# Presentation: 098485

## Lead Poisoning Prevention...

- in a practice-based research network

## Presenters

**	**
**        ****Nancy L. Rothman, EdD, RN**
-       Temple University
**     ****Tine Hansen-Turton, MGA**
-       National Nursing Centers Consortium (NNCC)
**	**** ****Laura Line, MS**
- National Nursing Centers Consortium (NNCC)
**	**** ****Grace Lee, MEng**
-       National Nursing Centers Consortium (NNCC)

## CDC and HUD funded Partnership

- Childhood Lead Poisoning Prevention Program, City of Philadelphia, Department of Public Health

- National Nursing Centers Consortium

## Lead poisoning is a preventable environmental health problem in need of primary prevention, as opposed to allowing children to become lead poisoned and then treated.

## To determine whether a home visiting program in the community surrounding a primary care center will increase childhood blood lead testing within a primary care site.

## Two primary care sites within a practice-based research network, one with the intervention in the surrounding community and one without, were compared.

## A trademarked primary prevention evidenced-based intervention created by the National Nursing Centers Consortium

- A trademarked primary prevention evidenced-based intervention created by the National Nursing Centers Consortium

## Pregnant women and caregivers of children less than one year of age in Philadelphia

- Children under six years of age who are capitated for primary care to two nurse-managed care sites

## Consent - Lead Bucket
Pre-test
Intervention
Post-test -$10 gift card
9 mo. Follow-up phone call

- Consent - Lead Bucket
- Pre-test
- Intervention
- Post-test -$10 gift card
- 9 mo. Follow-up phone call

## Intervention

- Scripted education
- Home visit for lead swipes & environmental assessment
- Interim controls -  Super clean or hazard remediation
- Notified >/= EPA standard; >/= 1,000 μg/sq.ft. on window sills or floors triggers intervention
- @ lower levels when resources available
- EPA standard
- >   40 μg/sq.ft. floor
- > 250 μg/sq.ft. sill

## Sample Sizes 2004-2005Primarily African American or  Latino & Low-Income

- N = 2,319
- 1,116 homes with no prior lead elevations
- 774 born within 6 months of enrollment
- 95 homes with interim controls

## Knowledge Evaluation

- The NNCC analyzed the Pre- and Post-Tests of        caregivers:
- The results showed a statistically significant difference between Pre- and Post-Test scores (paired t-test, 95% confidence level or alpha of .05)
- There was an increase in lead poisoning prevention knowledge after clients participated in LSB.

## For analysis of blood lead levels...

- Block group assigned by pre-coding with Aromap 9.1.
- Mean calculated for all block groups with more than 15 children tested.
- High risk block groups > than citywide geometric mean
- <6 mo. at time of enrollment – meant no prior exposure

## Blood lead level comparisons

| By highest blood lead | Children Tested | > 10μg/dL | > 20μg/dL | Geometric Mean |
| --- | --- | --- | --- | --- |
| Citywide | 86,532 | 10.3% | 1.2% | 4.44μg/dL |
| LSB Homes |   2,319 | 17.4% | 6.4% | 5.00μg/dL |
| LSB Homes- no prior elevation(npe) |   1,116 | 11.6% | 3.9% | 4.34μg/dL |
| LSB clients-
born within 6 mo. (npe) |     774 |   6.1% |  .06% | 3.92μg/dL |

## Blood lead level comparisons

| By highest blood lead | Lower than BG Mean | Greater than BG Mean | Lower in high risk blocks  |
| --- | --- | --- | --- |
| Citywide | 57.9% | 42.1% | 54.3% |
| LSB Homes | 53.3% | 46.6% | 49.8% |
| LSB Homes- no prior elevation (npe) | 62.2% | 37.8% | 62.2% |
| LSB clients-
born within 6 mo. (npe) | 67.2% | 37.9% | 69.1% |

## Clients (n=95) born within 6 months of program enrollment with interim controls

- 70.5% lower than block group mean
- 71.2% in high risk blocks were lower than block group mean

## Interim controls based on...

**Interim controls based on...**

- Environmental assessments
- High lead dust swipes
- Analysis of correlation between assessments and dust wipes (n=200) found no correlation.

## Outcomes

- Caregivers of all LSB clients had a significant increase in knowledge about lead poisoning.

- Focusing on LSB clients in homes with no prior blood lead elevations and born within 6 mo. of enrollment:
- 	69% of LSB clients living in high risk blocks and 71% of LSB clients that benefited from interim controls and lived in high risk blocks had lower blood levels than their block group mean (vs. 54% for City) .

## 34-43% increase in blood lead testing over two years in the network site with the Lead Safe Babies intervention versus the network site without

## Lead Safe Babies is available at both primary care network sites serving children in Philadelphia
Lead Safe Babies is an evidence-based intervention ready for replication.

- Lead Safe Babies is available at both primary care network sites serving children in Philadelphia
- Lead Safe Babies is an evidence-based intervention ready for replication.

## www.nncc.us

## Lead Poisoning Prevention Program of the Philadelphia Department of Public Health
Richard Tobin
Peter Palermo
Rob Himmelsbach

- Lead Poisoning Prevention Program of the Philadelphia Department of Public Health
- Richard Tobin
- Peter Palermo
- Rob Himmelsbach