Mary Jean Brown1, Pat McLaine, Sherry Dixon, Peter Simon. 1. Lead Poisoning Prevention Branch, Division of Emergency and Environmental Health Services, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. mjb5@cdc.gov
Abstract
OBJECTIVE: The objective of this study was to measure the effectiveness of intensive case management to reduce blood lead levels (BLLs) in children. Lead poisoning remains a common, preventable pediatric condition despite advances in reducing children's BLLs in the United States. Substantial evidence implicates lead paint-contaminated house dust as the most common high-dose source of lead in children's environments. Housekeeping and parental supervision also may contribute to risk for lead exposure. METHODS: We conducted a community-based, randomized trial of comprehensive education and home visitingfor families of children with BLLs 15 to 19 microg/dL. BLLs after 1 year of follow-up were compared for intervention group children, whose families receivedindividualized education that was designed to address specific risks factors in a child's environment, and comparison group children, whose families received customary care, usually 1 or 2 educational visits. Environmental samples were collected at baseline and after 1 year of follow-up for intervention group children and compared with those of comparison group children, collected only at the end of study. RESULTS: During the follow-up period, parents of intervention group children (n = 92) successfully decreased dust lead levels and significantly improved parent-child interaction and family housekeeping practices compared with comparison group children (n = 83). Overall geometric mean BLLs declined by 47%, and the difference in BLL by group was not significant (9 vs 8.3 microg/dL for intervention versus comparison group children, respectively.) After 1 year, nearly half of enrolled children had BLLs > or = 10 microg/dL. CONCLUSIONS: Until a reservoir of lead-safe housing is created, programs that educate families to reduce environmental exposure are needed. Although providing families with quantitative information regarding lead contamination may have a role in short-term efforts to prevent lead exposure, these null findings suggest that it has little benefit once BLLs are elevated.
RCT Entities:
OBJECTIVE: The objective of this study was to measure the effectiveness of intensive case management to reduce blood lead levels (BLLs) in children. Lead poisoning remains a common, preventable pediatric condition despite advances in reducing children's BLLs in the United States. Substantial evidence implicates lead paint-contaminated house dust as the most common high-dose source of lead in children's environments. Housekeeping and parental supervision also may contribute to risk for lead exposure. METHODS: We conducted a community-based, randomized trial of comprehensive education and home visiting for families of children with BLLs 15 to 19 microg/dL. BLLs after 1 year of follow-up were compared for intervention group children, whose families received individualized education that was designed to address specific risks factors in a child's environment, and comparison group children, whose families received customary care, usually 1 or 2 educational visits. Environmental samples were collected at baseline and after 1 year of follow-up for intervention group children and compared with those of comparison group children, collected only at the end of study. RESULTS: During the follow-up period, parents of intervention group children (n = 92) successfully decreased dust lead levels and significantly improved parent-child interaction and family housekeeping practices compared with comparison group children (n = 83). Overall geometric mean BLLs declined by 47%, and the difference in BLL by group was not significant (9 vs 8.3 microg/dL for intervention versus comparison group children, respectively.) After 1 year, nearly half of enrolled children had BLLs > or = 10 microg/dL. CONCLUSIONS: Until a reservoir of lead-safe housing is created, programs that educate families to reduce environmental exposure are needed. Although providing families with quantitative information regarding lead contamination may have a role in short-term efforts to prevent lead exposure, these null findings suggest that it has little benefit once BLLs are elevated.
Authors: Chinaro Kennedy; Robert Lordo; Marissa Scalia Sucosky; Rona Boehm; Mary Jean Brown Journal: Int J Hyg Environ Health Date: 2015-10-09 Impact factor: 5.840
Authors: Barbara Nussbaumer-Streit; Berlinda Yeoh; Ursula Griebler; Lisa M Pfadenhauer; Laura K Busert; Stefan K Lhachimi; Szimonetta Lohner; Gerald Gartlehner Journal: Cochrane Database Syst Rev Date: 2016-10-16
Authors: Chinaro Kennedy; Robert Lordo; Marissa Scalia Sucosky; Rona Boehm; Mary Jean Brown Journal: Environ Health Date: 2014-11-07 Impact factor: 5.984
Authors: Barbara Nussbaumer-Streit; Verena Mayr; Andreea Iulia Dobrescu; Gernot Wagner; Andrea Chapman; Lisa M Pfadenhauer; Szimonetta Lohner; Stefan K Lhachimi; Laura K Busert; Gerald Gartlehner Journal: Cochrane Database Syst Rev Date: 2020-10-06