Strategic Plan to address Childhood Lead Poisoning in Henry

Strategic Plan to Address Childhood Lead Poisoning Knox County, IL Prepared for: Illinois Department of Public Health Childhood Lead Poisoning Prevention Program Prepared by: Knox County Lead Advisory Group June 2005 1 Section 1 – Mission Statement The following mission statement directs the activities carried out under this strategic plan: The Knox County Lead Advisory Group is committed to address the problem of lead exposure in children. We intend to achieve the national Healthy People 2010 goal of eliminating blood lead levels at or above 10 µg/dL in children living in Knox County. 2 Section 2 – Executive Summary The Illinois Department of Public Health created the Illinois Childhood Lead Poisoning Elimination Advisory Council in late 2003. The Council created a strategic plan for decreasing the high number of children diagnosed with lead poisoning. Since then, dedicated groups of professionals, community activists and other interested parties worked together to develop goals, objectives, strategies and targeted activities as part of a five year plan to protect the health of Illinois children. This effort has nine major goals: To improve awareness of childhood lead poisoning among parents, health care providers, the housing industry, elected officials and opinion leaders. To make lead-safe housing a priority in all areas of the state. To provide a mechanism to allow the public to make lead-safe housing choices. To be more aggressive in interventions against unsafe housing. To improve regulatory tools and compliance efforts against housing containing lead. To simplify and improve screening practices for at-risk children. To focus screening efforts on areas of highest concern. To identify children in rural areas at risk for lead poisoning. To provide better data analysis and an effective framework for the evaluation of long-term and short-term outcomes for the implementation of this strategic plan. To achieve these goals, five geographic areas were selected to receive grant funding from the Illinois Department of Public Health’s Childhood Lead Poisoning Prevention Program. These targeted areas are: Springfield, Peoria, Rockford, East St. Louis, and the rural targeted areas, Henry, Knox and Rock Island Counties. The targeted areas were chosen by analyzing the number of children being screened for elevated blood lead levels, the number of children who have been lead poisoned and the amount of pre-1950 housing in the community. A requirement of the grant was to form a Lead Advisory Group to develop a strategic plan to address risk factors attributed to the incidence of lead poisoning within their community. The plan was to include activities to increase education and awareness efforts in the community, increase the number of lead-safe homes, and increase screening rates in the targeted area The strategic planning process began with the recruitment of community resources and stakeholders on to the advisory committee. The committee is comprised of representatives from environmental, housing, health, and community organizations. The group met monthly to discuss lead elimination goals and strategies for Knox County. 3 Knox County Lead Advisory Group Members Alisha Dickerson Child Welfare Advanced Specialist Department of Child and Family Services Doug Gibb Educational Consultant Knox County Regional Office of Education Josh Gibb County Farm Manager Knox County Farm Bureau Dr. Lynn Greeley Pediatrician Galesburg Clinic Amy Finley Community Worker Knox County University of Illinois Extension William Fitch Realtor Mel Foster Real Estate Rita Frakes Health & Nutrition Services West Central Community Services, Inc. Wil Hayes Director of Environmental Health Knox County Health Department Katherine McCrery Public Health Nurse Knox County Health Department Carrie Neff Andrews Director of Health Education and Promotion Knox County Health Department Roy Parkin Community Development Director City of Galesburg Tara Strayer Project Coordinator Knox County Health Department Don Tomlin Executive Director Knox County Housing Authority 4 Section 3 – Scope of the Problem What is lead? Lead is a soft, naturally occurring metal. It can be found in all parts of our environment. Much of the lead in the environment comes from human activities including burning fossil fuels, mining, and manufacturing. Until 1978, lead was used in paint because it allowed the paint to “stick” better onto painted surfaces. Paint with lead in it can stay in very good condition for years if it is undisturbed. It is when the leadbased paint begins to chip and flake off the surface that it is considered a hazard. Most homes built prior to 1950 are assumed to have lead paint on the walls. Though many lead poisonings are caused by a child picking or mouthing areas with chipping and peeling lead-based paint, lead poisonings can also be caused by the following methods: • • • • • • • • • In soil around a home. (Soil can pick up lead from exterior paint, or other sources such as past use of leaded gas in cars.) Household dust. (Dust can pick up lead from deteriorating lead-based paint or from soil tracked into a home.) Drinking water. Older homes may have plumbing with lead or lead solder. At a place of employment. If you work with lead, you could bring it home on your hands or clothes. Old painted toys and furniture. Food and liquids stored in lead crystal or lead-glazed pottery or porcelain. Lead smelters or other industries that release lead into the air. Hobbies that use lead, such as making pottery or stained glass, or refinishing furniture. Folk remedies that contain lead, such as "greta" and "azarcon" used to treat an upset stomach. How Lead Can Affect a Person’s Health Children are more vulnerable to lead poisoning than adults. A child who swallows or inhales lead may develop blood anemia, severe stomachache, muscle weakness, and brain damage. A large amount of lead might get into a child's body if the child ate small pieces of old paint that contained large amounts of lead. Even at much lower levels of exposure, lead can affect a child's mental and physical growth. According to the Illinois Department of Public Health, very high levels lead poisoning can cause learning disabilities, behavior problems, lowered intelligence and mental retardation. At levels of 70 micrograms per deciliter (µg/dL) lead poisoning can cause seizures, coma, and can be fatal to children. Adults can be poisoned as well if they are exposed to large amounts of lead. It is possible for an adult to be poisoned if they are renovating homes that contain lead based paint, participate in hobbies that require working with lead or work in an industry that uses lead. Adults that are exposed to high levels of lead may suffer from difficult pregnancies, other reproductive problems (in men and women), high 2 blood pressure, digestive problems, nerve disorders, memory and concentration problems, and muscle and joint pain. Lead Poisoning is a very serious condition that can be easily prevented by educating families to know what lead is and how it can affect a person’s health. Knowing what activities the family is engaging in that may contain lead can keep a family healthy. Blood Lead Levels When a child is screened for lead poisoning, it can be done by either a venous draw of blood or a capillary test. Venous testing is done by collecting blood from a vein, either in the forearm or hand. A capillary sample is taken by a simple finger prick to collect a very small amount of blood. The venous method is the preferred method for the lead test because the results are considered confirmatory. Using the capillary method can have skewed results if the child’s hand is not washed properly and lead is on their hands. Blood lead levels are measuring using micrograms per deciliter (µg/dL). When a child has an elevated blood lead level, it means that the level of lead in their blood is 10 µg/dL or more. According to health data, having only 10 µg/dL of lead in the blood can cause developmental problems. There is no “normal” level of lead in the blood. Humans have no need for lead in their blood system, but since lead has been present in the environment for so long, it is expected that most everyone has a small amount of lead in their blood, which is not a problem until it reaches the level of 10 µg/dL. Community Description According to the 2000 Census, the population of Knox County is approximately 55,836. Nearly half of Knox County’s zip codes are considered high risk areas for lead poisoning. While the whole county is affected by lead poisoning, the areas at highest risk are: Galesburg, Altona, Delong, Maquon, Oneida, St. Augustine, Victoria, Williamsfield, and Yates City. Evidence from the Centers for Disease Control has shown that elevated blood lead levels in children under six have been falling over the past decade throughout the nation. However, Illinois still has the highest prevalence of childhood lead poisoning. According to statistics obtained by the Illinois Department of Public Health (IDPH) in 2002, Knox County was ranked eighth in a list of top ten counties with the highest prevalence rate of lead poisoning in children age six and younger (excluding the Chicago, East St. Louis, Peoria, Springfield, and Rockford areas.) 3 Knox County Data o Lead Poisoning Data (from 2003 IDPH Lead Poisoning Surveillance Report) Approximately 18% of Knox County’s 4,532 children under six were tested for lead poisoning. • Of those tested, there is a prevalence rate of approximately 8%. Only 26% of 2003 Medicaid children were tested for lead poisoning. • Of these Medicaid children, there is a prevalence rate of approximately 11%. o Housing Data (from 2000 U.S. Census Data) Approximately that 90% of the county’s housing was built before 1978. Approximately 28% of Knox County housing is rental housing. o Poverty Data Approximately 7.7% of Knox County families are in poverty (from 2000 U.S. Census Data). According to the Illinois State Board of Education, in the 2004 – 2005 school year, 46% of students enrolled in Knox County schools are eligible for the free or reduced lunch plan. Explanation of Risk Criteria Lead Screening Data The data above illustrates why Knox County is considered a “high risk” targeted area for the prevention of childhood lead poisoning by the Illinois Department of Public Health. The County’s lead screening data suggests that a major obstacle to eliminating lead poisoning is poor screening rates. With only 18% of the under six population being tested, many of Knox County’s children may be lead poisoned, but they are not being screened. The prevalence rate of 8% is the percentage of children that were tested in 2003 and had elevated blood lead levels. While this number may seem low, it is an indicator that screening rates must be increased to prevent further poisonings in Knox County. Housing Data Knox County’s high prevalence rate can be attributed to the fact that 90% of the county’s housing was built before 1978. Houses built before 1978 are more likely to contain lead-based paint. Housing condition is also a risk factor of lead poisoning, because residents are more likely to renovate an older, run down home than a newer home. Knox County has many residents that buy older, historic homes to raise their families. Residents will often renovate the homes themselves, likely generating lead dust that their families inhale. 4 Approximately 28% of Knox County housing are rental units. Rental units, because of the high turnaround of tenants, can deteriorate faster than a home that is owned. Lead-based paint may chip faster in high traffic, multi-family units and the risk of lead poisoning may remain unseen by landlords until after a child is lead poisoned. Poverty Data Poverty can also contribute to the risk of lead poisoning. In Knox County, 7.7% of families are in poverty according to the 2000 Census. Families and children in poverty are more likely to live in dilapidated housing, participate in the Medicaid program, and are more likely to be part of the Supplemental Nutrition Program for Women, Infants, and Children (WIC). As a result of these populations’ increased risk for lead poisoning; both programs have implemented blood lead screening requirements. Children enrolled in Medicaid are eligible for lead screening at no cost to their families. Health statistics indicate that Medicaid-eligible children represent a greater percentage of lead poisoned children when compared to other income households. One reason for this higher percentage is due to the fact that many low income families reside in older dilapidated homes where exposure to lead bearing substances may be more prevalent. Knox County has only tested 26% of their Medicaid children, yet these children have a much higher prevalence rate at 11%, over double the prevalence rate of the entire population of Knox County children. An indicator of poverty among children is the number of school-aged children who are eligible to receive free or reduced lunches at Knox County schools. During the 2004-2005 school year, approximately 46% of enrolled students were eligible. Some schools in the county have as many as 75% of their students in the free and reduced lunch program. Children enrolled in the free and reduced lunch program are most likely living in older homes that their parents own or rent and should be screened for lead poisoning. 5 Section 4 – Strategic Plan The Knox County Lead Advisory Group’s goals stem from three core areas: o Education and Awareness o Primary Prevention o Screening Education and Awareness Goal I: Objective: Activities: Increase parent and family awareness of lead poisoning and its health effects. Use community resources to get information about lead poisoning to Knox County residents. ○ Use existing newsletters that are sent to families from schools, farm bureau, childcare associations and daycares to educate them regarding lead poisoning prevention tactics. ○ Work with hospitals and family/child services to include lead information in “new mommy” packets. ○ Distribute information in DCFS’ home safety packets. ○ Include lead information in utility bills for countywide distribution. ○ Research area industries and hobbies that may use lead (soldering, stained glass, etc.) and offer information to employees or participants. Goal II: Objective: Activities: Involve the media to cover the lead poisoning problem and spread awareness throughout Knox County. Contact media outlets to feature stories on lead poisoning and continually return to the issue to spread awareness. ○ Use public service announcements in local newspapers, radio, and television. ○ Post lead information on the local public access channel. ○ Purchase radio ads to boost lead awareness and screening. ○ Encourage local newspapers and news stations to publish stories on lead poisoning and the effects it can have on children. 6 Goal III: Objective: Encourage area schools to direct lead poisoning information to parents that may have younger children. Educate parents of school-aged children (that may also have younger children) of the problems lead poisoning can cause in young children and ways to prevent further poisoning. ○ Encourage school nurses to send letters home to parents of children who did not complete the lead assessment with their physicals. ○ Present lead poisoning information to school nurses at annual meetings during the summer. ○ Attend school fairs and “parent night” activities to offer lead poisoning information and promote screening of younger children. ○ Make a “Project Kit” for elementary school teachers to use. School aged children can learn about lead poisoning and have a worksheet to spot hazards in their homes. ○ Organize a coloring contest to make lead awareness calendars (possibly to raise money to help families make their homes lead-safe). Activities: Goal IV: Objective: Activities: Establish relationships with area daycare providers and daycare licensing associations. Increase daycare providers’ and babysitters’ knowledge of lead poisoning risks and hazards. ○ Work with Childcare Resource and Referral Network to develop in-services for day care providers to educate about lead poisoning and insert lead information in quarterly newsletters. ○ Encourage daycares to give parents information about lead poisoning at the time of enrollment. Goal V: Objective: Activities: Establish relationships with area businesses and community resources to increase lead poisoning awareness. Distribute and display information at high traffic areas that will reach a high number of parents and community stakeholders. ○ Display flyers and displays at area grocery stores, focusing on stores that may carry ethnic foods or cater to low-income families. ○ Purchase ad space on buses and billboards. ○ Distribute lead poisoning information at health fairs and community events. ○ Display lead information at area home shows, farm and agricultural events, and children’s events. 7 ○ Contact banks to offer lead information to those applying for home mortgages and work with banks to offer a lower interest rate to those abating lead. ○ Meet with local legislators to make them aware of the childhood lead poisoning problem in Knox County. ○ Purchase home lead test kits to sell or give away at the health department. Goal VI: Objective: Activities: Increase the number people preparing their home to be lead-safe prior to starting a family. Focus more lead education and awareness to young homebuyers and those who have not yet started a family. ○ Display lead information in OB/GYN offices to young women and those who are not yet mothers. ○ Get lead information in “preparing to be a mom” packets at physicians offices. ○ Encourage banks to offer lead information to new homeowners and those applying for mortgages. ○ Educate new homeowners and soon-to-be parents through presentations and displays regarding the importance of having a lead safe home and how cost effective it would be by starting renovations sooner than later. Information can be displayed at home improvement stores, available at Lamaze classes, and young child fairs. ○ Contact local home inspectors, requesting that lead information be distributed at time of inspection. Primary Prevention Goal I: Objective: Activities: Increase resources available to families who cannot afford full abatement of lead in their home. Work with area organizations to create and distribute information about inexpensive prevention techniques and possible funding for lead abatement. ○ Research grants available for homeowners to ease the financial burden of making their home lead safe. ○ Educate families on how to live safely with lead in the home. ○ Design pamphlets that show inexpensive ways to prevent further poisonings in the home by using wet scraping and cleaning techniques, using duct tape, and repainting. ○ Find area contractors that are licensed to do lead abatement. ○ Develop a walkthrough video, pointing out possible lead hazards and what families can do to protect children from lead. 8 Goal II: Objective: Activities: Increase realtor and homebuyer awareness of the Real Estate Disclosure Law and childhood lead poisoning. Establish partnerships with area realtor associations and realtor certification classes to increase lead awareness. ○ Present lead information at association meetings. ○ Have pamphlets available to homebuyers at realty firms to further explain lead poisoning in addition to the EPA pamphlet that is already distributed. ○ Encourage families that are preparing to buy a home to spend the extra money for a lead inspection by offering information through banks and realtors. ○ Compile a list of area lead inspectors. Goal III: Objective: Activities: Increase the information available to landlords and tenants concerning their rights and responsibilities when it comes to lead. Establish relationships with area landlords and tenant groups in Knox County to promote lead education to both groups. ○ Distribute educational pamphlets and present information to landlords and tenants about lead poisoning through community services that cater to families. ○ Work with IDPH lawyers to develop information on legal steps tenants can take if landlord is not abating the lead. Similar pamphlets could be made to inform landlords what are the legal implications of lead poisonings in their properties. Goal IV: Objective: Activities: Increase the amount of lead information available at area hardware stores. Encourage stores to provide more information and train their employees to offer correct abatement advice. ○ Encourage home stores to offer lead education in their painting and renovation classes. If enough interest is generated, a class on making homes lead-safe could be offered. ○ Display lead information with the painting supplies at home improvement stores and train employees to offer information at paint product point of sale. ○ Contact home stores to discuss if lead information could be presented to their employees at staff meetings. ○ Request that home improvement stores place information regarding safe removal of old paint next to sanders and heat guns. 9 Screening Goal I: Objective: Activities: Increase the number of lead screenings in children between the ages of 6 months to 6 years. Work with area physicians and clinics to stress the importance of screening for lead poisoning and the legal requirements regarding screening. ○ Have pamphlets and information available at pediatrician’s offices, family practice offices, and walk-in clinics. ○ Distribute lead posters to area clinics to display in pediatrician exam rooms. ○ Visit physicians’ offices at least yearly encourage screening before school physicals begin. ○ Contact area medical societies to arrange a lead poisoning presentation with Dr. Helen Binns. ○ Encourage mothers who come to the health department for any service to have their children tested for lead poisoning. ○ Research the idea of having a system in place where children born in Knox County hospitals are sent reminders that at age one and two that child should have a lead test. 10