The Foundations of Better Lead Screening for Children in Medicaid: Data Systems and Collaboration was developed with the support of The Commonwealth Fund and showcases strategies from five states where intense effort has gone into improving lead screening among the high-risk population of children who are Medicaid beneficiaries. The report’s practical how-to information is of immediate importance to administrators and staff of state Medicaid agencies and state and local health departments, as well as to advocates and policy makers. Among the various topics covered are: combining lead screening data with Medicaid data; state policies that support screening and follow-up care; and using maps to simplify complex information on screening.

Young Medicaid beneficiaries comprise 83% of children in the US with lead levels high enough to require professional follow-up care. Even so, screening among these children remains astonishingly low. In fact, of 42 states reporting Medicaid screening rates for 1999, 25 reported screening fewer than 10% of enrolled children. These rates are even more startling given that a federal requirement for lead screening has been in for nearly a decade.

The Foundations of Better Lead Screening for Children in Medicaid: Data Systems and Collaboration describes promising strategies to improve lead screening for this high-risk group. Free copies can be obtained from the links below or by contacting the Alliance at info@afhh.org or 202-543-1147.

This report can be downloaded entirely in three PDF files:

• Front and Back Covers [PDF]

• Inside Cover, Acknowledgments and Table of Contents [PDF]

• Report Text [PDF]

The Lead Poisoning Prevention Branch of the Centers for Disease Control and Prevention (CDC) is fulfilling its commitment to the 2010 goal through its grant program requiring that jurisdictions develop and implement a strategic plan for elimination that includes primary prevention, partnering, and program evaluation.  Through this Building Blocks publication, the Branch now offers grantees and others access to promising approaches, including protective public health policies to reduce lead hazards and other promising strategies.

State and local childhood lead poisoning prevention programs (CLPPPs) universally acknowledge the importance of primary prevention and are beginning to address it in their strategic plans and funding applications.  However, many programs’ primary prevention efforts are confined to parent education about hygiene, nutrition, and housekeeping, despite research that makes clear the limitations of these interventions for families whose homes pose significant hazards.  Inability to institute durable primary prevention is caused in part by the pressure to focus resources and attention on secondary prevention: identifying and managing individual cases of elevated childhood BLL.  Indeed, in communities where follow-up on actual poisonings is limited to educating family members about lead hazards and behavioral change (because public resources are not available to control identified lead hazards and halt further exposure), meaningful primary prevention can seem like an extremely remote target. Programs facing these circumstances need ideas for sharing responsibility within the jurisdiction for stopping repeat offenders, expanding access to lead-safe housing, and ultimately arresting the cycle of inferior housing continually producing new poisonings.

Exposure to several substances found in the home can increase the risk of cancer, which is the second leading cause of death among adults and children in the U.S. According to the American Cancer Society, environmental factors including tobacco, chemicals, infectious diseases, and radiation are responsible for three-quarters of all cancer deaths in the U.S. While many adult cancers can be traced to these environmental factors, the causes of most childhood cancers are unknown. Like many environmentally related diseases, cancer takes a greater toll on African-Americans, who are more likely to develop and die from cancer than persons from other racial and ethnic groups.

According to the American Cancer Society, smoking, unhealthy diet, and physical inactivity play a greater role in determining cancer risk than exposure to trace levels of pollutants in food, air, and drinking water. However, the degree of risk from chemical exposure depends on the concentration and duration of exposure. Individuals exposed to high concentrations of cancer-causing substances bear a significantly higher risk of developing cancer. At the same time, widespread exposure to low concentrations of carcinogens can increase the risk of cancer across the population as a whole. For environmentally related cancers, ten or more years typically pass between exposure to cancer-causing substances and detectable cancer.

Introduction

Although the health of most Americans has improved significantly over time, not all racial and ethnic groups have benefited equally. African-Americans and Hispanics, for example, are more likely than whites to suffer from poor health and to die prematurely. Minority and low-income families are more likely to live in substandard housing and polluted communities, increasing their risk of childhood lead poisoning, asthma, cancer, and other environmentally related diseases. In addition to being disproportionately affected by disease, minorities often lack adequate insurance and access to health care due to financial and cultural barriers.

To a large extent, disparities in health and access to care among minorities reflect disparities in socioeconomic status. In fact, according to the Health Resources and Services Administration, the connection between socioeconomic status and health disparities is so strong that income and education levels often serve as proxies for health status. The fact that minority populations on average are poorer than whites underlies many health disparities.

Insurance Coverage and Access to Health Care

Good property maintenance is the foundation for ensuring healthy housing conditions. If hazards do develop, a range of strategies are available to remediate specific housing-related health hazards.

Many homes fall short of the basic requirements of a healthy home and contain one or more hazards that adversely affect human health. Among the health hazards we may encounter in our homes are those that cause and contribute to asthma (such as dust allergens, mold, and pests), toxic materials (such as lead, asbestos, and chemical pesticides), and poisonous gases (such as carbon monoxide and radon).

Proper ventilation helps improve indoor air quality. Ventilation can control indoor humidity and airborne contaminants, both of which either contribute to or act as health hazards. The American Society of Heating, Refrigerating, and Air Conditioning Engineers (ASHRAE) and several states (Minnesota, Washington, and Vermont) have ventilation standards designed to ensure acceptable indoor air quality.

High indoor humidity can spur mold growth. High humidity may result from poor construction/rehabilitation, site design that does not properly manage water, and/or inadequate air exchange. A reasonable target for relative humidity is 30-60 percent. A low cost hygrometer, available at hardware stores, can be used to measure relative humidity. In cool climates, inadequate ventilation in the winter can contribute to excessive moisture and humidity because normal activities create moisture (cooking, bathing, breathing), and there is insufficient natural ventilation (opening windows) or mechanical ventilation (fans, exhaust systems) to remove the moisture. In warmer climates, the heating, ventilation, and air conditioning (HVAC) system can pull warmer, humid air inside. In this case, the ventilation system may help create indoor humidity problems unless the system also dehumidifies the air.

Common sources of airborne contaminants include:

Carbon monoxide (CO) is an odorless, colorless gas formed when carbon in fuels does not burn completely. Hundreds of Americans die every year from carbon monoxide poisoning caused by improperly used or malfunctioning fuel-burning appliances. Fetuses, young children, and the elderly are particularly susceptible to carbon monoxide poisoning.

Carbon monoxide is a “combustion pollutant”—a gas (or particle) that comes from burning carbon-based materials. Combustion pollutants are most often released into the home by vented or unvented appliances and vehicles running in an attached garage. Carbon monoxide is produced when there is a lack of oxygen or enough heat to burn fuels completely. The smoldering burn of incense or cigarettes also produces carbon monoxide.

Indoor Sources of Carbon Monoxide