California's Childhood Lead Poisoning Prevention Program

Sequoia Foundation, Berkeley CA

Investigators

Abstract

ABSTRACT: This cooperative agreement will help California (CA) eliminate childhood lead[unreadable] poisoning (LP), define lead burden, and prevent exposure. The CA Childhood Lead Poisoning[unreadable] Prevention Branch (CLPPB) contains two programs that create a unique childhood lead poisoning[unreadable] prevention (CLPP) partnership- a CLPP Program and a Lead Related Construction Program (LRC).[unreadable] The CLPP: tracks exposure; identifies LP children; assures case management; educates on lead risks;[unreadable] and detects and prevents lead hazards. Direct case management is provided by 46 state contracted[unreadable] local CLPP Programs (CLPPPs). Twenty additional compliance contracts focus on correction of[unreadable] lead hazards. LRC is supported by USEPA funds, meets federal Title X requirements, informs work[unreadable] practices, accredits training providers, certifies personnel, and adopts regulatory standards.[unreadable] Need: CAis the most populous state, with 3 million <age 6. Universal laboratory reporting of[unreadable] blood lead levels (BLLs) became mandatory in 2003 and electronic reporting in 2005. In FY 2004-[unreadable] 05, 688,736 BLLs were reported; 4,287 children had an elevated BLL (EBLL), under 1% of those[unreadable] tested. 87% with EBLLs were <age 6. In 2005, counties with the most EBLLs <age 6 were: Los[unreadable] Angeles (LA) 1,092; Fresno 397; San Diego 384; Orange 261; San Bernardino 214; and Alameda[unreadable] 174. % of EBLLs has decreased since universal reporting began, from 1.4% to 0.7% in the first half[unreadable] of 2003 vs 2005. CAMedicaid (Medi-Cal) had 1,303,776 children <age 6 in 2005. Medi-Cal data[unreadable] indicated 42% of 1 and 2 year olds are lead screened, suggesting many EBLLs are unidentified.[unreadable] There are >3 million rural residents; 18% of the rural population is eligible for Medi-Cal vs 14%[unreadable] of the urban. There are 12 million housing units; over 70% built pre 1980 and 2 million pre 1950.[unreadable] 69 % of children <6 years belong to non-White racial/ethnic groups. Hispanics account for[unreadable] under one-half of children <age 6 but 85% of children identified as LP cases. In 2005, 715 children[unreadable] me': the criteria of a new LP "case" (<21 years with a single venous BLL > 20 ug/dL or two BLLs[unreadable] > 15 p.g/dL). Case analyses from 2000-2002 indicate that lead paint exposure was seen in 66-85%,[unreadable] anc. leaded soil exposure in 32-70%, depending on the exposure defined. A minority, 6-14%, did not[unreadable] have these housing-related exposures. 36% of cases reported some non-housing exposure; the most[unreadable] frequent were take-home, home remedies, hobbies, and pottery, all others (eg. candy) totaled 8.8%.[unreadable] Children considered at high risk for lead are: low-income; reside in old housing with deteriorated[unreadable] or recently renovated paint; reside in a locale with increased EBLLS and cases; and of Hispanic[unreadable] ethnicity or refugee status. Further definition of risk is a goal for this cooperative agreement.[unreadable] Capacity: Since 2003, CLPPB has worked with stakeholders to develop a strategic plan for the[unreadable] elimination of LP. The plan's piroximate goal for the next 5 years is for no child <age 6 to have an[unreadable] EBLL. Progress will be evaluated at least twice a year and reviewed with stakeholders. The key[unreadable] outcome indicator will be the decrease in prevalence of EBLLs, with focus on improved surveillance[unreadable] to guide actions. Activities will be modified, to reach desired groups and outcomes.[unreadable] CA implemented a targeted-screening plan, which was adopted as regulations in 2001. The plan[unreadable] targets children <age 6, particularly <3 and at highest risk of LP, as defined above. CLPPPs[unreadable] provide case management, including nursing visits and environmental investigations (Els). Els[unreadable] include comprehensive assessment of paint, dust, soil, water, and other exposures. CLPPPs work[unreadable] closely with their communities and are monitored by progress reports, site visits and case review. In[unreadable] the first six months of 2005, 96% of newly identified LP cases received nursing visits and Els.[unreadable] Our surveillance/ case management system integrates electronic data from CLPPB, local health[unreadable] depiartments, and over 120 laboratories, and transmits data to the CDC. Features include the[unreadable] capacity to: relate multiple addresses and BLLs to individual children; generate notification letters on[unreadable] a new case of lead poisoning; monitor case management; and report number of BLLs and EBLLs by[unreadable] jurisdiction. Linkage to other datasets, such as environmental health tracking, allows functions such[unreadable] as geocoding. CLPPB has methods for measuring screening performance of Medi-Cal providers. In[unreadable] Ap:il 2006, we will migrate to a web-based surveillance system allowing for real-time data sharing with counties. The system will include features, to track lead hazards and enforcement and follows[unreadable] standards consistent with the National Electronic Disease Surveillance System (NEDSS).[unreadable] As a USEPA authorized program, CLPPB has adopted regulations as protective as federal[unreadable] requirements, governing the identification and abatement of lead hazards in housing. We work with[unreadable] the EPA on Special Environmental Programs (SEP) and HUD on Child Health Improvement[unreadable] Programs (CHIP), on issues relating to violations of the 1018 Disclosure Rule. We review our Lead[unreadable] Evaluation and Abatement Database (LEAD), which includes all lead hazard evaluation activities[unreadable] and abatement activities conducted in CA, for addresses identified in 1018 settlement decrees.We[unreadable] partner with the Department of Housing and Community Development (HCD) and ensure that lead[unreadable] issues are incorporated into the State Consolidated Plan. CLPPB, HCD, and advocacy groups[unreadable] achieved legislation, effective 2003, which increased enforcement authority against lead hazards in[unreadable] housing, defining those making a dwelling untenantable. Our manual for Els, includes guidance on[unreadable] lead hazard assessment of secondary properties and protocols for clearance inspections. CLPPB[unreadable] Tit'.e X activities inform the construction industry and assure that lead hazards are safely corrected.[unreadable] CLPPB and CLPPPs educate healthcare providers, families, schools and childcare providers[unreadable] about LP and screening. Materials are in English, Spanish, Chinese, Vietnamese, Hmong and Lao.[unreadable] CLPPB disseminates information about diverse lead sources and works with CA Food and Drug,[unreadable] Attorney General, and CPSC, on other sources. 2005 legislation mandates maximum lead in candy.[unreadable] Numerous partnerships have been developed, including those discussed above, as well as with[unreadable] locd housing agencies, Association of Environmental Contractors, Refugee Health, Border Health,[unreadable] local WIQ Healthy Homes Collaborative, Indian Health, Immunization, other programs providing[unreadable] services to children, schools, child care, Occupational Health, FDA, and advocacy groups. CLPPB[unreadable] has increased data sharing with CA programs, including the Environmental Health Tracking[unreadable] Nerwork, Medi-Cal, and other programs participating in NEDSS activities.[unreadable] Work Plan: In 2006-2011, activities will be implemented that address goals in the areas of[unreadable] eliriination plan, screening/ case management, surveillance, primary prevention and strategic[unreadable] partnerships. These will: 1) implement the CA strategic elimination plan; 2) achieve maximal blood[unreadable] lead testing of high-risk groups currently targeted for screening; 3) define whether the current[unreadable] targeted screening plan is the best model for assessing the risk of lead poisoning or whether the plan[unreadable] needs to be modified; 4) evaluate whether expansion of screening to pregnant women or women of[unreadable] chidbearing age will improve identification of children and populations at risk and result in[unreadable] prevention of fetal and early childhood exposure; 5) achieve a graded management response to the[unreadable] continuum of lead levels in children, providing: preventive anticipatory guidance; treatment if[unreadable] needed; and environmental and support services, including neurodevelopmental; 6) characterize[unreadable] geographic and demographic-specific prevalence of EBLLs in CA and use information to develop[unreadable] program policy, 7) use surveillance and screening data to assess progress in elimination of EBLLs;[unreadable] 8) determine the extent to which lead hazards posed by paint, dust, and soil, and by other identified[unreadable] sources relate to EBLLs in CA; 9) reduce exposure by providing public information on lead[unreadable] exposure from lead-based paint and lead-contaminated dust and soil; 10) reduce exposure to lead[unreadable] ha2ards posed by lead-based paint and lead-contaminated dust and soil, through regulatory and[unreadable] corrective actions; 11) prevent lead hazard exposure through increased use of lead-safe work[unreadable] practices; 12) reduce exposure by providing public information on lead exposure from other[unreadable] sources; 13) reduce exposure to lead hazards from other sources of lead through regulatory and[unreadable] corrective actions; and 14) develop opportunities for integration with other programs.[unreadable] CLPPB will contribute more than matching resources.[unreadable] Evaluation: Every six months we will look at indicators of program progress and impact. Examples[unreadable] include number: of children screened, with EBLLs, receiving appropriate nursing and Els, of[unreadable] housing related prevention activities, and remediations. Barriers will be tracked and addressed.