Introduction
Lead poisoning is one of today’s most common and
preventable pediatric health problems (Anderson, Whitwell, Snyder and Besunder,
1999). Lead is a known neurotoxin that
adversely affects children’s behavior and development at levels as low as
10ug/dL, the lowest acceptable level of blood lead concentration established by
the Centers for Disease Control in 1991 (CDC, 1991).
young children who live in contaminated environments that ingest significant amounts
of lead dust through their hand-to-mouth behavior (Children’s Safety Network,
April 1997).
Despite efforts to eradicate the problem of
childhood lead poisoning, many urban areas continue to be plagued with
childhood lead poisoning incidences (Binns and Mehta, 1998).
from lead poisoning with a total of 3-4 million children affected nationwide
(Sum 10); 10% or approximately 2 million of them are preschool children (Sum
16). As many as 890,000 (8,9%) children
in the
today have levels high enough to affect learning and behavior (Sum 1-CDC,
1997).
In
population or 130,000 children between the ages of one and five have elevated
blood lead levels (California State Auditor, 1999).
lead poisoning cases than any other county in
It has been estimated that 12.7% of the population or 76,194 children
between the ages of one and five have elevated blood lead levels, using the third
National Health and Nutrition Examination Survey NHANES III, 1988-1991 (Pirkle
et al., 1994). Since 1991, the Childhood
Lead Poisoning Prevention Program (CLPPP) has identified 10,673 children with
blood lead levels higher than 10ug/dL, including 4,635 children under the age
of six. This information sets the stage
for this graduate project since it reveals that approximately 58.6% of the
children lead poisoned in the state of
reside in
2000).
This study will focus on the development and
administration of a survey to assess parents’ knowledge regarding the risk of
lead poisoning. A review of the
literature points to a significant gap in lead surveys that are designed to
properly assess parents’ knowledge regarding the risk of lead poisoning and
lead poisoning prevention, specifically in
group, not parents, that are most targeted through surveying (Goldman,
Demissie, DiStefano, McNally and Rhoads, 1998).
In addition, most studies using questionnaires and surveys are aimed at
assessing the prevalence of lead poisoning in children in high-risk populations
(Nordin, Rolnick, and Griffin, 1994) or are used to help identify children with
elevated blood lead levels, not to test parents (Schaffer, Szilagyi, and
Weitzman, 1994).
Unfortunately, in the limited studies that have been
conducted on the subject, many parents are still unaware of the dangers of lead
poisoning. Major gaps in parental knowledge
regarding the risk of lead poisoning and lead poisoning prevention methods
still exist. In one
About Lead Poisoning?’ Mehta and Binns (1998) showed that parents had limited
knowledge about ways to prevent lead poisoning and the importance of good
nutrition as a preventative measure. In
a second lead related study conducted by Irene Mahon, R.N., M.P.H. (1997) with
the Philadelphia Department of Public Health, a questionnaire was developed to
assess the knowledge, perceptions, and behaviors of family caregivers of
children under the age of eight. The
survey was administered at pediatric clinics in two geographic areas of the
city with documented severe and moderate lead poisoning rates.
children in high-risk areas did not mention lead poisoning as a health
concern. Only 15% of the parents in the
study had identified lead paint dust as a source of lead poisoning and
approximately 49% of the caregivers reported that they “never” or only
“sometimes” perform recommended prevention activities.
Sargent, and Stukel (1996) implemented a behavioral risk factor questionnaire
to identify children with elevated blood lead levels.
(N = 459) reported that
approximately 15% of their children use a pacifier, and that approximately 55%
of their children play within one yard of outside of the house, two risk
factors found to be associated with elevated blood lead levels in young
children. A large percentage of children
were reported as “not always washing their hands before eating” (50.3%) or
“after playing outside” (54%). Further,
parents reported that 11.5% of the children put paint chips in their mouth and
14.8% eat dirt or sand (Dalton, Sargent, and Stukel, 1996).
do not have much knowledge of ways to prevent childhood lead poisoning (Mehta
and Binns, 1998). Understanding what
parents know about the dangers of lead exposure can be helpful in curtailing
the problem of childhood lead poisoning.
Health professionals in the discipline of lead poisoning prevention may
use the information derived from parent knowledge surveys to develop
appropriate educational and intervention programs that address specific gaps in
knowledge and thereby affect a decrease of lead exposure in children.
Statement of the Problem
More research is needed using surveys that have been
properly designed and tested to assess parents’ knowledge regarding the risk of
lead poisoning within specific high-risk populations.
addressing the association of parental knowledge and lead poisoning in children
at high-risk. Existing surveys did not
have the questions needed to address the problem comprehensively and did not
have the questions needed to address the problem specifically for
of children at high-risk for lead poisoning know and/or don’t know about lead
poisoning and exposure. A comprehensive
survey including questions pertaining to the target population will be designed
and pilot-tested at the Watts Health Foundation WIC Clinic in the South Central
Los Angeles Community. At the Watts
Health Foundation WIC Clinic at
Avenue
assesses parents’ knowledge regarding the risk of lead poisoning to help plan
and develop more effective educational intervention programs for the community
on the subject of lead poisoning prevention.
The Watts WIC Clinic is of particular interest to
this project since it lies in a Lead Hot Zone and services five zip codes that
lie in Lead Hot Zones, including 90011, the area with the highest number of
lead poisoning cases, 504, reported to the Los Angeles Childhood Lead Poisoning
Prevention Program (CLPPP), to date.
CLPPP also has an invested interest in this project since they currently
need a standardized survey to measure parents’ knowledge regarding the risk of
lead poisoning. A standardized survey
would be beneficial to all units comprising CLPPP: Epidemiology, Health
Education, Case Management, and Environmental Health, as a means to obtain
information about what parents know or do not know about the dangers of lead
poisoning living in high-risk areas throughout Los Angeles County and as a
means to target these populations with effective educational interventions that
address the gaps in knowledge that exist.
A standardized survey would also give CLPPP a chance to combine their
efforts interdepartmentally to combat the problem of lead poisoning in these
high-risk areas.
Purpose of Project
1.
To query a selected panel of key informants with specific expertise in
childhood lead poisoning using the Delphi Method and utilize the information
derived for construction of a knowledge instrument.
2.
To design a standardized instrument for measuring parents’ knowledge
regarding the risk of lead poisoning to their children to be utilized by all
units at the Los Angeles Department of Health Services, Childhood Lead
Poisoning Prevention Program (CLPPP).
3.
To pilot-test the instrument on a large sample of parents using
services at the Watts WIC Clinic situated in a
determine any knowledge deficits that parents may have regarding the risk of
lead poisoning to their children.
4.
To make recommendations for the development of more effective
educational interventions at the
Clinic for parents regarding the risk of lead poisoning to their children.
Limitations of the Study
·
Specific target population investigated may not represent the general
population
across Lead Hot Zones in LA County.
·
Individuals participating may report inaccurate information.
Assumptions
Based on the literature review conducted and on informal
interviews and observations made by the researcher within the last year working
at LA County Childhood Lead Poisoning Prevention Program:
·
Results will show knowledge deficits in parents regarding the risk of
lead poisoning and lead poisoning prevention practices.
·
Family practices surveyed will reflect problems across Lead Hot Zones
throughout the County.
·
Parents participating in study will answer questions accurately and to
the best of their ability.
Definition of Terms
level, which is the amount of lead concentrated in the blood.
mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New Roman";
mso-char-type:symbol;mso-symbol-font-family:Symbol'>mg/dL).
Prevention Program
LEAD HOT
GIS and
percentage of pre-1960 housing, the percentage of children living in poverty,
and the number of children living in the area under the age of six.
area distinguished by these three characteristics and ranked in the top 25% by
these measures.
Methodology Outline
Querying a Selected Panel of Individuals
A.
select a panel of individuals knowledgeable in Childhood Lead Poisoning.
B.
members to help determine what types of questions should be included in the
“Lead Poisoning Knowledge Survey”
Development of the “Lead Poisoning Knowledge Survey”
A.
B.
use of a survey
C.
survey
1.
2.
pertinent questions expertly reviewed by panel members
3.
modifications to the lead survey instrument
D.
chairs
E.
approval
III.
Identify Target Population to Participate in Study
F.
of lead poisoning concern.
G.
target population can be reached
H.
IV.
Pilot-test the Lead Poisoning Knowledge Survey
A.
on a large sample of parents to see if it reveals knowledge deficits regarding
the risk of lead poisoning to their children.
1.
target population to receive instrument
2.
will be targeted
B.
the Lead Survey will be administered
1.
administration of the Lead Survey
2.
help administer the Lead Survey
V.
Analysis of the Data
A.
parental barriers to levels of knowledge regarding the problem of childhood
lead poisoning and lead poisoning prevention practices among the specific
target population assessed
1.
illustrations of frequency and percentages for each item on questionnaire.
VI.
Discussion of the Results
VII.
Development of Recommendations
A.
improving the design of more effective educational interventions directed at
parents using the Watts Health Foundation WIC services at
risk of lead poisoning
Literature Review
I. Search Topics
·
Studies conducted on parent’s knowledge regarding the risk of lead
poisoning and lead poisoning prevention methods
·
Surveys implemented on parents to assess their knowledge regarding lead
·
Child and caretaker attributes associated with lead poisoning in
children
·
National, State, and Countywide estimates for incidence and prevalence
rates of lead poisoning
·
Sources of lead poisoning
·
Symptoms of lead poisoning
·
Impact of lead poisoning on young children
·
Solutions to the problem of lead poisoning- preventative measures
·
The cultural parameters of childhood lead poisoning
·
Demographic characteristics of children who are lead poisoned
·
Description of target populations affected by lead poisoning
·
Blood lead levels in children in South Central Los Angeles
·
·
Age of housing in
Angeles
·
Lead Hot Zones within the
of
·
WIC services within Lead Hot Zones in
·
Survey design
I.
Journals
·
American Journal of Public Health
·
Archives of Environmental Health
·
Archives of Pediatric Adolescent Medicine
·
Health Education Quarterly
·
Journal of American Medical Association
·
Journal of Environmental Health
·
Journal of the National Medical Association
·
Journal of Pediatric Health Care
·
Pediatrics
·
Pediatric Nursing
·
Public Health Nursing
·
Public Health Reports
III. Other Resources
·
Poisoning
·
California Department of Health Services
·
Centers for Disease Control
·
Community based organizations
·
Environmental Protection Agency (EPA)
·
·
Los Angeles County Childhood Lead Poisoning Prevention Program,
Epidemiology, Case Management, Health Education, and Environmental units
·
Medline
·
National Health and Nutrition Examination Survey (NHANES III)
·
National Research Council, 1993
·
Other state and local Childhood Lead Poisoning Prevention Programs
·
·
Social Services
·
Development
Projected Graduate Project Chapters
I.
Introduction
A.
B.
C.
D.
E.
Definition
of Terms
II.
Review of the Literature
III.
Methodology
IV.
Results
V.
Discussion
References
California
State Auditor, Bureau of State Audits (April 1999), “Department of Health
Services has made little progress in protecting
poisoning.” [Internet address]:
Centers
for Disease Control and Prevention. (1991).
Preventing lead poisoning in young
children: A statement by the Centers for Disease Control.
Department of Health and Human Services, Public Health Service.
Children’s
Safety Network at CSR, Maternal and Child Health Bureau, Health Resources and
Services Administration, Public Health Service, U.S. Department of Health and
Human Services, April 1997.
TA. Utility of a risk assessment
questionnaire in identifying children with lead exposure.
of Pediatric Adolescent Medicine, Vol. 150, p. 197-202.
Goldman, KD, Demissie K, DiStefano, D, Ty, A, McNally, K, Rhoads, GG.
(1998). Childhood lead screening
knowledge and practice. Results of a
New Jersey physician
survey. American Journal of Preventative Medicine, Vol. 15, No. 3
Mahon , I.
(1997). Caregivers’ knowledge and
perceptions of preventing childhood lead poisoning.
Health Nursing, Vol. 14, No. 3 p.
169- 182.
Mehta, S, Binns, HJ. (1998). What do
parents know about lead poisoning?
Vol. 152. P. 1213-1218.
Nordin,
J, Rolnick S,
J. (1994). Prevalence of excess lead
absorption and associated risk factors in children enrolled in a Midwestern
health maintenance organization.
Pirkle,
JL, Brody, DJ, Gunter, EW, Kramer, RA,
(1994). The decline of blood lead levels
in the
Survey (NHANES). Journal of the American Medical Association, Vol. 272
Schaffer,
SJ, Szilagyi, PG, Weitzman, M. (1994).
Lead poisoning risk determination in an urban population through the use
of a standardized questionnaire.
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