The Massachusetts Childhood Lead Poisoning Prevention Program
By Sarah Stone, CDC/CSTE Applied Epidemiology Fellow
Co-authored by Alicia Fraser, Mariya Fishbeyn, Paul Hunter, Susan E. Manning, Sarah Stone, Carolyn Weber
Exposure to lead is a pervasive public health
problem that disproportionately affects racial and ethnic minorities and low
income families. Childhood lead exposure is especially concerning due to the
deleterious neurotoxic effects lead has on cognitive, physical, and behavioral
development. Despite the U.S. ban on household lead-based paint in 1978, and
the phasing out of leaded gasoline in the 1970s - 1980s, lead persists in our
environment. Recent events in Flint, Michigan and Newark, New Jersey have brought
the issue of lead poisoning back into the public spotlight, specifically
lead-contaminated water. Even before these news stories made headlines, lead
poisoning was a major issue for medical and public health practitioners. Lead
exposure in children can occur in a variety of ways, including hand-to-mouth
behaviors leading to ingestion of leaded paint chips, dust, and contaminated
soil. There is no known safe level of lead, and exposure to low levels can be
detrimental to a child’s growth and development. Therefore, preventing
childhood lead exposure and identifying exposure early are paramount in
protecting children’s health and well-being.
In 2012, the CDC updated its 10 µg/dL level of
concern to a reference level of 5 µg/dL. Massachusetts regulations currently
define ‘lead poisoning’ as a blood lead level (BLL) of ≥ 25 µg/dL in a child.
Unlike the CDC reference value, the Massachusetts blood lead poisoning level is
one of strict legal liability for the property owner and triggers mandatory
code enforcement interventions, including inspections and deleading. In fact,
it is one of the first of its kind nationally. Massachusetts offers case
management activities, such as clinical case management, environmental
inspections and community health worker services, at no cost to any child with
a blood lead level ≥10 µg/dL. Massachusetts is currently assessing a reduction
of its regulatory BLL to be more in line with the CDC. Consistent with the CDC,
Massachusetts maintains that no lead exposure is safe for children.
Massachusetts uses its comprehensive universal
screening data to conduct detailed surveillance of children’s BLLs. The Childhood Lead Poisoning Prevention Program
(CLPPP) database receives close to 250,000 blood test results annually. These
data are used to create reports on screening and prevalence rates for each
community in Massachusetts. The data are also used on the Massachusetts Environmental
Public Health Tracking Portal, where users can view maps
and tables down to the census tract level to evaluate trends in BLLs across
time and geography.
As part of its prevention strategies, Massachusetts has also used these data to develop predictive models of risk, enabling targeted outreach in high risk communities. This high risk community algorithm incorporates five years of elevated BLL incidence data, the proportion of homes built prior to 1978, and the proportion of families having incomes below 200% of the poverty threshold to determine communities at higher risk for childhood lead poisoning. These communities are then targeted for more surveillance and prevention activities as well as educational and awareness campaigns, including information about tax credits and financial assistance for low-income homeowners for lead abatement costs.
The best way to eliminate childhood lead poisoning is to target it at its source. The availability of quality surveillance data and analytical capacity help Massachusetts meet that goal. The Massachusetts CLPPP supports a network of community partners who strive to reach the goal of creating a lead safe environment for all children. As current knowledge and recommendations surrounding the long-term harmful effects of low-level lead exposure are incorporated into policies and practices in all sectors of children's health, we will move closer to achieving this goal.