CHILDHOOD LEAD POISONING: EVALUATING NEW CONTROL EFFORT

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Lead poisoning is one of the most significant, pervasive, and persistent childhood problems in this country. The latest federal Health and Nutrition Examination Survey indicated that 1 in 25 American children and nearly 1 in 5 poor black urban children under age 5 is affected. This study proposes to conduct a ramdomized control trial of two new strategies to reduce childhood lead poisoning (CLP) in a high risk urban setting. Young children readily absorb lead which is ubiquitous in the urban environment. There is a growing body of evidence that lead, which accumulates in children, is associated with significant neurological and behavioral deficits. The serious nature of these effects combined with the high prevalence constitute a major public health concern, yet little is known about appropriate public policies for minimizing lead exposure. Apart from the merits of reducing lead in gasoline, there is scant information on the effectiveness of methods for reducing childhood exposure to other important sources of lead, such as household dust and paint. There is a need for and a growing national interest in research appraising the effectiveness of new and current approaches to the prevention and management of CLP. The purpose of the proposed research is to evaluate alternative strategies to reduce childhood exposure to household sources of lead and to formulate recommendations. This project will initiate a demonstration of alternative strategies by workers from the community as a vehicle for testing efficacy for reducing CLP. Testing will be done by randomizing households with an affected child to a housing rehabilitation intervention, a leaded housedust management intervention or to a control intervention consisting of current practices for managing household lead exposure. The evaluation will consist of an analysis of the feasibility and cost-effectiveness of these promising approaches under realistic conditions and will compare them to current techniques. This project involves both community organizations and private sector collaboration. It is expected that the results of this research will have practical applicability for both health authorities and community groups in Baltimore and other affected areas in planning for more effective programs. The demonstration will serve as a model for what can be accomplished when community groups and the private sector combine resources in new ways to attack a complex public health problem.