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CSTE Position Statements 2000 OCC #1 Committee: Occupational Title:
Designation of Adult Blood
Lead Epidemiology and Surveillance as the initial core component of state-based
occupational health and safety surveillance Position
To Be Adopted: CSTE
supports the National Institute for Occupational Safety and Health (NIOSH)
Surveillance Strategic Plan and its recognition of the importance of
establishing core state-based occupational health and safety surveillance
programs in every state. CSTE
recommends that establishment of Adult Blood Lead Epidemiology and Surveillance
(ABLES) programs in all states seeking to address this core capacity is the
highest priority with respect to occupational health surveillance requiring
federal assistance. CSTE
will promote maximal utilization of ABLES data through expanded partnerships
with federal agencies/programs active in lead poisoning prevention (e.g., NIOSH,
HUD, EPA, OSHA, NCEH, HRSA, NCHS). Background And Justification: The
role of public health practitioners in state health agencies is to assess
factors that adversely impact the public's health and implement effective
intervention activities to reduce the extent of illness and injury.
In the area of occupational health and safety, public health prevention
activities are also needed to support efforts in regulation and enforcement
carried out by the Occupational Safety and Health Administration (OSHA). In 1987, NIOSH and four states established the ABLES Program, a surveillance system for identifying and preventing cases of elevated blood lead levels (BLLs) among U.S. adults, most of whom are exposed to lead at work. There are currently 28 ABLES states with programs that:
Twenty-one
of the 28 ABLES state programs currently (fiscal year 2000) receive funding
support from NIOSH ranging from $19,000 to $26,000 per year, and approximately 5
to 7 states are interested in developing programs if additional funding were to
become available. The experience of NIOSH and the ABLES state programs has shown that effective state-based surveillance of elevated blood lead levels is straightforward and minimally achievable with limited resources. The diagnosis of elevated blood lead levels is clear cut. Mandatory state requirements for laboratory reporting of BLLs to state health departments provide usable data for public health action. These data enable ABLES state programs to perform case follow-up of individual workplaces and targeting for broader interventions. Providing education and training about appropriate prevention measures has been effective in improving workplace conditions and preventing future disease. Many ABLES programs also make referrals of problem workplaces to OSHA for enforcement action and/or have memoranda of understanding with OSHA to use ABLES data for targeting purposes. The ABLES Program provided input to CDC in the development of a Healthy People 2010 objective for adult lead poisoning prevention (1). This objective seeks to eliminate exposures to lead that result in adults with blood lead levels above 25 ug/dl by the year 2010. Each
quarter, approximately 4000 individuals nationwide are identified with BLLs 25
micrograms per deciliter (ug/dl) or higher by the 28 state-based ABLES programs
(2). However, these data likely
represent only the tip of the iceberg with respect to the extent of occupational
lead exposure in the U.S. ABLES
programs have found that many workers do not receive routine blood lead testing
despite OSHA regulations requiring testing.
ABLES case follow-up often identifies additional workers at risk and new
sentinel exposures. In addition to the adults identified with elevated BLLs and potential lead poisoning, ABLES programs identify children at risk from lead brought home from the workplace on workers' clothes, shoes and bodies ("take-home lead"). Several significant studies have documented lead contamination in the homes of lead-exposed workers and elevated BLLs among their children (3,4), and NIOSH has issued a Report to Congress on this topic (5). ABLES programs work closely with childhood lead poisoning programs to refer the children of lead-exposed workers for testing and work with employers to reduce risk factors for take-home lead exposure. A recently published ABLES meta-analysis of workers and their children's lead levels estimated that 2 to 3% of child lead poisonings (potentially 24,000 out of 890,000 children with BLLs over 10 ug/dl) may result from take-home lead exposure (6). Nationwide, there is currently a major focus on addressing the problem of childhood lead poisoning, in particular that which results from exposure to lead paint and dust in housing. Several federal agencies (CDC, HUD, EPA, HRSA) have major initiatives and resources devoted to this effort. The primary intervention for child lead exposure is remediation of deteriorated paint and contaminated dust in housing; this work requires a vast workforce of construction workers to accomplish this task in an estimated 77 million privately-owned housing units that contain lead-based paint (7). If not done properly, this work will expose both workers and building occupants to unsafe levels of lead. In a recent Report to Congress, NIOSH recommended that evaluation of the safe progress of remediation, renovation and remodeling work requires the effective surveillance systems for adult lead poisoning established by the state ABLES programs (8). The report stated that, "State surveillance programs should be expanded to all states where workers are exposed to lead-based paint hazards to identify high-risk workplaces and conduct follow-up investigations where needed." In addition, several ABLES programs have conducted projects aimed at educating contractors and workers about working safely around lead-based paint, and at evaluating work methods that reduce lead exposure and the potential for contamination during renovation activities. Over the last several years, a NIOSH-State Work Group representing the approximately 30 states with surveillance programs for various occupational health endpoints established an overall goal of conducting core occupational health surveillance and prevention activities in 50 states (9). The NIOSH Surveillance Strategic Plan has as a major goal to strengthen the capacity of state health departments and other state agencies to conduct occupational health and safety surveillance (10). The ABLES Program is an essential step toward meeting that goal, as for most states the only occupational health condition currently under surveillance is elevated BLLs. State-based ABLES programs can serve as the basic infrastructure on which to expand to include other occupational or environmental health endpoints. Many of the states that conduct occupational health surveillance started with an ABLES program and have gone on to obtain state funds for increasing state health department-based occupational health prevention activities. Leadership
is needed from NIOSH in establishing partnerships with other federal
agencies/programs with a stake in lead poisoning prevention to support the
capacity of ABLES programs nationwide. CSTE adopted a position (11) in 1995 recommending the addition of elevated adult BLLs to the National Public Health Surveillance System (NPHSS). In 1999 CSTE adopted a position (12) which established a surveillance case definition of 25 ug/dl or higher for adult BLLs to be reported to NPHSS. This Position Statement is intended to promote the capacity of state-based occupational health surveillance programs to contribute occupational lead poisoning surveillance data to NPHSS by maintaining ABLES programs in the current 28 states and continuing to develop the capacity for collecting such data in all states nationwide. Coordination With Other Agencies Agencies
for Response: Jeff
Koplan Centers
for Disease Control and Prevention Office
of the Director 1600
Clifton Road, NE M/S
D14 Atlanta,
GA 30333 Linda
Rosenstock National
Institute for Occupational Safety and Health 200
Independence Ave SW Room
715 H Washington,
DC 20201 Dick
Jackson Centers
for Disease Control and Prevention Epidemiology
Program Office 1600
Clifton Road, NE Mailstop
C 8 Atlanta,
GA 30333 Earl
Fox Health
Resources and Services Administration 5600
Fisher Lane PKLN
Room 14-05 Rockville,
Maryland 20857 Carol
Browner Environmental
Protection Agency 1200
Pennsylvania Ave, NW Washington,
DC 20460 Charles
Jeffers Occupational
Safety and Health Administration Division
of Adolescent and School Health Room
south 2315 200
Constitution Ave NW Washington,
DC 20210 Ed
Sondik Centers
for Disease Control and Prevention National
Center for Health Statistics Presidential
Building 6525
Belcrest Road Hyattsville,
Maryland 20782 Andrew
Cuomo Department
of Housing and Urban Development 451
7th Street , SW Washington,
DC 20410 Implementation of this resolution will be a priority activity of the CSTE Environmental and Occupational Health Committee and its Occupational Health Team. Agencies
for Information: For information on NIOSH policies and data on adult lead exposures, telephone the NIOSH hotline: 1-800-356-4674. For further information including contact persons and publications from the 28 states participating in the Adult Blood Lead Epidemiology and Surveillance (ABLES) Program, contact the NIOSH home page (www.cdc.gov/niosh/ables.html). For information on OSHA, EPA, and HUD lead policies and publications, contact their home pages: www.osha.gov, www.epa.gov, and www.hud.gov. Contact: Letitia
Davis Massachusetts
Department of Public Health 617-624-5621 REFERENCES
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