A federal agency's role in fulfilling the public health core functions: the childhood lead poisoning prevention program model

CDC's Lead Poisoning Prevention Program: A Long-standing Responsibility and Commitment to Protect Children From Lead Exposure

The Centers for Disease Control and Prevention's (CDC's) Childhood Lead Poisoning Prevention Program (CLPPP) serves as the nation's public health leader and resource on strategies, policies, and practices aimed at preventing lead exposure in young children. CDC supports and advises state and local public health agencies and works with other federal agencies and partners to achieve the Healthy People 2020 objective of eliminating childhood lead exposure as a public health concern. Primary prevention-the removal of lead hazards from the environment before a child is exposed-is the most effective way to ensure that children do not experience the harmful effects of lead exposure. Blood lead screening tests and secondary prevention remain an essential safety net for children who may be exposed to lead. CDC's key programmatic strategy is to strengthen blood lead surveillance by supporting state and local programs to improve blood lead screening test rates, identify high-risk populations, and ensure effective follow-up for children with elevated blood lead levels. Surveillance plays a central role in helping measure the collective progress of federal, state, and local public health agencies in protecting children from lead, as well as enhancing our ability to target population-based interventions for primary prevention to those areas at highest risk. The CDC CLPPP has been at the front line of efforts to protect children from lead exposure and the resulting adverse health effects over the last 3 decades. As we chart our path for the future, we will continue to learn from past successes and challenges, incorporate new evidence and lessons learned, and work closely with federal, state, local, and nonprofit partners, experts in academia, and the community to advance the overarching goal of eliminating lead exposure in children.

The presence and impact of environmental lead in passerine birds along an urban to rural land use gradient

Contamination of wetlands by lead shot and lead fishing weights has generated a tremendous amount of research into the impact of lead poisoning on wildlife. Less well known are the potential threats to wildlife posed by lead contaminants still prevalent in urban environments. Despite a U.S. federal ban on lead-based paint and gasoline in 1978 and 1986, respectively, lead residue is still prevalent at hazardous levels in urban and suburban environments and may present a health concern for people and wildlife, particularly birds. We quantified soil lead content in residential properties across a rural-to-urban land-use gradient in the metropolitan Washington, D.C. area and then assessed the impact of lead contamination on body condition in adult and nestling passerine birds at the same sites. Soil lead concentration was significantly higher in urban sites compared to rural sites. Accordingly, adult and nestling birds captured in urban sites had significantly higher blood lead concentrations than their rural counterparts. However, only gray catbird nestlings exhibited lower body condition as a result of lead contamination. Birds continue to breed in urban habitats despite numerous negative attributes to these environments including light, noise, pedestrian and toxic contaminants, such as lead. These sites often contain habitat that appears suitable for roosting, nesting, and foraging and thus may act as an ecological trap for breeding birds because breeding success is often negatively associated with increasing urbanization. Lead contamination is one more feature of urbanization that birds and other wildlife must face in an increasingly developed world.

Comparison of parental report of blood lead testing in children enrolled in Medicaid with Medicaid claims data and blood lead surveillance reports

The purposes of this study were to identify the congruence of blood lead testing based on parental self-reports with Medicaid claims and blood lead surveillance records, and to determine factors associated with agreement between parental reports of blood lead tests and Medicaid claims or blood lead surveillance records. Data were obtained from a cross-sectional mailed survey of a randomly selected sample of parents of children 1-2 years old enrolled in Medicaid (n=532) and from existing Medicaid claims and blood lead surveillance records. Fifty-six percent of survey respondents reported their child had a blood lead test completed. Of these, only 56% could be confirmed with Medicaid claims/blood lead surveillance data. Logistic regression analysis revealed the odds of blood lead testing per parental report confirmed with Medicaid claims/blood lead surveillance data were 2.6 times greater if the child had > or =3 provider visits, 2.5 times greater if parents reported receiving a reminder about blood lead testing, 2.2 times greater if parents reported receiving information about lead poisoning, 1.6 times greater if residing in an urban county, and 1.5 times greater if the child was more than 2 years old. In conclusion, parents are not always aware if their child had a blood lead test. Information and reminders about blood lead testing should be distributed to parents of young children enrolled in Medicaid and frequently reviewed by healthcare providers.

Needs Assessment and Intervention Strategies to Reduce Lead-Poisoning Risk Among Low-Income Ohio Toddlers

OBJECTIVE

Examine parental receipt of lead-poisoning prevention information and preferred methods of receiving this information.

DESIGN

Cross-sectional mailed survey of parents with children 1-2-year-old-enrolled in Medicaid.

SAMPLE

Respondents (n=532) were primarily female, white, with at least a high school education, and between the ages of 20-30 years.

MEASUREMENTS

Items from the Blood Lead Education and Screening Tool concerning parental receipt of lead-poisoning prevention information, persons with whom parents had discussed lead-poisoning prevention, parental receipt of a reminder about blood lead testing, and parents' preferred methods of obtaining lead-poisoning prevention information.

RESULTS

Most respondents had obtained lead-poisoning prevention information, but only 28% reported receiving a reminder to have their child's blood lead level assessed. Brochures and discussions with health care providers were the preferred methods of obtaining lead-poisoning prevention information. More minority respondents preferred receiving information via videos, billboards, and home visits. Younger parents preferred brochures, billboards, and speaking with someone at the health department or women, infants, and children supplemental nutrition (WIC). Most respondents identified multiple means by which they would like to receive lead-poisoning prevention information.

CONCLUSIONS

Implementation of individual, community, and system-level interventions by public health nurses are needed for comprehensive lead-poisoning prevention education.