family from Lead in Your Home..
• Include certain disclosure and acknowledgement language in the leasing contract.

Renovating a House

If you're renovating target housing, then you must give homeowners the Protect Your Family from Lead in Your Home.. Landlords and property managers who perform renovations must also give this pamphlet to tenants before they start work.

For Additional Information

If you're a landlord, seller, renovator, tenant, or (home) buyer and would like more information on the Disclosure Rule (Title X, Section 1018) and it's requirements, contact the EPA or the National Safety Council (NSC). 

Renovate Right! Guide

Centers for Disease Control and Prevention (CDC)
      Lead Poisoning Prevention Training Videos (CDC)
Consumer Product Safety Commission (CPSC)
Department of Housing and Urban Development (HUD)
Department of Natural Resources (GA)
Environmental Protection Agency (EPA)
National Center for Healthy Housing
National Lead Information Center (NLIC)
Poison Center (GA)

Screening

A blood test is the preferred method for lead screening. There are two tests used to obtain blood lead specimens, capillary blood test or venous blood test. Finger stick capillary blood tests can be done as the initial screening. However, safety measures should be taken to reduce the risk of contamination. These measures include:

• Rinsing powder from the examination gloves
• Thoroughly washing the patient's hands with soap and water, then drying before taking a sample

A venous blood test can be done as the initial screening as well. This method should always be used to confirm elevated blood lead test results when a capillary test was used as the initial screening.

Video on how to properly take a blood lead sample

Case Management

• Case Management Guidelines
• Recommended Medical and Case Management Actions and Retest Chart

Lab Submission

The Decatur Regional Laboratory provides an analysis of blood lead specimens to Georgia children less than 72 months of age. The provider's office should contact the laboratory to use this service. GHHLPPP does not recommend or endorse the use of another lab.

Decatur Public Health Laboratory
1749 Clairmont Road
Decatur, GA. 30033

For new submissions and account set up, please contact:

Nicole Harris
Laboratory Customer Service Rep.
Phone: 404-321-2261
Email: [email protected]

Reporting Guidelines

Laboratories attempt to test each lead specimen on the day it arrives. The reports are mailed back to providers on the same day. All laboratory data is sent monthly in electronic or paper format to GHHLPPP.

Providers should report the results of all screening and follow-up BLL tests to GHHLPPP. Because data from laboratories often do not include demographic information, complete reports from providers' offices are very important. If reports are not complete, GHHLPPP may contact providers' offices for missing information.

Results can be reported by:

• State Electronic Notifiable Disease Surveillance System (SENDSS)
• SENDSS is a web-based reporting system designed to collect information about notifiable diseases in Georgia.
  Click here  for reporting instructions.  Click here  for reporting spreadsheet template.

Data Submission Questions? Contact: 

Yu Sun 
404-657-6534
[email protected]

SENDSS Questions? Contact:

Anjali Betineni
Sendss Support Analyst
[email protected]

 

Screening for lead poisoning helps identify children who need interventions to reduce their blood lead levels. Many children who may have been exposed to lead or who are at risk for lead poisoning go without being screened. This makes their chances of being harmed by lead greater. Parents and providers should know when a child should be tested for lead poisoning.

The Importance of Childhood Blood Lead Testing (CDC Video)

 

Medicaid and PeachCare for Kids

All children enrolled in Medicaid and PeachCare for Kids should be tested for lead poisoning and offered certain services based on the following schedule:

Age	Lead Blood Test	Lead Risk Assessment Questionnaire	Anticipatory Guidance
6 months		X	X
9 months		X	X
12 months	X		X
24 months	X		X - At Well-Child visits
36 - 72 months	X - If there's no record of previous test at 12 and 24 months	X - Complete yearly unless blood tested	X - When lead risk assessment questionnaire is given

Lead Risk Assessment Questionnaire  

• English  
• Spanish  
• Vietnamese  

When using the questionnaire, blood lead tests should be done right away if the child is at high risk (one or more "yes" or "I don't know" answers on the risk assessment questionnaire) for lead exposure. Completing this questionnaire does not count as a lead screening.

All Other Children Living in Georgia

Children that are not enrolled in Medicaid and PeachCare for Kids should be tested for lead poisoning according to the 2022 Blood Lead Screening Guidelines for Georgia. The guidelines focus on screening children who are considered high-risk based on their membership in a high-risk group (i.e. Medicaid, WIC, etc.) or geographic location. Using GHHLPPP's elevated blood lead level surveillance data and housing data, 16 counties were identified where children living may have a higher risk of being exposed to lead. These counties include: Bibb, Chatham, Clayton, Cobb, Colquitt, DeKalb, Dougherty, Floyd, Fulton, Gwinnett, Hall, Houston, Laurens, Muscogee, Richmond, and Troup.

The key aims of GHHLPPP are to:

• Transition into a comprehensive Healthy Homes Program while continuing to monitor for lead exposure and provide case management and environmental investigations lead poisoned children;
• Develop and implement a strategic plan for the state to reduce or eliminate housing‐related health hazards and to promote housing that is healthy, safe, affordable, and accessible;
• Build a consortium of strategic partners to address unsafe and/or unhealthy housing conditions caused by housing‐based hazards by leveraging resources and seeking sustainability in funding;
• Assure that follow up care and interventions are provided for vulnerable populations who are identified with housing‐related health issues;
• Expand the GHHLPPP surveillance system to include not only blood lead levels, but also environmental tests results and selected healthy homes variables;
• Consolidate existing related Department of Public Health (DPH) programs into a comprehensive Healthy Homes and Lead Poisoning Prevention Program;
• Work with housing agencies to enforce hazard reduction in inspected housing through existing HUD hazard reduction programs, healthy homes local programs, and housing code enforcement mechanisms;
• Engage our Environmental Justice and Faith Based Partners to educate the community concerning the dangers of housing‐based hazards, including lead poisoning, and identifying vulnerable  populations that may suffer the most from these health threatening sources of exposure;
• Contribute to DPH’s mission of responsible health planning and improved health outcomes for the residents of Georgia;
• Expand GHHLPPP by adding staff training in healthy homes concepts and implementing interventions and referrals in response to the detection of housing‐based health hazards;
• Reduce the overall cost of expensive medical responses to injuries and the exasperation of health conditions such as asthma by applying primary prevention principles to reduce housing‐based hazards to reduce exposure prior to needing medical interventions;
• Employ indicator based evaluation techniques to evaluate every aspect of the program to increase efficiency and implement responsible health care planning and utilization of resources; and
• Continue to train and credential existing Environmental Health Branch and local environmental health specialists in lead inspection techniques as well as Healthy Homes Practitioner principles.