Advisory Committee On Childhood Lead Poisoning Prevention Meeting (San Francisco, California on October 15-16, 2002) Minutes

37% of programs do not evaluate zinc intake.

11 programs provide assistance in WIC enrollment.

14 programs conduct follow-up to determine whether WIC benefits were received.

11 programs never refer a child for a formal developmental assessment by a qualified professional. Of the 49 programs that make referrals, the majority are at BLLs which are inconsistent with the recommendations. Case management guidelines do not recommend referral unless the BLL is >20 mg/dL or other factors influence the child’s development. Five programs routinely make referrals when the BLL is 10 mg/dL; eight programs make referrals when the BLL is 15 mg/dL.

18 programs do not consider any risk factors other than BLLs in deciding to evaluate a child, such as prematurity, substance abuse or single parenthood.

8 programs conduct follow-up after case closure to detect additional problems when the child enters school.

8 programs recommend that the primary care physician follow-up the child with surveillance after case closure.

17 programs do not address any further issues with the child after case closure.

27 programs allow case managers to develop written plans in association with care givers to manage a child with a significant EBLL.

19 programs recommend that care givers create barriers to keep children away from obvious sources of EBLL in the home; 41 programs recommend washing hands and toys; 42 programs recommend wet mopping floors; 26 recommend wiping window compartments; 11 recommend leaving shoes at the door; and 7 programs recommend placing floor mats at entryways.

41 programs list management of lead hazards in the home as a top priority.

36 programs believe a child’s age is not a factor in prioritizing environmental assessment.

10 programs do not routinely collect dust wipes as a source of lead dust in the home; 53 programs routinely use XRF, which is far less important than dust wipes.

36 programs always obtain clearance by dust wipes before a child reenters the home; 7 programs almost always obtain clearance.

52 programs never use power sanding equipment to control lead in the home. Since this method is inappropriate, the 8 programs that use power sanding equipment must be educated.

48 programs follow up BLLs of 10-14 mg/dL.

22 programs recommend a complete history and physical for BLLs <20 Unless other risk factors have been identified, this practice is inappropriate according to the case management guidelines.

19 programs routinely test a child for anemia if the BLL is >20 mg/dL.

46 programs do not recommend long-bone x-rays; 50 programs do not recommend urinalyses and kidney function tests.

20 programs recommend that chelation be undertaken for BLLs <45 mg/dL. This practice is inappropriate according to the case management guidelines.

10 programs recommend hospitalization at BLLs <45 mg/dL; 17 programs recommend hospitalization at BLLs 45-69 mg/dL; 9 programs do not recommend hospitalization at any BLL.

41 programs follow up with primary care providers at case initiation; 26 programs submit summaries of initial evaluations to primary care providers; 17 provide primary care providers with case closure reports; 26 programs alert primary care providers to the potential for future problems.

• Develop a more concise and succinct document by decreasing the number of pages from 19 to five. Explain the rationale, briefly describe the context of primary prevention and list recommendations. Move all other text into an appendix.

• Use the case management document as a model and incorporate introductory pages that highlight key points and recommendations for each chapter.
  
  

• Describe the magnitude of childhood lead poisoning in more detail to reach audiences that may not be familiar with this issue. For example, clearly explain why childhood lead poisoning is “a major public health problem” at the beginning of the document. Use more basic terminology such as “prevention of lead poisoning of children who live in older housing” rather than “primary prevention.”

• Cite references, solid research and data needs to support key statements, models and strategies described in the document, such as the HIV Testing Survey that compares prevalence-wide screening data and door-to-door samples. Include epidemiological evidence on EBLLs by region and age of housing to strengthen the rationale for focusing the document on housing as the primary source of lead exposure. Present rigorous evidence on lead dust exposure and other risk factors in children who develop EBLLs to compensate for the lack of data on interventions.

• Explicitly state that variability exists in communities at local, national and international levels and between urban and rural environments. For example, some programs may not view housing as a major problem in lead exposure.

• Outline a strong approach that authorizes entry into lead-contaminated homes and mandates repairs. Place this language in the “Regulatory Infrastructure and Incentives” section. Reference Massachusetts and other states that take civil or criminal actions to enforce compliance with lead-safe housing standards. Add these examples to the living appendix.

• Ensure that ACCLPP’s position on primary prevention is emphasized in the document by listing recommendations on a particular issue at the end of each chapter.

• Acknowledge that primary prevention efforts will differ based on variability among private, public or rental housing stock.

• Recommend that fiscal incentives be provided to property owners who reduce risks by complying with lead-safe housing standards.

• Develop a transparent process to clearly identify homes with lead hazards when a regulatory public health approach is taken.

• Take a strong primary prevention position by advocating the elimination of lead into the environment by industries that can economically and viably make substitutions.

• Clearly identify target audiences, messages, expected outcomes and the most effective delivery methods of the document. For example, target the document to reach legislators who protect children.

• Maintain a narrow focus on housing as the primary source of lead exposure; create a companion document to focus on non-housing sources.

• Recommend that pediatricians be an active component in the primary prevention process when birth certificates are issued or when high-risk housing with children has been identified.

• Cite the recommendation in the case management document that supports temporary relocation of families when a home is being remediated and a child has been identified with an EBLL.

• Obtain CDC’s full endorsement of the document to ensure credibility, support, cooperation and implementation by EPA, HUD and other agencies. For example, ACCLPP could present its primary prevention guidelines to the Federal Interagency Task Force on Children’s Environmental Health.

• Incorporate guidance to empower individuals to identify risk factors and immediately become involved in the primary prevention process.

• Delete “secondary prevention” and “tertiary prevention” throughout the document. Focus on the window of opportunity to prevent lead exposure during a young child’s development.

• Add strong and clear recommendations from ACCLPP about the need for local housing programs and non-HHS agencies to provide adequate resources for primary prevention.

• Ensure that the FY’03 lead poisoning prevention cooperative agreement contains language for CLPPPs to play a leadership role in both primary prevention and overall childhood lead poisoning prevention. Achieve this goal by providing CLPPPs with adequate information to make appropriate decisions and evaluate priorities at the local level.

• Add “health departments” and other appropriate agencies to each reference of CLPPPs in the document.

• Add supporting data to illustrate the cost effectiveness of primary prevention interventions described in the document.

  SpecificComments

  • Page 1: Develop and include a three-page executive summary to highlight the key points of the document for non-technical audiences.

  • Page 3: Review data cited in the second and third paragraphs because this information is not consistent with data previously reported by Dr. David Jacobs of HUD.

  • Page 4: Delete references to the Treatment of Lead-Exposed Children Trial since the study demonstrated no changes in outcome.

  • Page 4: Add “were chelated” after the first phrase in Section II(2) to make a complete sentence.

  • Page 4: Include comparative data to the finding of a ”24% decline in children’s BLLs after paint abatement was completed.”

  • Page 4: Revise the “Rationale for Primary Prevention” section to focus more on the importance of prevention exposure, i.e., longevity of lead in the human body and the inability to reverse damage caused by lead.

  • Page 4: Describe effective strategies to strengthen the “Rationale for Primary Prevention” section. Revise the text to be evidence-based.

  • Page 10: Delete paragraphs 2-5 under the “Options for targeting high-risk families with young children” section. Detailed descriptions of these programs are unnecessary for a primary prevention document; the options can be summarized in one sentence.

  • Page 12: Decrease the “Existence of Comprehensive Secondary Interventions” section from three paragraphs.

  • Page 12: Modify ACCLPP’s recommendation for “HHS and DOA to fund research and demonstration projects” to encourage CDC to immediately undertake this activity in the FY’03 lead poisoning prevention cooperative agreement.

  • Page 12: Add language to more strongly emphasize condition of paint, maintenance, housekeeping and other basic housing factors in the “Development of an Evidence-Based, Cost-Effective Lead Safe Housing Standard” section.

  • Include data in the “Development of an Evidence-Based, Cost-Effective Lead Safe Housing Standard” section to assist CLPPPs or health departments in making a stronger case when requesting resources from other agencies. For example, the information could contrast costs for primary prevention versus treatment of EBLLs.

  • Page 17: Revise the “Collaboration with Multiple Stakeholders” section to be more realistic. CDC can achieve this goal by convening a primary prevention workshop with potential collaborators to discuss interests, issues, lessons learned and best practices of local groups.

  • Other: Add an appendix citing the scientific literature to support the “Rationale for Primary Prevention” section on page 4.

    On behalf of Dr. Richard Jackson, the NCEH Director, Mr. Robert Delaney welcomed ACCLPP members, liaisons and ex officio representatives to the meeting. He emphasized the importance of ACCLPP and recognized its valuable contributions, guidance, efforts and recommendations in preventing childhood lead poisoning. To further contribute to the significant reduction of the childhood lead poisoning burden in the United States, CDC has undertaken collaborative efforts with federal agencies, industry, professional organizations and advocacy groups.
    However, established partnerships must be strengthened to reach special populations of children who remain a major public health concern, i.e., those living in older housing with lead paint and lead-contaminated dust and those who are still at high risk for lead exposure. These partnerships must also be maintained to apply the best science, strengthen current programs and develop new strategies to eliminate childhood lead poisoning as a threat to children in the United States. Childhood lead poisoning will remain a top priority within NCEH. CDC looks forward to its continued collaboration with ACCLPP in significantly contributing to one of the most important public health success stories of the decade.
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    Federal Advisory Committee Act (FACA) Procedures
    Ms. Helen Kuykendall, of the CDC Management Analysis and Services Office (MASO), explained that FACA was enacted on October 6, 1972 under Public Law 92-463 as a system to create and operate advisory committees in the Executive Branch of the federal government. Congress created FACA to enhance accountability of advisory committees to the public; protect against undue influence of special interest groups; and reduce wasteful expenditures of public funds. Advisory committees are defined by FACA as “any committee, board, commission, council, conference, panel or task force established or utilized by the federal government for the purpose of obtaining consensus advice or recommendations on issues or policies.”
    Three types of groups can be chartered under FACA. A discretionary committee is established at the discretion of the agency head; a non-discretionary committee is mandated by legislation or statute; and a presidential committee is created by the President or Congress. Committees subject to FACA are established or controlled by the federal government; have other than full- or part-time federal employees; provide consensus advice; and have a specific purpose, organized structure and fixed membership. “Consensus advice” has not been defined by FACA or the General Services Administration (GSA) Final Rule. For purposes of HHS advisory committees, however, consensus is generally defined as a common viewpoint among members rather than advice from one individual.
    FACA requires advisory committees to have a charter, public access and balanced membership in terms of points of view represented and functions to be performed. Advisory committee meetings must be announced in the Federal Register at least 15 days prior to the proceedings. The public must be allowed to speak or file written statements during these sessions. Detailed minutes must be created and maintained for each advisory committee meeting. The documents must contain the meeting date and location; an attendee list; complete and accurate descriptions of discussions and conclusions; and advice or recommendations provided by the committee. Meeting minutes must be completed and submitted to the CDC Committee Management Office (CMO) within 90 days after the proceedings.
    Verbatim transcripts are also created and maintained for some advisory committees, but this document is not required by FACA and cannot substitute detailed minutes. Working papers, transcripts, drafts and all other materials shared among an advisory committee must be made available for public inspection as long as the group exists. ACCLPP is a discretionary committee chartered to (1) provide advice and guidance to the HHS Secretary, HHS Assistant Secretary for Health (ASH) and CDC Director regarding new scientific knowledge, technological developments and practical implications for childhood lead poisoning prevention efforts; (2) review and regularly report on childhood lead poisoning prevention practices; and (3) recommend improvements in national childhood lead poisoning prevention efforts. MASO is responsible for assisting ACCLPP in conducting its business and meeting FACA objectives.
    ACCLPP is governed by FACA, the GSA Final Rule and departmental and agency policies. FACA requires advisory committee charters to be renewed every two years or the group will be terminated. MASO consults with HHS, GSA and the Office of General Counsel (OGC) to explain the need to continue ACCLPP and describe a plan to ensure fairly balanced membership. Charter renewals must be filed with the GSA Secretariat, standing committees of Congress with legislative jurisdiction over agencies and the Library of Congress. The renewal notice must be published in the Federal Register when filed.
    In addition to the parent advisory committee, subcommittees or workgroups can be established to conduct business. Subcommittees are members from the advisory committee who report to the parent committee and are subject to FACA procedures. Non-members can serve as consultants to subcommittees if additional expertise is needed. Workgroups are two or more members from the parent committee or subcommittee who gather information, conduct research, analyze facts or address an issue on a short-term basis. Workgroups report to the parent committee or subcommittee and are not subject to FACA requirements. However, all workgroup activities must be presented to the parent committee or subcommittee and discussed in an open session.
    Advisory committees are structured with three components. First, the DFO or Executive Secretary supervises day-to-day operations of the advisory committee; approves meeting agendas; attends all committee meetings; and ensures all meeting notices are published in the Federal Register. Second, the chair presides over committee meetings; determines the operation of meetings in conjunction with the DFO; ensures public participation; and certifies the accuracy of meeting minutes. The chair is selected by the agency or members and also serves as a committee member. Third, committee members represent fairly balanced points of view; are appointed as special government employees (SGEs) and must comply with conflict of interest statutes. Members serve overlapping four-year terms up to four years.
    FACA defines an SGE as a private citizen appointed by the agency head, HHS Secretary or President. Appointments are based on an individual’s expertise that will contribute to the objectives of the advisory committee. Members serve with or without compensation for 130 days or less per year. Members are appointed to express personal opinions only, but are held legally accountable for ethical issues and financial interests. Members must complete and update all required appointment papers and financial disclosure forms; review and comply with standards of ethical conduct for employees of the Executive Branch; attend all meetings; and actively contribute to advisory committee discussions, deliberations and recommendations.
    The membership of advisory committees can also contain other individuals. An ex officio is typically a federal employee with full voting rights unless prohibited by statute. ACCLPP ex officios are currently non-voting members, but voting rights will be granted to these members when the charter is renewed in 2003. Liaisons represent a particular organization on an advisory committee and have no voting rights. Special consultants are invited to serve on advisory committees if additional expertise is needed. In terms of FACA management and communications, working relationships are established between the advisory committee and DFO; CMO and DFO; and OGC and CMO. Recommendations of advisory committees are communicated to the CDC Director and eventually forwarded to the HHS Secretary. Annual reports of advisory committees are submitted to Congress by GSA.
    A videotape was presented to further orient the new members on conflict of interest, legal responsibilities of SGEs, financial disclosures and other FACA procedures. Additional information on FACA as well as meeting minutes and annual reports for ACCLPP and other advisory committees can be accessed at www.gsa.gov/committeemanagment. Annual reports outline operating costs, projected expenditures, membership and frequency of meetings. Chapter 9 of the HHS General Administration Manual contains policies governing advisory committees and can be accessed at www.psc.gov/hhsmanuals.html.
    Dr. Meehan confirmed that he would closely collaborate with Dr. Campbell to more effectively communicate, disseminate and implement ACCLPP’s recommendations throughout HHS. ACCLPP guidance is typically submitted to the HHS Secretary and returned to the DFO for a response. With the new process, recommendations will also be forwarded to the CDC Director and HHS ASH. For example, Dr. Meehan plans to telephone the HHS ASH and discuss ACCLPP’s document on targeted screening for young children enrolled in Medicaid. At the invitation of the HHS ASH, Dr. Meehan, an ACCLPP member and a representative from the Centers for Medicare and Medicaid Services will discuss the document in more detail during a face-to-face meeting. In the future, ACCLPP communications will be submitted on CDC letterhead since EEHS recently learned that ACCLPP letterhead is in violation of FACA policies and procedures.
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    Public Comment Period
    A letter from Ms. Renee Robin, the California Director of the Children’s Environmental Health Network, was submitted into the public record. The letter expresses the group’s disappointment and concern that the HHS Secretary overruled CDC’s recommendations for ACCLPP nominees. The document is appended to the minutes as Attachment 1.
    Dr. Charlton announced that a bill was recently passed in California which makes the presence of deteriorated lead-based paint, lead-contaminated dust, lead-contaminated soil and other lead hazards violations of the housing code. Local environmental and health agencies have been authorized to distribute cease and desist orders in relation to these lead hazards. The new law does not specify age of housing. The legislation can be accessed at www.leginfo.ca.gov.
    Dr. Piomelli submitted a letter from Attorney David Schoenbrod into the public record. The document asks ACCLPP to reconsider the definition of “lead poisoning” as childhood BLLs >10 The letter is dated April 24, 1996 and was addressed to Dr. Henry Falk, the ACCLPP Executive Secretary at that time. Dr. Piomelli reported that the letter was never distributed to ACCLPP. The document is appended to the minutes as Attachment 2.
    There being no further discussion, Dr. Campbell adjourned the ACCLPP meeting at 5:15 p.m. on October 15, 2002.
    Update by the Review of Evidence for Effects at Low BLL Workgroup
    Dr. Campbell reconvened the ACCLPP meeting at 9:00 a.m. on October 16, 2002 and opened the floor to the first presenter. Dr. Michael Weitzman, of the University of Rochester, joined the meeting via conference call. Although his term has expired, he will continue to chair the workgroup that was charged by ACCLPP to review existing data on potential adverse effects in children from lead exposure at levels <10 mg/dL. The workgroup has maintained constant communication and was successful in engaging all outside experts who were asked to assist in this effort. The workgroup welcomes input and recommendations from ACCLPP on the process that has been established to review evidence on low BLL effects.
    Dr. Tom Matte of NCEH clarified that neither ACCLPP nor the workgroup is charged to take action on BLLs <10 mg/dL. To date, the workgroup has compiled its membership; identified outside experts to answer scientific questions; and selected Battelle to manage the literature, retrieve data, facilitate logistics, summarize results and support other activities. The workgroup members represent expertise in clinical pediatrics, neuropsychological assessment, environmental epidemiology, lead-related developmental neurotoxicity, biostatistics, quantitative risk assessment and laboratory science. During the literature retrieval process, the workgroup primarily focused on human studies and identified data that included participants with BLLs <10 mg/dL.
    The workgroup agreed that animal studies will not sufficiently answer questions related to dose response at a specific range of BLLs. Evidence the workgroup collected to date measures one or more health outcomes. The initial bibliography was limited to toxicological profiles developed by the Agency for Toxic Substances and Disease Registry, but the database is now being supplemented with additional literature searches and studies that are in press or will soon be published. To fulfill its charge and evaluate dose response, the workgroup has focused on high-relevance articles with a large number of study participants with BLLs <10 mg/dL.
    To date, only a small number of studies have published results that are directly relevant to health effects at BLLs <10 mg/dL. Other data clearly show a large number of children in the population with BLLs <10 mg/dL, but these published reports do not include statistical analyses to differentiate between children with BLLs greater or less than 10 mg/dL. The workgroup will focus on “type A” studies or published data. No plans have yet been made to focus on “type B” studies in which investigators may be able to access raw data. The workgroup will review and classify the quality of data from cross-sectional or cohort studies.
    During the workgroup’s two conference calls in August 2002, several scientific issues were discussed, but not resolved. These challenges include a process to summarize highly relevant evidence; an effective methodology to identify age, secular and seasonal trends of BLLs; and the time-line of the workgroup’s published report or policy recommendations versus activities by a consortium that has been assembled to conduct a pooled re-analysis of raw data from cohort studies and other investigations.
    Both CDC and the National Institute of Environmental Health Sciences are providing funds to support the pooled re-analysis group. Dr. Bruce Lanphear serves as the principal investigator of the consortium; Drs. David Bellinger and Joel Schwartz serve on the group as well. The workgroup will continue to hold monthly conference calls and will also convene a face-to-face meeting in November 2002 to review high-relevance type A articles identified to date. The workgroup hopes to complete an outline of a draft report in February 2003 and then finalize and present the document to ACCLPP in late spring 2003.
    ACCLPP commented on the workgroup’s activities. Dr. Binns was pleased the workgroup is separating studies in which BLLs were measured in very young children versus older cohorts. This approach will be key in answering scientific questions. She suggested that the workgroup advance beyond the development of an ACCLPP report and generate a paper citing current published data on adverse effects at low BLLs. Dr. Matte confirmed that the workgroup is charged with generating an ACCLPP-endorsed product suitable for publication in the peer-reviewed literature.
    In terms of challenges, Dr. Binns encouraged the workgroup to continue its progress in finalizing a summary statement by late spring 2003. The time-line should not be influenced by activities of the pooled re-analysis consortium since this group may not be in a position to publish results for quite some time. On the one hand, several ACCLPP members agreed with Dr. Binns that the workgroup should maintain communication with the pooled re-analysis consortium and be aware of its activities without compromising or delaying the workgroup’s independent effort. This goal can be achieved by inviting members of the pooled re-analysis consortium to present a status report at a future ACCLPP meeting.
    On the other hand, Dr. Hoffman saw the benefit in ACCLPP reviewing data collected by the pooled re-analysis consortium prior to publication. He indicated that some ACCLPP members may be asked to write an editorial or serve as peer reviewers of the pooled re-analysis. Dr. Meehan explained that any ACCLPP member can serve in this capacity so long as views are expressed from an individual rather than committee perspective.
    Dr. Piomelli acknowledged that the workgroup is addressing a controversial issue. He was disturbed that Drs. Bellinger and Schwartz serve on the workgroup, but have published data on adverse health effects at BLLs <20 mg/dL. Some conclusions reached in these studies have been criticized by many experts as “absurd,” “non-scientific” and “unsupported by statistics.” Dr. Piomelli strongly recommended that an individual be appointed to serve on the workgroup who does not believe, a priori, major adverse effects will occur at low BLLs. Four workgroup members are neutral on this issue; two are, a priori, in favor of the finding that adverse effects at BLLs <10 mg/dL are insignificant. He was concerned that if lead poisoning is defined as all children with BLLs <10 mg/dL, the population of children with actual lead poisoning will be forgotten.
    Dr. Matte pointed out that some workgroup members are credible and established investigators with solid scientific credentials and extensive backgrounds in lead developmental neurotoxicity. Other workgroup members bring an innovative perspective to the field. He was confident that the workgroup represents balanced perspectives and will be able to support conclusions. Dr. Meehan added that Dr. David Savitz is a workgroup member who completed a seminal study on electromagnetic fields. In this investigation, Dr. Savitz was extremely objective on another controversial subject. Dr. Harvey clarified that the workgroup is only charged with summarizing and presenting data to ACCLPP. Recommendations on policy issues will be made by ACCLPP rather than the workgroup. No other ACCLPP member expressed concern with the workgroup members.
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    ACCLPP Current Business
    Drs. Campbell and Meehan provided a status report on recent ACCLPP communications. ACCLPP’s August 23, 2002 letterto the HHS Secretary requested assistance in ensuring continued research to identify effective methods for reducing children’s exposure to lead and other environmental hazards. ACCLPP also asked the HHS Secretary to fully support and be actively engaged in a study by the National Academy of Sciences (NAS). This activity will examine ethical issues that may arise while conducting research to eliminate housing-related conditions associated with childhood lead poisoning and other diseases or injuries.
    A member of the NAS expert panel has been invited to attend a future ACCLPP meeting and provide a status report on this activity. Dr. Meehan will follow up with the HHS Secretary’s office to determine the status of a response to ACCLPP’s letter.
    ACCLPP’s September 23, 2002 letterto the HHS Secretary discussed the potential public health problem of lead poisoning among adopted and refugee children. To educate parents of immigrants and adopted children from overseas on the need for lead screening, ACCLPP asked the HHS Secretary to disseminate information to the U.S. Department of State and HHS agencies. To facilitate this process, ACCLPP attached to sample one-page letters that can be distributed to parents. (include info. below in same paragraph)Dr. Meehan reported that a response to the letter by the HHS Executive Secretary is forthcoming. He committed to submitting the letter to CDC’s Division of Quarantine (DQ) to obtain feedback, background data and guidance on effective approaches to address this issue. DQ has responsibility for medical screening of refugees and immigrants.
    ACCLPP’s September 26, 2002 letterto the HHS Secretary contained evidence-based recommendations on targeted lead screening for young children eligible for Medicaid services. (include info. below in same paragraph)
    Dr. Meehan asked ACCLPP to consider effective strategies to bring the recommendations to the attention of CMS. CDC policy staff will review CMS’s original proposal for targeted lead screening as well as the December 2000 Morbidity and Mortality Weekly Report that contains ACCLPP’s commitment to produce a document on this subject. The information will then be presented to CMS in an effort to identify next steps in the process. Dr. Meehan confirmed that he will contact CMS within the next 30 days.
    ACCLPP New Business
    The members suggested several items to be placed on future agendas.
    • Discussion of ACCLPP’s definition of “lead poisoning.”

    • Discussion of ACCLPP’s priorities.

    • Overview by CDC on the 60 CLPPPs and LPPB’s research priorities to ensure children not covered by CLPPPs are not being missed.

    • Discussion or formal review on the impact of ACCLPP’s guidelines and recommendations.

    • An orientation to inform new members on the proper procedure to ask for presentations, respond to requests and select priorities.
    Requests were also made for CDC to provide new members with the following information: the list of topics from which ACCLPP selected its priorities in 2001; a list of current ACCLPP members; and a description of current members and charges of workgroups. Dr. Campbell reported that core activities by the Case Management and Targeted Screening Workgroups are complete. The two workgroups no longer convene meetings since only follow-up activities are outstanding. The Primary Prevention and Evidence on Low BLL Effects Workgroups are active and made presentations during the meeting. Updates from these workgroups will continue to be placed on future agendas until the respective charges have been fulfilled.
    In addition to regular status reports by workgroups, other items are placed on future agendas by suggestions from members. Formal motions that are made and passed by voting members are eventually forwarded to the HHS Secretary. Other agenda items include updates on new data, results and interventions in the childhood lead poisoning prevention field. Dr. Campbell encouraged members to suggest future agenda items at least one month prior to a meeting.
    Public Comment Period
    The Chair opened the floor for public comments; no attendees responded.
    Closing Session
    The 2003 ACCLPP meetings will be held on March 18-19 and October 14-15. EEHS will confirm these dates by circulating an e-mail message to all members.
    There being no further discussion, Dr. Campbell adjourned the ACCLPP meeting at 10:30 a.m. on October 16, 2002.
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