Status of EPA Actions, Fiscal Year 2020

GOAL 1: REDUCE CHILDREN'S EXPOSURE TO LEAD SOURCES

Objective 1.1. Reduce Children's Exposure in Homes and Child-Occupied Facilities with Lead-Based Paint Hazards

The Dust-Lead Hazard Standards (DLHS) final rule was completed and signed on June 21, 2019. See EPA's press release on the final rule.

Consider changes to the post-abatement clearance levels consistent with the final revisions to the DLHS.

Considered changes to the post-abatement clearance levels.

Considered changes to the post-abatement clearance levels.

On June 17, 2020, EPA proposed to reduce the amount of lead that can remain in dust on floors and windowsills after lead removal activities to better protect children from the harmful effects of lead exposure. The proposal would lower the clearance levels for dust on floors and window sills after lead removal activities from 40 micrograms (µg) of lead in dust per square foot (ft2) to 10 µg/ft2 for floor dust and from 250 µg/ft2 to 100 µg/ft2 for window sill dust.

The comment period for the post-abatement clearance level proposal closed August 24, 2020. Reviewing public comments and developing the final rule with the goal of issuing by December 2020.

Continue to implement regulations and other relevant authorities that require individuals and firms conducting lead-based paint abatement, risk assessment or inspection to be properly trained and certified to be conducted according to reliable, effective and safe work practice standards.

Conducted 123 compliance assistance and 150 outreach activities that supported abatement, risk assessment and inspection components of the Lead-Based Paint Program.

Conducted 233 compliance assistance and 133 outreach activities that supported abatement, risk assessment and inspection components of the Lead-Based Paint Program.

REGION 6: On January 21, 2020, presented to over 200 realtors in Albuquerque, NM on the Lead Based Paint Disclosure Act; The Renovation, Repair & Disclosure Rule; and the Lead Abatement Rule.

Conducted 86 compliance assistance and 100 outreach activities that supported abatement, risk assessment and inspection components of the Lead-Based Paint Program.

Conducted 303 compliance assistance and 140 outreach activities that supported abatement, risk assessment, and inspection components of the Lead-Based Paint Program.

Increase the number (or percentage) of certified renovation firms capable of providing lead-safe renovation, repair and painting services through targeted outreach campaigns to contractors; continue to provide a nationwide list of certified renovation firms on EPA's website.

Updated the list of certified renovation firms. A total of 1,504 new RRP firms were certified and 8,045 contractors received RRP training.

Conducted 313 compliance assistance activities to increase the number of RRP certified firms.

Updated the list of certified renovation firms. A total of 1,644 new RRP firms were certified and 8,784 contractors received RRP training.

Conducted 335 compliance assistance activities to increase the number of RRP certified firms.

Reminder postcards and emails were sent to firms with expiring certifications.

Updated the list of certified renovation firms. A total of 1,432 new RRP firms were certified and 3,229 contractors received RRP training.

Conducted 494 compliance assistance activities to increase the number of RRP certified firms.

Updated the list of certified renovation firms on EPA's website.

A total of 1,982 new RRP firms were certified and 4,896 contractors received RRP training.

Conducted 516 compliance assistance activities to increase the number of RRP-certified firms.

Objective 1.2. Reduce Exposure to Lead from Drinking Water

Revise the Lead and Copper Rule (LCR) based on input EPA recently received from state, tribal and local partners, as well as the best available peer reviewed science, to ensure the rule reflects the best ways to improve public health protection and reduce levels of lead in drinking water.

Published the National Primary Drinking Water Regulations (NPDWR) for LCR revisions (LCRR) for public comment.

Provided briefing on the proposed LCRR to EPA's Science Advisory Board (SAB) on March 30, 2020.

Evaluated public comments received on the LCRR proposal.

The SAB reviewed and issued a Draft Report on EPA's Proposed Lead and Copper Rule Revisions.

Submitted the final rule to OMB for EO 12866 review.

Enhance implementation of the LCR by engaging with state, tribal, local and other stakeholders to identify implementation challenges, best practices and tools to address these challenges.

Continued to host webinars on lead service line replacement. This series showcases best practices for states and utilities implementing a voluntary lead service line replacement program. December's webinar focused on small water utility challenges. All webinars are recorded and posted as a reference of case studies and best practices on EPA's website.

Identified specific areas of the LCR that continue to pose implementation challenges to state, tribal and other stakeholders (e.g., identification of lead service lines). These areas will be incorporated into a new webinar series that provides targeted training to states and water systems and highlights additional tools that can be leveraged towards meeting those challenges to enhance national implementation.

Continued supporting efforts to enhance implementation by providing webinars.

EPA regions provided outreach to states on LCR implementation (e.g., assist in the creation of reports and other technical assistance that is needed).

Continued supporting efforts to enhance implementation by providing webinars through Q4.

EPA held two (2) webinars targeting areas of the existing rule that pose common implementation challenges to states and water systems. These webinars focused on Sample Site Selection and Creating a Proper Sample Pool for the current LCR. These were well-attended with 300 to 400 attendees. Recordings and slides will be posted on our training website.

Assist schools and child-care centers with the 3Ts approach (Training, Testing and Taking Action) to reduce lead in drinking water and increase the number of schools and child care centers that test and provide parents with information on how to minimize children's exposure to lead in drinking water.

EPA's 3Ts Guidance is a comprehensive resource for schools and child care facilities implementing a lead testing in drinking water program.

Began creating a Spanish version of the 3Ts manual and communication templates for parents.

Continued development of a Spanish version of the 3Ts manual and communication templates for parents.

Began developing the 3T's data e-tracker as a 3Ts Toolkit resource for schools and childcare facilities.

Began development of the plan E-Builder to automate development of 3Ts plan to test, train and take action.

Developed a template letter for schools to communicate sample results to parents, faculty and larger school communities.

Released Spanish translations of the 3Ts manual and communication templates.

Met with MOU partners to integrate the 3Ts Guidance in state lead testing programs and expand the federal family resources to support remediation and/or replacement.

Continued development of template correspondence (part of module 1 of the 3Ts Guidance) that states can use with communities to communicate pending testing programs that are newly implemented or expanded via grant funding.

Began development of sampling field guide and video targeted for schools and childcare facilities on "How to Take a Sample."

EPA regions have meet with their states to provide them with technical assistance (e.g., assistance in preparing outreach education materials, determining next steps, etc.).

Finalized template letter communicating sample results, which will be posted in the Toolkit in October for Children's Health Month.

Continued development of sampling field guide and video targeted for schools and childcare facilities on "How to Take a Sample."

Announced and released the Lead Testing in Schools grant program for Tribal Communities.

Initiated development of resources for the Tribal Lead Testing in School and Child Care Facilities grant program.

Finalize regulatory changes to the definition of lead-free plumbing products and make other conforming changes to implement the Reduction of Lead in Drinking Water Act and the Community Fire Safety Act enacted by Congress. The final regulation is expected to result in fewer sources of lead in drinking water by implementing new standards for lead content in plumbing materials used in new installations and repairs.

Submitted the draft of the final regulation to OMB for review.

Continued to engage with OMB on their review.

Addressed OMB comments and obtained clearance to finalize and promulgate the rule.

Issued the final rule and published in the Federal Register.

Collaborate with states and tribes to provide opportunities for low-interest loans and grants through the Drinking Water State Revolving Fund (DWSRF) and the Water Infrastructure Finance and Innovation Act (WIFIA) loan program for updating and replacing drinking water infrastructure.

Invited 38 new projects to apply for FY19 WIFIA loan funding round, 11 of which address lead or emerging contaminants.

Closed two (2) loans:

• Indiana Finance Authority: $436 million - Closed 10/17/2019
• City of Oak Ridge: $20.7 million - Closed 10/17/2019

Signed MOU with the Bureau of Reclamation on October 24, 2019, to seek opportunities to leverage funding provided by WIFIA with existing Reclamation funding programs.

Continued to work with borrowers invited to apply for WIFIA financing with the goal of closing additional loans for the projects aimed at addressing lead or emerging contaminants.

Closed three (3) loans:

• Coachella Valley Water District: $59.1 million - Closed 1/27/2020
• Toho Water Authority: $40.1 million - Closed 2/12/2020
• City of Morro Bay: $61.7 million - Closed 3/9/2020

Continued to work with borrowers invited to apply for WIFIA financing with the goal of finalizing applications and close loans.

Closed seven (7) loans.

Issued a notice of funding availability for $6 billion in loans that could finance over $12 billion in water infrastructure projects, with $5 billion available through WIFIA and $1 billion through EPA's new State Infrastructure Financing Authority WIFIA (SWIFIA) program. Only State water infrastructure authorities are eligible to submit a Letter of Interest for SWIFIA.

EPA Region 2 Awards New York $220 Million for Water Infrastructure.

EPA Awards New Jersey $84 Million for Water Infrastructure Improvements.

Continued to work with borrowers invited to apply for WIFIA financing with the goal of finalizing applications and close loans.

Seven (7) states have transferred funds from Clean Water State Revolving Fund (CWSRF) to DWSRF for projects that address lead-related threats to public health, using the one-time transfer authority under the 2019 Water Infrastructure Fund Transfer Act (WIFTA). Two (2) additional states intend to transfer funds by the October 4, 2020 deadline. A total of approximately $550 million will likely be transferred. These funds must be used as additional subsidy (i.e., loan forgiveness, negative interest loans, and/or grants).

Implement three newly authorized grant programs under the Water Infrastructure Improvements for the Nation (WIIN) Act, for which Congress appropriated $50 million in FY 2018, to fund grants to small and disadvantaged communities for developing and maintaining infrastructure, for lead reduction projects and to support the voluntary testing of drinking water in schools and child care centers.

These programs decrease exposure to lead in drinking water by providing financial incentives to test, educate and replace infrastructure.

Began awarding grants to states for the Lead Testing in School Drinking Water Grant and the Assistance for Small and Disadvantaged Communities Grant.

Began awarding grants to states for the Lead Testing in School Drinking Water Grant and the Assistance for Small and Disadvantaged Communities Grant.

As of FY20 Q2, there are 45 states with awards and 18 with programs underway.

Regions/states requested extensions for grant reporting period due to the impact of COVID-19 to states, schools and administrators.

Released and announced opening of the Request for Applications via Grants.gov for the final WIIN grant, Reductions in Lead Exposure, for $39.9M.

Announced the FY2020 state funding allotments to continue the Lead Testing in Schools Drinking Water Grant.

Announced FY20 funding availability for new participants (e.g., Puerto Rico and U.S. territories) to partake in the Lead in Testing in Schools Drinking Water Grant Program.

Began the development of options for the SDWA 1459A, Increasing Resiliency to Natural Hazards Grant Program.

Completed awards for 49 participating states and DC with funding for the initial launch of the Lead Testing in Schools Drinking Water Grant.

Announced FY20 funding for participating states and territories for the Lead Testing in Schools Drinking Water Grant.

RFA for $39.9 million in WIIN Reduction in Lead Exposure Grant closed on June 1, 2020. Began review of qualified applications.

Continued providing webinars/outreach to states on topics or questions related to the Lead Testing in Schools and Childcare Facilities Drinking Water and Assistance for Small and Disadvantaged Communities Drinking Water Grant Programs.

Received initial grant progress reports on the lead testing programs in schools.

Continued review and approval of project applications for the grant awards for the Assistance for Small and Disadvantaged Communities Grant.

Continued development of SDWA 1459A Increasing Resiliency to Natural Hazards Grant Program.

Developed draft final implementation guide for Tribal Lead Testing in Schools and Childcare Drinking Water Grant Program.

Awarded five (5) states with Small and Disadvantaged Communities Grants totaling over $5.8M funding.

Continued to implement the Small and Disadvantaged Tribal Grant Program.

EPA regions continued to provide outreach to their states on the WINN grant program and upcoming funding opportunities.

Completed awards for all participating states and DC with funding for the initial launch of the Lead Testing in School Drinking Water Grant.

By the end of Q4, 23 participating states were awarded the FY2020 funding for the Lead Testing in Schools Drinking Water Grant.

Received 2nd set of grant progress reports on the lead testing programs in schools.

Announced $4.3M grant available to tribal consortia for the Tribal Lead Testing in Schools and Child Care Drinking Water Grant program.

Held an informational webinar for interested consortia before the Notice of Intent to Participate deadline for the Tribal Lead Testing in Schools and Childcare Drinking Water Grant Program.

Received consortia responses and held first meeting with participants.

Finalized the selection of RFA applications for award of the $39.9 million in WIIN Reduction in Lead Exposure Grant.

Continued development of SDWA 1459A Increasing Resiliency to Natural Hazards Grant Program.

Continued review and approval of workplans for grant awards for the Assistance for Small and Disadvantaged Communities Drinking Water Grant.

Awarded two (2) states with Assistance for Small and Disadvantaged Communities Drinking Water Grants totaling over $2.25M funding.

EPA regions continued to provide outreach to their states on the WIIN grant program and upcoming funding opportunities.

EPA regions continued to engage with their states/tribal partners and other stakeholders to conduct water testing and other outreach events in schools and childcare centers.

Objective 1.3. Reduce Exposure to Lead in Soil

Manage lead contamination at Superfund, RCRA Corrective Action and other sites to reduce exposure to community residents.

Continue to reduce childhood exposures to lead in soils through removal, remedial and corrective actions at contaminated sites and reduce lead soil exposures to the most sensitive community residents.

Continue to support the evaluation of lead exposure at contaminated sites and identify ways to protect the public's health.

Completed twelve (12) Superfund cleanup actions where lead is a contaminant of concern.

Two (2) of these actions were at remedial sites. One (1) was at Picatinny Arsenal in NJ which removed 261 cubic yards of soil where lead was a contaminant of concern. The maximum detected level of lead in this area prior to cleanup was 2,400 mg/kg or parts per million.

Completed ten (10) removal actions to address lead in soils in ID, IL, KS, MS, NY, and MO at a variety of sites, including former mining, mineral processing facilities and other industrial facilities.

Completed eight (8) Superfund cleanup actions at sites where lead is a contaminant of concern. Four (4) of these actions were at remedial sites and four (4) were under the removal program.

Completed twelve (12) Superfund cleanup actions at sites where lead is a contamination of concern. Three (3) of these actions were at remedial sites and nine (9) were under the removal program.

EPA's regions continued to conduct remediation and removal activities, including the following site examples:

REGION 6: EPA's Region 6 remediation efforts at Tar Creek Superfund Site include the remediation of source materials from a former lead smelter, chat piles and chat bases to reduce potential lead exposure of the communities. On 5/15/20, a Human Health Risk Assessment was released for comment through 8/17/20 for Operable Unit 5, which addresses sediment and surface water. Operable Unit 5 is one of the 5 Tar Creek Superfund Site operable units where an assessment was conducted on potential risks associated with exposures to surface water and sediment.

EPA's Region 9 Factory Street lead removal project in Honolulu, HI resulted in the removal of lead contaminated soils with levels up to 24,000 ppm. Extensive community outreach occurred, and the street was repaved in March following cleanup.

Completed 24 Superfund cleanup actions at sites where lead is a contamination of concern. Twelve (12) of these actions were at remedial sites and 12 were under the removal program.

EPA regions continue to conduct remediation and removal activities.

EPA regions continue to partner with ATSDR and local partners to conduct SoilSHOPs.

Objective 1.4. Reduce Exposure to Lead Associated with Emissions to Ambient Air

Continue to work with state and tribal air agencies to implement the National Ambient Air Quality Standard (NAAQS)for lead and aim to reduce the number of areas violating the lead NAAQS.

Continued to work with states to monitor lead emissions and work towards taking action on 2008 Lead NAAQS redesignation requests and maintenance plans.

Continued to work with states to monitor lead emissions and work towards taking action on 2008 Lead NAAQS redesignation requests and maintenance plans.

Continued to work with states to monitor lead emissions and work towards taking action on 2008 Lead NAAQS redesignation requests and maintenance plans.

EPA regions conducted calls with their states.

Continued to work with states to monitor lead emissions and work towards taking action on 2008 Lead NAAQS redesignation requests and maintenance plans.

Twelve (12) of the 22 initial areas designated nonattainment for the 2008 Pb NAAQS are attaining. For the majority of the remaining nonattainment areas, lead emissions and monitored concentrations are declining due to implemented control measures and all nonattainment areas have fulfilled air quality implementation plan requirements.

For more information click here.

EPA regions continued to conduct outreach.

Evaluate the impacts of lead emissions from aircraft using leaded aviation fuel under the Clean Air Act.

Finalized two (2) technical reports: Model-extrapolated Estimates of Airborne Lead Concentrations at U.S. Airports and National Analysis of Populations Residing Near or Attending School Near U.S. Airports.

Finalized two (2) technical reports: Model-extrapolated Estimates of Airborne Lead Concentrations at U.S. Airports and National Analysis of Populations Residing Near or Attending School Near U.S. Airports.

Posted the two (2) completed technical reports to EPA's website.

EPA regions coordinated with EPA HQs on public information requests.

EPA regions coordinated with EPA HQs on public information requests, as needed.

GOAL 2: IDENTIFY LEAD-EXPOSED CHILDREN AND IMPROVE THEIR HEALTH OUTCOMES

EPA's federal partners lead the actions under Goal 2 which are focused on improving the identification of children exposed to lead through surveillance of blood lead level (BLL) data and improving access to services and support designed to improve children's physical, developmental and mental health. Please visit https://ptfcehs.niehs.nih.gov/ for future updates on Goal 2 of the Federal Action Plan.

GOAL 3: COMMUNICATE MORE EFFECTIVELY WITH STAKEHOLDERS

Objective 3.1. consolidate and streamline federal lead-related communication and messaging

Create an online portal to enhance, consolidate and streamline federal-wide communication to the public. Links will direct the public to agency-specific information. (Not everyone affected by lead exposures has access to the internet and therefore, agencies will continue to provide access to printed materials).

Refreshed links on EPA's lead website and connected links to web pages, as applicable.

Updated 2020 Children's Health Month and National Lead Poisoning Prevention Week content on the web.

Released the October 2019 Progress Report on the Federal Action Plan to Reduce Childhood Lead Exposures and Associated Health Impacts.

Released the October 2019 Protecting Children's Health report which included information on the agency's efforts to reduce and prevent lead exposures.

Released the America's Children and the Environment, October 2019 report which included information on lead indicators.

Released the Supporting Houses of Worship: Effective Affordable Measures to Protect the Health of Congregations and Staff, October 2019 report which included background information on lead and steps that can be taken to reduce lead exposures.

Released the Protecting Children's Health October 2019 Tips poster which included information on how to reduce exposures to lead.

Released EPA's Lead-based Paint Enforcement Helps Protect Children and Vulnerable Communities - 2019 resource in October 2019.

Posted EPA Reduces Lead Exposures Through Cleanup Enforcement 2019online in December 2019.

Refreshed links on EPA's lead website and connected links to web pages, as applicable.

Continued to refresh links and connect links to web page as applicable.

Worked across the agency (HQs and with EPA's regional offices) to make updates.

Continued to update links and web content, as needed.

Prepared communications and web content for Children's Health Month and National Lead Poisoning Prevention Week.

Provide periodic updates on the progress of implementing the Action Plan on the online portal.

Updated the Implementation Status for EPA Actions Under the 2018 Federal Action Plan to Reduce Childhood Lead Exposures and Associated Health Impacts web page with FY19 Q4 actions.

Updated the Implementation Status for EPA Actions Under the 2018 Federal Action Plan to Reduce Childhood Lead Exposures and Associated Health Impacts web page web page with FY20 Q1 actions.

Updated the Implementation Status for EPA Actions Under the 2018 Federal Action Plan to Reduce Childhood Lead Exposures and Associated Health Impacts web page web page with FY20 Q2 actions.

Updated web page to increase accessibility of information for the public.

Updated the Implementation Status for EPA Actions Under the 2018 Federal Action Plan to Reduce Childhood Lead Exposures and Associated Health Impacts web page with FY20 Q3 actions.

Enhance local partnerships with community organizations, local health agencies, faith-based organizations and private philanthropies to raise awareness of the dangers of exposure to lead based paint hazards, and to promote data sharing.

Released a new EPA booklet, Supporting Healthy Houses of Worship: Effective, Affordable Measures to Protect the Health of Congregations and Staff which includes information on lead.

Continued to work with PEHSUs in all of EPA's 10 regions to raise awareness of the dangers of exposure to lead based paint hazards (see objective 3.2) and with our federal partners to promote data sharing (see goal 4).

For highlights of EPA regional and local partnerships, see EPA's Implementation Status of the Lead Action Plan web page.

Continued to work with PEHSUs in all of EPA's 10 regions to raise awareness of the dangers of exposure to lead based paint hazards (see objective 3.2) and with our federal partners to promote data sharing (see goal 4).

For highlights of EPA regional and local partnerships, see EPA's Implementation Status of the Lead Action Plan web page.

Continued to work with PEHSUs in all of EPA's 10 regions to raise awareness of the dangers of exposure to lead based paint hazards (see objective 3.2) and with our federal partners to promote data sharing (see goal 4).

For highlights of EPA regional and local partnerships, see EPA's Implementation Status of the Lead Action Plan web page.

Continued to work with PEHSUs in all of EPA's 10 regions to raise awareness of the dangers of exposure to lead based paint hazards (see objective 3.2) and with our federal partners to promote data sharing (see goal 4).

For highlights of EPA regional and local partnerships, see EPA's Implementation Status of the Lead Action Plan web page.

Objective 3.2. improVe awareness of lead hazards, prevention and remediation among diverse populations, especially those most at risk

Utilize Pediatric Environmental Health Specialty Units (PEHSUs) to develop appropriate, evidence-based lead exposure prevention and intervention communication materials and disseminate them through the PEHSUs established community networks.

Exhibited and presented Translating Science to Action: The Role of Pediatric Environmental Health Specialty Units in Public Health Messaging and Addressing an Old Problem with New Innovations: How a Network of Experts Reduces Pediatric Lead Exposure at the APHA Annual Meeting talking with more than 150 attendees.

REGION 3: Trained 25 public health and 40 nursing students on epidemiological perspectives and health impacts of lead.

REGION 5: At the request of the state of MN, reviewed the Childhood Blood Lead Clinical Treatment Guidelines for Minnesota. Revised in October 2019 based on national recommendations, alignment with case management guidelines and input from a multi-disciplinary workgroup.

REGION 9: Sent e-newsletter with information about lead to promotores and community health workers.

Completed chapter in A Story of Health on how environmental exposures over the life course, including lead, can influence cognitive function and decline as we age.

REGION 10: Presented at the Alaska Environmental Health Association conference and the All Alaska Pediatric Partnership symposium on childhood lead exposures in October 2019.

With AAP, recruited pediatric primary care practices to participate in a lead testing tele-mentoring program, Extension for Community Healthcare Outcomes. PEHSU faculty serve as subject matter experts.

REGION 3: Lectured Thomas Jefferson University nursing students on children's environmental health issues, including lead, during the Pediatric Environmental Health Symposium.

REGION 4: Educated Historic Westside Gardens and other community groups about how to test children for lead exposure in response to community concerns. Beneficiaries included community members in SW Atlanta affected by potential lead exposure in soil.

REGION 5: Created a video covering environmental issues such as radium, lead and mercury for first year medical students.

REGION 9: Completed a chapter in A Story of Health, which focuses on cognitive decline. The new chapter discusses how environmental exposures over the life course, including exposure to lead, can influence cognitive function and decline as we age.

Developed a fact sheet for the general public on why children have higher exposures to toxins, including lead, and increased vulnerability to those exposures relative to adults in English and Spanish.

Sponsored an interview on Afghan Theater TV about lead exposure caused by use of imported eye makeup ("surma" or kohl). This led to increased downloads of the Lead in Imported Makeup fact sheets in Dari, Pashto, Hindi, Arabic, Somali and Urdu.

REGION 10: Presented "No Level is Safe: Pediatric Lead Exposure" to >30 attendees at PeaceHealth Hospital Pediatric Grand Rounds.

With AAP, served as instructors for the Lead Testing Extension for Community Healthcare Outcomes project launched in February 2020.

Beginning mid-March, many states were ordered to shelter-in-place due to COVID-19. Because of the pandemic, numerous PEHSU operations were affected, including canceled events and educational offerings, reduced consultations and challenges working remotely across the network. Despite these challenges, significant progress was made with resource development and outreach activities and provided insight on children's health issues related to the pandemic. Units are actively engaged in developing and providing guidance on safe disinfectant use to create and maintain healthy home environments during COVID-19.

REGION 1: Conducted >50 clinical and educational consultations regarding children with elevated BLLs. Staff successfully transitioned to a new normal created by the COVID-1919 pandemic with continued focus on how to educate and reduce environmental health exposures as a result of families staying in their homes more.

Created a fact sheet on lead in pregnancy that has been distributed locally and nationally.

Met with the Dimock Health Center's OB-GYN department to discuss how PEHSU providers can assist the Health Center and their patients with lead and other environmental health exposures and provided a reference for clinical resources.

Taught the fundamentals of childhood lead for local trainees serving as medical toxicology fellows through the Massachusetts-Rhode Island Poison Control Center.

Strengthened partnership with the Massachusetts Department of Public Health to innovatively address and respond to childhood lead poisoning during the COVID-19 pandemic. In the first 3 months of the pandemic, many doctor's offices were closed, and families were nervous about going to a health care facility for illness, including well-child visits. As a result, testing children for lead exposure between March and May was down by 75% from the same reporting period in 2019, requiring proactive methods to identify children at risk of lead poisoning.

Published in peer-reviewed journal:

• Stierman B, Hauptman M, Woolf AS. Severe lead poisoning requiring hospitalization: a case report. Curr Prob Pediatr Adolesc Heal Care. 2020 Mar; 50(2):100757 doi: 10.1016/j.cppeds.2020.100757

Health educators increased education and outreach on social media to supplement the lack of in-person opportunities due to COVID-19. PEHSU has 51 followers on Instagram, 142 on X and 71 on Facebook, and hope to expand to Pinterest, Reddit and YouTube. In 28 days, total engagement on the New England PEHSU Facebook page increased by 84%.

REGION 2: Continued collaboration with the Mount Sinai Pediatrics Associates Clinic on the SDOH screening tool which identifies common unmet social needs and connects families to local resources and partner organizations to address needs. The tool was integrated into the clinic electronic medical record to facilitate BLL screening rates, direct feedback to the primary care provider and provide automatic referrals to community resources.

Met with the Region 4 PEHSU to discuss adapting Region 2 Prescriptions for Prevention process to Region 4's Black Women's Environmental Wellness Project (BWEWP), a collaborative effort between Region 4 PEHSU and the Center for Black Women's Wellness. Aim to increase environmental health literacy and reduce environmental exposures, including lead, among African American women and children in Atlanta. The Region 2 PEHSU will be offering technical support during the material adaptation process.

REGION 3: With the Children's Environmental Health Network, held a webinar for childcare providers. There were 673 registrations and 283 participants, with participation from every region. At least 17,572 children nationally, in the care of providers that attended the webinar, will potentially benefit from the discussions on how to minimize potential harmful environmental exposures to children in early care settings. Childcare licensing staff, nurse consultants and others who work with childcare providers were in attendance and will expand the reach of this information.

REGION 4: Supported the Center for Black Women's Wellness in applying and receiving the Cedar Tree foundation award to share information on lead and other harmful environmental exposures to African American women in metro Atlanta, GA; anticipated reach is 3,000 over 3 years.

REGION 5: Continued development of a lead screening and follow-up project with the Ohio AAP Chapter and held webinars with the hope of enrolling practices from across OH into the pilot phase. Since primary care practices are recovering missed preventive care visits and decreased lead testing (down 70%) in OH because of COVID-19, this will help practices track their well child visits.

With the Community Engagement Core at the University of Cincinnati, Dr. Nick Newman created a home video on easy ways to prevent lead exposure in the home. The group is working on a Spanish version.

REGION 6: Presented lead mapping efforts to the Arkansas Department of Energy & Environment and Department of Health to discuss possible collaborations with data sharing and analyses.

REGION 8: Hosted Healthy Buildings webinar with the Indoor Air Program and HUD Region 8. 785 people registered and 258 attended.

REGION 9: Updated the developmental disabilities chapter in the A Story of Health eBook. Over 12,000 health professionals have already registered for this free learning tool. Materials include easy-to-read PDF, videos, infographics, articles by experts and linked to additional resources and scientific references on how the environment interacts with one's genes to influence health across the lifespan.

Produced a new fact sheet on take home exposures to contaminants, including lead.

Sent written materials to 26 families in HI with children <6 with elevated BLLs. This number is low due to reductions in lead testing from COVID-19 concerns.

REGION 10: Updated Clinical Management of Lead Exposure in Pregnant and Lactating Women and the Breastfed Infant fact sheet.

Held a lead screening training for the Oregon Pediatric Society.

Held PEHSU and University of Washington School of Medicine Pediatrics Bootcamp. "I've never heard about this before, we should have more time for environmental pediatrics" was a comment Catherine Karr, MD, PhD, MS received from a medical student. The Northwest PEHSU Director presented Introduction to Pediatric Environmental Health. UW School of Medicine invited Dr. Karr to engage 4th year medical students preparing for transition to pediatric residency.

Delivered two (2) lectures to undergraduates at UW Seattle titled "Lead and Children" where 47 students learned about impacts of lead on children's health.

REGIONS 1, 2, 8: Launched the 2nd AAP Lead Testing ECHO, which is co-branded with the PEHSU program to ensure expertise of the program around childhood lead exposure is recognized. Initially disrupted by COVID-19, the project now ensures lead exposure remains a relevant topic in pediatric primary care during the pandemic which is underscored by the increased amount of time children spend in their homes.

Region 1: Developed and delivered to 20 toxicology physicians two (2) presentations on the global implications and principles of lead poisoning management and on lead poisoning during COVID-19.

R1 PEHSU doctors wrote an article on angiogenic factors and lead levels in pregnancy.

Region 2: A primary care pediatrician contacted the R2 PEHSU and asked the unit to connect with the mom of a patient whose lead levels were elevated. The primary concern was the cost of home repairs needed to be lead free. The PEHSU connected the family with the NYC Hazard Reduction Program and the Home Repairs Loans program. Resources to afford home repairs and prevent further lead exposure were given to the family.

A medical doctor contacted the PEHSU to learn about lead testing with an XRF device by NYC DOH and EPA-certified lead swabs test kits. The PEHSU provided advice on practicing precautions with kids and resources from EPA and New York City DOH for homeowners dealing with lead paint.

A pediatrician in NJ called the R2 PEHSU for consultation of a 2-year-old with persistent elevated lead levels since March 2019. The NJ DOH conducted a home visit and identified imported eyeliner from India applied to the child's face that seemed to be the source of exposure. The family was educated on lead, its sources, settings, and common effects associated with lead poisoning. The parents were counseled on lead prevention steps, sources, and follow up with the pediatrician for a new venous BLL test in a few months.

Region 3: Though COVID-19 prevented in-person events, the PEHSU educated refugees in Prince George's County, MD about the lead exposures that pose risks for refugee children.

The PEHSU worked with university students, nursing students, clinicians, and exposed families and provided lead education and consultations.

Region 5: Published "Lead Poisoning" in Benign Hematological Disorders in Children - A Clinical Guide.

Region 6: In August, the PEHSU Pediatric Environmental Health Grand Rounds educated 47 healthcare professionals in a webinar titled "Flint Michigan: The Real Risk."

The PEHSU conducted RRP training for:

• five (5) community members in New Mexico
• 48 healthcare professionals in Grand Rounds
• several communities in New Mexico.

Region 7: Reported handling 27 cases of lead poisoning incidents or families looking for information about lead home assessments. In one (1) case in Nebraska, seven (7) children were at risk due to lead on windowsills, a porch, and in the yard for which the family was looking for remediation assistance and advice. Another case involved ingestion of a lead fishing sinker by a 2-year-old child.

Region 10: Presented "No Level is Safe: Pediatric Lead Exposure" at Oregon Health & Science University to 24 nursing students in August and presented an e-learning course for 17 Oregon health professionals on diagnosing and managing pediatric lead exposure. Another course for 14 Washington health professionals was offered to promote pediatric lead screening. Through the PEHSU National Classroom, 177 health professionals and 24 community members completed an e-learning course: "Pediatric Lead Exposure: Diagnosis, Management and Prevention."

Twenty-three (23) health professionals and one (1) community member completed the Promoting Pediatric Lead Screening e-learning in Washington and five (5) health professionals completed the Promoting Pediatric Lead Screening in Oregon.

Enhance partnerships with state, tribal and local governments and key stakeholders (e.g., media, community groups, faith-based groups, advocacy groups, departments of health, departments of environmental quality, medical providers, philanthropies, federal grantees and others) that represent or serve communities at risk for childhood lead exposure.

Completed review of tribal input and made revisions to the curriculum, as appropriate.

Continued to revise the curriculum, developed a communications plan and created new supplemental materials.

Developed communications materials and obtained final partner feedback. Initiated internal review process.

REGION 3: Continued to conduct follow up as part of the October 2019 Mid-Atlantic Lead Forum.

Completed final revisions and approvals to publish the Tribal Lead Curriculum in mid-October 2020.

Collaborated with tribal partners to finalize communications materials and plan presentations.

Increase outreach events and engagement processes in collaboration with at-risk communities and lead-safe coalitions to provide education on the dangers of lead exposures, strategies for reducing exposures in children, and actions to support exposed children and their families.

Continued to work with PEHSUs in all of EPA's 10 regions to raise awareness of the dangers of lead exposures (see above).

For highlights of EPA regional collaborations with at-risk communities and lead-safe coalitions, see EPA's Implementation Status of the Lead Action Plan web page.

Continued to work with PEHSUs in all of EPA's 10 regions to raise awareness of the dangers of lead exposures (see above).

For highlights of EPA regional collaborations with at-risk communities and lead-safe coalitions, see EPA's Implementation Status of the Lead Action Plan web page.

Continued to work with PEHSUs in all of EPA's 10 regions to raise awareness of the dangers of lead exposures (see above).

For highlights of EPA regional collaborations with at-risk communities and lead-safe coalitions, see EPA's Implementation Status of the Lead Action Plan web page.

Continued to work with PEHSUs in all of EPA's 10 regions to raise awareness of the dangers of lead exposures (see above).

For highlights of EPA regional collaborations with at-risk communities and lead-safe coalitions, see EPA's Implementation Status of the Lead Action Plan web page.

REGION 2: Distributed sampling information to Red Hook, Brooklyn (Columbia Smelting and Refinery Site) residents about lead content in their community.

Conducted resident outreach at the Kil-tone Superfund Site.

GOAL 4: SUPPORT AND CONDUCT CRITICAL RESEARCH TO INFORM EFFORTS TO REDUCE LEAD EXPOSURES AND RELATED HEALTH RISKS

Key Priorities: Prioritize and Address the critical research and data needs to inform lead policies and guide decisions

Enhance and apply data and tools (e.g., models or approaches) and determine the key drivers of BLLs from multimedia exposures to inform lead regulatory decisions and site assessments.

Co-led Cross-Agency Research Workshop with HHS and HUD. Participants included DC/ATSDR, FDA, CPSA and other agencies. EPA progress on the evaluation, updating and use of blood lead models was presented.

Continued progress on evaluation of updated Integrated Exposure-Uptake Biokinetic (IEUBK) model used for regulatory decisions.

During the public meeting, SAB's peer review of the updated All Ages Lead Model (AALM) and technical documentation was overall very positive.

Drafted Cross-Agency Research Workshop summary report.

Added batch-mode capability to updated AALM to allow rapid calculation of estimate BLLs for large datasets.

Drafted report on evaluation of updated IEUBK 2.0 model.

Drafted manuscript on SHEDS-IEUBK exposure-internal BLL model submitted for peer-reviewed publication.

Finalized December 2019 Federal Lead Action Plan Research Workshop report.

Received the SAB report following peer review including tiered recommendations.

Drafted response to letter peer review of evaluation of updated IEUBK 2.0 model.

Published peer-reviewed manuscript on SHEDS-IEUBK exposure-internal BLL model.

Convened Federal Lead Action Plan Goal 4 working group to continue cross federal agency research coordination.

Received completed contractor report onpeer review of evaluation of updated IEUBK 2.0 model.

Provided technical support to EPA Regions 1, 2, 3, and 5 and municipalities on corrosion control methods to reduce release of lead into drinking water from sources within water systems and point-of-use filtering to mitigate lead in drinking water.

Generate data, maps and mapping tools to identify high exposure communities or locations and disparities for prioritization efforts to reduce children's BLLs.

Co-led Cross-Agency Research Workshop with HHS and HUD. Participants included DC/ATSDR, FDA, CPSA and other agencies. EPA's research on lead mapping to identify high lead exposure locations was presented.

Provided technical assistance to regional partners to identify high exposure locations.

Provided additional MI maps and data analyses for continued technical support to identify high lead exposure locations and inform targeting efforts and joint planning with state partners.

Participated in meeting with Region 5 state partners including Michigan Department of Environment, Great Lakes and Energy and Department of Health and Human Services.

Participated in a kick-off call with ASTHO and ECOS and Region 5 to initiate pilot project on mapping lead exposure risk with collaboration of state public health and environmental officials.

Drafted Cross-Agency Research Workshop summary report.

Provided technical assistance to regional partners to identify high exposure locations.

Provided additional MI maps and data analyses for continued technical support to identify high lead exposure locations and inform targeting efforts and joint planning with state partners.

Participated in Region 5 meetings with their state partners including Michigan Department of Environment, Great Lakes and Energy) and Department of Health and Human Services.

Participated in a call with ASTHO and ECOS and Region 5 to discuss mapping higher lead exposure locations with collaboration of state public health and environmental officials.

Provided summary of lead mapping and data analysis research efforts for Ohio for their Ohio Governor's Lead Advisory Committee, reflecting EPA collaborations with OH state partners.

Obtained data sharing agreement approvals for more comprehensive children's blood lead data sets from MI and OH to inform additional mapping analyses for joint planning.

Provided mapping assistance for Region 1's CT lead geographic initiative. Shared several data layers to inform targeting efforts, including one from HUD shared through interagency collaborations.

Presented lead mapping efforts to the Arkansas Department of Energy & Environment and Department of Health to discuss possible collaborations with data sharing and analyses.

Provided lead mapping results and updates for Region 7's inter-Federal Agency Lead Task force follow-up meeting.

Finalized December 2019 Federal Lead Action Plan Research Workshop report.

Participated in continued discussions with Region 5 state partners on the development of peer-reviewed methodology for identifying high lead exposure locations.

Convened Federal Lead Action Plan Goal 4 working group to continue cross federal agency research coordination.

Drafted peer reviewed manuscript describing methodology for identifying high lead exposure locations and key factors in those locations.

Completed internal report on providing technical assistance on mapping and identifying high lead exposure locations and targeting potential exposure sources in those locations to EPA Regions 1, 5, 6, and 7, with results for 16 States.

Generate data to address critical gaps for reducing uncertainty in lead modeling and mapping for exposure/risk analyses and for estimating population-wide health benefits of actions to reduce lead exposures.

Co-led Cross-Agency Research Workshop with HHS and HUD. Participants included CDC/ATSDR, FDA, CPSA and other agencies. Progress on bioavailability and innovative methods to reduce soil lead toxic exposures was presented.

Drafted Cross-Agency Research Workshop summary report.

Continued to process drinking water, soil and dust samples received from the HUD-sponsored American Healthy Homes Survey II to estimate total lead in these different media and the bioavailability of the lead in a representative set of the soil and dust samples, with HUD.

Developed and obtained internal approval of STAR RFA on soil and dust ingestion by children.

Finalized December 2019 Federal Lead Action Plan Research Workshop report.

Drafted report on drinking water samples received from the HUD sponsored American Healthy Homes Survey II.

Laboratory processing of soil and dust samples received from the HUD sponsored American Healthy Homes Survey II is delayed by COVID-19 COOP closing of laboratories.

Released STAR RFA on soil and dust ingestion by children.

Convened Federal Lead Action Plan Goal 4 working group to continue cross federal agency research coordination.

Reviewed applications to STAR RFA on soil and dust ingestion by children.

Continued progress in quantifying the bioavailability of lead from residential sources. Analysis of drinking water samples from American Healthy Homes Survey II in progress; laboratory processing of soil and dust samples received from the HUD sponsored American Healthy Homes Survey II is delayed by COVID-19 COOP closing of laboratories.

Identify approaches to prevent, mitigate and communicate about lead exposures and risks in exposed communities.

Co-led Cross-Agency Research Workshop with HHS and HUD. Participants included DC/ATSDR, FDA, CPSA and other agencies. Progress and proposed research to mitigate lead risk from water systems was presented.

Drafted Cross-Agency Research Workshop summary report.

Provided ongoing technical support to assess effectiveness of corrosion control treatment in multiple cities applying innovative lead mitigation methods for addressing lead in drinking water.

Progressed on research using drinking water sampling methods to identify the presence of lead service lines.

Progressed on the development of a premise plumbing model.

Developed methods for producing standardized lead phosphate nanoparticles for potential use in water filter design.

Drafted updated lead research web content for posting to internet.

Finalized December 2019 Federal Lead Action Plan Research Workshop report.

Drafted peer reviewed manuscript on novel approaches for in situ remediation.

Drafted peer-reviewed manuscripts on water sampling strategies for lead service line identification.

Reported on methods for producing standardized lead phosphate nanoparticles for potential use in water filter design.

Developed reports on technical support provided to multiple communities.

Field research using drinking water sampling methods to identify the presence of lead service lines is delayed due to COVID-19 COOP interruption of field work.

Posted updated lead research web content on EPA lead research web page.

Convened Federal Lead Action Plan Goal 4 working group to continue cross federal agency research coordination.

Completed internal clearance of peer reviewed manuscript on novel approaches for in situ remediation of soil lead.

Initiated the update of the science information base (Integrated Science Assessment) for the review of the lead National Ambient Air Quality Standard.

Published research on Evaluation of Lead Pipe Scale and Orthophosphate Treatment.

Published critical literature review on water sampling strategies.

Field research using drinking water sampling methods to identify the presence of lead service lines is delayed due to COVID-19 COOP interruption of field work.

Evaluate the effectiveness of actions (e.g., interventions, programs, policies, enforcement) to prevent lead exposure, mitigate health effects and communicate on lead exposures/risks.

Co-led Cross-Agency Research Workshop with HHS and HUD. Progress on research to evaluate the effectiveness of lead mitigation actions at a Superfund site was presented.

Drafted Cross-Agency Research Workshop summary report.

With support from the Douglas County Health Department and the City of Omaha, continued to prepare a report on the effectiveness of the actions to address lead contamination in residential soil, dust and paint at the Omaha Lead Superfund Site in reducing elevated BLLs in young children.

Drafted updated lead research web content for posting to EPA lead research web page.

Finalized December 2019 Federal Lead Action Plan Research Workshop report.

Prepared peer-reviewed manuscript on the effectiveness of the actions to address lead contamination in residential soil, dust and paint at the Omaha Lead Superfund Site in reducing elevated BLLs in young children.

Posted updated lead research web content on EPA's lead research web page.

Convened Federal Lead Action Plan Goal 4 working group to continue cross federal agency research coordination.

Completed internal clearance of peer-reviewed manuscript on the effectiveness of the actions to address lead contamination in residential soil, dust, and paint at the Omaha Lead Superfund Site in reducing elevated BLLs in young children.