Childhood Lead Poisoning Prevention

Chicago Department Of Public Health, Chicago IL

Investigators

Abstract

Chicago has historically had a serious lead poisoning problem. This problem stems from[unreadable] the high concentration of older housing units, high content and volume of lead-based paint used[unreadable] to stand up to Chicago's extreme weather conditions, and the high concentration of children[unreadable] living in poorly maintained, low-income rental housing. High soil lead levels resulting from the[unreadable] use of leaded gasoline by the transportation industry, lead-based paint manufacturing and lead[unreadable] smelters also contribute to childhood lead exposures in Chicago. To combat this problem,[unreadable] community advocates and government agencies have worked together to find effective public[unreadable] policy and community level interventions to eliminate childhood lead poisoning.[unreadable] Much attention has been given to the overall decrease in rates of lead poisoning among[unreadable] U.S. children, which is a significant accomplishment for children's health. However, lead[unreadable] poisoning rates in urban communities are still high and pose a serious threat to the health of inner[unreadable] cily children. Chicago, the nation's 3r largest city, and one with an old housing stock, has a[unreadable] serious lead poisoning problem. During 1999-2000, 17.3% of the children tested were found to[unreadable] have an elevated blood level. The estimated number of children with blood lead levels (BLLs)[unreadable] grsater than 10 jLig/dL was 53,355. Although it remains difficult to compare data nationally due[unreadable] to different reporting requirements, the NHANES data from 1999-2000 estimate that 2.2% (or[unreadable] 434,000 children) of the nation's children have elevated blood lead levels. Based on these[unreadable] estimates, over 12% of the nation's lead poisoned children resided in the city of Chicago. The[unreadable] federal strategy to eliminate childhood lead poisoning by 2010 has prioritized the provision of[unreadable] resources to urban areas including Chicago's inner city neighborhoods. The Chicago Blood[unreadable] Lead Surveillance (CBLS) system includes blood lead data, birth registry data, environmental[unreadable] sampling data, medical and environmental management data, Medicaid data, public housing data[unreadable] and Section 8 housing data. The Chicago Childhood Lead Poisoning Prevention Program[unreadable] (CLPPP) and partners have used this data to identify target hazards, develop interventions and[unreadable] monitor Lead Safe Chicago, the citywide plan for eliminating lead poisoning. Lead Safe[unreadable] Chicago and the Chicago CLPPP use data to focus interventions in our high-risk target areas.[unreadable] Chicago took a leadership role by developing the first local plan to eliminate childhood[unreadable] lead poisoning in 2003. The elimination plan entitled Lead Safe Chicago was developed in[unreadable] partnership with a wide representation of stakeholders including health, environmental and[unreadable] housing advocates and governmental agencies. The plan has clear and measurable goals and[unreadable] objectives and is focused around the following four target strategies: (1) Leveraging dollars for[unreadable] making housing lead safe; (2) Working with Property Owners to establish lead safe housing[unreadable] standards; (3) Increasing identification of children at risk for lead exposure; and (4) Putting[unreadable] childhood lead poisoning on decision-makers' radar screen. The Lead Safe Chicago team, under[unreadable] the leadership of the Chicago CLPPP, will continue implementing the Lead Safe Chicago Plan[unreadable] until the elimination objectives are met. Progress towards elimination is monitored quarterly by[unreadable] the Illinois Lead Safe Housing Task Force.[unreadable] The Chicago CLPPP continues efforts to improve blood lead screening for all children[unreadable] aged 6 months to 6 years with a special emphasis on young children aged 0-3 years and children[unreadable] living in the high risk target areas identified in the Lead Safe Chicago plan. The Chicago CLPPP[unreadable] has developed methods to identify high-risk housing based on previous inspection history,[unreadable] Chicago Department of Public Health, CLPPP[unreadable] identification of repeat offenders, data from local housing groups, census data, and on direct[unreadable] database matching. Specifically, the Chicago CLPPP uses the results of the Medicaid match,[unreadable] "WIC match and housing database match to identify high risk children, housing and target areas.[unreadable] The Chicago CLPPP uses this information to identify Medicaid enrolled children who have not[unreadable] been tested and targets direct outreach to these families.[unreadable] The Chicago CLPPP case management activities are comprehensive to assure that EBL[unreadable] children, high-risk children, pregnant women and women of child bearing age are in lead safe[unreadable] housing. Our case management protocols address primary residences, secondary residences[unreadable] including grandparents, daycare providers, schools and any residential environments where[unreadable] children spend more than 6 hours per week. The environmental case management protocol[unreadable] includes the lead risk assessment per state and federal guidelines, XRF testing, dust wipe[unreadable] analysis, visual assessment, clearance testing, the development of a maintenance plan to assure[unreadable] on-going compliance with lead safe housing standards. Risk communication, including lead[unreadable] safe work practices training, for property owners and tenants is a critical component of the[unreadable] Chicago CLPPP process because it teaches owners, tenants and families about the risks[unreadable] associated with the presence of lead-based paint.[unreadable] Repeat offenders are targeted for environmental inspection and stepped-up enforcement.[unreadable] Properties that have multiple lead poisoned children over time are referred from joint[unreadable] enforcement of the lead disclosure rule with USEPA and HUD. These enforcement actions have[unreadable] resulted in several Supplemental Environmental Projects to support primary prevention efforts.[unreadable] The Chicago CLPPP works closely with the Metropolitan Tenants Organization (MTO), the[unreadable] community based agency that operates the city's tenant complaint hot line, to assure that the city[unreadable] ordinance prohibiting retaliatory evictions is enforced and that tenants have access to Legal Aid[unreadable] attorneys to represent them in retaliatory eviction cases.[unreadable] The Chicago CLPPP has a comprehensive primary prevention plan. A central focus of[unreadable] the Lead Safe Chicago plan is to maximize the number of lead safe housing units by targeting[unreadable] high-risk housing before children become poisoned. To achieve this goal, the Chicago CLPPP[unreadable] has a whole building approach which includes identifying high risk buildings, targeting[unreadable] inspections and enforcement and educating property owners on the Chicago Primary Prevention[unreadable] ordinance. The primary prevention strategy includes targeting information through hardware[unreadable] stores to the remodeling and renovation community, providing services to pregnant women and[unreadable] women of child-bearing age at WIC sites, and addressing non-paint lead hazards including[unreadable] candy, toy jewelry and traditional medicines.[unreadable] Lead Safe Chicago and the Chicago CLPPP strategy are built on strong partnerships with[unreadable] key housing, environmental, health and child advocates and agencies. Key partners include the[unreadable] Chicago Housing Authority,, Medicaid, WIC, community-based organizations, lead abatement[unreadable] contractors, hardware stores, tenant's rights groups, landlord groups, the state's Attorney[unreadable] General's Office, lead abatement contractors, the city's refugee program coordinator, and[unreadable] universities.[unreadable] It is important to provide significant resources to the Chicago program because so many[unreadable] al risk children live in Chicago, and because the Chicago CLPPP interventions and policies have[unreadable] proven effective, resulting in a total reduction of 17,000 lead poisoning cases between 1997 and[unreadable] 2003.[unreadable]