A Randomized Controlled Trial to Reduce Childhood Lead Exposure and Lead-Associated Neurobehavioral Deficits: The HOME Study

Background: Childhood lead exposure is associated with neurobehavioral impairments in children. No randomized trials have tested whether a comprehensive residential lead hazard intervention can prevent elevated blood lead concentrations and associated neurobehavioral outcomes.Objectives: We tested whether an intervention designed to reduce residential lead exposure completed during pregnancy could prevent elevated blood lead concentrations and improve neurobehavioral outcomes in children.Methods: We enrolled 355 pregnant women from the Cincinnati, OH metropolitan area in a randomized controlled trial. We randomly assigned women to receive either residential lead or injury hazards. The lead hazard intervention included elements designed to reduce or eliminate lead exposure from paint, drinking water, and soil. We assessed residential dust lead loadings at baseline and when children were ages 1 and 2 years. From ages 1-8 years, we measured blood lead concentrations and assessed cognition, behavior, and executive functions.Results: The intervention reduced floor, windowsill, and window trough dust lead loadings at ages 1 and 2 years by 24% (95% CI: -43, 1), 40% (95% CI: -60, -11), and 47% (95% CI: -68, -10), respectively. The intervention non-significantly reduced children’s blood lead concentrations (-6%; 95% CI:-17, 6). Race modified the intervention effect on children’s blood lead concentrations (intervention x race p-value=0.03); Black children had greater reductions in blood lead concentrations (-31%; 95% CI:-50, -5) than White children (-2%; 95% CI:-14, 12). Neurobehavioral test scores were subtly better among children in the intervention group than control group; all were statistically non-significant, except for a reduction in anxiety scores (-1.6; 95% CI:-3.2, -0.1).Conclusions: This intervention reduced residential lead exposures and, among Black children, blood lead concentrations, but did not result in substantive neurobehavioral improvements.