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Lead is an extensively studied environmental toxicant, particularly in children < 6 years old. Lead is a potent neuro-toxicant that significantly reduces intelligence quotient and affects neurobehavioral development. Inequitable exposures to lead exist in communities across the United States. Many jurisdictions collect blood lead surveillance data reported by health care providers and laboratories and also provide other types of blood lead screening to at–risk children including at health fairs, door to door or through the Women, Infants and Children Supplemental Nutritional Program (WIC). However, these surveillance activities and data are of limited use to assess population level blood lead levels (BLLs). A population-based, cross sectional and multi-stage cluster survey sample not only provides a representative estimate of BLLs in an area, but also is useful to understand potential risk factors and geographic distribution of BLLs and supports evidence based public health decisions. Prevalence surveys can complement local blood lead surveillance data and national surveys.
METHODS:
We describe methods for conducting a prevalence survey rapidly (usually 2-3 weeks). Prevalence surveys consist of partner identification, obtaining background data of assessment area (e.g., BL testing data, census data, tax assessor data, etc.), resource identification, obtaining consent, survey administration, blood lead data collection and analysis, environmental sampling, educational outreach, data entry/analyses, and public health follow-up/referral. Public health officials needing to assess child blood lead prevalence rates and household-level environmental risk factors may quickly apply this methodology. A well-organized, trained team using a standardized protocol and questionnaire are critical to high quality data.
RESULTS:
We present child blood lead prevalence study results from three investigations: Chicago (2001), Puerto Rico (2010) and Philadelphia (2014). We describe data collection instruments, statistical methodology, risk factors that predict elevated BLLs among children, and use of results to inform local decision makers to rapidly conduct child blood lead prevalence surveys at low cost using cluster sampling methodology.
CONCLUSIONS:
Maintaining capacity to respond to elevated BLLs, targeting screening to at-risk populations, and identifying lead “hotspots” are crucial to primary and secondary prevention efforts. In light of recent research that there is no safe BLL threshold for children and in the absence of surveillance data, prevalence surveys are advantageous. For example, findings of low prevalence may allow local decision makers to revise mandatory blood lead testing policies, while a high prevalence determination may allow local decision makers to institute programs to control or eliminate lead hazards before children are exposed.