Inequities in Childhood Life-Course Lead Exposure and Academic and Neurobehavioral Outcomes (I-CLEAN)

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Santa Ana in Orange County (OC), California (CA) is a predominantly Latina/o, immigrant and low-income community that is bound by multiple freeways, has a large industrial corridor, and has 65% of houses built prior to 1960. Residents of Santa Ana have identified lead (Pb) exposure in the community as a major environmental health concern. Responding to the concerns, we established the ¡Plo-NO! Santa Ana! (Lead-Free Santa Ana!) community-based participatory research partnership to examine elevated Pb levels in urban soil in Santa Ana since 2017. In this study, we propose to address the community-identified concerns of lead exposure and its impact on children’s health and academic performance using a community-based participatory research (CBPR) approach. We will also address important gaps in previous Pb research and practice, including 1) limited consideration of both life course exposure and susceptible time window for chronic low- level Pb exposure; 2) lack of research based on repeated outcome measures; 3) few studies on synergistic effect of metal mixtures; 4) few studies on multi-level (e.g. household, school, neighborhood) intervention; and 5) lack of community- driven research devoted to translating knowledge to effective public health equity strategies. Our overarching goal is to examine associations of life course and current Pb exposures with children’s academic performance and neurobehavioral outcomes, identify risk factors of current Pb exposure, and develop and implement a Public Health Equity Action Plan (PHEAP), with particular attention to health equity. Study population involves 600 children 7-10 years old at enrollment and their primary caregiver. Individual-level exposure to Pb and other metals will be estimated from 1) deciduous tooth-based exposure at a weekly resolution from the 2nd trimester of gestation up to the 1st year of life and every 6-months from age 1 up to the time when the tooth is shed; 2) blood for current exposure. Repeated outcomes include 5 years of academic performance and 3 years of behavior outcomes based on validated Child Behavior Checklist (CBCL) questionnaire. We will examine associations of academic performance and behavioral outcomes with deciduous teeth-based early life Pb exposure (Aim 1) and current blood Pb exposure (Aim 2). Further, we will develop, disseminate, implement, and evaluate a multi-level (e.g. household, school, neighborhood, city, county) Public Health Equity Action Plan, with a focus on equity (Aim 3). The strengths of this study include: bridging CBPR and implementation science by leveraging results from Aims 1-2 of this study and practice-based evidence to inform the PHEAP, responsiveness to community-driven priorities, strong community and university leadership, life course measurements of Pb and metal mixtures, a large prospective cohort with longitudinal measurements of both exposure and outcomes, and multiple levels of assessments (i.e. household, school, neighborhood) that advance the science on environmental health inequities to develop, evaluate, and pilot action plans and community-driven interventions. We will advance knowledge on how low levels of Pb exposure over the life course adversely affect children’s school performance and behavioral outcomes. The translational value of this study is noteworthy, as it integrates etiologic data and practice-based evidence to an equity- oriented multi-level action strategy to improve child academic and neurodevelopmental outcomes.