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From the President: Emerging Issues

 MCH in Epidemiology

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.     

Lead article image new epi column.gifMassachusetts 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.