Effectiveness of cleaning and health education in reducing childhood lead poisoning among children residing near superfund sites in Missouri

LEAD POISONING remains single of the major public health point in disputes facing children in the United States today. (1-4) This is particularly pure for children living in urban, low-income communities and in areas with active lead mining and smelting or where lead mining operations have occurr (5-7)

A number of studies have evaluated the effectiveness of various interventions in reducing children's vital current lead levels. The methods used in these studies included mastery of nonintact lead paint, lead dust cleaning, measures to make floors even and cleanable, and replacement of building constitutings However, uncertainty remains regarding the effectiveness of interventions to bring lead hazards and blood lead horizontals It seems clear that interventions that are implemented without appropriate lead hazard mastery methods and protection of occupants can follow in increases in lead dust and vital current lead levels. (8,9)

Lead dust take care ofs to be the primary source of childhood lead exposure; (10) therefore, various interventions have focused upon removing lead dust by using specialized cleaners and educating residents upon how to clean lead dust. The springs of these interventions have been mixed. A review of randomized lead hazard rule trials found no statistically significant differences between clumps that received educational dust ascendency or specialized dust control services and those that did not, although there were significant reductions in life-current lead levels for children with horizontals [less than or equal to] 15 [micro]g/dl. (11) Also, dust removal using high-efficiency particulate air (HEPA) filter vacuuming through specially trained cleaners (12) and relying exclusively upon lead dust cleanings done by the agency of residents (13,14) did not decrease lead dust or vital fluid lead levels significantly. Nevertheless, a certain number of studies suggest that interventions combining multiple processs can be more successful. (15-18) Intensive lead dust cleaning performed by dint of specialized cleaners and residents, in combination with parental education and continuous follow-up abode visits, have resulted in significant decreases in interior lead dust and children's life-blood lead levels. (19-24)

The authors directioned the present study in 2 former lead mining areas in 2 counties upon opposite sides of Missouri: St Francois shire in the east and Jasper shire in the west. The U Environmental Protection Agency (EPA) designates one as well as the other areas as Superfund sites because of the large amounts of lead mining waste. These counties combined have 4434 children below the age of 72 mo in the Superfund affected areas. (25) Prior investigations to evaluate the prevalence of elevated vital fluid lead levels were completed for Jasper shire in 1991 and for St Francois shire in 1996. Of 381 Jasper shire children randomly selected for close attention 14% of those living near the Superfund sites and 0% of sways had blood lead levels greater than 10 [micro]g/dl. (26) In St Francois shire 295 children were evaluated; 17% of investigation participants and 3% of directions had elevated blood lead horizontals (27) Using this prevalence, we estimated that there were 679 children with elevated lead horizontals living in the 2 counties. The resulting attributable risk percentage of 90% quicked the initiation of the intervention research reported here.

Our objective in this application of mind was to determine whether a combination of tailored education, lead dust removal through specially trained cleaners, and family follow-up visits would be more effective than conventional health educational programs in reducing elevated life-current lead levels in children living in or near lead mining hazardous waste sites. We modified way s for tailored education and specialized dwelling cleaning used in prior fortunate trials cited above for application in the research areas.

Method

Children were eligible to participate in the randomized research if they were between 6 and 72 mo of age, had a life-blood lead level between 10 and 20 [micro]g/dl, and had lived in the residence for 6 mo We did not randomize children with life-current lead levels 20 [micro]g/dl or greater; we provided them with all interventions proffered in the study, and they were also eligible for lead and soil abatement of their dwellings and yards. We did not include these children in this evaluation. For Jasper shire there was the additional requirement that households must be below the medium income horizontal for the area. There was no income restriction for children from St Francois shire We located children with elevated vital current lead levels through screenings in health department lead clinics; women infants, and children's clinics; daycare centers; door-to-door screening; and health fairs. We recruited a total of 134 eligible children into the study; 100 participated completely through three quarterly follow-up evaluations.

We randomized eligible children into Standard Care or single of two intervention groups: Tailored Newsletter solitary or Tailored Newsletters and Specialized Cleaning. The Standard Care cluster received one health education session upon lead exposure reduction activities, given by means of a nurse educator; a alphabetic character reporting the results of the environmental lead assessment of the home; and generic educational information in the form of pamphlets produc by means of state and federal agencies. The Tailored Newsletter solitary group received everything that the Standard Care collection received, plus quarterly visits by means of a public health nurse educator and six tailored newsletter upon lead poisoning prevention. The Tailored Newsletter and Specialized Cleaning collection received everything that the Tailored Newsletter single group received, plus quarterly house cleaning performed by means of specially trained cleaners. We used professional cleaning services to bring the amounts of lead-contaminated dust. Contract companies provided the cleaning services. We trained cleaning ship's companys in wet cleaning, carpet shampooing, and HEPA vacuuming protocols.