Feature 1

Food Sources of Lead May Exacerbate Occupational Exposures to Lead: Recommendations for Occupational Investigations

Elisabeth Maxwell, MS and Dr. Cathy Neumann

Biographies

Elisabeth Maxwell, M.S., Doctoral Candidate
Elisabeth Maxwell is a Graduate Research Assistant in the Environment, Safety and Health Program at Oregon State University. She is a PhD candidate and currently investigating the link between business decisions and occupational health and worker safety outcomes.

Catherine Neumann, Ph.D.
Catherine Neumann was most recently an Associate Professor in the Environment, Safety and Health Program at Oregon State University. She also served as the program’s Graduate Program Coordinator. Her areas of research have been in lead-tainted consumer products, hazardous waste disposal, toxicology, and air quality issues. Dr. Neumann is currently retired from teaching at OSU.

Abstract

Detrimental lead exposure is common in industry and is a leading cause of workplace illness. Because of this, OSHA has made the reduction of lead exposure a high strategic priority. The goal of this article is to highlight how a food source exposure from lead might exacerbate an occupational exposure, and that it is worthwhile for SHE professionals to keep these other sources of exposure in mind when working with occupationally exposed individuals. Moreover, the results of this study may also be used to inform university instructors and their students in the study of unusual or complex occupational exposures to lead. Tiendas were chosen using information obtained from the Oregon Department of Agriculture, local environmental health specialists, and local Hispanic service organizations. Once candies were purchased, they were labeled, placed into sterile containers, and kept in a temperature-controlled environment until they were sent to an EPA certified laboratory for analysis of lead content. Forty-five percent (57 out of 128 samples) of the Mexican candies tested had detectable levels of lead (ranging from 0.08 ppm to 2.2 ppm). Eighty-seven percent of candies with detectable levels of lead met or exceeded the new FDA guideline of 0.1 ppm lead. Elevated levels of lead were also found in candy wrappers and sticks. When an occupational exposure occurs and is documented with an elevated BLL, it is worthwhile for the ESH professional to consider not just the work-related exposure, but also any home sources that could make the health impacts worse. This study provides preliminary evidence to inform how ESH investigations are conducted for the worker’s own health (as well as their family’s health), liability issues in the workplace, and the long-term retention of healthy workers.

Full Text

Detrimental lead exposure is common in industry and is a leading cause of workplace illness. Because of this, OSHA has made the reduction of lead exposure a high strategic priority. “OSHA's five year strategic plan sets a performance goal of a 15% reduction in the average severity of lead exposure or employee blood lead levels in selected industries and workplaces” (Occupational Safety & Health Administrations, 2008).

Unfortunately, occupational lead exposure is not the only pathway through which workers and their families are exposed. Lead can also be present in hazardous concentrations in food, water, soil, and air. Workers and their families can be exposed to lead from many sources including, food, house paint, toys, dust, and folk remedies. In 2007, 15.7 percent of the U.S. civilian labor force age 16 and over, were foreign born (United States Department of Labor, 2008). This could mean that workers consume imported foods, or use imported medicines, or participate in recreational activities that can be a significant source of lead exposure. Most of us have been aware in the last few years of lead exposures from foreign imports that have significantly impacted the health of people in the U.S. (candy, Mattel toys, metal jewelry, lunchboxes, etc). Therefore, what should managers and Safety, Environment and Health (SHE) professionals understand about the ways in which workers can be exposed occupationally and at home to lead? Moreover, how might these different pathways of exposure interact with one another? The goal of this article is to highlight how a food source exposure from lead might exacerbate an occupational exposure, and that it is worthwhile for SHE professionals to keep these other sources of exposure in mind when working with occupationally exposed individuals. It may be that what initially appears to be an occupational exposure is actually due to an exposure to lead from a home or non-work source; or that an occupational source is exacerbated by a home-source. Moreover, the results of this study may also be used to inform university instructors and their students in the study of unusual or complex occupational exposures to lead. It is also worth noting that such an assessment must be undertaken with the utmost in sensitivity to individual cultures.

First, it is important to briefly review why lead is such a health problem for humans, but especially for children. Lead poisoning is the leading illness caused by an environmental exposure in children (Occupational Safety & Health Administrations, 2008). Fetuses, babies, and young children with developing nervous systems are particularly sensitive to adverse health effects associated with lead. Lead poisoning in children can result in decreased intelligence, impaired neurobehavioral development, stunted physical growth, hearing and kidney problems, juvenile delinquency, and a propensity to commit criminal acts (Bellinger, Sloman, Leviton, Rabinowitz, Needleman, & Waternaux, 1991; Bellinger, Stiles, & Needleman, 1992; Dietrich, Ris, Succop, Berger, & Bornschein, 2001; Fels et al., 1998; Needleman, Riess, Tobin, Biesecker, & Greenhouse, 1996; Needleman, McFarland, Ness, Fienberg, & Tobin, 2002; Otto & Fox, 1993; Sanin et al., 2001).

Symptoms of lead poisoning in adults can include the following:

Moreover, lead poisoning, neurological effects, and mental retardation have occurred in the children of workers engaged in occupations where the worker is exposed to lead (NIOSH, 2008).

The current definition of an elevated blood lead level (BLL) in children established by the U.S. Centers for Disease Control and Prevention (CDC) is ≥ 10 micrograms per deciliter (µg/dL). The CDC’s BLL has been reduced four times over the past 30 years due to evidence indicating adverse effects at lower levels. The Third National Health and Nutrition Examination Study (NHANES III) 1999-2000 estimated that 434,000 children or 2.2% of children aged 1 to 5 years had BLLs ≥ 10 µg/dL (Meyer, Pivetz, Dignam, Homa, Schoonover, & Brody, 2003). The highest BLL acceptable by the standards of OSHA for workers is 40 µg/dL (MMWR, 2006). However, the U.S. Department of Health and Human Services recommends that BLLs among all adults be reduced to <25 µg/dL (MMWR, 2006).

Historical sources of occupational and environmental exposure to lead have been from mining, smelting, gasoline and paint (Agency for Toxic Substances and Disease Registry (ATSDR), 2006a). Mexican folk remedies such as Alarcon, Azarcon, Coral and Greta have also been shown to contain up to 90% lead (ATSDR, 2006b). Lead has also been reported in a number of products used by children including imported crayons (Arreola, Fowler, Schaller, Weaver, Neumann, & Boyer, 1996: Neumann, Kauffman, & Arreola, 1996), jewelry (Consumer Product Safety Commission (CPSC), 2006), lunch boxes (United States Food and Drug Administration (FDA), 2006a), chocolate (Dahiya, Karpe, Hegde, & Sharma, 2005; Onianwa, Adetoal, Iwegbue, Ojo, & Tell, 1999; Rankin, Nriagu, Aggarwal, Arowolo, Adebayo, & Flegal, 2005) and tamarind-based candy (Lynch, Boatright, & Moss, 2000). Recently, Dagoba, an organic chocolate company in Ashland, OR, recalled 10,000 pounds of bars, bricks and drops because of lead (O’Neill, 2006, FDA 2006b). Routine testing showed widely varying levels of lead in some Dagoba products. The raw organic cocoa came from a single supplier in Ecuador in a region of volcanic soils (O’Neill, 2006).

Lead-tainted candy wrappers and other labels have also been on-going concern (CPSC, 1998; FDA, 2002). Lead-based inks are used in labels and wrappers due to their bright colors. Recently, Pepsi settled a lawsuit with the state of California over labels on bottles manufactured in Mexico that contained up to 45% lead (Associated Press, 2006).

Lead is on the FDA’s list of poisonous and deleterious substances which was established to control contaminants in food (ATSDR, 2006c). FDA’s current recommendation for the Provisional Total Tolerable Intake for Lead (PTTIL) that children under age six consume less than 6.0 µg lead daily from all food sources (Carrington & Bolger, 1992). Moreover, a recent review of the regulatory role that the FDA, the State of California and the Consumer Product Safety Commission (CPSC) played in the lead in candy issue has demonstrated that these agencies have been dealing with this issue for many years (Maxwell & Neumann, 2007).

Since the early 1990s, the FDA, the California Department of Health Services (CA DHS), and independent investigators (Lynch et al., 2000, Orange County Register, 2004) detected lead in a number of brands of imported candies from Mexico, Philippines and other countries. The authors are aware of only one published report on lead in candy. Lynch et al. (2000) found over 50% of tamarind suckers tested exceeded FDA’s original enforcement level of 0.50 ppm (Lynch et al., 2000). This study was initiated after a child was found to have continued elevated BLLs even after remedial action was taken to reduce environmental sources of lead. Tamarind-containing suckers were implicated as the source of on-going lead exposure in this case. Lynch found that in two kinds of tamarind candy lollipops, lead levels were high enough that a child consuming one-quarter to one-half of either of these would exceed the maximum FDA’s tolerable intake. FDA recently reduced the acceptable level of lead in candy to 0.1 ppm (FDA, 2006c).

According to CDC, there have been five other documented cases of elevated BLLs (>10 µg/dL) in young Hispanic children in the U.S. from eating imported candy (United States Center for Disease Control (CDC), 2002). Of approximately 1,000 cases of elevated BLLs among children that were reported to CA DHS during May 2001 - January 2002, candy produced in Mexico was identified as a possible source of lead exposure in approximately 150 cases (CDC, 2002). As can be readily seen, if a worker engages in a job where he or she may experience a lead overexposure and also regularly ingests a food that contains a significant amount of lead, a serious health crisis could occur.

Methods

County Selection

Four counties were selected in this study based on percent Hispanics (2000 census data): Hood River (24.3% Hispanic), Multnomah (23.9% Hispanic), Marion County (16.4% Hispanic), and Benton (5.3%).

Tienda Selection

Candies were purchased from small Mexican markets called tiendas in the selected counties. To select these stores, a list of retail stores in each county was provided by the Oregon Department of Agriculture (OR DOA). In some counties, such as Hood River, there were only two tiendas, while Multnomah County had numerous small Mexican markets. Tiendas in Multnomah County and others with multiple tiendas were selected using the following two criteria: (1) a large and varied selection of candy brands; and (2) a large volume of business. Information was kept on the exact location where the candy was bought, the manufacturer, and the lot number of the candy (when available).

Candy Selection

In the current study, 142 candies were collected from four counties in OR and analyzed for lead. Some candy wrappers and lollipop sticks were also tested for lead. Candy samples were selected by ingredient. Candies were chosen that had ingredients previously implicated for lead contamination such as tamarind, chili and salt (FDA, 1993; FDA, 2001; FDA, 2004a; FDA, 2005a, OCR, 2004). Although chocolate candies have not been singled out as having lead contamination, several chocolate candies were also selected. Each candy with its wrapper was placed in individual sealed plastic bags and labeled. Pictures were taken of the wrapper and candy, and all other identifiers on the package were recorded. Each sample was also assigned an identifying code and securely stored at room temperature until it was sent to the laboratory for lead analysis. The chosen laboratory is accredited by the American Industrial Hygiene Association (AIHA) and the Environmental Laboratory Accreditation Program (ELAP) in association with EPA National Lead Laboratory Accreditation Program (NLLAP).

Statistical Analysis

Chi-square calculations for lead values by ingredient (chili, tamarind and salt) were analyzed. Spearman’s Rank Correlation Coefficient was used to determine whether a relationship exists between lead in Tama Roca (n=18) and lead in the wrappers or sticks of this candy.

Calculation of Total Lead

To assess the total micrograms of lead in a serving of candy, the following equation was used: Micrograms (µg) lead= µg/g* (gram) X wt of candy (g)

*Note: µg/kg is converted to µg/g via the equation: µg/kg X 1kg/1000g

For example, candy sample 3AK weighed 28.35 g and had 2200 µg/kg of lead: 2200 µg/kg x 1kg/1000g= 2.2 µg/g x 28.35 g = 62.37 µg lead in the entire piece of candy. For all of the candies collected, the serving size listed on the label is one piece.

Results

Lead levels in the 140 candy samples collected from four counties in Oregon ranged from <80 µg/kg to 2200 µg/kg. Forty five percent (%) (64/142) of samples exceeded 80 µg/kg (analytic reporting limit). Twenty-three (16.1%) had lead levels between 80 to 130 µg/kg; 28 (19.7 %) had lead between 140 and 260 µg/kg; eight (5.6%) had lead between 300 and 460 µg/kg of lead; two candies (1.4%) had lead between 540 and 650 µg/kg; and 3 (2.1%) had lead from 1000 µg/kg to 2200 µg/kg.

Table 1. Lead in Imported Candy in OR (> 80 µg/kg, Reporting Limit) (n=64)

Sample Number Lead
(µg/kg) 		Candy
Description 		Main
Ingredients 		County
3Ab 220† Tamarind fruit roll coated with chili/salt Tamarind, chili, salt Multnomah
3Ac 540† Lollipop with chili powder Chili, salt Multnomah
3Ae 200† Fruit-flavored candy in a plastic tube Chili, salt Multnomah
3Af 190† Candy with hazelnut and strawberry flavor Sugar Multnomah
3Ag 190† Sweet/sour mango powder Chili, salt Multnomah
3Ai 140† Cucumber-flavored lollipops with chili powder Chili, salt Multnomah
3Aj 110† Chili coated lollipop Chili, salt Multnomah
3Ak 2200† Tamarind-flavored candy in a tube Chili, salt Multnomah
3Al 310† Tamarind/mango flavored candy coated spoon Chili, salt Multnomah
3An 240† Mango-flavored lollipop with chili powder Chili, salt Multnomah
3Ao 180† Fruit-flavored soft candy Chili, salt Multnomah
3Ar 650† Candy wrapped in tamale-like corn husk Appears to have chili Multnomah
3Ba 240† Lollipop with a fruit gummi Chocolate, marshmellow Multnomah
3Be 200† Fruit-flavored lollipop with chili powder for dipping Chili, salt Multnomah
3Bi 80 Mango-flavored powder Chili, salt Multnomah
3Bk 170† Fruit-flavored candy in a tube Chili, salt Multnomah
3Bl 180† Fruit-flavored lollipop Chili, salt Multnomah
3Bm 80 Tamarind fruit roll coated with chili/salt Tamarind Multnomah
3Bo 300† Vanilla/hazelnut flavored candy Sugar Multnomah
3Ca 140† Lollipop with a fruit gummi Chocolate, marshmellow Multnomah
3Cg 230† Tamarind-flavored soft candy in a tube Chili, salt Multnomah
3Ch 170† Tamarind pulp in a clear packet Tamarind, chili, salt Multnomah
3Ci 110† Mango-flavored lollipop Chili Multnomah
3Cp 210† Lollipop with a fruit gummi Chocolate, Marshmellow Multnomah
3Da 300† Lollipop with a fruit gummi Chocolate, marshmellow Multnomah
3Db 160† Tamarind fruit roll on a stick coated with chili/salt Tamarind, chili, salt Multnomah
3Dc 100† Mango-flavored fruit roll on a stick coated with chili/salt Tamarind, chili, salt Multnomah
3Di 180† Hot/salty powder Chili, salt Multnomah
3Dj 110† Strawberry-flavored hard candy Sugar Multnomah
3Dk 130† Roasted chicken-shaped lollipop Chili, salt Multnomah
3Dn 360† Dried mango Mango, chili Multnomah
3Dr 180† Chocolate bar Chocolate Multnomah
4Ac 250† Loose in bulk jar: appears coated with chili Unknown Hood River
4Ag 110† Lemon-lime powder Salt Hood River
4Al 180† Fruit-flavored soft candy Sugar Hood River
4Ao 2000† Sweet/sour fruit powder Chili, salt Hood River
4At 300† Watermelon-flavored hard lollipop Chili Hood River
4Bb 460† Lollipop with a fruit gummi Chocolate, marshmellow Hood River
4Bf 190† Strawberry/vanilla flavored soft candy Sugar Hood River
4Bj 400† Fruit-flavored hard lollipop Chili, salt Hood River
4Bo 220† Mango-flavored hard lollipop Chili Hood River
4Bp 1000† Tamarind fruit roll on a stick coated with chili/salt Tamarind, chili, salt Hood River
4Bq 260† Tamarind fruit roll on a stick coated with chili/salt Tamarind, chili, salt Hood River
1Bg 100† Tamarind fruit roll on a stick coated with chili/salt Tamarind, chili, salt Benton
1Ab 150† Chili-coated lollipop Chili, salt Benton
1Ac 150† Fruit-flavored candy coated plastic spoon with chili/fruit sauce Tamarind, chili, salt Benton
1Ba 90 Sweet/sour mango powder Chili, salt Benton
1Bb 80 Mango flavored lollipop Chili, salt Benton
1Bc 120† Fruit flavored lollipop Chili, salt Benton
1Bd 100† Clear packet of tamarind pulp Tamarind, chili, salt Benton
1Be 110† Tamarind fruit roll coated with chili/salt Tamarind, chili, salt Benton
1Bf 80 Mango flavored lollipop Chili, salt Benton
1Bg1 150† Tamarind fruit roll coated with chili/salt Tamarind, chili, salt Benton
1Ca 100† Lollipop with a fruit gummi Chocolate, marshmellow Benton
1Cb 110† Hard candy lollipop Chili, salt Benton
1Cc 90 Sweet/sour powder Chili, salt Benton
1Ce 130† Loose in bulk jar: appears coated with chili Unknown Benton
2Ab 80 Tamarind fruit roll on a stick coated with chili/salt Tamarind, chili, salt Marion
2Ac 80 Tamarind fruit roll on a stick coated with chili/salt Tamarind, chili, salt Marion
2Ad-c 300† Tamarind fruit roll on a stick coated with chili/salt Tamarind, chili, salt Marion
2Ae-c 100† Tamarind fruit roll on a stick coated with chili/salt Tamarind, chili, salt Marion
2Bb-c 140† Tamarind fruit roll on a stick coated with chili/salt Tamarind, chili, salt Marion
2Be-c 130† Tamarind fruit roll on a stick coated with chili/salt Tamarind, chili, salt Marion
2Bf-c 200† Tamarind fruit roll on a stick coated with chili/salt Tamarind, chili, salt Marion
†Meets or exceeds FDA Guideline for candy 100 µg

Table 1 shows lead content, candy descriptions, main ingredients and county collected for the 64 samples that exceeded the analytic reporting limit. Fifty-six out of sixty-four (87.5%) samples met or exceeded FDA’s guideline of 0.1 ppm lead (100 µg) (FDA, 2006c). The most common ingredients in candies exceeding FDA’s guideline were tamarind, chili and salt. However, elevated levels of lead were also detected in candy containing sugar, chocolate and marshmallow.

The Chi-square calculations for lead values by specific ingredient (tamarind, chili or salt) were not found to be significant (df=6, χ2 =1.688). Therefore, no specific ingredient was associated with lead levels in the candies in this study. Spearman’s Rank Correlation Coefficient found a negative correlation (ρ = -0.495; p-value = 0.037 between lead in the candy and sticks. However, there was no significant relationship (ρ = 0.049; p-value = 0.848) between lead in the candy and wrappers.

Table 2. Total Lead in Imported Candy by Weight

Sample
Number 		Serving
Size (g) 		Lead/Piece
(µg) 		Total Lead (µg)
2 Pieces 		Total Lead (µg)
4 Pieces
3Ab 44.79 9.85* 19.7* 39.4*
3Ac 25 13.5* 27* 52*
3Ae 28 5.3 11.2* 22.4*
3Af 15 2.85 5.7 11.4*
3Ag 20 3.8 7.6* 15.2*
3Ai 9 1.26 2.52 5.04
3Aj 19 2.09 4.18 8.36*
3Ak 28.35 62.37* 124.74* 249.48*
3Al 20 6.2* 12.4* 24.8*
3An 9 2.16 4.32 8.64*
3Ao 14 2.52 5.04 10.08*
3Ar None -- -- --
3Ba 45 10.8* 21.6* 43.2*
3Be 22.7 4.54 9.08* 18.16*
3Bi 5 4 8* 16*
3Bk 35 5.95 11.9* 23.8*
3Bl 15 2.7 5.4 10.8*
3Bm 48 3.84 7.68* 15.36*
3Bo 15 4.5 9* 18*
3Ca 45 6.3* 12.6* 25.2*
3Cg 15 3.445 6.9* 13.8*
3Ch 14 2.38 4.76 9.52*
3Ci 35 3.85 7.7* 15.4*
3Cp 24 5.04 10.08* 20.16*
3Da 45 13.5* 27* 52*
3Db 40 6.4* 12.8* 25.6*
3Dc 20 2 4 8*
3Di 15 2.7 5.4 10.8*
3Dj 5 0.55 1.1 2.2
3Dk 14 1.82 3.64 7.28*
3Dn 56.6 20.376* 40.752* 81.504*
3Dr 21 3.78 7.56* 15.12*
4Ac None -- -- --
4Ag 25 2.75 5.5 11*
4Al 23 4.14 8.28* 16.56*
4Ao 20 40* 80* 160*
4At 25 7.5* 15* 30*
4Bb 45 20.7* 41.4* 82.8*
4Bf 15 2.85 5.7 11.4*
4Bj 35 14* 28* 56*
4Bo 35 7.7* 15.4* 30.8*
4Bp 40 40* 80* 160*
4Bq 60 15.6* 31.2* 62.4*
1Bq 40 40* 80* 160*
1Ab 17 2.55 5.10 10.20*
1Ac 43 6.45* 12.90* 25.8*
1Ba 20 1.80 3.60 7.20*
1Bb 25 2.00 4.00 8.00*
1Bc None -- -- --
1Bd None -- -- --
1Be 45 4.95* 9.90* 19.80*
1Bf 16 1.28 2.56 5.12
1Bg1 40 6.00* 12.00* 24.00*
1Ca 45 4.50 9.00* 18.00*
1Cb 25 2.75 5.50 11.00*
1Cc 5 0.45 0.90 1.80
1Ce None -- -- --
2Ab 40 3.2 6.4* 12.8*
2Ac 40 3.2 6.4* 12.8*
2Ad-c 40 12.00* 24.00* 48.00*
2Ae-c 40 4.00 8.00 16.00*
2Bb-c 40 5.60 11.20* 22.40*
2Be-c 40 5.20 10.40* 20.80*
2Bf-c 40 8.00* 16.00* 32.00*
*Meets or exceeds FDA's PTTIL 6µg lead/day

Table 2 depicts calculations of the total lead content per individual serving size of candy (for 1, 2 and 4 pieces). As shown, as the number of lead-tainted candies consumed increases, so do the number of brands that exceed FDA’s PTTIL of 6 µg lead per day. For example, when one piece of candy is consumed, 33% of the samples exceed the FDA’s PTTIL and total lead content ranges between 6 to 62.4 µg lead (up to 10-fold over FDA’s PTTIL). With two candies consumed, 63% of the samples exceed the PTTIL and range from 6.4 to 124.7 µg lead (21 times over FDA’s PTTIL). With four pieces is consumed, 86% of the samples exceed the PTTIL and the range is 7.2 to 249.5 µg lead (41 times over FDA’s PTTIL).

Limited laboratory testing was also done on one brand of candy, wrappers and sticks. This candy is packaged in a bright yellow wrapper that contains a tamarind roll containing chili and salt. Fifty percent (9/18) of the samples met or exceeded the analytic reporting limit with values ranging from 80 µg/kg to 1000 µg/kg. The mean for lead in this candy was 118 µg/kg ± 236 µg/kg. Calculating total lead per piece of candy ranged from 3 to 40 µg with a mean of 10 ug. Lead in candy wrappers ranged from 90 µg/kg to 5900 µg/kg while lead in candy sticks ranged from <80 µg/kg to 96,000 µg/kg. Seven of the sticks had lead levels greater than 1000 µg/kg and four exceeded 10,000 µg/kg.

Discussion

Identifying and eliminating sources of lead is critical in the primary prevention of lead poisoning in children, but also in assessing occupational exposures to lead. Results from this study indicate that lead-tainted candies are available in the four selected counties in OR. Moreover, for workers already being exposed to an occupational source of lead, it is apparent that a food or other source could easily exacerbate the health issues. In this study lead was detected in 45% of candy samples tested with levels ranging from 80 µg/kg lead to 2,200 µg /kg. The health impact upon children is obviously concerning, but also is an important consideration when assessing occupational exposures as well. A worker could be getting a much larger dose of lead exposure when home or extracurricular sources are taken into account.

In past advisories, FDA advised parents to not let their children consume candy from Mexico with chili and/or tamarind (FDA, 2004c; Maxwell and Neumann, 2007). However, in the current study, elevated levels of lead were also detected in candy whose main ingredients were sugar or chocolate. There was no relationship found in this study, with respect to specific ingredient and lead content of candy.

The current study also found that consuming even one piece of some brands of lead-tainted candy can result in a child exceeding FDA’s PTTIL of 6 µg/day up to 41-fold. Importantly, the PTTIL is established for lead in food, and does not consider other sources of lead exposure such as in traditional medicines, lead-tainted soil, paint, or possible occupational exposure from a parent’s clothes or skin.

Another objective of this study was to compare the differences in lead levels between candy, wrapper, and stick of one brand of Mexican imported candy. This brand has been identified by OCR as having unacceptably high levels of lead (OCR, 2004). In this study, lead ranged from below the reporting limit up to 1000 µg/kg. With respect to lead in the candy wrapper, levels ranged from 90 µg/kg to 5900 µg/kg. Importantly, this study is the first to report lead in the candy sticks with levels ranging from 80 ug/kg to 96,000 µg/kg. It is unclear at this time why there is lead in the candy stick. Perhaps during the synthesis of sticks, lead is added as part of the manufacturing process. Given the large variation in lead levels in the sticks, further study is warranted to determine whether this poses a risk to human health. Children (and adults) with mouthing activity often chew on lollipop and candy sticks and it is unknown at this time whether this could be another source of lead exposure.

Statistical analysis using Spearman’s Rank Correlation Coefficient test did not detect a relationship between lead in the candy and lead in the wrappers. The CPSC regulates lead in consumer products including candy wrappers (CPSC, 1998). Products are subject to action by CPSC if the leaded inks contaminate the candy either upon storage or once the candy is opened and eaten. In December 1998, CPSC issued the Codification of Guidance Policy on Lead in Consumer Products (CPSC, 1998). This document directs candy manufacturers to eliminate lead in their products and test for lead periodically. A negative relationship was found between the lead in the candy and the lead in the sticks. Some candy samples had very high levels of lead in the stick with low levels in the candy indicating little or no lead migration occurred.

Given the limited number of candy samples tested in this study, additional sampling and analysis is warranted by FDA and state health departments to ensure the candy supply is safe for children and adults. Clearly as new evidence mounts suggesting there is no safe level of lead in children, federal agencies such s FDA, CPSC and CDC must revise their policies, guidance documents, and enforcement criteria in order to more fully protect all children, including high risk groups.

FDA has been aware for approximately the last twelve years that the issue of lead-tainted, imported candies has been a problem. FDA has issued import alerts, health advisories, and guidelines to try to gain firm control of this issue and to protect children from the insidious adverse effects of lead poisoning (Maxwell and Neumann, 2007). However, this study suggests that lead-tainted candies are still widely available in Oregon.

Some of these same children may also bear burdens of poverty which make them more vulnerable to the harmful effects of lead. Moreover, due to how ubiquitous lead is in the natural environment and from anthropogenic sources, it is imperative to control lead exposures which can be easily prevented, such as from food or industry.

Conclusion

Although the health impacts upon adults from lead over-exposure are not as dire as they are in children, high lead exposure can damage adult organs, cause brain damage and even death. Therefore, when an occupational exposure occurs and is documented with an elevated BLL, it is worthwhile for the ESH professional to consider not just the work-related exposure, but also any home sources that could make the health impacts worse. In addition, it is important to keep studies like this one in mind when training and teaching new occupational health students. There is an art to determining the possible sources of exposure, especially with a substance as universal as lead. Students should be taught to think creatively and even outside the box when conducting investigations. With the high levels of lead found in the food products in this study, it is even possible that an occupational exposure may not be responsible for an elevated BLL in a worker. For the worker’s own health, liability issues in the workplace, and the long-term retention of healthy workers, it is worth considering all the sources of lead exposure when conducting an investigation. In addition, if a home-source of lead exposure is discovered, this important information needs to be communicated to the worker and his or her family, so that appropriate action can be taken to protect any exposed children or other vulnerable members of the household.

References

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Agency for Toxic Substances and Disease Registry. 2006c. “Health effects.” Retrieved on May 8, 2007. http://www.atsdr.cdc.gov/toxprofiles/tp13-c3.pdf

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