Chocolate

Lead levels in chocolate products exceed those in other foods. In 1980, the market basket Total Diet Study (TDS) by the FDA found lead levels in chocolate milk more than three times those in whole milk, and levels in milk chocolate candy approximated those in canned foods (Pennington 1983). In the 2004 TDS, chocolate bars had the highest lead levels of the 280 items surveyed (FDA 2006a). A 2005 study comparing lead concentrations and isotopic compositions of cocoa beans grown in Nigeria with finished candy products found levels 60 times higher in finished candy versus cocoa beans (Rankin et al. 2005). No single source of lead was identified; levels rose at each stage of production.

Candy

Candy imported from Mexico is found repeatedly with high lead levels. Both candy and wrappers printed with lead ink have been cited (CDC 2002a; FDA 1995; Lynch et al. 2000; North Dakota Department of Health 2004). Lead-contaminated candy has also been imported from the Philippines and from Asian and Latin American countries. EBL cases have been reported in California, New York, North Dakota, Oklahoma, and Texas. In California, in 2001, candy was identified as a possible lead source for > 150 children with EBLs. In November 2006, the FDA reduced its recommended maximum lead level for candy consumed by children from 0.5 ppm to 0.1 ppm (FDA 2006b).

Imported foods

Foods and packaging produced outside the United States can contain high lead levels. Several spices (Sattar et al. 1989; Woolf and Woolf 2005), especially Hungarian paprika, have been contaminated (Kakosy et al. 1996). Food coloring also has been implicated in children’s EBLs (Vassilev et al. 2005). In 2006, California sued PepsiCo and Coca-Cola Co. concerning lead in the labels of bottles brought to the United States from Mexico (Lifsher 2006).

Dietary supplements

An assessment of 84 dietary supplements found lead in all, with 11 samples exceeding the tolerable dietary lead intake level (Dolan et al. 2003). These results correlate with other FDA data (Hight et al. 1993; Wong et al. 2004). Other herbal supplements associated with high levels of lead include nettle (FDA 2002) and supplements to treat hair loss (Health Canada 2004).

The Dietary Supplement Health and Education Act prevents the FDA from requiring premarket safety approval for supplements; hence, they require neither proof of safety nor efficacy (Marcus and Grollman 2002). The FDA recently proposed good manufacturing practice regulations to help ensure the safety of dietary supplements (FDA 2003b) and is developing a final rule.

Glass and dishes

Leaded crystal contains 24–32% lead oxide. Crystal decanters and glasses can release high amounts of lead in a short time, especially with cola (Guadagnino et al. 2000). The FDA has cautioned that children and pregnant women should avoid frequent use of crystal glassware and should not use lead crystal baby bottles (Farley 1998).

Ceramic pottery and other dinnerware containing lead glazes can be important exposure sources. Numerous reports of EBLs associated with homemade or low-fired ceramics from Mexico, southern Europe, North Africa, and the Middle East exist (Hellstrom-Lindberg et al. 2006; Manor and Freundlich 1983; Matte et al. 1994). Relatively new, commercially manufactured ceramic dinnerware has also been cited (CDC 2004a). The FDA has established criteria for leachable lead in ceramics ranging from 0.5 to 3.0 μg/mL, depending on the product (FDA 2005c).

Glassware with decals or painted surfaces can also contain lead (Sheets 1999). In 1979, the FDA and the U.S. glassware industry established a voluntary quality control program for decorated glasses that contain lead (FDA 1992). Since 1994, the FDA has exempted ornamental ceramicware from lead-leaching requirements if it contains a permanent marking warning “for decorative use only” (FDA 1992). A complete listing of dishware restricted for importation is available (FDA 2007b).

Vinyl lunchboxes

The U.S. FDA advised manufacturers and suppliers that lead in soft vinyl lunchboxes (FDA 2006c) may transfer to food. Thus, it could be deemed an unsafe food additive (under Section 409 of the Federal Food Drug and Cosmetic Act) (FDA 2008) and adulterated within the meaning of Section 402(a)(2)(C) of the statute and subject to regulation.

Lead in consumer goods

According to the Consumer Product Safety Commission (CPSC), lead is the most frequently recalled substance that could result in poisoning. Many products associated with childhood lead poisoning are imported and do not meet U.S. standards (CDC 2002a; Geltman et al. 2001). A listing of all CPSC-recalled items is available (CPSC 2007). Products containing wood, metal, plastic, ceramics, and paper have been found with high lead concentrations.

Lead paint in housing

Approximately 38 million homes had lead-based paint (LBP) in 2000 (Jacobs and Nevin 2006). Of those, an estimated 24 million units had deteriorated lead paint, dust lead, or bare soil contaminated with lead (Jacobs et al. 2002). Of those with LBP hazards, 1.2 million units housed low-income families with children < 6 years of age. A relatively small number of properties may account for large numbers of children with EBLs (Korfmacher and Kuholski 2007; Meyer et al. 2005; Reyes et al. 2006).

Housing units with LBP hazards are not evenly distributed (Jacobs et al. 2002). In 2000, for households with incomes ≤ $30,000—the federal poverty level at that time—35% of the housing units had LBP hazards compared with 19% of all housing units. Northeast and Midwest housing has twice the prevalence of LBP hazards compared with housing in the South and West. Although the prevalence of LBP hazards increases with the age of the building, most painted surfaces, even in older housing, do not have lead paint; only 2–25% of building components have LBP (Jacobs et al. 2002).

Children in units with LBP are almost 10 times more likely to have an EBL than children in similar housing without lead paint (Schwartz and Levin 1991). Addressing lead paint hazards significantly reduces the risk of identifying another child with an EBL in a unit where one was previously identified (Brown et al. 2001a).

Mean BLLs of children whose housing was abated show a 38% decrease over a 2-year period after lead hazard control (National Center for Healthy Housing and the University of Cincinnati Department of Environmental Health 2004). Nonetheless, disturbing lead painted surfaces can increase the BLLs of children living in those units during repair work unless appropriate controls are instituted, especially dust clearance levels (Amitai et al. 1991; Bellinger et al. 1986; HUD 1995). Studies of well-conducted renovation activities show that although lead hazard interventions reduce most children’s BLLs, about 10% of the time BLLs significantly increased (CDC 1997; Clark et al. 2004); young children (< 18 months of age) are at highest risk of increases. BLLs of children who continued to live in the house or relocated for less than the full work period also were significantly more likely to increase than those of children who relocated for the entire renovation. Consequently, remediation and abatement activities that disturb lead paint must be followed by specialized cleaning and dust-lead testing to determine whether the unit is safe for re-occupancy. bonne lecture.