To the Editor We read with interest the results of the study of the effect of prenatal residential lead-hazard intervention on residential dust lead loadings, child blood lead concentrations (BLCs), and neurobehavioral outcomes.1 Despite the small number of African American participants, the population most likely to be affected by lead exposure (45 randomized to intervention and 44 randomized to control condition), the effect of the intervention in this small group was large enough that at ages 1 and 2 years, when lead exposure is most likely to result in elevated BLCs and adverse effects, striking reductions in geometric mean BLCs (33.3% and 37.5% at 1 and 2 years; P = .03 and P = .004, respectively) were associated with the intervention. For pediatricians and researchers in inner-city African American communities, anxiety reduction associated with the intervention was an encouraging and interesting finding.1 It is consistent with associations we and others have observed between early-life environmental lead exposure and dysfunction of the subcortical dopaminergic system in animal models.2,3 Dopaminergic hyperactivity is strongly linked to anxiety in both humans and other mammals.4
Beck-Sagué CM, Guilarte TR. Residential Lead-Hazard Interventions, Childhood Anxiety, and Cognitive Impairment. JAMA Pediatr. Published online December 28, 2018. doi:10.1001/jamapediatrics.2018.4710
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