Health Disparities and Childhood Lead Exposure in the Benjamin van Clark Neighborhood, Savannah, Georgia

1. Health Disparities and Childhood Lead Exposure in the Benjamin van Clark Neighborhood, Savannah, Georgia  PI: Dr. Nicole Oretsky Savannah State University National Institutes of Health (NIH) National Center on Minority Health and Health Disparities (NCMHD) May 19, 2010

2. Project Partners A. Philip Randolph Institute Benjamin van Clark Neighborhood Association Chatham County Health Department Coastal Health District Representative Lead-Based Paint & Asbestos Program, Georgia Environmental Protection Division Childhood Lead Poisoning Prevention Program, Georgia Department of Community Health

3. Graduate Student Fellows Olivia McIntosh Christine Dolbow

4. Purpose The study is concerned with the distribution and frequency of childhood risk for lead poisoning in the Benjamin Van Clark (BVC) neighborhood of Savannah, Georgia. Researchers are concerned with health risk: (1) Lead exposure and children <6 years old; (2) Household historical access to testing; and (3) Lead knowledge.

5. Research Questions What is the frequency and distribution of health risk for children (<6 years old) due to lead-based paint hazards in the Benjamin van Clark neighborhood in Savannah, Georgia? Health Risk: (1) Presence of lead-based paint hazards (2) Lack of access to testing (3) Lack of lead knowledge What municipal policy interventions can decrease lead-based paint hazards in the Benjamin van Clark Neighborhood?

6. Health Disparity African American children who are on Medicaid and live in housing built before 1978 are considered to be of highest risk. ‘Black’ children are four times as likely to have high levels of lead in their blood as White children. Medicaid requires that children be tested at years one and two. If physicians find that a child has not been tested, they are expected to do so immediately. Yet, according to screening analysis performed by GCLPPP, less than 20% of Georgia Medicaid children are tested for lead. Children not on Medicaid are even less likely to be tested.

7. Research Objectives (1) Describe the experience of BVC residents with current systems of access to testing; (2) Map lead presence in BVC; (3) Test at-risk children and their housing; and (4) Provide outreach and education about lead hazards to BVC.

8. Rationale Lead poisoning is a serious health threat and disproportionately effects African American and low income households. More particularly, it diminishes learning ability and IQ, as well as causing behavioral problems, and has causal linkages to juvenile delinquency. The health disparity contributes to higher frequency of incarceration, lowered levels of academic achievement and compromised life chances.

9. Lead Poisoning Lead-contaminated dust from deteriorated lead-based paint in older homes is the primary pathway for lead exposure in young children. Lead is a neurotoxin with serious health impacts, such as brain damage, including encephalopathy (a brain disease) and decreased I.Q. levels; kidney and bone marrow damage; weight loss; anemia; muscle weakness; and hearing impairment. Long-term exposure can result in decreased performance of the nervous system. Linked behavioral impacts include learning difficulties, aggression, violence, hostility, and anti-social or delinquent behavior.

10. EBLLs When absorbed into the body it is highly toxic to many organs. The effects of lead are the same whether it enters the body through breathing or swallowing. The blood lead level (BLL) greater than 10 mg of lead per dL of blood is considered harmful to children by the U.S. Centers for Disease Control (CDC). A level below 25 mg per dL is generally considered to be acceptable for adults for both men and women. Pregnant women need to limit their exposure to lead to maintain a blood level below 10 mg per dL because lead will pass through the blood to an unborn child. The main target for lead toxicity is the nervous system, both in adults and children.

11. High Risk Zone Benjamin van Clark is considered to be a high-risk area by the GCLPPP. For this study, using Geographic Information Systems (GIS) mapping technology, Director Forrest Staley has pinpointed BVC block groups with intense clustering and high frequency of high-risk features.

12. High Risk Features These features include housing and other buildings constructed before 1978, and particularly those built before 1950; older units that have never been renovated, rental housing; the presence of African American East Indian and Mexican, populations; and the proximity to Toxic Release Inventory (TRI) sites.

13. Benjamin van Clark I BVC is an ideal research site as it is a high risk area for childhood lead exposure. It meets the primary criteria of containing old housing stock where 2/3 of the units were built before 1950. According to the Georgia Environmental Protection Division (EPD), 69% of units of that age contain lead-based paint.

14. Benjamin van Clark II There is a large percentage of rental units (61%), an African American and low-income population (98%), and a high percentage of households with children (61%). This is a distressed area where 40% of the population lives below the poverty line. The unemployment rate is at a staggering 19% and of the working population, 62% make under $20,000 per year. Half the population has less than a high school education.

15. Research Methodologies Triangulation – Three Prong Approach Lead Exposure and Health Risk Survey; Test housing for lead hazards using dust wipe kits and XRF machines; and Test children for EBLLs using venous and capillary methods and according to Georgia Childhood Lead Screening Guidelines;

16. Lead Exposure and Health Risk Survey Target Housing, Child Occupied Facilities Housing Status Access to Lead Testing Childhood Risk Childhood Lead-Related Symptoms Recommendations: Testing Children and/or Housing

17. Testing Housing 1. High risk units detected through analysis of ‘Lead Exposure and Health risk’ survey 2. Field team contacts households and teach residents how to use the kits and monitor implementation 3. Test wipes sent to lab for analysis 4. Lead Hazards = Resident Notification 5. Lead Hazards = Test Children 6. EBLLs = Resident Notification 7. EBLLs = Certified Risk Assessments

18. Testing Children Venous and capillary methods According to Georgia Childhood Lead Screening Guidelines Cindy Zipperer, Lead Nurse, Chatham County Health Department WW Law Center

19. Findings Triangulated from the three data sets will substantiate frequency and distribution of health risk. Outreach and Education Municipal policy recommendations Justification for replicating project in neighborhoods, cities and towns– Community Health Department

20. Concluding Remarks There is a critical need for this health disparity study as it will lay the foundation to document and explore the biomedical implications of lead exposure for Savannah’s African American community, and ultimately aid in the elimination of lead-based health effects. This small-scale pilot project will produce preliminary data to develop future proposals for larger-scale studies.