# Community-Based Strategy to Improve Lead (Pb) Screening for Low-Income Neighborhoods in Chicago, Illinois 

# 2007 - 2008 

# 

#  Environmental Public Health Leadership Institute Fellow(s):

# Mrs. Tammy Dillard-Steels, M.P.H., M.B.A.

*Executive Director; Urban Sustainability Authority*

*27 North Wacker Drive, STE 145, Chicago, Il 60606*

*Phone: 312-602-9763, TSteels@urbansustain.org*

# Mentor(s):

### **Timothy J. Murphy, Ph.D., CHMM, R.E.H.S., CET**

*Associate Professor*

*The University of Findlay*

*1000 North Main Street Findlay, Ohio, 45840*

*Phone: 419-434-4588, Murphy@findlay.edu*

# (Acknowledgements):

### **Patrick MacRoy**

*Program Director;*

*Chicago Department of Public Health*

*Childhood Lead Poisoning Prevention*

> ![](media/image1.jpeg){width="1.3756944444444446in"
> height="0.6368055555555555in"}

# EXECUTIVE SUMMARY:

In 2003, only 37% of the children under the age of 6 in South Shore, a
community located in the Southern Region of Chicago have been tested for
blood lead level. Of the 2700 children tested in South Shore, 230 had
elevated blood levels of lead. At this time there is limited outreach to
communities to inform, promote lead screening or lead poisoning
prevention.

In the summer of 2008 Urban Sustain's strategy to improve South Shore's
screening of lead is to create a community-based collaborative
partnership to develop a one day symposium. Urban Sustain will act as a
catalyst to gather a core team of community members. Currently, Urban
Sustain has contacted the South Shore Chamber of Commerce, South Shore
United Methodist Church, the Chicago Department of Public Health,
Chicago Department of Environment, Jackson Park and LaRabida Hospital
and others partners.

This symposium will provide a comprehensive understanding of the many
sources and risk of inorganic lead. The symposium will provide a local
resource to foster awareness about lead screening for children under
six. Other topics addressed lead safety, the hazards, sources and
effects of lead. This symposium will offer on-site workshops on home
lead detection methods, lead mitigation, effective cleaning techniques
and blood lead screenings. Currently, there is minimal outreach, if any
to these communities. This symposium is the beginning of bringing
culturally sensitive information about lead into their community.

# INTRODUCTION/BACKGROUND:

In the last 5-10 years it has become clear that there are neurological
effects of exposure to lead levels below the current defined threshold
of 10µg/dl1. Although the percent of children with elevated lead levels
in Chicago, as elsewhere, has continued to fall, there remain areas of
the city where 8-15% of the children have levels \>10µg/dl, with an even
greater percent of children at risk if we include levels below 10µg/dl.
Thus, in 2003 6.3% of the children in Chicago overall had levels \>
10µg/dl, whereas Englewood and west Englewood had 17.3% and 15.6%
elevated levels respectively -- the highest percentages in Chicago2.
Similarly, South shore, a neighboring low income community had 8.7% with
elevated levels. In 2004, while the percent of children with elevated
levels in Chicago had fallen to 5.19%, the percents in Englewood and
West Englewood remained high at 15.19% and 13.24%.^1^

Targeted communities: The proposed project will address lead exposure in
two low income predominantly African American areas on the Southside of
Chicago. South Shore has the zip code of 60649 with a population of
61,556, ninety-six percent of the population is African American and per
capita income in 1999 was \$15,250. The South Shore community is located
between 67th Street to the North, 79th Street on the South, Lake
Michigan on the East, and Stony Island Ave on the West in Chicago,
Illinois in Cook County. The Greater Englewood community, which includes
Englewood and West Englewood, is west of South Shore. The community is
98.7% African American, with an unemployment rate of 14.8% compared with
5.7% for the city, nearly half of its children below the poverty level,
and median household incomes in Englewood and West Englewood \$18,955
and 26,693, respectively ^2,3^.

# Problem Statement: 

In recent years, the low income communities' environment has emerged as
an important area to address in regards to health. Academic researchers,
policy experts, and community experts have documented a variety of low
income communities environmental health issues and their effects. Many
experts have developed proposals and solutions to address these ranges
of issues in the form of state laws, low income communities district
policies, training, and education programs without including input from
the community. As a result of not utilizing applied Community --based
research, many of these proposed solutions are not readily being
implemented nor understood in low income communities.

Within Chicago despite the aggressive approach of the Chicago Department
of Public Health (CDPH) to lead screening and follow-up there are
substantial barriers to success. The CDPH mandates that all Chicago
children be considered high risk and be tested beginning at 6 months of
age as per the physicians guidelines established in 1999. The average
age for the first test is around two years. 80% of first EBLs are
identified by age three. Often, children are poisoned when they are one
or two years old and by the time they're about to enter school, when the
blood lead test is done, their blood lead levels have begun to decline.
On average, 63% of the children in the high risk area are not being
properly screened for blood lead levels. Improvement in these rates
requires expanded education, relating screening to health outcomes, and
the development of local infrastructures linking appropriate services.

####### 

####### ***Behavior Over Time Graph:***

####### ![](media/image2.wmf) 

####### ***Causal Loop Diagrams and applicable archetypes:***

####### 

![](media/image3.jpeg){width="8.997916666666667in"
height="4.904166666666667in"}

####### ***10 Essential Environmental Health Services:***

-   Inform, Educate & Empower - Guided by a "participatory research"
    framework that calls for the active involvement of ordinary people
    in the target community in the collective assessment/investigation
    of the reality related to Lead poisoning in order to transform it.
    Through the establishment of teams with the community and subsequent
    team training; we hope to achieve the emergence of a shared
    perspective on goals, mechanisms and curriculum that lead to
    positive improvements in the detection and screening of Lead and
    prevention of poisoning.

-   Develop Policies - As the project develops barriers and
    accomplishments will documented and reported to the Lead Safe
    Illinois Taskforce to build a better infrastructure and programs
    between the community and academia. This research will prepare the
    community to seek advice on advocacy strategies such improving the
    current labeling of products, requiring both the WIC and MAC
    (Mothers and Children -- MAC -- is a free food program for
    low-income families) to include lead testing on the forms that must
    be completed in order to be eligible for services and regulatory
    action on Lead in Children products.

-   Enforce Laws - The Chicago Department of Public Health also mandates
    that all Chicago children be considered high risk and be tested
    beginning at 6 months of age as per the physicians guidelines
    established in 1999. According to the Chicago Department of Public
    Health most children are tested, not when they are one or two years
    old, however, but only when they are entering pre-kindergarten or
    later. Urban Sustain goal is to develop a community lead
    intervention program targeting young women with children in two
    areas on the Southside of Chicago with documented high proportions
    of children with elevated lead levels.

![](media/image4.png){width="3.75in" height="3.8125in"}

Figure 1: Public Health Function Steering Committee (July 1995)

####### ***National Goals Supported*** 

1.  **CDC Health Protection Goals**

Healthy People in Every Stage of Life

-   All people, and especially infants at a greater risk of Lead
    poisoning, will achieve their optimal lifespan with the best
    possible with the best possible quality of health in every stage of
    life.

-   Prevent chronic diseases and their consequences among children.

-   Increase the number of children who live, learn, and play in social
    and physical environments that are accessible, that support health ,
    safety and development, and that promote healthy behaviors.

2.  **National Strategy to Revitalize Environmental Public Health
    Services**

Build Capacity

-   Strengthen and support environmental public health services at the
    community, local , state and federal level.

Communicate and Market

-   Improve communication and information sharing among environmental
    public health agencies, communities, strategic partners, and other
    stakeholders and better market environmental public health services
    to policy makers and the public.

Create Strategic Partnerships

-   Foster interaction among agencies, organizations, and interests that
    influence environmental public health services.

####### Project Logic Model: ![](media/image5.wmf){width="8.874305555555555in" height="6.191666666666666in"}

# PROJECT OBJECTIVES/DESCRIPTION/DELIVERABLES:

***Program Goal -***

"Increase the number of children Lead screening under the age of 3 in
South Shore "a working poor neighborhood"

***Philosophical Parameter --***

Often, children are poisoned when they are one or two years old and by
the time they're about to enter school, when the blood lead test is
done, their blood lead levels have begun to decline. Then it is too
late.

Health Problem --

Lead is a neurotoxin that can cause brain damage and lowered IQ as well
as stunt growth; cause behavior problems, seizures, anemia, kidney
problems, reproductive problems, and birth defects.

####### ***Outcome Objective --*** 

Early detection of high lead levels may improve crime statistics, a
child's educational experience or reduce the physiological effects of
caused by the lead.

***Determinant --***

The average home built in South Shore dates back to 1948; these homes
may be filled with lead dust.

***Impact Objective --***

Starting January 2008 the strategy to improve South Shore will create
community-based collaborative partnerships; develop outreach for
comprehensive understanding of the many sources and risk of inorganic
lead. Also South Shore will set community risk priorities.

***Contributing Factors --***

Historically, environmental health is not seen as a priority in
economically disadvantage areas.

***Process Objectives --***

Activities include gathering a core team of community members. The team
will identify community needs, inventory assets, assess the capacity for
community improvement and launch a public outreach and media campaign.

# METHODOLOGY:

####### ***Events and Activities***

Compile, collect and analyze the community data. Create a focus group of
community volunteers to identify community volunteers/stakeholders,
needs, inventory assets and assess the capacity for lead screening
improvement. Provide a symposium based on needs.

A symposium to provide a local resource to foster awareness about the
hazards of lead in products available to children and the importance of
lead screening for children under six. The Connection addresses and will
further research on the impact of Lead poisoning on the urban
educational and criminal system.

The symposium offers seminars and professional panels on toy safety,
general lead safety, the hazards, sources and effects of lead; on-site
workshops on home lead detection methods, lead mitigation, effective
cleaning techniques and blood lead screenings. Currently, there is
minimal outreach, if any to these communities. This symposium is the
beginning of bringing culturally sensitive information about lead into
their community.

# Next Steps:

1.  Have community meetings to gauge the interest and knowledge.

2.  Distribute the information to all that are affected in these
    communities.

3.  Build community collaborative

4.  Provide a one day event with seminars, blood screenings and
    workshops.

5.  Secure funding for symposium.

6.  Invite the residents; home and institutional day care providers,
    social workers, health educators, politicians, local school
    administrators and medical providers to attend.

# LEADERSHIP DEVELOPMENT OPPORTUNITIES:

####### ***Tammy Dillard-Steels***

Being an EPHLI fellow has been an inspiration. I have received
leadership skills and knowledge on subjects that I did not know existed.
I have been motivated to continue working as the Executive Director for
Urban Sustain to promote environmental health in at-risk communities.

Being a community grassroots organization I have felt prior to this
experience that I was on an island and was the only one who truly cared
about the future of environmental public health and resources are
scarce. I was wrong and appreciate the enlightenment!. After meeting so
many other smart, creative Environmental Health professionals, it has
renewed my respect for the profession.

I sincerely thank CDC for this eye opening opportunity. I had blast
learning, sharing, building relationships, and becoming a leader.

# ABOUT THE EPHLI FELLOW(s)

Tammy Steels, Executive Director and founder of Urban Sustainability
Authority. Her passion to help others was ignited very early in life by
her mother.   As Executive Director she has partnered with After School
Matters and South Shore High Schools to implement the Exposure 101, an
apprenticeship project, giving at risk youth the knowledge and skills to
non-traditional careers, such environmentalist, organizers, public
relations, lobbyist and economist to name a few.

She has created and delivered numerous environmental health programs,
such as Asbestos Abatement, Respiratory Protection, Hazardous Waste
Removal and Environmental Sampling for several major US corporations.
 She has held the position of Senior Safety Professional for
commonwealth Edison, Environmental Health Director for Healthy Schools
Campaign and Project Coordinator for the University of Illinois at
Chicago -- Center for Advance Distance Education.   

Tammy Steels received her Bachelor of Science in Environmental Health
from Illinois State University, is a graduate of the University of
Illinois at Chicago- School of Public Health where she received a Master
of Public Health and completed her Master of Business Administration in
Marketing and Non-Profit Management from Keller Graduate School of
Management in 2004. With over 20 years of Environmental Health and
Managerial experience in both the private and non-profit sectors, she is
dedicated to preserving and improving the urban communities. 

# REFERENCES

1.  Chicago Department of Public Health, Childhood Lead Poisoning and
    Prevention Program, 2003 Surveillance Data

2.  Chicago Department of Public Health, Childhood Lead Poisoning and
    Prevention Program, 2004 Provisional Surveillance Data

3.  4\. Chicago Department of Public Health, Chicago Health and Health
    Systems Project 18, May 2005. http://www.cchsd.org/cchsd_home.html