Lessons from a Primary-Prevention Program for Lead Poisoning among Inner-City Children

By Dugbatey, Kwesi; Croskey, Valda et al. | Journal of Environmental Health, December 2005 | Go to article overview

Lessons from a Primary-Prevention Program for Lead Poisoning among Inner-City Children


Dugbatey, Kwesi, Croskey, Valda, Evans, R. Gregory, Narayan, Gopal, Osamudiamen, Osa-Edoh, Journal of Environmental Health


Introduction

The city of St. Louis has maintained a Childhood Lead Poisoning Prevention Program for over 25 years. Efforts have focused exclusively on the identification of lead-poisoned children and their lead-contaminated environments. Educational efforts, in the form of pamphlets and personal communications, have been provided to families with lead-poisoned children. This strategy, along with the elimination of lead in paint and gasoline, has been effective in reducing extreme levels of childhood lead poisoning. Despite these efforts, however, blood lead levels in St. Louis children younger than six years of age remain some of the highest in the country. The city of St. Louis ranked ninth in the nation for the number of new cases of lead poisoning of >20 [micro]g/dL for 1994. This ranking is against much larger cities such as New York, Philadelphia, and Chicago.

The National Health and Nutrition Examination Surveys (NHANES) has been tracking blood lead levels in the United States through periodic population-based surveys. NHANES III Part 2 (1991-1994) reported a geometric mean blood level of 2.7 [micro]g/dL (Centers for Disease Control & Prevention [CDC], 1997). Surveillance data for 1996 from the City of St. Louis Department of Health and Hospitals reports a geometric mean lead level of 5.6 [micro]g/dL (Weiss, 1997). Lead poisoning prevalence (blood lead [greater than or equal to]10 [micro]g/dL) in St. Louis children under six years of age was 28.5 percent--nearly sevenfold that found by NHANES III Part 2.

Lead levels as low as 10 [micro]g/dL have been shown to affect child development (Bellinger, Leviton, Waternaux, Needleman, & Robinowitz, 1987; Bellinger et al., 1991; Dietrich et al., 1987; Ernhart et al., 1986; Lyngbye, Hansen, Trillingsgaard, Beese, & Grandjean, 1990; Needleman, Schell, Bellinger, Leviton, & Allred, 1990). Adverse effects of lead on intelligence are persistent across socioeconomic strata and different ethnic and racial groups (Dietrich, Berger, Succop, & Hammond, 1993). Pregnant women, fetuses, and children are particularly affected by lead. The Agency for Toxic Substances and Disease Registry (ATSDR) has estimated that 17 percent of all American children have blood lead levels above 15 [micro]g/dL. Seven percent of white children with good socioeconomic conditions have blood lead at these levels, in contrast with 25 percent among poor whites. Poverty is a major contributor to the cycle of lead poisoning; poor and minority children are at higher risk as a result of living conditions, unhealthy behaviors, and poor nutritional status. The estimates of lead poisoning for black children are 25 percent among those with good socioeconomic conditions, compared with 55 percent among poor blacks. As a consequence, more than half of black children of preschool ages are potentially at a disadvantage even before entering school (ATSDR, 1988).

From lead-based paint, indoor dust, soil, and probably contaminated water pipes, children living in poor areas are exposed to lead through ingestion, inhalation, or both. Lead-based paint continues to be a problem in older homes and therefore is the major contributor to lead poisoning through ingestion of paint chips or ingestion of dust and soil contaminated with lead paint. Estimates from the U.S. Department of Housing and Urban Development (HUD) indicate that 3.8 million homes inhabited by children have high levels of lead in dust and lead-based paint in poor condition (HUD, 1990). Evaluation of existing lead education programs shows that the less-than-satisfactory impact of these programs on childhood lead poisoning is not due to lack of effort or education material (Healthcom Project, 1991). On the contrary, a host of traditional educational materials are available in the form of publications, videos, slides, and mass media endeavors. The key problem seems to be that the people for whom these materials are intended do not use them effectively. …

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