Impact of federal housing assistance on children’s blood Lead Levels, NHANES 1999–2016

Background: Lead is toxic for children’s neurodevelopment, and low-income families face higher exposure. Federal housing assistance has been shown to decrease blood lead levels (BLLs), though its impact on children’s BLLs is underexplored. We examined differences in BLLs among assistance-eligible US children aged ≤5 years by housing assistance status and program type. Methods: Using linked 1999–2016 National Health and Nutrition Examination Survey (NHANES) and US Department of Housing and Urban Development records, we compared BLLs of children on housing assistance (n = 557) and children who would receive assistance within two years after NHANES participation (pseudo-waitlist; n = 317). We estimated geometric mean BLLs and adjusted odds ratios for BLLs ≥3.5 µg/dL—Centers for Disease Control and Prevention blood lead reference value—and assessed effect modification by program type, i.e., project-based (public and multifamily income-restricted housing) versus housing choice vouchers. Results: Housing-assisted children had lower geometric mean BLLs (1.58 vs. 2.10 µg/dL) and lower prevalence of BLL ≥3.5 µg/dL (12.8% vs 24.9%) than pseudo-waitlisted children ( P ≤ 0.001). In adjusted models, federal housing assistance had a negative but nonstatistically significant association with BLL ≥3.5 μg/dL (adjusted odds ratio = 0.71; 95% confidence interval = 0.48, 1.05). We also observed effect modification by program type (p interaction = 0.0024): project-based housing (0.46 [0.25, 0.86]) versus housing choice vouchers (1.61 [0.78, 3.33]). Conclusion: Project-based federal housing assistance was associated with lower odds of elevated BLLs among young children, highlighting potential differences in housing quality, management, or enforcement across programs. Strengthening housing quality standards and lead-free enforcement across all federal housing assistance programs is critical to reducing inequities in childhood lead exposure.