Federal housing assistance may help reduce young children's exposure to lead, according to a new Tufts Medicine-led study published recently in Environmental Epidemiology.
The study found that children age 5 and younger receiving federal housing assistance had lower average blood lead levels than children who were waiting to receive assistance. The greatest benefit was seen among children living in project-based housing programs, including public housing and multifamily income-restricted housing, where researchers found significantly lower odds of elevated blood lead levels.
Lead exposure remains one of the most preventable environmental threats to children's health. According to the Centers for Disease Control and Prevention, no safe level of lead in children's blood has been identified, and even low levels can affect brain development, learning and behavior.
The study, Impact of Federal Housing Assistance on Children's Blood Lead Levels, NHANES 1999–2016, examined blood lead levels among 874 U.S. children using linked data from the National Health and Nutrition Examination Survey and administrative records from the U.S. Department of Housing and Urban Development.
Children currently receiving housing assistance were about half as likely to have blood lead levels at or above the CDC blood lead reference value compared with children who would receive assistance within the following two years (12.8% versus 24.9%).
"Our study shows that housing systems matter," said lead author MyDzung T. Chu, PhD, MSPH, assistant professor at Tufts University School of Medicine, researcher at Tufts Medical Center's Institute for Clinical Research and Health Policy Studies, director of ADAPT at Tufts Clinical and Translational Science Institute and principal investigator at the Women, Mother + Baby Research Institute (WoMB). "Federal housing assistance has the potential to help prevent exposure before it harms a child. The next step is making sure those protections reach every family, regardless of which housing program they use."
The researchers found the strongest protective association among project-based housing programs, which are generally subject to more consistent oversight, maintenance requirements and lead hazard controls. They did not observe the same protective pattern among children participating in the Housing Choice Voucher program, where housing quality and inspection practices may vary across privately owned rental properties.
The study builds on earlier research showing lower blood lead levels among people living in federally assisted housing. It extends those findings by focusing specifically on children younger than 6 years old, the age group most vulnerable to the harmful effects of lead exposure, and by comparing outcomes across different types of federal housing assistance.
To better isolate the impact of housing assistance, the researchers used a "pseudo-waitlist" study design, comparing children already receiving assistance with children who would begin receiving assistance within two years. This approach created a more comparable control group than studies comparing assisted and non-assisted families.
“These findings move the conversation from documenting disparities to identifying policy solutions,” said Ami R. Zota, ScD, MS, senior author of the study and professor in the Department of Environmental Health Sciences at Columbia University Mailman School of Public Health. “When housing programs include strong standards, inspections, and accountability, they can help reduce children’s exposure to toxic chemicals and advance environmental justice.”
Because the Housing Choice Voucher program serves more than 2 million low-income families nationwide, the researchers say strengthening lead prevention and housing quality protections within voucher-based housing could have a substantial public health impact.
"Families shouldn’t have to choose between affordable housing and safe housing," Dr. Chu said. "The goal should be lead-free homes for every child."
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