Childhood Lead Poisoning Prevention Program

Maine State Dept/Health/Human Servs, Augusta ME

Investigators

Abstract

The state of Maine is committed to the goal of eliminating childhood lead poisoning by[unreadable] the year 2010. Not only is it a Healthy Maine 2010 goal, it is also a provision in Maine law, the[unreadable] Lead Poisoning Control Act, which states "The goal of the State in the area of lead poisoning is[unreadable] to eradicate childhood lead poisoning by the year 2010 through the elimination of potential[unreadable] sources of environmental lead." This statement in Maine law provides the Maine Center for[unreadable] Disease Control and Protection (ME-CDC) with additional leverage in promulgating statutes and[unreadable] regulations intended to achieve this goal.[unreadable] Maine has a number of provisions in state laws that provide the Maine Childhood Lead[unreadable] Poisoning Prevention Program (MCLPPP) with the authority to conduct and enforce[unreadable] environmental investigations; in homes of children with elevated blood lead levels, and protects[unreadable] families from retaliation by property owners. Other provisions in the law require healthcare[unreadable] providers to collect blood lead screening tests on all one-and-two year olds, unless they can[unreadable] demonstrate that the child is not at risk for lead exposure, and mandates that all blood lead[unreadable] spscimens for children under 6 years of age be analyzed exclusively at the state public health[unreadable] laboratory. This last provision provides the program with high quality, comprehensive blood lead[unreadable] testing data.[unreadable] The MCLPPP, operating in the Maine Center for Disease Control and Prevention (MECDC),[unreadable] has been continuously funded by the U.S. Centers for Disease Control and Prevention[unreadable] (CDC) since 1992. In 2004, the program was relocated from the Division of Maternal and Child[unreadable] Health to the Division of Environmental Health and integrated into the Environmental and[unreadable] Occupational Health Program (EOHP). The EOHP is staffed with surveillance and[unreadable] environmental epidemiologists, toxicologists, a database administrator, a comprehensive health[unreadable] planner and a public health physician. The move of MCLPPP into the EOHP has resulted in an[unreadable] enhanced surveillance program including spatial analyses to better identify high risk groups and[unreadable] reinforce the program's emerging focus on primary prevention.[unreadable] Using a statistical model based on the Phase II (1991-1994) data from the Third National[unreadable] Health and Nutrition Examination Survey (NHANES El), CDC calculated that 2700 Maine[unreadable] children aged 1-5 years were expected to have elevated blood lead levels (i.e. > 10 ng/dl),[unreadable] ranking Maine 38th among 50 states. More recent data suggests that the current number of[unreadable] chi dren in Maine with elevated blood lead levels (EBLL) is now approximately 1,000.[unreadable] Maine has seen an ongoing decline in the number of screened children aged < 72 months[unreadable] wit i confirmed EBLL. This decrease occurred despite an increase in screening over the period of[unreadable] 1957-2004. During this time period, there has also been a shift in the distribution of EBLL with a[unreadable] decrease in the relative propoition of EBLL in the higher ranges and concomitant increase in the[unreadable] proportion of EBLL in the lower ranges.[unreadable] Maine is a large state with the lowest population density east of the Mississippi River;[unreadable] fifty-five percent of Maine is considered rural. Maine ranks 36th in per capita income; nineteen[unreadable] percent of Maine children under age 5 were living below the poverty line in 2002, the last year[unreadable] for which data is available. In the 2000 census, Maine was identified as having the highest[unreadable] population of white, non-Hispanic inhabitants. There is a small, but growing, population of[unreadable] refugees and immigrants, primarily in two of Maine's largest cities, Portland and Lewiston.[unreadable] National surveys indicate that residing in housing built prior to 1950 is one of the leading[unreadable] predictors for lead exposure in young children as it often contains some of the highest amounts[unreadable] of lead-based paint. Maine has a high proportion of housing built before 1950 (36%).[unreadable] Approximately half of lead poisoned children identified in Maine reside in single-family private[unreadable] homes, the other half in rental units. Data obtained from environmental investigations conducted[unreadable] 2301-2004 in homes where lead poisoned children reside revealed that sixty percent of lead[unreadable] poisoned children were in homes with recent or ongoing renovation activity with high levels of[unreadable] le ad-contaminated dust.[unreadable] MCLPPP utilized information on Rural-Urban Commuting Areas (RUCA) to compare[unreadable] children and lead exposure risks in rural and urban regions in Maine. The findings suggested that[unreadable] the proportion of pre-1950 housing was slightly lower in rural versus urban areas; the proportion[unreadable] of children aged <72 months below the poverty level was about the same as was the percent of[unreadable] the lead screened population and the percent of the population with EBLL. The conclusion[unreadable] drawn from this comparison was that children in rural areas in Maine are at least as likely to be[unreadable] exposed to lead and to suffer from lead poisoning as their urban counterparts.[unreadable] Maine has been a national leader in examining rural factors affecting childhood[unreadable] lead poisoning. In July 2005, the MCLPPP collaborated with the CDC Childhood Lead[unreadable] Poisoning Prevention Branch to convene a national summit on Childhood Lead Poisoning in[unreadable] Rural States. The attendees developed surveillance, education, case management and primary[unreadable] prevention models for use in rural areas.[unreadable] The MCLPPP convened and continues to facilitate the Lead Elimination Advisory[unreadable] Council of Maine (LEAd-ME), a vibrant and committed group of diverse people from across the[unreadable] state. The LEAd-ME members actively design and pursue strategies to achieve their elimination[unreadable] pl;m objectives, and regularly evaluate progress towards the defined goals.[unreadable] The MCLPPP strives for program sustainability. Funding contributions are obtained from[unreadable] multiple sources, both public and private. Support for primary prevention activities is directed[unreadable] toward two principal objectives: education and remediation.[unreadable] The most significant contribution comes from a legislative bill passed in 2005 that[unreadable] imposes a 25-cent fee per gallon on all paint sold in the state of Maine. This fee, collected at the[unreadable] manufacturer and distributor level, will fund the Lead Poisoning Prevention Fund, established to[unreadable] provide public health education and training resources statewide. The fee is expected to generate[unreadable] approximately $500,000 per year in state revenue. Much of the educational programs will[unreadable] address lead exposures resulting from uncontrolled home renovations. This could immediately[unreadable] decrease the childhood lead poisoning rate in Maine by 50%.[unreadable] Accomplishing the second primary prevention objective, reducing exposures through[unreadable] remediation of lead hazards, is accomplished through federal and private funding for lead hazard[unreadable] control housing work. The Maine State Housing Authority was recently awarded a SI.2 million[unreadable] HLTD grant to provide funding for lead abatement work in single-family homes and multi-unit[unreadable] dwellings that are occupied by young children. Maine does not rely solely on federal funds for its[unreadable] housing remediation work. The Lead Safe Kids Fund is a non-profit group that is part of the[unreadable] national Coalition for Environmentally Safe Communities. With initial seed monies from FfUD,[unreadable] the Lead Safe Kids Fund seeks contributions from private foundations and organizations to fund[unreadable] lead hazard control work in homes throughout Maine. Additionally they are establishing a[unreadable] housing co-op that will provide donated supplies and volunteers to augment the remediation[unreadable] work done by families who have minimal resources but would like to do the work themselves.[unreadable] The MCLPPP has the capacity, the understanding of state needs and the strategic[unreadable] partnerships to reach the state's elimination goal by 2010. With continued funding from the[unreadable] Centers for Disease Control and Prevention, the state of Maine could be one of the first states to[unreadable] virtually eradicate childhood lead poisoning.