1. DEPARTMENT OF Building A Healthy New Mexico! DEPARTMENT OF Childhood Lead Poisoning Prevention Program Julianne Vollmer MS Program Coordinator January 26, 2006

2. NEW MEXICO Building A HEALTHY New Mexico! History of Childhood Lead Poisoning Prevention Program 1990 - NM Environment Department and EPA did study of lead in soil near smelters in Socorro, NM. 1990 - NMDOH offered blood lead level (BLL) screening to residents. 1991 - ATSDR Funded study to examine drop in BLLs after cleanup.

3. NEW MEXICO Building A HEALTHY New Mexico! 1993 - NMDOH received CDC grant for childhood lead poisoning prevention. 1993 to 2000 - Lead program funded by CDC. Staff includes program manager, epidemiologists, case mangers/health educators, clerk. April 1993 - NM Administrative Code requires that all BLL test done on NM residents be reported to NMDOH. History

4. NEW MEXICO Building A HEALTHY New Mexico! July 1995 - 600 NM adults surveyed by phone about knowledge, attitudes, and beliefs regarding childhood lead poisoning. 85% knew old homes often painted with lead-based paint. 34% believed parent could tell when child was lead poisoned. 67% unaware of role of diet. 12% had a household member who worked with lead - of these 45% took measures to prevent “take home” lead exposure. History

5. NEW MEXICO Building A HEALTHY New Mexico! Program very active during CDC funding: Lead tests done by NM State Lab Numerous free clinics PSAs and media information compaign Educational outreach NM and Navajo Nation epidemiology reports Lead Poisoning Prevention Task Force History

6. NEW MEXICO Building A HEALTHY New Mexico! Task force works to develop interim screening guidelines and influence legislation. 1998 and 1999 - Task force makes 2 attempts to pass legislation to require NM to certify lead paint inspectors/risk assessors. Attempts fail. Certification still done by EPA region 6. History

7. NEW MEXICO Building A HEALTHY New Mexico! History Spring 1999 – CDC binational study of lead levels in children along the border. Sampled 941 children and 2% had BLLs >10 µg/dL. 2001 - CDC funding no longer available. Scaled down version of Program continues despite loss of staff and revenue.

8. NEW MEXICO Building A HEALTHY New Mexico! Testing drops as state lab no longer doing BLLs and free clinics no longer available. Misconception among health care providers that there “no longer is a lead program in NM.” Environmental health staff increase efforts to revitalize program. History

9. NEW MEXICO Building A HEALTHY New Mexico! September, 2001 - Efforts began to develop data sharing agreement with State Medicaid. December, 2001 - NMDOH requests NM state Medicaid to support filter paper testing and reimburse for cost of test. History

10. NEW MEXICO Building A HEALTHY New Mexico! October, 2002 - MOA signed to share data with State Medicaid on BLL tests on children <6 yrs/age. April, 2003 - State Medicaid approved reimbursement for filter paper testing. History

11. NEW MEXICO Building A HEALTHY New Mexico! June 2003 - Letters sent to all Medicaid providers reminding them of EPSDT requirements for lead testing and informing them of Medicaid reimbursement for filter paper testing. Lead risk questionnaire updated and screening guidelines finalized. History

12. NEW MEXICO Building A HEALTHY New Mexico! 2003 to present - BLL testing of children essentially doubles and equals 1997 screening levels. 2004 - EPA Environmental Education Grant – lead education for teen parents and pregnant teens. Pilot program presented to 6 teachers and 100 students in 2 schools. 3 workshops presented to an additional 15 teachers. History

13. NEW MEXICO Building A HEALTHY New Mexico! May and August 2004 - Issued press releases on lead in Mexican candy along with information on other sources of lead and health effects. December, 2004 - Informal phone survey about consumption of Mexican candy in 30 families with children with EBLLs. Candy consumption very low. History

14. NEW MEXICO Building A HEALTHY New Mexico! March and April, 2005 - Distributed Orange County Register lead posters to schools, WIC clinics, Head Start, and teen parent programs. Gave information for TV, radio and newspaper interviews, always stressing importance of screening, multiple sources, and health effects. History

15. NEW MEXICO Building A HEALTHY New Mexico! January, 2005 - assisted Santa Fe Boys and Girls Club in successful application for EPA grant for lead screening and education. May to June, 2005 - BHO tested lead in soils and indoor in dust Sunland Park, NM January, 2006 - Lead risk questionnaire updated. Working with WIC clinics to have questionnaire distributed to parents History

16. NEW MEXICO Building A HEALTHY New Mexico! Surveillance 1994 to 1998 – 36,244 children tested for lead, 3.2% (1127) had EBLLs. 1999 to 2003 – 16,525 children tested for lead, 1.6% (271) had EBLLs.

17. NEW MEXICO Building A HEALTHY New Mexico! # of children screened % of NM children * <6 years of age screened 7,5749,1417,1636,9155,4514,1793,0202,6912,8763,7596.689 9.05.94.64.53.52.71.91.71.82.34.2 † data for 2005 incomplete based on ~ 11 months * Denominator derived from US census data 6,000 NM Childhood Lead Surveillance Data # of Children Tested 1994 – 2005†

18. NEW MEXICO Building A HEALTHY New Mexico! NM Childhood Lead Surveillance Data % of NM Children* Tested for Lead Who Have EBLLs >10 µg/dL 1994 – 2004 * for children < 6 years of age

19. NEW MEXICO Building A HEALTHY New Mexico! Challenges Limited funding - Program supported by NIOSH money only. Limited staff. Misconception continues that lead poisoning doesn’t happen in NM. Very low testing of Medicaid recipients.

20. NEW MEXICO Building A HEALTHY New Mexico! ~28,00 children born in NM each year. In 2004 ~70% of children aged 2 and under were enrolled in Medicaid in New Mexico. In 2003 and in 2004 only 1% of children aged 2 and under enrolled in Medicaid were tested for lead. Challenges Medicaid

21. NEW MEXICO Building A HEALTHY New Mexico! Successes Increased screening since Medicaid reimbursement for filter paper testing. Increased awareness among teen parents. Recent publicity from lead in Mexican candy seen as opportunity for education of general public.

22. NEW MEXICO Building A HEALTHY New Mexico! Future plans Updated lead risk questionnaire and case management guidelines will be posted on NMDOH web site and mailed to all Medicaid providers along with information on health effects of BLLs <10 µg/dL. Recommendations for testing of pregnant women will be mailed to obstetricians.

23. NEW MEXICO Building A HEALTHY New Mexico! Future Plans Collaborate with IHS and Navajo Nation to provide education on dangers of lead from lead glazes used in pottery making - effects on pregnant women and children. Continue work with Medicaid: Input into letter sent to parents of all Medicaid enrolled children prior to first and second birthday stressing importance of lead screening.

24. NEW MEXICO Building A HEALTHY New Mexico! Continued efforts to seek funding and increase program capacity. Conduct testing in immigrant and migrant population. Expand educational outreach and screening in high risk areas. Future Plans