REFERENCES

1
Assessing the Risks and Knowledge of
Econominically-Disadvantaged, Minority Urban
Population in Preventing and Reducing Childhood
Lead Poisoning
Janvier Gasana, MD, MPH, PhD, Wayway Hlaing,
MBBS, MS, PhD, Kristy A. Siegel, MPH, CHES,
Janisse Rosario, MPH, Krishna Dummula, MD, and
Emily A. Owens, MPH Florida Childrens
Environmental Health Alliance, Stempel School of
Public Health, Florida International University,
Miami, Florida
DISCUSSION
During the period 1995-2000, there were
approximately 3000 cases of CLP reported to the
Miami-Dade County Health Department at a rate of
500 cases per year. Of these reported cases, 53
were among black children while 31 were among
Hispanics. A GIS map of lead poisoning cases in
the County shows two main clusters, one in North
Miami Dade and the other in South Miami Dade.
North Miami Dade is the larger of the two and
includes the contiguous inner city areas of
Liberty City, Little Haiti, and Little Havana,
which account for more than 30 of pediatric lead
cases reported. Of this 30, Liberty City
accounts for 17 of all reported pediatric cases.
Based on the selected risk factors of
enrollment in Medicaid, annual income of 10,000
or below, home built before 1978, and existence
of dirt in yard, respondents children were
categorized on their level of risk of childhood
lead poisoning none (having no risk factor) to
very high (having all four risk factors). Almost
a third of respondents children (n 151) have
high to very high level of risk. More than half
of the children with a very high risk level have
not received a venous blood lead test.
Additionally, 60.8 of children with a high risk
level have not received one either. This is even
more alarming when 96 of high to very high
children are Medicaid-enrolled. Because of their
insurance status, these children should have
received a venous blood test at least once
according to Federal Medicaid rules, but also
taking into account their dangerous risk levels,
it is paramount that they be screened. A little
over a quarter of respondents with children that
have high to very high level of risk have both
heard of CLP and had their child screened.
Another concern is parents and guardians not
being aware of the age of their residence. More
than 50 of the respondents that have never heard
of childhood lead poisoning do not know if their
residence was built before 1978. The survey
showed that overall, more than two-thirds of
respondents (67) have heard of childhood lead
poisoning, with half being told by a doctor.
Doctors being aware of and discussing CLP with
their clients is but one aspect of reducing the
cases of CLP. Doctors need to also follow
through and screen their at-risk pediatric
patients. Because doctors are opening a dialogue
with the clients regarding CLP, the question
arises then why are screening rates for our
target group so low. Some possible explanations
are parents and guardians are unaware of the
actual tests the doctor has performed, after the
discussion on CLP the doctor surmised the child
is not a high-risk patient and therefore did not
screen, or conversely, the parents felt their
child was not at high-risk and therefore denied
the venous blood test. This question is one that
needs to be further examined. Another area
of concern is of the 121 children screened,
nearly all of them had a result of normal, as
reported by their parent or guardian. Does this
imply that the wrong children are being screened?
Miami-Dade County has one of the highest rates
of CLP in Florida, particularly in Liberty City
and the surrounding communities. This scenario
highlights one of the limitations of
self-administered surveysrespondent uncertainty
of the question/answer. To increase the accuracy
of the findings, we would need to cross-reference
the respondents answers to medical testing
records. However, this would create
confidentiality concerns and consequently would
not be an option.
ABSTRACT
In the U.S., childhood lead poisoning (CLP)
remains an environmental health threat. Florida
Childrens Environmental Health Alliances
Partnership Against Lead (PAL) Project proposes
to educate children and parents in Miami-Dade
County to decrease exposure in the home. The PAL
Project serves the high-risk communities of
Liberty City, Little Haiti, Little Havana, and
Overtown. These neighborhoods are predominantly
African American, Haitian, Cuban, and African
American, respectively. Analysis of data
collected using our risk assessment questionnaire
shows more than two-thirds of respondents have
heard of CLP, with half being told by a doctor.
But the vast majority of parents (71) of
Medicaid-enrolled children reported their
children have not been screened. Based on
selected risk factors, respondents children were
categorized on their level of risk of CLP none
(having no risk factor) to very high (having all
four risk factors). Almost a third of
respondents children have high to very high
level of risk. More than half of the children
with a very high risk level have not been
screened, likewise for 60.8 of children with a
high risk level. More than a quarter of
respondents (26.8) that have not heard of CLP
have a child with high to very high level of
risk. The disparities observed are result of a
high percentage of linguistically isolated
households and other culturally associated
factors that need to be addressed.
METHODS
From 2002-2003, 500 surveys were
self-administered by persons with children
attending health fairs, Caleb center, and Juanita
Mann Health Clinic in the areas of Little Haiti
(33127), Miami Shores (33150), and Liberty City
(33142, 33147). Analysis of data was conducted
by SAS 9.0 and SPSS 12.0.
RESULTS
The sample consisted of 500 respondents.
However for analysis, 3 cases had to be deleted
because the contact information given was
out-of-state. The majority of respondents
consider themselves black / African American.
The remaining respondents were Hispanic (13),
Haitian (10), other (3), Jamaican (1), and
White (lt1). The age of children reported by the
respondents ranged from less than one to 21 years
old. The most frequent reported age was 4 years.
Approximately three-fourths of respondents (n
371) reported they have children 6 years of age
and younger. Eighty-six percent of respondents
dwell in rental property. And almost half of
respondents (n 190) do not know the age of
their residence.
Eighty-nine percent of respondents children are
insured most of which with Medicaid (86). Of
the Medicaid-enrolled children, only 29 have
received a venous blood lead test, as reported by
their parent or guardian. Similarly, only 29 of
the respondents who take their child to a
pediatrician for medical care reported their
child has received a venous blood lead test.
More than two-thirds of children six years of age
and younger (n 213) have not received a venous
blood lead test. Of the 121 children screened,
nearly all of them had a result of normal, as
reported by their parent or guardian.
BACKGROUND
Although lead exposure and blood lead levels
have been reduced over the last two decades in
the U.S., mainly because of the phase-out of lead
from gasoline and house paint, it is still
considered a major preventable environmental
health threat to children under the age of six.
There are many ways in which children are exposed
to lead through air, drinking water, food,
contaminated soil, deteriorating paint, and dust.
Old lead-based paint is the most significant
source of lead exposure in the U.S. today. High
concentrations of lead particles in homes can
also result from lead dust from outdoor sources,
including contaminated soil tracked inside.
The disparities in the distribution of childhood
lead poisoning (CLP) is evident. Lead hazards are
rather localized within neighborhoods, largely
due to such factors as housing conditions,
income, race, industrial emissions, or dust and
soil contamination. CDC has recommended that
surveillance efforts should be used to target
screening efforts to high-risk communities versus
universal screening. The city of Miami is a
densely populated urban area where families with
urgent social and economic needs live in old and
deteriorating housing. For the purpose of CLP,
older housing stock is defined as that built
before 1950, although housing built before 1978
can contain lead paint as well. Miami-Dade County
has the highest number of housing units with a
high risk of lead hazards (15,000) among all the
counties in Florida.
CONCLUSION
Childhood lead poisoning will continue to be
a problem in South Florida if parents of high
risk children do not have basic knowledge of CLP,
understand the risks their children are exposed
to, and have their children screened. When only
a quarter of those surveyed with high/very high
risk children have heard of and had their child
screened for CLP, there is much work left to be
done. Along with community involvement and
education, the most appropriate solution would
engage the doctors and health care professionals.
Our respondents take their children to a
specific doctor or pediatrician for medical care,
with almost all already discussing CLP with them.
Therefore, if health care professionals screened
their high risk pediatric patients, then
screening rates for the county would increase and
subsequently rates of CLP would decrease because
of the increase in awareness throughout the
communities of Liberty City, Miami Shores, and
Little Haiti.
REFERENCES
ACKNOWLEDGEMENTS

• Centers for Disease Control and Prevention.
  (1997). Screening Young Children for Lead
  Poisoning Guidance for State and Local Public
  Health Officials. Atlanta
• Gasana, J Chamorro, A. (2002). Environmental
  lead contamination in Miami inner-city area.
  Journal of Exposure Analysis of Environmental
  Epidemiology, 12, 265-272.
• Needleman, H. (2004). Lead Poisoning. Annual
  Review of Medicine, 55, 209-222.
• Silbergeld, E.K. (1997). Preventing Lead
  Poisoning in Children. Annual Review of Public
  Health, 18, 187-210.

Florida International University Dev Pathak, MS,
MBA, DBA Veronica Bedford
Barry University Jeremy Montague, Ph.D.