Screening Strategies Aim to Protect Children in the Omaha Community from Lead Exposure
by Leslie Elliott, MPH, PHD, assistant professor in the COPH Department of Epidemiology

The COPH is partnering with the Children’s Physicians Medical Group in Omaha (affiliated with Children’s Hospital and Medical Center, and Creighton University) to develop new screening strategies for identifying children at high risk of lead toxicity. Lead toxicity can lead to many adverse health conditions, especially learning and behavioral disorders.

In the past, the major sources of lead exposure for children in the United States were from (1) airborne lead from combustion of gasoline containing lead and (2) leaded chips and dust from deteriorating lead-based paints. Since lead has been eliminated from gasoline and paint, the risk of exposure has been mostly from paint chips in old houses or from soil in areas of heavy traffic.

In Omaha, some children may have an increased risk of exposure from lead in the soil due to air emissions from lead smelting operations that began in the 1870s and continued until the late 1990s. Because of the potential for high lead levels in the soil, the Environmental Protection Agency (EPA) added an Omaha residential area of almost 9,000 acres to its National Priorities List (NPL), which guides the EPA in investigating geographical areas with hazardous substances.

Because lead toxicity may not always have obvious symptoms, the best way to identify it in children is through screening, which usually includes a questionnaire, a finger-stick blood sample, and/or a blood sample from the vein. In 1991, the Centers for Disease Control and Prevention (CDC) recommended that every child between the ages of 9 and 72 months be screened for lead poisoning, except in communities with sufficient data to show that children did not have high risks of exposure. This essentially meant that every child should be screened (“universal screening”) because most communities did not have sufficient data on risks of exposure.

In 2009, the CDC recommended that local communities develop their own screening strategies to identify children who are at high risk of lead exposure, which would reduce unnecessary medical procedures for children and lower health-care costs. An important component of developing a data-driven screening strategy is information from local blood lead surveillance.

Children’s Physicians, which provides care to over 70,000 children in the Omaha metropolitan area, has been collecting information on blood lead levels for several years and wants to utilize this information to improve screening strategies for all children in Douglas County. Once risk factors are identified, the COPH, the Medical Center, and other community partners, including the Douglas County Health Department, will develop new screening strategies to improve the quality of life for children in Omaha.