January 24, 2008							

Dear Maria,

 Thank you for the opportunity to review the document regarding using
NHANES data to evaluate impact of lead dust levels following renovation.
 You have clearly identified and discussed the drawbacks to such an
approach and justified the use of the LEGGET model.  I have a few
specific comments:

	1.  In the first paragraph on page 1, the sentence beginning “ A
basic assumption….”  I would end “…containing lead-based paint,
particularly those with lead paint hazards.”  

In the 2nd paragraph on pg. 1  the sentence beginning “The
HNAHES….” I would substitute after ‘a series of surveys’, 
NHANES oversamples for sub-populations or health conditions of
particular interest, rather than ‘focusing on different
population…’

On page 3 there is a discussion of the fact that  here are no
quantitative data available that related changes in dust or air lead
levels during renovation to children’s blood lead levels.  That is
certainly the case. However there are data about what happens both to
children both with already elevated blood lead levels and those
initially without elevated blood lead levels, who are exposed to
improper lead paint removal techniques including the failure to clean up
the worksite.  I include some references here:

Amitai Y, Graef J, Brown MJ, et al. Hazards of Deleading in Children
with Lead Poisoning. AJDC 1987; 14: 758-760.

Amitai Y, Brown MJ, Graef J, Cosgrove, E. Effects of Deleading on the
Blood Lead Levels of Lead Poisoned Children. Pediatrics 1991; 88:
893-897.

Rabinowitz M, Leviton A, Bellinger D. Home refinishing; lead paint and
infant blood lead levels. AJPH 1985;75:403-404.

Marino P, Landrigan P, Graef J, Nussbaum A et al. A case report of lead
paint poisoning during renovation of a Victorian farmhouse.  AJPH
1990;80:1183-1185.

Rey-Alvarez A, Menke-Hargrave T. Deleading dilemma: Pitfall in the
management of childhood lead poisoning. Pediatrics 1987;79:214-217.

Sincerely,

Mary Jean

