Newly recognized pathways of exposure to lead in the middle-income home.

Introduction

The prevention of childhood lead poisoning in the United States has been a medical and public health priority since the 1970s (American Academy of Pediatrics [AAP], 2005; Erikson & Thompson, 2005; Mattuck, Beck, Bowers, & Cohen, 2001). Although Campbell and Osterhoudt (2000) noted, and state and local screening data still indicate, that some areas of the country in which children are at risk (Binns, Kim, & Campbell, 2001), the latest National Health and Nutrition Examination Survey (NHANES) report shows a decline in mean blood lead levels in children nationwide (Bernard & McGeehin, 2003). The Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics, in response to the NHANES data, retreated from previous recommendations for universal screening of all children in favor of targeted screening of children considered at greatest risk (AAP, 2005; Manheimer & Silbergeld, 1998; Warren, 2005). With the removal of lead from gasoline in the United States, lead-based paint on both the exterior and interior walls of homes is considered by most official agencies to be the most serious pathway of childhood exposure to lead (Piomelli, 2002). Healthy People 2010 (U.S. Department of Health and Human Services [DHHS], 2005), CDC (Bernard, 2004), and the U.S. Department of Housing and Urban Development (HUD) (HUD, 1990, 1997) determined that the children at greatest risk of lead poisoning are those living in poor neighborhoods in older housing stock. AAP recommends universal screening only for children enrolled in the Women, Infants and Children Supplemental Food Program (WIC) (AAP, 2005).

A newly recognized pathway of childhood exposure to lead, however, involves the introduction of antique painted artifacts into middle and upper-income American homes. The term "shabby chic" was coined and copyrighted by a British decorator to describe this style of home decoration (Ashwell, 2000; Torres, 2001). Items such as old painted furniture, windows, doorframes, and toys with peeling, chipped, or chalky paint are featured in attractive layouts in the popular print media and on televised home-decorating programs (Ashwell, 2000; Bowles, 1993). Of particular concern is the widespread availability of old toys and jewelry in antiques stores, in second-hand stores, at garage sales, and over the Internet (Allen, 2002). In addition, collectors prefer antiques with original paint on the surface, even if the paint is worn and deteriorated (Fendelman, 2003). The desirability of such items is not lost on entrepreneurs, and the prices of antiques and junk with old paint have skyrocketed (Fendelman, 2003). Children in families who own or can purchase such items are not likely to qualify for universal screening from governmental food supplement programs or to fit into the officially recognized population of children most at risk for childhood lead poisoning.

Two objectives were 1) to assess the extent to which antiques with damaged paint are promoted in the popular home-decorating print media and over the Internet and 2) to gauge whether a casual shopper is apt to purchase lead-hazardous antiques in the United States.

Methods

Promotion of Antiques with Damaged Paint

Print Media

Home-decorating magazines aggressively promote the use of timeworn objects as attractive home decor (Bowles, 1993). A content analysis was conducted to determine the extent to which a typical reader of this genre would be exposed to images of antiques with worn or damaged paint. The photographic content of each of 12 issues of four home-decorating magazines from 2004 was evaluated. The magazines have up to 1.8 million subscribers. For each issue, the total number of non-advertising photos featuring items with damaged paint was determined.

Each photograph meeting the criteria was analyzed for three specific concerns. First, all objects in the pictures were assessed for potential accessibility to a child. For example, table legs with peeling paint are easily reached, but an antique sign hung high on a wall is not as accessible. Second, the objects in the pictures were examined for their potential appeal to children. For example, a piece of furniture would be accessible but not necessarily attractive to a child; by contrast, an old toy truck or wagon would be both attractive and accessible. Finally, we analyzed the text associated with each photograph to identify positive promotion of the object--as in a reference to the charm of the object or provision of purchasing information.

We determined the mean number of potentially lead-hazardous items per issue for the January--December 2004 period. The percentage of photographs featuring these items was derived in relation to the total number of non-advertising photographs. Additional categorization of the percentage of furniture items and the percentage of toys completed the analysis.

The magazines in this report are referred to as Magazines A, B, C, and D. Magazines A, B, and C are widely read, with more than 1 million paid subscriptions each. Magazine D has 0.5 million subscribers. Magazine C has an accompanying television program. All four are available in supermarkets, newsstands, drugstores, and public libraries and by subscription, and all four have corresponding online shopping sites.

Internet

To determine the availability of such items for purchase over the Internet, the term "shabby chic" and several limiting terms were typed into two online shopping sites: eBay (a popular online auction house at www.ebay.com) and Amazon (an online book and home products shopping site at www.amazon.com).

Availability of Lead-Hazardous Antiques

Instruments

The lead-testing instrument used for our research is sold commercially under the name Lead Check Swab. The device is a paper tube about the size of a cigarette with a cotton swab on the end. Inside the tube are two plastic cartridges, one containing a clear liquid and the other containing a dry yellow powder. When the user crushes the two cartridges and shakes the tube, a yellow liquid forms inside. Squeezing the tube dampens the swab with the liquid, which can then be rubbed onto the surface of the item being tested. If lead is present in significant quantities, the yellow liquid will turn a pink to rose color relative to the quantity of lead on the surface of the item. The manufacturer states that the sensitivity of the swabs has been independently tested and that the Lead Check Swab can detect down to 2 micrograms of lead with almost 100 percent accuracy (Hybrivet Systems, Inc., 2002). Typically the test solution does not abrade, mark, or harm the surface of the object being tested. Further information on the kit can be found from the Web site (http://www.leadcheck.lcom/LeadCheck-SwabHU.shtml) or through the U.S. Patent Office (Patent Number 5,039,618).

Purchasing Lead Hazardous Antiques

To determine if antiques stores and junk shops are selling items that that may pose a lead exposure hazard, the researchers went "antiquing" in 13 shops and stores in New York State, Virginia, and Oregon throughout 2005.

Many of the stores were clearly set up to appeal to the middle- or upper-income shopper and were located in shopping malls or on quaint avenues. Items in these stores were similar to those portrayed in the magazine photo layouts. Some stores featured apparent construction demolition debris such as old doors and windows 

The researchers browsed for items as a potential home decorator might do. Items suspected of containing lead were swabbed clandestinely in the store. Such items included old windows and doors, exterior shutters, furniture, toys, ceramic and pewter ware, jewelry, and other miscellaneous items. In most cases, if an item tested positive on the swab test, the item was purchased. Eight items found to be positive but priced over $100 were photographed with permission but not purchased.

Results

Promotion of Antiques with Damaged Paint

Print Media

All four of the magazines featured photographs of antiques or junk with damaged or deteriorated paint in their 2004 issues. In magazines A and B, 20 percent and 22 percent of the total non-advertising photographs featured items potentially bearing lead. Many of the photographs displayed two or more items. Such photos were often featured on the magazine cover. A casual shopper just scanning for reading material could, then, without purchasing the magazine, be exposed to the message that antiques with damaged paint are desirable.

A regular monthly column in five of the 2004 issues of Magazine A reminded readers of the importance of old paint to collectors and were warned not to remove or refinish their painted antiques. Although the focus of Magazine C is not on decorating, 12 of the 2004 issues featured at least one item with damaged paint in non-advertising photo layouts. Magazine D is primarily devoted to gardens and landscaping, and many of the photographic presentations of the gardens featured items such as wooden chairs and benches with chipped paint, old window frames, fences, or rusty metal items as art objects in the garden.

Some of the photographs showed visual characteristics that were particularly indicative of potential lead hazards, including peeling and chipped paint on a metal bed and a toy box in a child's bedroom, food being served on breadboards with old paint, and deteriorated paint on a floor. Antique toys were widely displayed in the photographs and included such items as toy boats, hobbyhorses, wooden blocks, dolls, and toy trucks and wagons. Table 1 gives a summary of the content analysis.

Internet

When "shabby chic" is typed into the search engine of eBay, as many as 8,000 hits are returned. Many of the items for sale are described in terms of the worn paint on the object--for example: "Has been painted in a nice cottage white which has worn and chipped over the years and has a great aged look." Or "It is made out of wood and has a few layers of its ORIGINAL old cream chippy paint with some of the wood showing from underneath...." Refining the search to include the terms "antique," "furniture," or "toys" will still yield hundreds of hits. The terms "shabby chic," and "home and garden" put into the search engine on Amazon.com will return more than 500 hits.

Availability of Antiques that Bear Lead on Painted Surfaces

Within the first five minutes in each of the 13 stores, it was possible to find and purchase an object that tested positive on the swab test. Twenty-eight of the items testing positive for lead were purchased for further quantitative analysis. The purchased items were categorized by type of item (painted wood, painted metal, ceramic or pewter, painted glass, or miscellaneous), and cross-categorized for potential attractiveness to children, potential to come into contact with food or beverages, or both. The results are presented in Table 2.

The total cost of the 28 items purchased was $495.00. Other items for sale but not purchased ranged in price from $100.00 to $895.00, a price likely to be unaffordable for families with children who are officially targeted for lead screening according to designated categories of lead-poisoning risk. Many of the items were attractively displayed for casual shoppers and their children. A white painted entry door found at a large old-fashioned antiques and furniture store in Oregon had lead-based paint on the frame so chalky it came off on the researcher's hands. The door was priced at $895.00. A store in Virginia had an old wooden bouncing-horse toy displayed at the entrance. Particles of the lead paint from the toy had fallen and collected on the floor beneath it as a result of customers testing out the spring. An old wooden bed frame tagged at $475.00 was displayed outside the front of the store. The blue paint on the frame was also positive for lead.

Some items, such as a Japanese wine cup and a set of Russian nesting dolls, had been manufactured in foreign countries. The Consumer Product Safety Commission (CPSC) is collaborating with the U.S. Customs Service in a program to intercept and prohibit the importation of children's toys that may contain lead (U.S. HUD, 1997), and CPCS regulations restrict lead in consumer products to less than 0.06 percent. Most of the lead-hazardous items that were purchased for our research, however, were manufactured and produced in the United States prior to the enactment of the current CPSC regulations. Items such as a drinking glass featuring Garfield the Cat, tops of salt and peppershakers, and old Pyrex casserole dishes tested positive for lead. The surface of a gray metal necklace in the shape of a turtle also tested positive and had a chain long enough to allow a child to put the necklace in her mouth. Although the U.S. Food and Drug Administration (FDA) Food Code does not allow pewter intended for food to contain lead (FDA, 2005) it was possible to purchase a pewter pitcher and a pewter bowl that were positive for lead and apparently produced before the official guidelines went into effect. Both articles were American-manufactured.

Discussion

Limitations

Our research examined a very small portion of the print and electronic media's presentation of artifacts with damaged paint as fashionable home decorations. Although popular television programs such as The Antiques Roadshow on the Public Broadcasting System (PBS), and cable television's Design on a Dime often promote damaged or old paint as desirable, these electronic-media productions were not analyzed, and neither were print media items such as home-decorating catalogs and books. Our research determined the ease of purchasing lead-bearing articles at antique stores, but there are also thousands of diverse locations selling items of these types and reproductions throughout the United States, seriously limiting any estimates on total sales or availability.

The instrument used for testing the articles for sale in the antiques stores provides only a positive/negative result. In order to determine the amount of lead in the purchased antiques, researchers would have needed to analyze the items using X-ray fluorescence techniques.

Recommendations

In addition to continued research into this problem, including quantitative analysis of the already purchased antiques, an effective solution would have four parts:

1. Education. Education is key to reducing and eventually eliminating childhood lead poisoning (AAP, 2005; Goldman, 1997). American consumers, particularly young middle-income families, need to learn about the potential hazards associated with antiques before they buy them and about the importance of disposing of or testing items already in their homes. Equally important, official public health agencies at the local, state, and federal levels need to be educated about this issue. Either CDC or HUD should take the lead and conduct video conferences on this issue for state and county health departments throughout the United States. HUD should make grant funds accessible to health educators who can begin work on the problem. Health care providers who treat middle-income children and families should be updated on the issue and should provide educational material featuring photographic examples of potentially dangerous items to parents during well-child checkups.

2. Screening. Secondary prevention techniques should determine if children in households containing antiques with lead-bearing surfaces have been exposed. Health care professionals who identify potential hazards through interventions at the office should recommend lead-screening tests to parents. It cannot be over-emphasized, however, that screening is not a panacea and that the only real solution to childhood lead poisoning is primary prevention (AAP, 2005; Rabito, White, & Shorter, 2004).

3. Regulation and enforcement. It would be difficult, if not impossible, to enforce regulations prohibiting the sale of lead-contaminated objects at the thousands of small-scale junk shops, estate sales, church rummage sales, and yard sales all over the United States. Local governments, with advice from their county health departments, however, could pass ordinances specifying that consumers purchasing used goods at an established business or auction must receive a warning about potential lead hazards and advice about where to go for additional information. At the state level, California's Safe Drinking Water and Toxic Enforcement Act of 1986 (Proposition 65) provides the best model for warning consumers about toxic hazards by using market forces to control exposures (Pease, 1991), but the law applies only to businesses that have 10 or more employees. At the federal level, the U.S. Environmental Protection Agency, through its Toxic Substances Control Act (TSCA), has regulations in place that govern the disposal of hazardous waste containing lead, and these regulations allow both residents and contractors to dispose of debris containing lead-based paint as household waste (Lead; Identification of Dangerous Levels of Lead Rule, 2001). See the sidebar at left for pertinent sections of the regulations. To be effective, the Toxic Substances Control Act would need to be amended to specify that such rubble could not be sold or resold.

4. The cooperation of the media. Understanding and manipulating consumer behavior is a major focus of the work of both print and electronic media (Cornwell, Weeks, & Roy, 2005). At the same time, the media presentation of old and used items as desirable is curious. Zukin and Maguire (2004) have suggested that displaying apparently worthless objects as fashionable may be a subtle but powerful influence in a desire to be more "democratic" in a global economy. Regardless of the reasons behind the consumption of hazardous waste as home decor, the media will be needed to play a significant role in turning the trend around and providing education on the safe use of potentially hazardous "heirlooms."

Conclusions

After decades of work at the public health, educational, and regulatory levels to reduce childhood lead poisoning in the United States, it appears that the lead hazards of the past are reentering American homes, and in a completely unexpected way. In addition, the children at risk from the reintroduction of these past hazards will not fall into the officially recognized risk categories for childhood lead poisoning. A family that can afford to pay $895.00 for a used door is not likely to be a WIC participant, and a child in such a family will not participate in the lead-screening programs that are recommended by AAP and CDC. At the same time, none of the federal agencies tasked with reducing and eventually eliminating childhood lead poisoning in the United States has as yet identified this particular pathway.

Of most serious concern is the extent to which old toys and items that would be attractive to children are being displayed and sold as decorating objects. The desirability of toys to collectors is driving up their price, and as a result, their popularity. Most experienced parents, however, can describe how a determined toddler can easily access objects parents believe are safely out of reach. It is hard to imagine the toy trucks, dolls, tea sets, and other toys purchased for this research going untouched or unused if they were displayed in a home with children.

This problem will not be easy to solve. As with all fads and fashions, it is probable that this one will diminish within the next decade and that young American families will no longer find old damaged paint attractive or desirable. The lead their children ingest or inhale while the fad is sweeping the country, however, will stay with them for decades to come.

Acknowledgments: The authors would like to acknowledge and thank Dr. Richard Jacobs, toxic metal expert with the U.S Food and Drug Administration, for his advice and recommendations during preparation of the manuscript.

Corresponding Author: Laurel Sharmer, Associate Professor, State University of New York at Potsdam, Department of Community Health, Potsdam, NY 13676. E-mail: [e-mail].

REFERENCES

American Academy of Pediatrics, Committee on Environmental Health. (2005). Lead exposure in children: Prevention, detection, and management. Pediatrics, 116(4), 1036-1046.

Allen, D. (2002). Out of the attic and online: Shabby chic sites on the Internet. Link-up, 24(1), 24-27.

Ashwell, R. (2000). Evolution of shabby chic. Style at Home, 27(3), 108-112.

Bernard, S. (2004). Should the Centers for Disease Control and Prevention's childhood lead poisoning intervention level be lowered? [Brief article]. Academy of Child and Adolescent Psychiatry, 43(2), 182.

Bernard, S., & McGeehin, M. (2003). Prevalence of blood lead levels [greater than or equal to]5 [micro]g/dL among U.S. children 1 to 5 years of age and socioeconomic and demographic factors associated with blood of lead levels 5 to 10 [micro]g/dL, Third National Health and Nutrition Examination Survey, 1988-1994. Pediatrics, 112(6, Pt 1), 1308-1313.

Binns, H., Kim, D., & Campbell, C. (2001). Targeted screening for elevated blood lead levels: Populations at high risk. Pediatrics, 108(6), 1364-1366.

Bowles, H. (1993). In rare form: Shabby chic interior decoration. Vogue, 183(7), 187-189.

Campbell, C., & Osterhoudt, K. (2000). Prevention of childhood lead poisoning. Current Opinions in Pediatrics, 12(5), 428-437.

Cornwell, T., Weeks, C., & Roy, D. (2005). Sponsorship-linked marketing: Opening the black box. Journal of Advertising, 34(2), 21-43.

Fendelman, H. (2003). Antiques then and now: 25 objects, 25 years--A professional appraiser evaluates which of our favorites have endured over the years. Country Living, 26(10), 89-90.

Food and Drug Administration. (2005). 2005 food code: Summary of changes. Retrieved March 23, 2006, from http://www.cfsan.fda.gov/~dms/fc05-sum.html.

Erikson. L., & Thompson, T. (2005). A review of a preventable poison: Pediatric lead poisoning. Journal for Specialists in Pediatric Nursing, 10(4), 171-183.

Goldman, L. (1997). Information the key to preventing childhood lead poisoning. Journal of Environmental Health, 59(9), 45-47.

Hybrivet Systems, Inc. (2002). Performance curves for leadcheck swabs prove reliability. Retrieved March 23, 2006, from http://www.leadcheck.com/Pcurve.shtml.

Lead; Identification of Dangerous Levels of Lead Rule, 40 C.F.R. [section] 745 (2001). Retrieved June 27, 2007, from http://www.epa.gov/fedrgstr/EPA-TOX/2001/January/Day-05/t84.pdf.

Manheimer, E., & Silbergeld, E. (1998). Critique of CDC's retreat from recommending universal lead screening for children. Public Health Reports, 113(1), 38-46.

Mattuck, R., Beck, B., Bowers, T., & Cohen, J. (2001). Recent trends in childhood blood lead levels. Archives of Environmental Health, 56(6), 536.

Pease, W. (1991). Chemical hazards and the public's right to know: How effective is California's Proposition 65? Environment, 33(10), 12-21.

Piomelli, S. (2002). Childhood lead poisoning. Pediatric Clinics of North America, 49, 1285-1304.

Rabito. F., White, L., & Shorter, C. (2004). From research to policy: Targeting the primary prevention of childhood lead poisoning. Public Health Reports, 119(3), 271-279.

Torres, N. (2001). Much to-do about something: Interview with designer Rachel Ashwell. Entrepreneur, 29(5), 18.

U.S. Department of Health and Human Services. (2005). Healthy People 2010, Objective 8. Retrieved July 9, 2007, from http://www.healthypeople.gov/Document/HTML/Volumel/08Environmental.htm.

U.S. Department of Housing and Urban Development. (1990). Comprehensive and workable plan for the abatement of lead paint in privately owned housing: Report to Congress (Report No. HUD-PDR-1295). Washington, DC: Author.

U.S. Department of Housing and Urban Development. (1997). Moving toward a lead safe America: A report to the Congress of the United States. Washington, DC: Author.

Warren, C. (2005). Little pamphlets and big lies: Federal authorities respond to childhood lead poisoning 1935-2003. Public Health Reports, 120(3), 322-329.

Zukin, S., & Maguire, J. (2004). Consumers and consumption. Annual Review of Sociology, 30, 173-197.

Laurel Sharmer, Ph.D., M.P.H., C.H.E.S.

Kathlynn Northrup-Snyder, Ph.D., R.N., C.N.S.

WenYen Juan, Ph.D.

RELATED ARTICLE: Handling Lead-Based Paint Debris--Guidance from U.S. EPA*

The U.S. Environmental Protection Agency encourages everyone who handles lead-based paint to follow several commonsense measures:

* Collect paint chips, dust, dirt, and rubble in plastic trash bags for disposal.

* Store larger building parts with lead-based paint in containers until ready for disposal.

* If possible, use a covered mobile dumpster (such as a roll-off container) to store lead-based-paint debris until the job is done.

* Contact local solid waste authorities to determine where and how lead-based-paint debris can be disposed of.

* U.S. Environmental Protection Agency. (August 2000). Regulatory Status of Waste Generated by Contractors and Residents from Lead-Based Paint Activities Conducted in Households. Retrieved August 2, 2007, from http://www.epa.gov/oppt/lead/pubs/fslbp.htm.

TABLE 1 Print Media Content Analysis, January-December 2004

Non-advertising
Photographs of Objects
with Damaged Paint        Magazine A  Magazine B  Magazine C  Magazine D

Mean number per issue     15          13           7           5
Percentage that were      53          70          20          60
  accompanied by
  supporting text
Percentage showing        80          81          71          40
  furniture
Percentage showing toys    5           9           0          20
Percentage with items     66          69          67          80
  shown accessible
  to children
Percentage showing items  20          25          29          40
  that would appeal to
  children
Percentage of total       20          22           4           8
  non-advertising
  photographs with
  items of concern

TABLE 2 Antiques Bearing Lead on the Surface, Categorized by Type

Painted Wood        Painted Metal            Ceramic or Pewter

White windows (3)   Toy trucks (2)           Pewter pitcher
White door          Salt/pepper shakers (3)  Pewter bowl
Shutters (2)        Potato ricer             Ceramic plate
Nesting dolls       Toy top                  Toy tea sets (2)
Chest of drawers    Garden cultivator        Ceramic-headed doll
Decorative apples   Candle holder            Japanese wine bowl
Bed frame                                    Condiment set
Bouncing toy horse

Painted Glass            Miscellaneous

Pyrex casserole          Cash register
Cartoon character glass  Necklace
Soda bottle              Ice cream scoop
                         Duck decoy
                         Planter