Addressing Community Pb Concerns: A Health Screening and Education Approach Across Three States Mary...
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Addressing Community Pb Concerns: A Health Screening and Education Approach Across Three States Mary O. Dereski, Ph.D. Associate Professor Institute of Environmental Health Sciences Department of Family Medicine and Public Health Science Wayne State University Detroit, Michigan
Transcript of Addressing Community Pb Concerns: A Health Screening and Education Approach Across Three States Mary...
Addressing Community Pb Concerns: A Health Screening and Education Approach Across Three States
Mary O. Dereski, Ph.D.Associate ProfessorInstitute of Environmental Health SciencesDepartment of Family Medicine and Public Health ScienceWayne State UniversityDetroit, Michigan
Collaborators
Laurel Berman, PhDAgency for Toxic Substances and Disease Registry (ATSDR)
Sue CasteelRegional Representative or Health Education and Community Involvement Coordinator, ATSDR Region 4
Robert L. ScottHealthy Homes and Lead Poisoning Prevention ProgramMichigan Department of Community Health
Margaret TuftsEnvironmental HealthEpidemiologist
Approximately 250,000 children ages 1-5 in the USA have blood lead levels at or above 10 µg/dL
I will focus on EBLL issues in three high risk cities in 3 states
Omaha, Nebraska
Blue Island,Illinois
Detroit, Michigan
Michigan Lead Story According to the
2010 US Census data: 24.7% of Michigan’s
housing stock was built before 1950
Michigan has 720,314 children under age six residing in the state
Michigan Lead Story For 2011:
151,867 children under six years of age were tested for lead poisoning
The number of children tested has decreased by 3,980 from 2010 to 2011
Testing rate for children under 6 = 21.0%
Testing rate for children one and two years of age = 37.5%
Michigan ranks 6th in the nation for number of children with elevated BLLs
Michigan Lead Story
Michigan
Detroit
Michigan
According to the Detroit Department of health and Wellness Promotion (DHWP), Detroit has consistently accounted for more than 50% of the State’s level of lead poisoning burden
Detroit, MichiganLead Story
Childhood Lead Poisoning Surveillance Report, 2009 EditionDetroit, MichiganCity of Detroit Department of Health and Wellness Promotion
A greater percentage of
incident (newly lead poisoned children) cases
are seen in children one and two years of age
< 1 1 2 3 4 50%
10%
20%
30%
40%
50%
1%
27% 27%
21%
15%
9%
2%
38%
30%
16%
11%
4%
Prevalent EBL CasesIncident EBL Cases
Age (yrs)
Perc
ent
of
Inci
dent
and P
revale
nt
Cases
Detroit, Wayne County, Michigan Comparison (2010)
1Venous sample type only2Prevalence is calculated by dividing the number of children less than 6 years of age with a confirmed EBLL by total number of children less than 6 years of age tested during that year
3Venous ,capillary, and unknown sample types
Detroit, MichiganLead Story
Childhood Lead Poisoning Surveillance Report, 2009 EditionDetroit, MichiganCity of Detroit Department of Health and Wellness Promotion
Detroit Education and Outreach Efforts
Detroit, MichiganLead Story
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
500
1,000
1,500
2,000
2,500
3,000
3,500
0.0
4.0
8.0
12.0
16.0
20.0
2,535
3,214
2,853
2,026 1,977 2,013
1,3941,168
992838
701
10.7 10.5
8.8
6.4 6.0 6.2
4.23.6 3.1 2.6 2.4
Number and Percentage of Children with an Elevated Blood Lead Level
(greater or equal to 10 µg/dl) by YearChildren Less Than Six YearsNumber of EBLL Children Prevalence
Num
ber
of
Childre
n w
/ an E
BLL
Perc
enta
ge o
f C
hildre
n T
este
d w
/ an E
BLL
1Venous sample type only2Prevalence is calculated by dividing the number of children less than 6 years of age with a confirmed EBLL by total number of children less than 6 years of age tested during that year, the number of children tested has remained relatively constantCity of Detroit Department of Health and Wellness Promotion
Omaha, NebraskaLead Story Omaha
Omaha, NebraskaLead Story
Largest Residential Superfund Lead site in United States
Covers approximately 27 square miles of residential downtown Omaha
Approximately 14,117 children live in the Superfund site
Lead smelter operated from early 1870s until 1997
Omaha, NebraskaLead Story Children living in the area were diagnosed
with childhood lead poisoning more frequently than children living in other areas of Omaha
The Environmental Protection Agency (EPA) determined that many residential properties exceeded the 400 ppm soil remediation level
A lead poisoning education prevention program was implemented
The importance of testing children six years of age and younger was emphasized
Omaha, NebraskaLead Story Blood lead screening at health fairs and Head Start
programs was advocated A lead poisoning exhibit was placed at the Omaha
Children’s Museum A children’s health education program was developed in
partnership with the Omaha School District Radio and television childhood lead poisoning advertising
was developed ATSDR working with the Omaha County Health Department
provided funding and technical assistance to develop and implement programs to increase the percentage of children screened living in or near the Omaha Lead Site
The percentage of children with lead poisoning has dropped from 9.1% in 2000 to 1.8% in 2010
SMELTER SHUTDOWN 1997EPA SOIL ACTIONS BEGIN 1999
Elevated Blood Lead Level (EBLL) RatesPercent by Year
Blue Island, IllinoisBlue Island
Heavily industrialized city Collar suburb just south of Chicago Industrial past – metals (lead), older
housing stock 400 underutilized “brownfields” sites
throughout its 4 square miles
Blue Island, IllinoisLead Story
Blue Island, IllinoisLead Story Illinois law requires children 6 months
through 6 years of age who live in high risk areas to be tested for lead poisoning
Blue Island (along with 16 other zip codes outside of the city of Chicago) is considered to be a high risk area, likely due to a high percentage of older housing stock
Before a child can attend a licensed day care center, kindergarten or school the child must be tested for lead
Blue Island Health Fair
Lead Screening and Education
Blue Island, IllinoisLead StoryChildren tested in Blue Island Illinois: 1995-2010
Nu
mb
er
of
Ch
ild
ren
Te
ste
d
Where are we now?• As of January 2012, the CDC’s Advisory Committee on
Childhood Lead Poisoning Prevention (ACCLPP) in the report Low Level Lead Exposure Harms Children: A Renewed Call for Primary Prevention (2012) recommends that the term “blood lead level of concern” should be eliminated from the Center’s for Disease Control (CDC) policies, guidance, and publications.
• In May 2012 the CDC accepted these recommendations
• The ACCLPP recommends primary prevention when a child has a BLL greater than 5 μg/dL rather than action being taken at 10 μg/dL and above
• Currently, approximately 450,000 children across the US have BLLs > 5 μg/dL compared to the 250,000 at 10 and above
Where are we now?Funding for primary prevention does not accompany the “call”
(Primary prevention may include counseling of patients, lead education, environmental investigations, and additional medical monitoring, all focused on preventing exposures to lead.)
Detroit• Until 2011, Detroit was one of the few cities directly funded
by the CDC• The Detroit Department of Health and Wellness Promotion
has lost federal funding and may lose state funding for lead prevention and does not anticipate funding to be restored
• Currently no children are being tested other than in their pediatrician’s office, or through various research studies
• In 2011 about 8% of Detroit’s children tested for lead have BLL between 5 – 9 µg/dL, or 10% > 5 µg/dL
Where do we go from here?
Number of children with BLL of >10 µg/dL was 701 in
2010
REGION 7
Another consideration is children are exposed to Pb from multiple sources, so if their primary source of exposure is imported food, etc. then yard remediation, although a contributing factor, may not have as much impact on childrens BLL as eating contaminated food. If soil is the primary source of exposure, or a large contributor to exposure then we would hopefully see a large reduction in a childs BLL following yard remediation. Hard to say how this will fall out - my thoughts only.
REGION 7
If EPA continues to utilize the IEUBK model it will be interesting to see how soil cleanup levels will be impacted. Utilizing the default values that have been utilized in the past, the cleanup goals will be substantially lowered. The default values may be changed to more closely reflect the conditions at each site - not sure - still a work in progress. Also EPA must address the issue of whether to grandfather the yards that were historically cleaned to 400 ppm.
Where do we go from here? Omaha• Will CDC’s adoption of the BLL of
concern of 5 µg/dL impact regulatory soil levels?
• If soil regulatory cleanup standards for residential properties drops below 400 ppm, can we meet the standard?
REGION 7
Another consideration is children are exposed to Pb from multiple sources, so if their primary source of exposure is imported food, etc. then yard remediation, although a contributing factor, may not have as much impact on childrens BLL as eating contaminated food. If soil is the primary source of exposure, or a large contributor to exposure then we would hopefully see a large reduction in a childs BLL following yard remediation. Hard to say how this will fall out - my thoughts only.
REGION 7
If EPA continues to utilize the IEUBK model it will be interesting to see how soil cleanup levels will be impacted. Utilizing the default values that have been utilized in the past, the cleanup goals will be substantially lowered. The default values may be changed to more closely reflect the conditions at each site - not sure - still a work in progress. Also EPA must address the issue of whether to grandfather the yards that were historically cleaned to 400 ppm.
Where do we go from here? Blue Island• Cook County Department of Public Health does not
screen children for blood lead, leaving primary prevention as the means for testing
• Funding has been cut for local lead programs• Children are screened by pediatricians/primary
care providers only• There are 400 brownfields/underused sites in 4
square miles, some of which may have lead based paint or industrial legacy lead contamination, which adds to the overall burden
Where do we go from here? Many questions are raised with very few
answers. The impact will be substantial. How will this impact Canada? Could collaborations between the U.S.
and other countries like Canada help the efforts as the overall level of funding decreases?
Thank you for your attention!Contact information:
Mary O. Dereski, Ph.D.Associate ProfessorInstitute of Environmental Health SciencesDepartment of Family Medicine and Public Health SciencesWayne State UniversityDetroit, Michigan 48201Phone: 313-577-5597Email: [email protected]
