"EFFECT OF IN-HOME EDUCATIONAL INTERVENTION ON CHILDREN'S BLOOD
LEAD LEVELS IN MILWAUKEE"
EPA Report No. 747-R-95-009 (April, 1996)
Full report available by calling 1-800-424-LEAD
Executive Summary
BACKGROUND
Education and counseling are relatively inexpensive components
of some programs for reducing blood lead levels in children.
However, these measures have not been conclusively demonstrated to
be effective. The purpose of this study was to determine whether
blood lead levels declined after in-home educational visits. The
interventions were conducted from 1991 to 1993 by regular Milwaukee
Health Department staff who went to homes of children with elevated
(20-24 ]jg/dl) blood lead levels. The in-home educational visits
described hazards associated with childhood lead exposure, and
potential sources of the hazards in the home were identified. The
importance of the child's personal hygiene, the child's nutrition,
and overall dust reduction and cleaning practices was also
discussed. The visits lasted about one hour and were performed by
health department paraprofessionals. The in-home educational
visits are part of a program designed to reduce children's lead
exposure in Milwaukee where widespread blood lead testing
identifies children with elevated blood lead levels. Outreach
workers and/or other public health officials currently attempt to
contact each family with children having elevated blood lead
levels.
METHODS
Data was compiled retrospectively from the Milwaukee Health
Department records of blood lead measurements compiled through the
blood lead testing program. The analysis was based on a comparison
of changes in blood lead levels for a study group of children who
received the outreach educational interventions versus a reference
group of children who did not receive the educational
interventions. Children who moved or whose blood lead levels may
have been affected by a lead paint abatement were eliminated from
the study. The study group includes all other children who
received outreach interventions between 1991 and 1993, had at least
one blood lead measurement between 20-24 ]jg/dl before the
intervention, and at least one measurement after the intervention.
Similarly, the reference group includes children who from 1990 to
early 1994 had at least one measurement between 20-24 ]jg/dl and a
followup measurement. Comparisons of the children whose families
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received an educational visit with a reference group were
important, because changes in average blood lead level measurements
may be caused by phenomena unrelated to educational intervention.
RESULTS
Average blood lead levels, adjusted for seasonality and age of
the children in the Milwaukee outreach intervention program, were
about 21% lower after intervention than before intervention. Blood
lead levels in the reference group of non-recipients of outreach
visits also declined, but by about 6%. This difference was
statistically significant at a p-value less than 0.001. The
difference in the average declines in blood lead levels yielded an
estimate of the net effectiveness of outreach educational
intervention of 21% - 6% = 15% (with a 95% confidence interval of
8% to 23%) . Effectiveness of the educational intervention did not
depend significantly on a child's age or sex.
DISCUSSION
The retrospective comparison shows that in-home educational
visits may have resulted in reducing children's blood lead levels
by about 15% more than for a reference group without interventions.
The validity of this conclusion depends upon whether children who
received the visits were comparable to reference group children
whose families were often unavailable for outreach visits.
Families that were unavailable for outreach visits may have been
more likely to exhibit behavior patterns responsible for the
continued elevation of their children's blood lead levels.
Nevertheless, an examination of available data on blood lead levels
and demographics indicated that the study and reference groups were
similar and were comparable for the purposes of determining the
beneficial effects of the outreach educational program.
Educational efforts at doctor's offices and clinics may also have
contributed to reduced blood lead levels in both groups, thus
having little effect on the net reduction.
Total costs of the outreach educational visits were estimated
to be in the range of $100 per visit. Blood lead levels of the
children studied were usually still elevated after the educational
intervention alone. However, important declines were observed.
Educational intervention appears to be a useful and inexpensive
component of lead exposure reduction programs.
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