Implementation of the law: city housing inspections. Before the law was passed, debate about the proposed inspection process centered around two key issues: the cost of the lead inspections, and whether the city inspectors had the capacity to inspect all high-risk rental properties by 2010. To implement the lead law, the city hired and trained four new lead inspectors whose primary responsibility was to perform dust-wipe tests in high-risk units that passed a visual inspection for deteriorated paint. These inspectors, additional administrative needs, and analysis of lead dust wipes cost approximately $600,000 per year.
During discussions of the impacts of the lead law, city staff had estimated that they would inspect approximately 16,500 units each year. A total of 58,177 interior visual inspections were conducted in the first 4 years ()—within 15% of the number predicted by city staff before the law was adopted. As a result, the city was able to inspect nearly all pre-1978 rental units during the first 4 years of implementation.
| Table 1Interior inspections for deteriorated paint (visual inspections). |
During the first 4 years of implementation, 94% of inspected properties passed the interior visual inspections (). This passing rate was much higher than had been anticipated based on prior lead assessments in high-risk areas. For example, in 2004, a community-based project that conducted full risk assessments in 70 homes in a high-risk neighborhood in Rochester found deteriorated leaded paint, lead in soil, or lead dust hazards in 95% of units (
Korfmacher 2008;
O’Fallon and Dearry 2002). As a result of this survey, as well as observations by city and county inspectors, CPLP members expected that Rochester would have much higher rates of housing with deteriorated paint than the national average. The National Survey of Lead and Allergens in Housing, a nationally representative, random sample of 831 housing units surveyed between 1998 and 2000, found only 14% had significantly deteriorated paint (
Jacobs et al. 2002). Given the prior expectations, CPLP members were surprised that the actual visual inspection passing rate was higher than those in the national survey.
The national survey also indicated that lead in dust or soil lead hazards may exist in a significant number of units that pass a visual inspection (
Jacobs et al. 2002). To address this risk, the Rochester law requires that units in high-risk areas that pass an interior visual inspection for deteriorated paint also pass a dust-wipe test. During the first 4 years, 20,555 units were referred for dust-wipe inspections (). A lower percentage of referred units received dust-wipe inspections in the first 2 years than in the second 2 years of implementation (77% vs. 88%;
p < 0.001). According to city officials, the initially slow rate of dust testing was due to administrative challenges in scheduling follow-up visits with landlords. The increased proportion of referred units receiving dust-wipe testing in later years reflects increased efficiency of implementation as city inspectors and landlords adjusted to the requirements of the new law. Because of phased-in implementation (to keep the inspectors’ workload manageable, the city defined a smaller initial high-risk area in year 1), the total number of properties eligible for dust-wipe referrals increased in year 2 when the high-risk area was expanded to its full extent. This explains why the total number of units referred for dust wipes increased (from 3,850 to 5,778) in the second year.
| Table 2Dust-wipe tests in units passing visual inspections in high-risk areas. |
Of the 17,050 units that actually received dust-wipe tests during the first 4 years of implementation, 89% passed. This passage rate exceeded predictions based on the National Survey of Lead and Allergens in Housing, in which only 67% of units with intact paint had no interior dust hazards (
Clickner et al. 2001). Dust-wipe test passing rates significantly increased from years 1 and 2 to years 3 and 4 (85% vs. 91%;
p < 0.001), which may indicate, as suggested by landlord survey and focus group participants, that property owners learned how to repair hazards effectively and to do these repairs before inspections as they gained experience complying with the law. Nonetheless, the dust-wipe testing identified almost 500 units each year (1,921 over the first 4 years of implementation) () that had hazardous levels of lead in household dust, despite passing a visual inspection.
Because the city records exterior inspections by property (each of which may consist of multiple units), exterior violations data were reported separately from interior violations (). A total of 40,889 exterior inspections were conducted in the first 4 years; these inspections resulted in 5,637 citations (86% passing rate) for deteriorated paint or bare soil within 3 ft of the house. No clear pattern of change was observed in passing rates of exterior inspections over time.
| Table 3Visual inspections for exterior lead hazards (deteriorated paint or bare soil). |
Effectiveness of the law: impacts on children’s blood lead levels. Evaluating the impact of the law on children’s lead levels is complex. One approach is to track changes in the extent of lead hazards in children’s homes. Ideally, one might conduct independent risk assessments in homes that had passed the city inspection to determine whether the environments were indeed lead safe. Because past research has correlated dust lead levels with blood lead levels, low dust lead levels in homes that passed the city inspection would suggest that the law is effectively protecting children’s health (
Lanphear et al. 1996,
1998b). However, conducting independent risk assessments of inspected units was prohibitively expensive and logistically challenging—landlords were unlikely to grant access to their properties for a nonmandatory inspection. Instead, CGR compared results of city lead inspections with the results of subsequent inspections conducted by the county health department as part of case management for an EBL child. Although this was uncommon, in several cases county inspectors found hazards in properties that recently had passed city inspections. City and county staff reviewed the specific lead hazards in these cases and found that many of the hazards identified by county inspections were below the
de minimis standard of the city lead law for lead violations. Nonetheless, city staff plan to use these findings for ongoing training of city inspectors. Both the CGR report and the state comptroller’s audit recommend that the city inspections office conduct annual cross-comparisons with health department inspections to identify any patterns of hazards in the homes of EBL children that were not detected during city lead inspections, or treatments that failed to eliminate hazards to children who were subsequently identified as having EBL.
A second approach to assess the effect of the lead law on children’s health is to examine trends in blood lead levels before and after implementation of the law. Before the passage of the law, some CPLP members speculated that a flurry of home renovations (not using lead-safe work practices) would be conducted in an attempt to comply with the law and would generate additional lead-laden dust. Thus, there were concerns that initial implementation might increase children’s lead exposures. It is reassuring to note that the prevalence of EBL among children tested in Rochester declined from 8.3% 2 years before implementation to 4.4% 2 years after implementation (p = 0.027) (). Although it is possible that renovation-related exposures increased during this time period, but were masked by background declines in EBL, such an effect was not reflected in the overall proportion of children with EBL.
| Table 4Children’s blood lead results, City of Rochester, July 2004–June 2008.a |
CGR pursued a third approach based on the fact that Rochester’s lead law applied only to pre-1978 rental housing. In the 2 years before the law’s implementation, 79% (year –2, 1 July 2004–30 June 2005) and 71% (year –1, 1 July 2005–30 June 2005) of positive properties (those the county found to have lead hazards in the course of investigating the housing of an EBL child with blood lead levels > 15 µg/dL) were rentals (), higher than the proportion of homes citywide that were rentals (56% in 2006). This is consistent with research findings that rental housing tends to have more lead hazards than owner-occupied housing (
Jacobs et al. 2002). Because the lead law affects only rental housing, it was expected that the proportion of positive properties that were owner-occupied properties would increase after passage of the lead law. However, the proportion of positive properties that were owner occupied did not change significantly when comparing the 2 years before implementation with the 3 years after (24% vs. 21%;
p = 0.480).
| Table 5Positive properties in City of Rochester, by ownership status, July 2004–June 2009 [n (%)].a |
Another way to examine this effect is to see whether the proportion of EBL children who lived in rental housing declined relative to the proportion of EBL children who lived in owner-occupied homes after implementation of the lead law. Because of data limitations of the county health department’s screening database, CGR was unable to determine the ownership status of all units in which a child with an EBL resides. Therefore, we used a case–control approach to compare a random sample, taken from screening data, of 100 EBL cases and 100 non-EBL cases for each year of implementation. We calculated odds ratios comparing EBL among children living in a rental unit versus an owner-occupied unit. The resulting analysis showed that odds ratios after implementation were lower than in the 2 years before implementation. However, this change was not statistically significant [2.42, 95% confidence interval (CI): 1.69, 3.48 vs. 3.45, 95% CI: 2.07, 5.75; p = 0.276] ().
| Table 6Odds ratios of EBL children residing in rental property versus EBL children living in owned-occupied property, City of Rochester, July 2004–June 2009. |
Costs of compliance: impacts on rental housing market. During discussions leading up to passage of the lead law, one of the most significant areas of concern was the predicted economic impact of the lead law on the housing market in Rochester. Because of low property values and narrow profit margins in Rochester’s rental housing, landlord groups asserted that the additional costs of complying with the lead law would cause widespread abandonment of rental properties. Although it is difficult to separate the impacts of the lead law from other ongoing changes in the housing market, the CGR landlord survey and focus group results suggest that the lead law has not resulted in significant additional costs to landlords nor disruption of the rental housing market.
Results from the CGR telephone survey of landlords of duplex properties contributed to understanding of the law’s impacts on Rochester’s rental housing market. Among the 183 respondents who provided cost of compliance information, 34% said they spent nothing, 37% spent < $1,000, and 30% spent > $1,000 (). The mean per unit cost of repairs was $1,726 (median, $300). Notably, owners of higher-value duplex properties (> $40,000) spent less on repairs than did owners of lower-value duplex properties; over half of the higher-value properties required no or minimal repairs to comply with the new law (55% spent < $250; median, $120).
| Table 7Cost of repairs to comply with lead law [n (%)]. |
Respondents were not asked to distinguish whether they made repairs in anticipation of an inspection or to comply with a citation under the law. However, the fact that so many properties passed visual inspections suggests that most owners undertook necessary repairs before their inspection took place. Although this may have contributed to the higher-than-expected passing rates, one possible drawback to property owners prepping their units before inspection is that workers performing repairs may not have been trained in lead-safe work practices, as required when a unit is cited under the lead law. The U.S. EPA Renovation, Repair and Painting rule (RRP), implemented in April 2010, requires training of all paid workers (including landlords) who disturb paint in pre-1978 dwellings (U.S. EPA 2008). Before implementation of the RRP, there was concern that repair work conducted without lead-safe work practices would result in units that would appear safe, yet have extremely high levels of lead in remaining dust (
Breysse et al. 2007). However, the 88% passing rate for dust-wipe tests conducted in units that passed the visual inspection suggests that preinspection renovation work generally resulted in lead-safe units. Both of these factors suggest that landlords used lead-safe work practices when making repairs.
CGR’s landlord focus groups affirmed that property owners did not find complying with the law prohibitively costly. Most violations were addressed by paint repair and cleaning, although some owners chose to conduct more extensive repairs, like window replacement. City inspectors provided property owners cited under the lead law with information on the city and county HUD-funded Lead Hazard Control grant programs in Rochester. Between 2003 and 2009, these and other local grant programs allocated $45 million to make > 1,200 units in Rochester lead safe (
Office of the New York State Comptroller 2010). Although this was a small percentage of all the pre-1978 housing units in the city, these grant programs provided a resource to owners who needed financial assistance to undertake major repairs.
Before passage of the lead law, property owners also expressed concern about the cost of clearance testing. Under the lead law, owners must hire a private firm to conduct visual and dust-wipe testing after repairs are completed to clear the violation in a cited property. Initial estimates were that clearance testing would cost around $300 per unit. However, city staff reported that the average costs for clearance dropped to < $150 after implementation of the law as more firms became certified to conduct this testing and competition increased.
A separate concern raised by officials from the county Department of Human Services (DHS) was the impact that the law might have on demand for emergency housing. DHS provides emergency housing for a variety of crisis situations, including health and safety hazards. To examine this issue, CGR requested emergency placement data from DHS for 1 year before the law went into effect and for 2 years after. The number of emergency placements for lead contamination remained very low (between 3 and 13 of the approximately 9,000 annual emergency housing requests). According to city and county staff, the impacts of the law on demand for emergency placement may have been limited because
a) many units are inspected and repaired while vacant;
b) the majority of cited units can be repaired without relocating residents; and
c) tenants and landlords prefer private relocation to emergency placement (i.e., staying with friends or relatives or going to a hotel). Overall, it appears that the lead law has not had the negative effects that some landlords predicted it would have on rental housing in Rochester. Indeed, the CGR focus group participants were “enthusiastic about the law and felt that it will help children in the City” (
Boyce et al. 2008).
1 Maria Ayoob,2 and Rebecca Morley3