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Successfully Changing a State's Climate to Increase Blood Lead Level Testing
Gail Coppins Gettens1, Beverly Baer Drouin
1NH Department of Health and Human Services, Division of Public Health Services, Healthy Homes and Lead Poisoning Prevention Program, Concord, New Hampshire.
Insights
Childhood lead poisoning remains a concern, with low testing rates in New Hampshire. A targeted strategy significantly improved blood lead testing compliance among young children.
Area of Science:
- Environmental Health
- Pediatric Public Health
- Preventive Medicine
Background:
- Childhood lead poisoning is a persistent environmental health issue in New Hampshire.
- In 2015, 4.9% of children under 6 had elevated blood lead levels, yet only 16.8% were tested.
- Barriers included low venous testing compliance and limited provider understanding of testing importance.
Purpose of the Study:
- To develop and implement a strategy to increase blood lead screening and testing rates in New Hampshire.
- To address barriers to testing in a rural state context.
- To create a model for improving lead screening in other rural areas.
Main Methods:
- Implemented a 5-part integrated strategy by NH's Healthy Homes and Lead Poisoning Prevention Program (HHLPPP).
- Included medical education, promoting point-of-care testing, distributing reference materials, parent reminders, and increasing equipment availability.
- Focused on high-risk communities and engaged pediatric providers.
Main Results:
- Blood lead testing rates improved significantly statewide following strategy implementation.
- Dramatic improvements were observed at sites combining face-to-face education with point-of-care testing.
- NH's HHLPPP conducted 25 medical education sessions in 2016.
Conclusions:
- The integrated strategy effectively increased childhood blood lead testing rates in New Hampshire.
- Combining education with accessible point-of-care testing is crucial for success in rural settings.
- This approach offers a replicable model for enhancing lead screening in similar regions.
Abstract:
Childhood lead poisoning continues to be a persistent environmental pediatric health problem in New Hampshire (NH). In 2015, 660 (4.9%) children younger than 6 years had blood lead levels of 5 µg/dL or more, the Centers for Disease Control and Prevention's recommended level for public health action. Yet, only 16.8% of NH children younger than 6 years were tested. NH's Healthy Homes and Lead Poisoning Prevention Program (HHLPPP) identified 2 barriers to blood lead testing and the opportunities to resolve them: (1) venous testing had lower compliance and resulted in costly follow-up time for providers and (2) lack of understanding in the medical community about the importance of blood lead testing. Strategies to engage pediatric providers needed to recognize the realities of this rural state. In 2016, a strategy with goals of increasing blood lead screening and testing rates statewide with focus on high-risk communities was developed and implemented. The 5-part integrated strategy included the following: (1) implement a medical education program for pediatric providers; (2) increase provider awareness of point-of-care testing equipment; (3) create and distribute medical reference materials; (4) develop parent reminders for blood lead tests; and (5) increase the availability of point-of-care testing equipment. During 2016, NH's HHLPPP presented 25 medical education sessions. Blood lead testing rates improved dramatically, especially at medical sites where both face-to-face education and point-of-care testing were implemented. NH's success serves as a model for other rural areas seeking to improve lead screening rates.