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. 2003 Dec;111(16):1947–1951. doi: 10.1289/ehp.6352

A randomized trial of education to prevent lead burden in children at high risk for lead exposure: efficacy as measured by blood lead monitoring.

Catherine M Jordan 1, Becky L Yust 1, Leslie L Robison 1, Peter Hannan 1, Amos S Deinard 1
PMCID: PMC1241771  PMID: 14644671

Abstract

In this article we report on the effectiveness of a community-based, culture-specific, controlled trial of intensive peer education aimed at preventing lead burden in children 0-36 months of age within a neighborhood with high risk for lead exposure. Mothers (n = 594) were randomly assigned to control or intervention groups. Offspring blood lead levels were assessed every 4 months. All participants received brochures on basic lead prevention strategies. Intervention participants were offered 20 bi-weekly educational sessions by same-ethnicity peer educators over the course of 1 year, and quarterly booster sessions for 2 years afterward. The intervention group's educational curriculum included information on lead sources (e.g., paint, dust, water, soil, and risks from home repairs and remodeling), health consequences of lead burden, and strategies to reduce lead exposure, including household cleaning, hygiene, safe use of water, and nutritional recommendations. Results indicated that of the 378 children contributing sufficient blood data for analysis, 23% had blood lead levels > 10 micro g/dL before 3 years of age. Intervention participants were more likely to maintain blood lead levels < 10 micro g/dL than were controls (81% vs. 73%; p = 0.08). Multivariate analyses demonstrated that the intervention reduced the risk of blood lead levels > 10 micro g/dL by approximately 34%. We conclude that although intensive education resulted in a lower proportion of children with elevated lead levels, education alone cannot be relied upon to prevent lead burden.

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Selected References

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  1. Aschengrau A., Hardy S., Mackey P., Pultinas D. The impact of low technology lead hazard reduction activities among children with mildly elevated blood lead levels. Environ Res. 1998 Oct;79(1):41–50. doi: 10.1006/enrs.1998.3858. [DOI] [PubMed] [Google Scholar]
  2. Baghurst P. A., McMichael A. J., Wigg N. R., Vimpani G. V., Robertson E. F., Roberts R. J., Tong S. L. Environmental exposure to lead and children's intelligence at the age of seven years. The Port Pirie Cohort Study. N Engl J Med. 1992 Oct 29;327(18):1279–1284. doi: 10.1056/NEJM199210293271805. [DOI] [PubMed] [Google Scholar]
  3. Bellinger D. C., Stiles K. M., Needleman H. L. Low-level lead exposure, intelligence and academic achievement: a long-term follow-up study. Pediatrics. 1992 Dec;90(6):855–861. [PubMed] [Google Scholar]
  4. Bellinger D., Leviton A., Allred E., Rabinowitz M. Pre- and postnatal lead exposure and behavior problems in school-aged children. Environ Res. 1994 Jul;66(1):12–30. doi: 10.1006/enrs.1994.1041. [DOI] [PubMed] [Google Scholar]
  5. Bellinger D., Sloman J., Leviton A., Rabinowitz M., Needleman H. L., Waternaux C. Low-level lead exposure and children's cognitive function in the preschool years. Pediatrics. 1991 Feb;87(2):219–227. [PubMed] [Google Scholar]
  6. Bergomi M., Borella P., Fantuzzi G., Vivoli G., Sturloni N., Cavazzuti G., Tampieri A., Tartoni P. L. Relationship between lead exposure indicators and neuropsychological performance in children. Dev Med Child Neurol. 1989 Apr;31(2):181–190. doi: 10.1111/j.1469-8749.1989.tb03977.x. [DOI] [PubMed] [Google Scholar]
  7. Casey R., Wiley C., Rutstein R., Pinto-Martin J. Prevalence of lead poisoning in an urban cohort of infants with high socioeconomic status. Clin Pediatr (Phila) 1994 Aug;33(8):480–484. doi: 10.1177/000992289403300806. [DOI] [PubMed] [Google Scholar]
  8. Charney E., Kessler B., Farfel M., Jackson D. Childhood lead poisoning. A controlled trial of the effect of dust-control measures on blood lead levels. N Engl J Med. 1983 Nov 3;309(18):1089–1093. doi: 10.1056/NEJM198311033091804. [DOI] [PubMed] [Google Scholar]
  9. Dietrich K. N., Berger O. G., Succop P. A., Hammond P. B., Bornschein R. L. The developmental consequences of low to moderate prenatal and postnatal lead exposure: intellectual attainment in the Cincinnati Lead Study Cohort following school entry. Neurotoxicol Teratol. 1993 Jan-Feb;15(1):37–44. doi: 10.1016/0892-0362(93)90043-n. [DOI] [PubMed] [Google Scholar]
  10. Dietrich K. N., Ris M. D., Succop P. A., Berger O. G., Bornschein R. L. Early exposure to lead and juvenile delinquency. Neurotoxicol Teratol. 2001 Nov-Dec;23(6):511–518. doi: 10.1016/s0892-0362(01)00184-2. [DOI] [PubMed] [Google Scholar]
  11. Dietrich K. N., Succop P. A., Berger O. G., Hammond P. B., Bornschein R. L. Lead exposure and the cognitive development of urban preschool children: the Cincinnati Lead Study cohort at age 4 years. Neurotoxicol Teratol. 1991 Mar-Apr;13(2):203–211. doi: 10.1016/0892-0362(91)90012-l. [DOI] [PubMed] [Google Scholar]
  12. Fergusson D. M., Horwood L. J., Lynskey M. T. Early dentine lead levels and educational outcomes at 18 years. J Child Psychol Psychiatry. 1997 May;38(4):471–478. doi: 10.1111/j.1469-7610.1997.tb01532.x. [DOI] [PubMed] [Google Scholar]
  13. Haynes Erin, Lanphear Bruce P., Tohn Ellen, Farr Nick, Rhoads George G. The effect of interior lead hazard controls on children's blood lead concentrations: a systematic evaluation. Environ Health Perspect. 2002 Jan;110(1):103–107. doi: 10.1289/ehp.02110103. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Javier F. C., 3rd, McCormick D. P., Alcock N. W. Lead screening among low-income children in Galveston, Texas. Clin Pediatr (Phila) 1999 Nov;38(11):655–660. doi: 10.1177/000992289903801104. [DOI] [PubMed] [Google Scholar]
  15. Lanphear B. P., Burgoon D. A., Rust S. W., Eberly S., Galke W. Environmental exposures to lead and urban children's blood lead levels. Environ Res. 1998 Feb;76(2):120–130. doi: 10.1006/enrs.1997.3801. [DOI] [PubMed] [Google Scholar]
  16. Lanphear B. P., Dietrich K., Auinger P., Cox C. Cognitive deficits associated with blood lead concentrations <10 microg/dL in US children and adolescents. Public Health Rep. 2000 Nov-Dec;115(6):521–529. doi: 10.1093/phr/115.6.521. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Lanphear B. P., Eberly S., Howard C. R. Long-term effect of dust control on blood lead concentrations. Pediatrics. 2000 Oct;106(4):E48–E48. doi: 10.1542/peds.106.4.e48. [DOI] [PubMed] [Google Scholar]
  18. Lanphear B. P., Howard C., Eberly S., Auinger P., Kolassa J., Weitzman M., Schaffer S. J., Alexander K. Primary prevention of childhood lead exposure: A randomized trial of dust control. Pediatrics. 1999 Apr;103(4 Pt 1):772–777. doi: 10.1542/peds.103.4.772. [DOI] [PubMed] [Google Scholar]
  19. Lanphear B. P., Winter N. L., Apetz L., Eberly S., Weitzman M. A randomized trial of the effect of dust control on children's blood lead levels. Pediatrics. 1996 Jul;98(1):35–40. [PubMed] [Google Scholar]
  20. Lanphear Bruce P., Dietrich Kim N., Berger Omer. Prevention of lead toxicity in US children. Ambul Pediatr. 2003 Jan-Feb;3(1):27–36. doi: 10.1367/1539-4409(2003)003<0027:poltiu>2.0.co;2. [DOI] [PubMed] [Google Scholar]
  21. Lanphear Bruce P., Hornung Richard, Ho Mona, Howard Cynthia R., Eberly Shirley, Knauf Karen, Eberle Shirley. Environmental lead exposure during early childhood. J Pediatr. 2002 Jan;140(1):40–47. doi: 10.1067/mpd.2002.120513. [DOI] [PubMed] [Google Scholar]
  22. Liu Xianchen, Dietrich Kim N., Radcliffe Jerilynn, Ragan N. Beth, Rhoads George G., Rogan Walter J. Do children with falling blood lead levels have improved cognition? Pediatrics. 2002 Oct;110(4):787–791. doi: 10.1542/peds.110.4.787. [DOI] [PubMed] [Google Scholar]
  23. Needleman H. L., Geiger S. K., Frank R. Lead and IQ scores: a reanalysis. Science. 1985 Feb 15;227(4688):701-2, 704. [PubMed] [Google Scholar]
  24. Needleman H. L., Riess J. A., Tobin M. J., Biesecker G. E., Greenhouse J. B. Bone lead levels and delinquent behavior. JAMA. 1996 Feb 7;275(5):363–369. [PubMed] [Google Scholar]
  25. Needleman H. L., Schell A., Bellinger D., Leviton A., Allred E. N. The long-term effects of exposure to low doses of lead in childhood. An 11-year follow-up report. N Engl J Med. 1990 Jan 11;322(2):83–88. doi: 10.1056/NEJM199001113220203. [DOI] [PubMed] [Google Scholar]
  26. Needleman Herbert L., McFarland Christine, Ness Roberta B., Fienberg Stephen E., Tobin Michael J. Bone lead levels in adjudicated delinquents. A case control study. Neurotoxicol Teratol. 2002 Nov-Dec;24(6):711–717. doi: 10.1016/s0892-0362(02)00269-6. [DOI] [PubMed] [Google Scholar]
  27. Nordin J., Rolnick S., Ehlinger E., Nelson A., Arneson T., Cherney-Stafford L., Griffin J. Lead levels in high-risk and low-risk young children in the Minneapolis-St Paul metropolitan area. Pediatrics. 1998 Jan;101(1 Pt 1):72–76. doi: 10.1542/peds.101.1.72. [DOI] [PubMed] [Google Scholar]
  28. Rhoads G. G., Ettinger A. S., Weisel C. P., Buckley T. J., Goldman K. D., Adgate J., Lioy P. J. The effect of dust lead control on blood lead in toddlers: a randomized trial. Pediatrics. 1999 Mar;103(3):551–555. doi: 10.1542/peds.103.3.551. [DOI] [PubMed] [Google Scholar]
  29. Rifai N., Cohen G., Wolf M., Cohen L., Faser C., Savory J., DePalma L. Incidence of lead poisoning in young children from inner-city, suburban, and rural communities. Ther Drug Monit. 1993 Apr;15(2):71–74. doi: 10.1097/00007691-199304000-00001. [DOI] [PubMed] [Google Scholar]
  30. Schwartz J. Low-level lead exposure and children's IQ: a meta-analysis and search for a threshold. Environ Res. 1994 Apr;65(1):42–55. doi: 10.1006/enrs.1994.1020. [DOI] [PubMed] [Google Scholar]
  31. Singer L., Uphold C. R., Graham M. V., Hernandez B. Lead poisoning and associated risk factors among preschoolers enrolled in a Head Start program. Public Health Nurs. 1997 Jun;14(3):161–168. doi: 10.1111/j.1525-1446.1997.tb00288.x. [DOI] [PubMed] [Google Scholar]
  32. Tait Paul A., Vora Amish, James Simon, Fitzgerald D. James, Pester Beverly A. Severe congenital lead poisoning in a preterm infant due to a herbal remedy. Med J Aust. 2002 Aug 19;177(4):193–195. doi: 10.5694/j.1326-5377.2002.tb04731.x. [DOI] [PubMed] [Google Scholar]
  33. Tong S., Baghurst P. A., Sawyer M. G., Burns J., McMichael A. J. Declining blood lead levels and changes in cognitive function during childhood: the Port Pirie Cohort Study. JAMA. 1998 Dec 9;280(22):1915–1919. doi: 10.1001/jama.280.22.1915. [DOI] [PubMed] [Google Scholar]
  34. Walkowiak J., Altmann L., Krämer U., Sveinsson K., Turfeld M., Weishoff-Houben M., Winneke G. Cognitive and sensorimotor functions in 6-year-old children in relation to lead and mercury levels: adjustment for intelligence and contrast sensitivity in computerized testing. Neurotoxicol Teratol. 1998 Sep-Oct;20(5):511–521. doi: 10.1016/s0892-0362(98)00010-5. [DOI] [PubMed] [Google Scholar]
  35. Wang Chao-Ling, Chuang Hung-Yi, Ho Chi-Kung, Yang Chun-Yuh, Tsai Jin-Lian, Wu Ting-Shan, Wu Trong-Neng. Relationship between blood lead concentrations and learning achievement among primary school children in Taiwan. Environ Res. 2002 May;89(1):12–18. doi: 10.1006/enrs.2002.4342. [DOI] [PubMed] [Google Scholar]
  36. Winneke G., Altmann L., Krämer U., Turfeld M., Behler R., Gutsmuths F. J., Mangold M. Neurobehavioral and neurophysiological observations in six year old children with low lead levels in East and West Germany. Neurotoxicology. 1994 Fall;15(3):705–713. [PubMed] [Google Scholar]
  37. Winneke G., Krämer U. Neurobehavioral aspects of lead neurotoxicity in children. Cent Eur J Public Health. 1997 Jun;5(2):65–69. [PubMed] [Google Scholar]

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