1. 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

2. Collaborators Laurel Berman, PhD Agency for Toxic Substances and Disease Registry (ATSDR) Sue Casteel Regional Representative or Health Education and Community Involvement Coordinator, ATSDR Region 4 Robert L. Scott Healthy Homes and Lead Poisoning Prevention Program Michigan Department of Community Health Margaret Tufts Environmental Health Epidemiologist

3. Approximately 250,000 children ages 1-5 in the USA have blood lead levels at or above 10 µg/dL

4. I will focus on EBLL issues in three high risk cities in 3 states Omaha, Nebraska Blue Island, Illinois Detroit, Michigan

5. 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

6. 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

7. Michigan Lead Story

8. Michigan

9. 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

10. Detroit, Michigan Lead Story Childhood Lead Poisoning Surveillance Report, 2009 Edition Detroit, Michigan City 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

11. Detroit, Wayne County, Michigan Comparison (2010) 1 Venous sample type only 2 Prevalence 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 3 Venous,capillary, and unknown sample types

12. Detroit, Michigan Lead Story Childhood Lead Poisoning Surveillance Report, 2009 Edition Detroit, Michigan City of Detroit Department of Health and Wellness Promotion

13. Detroit Education and Outreach Efforts

14. Detroit, Michigan Lead Story 1 Venous sample type only 2 Prevalence 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 constant City of Detroit Department of Health and Wellness Promotion

15. Omaha, Nebraska Lead Story Omaha

16. Omaha, Nebraska Lead 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

17. Omaha, Nebraska Lead 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

18. Omaha, Nebraska Lead 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

19. SMELTER SHUTDOWN 1997 EPA SOIL ACTIONS BEGIN 1999 Elevated Blood Lead Level (EBLL) Rates Percent by Year

20. Blue Island, Illinois Blue Island

21.  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, Illinois Lead Story

22.  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

23. Blue Island Health Fair

24. Lead Screening and Education

25. Blue Island, Illinois Lead Story Children tested in Blue Island Illinois: 1995-2010 Number of Children Tested

26. 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

27. 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

28. Where do we go from here? Number of children with BLL of >10 µg/dL was 701 in 2010

29. 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?

30. 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

31. 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?

32. Thank you for your attention! Contact information: Mary O. Dereski, Ph.D. Associate Professor Institute of Environmental Health Sciences Department of Family Medicine and Public Health Sciences Wayne State University Detroit, Michigan 48201 Phone: 313-577-5597 Email: m.dereski@wayne.edu