Understanding childhood lead poisoning preventive behaviors: the roles of self-efficacy, subjective norms, and perceived benefits

Contaminated sites and Indigenous peoples in Canada and the United States: A scoping review

Indigenous communities are disproportionately exposed to contaminated sites, and this poses unique challenges as many Indigenous peoples consider land as an integral part of their culture and economy. This scoping review aimed to identify and map information on contaminated sites and Indigenous peoples in Canada and the United States, namely (1) the relationship between contaminated sites and Indigenous peoples and their land and food systems; (2) strategies, challenges, and successes for contaminated sites assessment and management on Indigenous land; and (3) Indigenous leadership and inclusion in contaminated site assessment and management. We followed a PRISMA-ScR (Transparent Reporting of Systematic Reviews and Meta-Analyses-Extension for Scoping Reviews) checklist to collect data that could be categorized into these three objectives. Between October 2021 and July 2023, information from three data streams was retrieved: a systematic literature search; a grey literature search; and federal site data retrieval (Canada's Federal Contaminated Sites Inventory, USEPA's contaminated sites databases, including Superfund). This search yielded 51 peer-reviewed articles, 21 grey literature articles, and 11 404 federal site records, evidencing the contamination of the lands of 875 Indigenous communities and the presence of 440 different contaminants or contaminant groups. The body of information was categorized into three themes within the above objectives: Objective 1: Indigenous communities and geographic patterns; Contaminated sites, sources, and media; Contaminated sites and Indigenous lands; Contaminated sites and Indigenous food systems; Contaminated sites and the health of Indigenous peoples; Objective 2: Site management and classification processes; Health risk assessment; Risk management; Long-term management; and Objective 3: Collaborative research, Collaborative site management; Traditional knowledge and contaminated sites. Results highlighted a need to prioritize holism, efficiency, and Indigenous leadership in site assessment, management, and research, including a focus on community-specific approaches to site assessment and management; a reconceptualization of risks that privileges Indigenous epistemologies; and greater collaboration between stakeholder networks. Integr Environ Assess Manag 2024;20:1306-1329. © 2023 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Perceived Risk and Intentions to Practice Health Protective Behaviors in a Mining-Impacted Region

Effective risk communication strategies are critical to reducing lead exposure in mining-impacted communities. Understanding the strength of the associations between perceived risk and individuals' behavioral intentions to protect their health is important for developing these strategies. We conducted a survey within three communities of northern Idaho, USA (n = 306) in or near a Superfund Megasite with legacy mining contamination. Survey data were used to test a theoretical model based on the Health Belief Model. Respondents had higher intentions to practice health protective behaviors when they perceived the risk of lead contamination as severe and recognized the benefits of practicing health protective behaviors. Women reported higher behavioral intentions than men, but age and mining affiliation were not significantly associated with behavioral intentions. Although managing lead hazards in communities impacted by mining is challenging due to widely distributed contamination, effective health risk messages, paired with remediation, are powerful tools to protect the health and safety of residents.

Effectiveness of a household environmental health intervention delivered by rural public health nurses

OBJECTIVES

Parents need meaningful and actionable information if they are to reduce household environmental health risks to their children. To address this issue, we tested the effectiveness of a multi-risk social/cognitive intervention on rural low-income parents' (1) environmental health self-efficacy and (2) stage of environmental health precautionary adoption.

METHODS

Biomarker (lead, cotinine) and household samples (carbon monoxide, radon, mold/mildew, and drinking water contaminants) were collected from 235 families (399 adults, 441 children) in Montana and Washington states. Families were randomly assigned to intervention or control groups; intervention families received 4 visits from public health nurses who provided tailored information and guidance to parents; controls received usual and customary public health services.

RESULTS

At 3 months, the intervention group had significantly higher scores on (1) all 6 risk-specific self-efficacy subscales (P < .01), (2) general environmental health self-efficacy (P < .001), (3) 5 of 6 risk-specific precaution adoption subscales (P < .05), and (4) general environmental health precaution adoption (P < .001).

CONCLUSIONS

The intervention yielded significant improvements in both outcomes. This evidence supported the need for a policy discussion addressing the added value that broadbased public health nurse interventions might bring to children's environmental health.

Community- and family-level factors influence care-giver choice to screen blood lead levels of children in a mining community

CONTEXT

Bunker Hill, in Kellogg, Idaho, formerly a lead mine (1884-1981) and smelter (1917-1981), is now a Superfund site listed on the Environmental Protection Agency's (EPA) National Priorities List. Lead contamination from the site is widespread due to past smelter discharges to land, water, and air, placing children at risk for both exposure to lead and resultant health effects of lead. Since 1983, the EPA has used child blood lead levels to inform the clean-up standards for the Bunker Hill Superfund site. This study was undertaken to examine factors that have contributed to the significant fall-off in the rates and numbers of children being screened for blood lead in Kellogg (number screened decreased from 195 to 8 from 2002 to 2007). The goal of this research project was to define community- and family-level factors which influence care-giver choice to screen blood lead levels of their children in this environment.

METHODS

This formative research study used mixed methods and was comprised of three research components: (1) preliminary interviews using community-based participatory research methods to define key research questions of relevance to community members, government and NGOs working in relation to the Bunker Hill clean-up; (2) a quantitative analysis of a cross-sectional household survey conducted with adult care-givers about child blood lead screening in Kellogg; and (3) ethnographic community rapid assessment methods formed the in-depth interview process and qualitative analysis.

RESULTS

The survey showed the likelihood of blood lead screening that for children under the age of 18 years increases 34% with each one-year increase in current age of the child (95% CI, 1.08-1.67, p-value=0.009), and decreases 45% with annual household income greater than $10,000 (95% CI, 0.35-0.88, p-value=0.013). Sibling birth order increased the likelihood of blood lead screening by 61% (95% CI, 1.04-2.48, p-value=0.032) for each successive child. Female children were rated by their care-givers as 3.7 times less agitated or easily angered than male children (95% CI, 1.5-8.8, p-value=0.005). Across all levels of interviews, regulators, residents, and non-governmental organization representatives reported that Kellogg's long history as a mining town has continued to influence attitudes and actions of care-givers to access blood lead screening for their children. The mining context has been described as instilling stigmas, parental blame and a sense of shame about lead exposure and resultant health effects.

DISCUSSION

Children under 6 years of age are currently the least likely to have been screened for lead in Kellogg and screening rates decreased in the 2000s. According to most indicators, socio-economic status did not influence the likelihood of a care-giver to screen children's blood lead levels. However, children in homes with an annual income below $10,000 were more likely to have been screened than the rest of the population. Former concerted screening efforts, including outreach, support, follow-up, and financial incentives in the 1980s-1990s to screen children, may have influenced low-income residents. Programmatic outreach for children under 6 years of age in Kellogg should focus on increasing female child and first child blood lead screening, rather than targeting only low-income families, by improving approaches to promotion, implementation and environmental follow-up for child lead screening. Some families have resided in Kellogg for five to six generations, and the long-term mining context influences community values and perceptions of lead exposure and screening for children through a conflicted combination of pride in the mining history, attachment to the past economy that supported the community in juxtaposition to the personalized blame, shame, guilt, and stigma associated with children having high blood lead levels. Health communication and other programs should prioritize methods of reducing parental feelings of blame, shame and guilt, and stigmas associated with the health effects of lead in a way that respects the pride of former mine workers, their families, and the history of the town.

Screening children for elevated blood lead - learnings from the literature

INTRODUCTION

Although it is important that children at risk of developing elevated blood lead receive regular screening, attendance at screening programs is variable. A literature review was undertaken to better understand the factors that affect carers' decisions about whether or not to take their children for blood lead screening.

METHOD

Electronic databases (Medline, EMBASE, CINAHL, Psychinfo) were searched to identify relevant publications, supported by reviewing reference lists of identified articles and searching with internet-based search engines.

RESULTS

Thirty-four published studies dealing with blood lead screening rates were identified, of which only seven papers focused specifically on parent's attitudes to blood lead screening. The barriers to and enablers of screening for elevated blood lead levels appear to be similar to those identified for other screening programs.

DISCUSSION

It is recommended that attendance at screening be routinely monitored, and that where participation is suboptimal further research be undertaken, in close co-operation with affected communities or sub-groups, to determine how best to encourage screening and to protect children from lead. It is important to minimize stigma and to ensure, as far as possible, that practical barriers such as lack of transport do not restrict access to screening programs.