Pediatric neurobehavioral outcomes: lead-hazard intervention has limited benefit

  • JAMA Pediatr

  • curated by Susan London
  • Clinical Essentials
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Takeaway

  • A comprehensive lead-hazard intervention reduced lead exposure without increasing body lead burden among children but failed to improve most neurobehavioral outcomes.

Why this matters

Key results

  • Intervention reduced dust lead load by 24% for floors, 40% for windowsills, and 47% for window troughs.
  • Compared with control, intervention reduced blood lead concentration by 6% among children overall (P=.29) and by 31% among children of non-Hispanic black women (P=.02).
  • There was no significant difference on most neurobehavioral test scores.
  • Exception was lower anxiety scores in intervention group (β, –1.6; P=.04).
  • Editorialist: “More targeted and ambitious lead policy could be a pivotal element of broader social policy to address the environmental legacy of structural racism and thereby close racial gaps in achievement, behavior, and well-being.”

Study design

  • Longitudinal, community-based randomized controlled trial of pregnant women and their children (metropolitan Cincinnati; HOME Study).
  • 355 pregnant women randomly assigned to residential lead-reducing intervention or control intervention.
  • Main outcomes: dust lead load, blood lead concentration, neurobehavioral outcomes up to 8 years of age.
  • Funding: National Institutes of Environmental Health Sciences; others.

Limitations

  • Only some children were at high risk.
  • Certain subgroups were small.
  • Nonresidential lead was not addressed.

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