Childrens' touching and mouthing behaviors during outdoor play in urban residential yards were measured using video observations. Descriptions were made of childrens' outdoor residential play environments. Behaviors assessed were used to examine (1) validity of parental responses to questions on childrens' oral behaviors and outdoor play and (2) relationships of mouthing behaviors to blood lead levels (BLLs). Thirty-seven children aged 1–5 years were recruited for 2 h of video recording in their yard and blood lead measurement. Video assessments included hourly rates of hand touches to ground/walking-level surfaces (cement/stone/steel, porch floor/steps, grass, and bare soil) and oral behaviors. Parental questionnaires assessed their child's outdoor activities, behaviors, and home environment. The children were: mean 39 months; 51% male; 89% Hispanic; and 78% Medicaid or uninsured. Twenty-two children had a blood lead measured (mean 6 μg/dl). During taping, all children had access to cement, 92% to grass, 73% to bare soil, and 59% to an open porch. Children had frequent touching and mouthing behaviors observed (median touches/h: touches to surfaces 81; hand-to-mouth area (with and without food) 26; hand-in-mouth 7; and object-in-mouth 17). Blood lead was directly correlated with log-transformed rates of hand-in-mouth (Pearson's correlation, r=0.564, n=22, P=0.006) and object-in-mouth (Pearson's correlation, r=0.482, n=22, P=0.023) behaviors. Parental questionnaire responses did not accurately reflect childrens' observed oral behaviors, play habits, or play environment. These data confirm the direct relationship between hand-to-mouth activities and BLLs and fail to validate parental perceptions of their child's mouthing behaviors or outdoor play environment.
This is a preview of subscription content, access via your institution
Subscribe to Journal
Get full journal access for 1 year
only $19.83 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Tax calculation will be finalised during checkout.
Get time limited or full article access on ReadCube.
All prices are NET prices.
Baghurst P.A., Robertson E.F., McMichael A.J., Vimpani G.V., Wibb N.R., and Roberts R.R. The Port Pirie Cohort Study: lead effects on pregnancy outcome and early childhood development. Neurotoxicology 1987: 8: 395–402.
Binns H.J., Gray K.A., Chen T., et al. Evaluation of landscape coverings to reduce soil lead hazards in urban residential yards: the Safer Yards Project. Environ Res 2004: 96: 127–138.
Binns H.J., LeBailly S.A., Fingar A.R., Saunders S., and for the Pediatric Practice Research Group Evaluation of risk assessment questions used to target blood lead screening in Illinois. Pediatrics 1999: 103: 100–106.
Black K., Shalat S.L., Freeman N.C.G., Jimenez M., Donnelly K.C., and Calvin J.A. Children's mouthing and food-handling behavior in an agricultural community on the US/Mexico border. J Expo Anal Environ Epidemiol 2005: 15: 244–251.
Canfield R.L., Henderson C.R., Cory-Slechta D.A., Cox C., Jusko T.A., and Lanphear B.P. Intellectual impairment in children with blood lead concentrations below 10 μg per deciliter. N Engl J Med 2003: 348: 1517–1526.
CDC, Centers for Disease Control and Prevention. Managing Elevated Blood Lead Levels Among Young Children: Recommendations from the Advisory Committee on Childhood Lead Poisoning Prevention, Chapter 5, Developmental Assessment and Interventions. CDC, Atlanta, 2002, pp. 79–95. Available at www.cdc.gov/nceh/lead/CaseManagement/caseManage_main.htm (accessed 5/15/05).
Cohen Hubal E.A., Sheldon L.S., Burke J.M., et al. Children's exposure assessment: a review of factors influencing children's exposure, and the data available to characterize and assess that exposure. Environ Health Perspect 2000: 108: 475–487.
Dietrich K., Berger O., and Succop P. Lead exposure and the motor developmental status of urban six-year-old children in the Cincinnati Prospective Study. Pediatrics 1993: 91: 301–307.
Fleiss J.L. The Design and Analysis of Clinical Experiments. Wiley, New York, 1985, pp. 17–22.
Freeman N.C.G., Ettinger A., Berry M., and Rhoads G. Hygiene- and food-related behaviors associated with blood lead levels of young children from lead-contaminated homes. J Expo Anal Environ Epidemiol 1997: 7: 103–118.
Freeman N.C., Jimenez M., Reed K.J., et al. Quantitative analysis of children's microactivity patterns: The Minnesota Children's Pesticide Exposure Study. J Expo Anal Environ Epidemiol 2001a: 11: 501–509.
Freeman N.C.G., Lioy P.J., Pellizzari E., et al. Responses to the Region 5 NHEXAS time/activity diary. J Expo Anal Environ Epidemiol 1999: 9: 414–426.
Freeman N.C.G., Sheldon L., Jimenez M., Melnyk L., Pellizzari E., and Berry M. Contribution of children's activities to lead contamination of food. J Expo Anal Environ Epidemiol 2001b: 11: 407–413.
Gallicchio L., Sexton M., and Werner M.L. A comparison of household lead exposure assessment methods in an old, urban community. Environ Res 2002: 89: 50–57.
Jacobs D.E., Friedman W., Clickner R.P., et al. The prevalence of lead-based paint hazards in U.S. housing. Environ Health Perspect 2002: 110: 599–606.
Juberg D.R., Alfano K., Coughlin R.J., and Thompson K.M. An observational study of object mouthing behavior by young children. Pediatrics 2001: 107: 135–142.
Laidlaw M.A.S., Mielke H.W., Filippelli G.M., Johnson D.L., and Gonzales C.R. Seasonality and children's blood lead levels: developing a predictive model using climatic variables and blood lead data from Indianapolis, Indiana, Syracuse, New York, and New Orleans, Louisiana (USA). Environ Health Perspect 2005: 113: 793–800.
Lanphear B.P., Burgoon D.A., Rust S.W., Eberly S., and Galke W. Environmental exposures to lead and urban children's blood lead levels. Environ Res 1998a: 76: 120–130.
Lanphear B.P., Matte T.D., Rogers J., et al. The contribution of lead-contaminated house dust and residential soil to children's blood lead levels: a pooled analysis of 12 epidemiologic studies. Environ Res 1998b: 79: 51–68.
Lanphear B.P., and Roghmann K.J. Pathways of lead exposure in urban children. Environ Res 1997: 74: 67–73.
Lanphear B.P., Weitzman M., Winter N.L., Eberly S., Yakir B., and Tanner M. Lead-contaminated house dust and urban children's blood lead levels. Am J Public Health 1996: 86: 1416–1421.
Mehta S., and Binns H.J. What do parents know about lead poisoning? The Chicago Lead Knowledge Test. Arch Pediatr Adolesc Med 1998: 152: 1213–1218.
Melnyk L.J., Berry M.R., Sheldon L.S., Freeman N.C.G., Pellizzari E.D., and Kinman R.N. Dietary exposure of children in lead-laden environments. J Expo Anal Environ Epidemiol 2000: 10: 723–731.
Mielke H.W., Gonzales C.R., Smith M.K., and Mielke P.W. The urban environment and children's health: soils as an integrator of lead, zinc, and cadmium in New Orleans, Louisiana, USA. Environ Res 1999: 81: 117–129.
Mielke H.W., and Reagan P.L. Soil is an important pathway of human lead exposure. Environ Health Perspect 1998: 106 (Suppl 1): 217–229.
NEWS: The Neighborhood Early Warning System. http://www.newschicago.org (accessed 5/15/05).
Que Hee S.S., Peace B., Clark C.S., Boyle J.R., Bornschein R.L., and Hammond P.B. Evolution of efficient methods to sample lead sources, such as house dust and hand dust, in the homes of children. Environ Res 1985: 38: 77–95.
Reed K.J., Jimenez M., Freeman N.C.G., and Lioy P.J. Quantification of children's hand and mouthing activities through a videotaping methodology. J Expo Anal Environ Epidemiol 1999: 9: 513–520.
Schwab M., McDermott A., and Spengler J.D. Using longitudinal data to understand children's activity patterns in an exposure context: data from the Kanawha County Health Study. Environ Int 1992: 18: 173–189.
Shinn N.J., Bing-Canar J., Cailas M., Peneff N., and Binns H.J. Determination of spatial continuity of soil lead levels in an urban residential neighborhood. Environ Res 2000: 82: 46–52.
Succop P., Bornschein R., Brown K., and Tseng C. An empirical comparison of lead exposure pathway models. Environ Health Perspect 1998: 106 (Suppl 6): 1577–1584.
Succop P.A., Clark S., Chen M., and Galke W. Imputation of data values that are less than a detection limit. J Occup Environ Hyg 2004: 1: 436–441.
US Environmental Protection Agency. Lead Exposure Associated with Renovation and Remodeling Activities: Phase III, Wisconsin Childhood Blood Lead Study. EPA, Washington, DC, 1999 (EPA 747-R-99-002).
US Environmental Protection Agency. Lead; Identification of Dangerous Levels of Lead: Final Rule, Federal Register, 40 CRF Part 745, January 5, 2001.
von Lindern I., Spalinger S., Petroysan V., and von Braun M. Assessing remedial effectiveness through the blood lead: soil/dust lead relationship at the Bunker Hill Superfund Site in the Silver Valley of Idaho. Sci Total Environ 2003: 303: 139–170.
Yiin L.M., Rhoads C.G., and Lioy P.J. Seasonal influences on childhood lead exposure. Environ Health Perspect 2000: 108: 177–182.
Zartarian V.G., Ferguson A.C., and Leckie J.O. Quantified dermal activity data from a four-child pilot field study. J Expo Anal Environ Epidemiol 1997: 7: 543–552.
We thank Mavis Brown, Erie Family Health Center, Chicago, IL, for assistance with community recruitment and follow-up and Edwin H. Chen, PhD, University of Illinois at Chicago, School of Public Health, for statistical review. We also thank Fenner Sutton, BS, Supervisor, Illinois Department of Public Health Blood Lead Testing Laboratory, for his assistance with laboratory proficiency testing information. This project was funded by a grant from the US Department of Housing and Urban Development, Grant ILLHR0067-99. Additional research support was provided by the Society for Pediatric Research and American Pediatric Society in the form of a Medical Student Research Program Grant for Dr. Ko.
Dr. Ko is now with the Department of Preventive Medicine, Stony Brook University, Stony Brook, NY and Columbia University School of Public Health, New York, NY. Mr. Schaefer is now with the Department of Communication Studies, University of Iowa, Iowa City, IA. Ms Vicario is now with Consoer Townsend Envirodyne Engineers Inc., Chicago, IL.
About this article
Cite this article
Ko, S., Schaefer, P., Vicario, C. et al. Relationships of video assessments of touching and mouthing behaviors during outdoor play in urban residential yards to parental perceptions of child behaviors and blood lead levels. J Expo Sci Environ Epidemiol 17, 47–57 (2007). https://doi.org/10.1038/sj.jes.7500519
- lead poisoning
Environmental Monitoring and Assessment (2021)
Age-related changes to environmental exposure: variation in the frequency that young children place hands and objects in their mouths
Journal of Exposure Science & Environmental Epidemiology (2020)
Relationship of Blood Levels of Pb with Cu, Zn, Ca, Mg, Fe, and Hb in Children Aged 0∼6 Years from Wuhan, China
Biological Trace Element Research (2015)
Journal of Immigrant and Minority Health (2010)