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October 2005

IN THIS ISSUE:

Alliance Welcomes New Executive Director

The Alliance for Healthy Homes, a national nonprofit organization dedicated to protecting children and families from housing-based environmental health hazards, has appointed Robert Zdenek as its new Executive Director. Zdenek will join the Alliance this month.

Zdenek brings to the Alliance a wealth of experience in housing and nonprofit management at both the community and national level. He served as President of the National Congress for Community Economic Development (NCCED) for thirteen years and then served in leadership positions at the United Way at both the local and national level. Most recently, Zdenek has run his own consulting firm focused on asset building strategies, organizational change, and community economic development initiatives for government agencies, community development corporations, and nonprofit organizations.

“We are delighted to welcome Bob Zdenek to the Alliance,” comments Bailus Walker, Chairman of the Board of Directors. “His outstanding credentials and track record of accomplishment are ideal for generating attention and action to protect children from lead and other hazards in their homes.”

Zdenek succeeds Don Ryan, who founded the Alliance in 1990 as the Alliance To End Childhood Lead Poisoning. In 2001, Ryan led the Alliance to expand its work on lead poisoning prevention to encompass other housing-related health hazards. Zdenek is poised to capitalize on the Alliance’s considerable past successes in childhood lead poisoning prevention and other important indoor environmental health issues by solidifying political, financial, and public support for healthy homes.

“I am honored and excited to join the Alliance for Healthy Homes and to build upon the strong foundation that the dedicated staff and board have created,” notes Zdenek. “The Alliance makes connections across sectors, among communities leaders across the country, and between communities and national policy, and I relish the opportunity to make further progress on its critical mission of protecting children and improving housing conditions for low-income families. In the aftermath of the Hurricane Katrina national tragedy, the work of the Alliance and our community partners is even more critical to ensure that all families and children live in housing that is environmentally safe.”

Hurricanes Katrina and Rita Put Healthy Homes Issues on the Front Burner

In the aftermath of Hurricanes Katrina and Rita, Gulf Coast residents and the nation are struggling to assess the scope of damage and begin to plan for recovery. In the process, the large-scale water and wind damage to homes and other buildings has brought new attention to healthy homes issues, creating challenges and opportunities at individual, institutional, and policy levels.

As has been widely broadcast, people returning to their homes in areas affected by Katrina and Rita are finding significant environmental health risks, both indoors and outdoors. Flooding is causing significant mold growth in homes and buildings throughout the region. Homeowners in Louisiana and Mississippi have reported the need to remove all the sheetrock, carpeting, and woodwork in their homes because mold has taken a very quick hold. Mold growth throughout the Gulf Coast has been accelerated by warm temperatures and high humidity, and exacerbated by power outages that prevent ventilation, air conditioning, and dehumidifying systems from working.

Other indoor environmental threats include fire and electrical hazards; serious structural damage that may result in human injury; asbestos releases from building materials; high carbon monoxide levels from damaged combustion appliances and improper, unvented indoor use of makeshift cooking devices or generators; and environmental contamination by toxic chemicals, biological waste, and bacteria. No systematic assessment of the condition of the housing stock has yet been done in any community, despite plans underway for residents to repopulate some areas soon.

Several public interest organizations are concerned that EPA did not test enough areas of New Orleans and nearby communities for contamination, and therefore, the full extent of the risk from toxic chemicals to homeowners and apartment dwellers is not known.

Recovery costs may also impact funding for healthy homes and other related domestic programs as costs continue to climb. Experts estimate that long-term rebuilding and recovery efforts will cost more than $200 billion. Because of large tax cuts passed in 2001 and 2003, Congress may cut important programs, such as housing and environmental health, in order to help fund hurricane recovery efforts.

Despite housing-related health hazards and escalating costs, there are a few housing-related bright spots from the recovery efforts. The U.S. Department of Housing and Urban Development (HUD) has issued a comprehensive question-and-answer sheet on assisting public housing and federally assisted housing residents displaced by Hurricane Katrina, and the Senate voted in September to provide 350,000 families with emergency housing vouchers, valued at $600 a month for six months.

Moreover, the challenges of addressing the health implications of the hurricanes’ large-scale impact on the housing stock in New Orleans and other communities in Louisiana, Alabama, Mississippi, and Texas may create greater awareness about healthy housing and prompt government agencies and other large institutions to consider policies regarding affordability, sustainability, and healthfulness for both existing and replacement housing.

Important healthy homes-related recovery information is available online. For CDC’s Hurricane Health and Safety page, see www.bt.cdc.gov/disasters/hurricanes/. EPA’s tips on returning home after a hurricane are located at www.epa.gov/katrina/sep14returnhomeadvisory.htm. CDC and EPA issued a Joint Taskforce Report on an initial assessment of New Orleans’ environmental health and habitability needs as the Katrina response continues, which can be found at www.epa.gov/katrina/reports/envneeds_hab_assessment.pdf. To view HUD’s post-Katrina Housing Assistance FAQ, visit www.afhh.org/res/res_pubs/HUD_Katrina_facts.pdf. OMB Watch has provided supplemental information on toxic chemicals in the New Orleans area, available at www.ombwatch.org/article/articleview/3088. The National Low-Income Housing Coalition has compiled an comprehensive set of readings on housing policy responses to Hurricane Katrina at www.nlihc.org/news/091305katrina.html, and the Center on Budget and Policy Priorities has put together a briefing paper on meeting the basic needs of Hurricane Katrina survivors, available from www.cbpp.org/9-9-05pov.htm.

Child Health Advocates Say EPA’s Proposed Pesticide Testing Rule Leaves Gaps in Protection for Women and Children

The U.S. Environmental Protection Agency (EPA) officially released its proposed “Protection for Human Test Subjects” rule regarding pesticide testing on September 12. The Agency claims that the rule “will establish stringent enforceable ethical safeguards governing the conduct of third-party intentional dosing human studies intended for submission to EPA...” The proposed rule comes in part as a response to public outcry over a study cancelled earlier this year that would have compensated low-income parents to continue exposing their children to household pesticides. The rule also purports to meet new requirements passed by Congress this summer limiting EPA’s ability to conduct research or use third party studies that intentionally dose pregnant women, infants, fetuses, and children with pesticides.

According to EPA, the proposed rule completely protects pregnant women, fetuses, infants, and children from being used as test subjects in intentional dosing studies. However, several public interest groups and legislators claim that the text of proposed rule provides several loopholes that will allow the pesticide industry to continue using these vulnerable groups in such dangerous studies. They say the rule provides exceptions to protection of pregnant women, fetuses, infants, and children from intentional dosing studies “when such research is deemed scientifically sound and crucial to the protection of public health.” The groups also state that third party pesticide research on children conducted in other countries that does not meet U.S. or international ethical standards can be used “in appropriate circumstances.” Lawmakers familiar with the legislative language passed by Congress also say these exceptions violate federal law. EPA’s Director of Office of Pesticide Programs, Jim Jones, disputes these claims, saying that the Agency’s initial assertion that the rules ban vulnerable groups from intentional dosing studies is accurate.

The proposed rule does contain what all agree are positive measures. Key among them is the creation of a Human Studies Review Board whose members would be non-EPA staff with expertise in the field of human subject research who meet ethics requirements to serve on federal review boards. The proposed rule charges the board to review and comment on the scientific and ethical aspects of research proposals and reports of completed intentional dosing research with human subjects. One identified drawback to this largely positive provision of the rule is that it does not provide explicit safeguards against the Board becoming unbalanced by members who have past or present ties to the pesticide industry.

The proposed rule is available for public review and comment until December 12. To view a summary and overview of the proposed rule, visit www.epa.gov/oppfead1/guidance/human-test.htm. To view the full text of the official proposed rule and to submit public comments, see www.regulations.gov. Select “ENVIRONMENTAL PROTECTION AGENCY” in the Agency drop-down menu, insert “human test subjects” in the Keyword box, and click the “Go” button on the right. This should return one result with Docket ID OPP-2003-0132; FRL-7728-2.

Federal Advisory Panel Urges More Protection for Children in Research

A federal advisory panel convened by the National Research Council and the Institute of Medicine of the National Academies issued a report in September that calls for more protection of children in studies of housing-related health hazards. The report was prompted by a review of a Baltimore study of lead paint hazard control methods in low-income households. A lawsuit filed by two families that participated in the study alleged that the researchers failed to disclose dangerous lead dust levels to them.

The report makes several recommendations, which include urging all federal agencies to adopt regulations giving greater protection to children in research; requiring ethics panels and researchers to ensure that parents truly understand the scope and possible consequences of their children’s participation in studies; including community representatives in designing research projects; and designing studies that have actual benefits for the children involved.

While many praised the report, some observers said it didn’t go far enough. Citizens for Responsible Care and Research said the report should have called on Congress to pass a law that would establish uniform standards for all research involving humans and that would provide training for researchers planning to work with children.

For more information on the report, visit www.nationalacademies.org/morenews/20050919.html.

EPA Enforces Pre-Renovation Disclosure Rule for First Time

For the first time ever, the EPA cited a housing contractor for violating the federal “pre-renovation rule” that requires housing contractors renovating residential housing built before 1978 to provide information to the property owners and residents about potential lead-based paint hazards.

The company, Virginia-based Millennium Quests, Inc., did not provide a homeowner with required information about lead-based paint hazards before renovating their home in 2003. One of the homeowner’s children was found to have an elevated blood lead level following the renovation, and the local health department found lead dust and lead-based paint chips throughout the family’s home. The health department ordered the company to clean up the lead hazards, but the company failed to comply with the order in a timely manner. This, in turn, forced the family to hire another contractor to perform the cleanup, at a cost of over $34,000. The family was eventually forced to sell the home.

EPA’s complaint proposes a penalty of $27,500 for failing to disclose potential lead hazards. The State of Virginia has already fined the company $8,000 and has revoked the company’s Class A Virginia Contractor License, and the local health department fined the company $1,500. The family affected also won a $1.3 million judgment against the company, which has now filed for bankruptcy.

National Childhood Lead Poisoning Prevention Week Planned for Oct. 23-29

A pending U.S. Senate resolution sponsored by Sen. Jack Reed (D-RI) will designate October 23-29, 2005, as National Childhood Lead Poisoning Prevention Week. This will be the seventh consecutive year that the Senate has designated the last full week in October for this observance. During this week, state and local governments, policymakers, lead poisoning prevention advocates, and others can help highlight successes in lead poisoning prevention, call attention to challenges that still remain, and advance primary prevention. Examples of past National Lead Poisoning Prevention Week events from across the country, as well as sample outreach and education materials, can be found on the Alliance’s website at www.afhh.org/res/res_by_topic_lead_outreach_education.htm.

Federal Judge in St. Louis Orders Faster Review of Ambient Air Standard for Lead

In September, U.S. District Court Judge Richard Webber in St. Louis ordered the EPA to accelerate the pace at which it is reviewing the ambient air standard for lead. Federal law requires that the airborne lead standard be reviewed every five years, in part to keep pace with changes in knowledge of how very small amounts of lead can negatively impact human health. The last review of the lead standard occurred in 1978.

In December 2004, EPA stated that it would quickly issue a plan for updating the lead standard, but proposed to wait until 2009 to complete the update. Community-based organizations and private citizens impacted by the Doe Run lead smelter located in Herculaneum, MO, filed suit, asking the court to order the review’s completion by 2007.

After hearing the lawsuit, Webber criticized EPA for dragging its feet on the lead standard review. He ordered the Agency to complete a first draft of an assessment that reviews studies related to airborne lead pollution by December 1, and he gave the Agency until November 1, 2007, to present the staff’s recommendations on whether to revise the standard. Under Webber’s order, EPA has until September 1, 2008 to issue a public notice of any updates to the lead standard.

For more information on the lawsuit, see the December 2004 issue of the Alliance Alert at www.afhh.org/res/res_alert_archives_dec04.htm#pbambientair.

Pennsylvania Utility Law Could Create Healthy Homes Crisis

A Pennsylvania utility law passed in 2004 could make it easier for utility companies to shut off oil and natural gas to homeowners who can’t afford to pay their bills. With heating costs expected to rise to record levels this winter, experts in the state estimate that 100,000 households in Pennsylvania are likely to lack utility service come November 1.

The law allows cold-weather utility shutoffs without the approval of the state Public Utility Commission, including shutoffs to low-income households. Though 66,000 households were without heating utilities in Pennsylvania on November 1, 2004, by mid-December of that year, the number fell to 14,000. This year, because the law makes it more difficult for some customers to get service restored once they begin paying off their bills, a similar drop in the number of unheated households may not be a reasonable expectation.

The utility law could spark a healthy homes crisis in the state if energy assistance is not provided to low-income households. When heating oil or natural gas is cut off, many households use dangerous methods in an attempt to heat their homes, including unvented wood stoves, regular stoves, and space heaters. Some of these devices can cause significant increases in carbon monoxide concentration, which can cause dizziness, headaches, nausea, coma, and death, while others can dramatically increase the risk of fire. Unheated homes can also exacerbate asthma symptoms, and residents can die from hypothermia if indoor temperatures fall low enough.

San Francisco Audits City Agency Efforts to Prevent Childhood Lead Poisoning

In September, the San Francisco Department of Public Health issued an audit and report to the Board of Supervisors on city agencies’ implementation of childhood lead poisoning ordinances. The report included progress reports on several agencies, as well as recommendations for further improvements.

The report highlighted a number of agencies that are excelling in their childhood lead poisoning prevention efforts, including the Mayor’s Office of Housing’s Lead Hazard Prevention Program; the Department of Building Inspection’s Lead Prevention Program that enforces the city’s lead-safe work practices requirements; the Recreation and Parks Department, and the Department of Public Health’s Childhood Lead Prevention Program.

Areas where improvement is needed include the city School District’s Child Development Program, whose facilities expose 1,400 low-income children to lead dust; and doctors in the city’s public health programs who fail to screen many eligible children for lead levels in blood.

Neil Gendel, Director of the Healthy Children Organization Project, said, “Every agency serving children and their families and impacting the condition of housing and public facilities is responsible for helping the city have healthy, lead-safe children. We need healthy, environmentally safe housing and public facilities to support lower-income families and help them succeed in San Francisco’s economic environment.”

For more information on the report, contact the Health Children Organizing Project at neil.gendel@consumer-action.org.

University Report Links Environmental and Occupational Exposures to Cancers

The University of Massachusetts Lowell in late September released a report that links dozens of environmental and occupational exposures to nearly 30 types of cancer.

The new study by the University’s Lowell Center for Sustainable Production reviewed scientific evidence documenting associations between environmental and occupational exposures and certain cancers in the United States, marking the first time this body of material has been summarized in one, accessible document.

“Environmental and Occupational Causes of Cancer: A Review of Recent Scientific Evidence” shows that many cancer cases and deaths are caused or contributed to by involuntary exposures. These include breast cancer from endocrine disruptors in some plastics components, lung cancer from residential exposure to radon, non-Hodgkin’s lymphoma from solvent and herbicides (which can be tracked indoors from the lawn and garden and become embedded in house dust), and childhood leukemia from pesticides.
“The sum of the evidence makes an airtight case for reconsideration of chemicals policies in the U.S.,” said Dr. Richard W. Clapp, lead epidemiologist for the report.

The report directly contradicts an oft-cited, 25-year-old analysis by Sir Richard Doll and Richard Peto that attributes only two to four percent of cancers to involuntary environmental and occupational exposures. “Our review makes it clear that new knowledge about multiple causes of cancer, including involuntary exposures, early-life exposures, synergistic effects, and genetic factors, renders making such estimates not just pointless, but counterproductive,” Clapp said.

A full press release, Executive Summary, and the entire report are available at www.sustainableproduction.org/pres.shtml and www.cheforhealth.org.

Research Shows Environmental Tobacco Smoke Harms Fetuses as Much as Active Smoking

Research published in BMC Pediatrics in June shows that environmental tobacco smoke, or secondhand smoke, can harm fetuses as much as if an expectant mother was smoking cigarettes herself.

While it is common knowledge among doctors that environmental tobacco smoke can increase the risk of miscarriage, premature birth, low birth weight, and sudden infant death syndrome, the recent research conducted at the University of Pittsburgh demonstrated that like active smoking, environmental tobacco smoke can damage a fetus’ DNA. These genetic mutations are tied to cancers like leukemia and lymphoma.

For a full text version of the study, visit www.biomedcentral.com/content/pdf/1471-2431-5-20.pdf.

HUD Announces FY 2005 Lead and Healthy Homes Grant Awards

The U.S. Department of Housing and Urban Development’s Office of Healthy Homes and Lead Hazard Control (OHHLHC) announced in late September that it awarded $139 million in funds for local projects to control lead hazards and advance healthy homes practices in locations throughout the country. OHHLHC chose not to award the full $167 million available to them for FY 2005, and of the 62 projects awarded funds, four will be carried out by nonprofit organizations.

The funds awarded fall under seven categories: Lead Hazard Control Grants, Lead Hazard Reduction Demonstration Grants, Lead Outreach Grants, Lead Technical Studies Grants, Operation LEAP, Healthy Homes Demonstration Grants, and Healthy Homes Technical Studies Grants. Full funding and FY 2005 grantee project information is located at www.hud.gov/news/release.cfm?content=pr05-129.cfm.

EPA Seeking Comments on Proposed Pesticide Review Program

To ensure that pesticide registrations continue to meet current health and safety standards, EPA is seeking public comment on a proposed approach to review each existing pesticide registration every 15 years. This new registration review program, mandated by the Food Quality Protection Act, will begin in 2006 to ensure that "older" pesticides will still meet the statutory standard of no unreasonable adverse effects.

Under the proposed process, the agency would assess any changes that have occurred since the agency's last registration decision on the pesticide. EPA would determine the significance of such changes and whether additional restrictions are needed to ensure that the pesticide meets current requirements under the Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA).

Registration review will replace the reregistration and tolerance reassessment programs that are nearing completion. As in those programs, the registration review process would allow for substantial public participation, but unlike those "one-time reassessment" programs, registration review will reoccur for each pesticide every 15 years.

Comments are due by October 11. For additional information, visit www.epa.gov/oppsrrd1/registration_review.

NIEHS Proposes Privatizing Environmental Health Perspectives

The National Institute of Environmental Health Sciences (NIEHS), part of the National Institutes of Health (NIH), proposed in late September to privatize publication of its leading journal Environmental Health Perspectives (EHP). NIEHS currently provides EHP free of charge through its open access website, located at http://ehp.niehs.nih.gov/.

Citing budgetary constraints, Dr. David Schwartz, the new director of NIEHS, is proposing to end NIEHS sponsorship of EHP, if the journal can be published by a private, for-profit publisher. Advocates are concerned about privatizing publication of EHP, as the journal may lose its free, open access status, dealing a blow to smaller nonprofit and community-based organizations that regularly use EHP articles in their work. Also, those who work in the environmental health field say having EHP housed at NIH is extremely important for the growing field of environmental health science. EHP currently ranks third among 132 environmental sciences journals and fifth among 90 public, environmental, and occupational health journals.

NIEHS is seeking public comments on its EHP privatization proposal. To submit your comment, visit www.niehs.nih.gov/external/ehp/home.htm.

OSHA Extends Comment Period for Revised Lead in Construction Standard

The Occupational Safety and Health Administration (OSHA) is extending until Nov. 7, 2005, the comment period for proposed changes to its lead in construction standard that requires testing for lead exposures, provisions to protect workers from exposure where lead is present, and medical monitoring of exposed workers.

The construction industry employs millions of workers in jobs where lead exposures are most likely to occur, like paint removal, building and bridge renovation, plumbing, smelting, battery manufacturing, auto repair, and water system repair and replacement. Exposure to lead can cause serious damage to the body's blood-forming, nervous, urinary, and reproductive systems, and cause high blood pressure and peripheral artery disease. Lead can also be brought home on clothes and work shoes, where it can contaminate household dust and be ingested by children. OSHA's lead in construction standard establishes procedures for minimizing the level of exposure to lead for all workers covered.

Comments should be addressed to Docket Office, Docket No. H023, Technical Data Center, Room N-2625, U.S. Department of Labor, 200 Constitution Ave., N.W., Washington, D.C. 20210. Comments can be submitted online at www.regulations.gov or http://ecomments.osha.gov, or faxed to 202-693-1648. All comments and submissions will posted on OSHA's Web site.

EPA Considers Changes in Lead Lab Accreditation Rules

EPA convened a discussion in mid-August for reactions to its plan for regulating field analytic technologies used to test for lead, such as XRF machines, under the National Lead Laboratory Accreditation Program (NLLAP) Laboratory Quality System Requirements (LQSR).

In subsequent comments, the Alliance generally supported EPA’s proposal to provide oversight for field technologies. However, the Alliance cautioned EPA not to dilute certification requirements and oversight for stationary laboratories while imposing new requirements on field analytic technologies. Instead, the Alliance urged EPA to maintain existing, effective requirements for stationary labs while establishing protocols, criteria, and minimum performance standards that are specific to field methodologies such as portable analytic systems and expand NLLAP to accredit or certify entities and persons using these methodologies independent of the program for stationary labs.

The proposal to revise NLLAP and all submitted public comments are available at http://docket.epa.gov/edkpub/do/EDKStaffCollectionDetailView?objectId=0b0007d48096745a.

Position Announcement—Project Coordinator at the National Center for Healthy Housing

The National Center for Healthy Housing in Columbia, Maryland has an immediate job opening for a project coordinator.

This position is responsible for coordinating research and training projects. Responsibilities also include assisting in the preparation of written materials for a variety of audiences, carrying out fund development activities, and working on special projects. This is a full time, regular position with benefits, based out of the National Center for Healthy Housing's office in Columbia, Maryland. Some travel required. The full position announcement is available at www.centerforhealthyhousing.org/html/project_coordinator.html. To learn more about the National Center for Healthy Housing, visit www.centerforhealthyhousing.org.

Funding Opportunities

LEAP (Leadership and Enhanced Assistance Program, and not the same as HUD’s Operation LEAP grant program) is a two-year organization development program of the Environmental Support Center (ESC) that provides assistance to grassroots environmental groups to build their organizational capacity through training, support, and funding. Goals of the program are to help groups establish and meet capacity-building targets, learn from each other, and build understanding among peer groups. ESC is currently accepting applications for small grants of up to $10,000 to engage in these activities. To be eligible, groups should be local, state, or regional nonprofit organizations working on environmental issues; be environmental justice organizations, environmental activist organizations, or networks and coalitions of environmental justice and/or activist groups. Eligible organizations must also have 501(c)(3) status and have an annual budget between $50,000 and $500,000. For more information about LEAP and how to apply for a grant, visit www.envsc.org.

Upcoming Conferences

The Environmental Health and Child Development Conference will be held in Ann Arbor, MI, November 3, at the University of Michigan—Ann Arbor (Rackham Graduate School). The conference will focus on preventing toxic threats to child neurological development in Michigan. Special emphasis will be placed on heavy metals and their effects and persistent organic compounds such as pesticides. It is co-sponsored by the American Association of Mental Retardation, Michigan Chapter of American Academy of Pediatrics, Ecology Center of Ann Arbor, Greater Boston Physicians for Social Responsibility, Michigan State Medical Society, and the Center for Children's Health and Environment. For more information, contact Lauren Zajac, MPH, at the Ecology Center of Ann Arbor, lauren@ecocenter.org.

Indianapolis will host the Indiana Lead-Safe and Healthy Homes Conference, November 8 and 9. The conference will cover topics including lead poisoning prevention, lead-safe work practices, indoor air quality, asthma, mold, and a look at leadership and advocacy for healthy homes in Indiana. For more information, visit www.ikecoalition.org or contact Janet McCabe at mccabe@ikecoalition.org or 317-902-3610.

Two regional conferences will bring together professionals engaged in health, housing, community development, awareness, and advocacy to explore ways to prevent incidents of lead poisoning and eliminate indoor environmental hazards. The Western Regional Conference on Eliminating Childhood Lead Poisoning and Combating Indoor Environmental Hazards will be held November 17 and 18 in San Diego. The Midwest Regional Conference on Eliminating Childhood Lead Poisoning and Combating Indoor Environmental Hazards will be held December 7 and 8 in St. Louis. For more information on both of these conferences, visit www.leadmoldconferences.com.

CONFERENCE LOCATION AND DATE CHANGE: The American Public Health Association’s National Conference has been relocated from New Orleans to Philadelphia and will run December 10-14. The changes were necessary in the aftermath of Hurricane Katrina. For more information about the location and date changes, see www.apha.org.

The Ohio Department of Health is sponsoring their 13th Ohio Lead Poisoning Prevention Conference June 20-22, 2006, in Columbus. The featured speakers and exhibitors will be from local, state, and national levels. The conference goal is to educate healthcare and environmental professionals, parents, and community leaders about the current medical, environmental, and programmatic issues of childhood lead poisoning prevention in Ohio. Continuing education units may be offered for nurses, sanitarians, and social workers. For more information, E-mail bcfhs@odh.ohio.gov or call Barbara Kochli Nixon at 937-285-6261.

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