Evaluating the Effects of Lead Mitigation Policy on Childhood Lead Exposure in Rhode Island Alyssa Sylvaria & Ryan Kelly The Providence Plan - Information Group

Outline 1.Background 2.Data and Methods 3.Compliance 4.Childhood Lead Exposure – Compliance – Exemption – Foreclosure 5.Implications 2

BACKGROUND 3

Childhood Lead Exposure 5 µg/dL 5 µg/dL CDC reference level for elevated blood lead levels (EBLL) as of 2012 Rhode Island 25% 2002 Incidence 25% 5% 2012 Incidence 5% 4 Sources: ACCLPP. (2012). Low Level Lead Exposure Harms Children: A Renewed Call for Primary Prevention. Centers for Disease Control and Prevention. Childhood Lead Poisoning Prevention Program. (2014). Childhood Lead Poisoning. Rhode Island Department of Health.

Federal Primary Prevention Efforts Title X: Lead Disclosure Rule HUD Lead Safe Housing Rule EPA Renovation, Repair, and Painting OSHA Interim Lead in Construction Standard 5 Sources: HUD Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing. (2012).

RI Primary Prevention Efforts As of 2005, most rental property owners need to obtain a compliance certificate Exemptions: – 1978 or later Built after lead was banned in paint – Owner-occupied properties with <4 units – ≤100 days a year Temporary or seasonal units – Age 62+ Designated elderly housing 6

RI’s Lead Law 7 Certificates of Conformance require that property owners 1.Attend a Lead Hazard Awareness Class 2.Visually assess the property 3.Get an Independent Clearance Inspection 4.Fix lead hazards 5.Use lead-safe work practices in any maintenance projects 6.Give tenants an Inspection Report and lead hazard info 7.Respond to tenants' concerns about any lead hazards

DATA AND METHODS 8

Population of Properties Residential properties Residential properties – 1 to 5 family properties – Apartments (6+ units) – Mixed use (commercial + residential) Core cities in Rhode Island Core cities in Rhode Island – Central Falls – Pawtucket – Providence – Woonsocket Built before 1978 Built before 1978 – For both exempt and non-exempt 9

Data 10 Property-Level Data Property-Level Data Compliance certificates Tax Assessor Data – Current as of… Providence, 2009 Woonsocket, 2009 Pawtucket, 2010 Central Falls, 2011 Master Look-Up Tables – Verifies the property associated with each address Child-Level Data Child-Level Data Blood Lead Levels (BLLs) – Confirmed blood lead test results – Children living at addresses in the core cities – Ages 0-72 months

Linking Method Standardize Address Data to Properties and Match 1. Aggregate Lead Test Results to Properties Lead- exposed children Lead Compliance Property descriptives

RESULTS 1: COMPLIANCE 12

Focus : Rates of compliance with the Lead Hazard Mitigation Act Population : 15,678 non-exempt properties – Did or did not have any children with blood lead tests (all non-exempt residential properties in our linked dataset) – Compliance 13

14 Properties with “Any Compliance” Had a Certificate of Conformance or Lead Safe Lead Free Certificate – At least one unit on the property (if multi-family) – Complied at any point between 2005 and 2012

15 Any Compliance & Lead Exposure Any compliance includes properties that did not comply until after a child had an elevated blood lead level (EBLL) from Not Compliant Until After EBLL Compliance Before EBLL or No EBLL NO COMPLIANCE Compliance & Lead Exposure at Property ANY COMPLIANCE

16 Compliance Results 30.4% of properties had ANY compliance

17 Compliance Results

18 Compliance Results

19 Compliance Summary Most non-exempt properties did not comply from 2005 to 2012, regardless of how broadly we defined compliance

RESULTS 2: CHILDHOOD LEAD EXPOSURE 20

21 Lead Exposure & Compliance Population 9,127 non-exempt properties with at least one child tested for lead ( ) Question Did compliant properties have lower rates of lead exposure than non- compliant properties?

22 Lead Exposure By Compliance Status

23 Any Compliance EBLL Timing

24 Any Compliance EBLL Timing

25 Lead Exposure & Compliance Summary Properties with any compliance had higher rates of lead-exposed children than non-compliant properties. Most of the compliant properties with lead-exposed children in were multi-families and had lead- exposed children before 2005.

26 Lead Exposure & Exemption Population 20,974 properties with at least one child tested for lead ( ) Question Do exempt properties still have lead-exposed children?

27 Lead Exposure & Exemption 56.5% of properties are exempt from the law

28 Lead Exposure & Exemption

29 Lead Exposure & Exemption

30 Lead Exposure & Exemption Summary Over half of the properties with children tested for lead are not subject to the law. Non-exempt properties had higher rates of EBLLs on the property, but the non- exempt and exempt categories had similar numbers of properties with EBLLs 4,291 non-exempt compared to 3,990 exempt

31 Lead Exposure & Foreclosure Population 39,903 children with blood lead test results Question Do foreclosed properties increase the likelihood of lead-exposed children? Context Housing market issues and home maintenance

32 5% of children lived in a property that foreclosed within 18 months of their lead test date (Adjusted for residence type, owner-occupancy, city of residence, year property built (pre-1950 vs ), and child’s age at time of test). Lead Exposure & Foreclosure Key Results Foreclosure within 18 months of test No:Yes:Difference Estimated BLL (p-value) All children ( ) Children in owner-occupied properties ( ) Children in non-owner- occupied properties ( )

33 Lead Exposure & Foreclosure Summary Children living in foreclosed rented properties had significantly higher estimated BLLs once we controlled for other variables. Relationship was not significant for owner- occupied properties. Foreclosure is likely one important factor out of many that can contribute to lead exposure.

Data Limitations Analysis is not unit-based Compliance does not account for expired certificates 34

Takeaways Enforcement is key to primary prevention Owner-occupied properties not less likely to have lead-exposed children Housing market issues can complicate efforts to reduce environmental health conditions 35

Implications & Next Steps Emphasize connection with healthy housing – Asthma – Energy usage – Inspections Local outreach around compliance and implications for child health 36

Contact us White Paper Provplan.org 37