Integrated Lead Poisoning Prevention Practice Lab

Background:

Lead has been used for centuries for a wide range of applications; the effects of lead contamination went undetected for many years.  The use of lead in gasoline and paints led to a vast distribution that resulted in environmental and household contamination (Frumkin, 2016). Children exposed to low levels of lead can result in lead poison that can cause cognitive, physical, and neurological disorders. At high levels lead poisoning can cause multiple organ failures, seizures, renal damage, and death. Globally lead exposure results in 2.5 million disability-adjusted life years (DALY) for intellectual disability, 1.3 million DALY’s for renal disease, and 20.6 million DALY’s for vascular diseases. Children are at higher risk of lead toxicity due to increased intake per body weight compared to adults (a 50% uptake compared to 10-15% in adults) and the rate of physical development. Lead poisoning has been linked with physical and cognitive impairment in children and adults. Efforts have been made to reduce or eliminate potential exposure, unfortunately children living in areas of lower socioeconomic status typically are near industrial areas that are lacking in preventative measures to effectively prevent lead exposure. Older households, built before 1987, are more likely to have sources of lead including paint and lead pipes (Frumkin, 2016). In 1991 the Centers for Disease Control and Prevention (CDC) defined blood lead levels more than 10 ug/dl as being of concern in children under five years of age.  Further studies revealed that even lower levels of blood lead levels can still result in adverse effects on children’s health, leading to the conclusion that there is no save level of lead for children (Barbara Nussbaumer-Streit, 2020).

Key study questions:

1. Identify and briefly explain six potential lead sources that could affect people’s health in the mock community. Which one is likely to affect the most people? Why?
2. Identify and briefly discuss three conditions/characteristics/practices/activities in the mock community – including cultural beliefs, values, and practices – that could affect people’s risk of lead poisoning? How are these factors important in how a lead poisoning education program is designed?
3. Why are cultural factors in the mock community important for effectively communicating lead poisoning information? Using what you know about this community and its situation, recommend three specific risk communication strategies for reaching three different audiences and sectors in the mock community.

Method:

The practice lab focused on a mock scenario of a community and required integration and application of class lectures and independent research of lead exposure. Interpretation and critical thinking were required to determine the potential sources of lead exposure and recognizing signs of lead poisoning. Cultural competencies and effective risk communication were needed to develop a community-based lead education and prevention program for the mock community.

Findings:

For the mock community sources of lead were identified, the first potential source of lead exposure would be household exposure from deteriorating lead paint. According to the information on the mock community the single-family homes and apartment buildings were built primarily between the 1930’s and 1950’s. Lead was officially banned in 1978, so homes built before this date are highly likely to contain paint contain lead both inside the home and the exterior. The second sources of exposure would potentially be the drinking water, according to the scenario the homes of the community were built in the 1930’s, homes built before 1986 are likely to contain lead pipes that have been shown to leach lead into the drinking water. The trend of restoring historical houses creates another potential source of lead exposure, as previously stated the homes of the community were built during the high regular use of lead in interior and exterior paint. The renovation of these historic homes potentially releases lead dust from the paint as it is removed from the home, the dust can be inhaled or ingested if proper protective equipment is not used during renovation of lead containing residences (Frumkin, 2016). The eye cosmetic Tiro is from Nigeria and reportedly contains lead. The face painting done at the New Residents Day would expose anyone who has Tiro applied to their eyes and allow lead to be absorbed by the capillaries of the eyes (Centers for Disease Control and Prevention, 2012). Arturo’s Place offers Chapulines, which are grasshoppers commonly eaten in Mexico and Central America. The chapulines have potential lead contamination from the contaminated soil from mines in the area of Oaxaca, Mexico and the lead glazed cookware used in the preparation of the chapulines (Villalobos, 2009). The last source of lead exposure is the venison and other game donated by the Buckshot Buddies Hunting Club. The buckshot used by the hunting club can potentially contaminate the meat of the animal if the lead buckshot is not completely removed during the cleaning process and if improperly cooked can result in lead exposure when consumed (U.S. Department of the Interior, 2019). The lead source most likely to affect the most people would be the household exposure. This being the result of the times from which the homes were built when lead paint was very commonly used and given the decades that have passed the paint deteriorating into a breathable dust can contaminate entire families. Factoring in the restoration efforts being encouraged in historic homes the odds of exposure to lead dust increase further without proper protection. Additionally, the possible existence of lead pipes used in the plumbing would result in ingestion of lead leeched from the pipes.

Recommendations:

Cultural backgrounds and traditions are a major component of how people understand and accept information. Public health communication may distribute information that may be contrary to a culturally established norm. Understanding cultural difference is important otherwise any efforts put forth may be less successful or end in complete failure. The diversity of the community does make communicating information to everyone in an equal manner more difficult. Public health communication may challenge the established norms for a community, in the case of lead poisoning prevention and education gaining an effective understanding of the information should be the main goal of interventions. Educating parents on the dangers lead presents to children is especially important as having an understanding of the most common and uncommon sources of lead exposure may actually be a surprise. The face painting using Tiro is one source of lead that a parent may overlook, using a fear communication approach is not advisable as overall the effects will be short lived and stopping a practice will only cease for a brief time. Communication in an honest and clear fashion is the best approach to help parents gain a true understanding of keeping their children safe from sources of lead. The housing sector in the scenario has homes built between 1930 and 1950, meaning there is a risk of lead being used in the homes. Communicating the dangers of lead exposure to the homeowners needs to be done with the understanding that they may not have a high health literacy, meaning using scientific and confusing terms will only confuse and frustrate those being educated. Communicating the information in an easily understood manner would yield the best retention of what was taught. In the community the food sector has a few culinary specialties that are potentially have been exposed to lead contamination. The restaurant Arturo’s Place has a specialty dish called Chapulines form Oaxaca, Mexico and Buford’s Restaurant with wild game killed by buckshot. The lead contamination of these foods puts those in the community at risk for ingesting lead, communicating this information with a credible source that has detailed evidence of the lead contamination is vital to change the practice of preparing these dishes.

Public health significance:

Institute for Health Metrics and Evaluations (IHME) for 2019 estimated lead exposure accounts for 900,000 deaths worldwide. The burden of disease is higher in low- and middle-income countries. In the U.S. 535,000 children ages 1-5 have blood lead levels high enough to cause health deterioration. Homes built before 1978 have a higher risk of containing lead pipes and paint that has deteriorated and become inhalable dust particles (World Health Organization, 2021). In the U.S. it is estimated that twenty-four million homes contain deteriorated lead-based paint and increased levels of lead contaminated house dust (Centers for Disease Control and Prevention, 2012).

References:

Centers for Disease Control and Prevention. (2012). Infant Lead Poisoning Associated with Use of Tiro, an Eye Cosmetic from Nigeria – Boston, Massachusetts, 2011. CDC.

Frumkin, H. (2016). Environmental Health from Global to Local. San Francisco: Jossey-Bass.

U.S. Department of the Interior. (2019, September 24). Lead Bullet Risks for Wildlife & Humans. Retrieved from National Park Services: https://www.nps.gov/pinn/learn/nature/leadinfo.htm

Villalobos, M. M.-S.-R. (2009). Lead (II) detection and contamination routes in environmental sources, cookware and home-prepared foods from Zimatlán, Oaxaca, Mexico. The Science of the total environment, 2836-2844.

MPH-613-Lead-Lab