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Ronnie Levin,¹ Mary Jean Brown,² Michael E. Kashtock,³ David E. Jacobs,^4* Elizabeth A. Whelan,⁵ Joanne Rodman,⁶ Michael R. Schock,⁷ Alma Padilla,¹ and Thomas Sinks²

¹U.S. Environmental Protection Agency, Boston, Massachusetts, USA; ²Centers for Disease Control and Prevention, Atlanta, Georgia, USA; ³Food and Drug Administration, Washington, DC, USA; ⁴Department of Housing and Urban Development, Washington, DC, USA; ⁵National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA; ⁶U.S. Environmental Protection Agency, Washington, DC, USA; ⁷U.S. Environmental Protection Agency, Cincinnati, Ohio, USA

Abstract
Objective: We reviewed the sources of lead in the environments of U.S. children, contributions to children's blood lead levels, source elimination and control efforts, and existing federal authorities. Our context is the U.S. public health goal to eliminate pediatric elevated blood lead levels (EBLs) by 2010.

Data sources: National, state, and local exposure assessments over the past half century have identified risk factors for EBLs among U.S. children, including age, race, income, age and location of housing, parental occupation, and season.

Data extraction and synthesis: Recent national policies have greatly reduced lead exposure among U.S. children, but even very low exposure levels compromise children's later intellectual development and lifetime achievement. No threshold for these effects has been demonstrated. Although lead paint and dust may still account for up to 70% of EBLs in U.S. children, the U.S. Centers for Disease Control and Prevention estimates that ≥ 30% of current EBLs do not have an immediate lead paint source, and numerous studies indicate that lead exposures result from multiple sources. EBLs and even deaths have been associated with inadequately controlled sources including ethnic remedies and goods, consumer products, and food-related items such as ceramics. Lead in public drinking water and in older urban centers remain exposure sources in many areas.

Conclusions: Achieving the 2010 goal requires maintaining current efforts, especially programs addressing lead paint, while developing interventions that prevent exposure before children are poisoned. It also requires active collaboration across all levels of government to identify and control all potential sources of lead exposure, as well as primary prevention.

Key words: children's health, environmental health, lead poisoning, primary prevention. Environ Health Perspect 116:1285–1293 (2008) . Online 19 May 2008]

Address correspondence to R. Levin, U.S. EPA SEP, One Congress St., Boston MA 02114 USA. Telephone: (617) 918-1716. Fax: (617) 918-0716. E-mail: levin.ronnie@epa.gov

*Current address: National Center for Healthy Housing, Columbia, Maryland, USA.

We thank J. Matheson, I. Cote, D. Brown, M. Bolger, J. Bryson, J. Mosby, and our anonymous reviewers for their assistance.

This article reflects the opinions of the authors, not the official positions of the federal agencies listed.

The authors declare they have no competing financial interests.

Received 7 January 2008 ; accepted 19 May 2008.

Correction

In "Sources of Lead Exposure," the percentages given for types of sources were incorrect in the manuscript originally published online. They have been corrected here.