Behavioral and Environmental Explanations of Elevated Blood Lead Levels in Immigrant Children and Children of Immigrants


Immigrant/refugee children sometimes have substantially higher blood lead levels (BLLs) than US-born children in similar environments. We try to understand why, by exploring the relationship between immigration status of mother and the BLLs of US-born children. We compared BLLs of children born in Michigan to immigrant and non-immigrant parents, using the Michigan database of BLL tests for 2002–2005, which includes the child’s race, Medicaid eligibility and address. We added census data on socio-demographic/housing characteristics of the child’s block group, and information about parents. Low parental education, single parent households, mothers’ smoking and drinking, all increase the child’s BLL. However, immigrant parents had fewer characteristics associated with high BLL than US born parents, and their children had lower BLLs than children of US-born mothers. Our findings suggest that prior findings of higher BLLs among immigrant/refugee children probably result from them starting life in high-lead environments.

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Blood lead level


Elevated blood lead level




Confidence interval






Hierarchical linear modeling


Logarithm to base e


Michigan Department of Community Health


Standard deviation


Standard error


  1. 1.

    Lanphear BP, Byrd RS, Auinger P, Schaffer SJ. Community characteristics associated with elevated blood lead levels in children. Pediatrics. 1998;101:264–71.

    CAS  PubMed  Google Scholar 

  2. 2.

    Schnur J, John RM. Childhood lead poisoning and the new Centers for Disease Control and Prevention guidelines for lead exposure. J Am Assoc Nurse Pract. 2014;26:238–47.

    PubMed  Google Scholar 

  3. 3.

    Dapul H, Laraque D. Lead poisoning in children. Adv Pediatr. 2014;61:313–33.

    PubMed  Google Scholar 

  4. 4.

    Kaplowitz SA, Perlstadt H, Post LA. Comparing lead poisoning risk assessment methods: census block group characteristics vs. zip codes as predictors. Public Health Rep. 2010;125:234.

    PubMed  PubMed Central  Google Scholar 

  5. 5.

    Ryan D. Calls for removing all lead paint from US housing are misguided. Am J Public Health. 2013;103:e5.

    PubMed  PubMed Central  Google Scholar 

  6. 6.

    McGill N. Lead poisoning prevention gains attention but loses funding: blood lead level standards tightened. The Nation’s Health. 2013;42:1–29.

    Google Scholar 

  7. 7.

    Levallois P, St-Laurent J, Gauvin D, Courteau M, Prévost M, Campagna C, Lemieux F, Nour S, D’Amour M, Rasmussen PE. The impact of drinking water, indoor dust and paint on blood lead levels of children aged 1–5 years in Montréal (Québec, Canada). J Eposure Sci Environ Epidemiol. 2014;24:185–91.

    CAS  Google Scholar 

  8. 8.

    Hegde S, Shubha A, Rao B. Indigenous tooth powders = Covert lead poisoning? Indian J Dental Res. 2013;24:678.

    Google Scholar 

  9. 9.

    Gardiner P, Adams D, Filippelli AC, Nasser H, Saper R, White L, Vohra S. A systematic review of the reporting of adverse events associated with medical herb use among children. Glob Adv Health Med. 2013;2:58–67.

    Google Scholar 

  10. 10.

    Nagarajan S, Sivaji K, Krishnaswamy S, Pemiah B, Rajan KS, Krishnan UM, Sethuraman S. Safety and toxicity issues associated with lead-based traditional herbo-metallic preparations. J Ethnopharmacol. 2014;151:1–11.

    PubMed  Google Scholar 

  11. 11.

    CDC. Lead poisoning associated with use of traditional ethnic remedies–California, 1991–1992. MMWR Morb Mortal Wkly Rep. 1993;42:521.

    Google Scholar 

  12. 12.

    CDC. Childhood lead exposure associated with the use of kajal, an eye cosmetic from Afghanistan-Albuquerque, New Mexico, 2013. MMWR Morb Mortal Wkly Rep. 2013;62:917.

    Google Scholar 

  13. 13.

    Tehranifar P, Leighton J, Auchincloss AH, Faciano A, Alper H, Paykin A, Wu S. Immigration and risk of childhood lead poisoning: findings from a case–control study of New York City children. Am J Public Health. 2008;98:92.

    PubMed  PubMed Central  Google Scholar 

  14. 14.

    Eisenberg KW, van Wijngaarden E, Fisher SG, Korfmacher KS, Campbell JR, Fernandez ID, Cochran J, Geltman PL. Blood lead levels of refugee children resettled in Massachusetts, 2000 to 2007. Am J Public Health. 2011;101:48.

    PubMed  PubMed Central  Google Scholar 

  15. 15.

    Raymond JS, Kennedy C, Brown MJ. Blood lead level analysis among refugee children resettled in New Hampshire and Rhode Island. Public Health Nurs. 2013;30:70–9.

    PubMed  Google Scholar 

  16. 16.

    Schmidt CW. Unsafe harbor? Elevated blood lead levels in refugee children. Environ Health Perspect. 2013;121:a190.

    PubMed  PubMed Central  Google Scholar 

  17. 17.

    CDC. Elevated blood lead levels in refugee children—New Hampshire, 2003–2004. MMWR Morb Mortal Wkly Rep. 2005;54:42.

    Google Scholar 

  18. 18.

    U.S. Department of Health and Human Services CfDCaP, National Center for Emerging and Zoonotic Infectious Diseases: lead screening during the domestic medical examination for newly arrived refugees. Division of Global Migration and Quarantine; 2013.

  19. 19.

    Goswami K. Eye cosmetic ‘Surma’: hidden threats of lead poisoning. Indian J Clin Biochem. 2013;28:71–3.

    CAS  PubMed  Google Scholar 

  20. 20.

    CDC. Lead poisoning associated with imported candy and powdered food coloring—California and Michigan. MMWR Morb Mortal Wkly Rep. 1998;47:1041.

    Google Scholar 

  21. 21.

    Vallejos Q, Strack RW, Aronson RE. Identifying culturally appropriate strategies for educating a Mexican immigrant community about lead poisoning prevention. Family Community Health. 2006;29:143–52.

    PubMed  Google Scholar 

  22. 22.

    Aguirre M, Hernandez S. Lead poisoning in Hispanic children: the great need for prevention education. Calif J Health Promot. 2003;1:52–8.

    Google Scholar 

  23. 23.

    Taylor JY, Holtrop TG. Yemeni families and child lead screening in Detroit. J Transcult Nurs. 2007;18:63–9.

    PubMed  PubMed Central  Google Scholar 

  24. 24.

    Woolf AD, Woolf NT. Childhood lead poisoning in 2 families associated with spices used in food preparation. Pediatrics. 2005;116:e314–8.

    PubMed  Google Scholar 

  25. 25.

    Araujo J, Beelen A, Lewis L, Robinson G, DeLaurier C, Carbajal M, Ericsson B, Chin Y, Hipkins K, Kales S. Lead poisoning associated with Ayurvedic medications—five states, 2000–2003. MMWR Morb Mortal Wkly Rep. 2004;53:582.

    PubMed Central  Google Scholar 

  26. 26.

    Institute ANS, Association AS, Pediatrics AAo: American standard specifications to minimize hazards to children from residual surface coating materials: ANSI ASA Z66.1-1964, Revision of Z66.1-1955, UDC 614.89:613.95. American Standards Association; 1964.

  27. 27.

    Laraque D, Trasande L. Lead poisoning: successes and 21st century challenges. Pediatr Rev. 2005;26:429.

    Google Scholar 

  28. 28.

    Warren C. Little pamphlets and big lies: federal authorities respond to childhood lead poisoning, 1935–2003. Public Health Rep. 2005;120:322.

    PubMed  PubMed Central  Google Scholar 

  29. 29.

    Crofton PM. Alternative fuels and developing nations: who will pay the piper. Emory Int’l L Rev. 2010;24:185.

    Google Scholar 

  30. 30.

    EPA takes final step in phaseout of leaded gasoline for release.

  31. 31.

    IPIECA: lead phase-out—eliminating lead through partnership. IPIECA ed. 2012.

  32. 32.

    Mathee A. Towards the prevention of lead exposure in South Africa: contemporary and emerging challenges. Neurotoxicology; 2014.

  33. 33.

    Yabe J, Nakayama SM, Ikenaka Y, Yohannes YB, Bortey-Sam N, Oroszlany B, Muzandu K, Choongo K, Kabalo AN, Ntapisha J. Lead poisoning in children from townships in the vicinity of a lead–zinc mine in Kabwe, Zambia. Chemosphere. 2015;119:941–7.

    CAS  PubMed  Google Scholar 

  34. 34.

    Hess CA, Cooper MJ, Smith MJ, Trueman CN, Schutkowski H. Lead exposure in adult males in urban Transvaal Province, South Africa during the Apartheid Era. PLoS ONE. 2013;8:e58146.

    CAS  PubMed  PubMed Central  Google Scholar 

  35. 35.

    Nathan RJ, Sharma P, Nathan LS, Kumar CT. Assessment of drinking water collected from refugee camps in india for toxic lead and copper levels by flame atomic absorption spectrometry. Indian J Forensic Med Toxicol. 2014;8:26–31.

    CAS  Google Scholar 

  36. 36.

    Cutler DM, Lleras-Muney A. Understanding differences in health behaviors by education. J Health Econ. 2010;29:1–28.

    PubMed  Google Scholar 

  37. 37.

    Kegler MC, Malcoe LH. Results from a lay health advisor intervention to prevent lead poisoning among rural Native American children. Am J Public Health. 2004;94:1730–5.

    PubMed  PubMed Central  Google Scholar 

  38. 38.

    Lang AR, Pelham WE, Atkeson BM, Murphy DA. Effects of alcohol intoxication on parenting behavior in interactions with child confederates exhibiting normal or deviant behaviors. J Abnorm Child Psychol. 1999;27:177–89.

    CAS  PubMed  Google Scholar 

  39. 39.

    Navas-Acien A, Selvin E, Sharrett AR, Calderon-Aranda E, Silbergeld E, Guallar E. Lead, cadmium, smoking, and increased risk of peripheral arterial disease. Circulation. 2004;109:3196–201.

    CAS  PubMed  Google Scholar 

  40. 40.

    Rhainds M, Levallois P. Effects of maternal cigarette smoking and alcohol consumption on blood lead levels of newborns. Am J Epidemiol. 1997;145:250–7.

    CAS  PubMed  Google Scholar 

  41. 41.

    Canfield RL, Henderson CR Jr, Cory-Slechta DA, Cox C, Jusko TA, Lanphear BP. Intellectual impairment in children with blood lead concentrations below 10 μg per deciliter. N Engl J Med. 2003;348:1517–26.

    CAS  PubMed  PubMed Central  Google Scholar 

  42. 42.

    Raudenbush SW, Bryk AS. Hierarchical linear models: applications and data analysis methods. London: Sage; 2002.

    Google Scholar 

  43. 43.

    Saper RB, Kales SN, Paquin J, Burns MJ, Eisenberg DM, Davis RB, Phillips RS. Heavy metal content of ayurvedic herbal medicine products. JAMA. 2004;292:2868–73.

    CAS  PubMed  Google Scholar 

  44. 44.

    Morales LS, Gutierrez P, Escarce JJ. Demographic and socioeconomic factors associated with blood lead levels among Mexican-American children and adolescents in the United States. Public Health Rep. 2005;120:448–54.

    Google Scholar 

  45. 45.

    Dustmann C, Van Soest A. Language and the earnings of immigrants. Indus Labor Relat Rev. 2002;55:473–92.

    Google Scholar 

  46. 46.

    Rumbaut RG. Introduction: immigration and incorporation. Sociol Perspect. 1997;40:333–8.

    Google Scholar 

  47. 47.

    Abraído-Lanza AF, Chao MT, Flórez KR. Do healthy behaviors decline with greater acculturation? Implications for the Latino mortality paradox. Soc Sci Med. 2005;61:1243–55.

    PubMed  PubMed Central  Google Scholar 

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We would like to thank Robert L. Scott for providing us with the Michigan Department of Community Health data base of BLL tests and providing the census block group for each address, Dr. Warren Brown for providing census 2000 data about each block group, Glenn Copeland for arranging the merging of the Registry of Live Births with the other MDCH data, Richard Miles for assisting with data processing and Dr. Steven J. Gold for valuable advice about the literature on immigrants.

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Correspondence to Stan A. Kaplowitz.

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Kaplowitz, S.A., Perlstadt, H., Dziura, J.D. et al. Behavioral and Environmental Explanations of Elevated Blood Lead Levels in Immigrant Children and Children of Immigrants. J Immigrant Minority Health 18, 979–986 (2016).

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  • Lead poisoning
  • Blood lead level
  • Immigrants
  • Health behaviors
  • Family structure