Lead Awareness in Indian Country
Keeping our Children Healthy!
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PREFACE
This Curriculum is meant to provide tribal communities an educational tool to discuss potential
lead exposure and promote in-home activities that parents, grandparents, childcare providers
and others can do to reduce childhood lead exposure.
Several pilots were conducted in partnership with Oneida Community Health and
Environmental Health Safety and Land Management Programs, the Shoshone-Bannock
Tribes, the Eight Northern Indian Pueblos Council, Inc., EPA Region 5 and EPA
Region 6. Over 200 tribal representatives contributed to the success of this Curriculum
by developing content, reviewing information and evaluating messages and use.
c/EPA
United States
Environmental Protection
Agency
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Lead Awareness in
Indian Country:
Keeping our
Children Healthy!
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TABLE OF CONTENTS
Introduction 1
Using the Curriculum 3
Module 1: Understanding Lead 9
Lesson Plan 11
Worksheet 35
Key Messages 37
Kids Activity Sheet 39
Module 2: Effective Cleaning Techniques 41
Lesson Plan 43
Worksheet 55
Key Messages 57
Kids Activity Sheet 59
Module 3: Personal Hygiene and Nutrition 61
Lesson Plan 63
Worksheet 83
Key Messages 85
Kids Activity Sheet 87
Module 4: Hiring Certified Lead Professionals 89
Lesson Plan 91
Worksheet 109
Key Messages 111
Kids Activity Sheet 113
Appendix A: Foods that Contain Calcium, Iron and Vitamin C 115
Appendix B: Renovation, Repair and Painting Projects for Do-lt-Yourselfers 121
Appendix C: Glossary 123
Appendix D: Supplemental Resources 125
Acknowledgements 131
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Lead Awareness in Indian Country: Keeping our Children Healthy!
INTRODUCTION
The Lead Awareness in Indian Country: Keeping our Children Healthy! Curriculum
(Curriculum) is designed to be a user-friendly tool to educate tribal communities about lead
exposure and promote in-home activities to reduce and/or prevent potential exposure to lead.
The Curriculum identifies key information to empower individuals to act within their own homes
to protect their children and communities. Several preventative actions such as effective
cleaning techniques, proper handwashing and good nutrition can be taken by parents,
grandparents, child care providers and others to reduce children's potential exposure to lead.
This Curriculum was developed in collaboration with tribal partners to:
Raise awareness in tribal communities about childhood lead exposure;
Expand understanding of lead's potential impacts on children's health and
cultural practices; and
Encourage actions that can be taken to reduce and/or prevent childhood
lead exposure.
Children's exposure to lead may come from multiple sources and can cause irreversible and
life-long health effects. Lead is particularly dangerous to children because their growing
bodies absorb more lead than adults due to mouthing and hand-to-mouth behaviors (Ref. 1).
Children's brains and nervous systems are particularly sensitive to lead's damaging effects.
In fact, lead can affect other organs (e.g., kidneys) and systems (e.g., muscular) in the body
(Ref. 2). No safe blood lead level in children has been identified. Even low levels of lead in
children's blood can result in:
Behavior and learning problems;
Lower intelligence quotients (IQ);
Increased hyperactivity;
Slowed and stunted growth;
Hearing problems; and
Anemia.
At high levels, lead can cause:
Coma;
Seizures; and
Death, in some cases.
During pregnancy, lead is released from the mother's bones along with calcium and can pass
from the mother, exposing the fetus or breastfeeding infant to lead. This can result in serious
effects to the developing fetus and infant, including
Causing the baby to be born too early or too small;
Hurting the baby's brain, kidneys and nervous system;
Increasing the likelihood of learning or behavioral problems; and
Putting the mother at risk for miscarriage.
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The Lead Awareness in Indian Country: Keeping our Children Healthy! Curriculum is
designed to balance diverse community backgrounds, technical information and localized
knowledge to allow community leaders (i.e., instructors) an opportunity to plan and deliver
unique messages within each structured module.
Four educational modules make up the Curriculum:
Module 1: Understanding Lead - provides an overview of lead, its impacts and actions
that can be taken to reduce potential lead exposures and lead poisoning;
Module 2: Effective Cleaning Techniques - explains and demonstrates recommended
cleaning techniques for reducing household lead dust;
Module 3: Personal Hygiene and Nutrition - focuses on the connections between
personal hygiene and nutrition for children and potential exposure to lead; and
Module 4: Hiring Lead Professionals - emphasizes the importance of hiring a certified
lead professional to follow lead-safe work practices to reduce exposure to lead.
Each module consists of materials (i.e., lesson plan, worksheet, key messages, presentation
slides and kids activity sheet) to facilitate interactive sessions with participants. Instructors
do not need to be experts on lead to conduct these educational sessions. The Curriculum
is designed to provide community leaders a step-by-step guide through each module with
outlined approaches, background information, resources and examples.
The Using the Curriculum section provides instructors an in-depth understanding of how
to use the materials and guidance to prepare and present the information. Instructors may
choose to conduct modules in a manner and pace that best works for their community,
whether conducted all at once or individually over time. This Curriculum is intended to provide
instructors a starting point to hold informed conversations within their communities and
encourage behavioral changes to protect children from potential lead exposure.
References
1. Agency for Toxic Substances and Disease Registry. Case Studies in Environmental
Medicine: Lead Toxicity. 2017. Available at https://www.atsdr.cdc.aov/csem/csem.
asp?cserm=34&po=0. [Accessed August 20, 2020],
2. U.S. Environmental Protection Agency. Protect Your Family from Lead in Your Home.
2020. Available at https://www.epa.aov/lead/protect-vour-familv-lead-vour-home. [Accessed
March 30, 2020],
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Introduction
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Lead Awareness in Indian Country: Keeping our Children Healthy!
USING THE CURRICULUM
The Lead Awareness in Indian Country: Keeping our Children Healthy! Curriculum
(Curriculum) was designed with the input of over 200 tribal representatives to raise awareness
and educate tribal communities about childhood lead exposure. The Curriculum provides
technical information and encourages the inclusion of local knowledge and culture.
Instructors have the flexibility to plan and deliver messages within each of the four modules
to fit their own community and participants' needs. Make the Curriculum your own!
The target audience is broad - parents, grandparents, tribal leaders, teachers, child care
workers, healthcare providers, youth (ages 12 and up) and anyone interested in learning more
about lead and protecting children. The Curriculum is designed to be taught by community
leaders with experience educating and training members of their tribal community but does
not require instructors to be experts on lead or lead exposure. These community leaders
may include teachers, outreach specialists, educators, environmental staff, social workers,
community health workers and youth leaders.
The Curriculum
The Curriculum consists of four modules designed to be delivered sequentially, although
the modules may be used individually or in a different order. It is recommended to start
with Module 1: Understanding Lead, since it is an introduction to the topic and contains
information covered in more detail in subsequent modules. To make the sessions personal
and relevant to participants, the Curriculum was designed to be adapted by instructors to
include relevant stories, images and videos from their communities.
Module 1: Understanding Lead - This module educates participants on potential sources
of lead exposure, and lead's impacts and health effects on humans, wildlife, the environment
and cultural practices. Module 1 empowers participants with practical actions they can take
to reduce potential exposure to lead. By the end of Module 1 participants will:
Recognize potential sources of lead exposure;
Understand impacts and effects of lead exposure;
Learn simple actions to reduce lead exposure; and
Know the importance of testing children's blood lead levels.
Module 2: Effective Cleaning Techniques - This module explains and demonstrates cleaning
techniques recommended to reduce household lead dust and potential lead exposure in
the home. The cleaning techniques can be performed by any person. Module 2 includes a
discussion on how to avoid re-contaminating an area once it has been cleaned. By the end of
Module 2, participants will:
Understand the importance of proper cleaning techniques to prevent exposure to lead;
Learn about lead dust;
Recognize potential lead dust traps in the home;
Know which materials are recommended to clean lead dust; and
Identify cleaning techniques that are most effective in reducing lead dust.
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Module 3: Personal Hygiene and Nutrition Practices - This module focuses on how good
personal hygiene habits and healthy nutritional practices may limit absorption of and reduce
exposure to lead in children. Module 3 includes discussions on the benefits that personal
hygiene and good nutritional practices can have to help reduce potential exposure to lead.
By the end of Module 3 participants will:
Learn specific personal hygiene techniques that help reduce potential childhood
lead exposure;
Identify foods that contain calcium, iron and vitamin C; and
Understand nutritional practices and foods that may limit the absorption of lead.
Module 4: Hiring Certified Lead Professionals - This module informs participants on what
to do if a home, child care facility or preschool built before 1978 contains lead-based paint.
Module 4 discusses the need to hire certified lead professionals and the differences between
a lead-based paint inspection and lead-based paint risk assessment. By the end of Module 4,
participants will:
Understand the difference between a lead-based paint inspection and a lead risk
assessment;
Learn that renovation, repair and painting (RRP) jobs in a pre-1978 home with
lead-based paint creates lead dust;
Recognize the difference between lead abatement and renovation, repair and painting
projects; and
Understand what must be done by Lead-Safe Certified Firms when conducting lead
renovation activities.
Module Materials
Each module includes the following materials to facilitate interactive sessions with
participants:
Lesson Plan - The lesson plan provides a detailed guide for instructors on how to teach the
information in each module. Each lesson plan outlines necessary preparation, suggested
materials, outcomes, demonstrations, direct notes to instructors and references. "Notes"
boxes with background information and space for instructors to take their own notes are
included within each lesson plan.
Presentation Slides- The presentation slides (i.e., PowerPoint) are the main tool used by
instructors to deliver the lesson plan to participants. Lesson plan content is included within
the notes section of each slide. Instructors should edit the presentation slides to incorporate
relevant stories, images and videos, and remove any slides they do not plan to use during the
session. If access to technology is limited, instructors can use hard copies (paper handouts
of the slides).
Worksheet - The worksheet is an interactive tool to facilitate discussion and review significant
concepts. The intention of each worksheet is to help participants become familiar with the
information presented. Worksheets include various exercises and questions for participants
to record answers and are intended to be completed during sessions. Instructor notes are
provided on how and when to use worksheets.
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Using the Curriculum
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Key Messages - The key messages document outlines main points of information intended for
participants to remember. This take-home resource summarizes information covered during
each session and highlights preventative actions participants can take in their own homes to
reduce their family's potential exposure to lead. Instructors can provide these documents with
the worksheet or at the end of the session.
Kids Activity Sheet - The kids activity sheet is a handout for elementary school children that
offers fun puzzles, games and coloring that present easier to understand concepts from each
lesson plan. The activity sheet could either be completed by the child on their own or with the
help of someone older, and can be given to participants as a take-home resource.
Appendices are included at the end of the Curriculum to provide additional information to
assist instructors:
Appendix A: Foods that Contain Calcium, Iron and Vitamin C- A table of over 150
foods known to contain calcium, iron and/or vitamin C.
Appendix B: Renovation, Repair and Painting Projects for Do-lt-Yourselfers -
Safeguards to follow to prevent lead dust from spreading throughout your home when
completing do-it-yourself renovation, repair or painting projects.
Appendix C: Glossary- A list that defines key terms used throughout the Curriculum.
Appendix D: Supplemental Resources - A list of additional resources, including videos,
that instructors or participants may find helpful to understand information covered in
the Curriculum.
Actions to Reduce Lead Exposure Infographic
The Actions to Reduce Lead Exposure
Infographic (Infographic) is a visual aid
designed to show participants actions
they can take to lower and prevent
their family's potential exposure to lead.
These eight actions are highlighted and
discussed throughout the Curriculum:
1. Keep Homes Clean & Dust Free.
2. Eat a Diet High in Iron, Calcium &
Vitamin C.
3. Wash Hands.
4. Play in Grass.
5. Hire Certified Lead Professionals.
6. Shower & Change.
7. Wash Toys, Pacifiers & Bottles.
8. Run Your Water.
The placement of these eight actions at
the beginning of Module 1 provides real-
time advice before diving into detailed
discussions. Understanding preventative
actions early may lower a participant's anxiety since the instructor provides methods to
prevent potential lead exposures right away. In addition, each preventative action is then
KEEP HOMES CLEAN
& DUST FREE
RUN YOUR WATER
EAT A DIET HIGH IN IRON,
CALCIUM & VITAMIN C
WASH TOYS
PACIFIERS & BOTTLES
WASH HANDS
SHOWER
& CHANGE
PLAY N GRASS
HIRE CERTIFIED LEAD
PROFESSIONALS
/ PAD
Using the Curriculum
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reinforced later with additional information throughout the Curriculum to focus on doable
solutions, connecting back to the Infographic.
The Infographic is a flexible communications tool that can be used by instructors and
communities to:
Announce the Curriculum - Use the Infographic on flyers and other promotional
materials to advertise a community's upcoming event;
Evaluate Learning - Use the Infographic throughout Curriculum sessions to check
knowledge and reiterate actions that can be taken in the home;
Remind Participants - Use the Infographic as part of participant follow-up to remind
them how to start new actions that may prevent potential exposure to lead; and
Inform Non-participants - Use the Infographic as a stand-alone resource to educate
the community about actions that can be taken to reduce potential lead exposure.
Teaching Strategies
The Curriculum format is designed to establish community-based learning where learning
and teaching strategies come together to focus on meaningful community engagement.
With advance preparation, instructors can adjust each session appropriately to capture and
incorporate personal and local observations and real-life scenarios unique to that community.
The opportunity to include thoughtful knowledge and ideas is based on the instructor's
interaction with participants and the use of the Curriculum content. The Curriculum was built
to enrich learning experiences, discuss pertinent issues of that community and work toward
identifying relevant solutions.
Communication and activities play a critical role in the learning process. Within the
Curriculum, instructors will find built-in opportunities to interact with participants such as
open-ended questions and optional demonstrations. Educating participants in a meaningful
way comes from the instructor's use of materials and planned interactions. For example, the
worksheets provide participants the ability to connect with and reinforce Curriculum topics.
Through preparation, instructors will become more comfortable with materials and think
through meaningful ways to customize presentation slides and certain topics within lesson
plans by adding relevant stories, images and videos, and removing any slides they do not
plan to use during that session.
Instructors should familiarize themselves with all the materials provided within the Curriculum
to have a strong understanding of the information. Information within each module builds
upon previous content. Therefore, instructors need to be familiar with all of that information
even if they choose to teach only a few modules. This ensures that instructors have a strong
starting point to teach and a thorough understanding of all the lead-related topics covered.
Instructors should read each lesson plan to:
Identify which module(s) they will present;
Consult with knowledgeable parties to prepare;
Invite others to present information with them;
Gather personal, community or regional information, stories, photos, etc. that would be
useful to build learning experiences; and
Identify additional resources that may be important to participants such as brochures
and phone numbers for future follow-up.
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Using the Curriculum
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For some participants, certain suggestions such as cleaning and good hygiene practices may
be sensitive topics if participants have clutter-filled homes, difficulty discarding possessions
or bad hygiene habits. Instructors should be aware of how participants react to information
presented and use terms such as "we" and "us" throughout teachings and discussions.
Promoting Attendance
Instructors should develop a plan or consider ideas on how to increase attendance and
community involvement as they start to review the Curriculum. However, an instructor should
keep things simple. Instructors should feel comfortable with organizing sessions and should
not overwhelm themselves with too many extra items. To maximize the number of participants
from the community, instructors should think about using creative partnerships.
Instructors may want to work with local entities, such as parent groups and associations;
school and community organizations; health and community associations; and environmental,
housing and government agencies. Partnering with others will provide an existing network of
people to invite to sessions as well as identify opportunities to think about what would appeal
to the audience (i.e., parents, grandparents, tribal leaders, teachers, child care workers,
healthcare providers, youth) and anyone interested in learning about protecting children from
potential lead exposure.
Tips for planning a successful session may include:
Pulling a team together;
Identifying a budget to provide refreshments, free child care or door prizes - think
about giving out items that align with the modules such as cleaning supplies, nutritious
foods, free services, etc.;
Choosing a location that is both convenient and appealing;
Holding sessions in conjunction with other short events;
Checking community calendars to ensure there are no scheduling conflicts;
Scheduling session(s) multiple times;
Providing translation services;
Organizing a potluck meal; and
Getting an announcement out through innovative means - such as sending flyers home
with students, advertising sessions in the local paper and partnering with organizations
to include flyers in newsletters and weekly items such as paychecks.
Using the Curriculum
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Lead Awareness in Indian Country: Keeping our Children Healthy!
Module 1:
Understanding Lead
Photo provided O f Zander Environmental and H&altIi Group
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Lead Awareness in Indian Country: Keeping our Children Healthy!
Lesson Plan | Module 1 , A
UNDERSTANDING LEAD
Module 1: Understanding Lead provides an overview of lead, its impacts and actions
that can be taken to reduce potential lead exposure and lead poisoning. This module is
developed to ensure that attendees understand the seriousness of lead exposure and steps
to prevent lead poisoning. By the end of Module 1, participants will:
Recognize potential sources of lead exposure;
Understand impacts and effects of lead exposure;
Learn simple actions to reduce lead exposure; and
Know the importance of testing children's blood lead levels.
Instructor Preparation
To prepare for Module 1: Understanding Lead, the instructor should take the following steps:
Preview the lesson plan to identify sections where examples, stories and local
information may be inserted.
Reach out to tribal personnel and seek other resources to find local information and
partners, if possible.
Invite a tribal or local healthcare provider or environmental health professional to
participate in the session and be available to answer attendees' questions about
childhood blood lead levels and testing. Review the Centers for Disease Control and
Prevention's (CDC) website for information on their recommendations on children's
blood lead levels: www. cdc. gov/nceh/lead/prevention/blood-lead-levels.htm.
Research and identify sources of lead exposure(s) in your community
Discuss with tribal leaders, elders and staff your intentions to conduct the training and
whether they have any stories related to lead and lead exposure they would like shared
during this session.
Make copies of the Module 1 worksheet, key messages and kids activity sheet
(1 copy per participant).
Edit the Module 1 Presentation Slides to incorporate relevant stories, images and
videos. Remove presentation slides you do not plan to use during the session.
Use the "Notes" boxes provided in the lesson plan for personal notes.
Instructor Notes written in italics can be found throughout the lesson plan. These notes are
intended to guide the instructor through the discussion and presentation and are not meant
to be read out loud during the session.
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Notes:
Suggested Materials
Laptop and projector to display Presentation Slides
Flipchart
Markers
Module 1 Worksheet
Module 1 Key Messages
Module 1 Kid's Activity Sheet
Pens or pencils
Hard copies of presentation slides to hand out to
participants (optional)
If access to technology is limited, you can use hardcopies
of presentation slides.
Outcomes
Upon the completion of Module 1, participants will be able to:
List three sources of lead exposure;
List three health effects of lead exposure in children;
Explain how lead impacts our cultural practices and
wildlife; and
List three actions that can minimize or eliminate
potential exposure to lead.
Outline
I. Introduction (10 minutes) 14
a. Actions to Reduce Lead Exposure
II. Potential Sources of Lead Exposure (15 minutes) 16
a. What is Lead?
b. Where is Lead Found and How is it Used?
i. Tar Creek Superfund Site: A Story from
Quapaw Nation
c. Are There Other Sources of Lead in the
Community?
III. Vulnerable Populations (5 minutes) 23
a. Children
b. Adults, Including Pregnant Women
IV. Impacts and Effects of Lead Exposure (15 minutes)....24
a. Health Effects of Lead
b. Health Effects of Lead on Wildlife
c. Potential Impacts of Lead on Cultural Practices
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Lesson Plan - Module 1
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V. Taking Action (15 minutes) 28
a. Keep Homes Clean & Dust Free
b. Eat a Diet High in Iron, Calcium & Vitamin C
c. Wash Hands
d. Play in Grass
e. Hire Certified Lead Professionals
f. Shower & Change
g. Wash Toys, Pacifiers & Bottles
h. Run Your Water
i. Get Your Child Tested
VI. Conclusion (10 minutes) 32
VII. References 33
Lesson Plan - Module 1
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Notes:
Lead Poisoning
Lead poisoning is a sickness
caused by swaiiowing or
breathing iead (Ref. 1).
I. Introduction (10 minutes)
Instructor Note: Allow participants to introduce themselves.
Use the questions below to determine participants' current
knowledge and awareness of lead and lead poisoning.
Record participants' responses on a flipchart for future
reference. Remember to place an emphasis on the sentence:
"Please keep in mind that lead exposure and lead poisoning
are preventable - we can take actions to reduce potential
exposure to lead, and there are laws in place to protect us."
You may have heard of lead or lead poisoning before today
but may not know much about it. Our goal today is for you to
walk away with an understanding of lead. We will learn:
What lead is;
Where lead is found;
How lead can harm both children and adults; and
Potential impacts on the environment, wildlife and
cultural practices.
Please keep in mind that lead exposure and lead poisoning
are preventable - we can take actions to reduce potential
exposure to lead, and there are laws in place to protect us.
At the end of this session, we will discuss several actions
we can take as a community and as individuals to reduce
potential lead exposure.
Before we begin, I have a few questions for the group to gain
a better understanding of what you already know about lead
and lead poisoning:
1. How many of you have ever heard of lead or lead
poisoning before today? Instructor Note: This
can be as simple as having participants raise their
hands or respond with "yes" or "no" or you can allow
participants time to share specific stories.
2. What are some things you have heard about lead or
lead poisoning? Instructor Note: This is another good
time to allow participants to share specific pieces of
information and/or stories.
3. Does anyone know what year their house or apartment
was built; was it built before or after 1978? For those of
you who live in a house or apartment built before 1978,
this session is going to provide you with information
about lead-based paint that may be in your home.
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Lesson Plan - Module 1
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Let's make a list of questions you have about lead and the
health impacts of being exposed to lead with the hope that by
the time we have covered all of the modules included within
the Lead Awareness in Indian Country: Keeping Our Children
Healthy! Curriculum we will have covered and answered all
your questions. If you do not have a question right now, you
are more than welcome to come up and add your question
later. Instructor Note: Allow participants time to think and
then have them share their questions. Have a participant
write questions on the flipchart so you can facilitate the
conversation. Refer back to the flipchart throughout.
I would like to acknowledge that the information we are
covering today may seem alarming, but when we become
aware of and educated on this subject, we are empowered to
take preventative action to safeguard our health. Preventing
lead exposure in young children (under age six) is especially
important because as their bodies grow and develop, they
are more vulnerable to the permanent harmful impacts of
lead. As parents, grandparents, teachers, tribal leaders and
others who care about our community wellbeing, we can take
simple actions right now to prevent lead exposure, which at
the same time can benefit the overall health of our land and
our families. Exposure to lead is preventable!
Instructor Note: Give a copy of the Module 1 Worksheet,
Module 1 Key Messages and a pencil to each participant.
Here are two handouts we will use today, the worksheet and
key messages. We will use the worksheet during this session
as a discussion tool and to review what we learned together.
The key messages is a take-home resource that summarizes
information covered.
Let's go over the image on the front of the worksheet. The
image shows simple actions we can take to reduce potential
exposure to lead. We will learn more details about each
action throughout different sessions.
a. Actions to Reduce Potential Lead Exposure
Clean your home once a week using a clean, wet or
damp cloth, sponge or mop to minimize dust, which
may contain lead.
Eat a well-balanced diet with foods high in calcium,
iron and vitamin C to help reduce the absorption
of lead.
Notes:
Lesson Plan - Module 1
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Notes:
Hiring a Certified Lead
Professional
It is important to hire a certified
lead professional who is trained
to address lead hazards safely
when: a) abating a home or child
care facility built before 1978 to
correct lead hazards permanently
and b) disturbing paint in a
renovation, repair or painting
project in homes or child care
facilities built before 1978.
When Can Lead Be Seen?
In the case of lead service lines
for water, you can identify them
easily (if they are accessible) by
carefully scratching the pipe with
a key. If the pipe is made of lead
the area you scratched will turn a
bright silver color (Ref. 2).
Use soap and water (warm or cold) to wash children's
hands several times a day, especially after playing
outside or with animals.
Play in grass and dirt not contaminated with lead, and
use designated picnic, camping and hiking areas.
Hire a certified lead professional when renovation,
repair or painting will disturb painted surfaces in a
home built before 1978. Keep family out of the work
area.
Change and wash clothes, remove shoes and shower
to avoid tracking lead into the home from soil, work
sites or hobbies.
Wash daily any items your child uses regularly, such as
pacifiers and toys, to minimize exposure to dust, which
may contain lead.
Flush your home's pipes by running your tap, taking
a shower or doing a load of laundry or dishes before
drinking or cooking.
These are a few of the actions we can take to reduce our
potential exposure to lead. Later in this session, we will revisit
these actions and learn more.
II. Potential Sources of Lead Exposure
(15 minutes)
Instructor Note: This section is meant to provide participants
with a brief introduction. Various examples of exposure are
provided; actual exposure depends on a variety of factors,
such as: source, location, manufacturing processes, age and
condition of products. Throughout this section, emphasize
that these are potential sources of lead exposure so as not to
alarm participants. If needed, use information provided within
the Taking Action section to assist with your discussion.
a. What is Lead?
Lead is a naturally occurring bluish-gray metal found in small
amounts in the earth's crust. Lead is mined and then used in
products to make them durable and last longer. Once lead is
used in a product, it is nearly impossible to identify with the
naked eye. Lead does not biodegrade or disappear from the
environment over time.
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Lesson Plan - Module 1
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b. Where is Lead Found and How is it Used?
Lead has been mined and used for a long time and can be
found in many different products and places. Where do you
think lead can be found? Take a moment to glance around
the space we are in and think about your everyday activities.
Pencils may come to mind, but they are made with graphite
and not lead.
Instructor Note: Give participants time to think and talk with
each other. If they are unable to think of something, you can
either prompt them by suggesting items or simply state:
"Don't worry if you cannot think of something. Today we will
learn where lead is found and how to prevent exposure."
Congress has passed several laws related to lead. These
laws address lead in paint, dust and soil; lead in the air; lead
in water; and disposal of lead waste. As a result, these laws
limit the amount of lead that can be in products, outdoor air,
emissions from some industrial sources, waste waters
and more.
Unfortunately, lead can be found in all parts of our
environment - the air, soil, water and inside our homes. Much
of our exposure comes from human activities involving the
use of fossil fuels, past use of leaded gasoline; some types of
industrial facilities (e.g., mining and manufacturing); leaded
aviation fuel and past use of lead-based paint in homes.
Historically, lead compounds were added to paints to
enhance color, reduce corrosion or shorten drying time.
Lead-based paint, if present in older homes built before 1978,
may be a major source of exposure to lead to those who live
there. When painted surfaces are not properly maintained,
paint can deteriorate, peel, chip, chalk or crack. When lead-
based paint is old and worn or is subject to constant rubbing
(as on doors and windowsills), lead-based paint chips and
dust can scatter and become a hazard. These hazards can
be breathed in or swallowed by children, residents and
workers. Lead dust can also be scattered when paint is
disturbed during renovation, repair or remodeling.
Today, one of the most common ways children can be
exposed to lead is through contact with lead-based paint
chips and dust in buildings and homes that have lead-based
paint present when they put toys, fingers and other objects
in their mouths as part of their normal behavior. Lead-based
paint has a "sweet" taste, which makes it appealing to young
children, so they may also lick or bite chewable lead-based
paint surfaces.
Lesson Plan - Module 1 17
Notes:
Leaded Gasoline
In 1990, the Clean Air Act was
amended to ban lead in gasoline,
and it became effective
January 1, 1996. However,
leaded gasoline may still be
used for off-road uses, including
aircraft, racing cars, farm
equipment and marine engines.
Leaded gasoline can be
absorbed through the skin
(Ret 3).
Housing Built Before 1978
Lead-based paint was banned for
use in housing in 1978. Houses
built before 1978 may contain
some lead-based paint. Find out
more at: www.epa.aov/lead.
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Notes:
Exemptions to Ban of Lead-
Containing Paint and Certain
Products Bearing Lead-
Containing Paint
J he United States banned the
use of lead-based paint (paint
containing lead more than 90
parts per million) in residential
paint and some consumer
products. However, there are
several exemptions to the ban on
lead-based paint. For example,
lead-based paint may be used in:
Agricultural and industrial
equipment;
Traffic and safety markings;
Billboards and road signs;
Lawn and garden equipment;
Appliances;
Motor vehicles and boats;
Mirrors that are part of furniture;
and
Artists' paints and related
materials (Ref. 4).
Housing Built Before 1986
Lead can enter drinking water
through the corrosion of plumbing
materials, especially where the
water has high acidity or low
mineral content that corrodes
pipe fixtures. The use of any pipe,
plumbing fitting or fixture, solder
or flux was banned in 1986.
Homes built before 1986 are more
likely to have lead pipes, fixtures
and solder. Find out more at:
www, epa. gov/lead.
When lead-based paint is in good condition and is not on an
impact or friction surface, like a window, the paint is usually
not a hazard. Childhood lead exposure and lead poisoning
from lead-based paint and other sources is preventable.
The key is to keep children from coming into contact with
lead. Throughout the Curriculum we will discuss how to limit
contact with lead to prevent exposure.
Later in the Curriculum (Module 2), we will discuss how
cleaning techniques can limit a child's contact with lead-
based paint chips and dust as well as discuss how you
should hire a certified lead professional to test and work
on older homes or buildings (Module 4).
Lead and lead compounds have been used in a wide variety
of products found in and around our homes, including paint
used on some farm equipment and boats; imported pottery,
scented candles and older mini blinds; glassware; toys;
ceramicware; solder; batteries; ammunition; old cell phones
that are in disrepair and cosmetics (e.g., lipstick).
Lead can enter drinking water when plumbing materials that
contain lead corrode. The most common sources of lead in
drinking water are from lead pipes, faucets and fixtures. Lead
pipes are more likely to be found in older cities and homes
built before 1986. You may be wondering if it is safe to take
a bath or shower using water suspected of containing lead.
The answer is yes. Bathing and showering should be safe for
you and your children, even if the water contains lead. Human
skin does not absorb lead in water (Ref. 5).
Lead can be released into the environment from industrial
sources and contaminated sites, such as former lead
smelters. Improper disposal or recycling of lead-acid
batteries, improper storage of metal parts such as machinery
components, and abandoned mines may also contribute to
lead in the environment.
Some traditional pottery made in other countries labeled as
"lead free" may contain lead in the glazes and/or decorations
covering the surface. If clay pieces are not manufactured
properly, lead glaze can leach into food and drinks that are
prepared, stored or served in these dishes.
Certain pottery and other forms of ceramicware are made
with earthenware, a porous form of clay that must be glazed
to hold food or liquid. Glazing applies and fuses a thin, glass-
like coating onto the surface of the clay to seal its pores. The
glaze - which may contain lead to facilitate the melting of
glaze particles - fuses to the piece when it is fired in a kiln, a
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special oven used to bake clay. When pieces are fired at the
proper temperature for the proper amount of time, essentially
all the lead is bound into the glaze. If a piece is not properly
fired, the lead glaze may not fuse to the earthenware and may
contaminate food and drinks when used to prepare, store or
serve food and drinks (Ref. 6).
Today, many potters of traditional or 'folk' pottery have
switched to non-lead glazes. Traditional potters instead are
using other techniques such as an inner coating of pitch (pine
sap), burnishing (polishing) the surface and applying white
slip. Many Native American traditional and non-traditional
potters use traditional paint recipes created from local plants
and mineral sources; however, some do use commercial
paints.
Many households in Indian country consist of hunting families
that rely on the use of firearms to acquire food year-round.
Elevated lead exposure has been correlated with subsistence
hunting communities when game meat is harvested with
lead ammunition. Additionally, discharging firearms in
poorly ventilated areas, cleaning firearms, or handling lead
ammunition can also be a source of exposure to lead and
other chemicals known to be toxic.
While it is against federal law to use lead ammunition to hunt
waterfowl most hunting ammunition currently sold in the
United States is lead-based. High velocity lead-core bullets
explode upon impact, sending out a plume of lead dust along
with hundreds of tiny fragments into the targeted animal. In
big game, this source of lead can travel up to 18 inches away
from the wound channel, inadvertently ending up in game
meat processed for consumption. For example, X-ray studies
of venison donated to food banks across the country have
documented health risks to humans from lead exposure.
Public health officials recommend the use of non-lead
ammunition as the simplest and most effective solution to
lead poisoning, in both humans and wildlife, arising from
the consumption of deer killed with lead ammunition. In
addition, food pantries and their clients should be made
aware of possible lead fragments in venison; processors of
deer should use best practices to avoid lead exposure from
venison (Refs. 7 - 9).
Solid copper bullets and slugs have been produced for
big game hunting with increasing effectiveness since the
1980s. Today high-performance, non-lead ammunition is
available in a wide range of brands and calibers from most
manufacturers. Since non-lead ammunition retains its weight
upon impact, it delivers high-performance results while also
Notes:
Traditional Pottery
There is no way of knowing if
traditionai pottery has iead uniess
you know the techniques used
to create that piece of pottery.
Techniques vary from potter to
potter, tribe to tribe and region
to region.
If clay or natural pigments
are collected from an area
contaminated with lead,
traditional pottery may contain
lead. Today many potters of
traditional or 'folk' pottery have
switched to non-lead glazes,
but they may still be using old
kilns that were once used for
firing lead-containing glazes,
unintentionally contaminating
the "lead free" pottery with
lead residues that remain
in the kiln from past usage.
Because the lead may not fuse
into the non-lead glaze, it may
contaminate food when the
pottery is used with food (Ref. 6).
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Notes:
Elevated Blood Lead Level
A single blood lead test at or
above the CDC blood lead
reference value. For more
information on CDC's current
blood lead reference value,
visit: www, cdc. aov/nceh/lead/
prevention/blood-lead-levels, htm.
Superfund Site
Superfund is a program
administered by EPA in
cooperation with state and tribal
governments. It allows EPA to
clean up contaminated hazardous
waste sites and to compel
responsible parties to perform
cleanups or reimburse the
government for cleanups led by
EPA. For more information about
Superfund, visit: www.epa.aov/
superfund.
preventing potential lead exposure in game meat harvested
with firearms. Lead-free hunters also play an important role in
ecosystem health and species conservation, since the use of
non-lead ammunition avoids the risk of lead exposure to both
humans and wildlife.
Lead products are commonly used for hunting, fishing and
making field equipment. In some cases, people melt lead
to cast their own bullets, sinkers, decoys and other metal
items. This process emits lead into the air and deposits lead
particles into the workspace, and on their clothes, shoes
and hair. Proper ventilation and equipment are important to
reduce potential lead exposure.
Identifying personal uses of lead products is important.
For example, in Cherokee Nation, a child was found to
have a confirmed high level of lead in their body (elevated
blood lead level) after making fishing sinkers with their
father. Identifying the source of exposure took time. The
environmental staff checked all sources of paint and other
potential sources in the home (even though they lived in post-
1978 housing) and checked the parents' work environment.
The source was not found until a follow-up search of the
garage, where a pile of lead fishing sinkers was discovered.
This was determined to be the source of the child's exposure
to lead. In this case, the father, with the help of his children,
made his own fishing sinkers using lead. Lead fishing sinkers
are typically made from 100% lead. It only takes a small
amount of lead to harm a child; however, there are lead-free
tackle options available, which would eliminate this source of
exposure.
Lead is known to have leached into soil and groundwater at
some Superfund sites, including the Tar Creek Superfund
Site in northeastern Oklahoma. The Tar Creek Site is just
one example of a Superfund Site located within or near
tribal boundaries that impacts a tribe's air, water and land.
Instructor Note: You may choose to share the story of the Tar
Creek Superfund Site as shared by the Quapaw Nation or
another example relevant to your community
i. Tar Creek Superfund Site: A Story from
Quapaw Nation
Today, the Quapaw Nation works hard to clean their land
and water to reduce the effects of lead and other pollution
that disproportionately affect Quapaw tribal members. The
Tar Creek Superfund Site also pollutes the lands and waters
of seven other tribes through the portions of the Spring
and Neosho watersheds that flow across the site and cross
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their tribal lands, affecting fishing as well as consumption,
medicinal and ceremonial uses of plants.
During both World Wars, bullets and bombshells were made
from metals mined in and near Quapaw lands, which resulted
in 500 million tons of chat (i.e., crushed limestone, dolomite,
and rocks left over from the metal ore separation process). In
the 1960s, lead and mining companies ceased operations of
these mines and left chat piles that measured as high as 10
stories. Mining activities and associated waste contaminated
the soil, sediment, groundwater and surface water, and
settled dust from the piles blew across the region. Today,
mining impacts continue to be felt near tribal members'
homes.
In the late 1970s, the groundwater started to run red as a
result of pollution from the heavy metals (lead, zinc, iron and
arsenic), and the community started to link the effects of
mining to health and developmental issues of young children.
In fact, local doctors noticed children seemed to get sick
often and teachers observed state testing scores significantly
lagged in comparison to others outside the region.
In the 1980s, mining-related issues, such as sinkholes,
started to become more prevalent, and people began
to understand the health and environmental impacts
of contamination from the mines. In 1983, the federal
government designated a 40-square mile area as the Tar
Creek Superfund Site. In 2006, an Army Corps of Engineers
study showed that almost 9 out of 10 buildings in Picher,
Oklahoma, were susceptible to collapse (due to unstable
land from undermining of the site for lead and zinc and the
removal of protective pillars beneath the surface). In 2008,
the federal government provided funding for residents
and business owners in Picher to relocate. Many residents
were reluctant to leave a place they had called home for
generations.
Today, the Quapaw Nation, along with state and federal
partners, continue to clean up the 40-square-rmile lead and
zinc mining area - land and a community that have been left
with pollution, adverse health effects, ruined property values
and cultural losses. Most remediation work now involves
removing chat piles, excavating contaminated soils and
adding passive water treatment units. New wells must be
drilled and cased through the contaminated aquifer and into
a clean aquifer below. The Quapaw Nation is also utilizing
filter-based semi-continuous air monitors in the Picher area to
measure concentrations of lead and dust in the air at the site.
Notes:
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Notes:
Due to the destruction and contamination of natural
resources, many Quapaw tribal members have ceased or
greatly reduced their traditional gathering and use of natural
resources to limit exposure. The Quapaw Nation recommends
avoiding the use of carpeting in the home and wet mopping
hard surfaces to minimize dust. Water trucks also routinely
spray the unpaved roads to minimize dust kicked up by
traffic, since most unpaved county roads in the area were
graveled with chat.
Unfortunately, lead can remain in the environment for many
years and enter soil and water. Lead in soil can settle on
or be absorbed by plants grown for fruits or vegetables,
or plants used as ingredients in food, including dietary
supplements (Ref. 10). Some plants that grow in soils with
a high lead concentration can absorb lead from the soil with
most of the lead remaining in the roots and, in some rare
cases, even making its way to the aboveground parts of
the plant (Ref. 11).
Lead can also be found on the outside surface of plants,
either by sticking to the roots or by settling on the leaves
and stems when lead dust is spread through the air. Lead
ingested by animals or absorbed by or found on the surface
of plants can then be passed along the food chain when they
are consumed by both wildlife and humans (Refs. 12 & 13).
For example, lead in soil can be ingested due to hand-to-
mouth activity that is common for young children and from
eating vegetables that may have taken up lead from soil in
the garden or field (Ref. 14). Lead in soil may also be inhaled
if resuspended in the air or tracked into a house on the
bottom of shoes.
A number of potential sources of lead exposure have
been discussed as well as several actions we can take to
reduce and/or prevent exposure to lead. We will continue
our discussion of preventative actions during this and
subsequent sessions.
c. Are There Other Sources of Lead in the
Community?
Instructor Note: Use this time to discuss potential sources of
lead exposure unique to your community. Ask participants:
"Are there sources of lead exposure in our community?"
Be prepared to discuss known sources of lead such as,
if appropriate, a Superfund Site, an abandoned mine, or
improperly stored automobile parts and batteries.
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III. Vulnerable Populations (5 minutes)
All humans may potentially be exposed to lead; however,
certain groups are more vulnerable than others to lead's
harmful effects, including young children under the age of six,
pregnant women and adults who are exposed to lead through
their jobs, hobbies and/or cultural practices.
a. Children
Lead is particularly dangerous to young children under the
age of six because their growing bodies absorb more lead
than adults, and their developing brains and nervous systems
are more sensitive to lead's damaging effects.
Babies and young children's exposure to lead can be higher
because they often put their hands and other objects into
their mouths that may be contaminated by lead from dust
or soil. This could include a pacifier dropped on the floor or
ground covered with lead dust or eating paint chips or soil
that contains lead.
Children may be exposed to lead by eating food or drinking
water that contains lead. This includes drinking powdered
formula made with lead-contaminated water (Ref. 15), eating
lead dust that has settled on food and food preparation
surfaces, eating game meat with lead particles, and eating
food or drinking liquids stored or cooked in lead crystal or
lead-glazed pottery and dishes. Food and liquids stored or
served in lead crystal or lead-glazed pottery or porcelain can
become contaminated because lead can leach from these
containers into the food or liquid.
Various toys and other products may contain lead. Older toys
and furniture passed down in the family, antique doll furniture
or toy jewelry could contain lead-based paint or contain lead
in the material it is made from. This could become a problem
if children bite or swallow toys or toy jewelry that contain lead.
Parents can stay up to date on product and toy recalls due to
lead contamination and other issues by visiting the Consumer
Product Safety Commission's website: http://www.cpsc.gov/.
b. Adults. Including Pregnant Women
Working in certain jobs may increase adults' potential
exposure to lead, such as: renovation or repair of older
homes and buildings; painting; construction; refinishing
furniture; smelting; mining; auto repair and working at
hazardous waste sites. Engaging in hobbies, such as making
Notes:
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Notes:
Definition of Pica
Pica is eating nonfood items,
such as day, soii, paint chips
or paper (Ref. 17), which do not
contain significant nutritionai
value, iron-deficiency anemia
and malnutrition are two of the
most common causes of pica,
followed by pregnancy. In these
individuals, pica is a sign that
the body is trying to correct a
significant nutrient deficiency.
Treating this deficiency with
medication or vitamins often
resolves the problem (Ref. 18).
stained glass, making ammunition, shooting at a gun range
or using certain folk remedies, may increase adults' potential
exposure to lead. These activities can cause lead dust or
soil to get onto your skin, in your hair and clothing, which
can then be transferred to the interior of your car or home,
creating additional lead exposure for the rest of your family.
A pregnant woman's exposure to lead from all previously
mentioned sources is of concern because it can result in
exposure to her developing fetus. While most common in 1-
and 2-year old children, some pregnant women may also be
exposed to lead from the intentional ingestion or mouthing of
soil, clay or pottery, which is a behavior known as pica. Some
people may also partake in the deliberate consumption of
earth's (clay, soil and rocks) as part of their cultural practices.
Pica can result in serious health effects to both the mother
and her developing fetus if the sources of clay, soil and rocks
contain lead.
IV. Impacts and Effects of Lead Exposure
(15 minutes)
Lead is found in many different places and has harmful
effects on human health. Lead exposure in humans can
cause negative health impacts, which often occur with no
obvious symptoms and frequently go unrecognized. Lead
impacts the environment and wildlife. Wildlife symptoms are
easier to recognize than those of humans.
a. Health Effects of Lead
There is no known safe level of exposure to lead. Even small
amounts of lead in the blood of children can result in:
Behavior and learning problems;
Lower IQ and hyperactivity;
Slowed growth;
Hearing problems; and
Anemia.
In rare cases, high amounts of lead can have devastating
effects on children, including seizures, coma and in some
cases, even death.
Adults exposed to lead can suffer from:
Nerve disorders;
Increased blood pressure and incidence of
hypertension;
Decreased kidney function;
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Lesson Plan - Module 1
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Reproductive problems (in both men and women); and
Memory and concentration problems.
Lead can accumulate in our bodies over time, where it is
stored in bones along with calcium. During pregnancy, lead is
released from the mother's bones along with calcium and can
pass from the mother, exposing the fetus or breastfeeding
infant to lead, especially when the mother does not receive
adequate calcium through her diet. This can result in serious
effects to the developing fetus and infant, including:
Causing the baby to be born too early or too small;
Hurting the baby's brain, kidneys and nervous system;
Increasing the likelihood of learning or behavioral
problems; and
Putting the mother at risk for miscarriage.
b. Health Effects of Lead on Wildlife
Like humans, ingestion of lead in the food web can also
impact wildlife species. Animals can be exposed to lead from
mining, facility emissions and lead-based paint, but research
indicates that the ingestion of lead fishing tackle and spent
lead ammunition are two of the major sources of exposure in
wildlife (Ref. 19). This includes the direct ingestion of spent
lead shot and bullet fragments. Secondary lead poisoning
can occur when predators and scavengers target wounded
prey that has been shot and animal parts or gut piles left by
hunters that contain lead fragments from spent ammunition
(Ref. 20). This source particularly impacts scavenging bird
species such as hawks, eagles, vultures, condors, ravens,
magpies, jays, etc. Lead poisoning affects their muscles,
nerves, kidney function, reproductive systems, flight capacity
and can result in paralysis and starvation.
Waterfowl species, such as loons, ducks, geese and swans,
are also commonly affected by lead ingestion through the
consumption of spent lead shot and used sinkers or tackle.
However, many other types of birds can also be affected.
Upon ingestion of sufficient amounts of lead, birds may show
behavioral changes, such as: unsteady legs, droopy wings,
accidents when trying to land, and in more severe cases,
blindness and the inability to hold up their head.
Other symptoms include listlessness (e.g., spiritless),
vomiting, diarrhea and impaired flight.
Lead poisoning can also occur in mammals, such as
raccoons, bears, wolves and foxes. Lead exposure for these
mammals can result in vomiting, loss of appetite, diarrhea,
Notes:
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Notes:
Amphibians
Amphibians' exposure to iead
is thought to resuit from the
ingestion of iead-contaminated
sediment and lead contained in
their food or dissolved in water.
It is not believed to be through
the direct ingestion of spent
ammunition and fragments
(Ftef. 21).
lethargy and uncoordinated body movements. Repeated
exposures over time can result in anemia, convulsions,
blindness, coma or death.
Lead exposure in amphibians, such as toads and frogs,
can result in an increase in skin shedding, sluggishness
and decreased muscle tone.
Given rising concerns over known and potential impacts
of lead on wildlife (Ref. 19), many tribes are taking action
to increase the use of non-lead alternatives for fishing
and hunting activities within their tribal lands. For example,
the Menominee Tribe requires non-lead ammunition for
any harvesting of animals for food. The Flathead Indian
Reservation Tribes require the use of non-toxic shot for both
waterfowl and upland bird hunting, as well as the use of
non-lead lures or sinkers for fishing (Ref. 22). Other tribal
nations, such as the Hopi Tribe, Navajo Nation, Confederated
Tribes of Siletz Reservation, Confederated Tribes of the
Umatilla Indian Reservation and a handful of smaller tribes
have either passed resolutions or proposed recommendations
to include a non-lead ammunition component in their
hunting guidelines.
The Nez Perce Tribe of north-central Idaho initiated regional
dialogue on this topic and established a Hunter Stewardship
and Safety Program centered on lead-free subsistence
hunting. The program offers an ammunition exchange option
and facilitates community outreach to share awareness
about the human health and wildlife conservation benefits
of choosing to switch to copper-based ammunition when
harvesting food. As non-lead options for both fishing and
hunting have continued to increase, some First Nations in
Canada have also urged more leadership on this issue.
Instructor Note: Check with your tribe to see if they have
similar recommendations or resolutions on lead ammunition
and fishing tackle. In 1991, the U.S. Fish and Wildlife Service
banned the use of lead shot nationwide for hunting waterfowl
(duck, geese, swans and coots). For more information on shot
types that are approved as nontoxic for waterfowl hunting
in the U.S., visit: https://www.fws.gov/birds/bird-enthusiasts/
huntina/nontoxic.php.
c. Potential Impacts of Lead on Cultural Practices
Lead, like other heavy metals, has the potential to impact
cultural practices and subsistence lifeways. From the
catching of fish, to the gathering of plants, to the harvesting
of wild game, or the collecting of wood and other life-
sources, subsistence lifeways are vulnerable to heavy metal
exposure because they are intricately linked to the ecological
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communities and processes of living landscapes. All of
these life supporting links can be eroded or destroyed from
exposure to heavy metals that would otherwise stay out of
harm's way underground. Tribes and indigenous populations
are extremely diverse in terms of lands, languages, cultures
and diets, and are closely linked to the environment and
natural resources. Due to their connection and dependence
on the environment for the survival of their culture(s) and their
subsistence practices, tribal and indigenous populations may
have different potential sources of exposure to lead.
Are you aware of specific stories of how lead has already
impacted our community? Instructor Note: Give participants
an opportunity to share a story. If they cannot think of one,
be prepared to share a story about how cultural practices
and/or subsistence foods may have been impacted by lead
contamination. Below are a few examples:
Hunting deer, moose, elk and game - Most hunting
ammunition is lead-based, which means both wildlife
and humans are at risk of lead exposure from the
consumption of spent ammunition in game meat and
internal organs of an animal used as food (Refs. 23
& 24). In a recent study completed in North Dakota,
participants who ate any wild game had higher blood
lead levels than participants who did not consume
wild game (Ref. 25). Lead exposure cannot be limited
by cutting out the bullet wound channel and trimming
meat at the site of impact. The typical lead-core
bullet loses 30-40% of its weight in big game animal
carcasses; hundreds of fragments are dispersed
when a lead bullet is fired into an animal, making
it impossible to remove all fragments. Using lead-
free ammunition is the best way to avoid this risk of
exposure.
Gathering traditional and cultural foods - Many
traditional and cultural foods are gathered in natural
areas that may be contaminated with lead (or other
harmful materials); thus it is important to wash items
thoroughly with clean water sources prior to eating. For
example, to reduce the risk of exposure to lead, one
southwest tribe makes sure its members thoroughly
wash watercress and wild onions grown in the early
spring to remove any contaminated soil from the plant's
surface. Another northwest tribe, living in an area with
known lead soil contamination, recommends washing
and then removing the skins of water potatoes prior
to cooking and eating to reduce exposure. Overall, it
is a good practice to thoroughly wash gathered foods
Notes:
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Notes:
prior to cooking and eating as well as to understand
whether possible exposure scenarios exist in your
community.
Burning materials and ingredients for cultural and
medicinal activities - Many tribal activities involve
burning different materials for traditional, cultural and
medicinal practices. In some cases, ashes and smoke
have been found to be contaminated with chemicals,
such as when unknowingly burning wood coated with
lead-based paint. It is important to know the source
of the materials being burned to prevent community
members from being exposed to lead through both
ingestion and breathing.
Using natural life sources for various items - Natural
resources are commonly used to create cultural items,
such as clay and soil for makeup and paints. However,
it is important to know whether natural resources being
used are contaminated with lead before using them.
Consider other options if possible. Hire a professional
or contact a lab to test for the presence of lead in
natural resources.
Returned museum artifacts - Museum artifacts were
often preserved using mercury, arsenic, lead and
other toxic chemicals. Although chemists are working
on ways to clean them well enough for reuse, it is
important to understand that some older items may
contain lead or other harmful chemicals and thus
increase potential exposure to lead. When these
artifacts are returned, be sure to ask questions about
the prior preservation processes used.
V. Taking Action (15 minutes)
Lead exposure and lead poisoning are preventable. In
fact, many groups and tribes throughout the country have
implemented their own programs and projects over the
years to lower their exposure to lead and its harmful effects.
Throughout the course of the different Lead Awareness in
Indian Country: Keeping Our Children Healthy! sessions,
we will discuss different actions that you can take to reduce
potential exposure to lead. Please pull out your worksheet as
we continue our discussion of actions you can take at home
to reduce your family's potential exposure to lead.
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a. Keep Homes Clean & Dust Free
Wet mop floors and hard surfaces (e.g., porches) to
minimize lead dust.
Wipe down hard surfaces such as countertops,
window sills and doors jambs with a wet cloth.
Inspect and maintain all painted surfaces to guard
against deterioration.
Wet wipe the area immediately if you notice any
peeling, chipping, chalking or cracking paint.
b. Eat a Diet High in Iron. Calcium & Vitamin C
Ensure family members eat a well-balanced diet of
fruits, vegetables, grains, dairy and protein foods.
Foods that are higher in calcium, iron and vitamin C
can help reduce the absorption of lead. Children with
healthy diets absorb less lead.
Wash all food, including traditional and cultural foods
gathered in natural areas, thoroughly with safe water
sources prior to eating. This would remove soil or lead
dust that may have adhered to the surface.
Do not eat food or drink water cooked or stored in
chipped or cracked lead-crystal, lead-glazed pottery
or lead-porcelain cookware.
Use only cold water for drinking, cooking and
preparing baby formula. Use water from a safe source
to mix baby formula. Heat up cold water on the stove
or in a microwave if hot or warm water is needed.
Boiling water does not remove lead from water.
Know the sources of natural resources, ingredients,
herbs, etc. being used for various purposes to prevent
exposure to lead through ingestion or breathing.
Check local, tribal and regional fish advisories for
recommendations on fish consumption for pregnant
women, children under 15 years of age and the
general public. This includes recommendations on
numbers to be consumed per month for specific fish
and whether it is recommended to eat only the fillet or
the whole fish.
Switch to non-lead ammunition and fishing tackle when
harvesting wild game and fish for food, when possible.
c. Wash Hands
Use soap and water (warm or cold) to wash children's
hands several times a day, especially after playing
outside or with animals.
Notes:
Using Hand Sanitizer
There are differences between
washing hands with soap and
water and cleaning them with
hand sanitizer. Alcohol-based
hand sanitizers do not kill all
types of germs and they may not
remove harmful chemicals, such
as pesticides and heavy metals,
such as lead. Handwashing with
soap and water reduces the
amounts of all types of germs,
pesticides and metals on hands.
For more information, read
Handwashing and Hand Sanitizer
Use at Home, at Play, and Out
and About at https://www.cdc.gov/
handwashina/pdf/hand-sanitizer-
factsheet.pdf.
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Notes:
Adults should wash hands after participating in
activities where they may have come in contact
with lead.
d. Play in Grass
Guide children to play in grassy or non-contaminated
bare soil areas, especially if play areas are near
roadways, junk yards, older buildings and uncontrolled
or abandoned sites or properties.
Use designated picnic, camping and hiking areas.
Teach children to wipe and remove their shoes and to
wash their hands after playing outdoors.
Wipe off pets' paws prior to bringing them indoors.
Place dust mats both inside and outside your home.
e. Hire Certified Lead Professionals
For homes built prior to 1978, hire a certified lead
professional for renovation and repair work. Keep
residents out of the work area during renovation or
repair work which disturbs painted surfaces in older
homes and buildings until the work area is cleaned.
When having home renovations, repairs or painting
done, make sure your contractor is Lead-Safe
Certified and follows lead-safe work practices per the
requirements of EPA's Renovation, Repair and Painting
Rule. These professionals have special training and
are certified to perform this type of work.
If you are renting your home or apartment and think it
may contain lead-based paint or lead hazards, make
sure your landlord or tribal housing authority hires a
Lead-Safe Certified contractor to do renovation, repair
and painting work.
f. Shower & Change
Clean or remove work clothes and shoes before
entering your home to avoid tracking in lead from soil,
work sites or hobbies. Store work clothes and shoes in
a designated area outside the home.
Wash work clothes separately from other family
members' clothes.
Shower after participating in activities where you may
have been exposed to lead to remove any lead dust
from your skin and hair.
30
Lesson Plan - Module 1
-------
g. Wash Toys. Pacifiers & Bottles
Wash children's bottles, pacifiers and toys, like stuffed
animals, often.
Do not let children chew on painted toys, window sills
or other painted surfaces.
h. Run Your Water
Before drinking, flush your home's pipes by running the
tap, taking a shower, doing laundry or doing a load of
dishes. The amount of time to run the water will depend
on whether your home has a lead service line or not,
and the length of the lead service line. Residents
should contact their water utility for recommendations
about flushing times in their community.
Use only cold water for drinking, cooking and making
baby formula. Remember, boiling water does not
remove lead from water.
Use a filter certified to remove lead. Read the
directions to learn how to properly install and use your
cartridge and when to replace it. Using the cartridge
after it has expired can make it less effective at
removing lead. Do not run hot water through the filter.
Clean your faucet's screen (also known as an aerator)
regularly. Sediment, debris, and lead particles can
collect in your aerator. If lead particles are caught in
the aerator, lead can get into your water.
Contact your water utility or a licensed plumber to
determine if the pipe that connects your home to the
water main (called a service line) is made from lead.
Contact your water utility to have your water tested and
to learn more about the lead levels in your drinking
water.
Check with your health department or nearby water
utilities that use ground water for information on the
water in your area, if your drinking water comes from a
private well (or cistern).
Be aware of any construction or maintenance work that
could disturb your lead service line. Construction may
cause more lead to be released from a lead service
line.
i. Get Your Child Tested
Instructor Note: Participants may have questions regarding
the specifics of blood lead testing or what happens if a child's
blood lead level is elevated. No specific blood lead reference
Notes:
Private Well Water Testing
Lead can contaminate ground
water in private wells due to
the local geology. If you have
a private well, you should
consider testing the well
water periodically. Oniy use
laboratories that are certified to
do drinking water tests. To find
a certified laboratory in your
state, you can contact:
A State Certification Officer
(to get a list of certified water
testing tabs in your state,
visit: httpsJ/www.epa.gov/
dwlabcert/contact-information-
certification-programs-and-
certified-laboratories-drinking-
water).
Your iocai health department,
which may also test private well
water for free.
Your local Indian Health
Service or tribal environmental
services may be able to test for
lead and other contaminants in
private wells.
Regulations on Private Wells
EPA does not regulate private
wells, nor does the Agency
provide recommended criteria
or standards for individual wells.
For information regarding the
importance of testing private wells
and guidance on technologies
that may be used to treat or
remove any contaminants, visit:
www.epa.gov/privatewells.
While state, local and tribal
governments may develop
regulations related to private
wells, private well owners are
responsible for the safety of
their water.
Lesson Plan - Module 1
31
-------
Notes:
Blood Lead Testing in
Pregnancy
Routine blood lead testing
of pregnant women is
recommended in clinical settings
that serve populations with
identified risk factors for lead
exposure. Blood lead testing of
all pregnant women in the United
States is not recommended
(Ftef. 27).
level is mentioned in this lesson plan because the Centers for
Disease Control and Prevention (CDC) periodically updates
its recommendations on children's blood lead levels. Please
visit CDC's website for the most up-to date information on
their recommendations on children's blood lead levels at
www. cdc. gov/nceh/lead/prevention/blood-lead-levels. htm.
Only answer the questions you are knowledgeable about
and comfortable with answering. If your tribe or local health
clinic has a blood lead testing program for children, it is
recommended that you invite a program representative to join you
for this part of the session or direct participants to that program.
Raise your hand if your children or grandchildren have been
tested for lead in the past.
The only way to know if a child has lead in their blood is
to have a blood test (Ref. 26). Because lead exposure
often occurs with no obvious symptoms, it frequently goes
unrecognized. No amount of lead is safe for children. It is
generally recommended that children be tested at ages one
and two.
Contact your healthcare provider, local health department,
clinic or hospital if you would like more information about
testing your children or family members for lead.
VI. Conclusion (10 minutes)
Today we discussed sources of lead exposure; how lead
harms children and adults; its impacts on the environment
and wildlife; and actions that you can take to prevent potential
exposure to lead. The upcoming modules will go into more
detail about how to effectively clean your home to reduce
exposure; good hygiene practices for both kids and adults,
including nutritional information and how and when to hire a
certified lead professional to remove lead from the home.
In order to review what we have learned today, please flip
over the worksheet and answer the fill-in-the-blank questions
on Potential Sources of Lead Exposure and Taking Action.
You will have about five minutes to answer as many questions
as possible and then we will go over the answers as a group.
Instructor Note: At the end of the five minutes, go over the
correct answers. It is recommended that you include this as
part of your conclusion; however, you can choose to have
participants answer the questions at home.
32
Lesson Plan - Module 1
-------
I also have a few questions for the group:
1. What are the potential health effects of children exposed to lead?
2. What are the impacts of lead on the environment and wildlife?
3. Does anyone have any questions about the information covered?
To receive general information about lead or ask questions, you can call the National Lead
Information Center (NLIC). The NLIC provides the public and professionals with information
about lead, lead hazards and prevention. Call and speak with a specialist Monday through
Friday, 8:00 am to 6:00 pm Eastern time (except federal holidays) at 1 (800) 424-LEAD [5323],
Hearing- or speech-challenged individuals may access this number through TTY by calling
the Federal Relay Service at 1-800-877-8339. Instructor Note: Participants can find this
number on both the worksheet and key messages.
Thank you for participating in this session. Here is the Module 1 Kids Activity Sheet tor you
to take home. The kids activity sheet has several activities that teach children about what
we learned today. Instructor Note: Give each participant a copy of the Module 1 Kids
Activity Sheet.
VII. References
1. Centers for Disease Control and Prevention. Lead Poisoning: Words to Know from A to Z.
Available at https://www.cdc.aov/nceh/lead/tools/LeadGlossarv 508.pdf. [Accessed January 27, 2020],
2. US Environmental Protection Agency. Advice to Flint Residents. 2016. Available at https://
www.epa.aov/flint/advice-flint-residents. [Accessed January 27, 2020].
3. U.S. Department of Health and Human Services: Agency for Toxic Substances and Disease
Registry. Toxicological Profile for Lead: Draft for Public Comment: May 2019. 2019. Available at https://
www.atsdr.cdc. gov/toxprofiles/tp.asp?id=96&tid=22. [Accessed July 13, 2020],
4. Consumer Product Safety Commission. Part 1303Ban of Lead-Containing Paint and Certain
Consumer Products Bearing Lead-Containing Paint. 2008. Available at https://www.apo.aov/fdsvs/pka/
CFR-2015-title16-vol2/pdf/CFR-2015-title16-vol2-part1303.pdf. [Accessed January 27, 2020],
5. U.S. Environmental Protection Agency. Basic Information about Lead in Drinking Water. 2019.
Available at https://www.epa.gov/ground-water-and-drinking-water/basic-information-about-lead-
drinkina-water#skin. [Accessed January 27, 2020].
6. U.S. Food and Drug Administration. Questions and Answers on Lead-Glazed Traditional
Pottery. Available at https://www.fda.gov/food/metals/guestions-and-answers-lead-glazed-traditional-
potterv. [Accessed January 27, 2020],
7. North Dakota Department of Health and North Dakota Department of Agriculture. 2008/09
Lead Fragments in Ground Venison Processors Study. 2009. Available at https://www.ndhealth.gov/
lead/venison/2008-2009LeadFraamentslnGroundVenisonProcessorsStudv.pdf.
[Accessed August 12, 2020],
8. Michigan Department of Community Health. Letter Health Consultation: Lead in Venison
in Michigan. 2010. Available at https://www.atsdr.cdc.gov/hac/pha/LeadinVenisoninMichigan/
LeadinVenisoninMichiganLHC03182010.pdf. [Accessed August 12, 2020].
9. U.S. Department of Health and Human Services: Public Health Service: Agency for Toxic
Substances and Disease Registry. Health Consultation: The Potential for Ingestion Exposures to
Lead Fragments in Venison in Wisconsin. 2008. Available at https://www.atsdr.cdc.gov/HAC/pha/
LeadFragmentsinVenison/Venison%20and%20Lead%20HC%20110408.pdf. [Accessed August 12, 2020].
10. U.S. Food and Drug Administration. Lead in Food, Foodwares, and Dietary Supplements.
2018. Available at https://www.fda.gov/Food/FoodbornelllnessContaminants/Metals/ucm2006791 .htm.
[Accessed January 27, 2020],
Lesson Plan - Module 1
33
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11. U.S. Environmental Protection Agency. 2014. Technical Review Workgroup Recommendations
Regarding Gardening and Reducing Exposure to Lead-Contaminated Soils. Available at https://www.
epa.gov/superfund/lead-superfund-sites-guidance. [Accessed July 13, 2020],
12. Pourrut, B.; Shahid, M.; Dumat, C.; Winterton, P.; and Pinelli, E. Lead Uptake, Toxicity,
and Detoxification in Plants. Reviews of Environmental Contamination and Toxicology. 2011. Vol.
213, pp. 113-136. Available at https://pdfs.semanticscholar.org/9be6/8222aa4e89eb91eae921f7
8517fe785477ce.pdf? na=2.57735337.2093406863.1532459162-1251993272.1532459162. [Accessed
January 27, 2020],
13. Wierzbicka, M. and Antosiewicz, D. How lead can easily enter the food chain - a study of
plant roots. The Science of the Total Environment. 1993. Supplement, pp. 423-429. Available at https://
www.sciencedirect.com/science/article/pii/S004896970580Q439. [Accessed March 4, 2020].
14. U.S. Environmental Protection Agency. Soil, Yards and Playgrounds. 2017. Available at https://
www.epa.gov/lead/protect-vour-familv-exposures-lead#soil. [Accessed January 27, 2020],
15. Centers for Disease Control and Prevention. Lead in Drinking Water. 2019. Available at https://
www.cdc.aov/nceh/lead/prevention/sources/water.htm. [Accessed January 27, 2020].
16. National Institute for Occupation Safety and Health. Lead: Information for Workers: Jobs
That May Have Lead Exposure. 2017. Available at https://www.cdc.oov/niosh/topics/lead/iobs.html.
[Accessed January 27, 2020],
17. Centers for Disease Control and Prevention. NCEH/ASTDR Clear Writing Hub: Environmental
Health Thesaurus: Pica. 2019. Available at https://www.cdc.aov/nceh/clearwritina/thesaurus/.
[Accessed January 27, 2020],
18. National Eating Disorders Association. Pica. 2018. Available at https://www.
nationaleatinadisorders.ora/learn/bv-eatina-disorder/other/pica. [Accessed January 27, 2020],
19. Golden, N.H.; Warner, S.E.; and Coffey, M.J. A Review and Assessment of Spent Lead
Ammunition and Its Exposure and Effects to Scavenging Birds in the United States. Reviews of
Environmental Contamination and Toxicology. 2016. Vol. 237, pp. 123-191. Available at https://link.
springer.com/chapter/10.1007/978-3-319-23573-8 6. [Accessed January 27, 2020],
20. U.S. Geological Survey. Lead Shot and Sinkers: Weighty Implications for Fish and Wildlife
Health. 2008. Available at https://www.sciencedailv.com/releases/2008/07/08Q711125733.htm.
[Accessed January 27, 2020],
21. The Wildlife Society and American Fisheries Society Technical Review Committee on
Lead in the Environment. Sources and Implications of Lead Ammunition and Fishing Tackle on
Natural Resources: Technical Review 08-01. June 2008. Available at http://wildlife.org/wp-content/
uploads/2014/05/Lead08-1 .pdf. [Accessed January 27, 2020],
22. Confederated Salish and Kootenai Tribes. Flathead Indian Reservation: Fishing, Bird Hunting,
and Recreation Regulations of the Confederated Salish and Kootenai Tribes and the Montana Fish,
Wildlife & Parks (for persons who are not enrolled members of the tribes). 2019. Available at http://
csktnrd.oro/component/rsfiles/download?path=Reoulations%2BApplications%252FCSKT%2BNon-
Member%2Bregs%2BWEB.pdf. [Accessed January 27, 2020].
23. Pain, D.J.; Cromie, R.L.; Newth, J.; Brown, M.J.; Crutcher, E.; Hardman, P.; et al. Potential
Hazard to Human Health from Exposure to Fragments of Lead Bullets and Shot in the Tissues of Game
Animals. 2010. PlosOne. Available at http://journals.plos.oro/plosone/article?id=10.1371/journal.
pone.0010315. [Accessed January 27, 2020],
24. Gerofke, A; Ulbig, E; Martin, A; et al. Lead content in wild game shot with lead or non-lead
ammunition - Does "state of the art consumer health protection" reguire non-lead ammunition?
2018. PLoS One. Vol. 13. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6062035/pdf/
pone.0200792.pdf. [Accessed March 4, 2020].
25. Igbal, S.; Blumenthal, W.; Kennedy, C.; et. al. Hunting with lead: Association between blood
lead levels and wild game consumption. Environmental Research. 2009. Vol. 109, pp. 952-959.
Available at https://www.ncbi.nlm.nih.gov/pubmed/19747676. [Accessed January 27, 2020].
26. Centers for Disease Control and Prevention. Lead Poisoning Prevention. 2019. Available at
https://www.cdc.gov/nceh/lead/prevention/default.htm. [Accessed January 27, 2020],
27. Centers for Disease Control and Prevention. Guidelines for the Identification and Management
of Lead Exposure in Pregnant and Lactating Women. 2010. Available at http://www.cdc.gov/nceh/lead/
publications/leadandpregnancv2010.pdf. [Accessed January 27, 2020],
34
Lesson Plan - Module 1
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Worksheet I Module 1
Lead Awareness in Indian Country: Keeping our Children Healthy!
UNDERSTANDING LEAD
Preventing lead exposure in young children (under age six) is especially important because
as their bodies grow and develop, they are more vulnerable to the permanent harmful impacts
of lead. As parents, grandparents, teachers, tribal leaders and others who care about our
community wellbeing, we can take simple actions right now to prevent lead exposure, which
at the same time can benefit the overall health of our land and our families.
Flush your home's
pipes by running your
tap, taking a shower
or doing a load of
laundry or dishes
before drinking or
cooking.
Clean your home once a
week using a clean, wet
or damp cloth, sponge
or mop to minimize dust,
which may contain lead.
Eat a well-balanced
diet with foods high
in calcium, iron and
vitamin C to help
reduce the absorption
of lead.
KEEP HOMES CLEAN
& DUST FREE
RUN YOUR WATER
EAT A DIET HIGH IN IRON
CALCIUM & VITAMIN C
WASH TOYS
PACIFIERS & BOTTLES
WASH HANDS
SHOWER
& CHANGE
PLAY II GRASS
HIRE CERTIFIED LEAD
PROFESSIONALS
4Z
Wash daily
any items your
child uses
regularly, such
as pacifiers and
toys, to minimize
exposure to
dust, which may
contain lead.
Use soap and
water (warm or
cold) to wash
children's hands
several times a
day, especially
after playing
outside or with
animals.
Change and wash
clothes, remove shoes
and shower to avoid
tracking lead into the
home from soil, work
sites or hobbies.
LEAD
Hire a certified lead
professional when renovation,
repair, or painting will disturb
painted surfaces in a home
built before 1978. Keep
family out of the work area.
Play in grass and dirt
not contaminated
with lead, and use
designated picnic,
camping and hiking
areas.
For more information, contact the National Lead Information Center (NLIC) at 1-800-424-LEAD (5323)
35
-------
LEAD: SOURCES AND ACTIONS
Directions: The columns below contain information regarding potential sources of lead exposure and
actions we can take to reduce exposure. Fill in the blanks using the best word from each column's word
box. Answers can be found at the bottom of the page.
Potential Sources of Lead Exposure Taking Action
boats lead-acid plants
candles lead-based
drinking mined
Lead has been and used for
a long time and can be found in many different
products and places.
Improper disposal or recycling of
batteries may release lead
into the environment.
The paint used on some farming equipment and
could contain lead.
Lead has also been found in a variety of
products found in our homes, including: imported
scented , toys, glassware,
ceramicware and cosmetics.
paint, if present in older
homes built before 1978, may be a major source
of exposure to lead to those who live there. Lead-
based paint was banned for use in housing in
1978.
The most common sources of lead in
water are from lead pipes,
faucets and fixtures.
Lead ingested by animals absorbed by or
found on the surface of can
be passed along the food chain when they are
consumed by both wildlife and humans.
blood cold water
chew painted wipe
cleaned wash
Inspect and maintain all
surfaces to guard against deterioration.
Do not let children on painted
toys, window sills or other painted surfaces.
Keep residents out of the work area during
renovation or repair work which disturbs painted
surfaces in older, pre-1978, homes and buildings
until the work area is
Use only water for drinking,
cooking and preparing baby formula.
all food thoroughly with safe
water sources prior to eating, including foods
gathered in natural areas.
Teach children to and remove
their shoes and to wash their hands after playing
outdoors.
Contact your utility or a
licensed plumber to determine if the pipe that
connects your home to the water main (called a
service line) is made from lead.
The only way to know if a child has lead in their
blood is to have a test.
Of all the actions mentioned todav. I think
would be
the easiest for me to do in my home.
poo/q gjaiBM / adrn g qsBM 'g ppo > paueap 'ฃ maqo 'zpaiuiBd'i :uoipy 6ui>jBฑ
spe/d i Buiyuup g paseq-pea/ g sa/pueo > spoq ฃ ppe-pea/ ^ pauiiu 7. :saojnos
SU3MSNV
36
Worksheet - Module 1
-------
Lead Awareness in Indian Country: Keeping our Children Healthy!
Key Messages | Module 1 UNDERSTANDING LEAD
Lead may affect our health, the environment and cultural practices. There are numerous actions we can
take to reduce potential exposure to lead.
WHAT IS LEAD AND WHAT ARE SOME POTENTIAL SOURCES OF EXPOSURE?
Lead is a naturally occurring bluish-gray metal found in small amounts
in the earth's crust. Lead is mined and then used in products to make
them durable and last longer. Once lead is used in a product, it is nearly
impossible to identify with the naked eye. Lead does not biodegrade or
disappear from the environment over time.
Much of our exposure comes from human activities involving the use of
fossil fuels, past use of leaded gasoline; some types of industrial facilities
(e.g., mining and manufacturing); leaded aviation fuel and past use of lead-
based paint in homes. Lead has also been found in a wide variety of products found in and around our
homes including paint used on farm equipment and boats, ceramicware, toys, plumbing materials and some
ammunition and fishing tackle.
One of the most common ways children can be exposed to lead is through contact with lead-based paint
chips and dust in older buildings and homes that have lead-based paint present when they put toys, fingers
and other objects in their mouths as part of their normal behavior. Lead-based paint has a "sweet" taste,
which makes it appealing to young children. Lead-based paint was banned for use in housing in 1978.
Homes built before 1978 may contain lead-based paint. When lead-based paint is in good condition and is
not on an impact or friction surface, like a window, the paint is usually not a hazard.
We can reduce our potential exposure with a few simple actions, such as: washing our hands several times
a day, cleaning our homes using wet washing or washing daily the items our children use regularly.
WHY SHOULD WE BE CONCERNED ABOUT LEAD?
Lead exposure can cause negative health impacts, which often occur with no obvious symptoms and
frequently go unrecognized. The only way to know if someone has lead in their blood is to have a blood test.
Babies and young children's exposure to lead can be higher because they often put their hands and other
objects into their mouths that may be contaminated by lead from dust or soil. Lead is particularly dangerous
to young children under the age of six because their growing bodies absorb more lead than adults, and
their developing brains and nervous systems are more sensitive to lead's
damaging effects. According to the Centers for Disease Control and
Prevention, no safe blood lead level in children has been identified. Even
small amounts of lead in the blood of children can result in:
Behavior and learning problems;
Lower IQ and hyperactivity;
Slowed growth;
Hearing problems; and
Anemia.
For adults, potential exposure to lead is increased by working in certain jobs such as: renovation or repair
of older homes and buildings, painting, construction, refinishing furniture, smelting, mining, auto repair and
working at hazardous waste sites. Engaging in hobbies, such as making stained glass, making ammunition,
shooting at a gun range or using certain folk remedies, may increase adults' potential exposure to lead.
37
-------
A pregnant woman's exposure is of concern because it can result in exposure to her developing fetus
causing the baby to be born too early or too small; hurting the baby's brain, kidneys and nervous system;
and putting the mother at risk for miscarriage.
Like humans, ingestion of lead in the food web can also impact wildlife species. Animals can be exposed
to lead from numerous sources, but research indicates the ingestion of lead fishing tackle and spent lead
ammunition are two of the major sources of exposure. Lead exposure and lead poisoning can result in
vomiting, diarrhea, impaired flight, behavioral changes, loss of appetite, lethargy and uncoordinated body
movements. Lead exposure can also affect their reproductive systems and even result in death.
Lead, like other heavy metals, has the potential to impact cultural practices and subsistence lifeways. From
the catching of fish, to the gathering of plants, to the harvesting of wild game or the collecting of wood and
other life-sources, subsistence lifeways are vulnerable to heavy metal exposure because they are intricately
linked to the ecological communities and processes of living landscapes. All of these life supporting links
can be eroded or destroyed from exposure to heavy metals that would otherwise stay out of harm's way
underground. Tribes and indigenous populations are extremely diverse in terms of lands, languages,
cultures and diets, and are closely linked to the environment and natural resources. Due to their connection
and dependence on the environment for the survival of their culture(s) and their subsistence practices, tribal
and indigenous populations may have different potential sources of exposure to lead.
WHAT CAN I DO TO REDUCE MY FAMILY'S POTENTIAL EXPOSURE TO LEAD?
Lead exposure is preventable - we can start with a few actions at home, such as those shown below, to
reduce potential exposure to lead.
KEEP HOMES CLEAN
& DUST FREE
RUN YOUR WATER
EAT A DIET HIGH IN IRON,
CALCIUM & VITAMIN C
WASH TOYS,
PACIFIERS & BOTTLES
WASH HANDS
x\ vV
\ SHOWER
PLAY IN GRASS
& CHANGE
HIRE CERTIFIED LEAD
PROFESSIONALS
LEAD
WHERE CAN I LEARN MORE?
For more information, contact the National Lead Information Center (NLIC) at 1-800-424-LEAD (5323)
or visit www.epa.gov/lead.
38
Key Messages - Module 1
-------
Lead Awareness in Indian Country: Keeping our Children Healthy!
Kids Activity Sheet | Module! UNDERSTANDING LEAD
Maze Fun
Lead is a metal that might be in paint in your house and is not good for our body. Make your
way through the maze and iearn 6 actions you can take to keep your family healthy.
Eat healthy
foods
Leave
dirty
shoes
at the
door
Wash
hands
with
soap
and
water
m
1
r
r
r
i
i
Wash
toys,
pacifiers
and
bottles
Use
cold
water
for
cooking
and
drinking
Clean
your
room
mm3
39
-------
Fill in the Blanks
Fill in the blank with the best word from the word box for each statement below:
fruits soap toys shoes cold
1. Use water for drinking or cooking.
2. Wash your hands with and water several times a day.
3. Remove your when you come inside after playing or working
outdoors.
4. Wash bottles, pacifiers and , like stuffed animals, often.
5. Eat plenty of and vegetables.
sjimf s 's/foj p !sdoqs ฃ '.doos z -Pioi l :sj9msu\/
Color Time
Run the water before
drinking or cooking.
To beep my family healthy, I will...
Draw or write which action you will do to keep your family healthy.
40 Kids Activity Sheet - Module 1
Use a wet cloth,
sponge or mop
to clean.
-------
Lead Awareness in Indian Country: Keeping our Children Healthy!
Module 2:
Effective Cleaning
Techniques
-------
42
-------
Lead Awareness in Indian Country: Keeping our Children Healthy!
Lesson 'Ian | Module 2 EFFECTIVE CLEANING TECHNIQUES
Module 2: Effective Cleaning Techniques explains and demonstrates recommended
cleaning techniques for reducing household lead dust, which is one of the most common
sources of lead exposure for young children. By practicing simple cleaning techniques
routinely, families can reduce their potential exposure to lead. By the end of Module 2,
participants will:
Understand the importance of proper cleaning techniques to prevent exposure to lead;
Learn about lead dust;
Recognize potential lead dust traps in the home;
Know which materials are recommended to clean lead dust; and
Identify cleaning techniques that are most effective in reducing lead dust.
Instructor Preparation
To prepare for Module 2: Effective Cleaning Techniques, the instructor should take the
following steps:
Preview the lesson plan to identify sections where examples, stories and local
information may be inserted.
Reach out to tribal personnel and seek other resources to find information and
partners, if possible.
Contact your tribal and/or local health departments and ask if they have a High
Efficiency Particulate Air (HEPA) vacuum available to loan to residents.
Make copies of Module 2 worksheet, key messages and kids activity sheet (1 copy per
participant).
Gather cleaning supplies and materials for demonstrations and the group activity
For the Group Activity: Lead Dust Clean-Up - Select a location (window or floor) in
the meeting space to be used and prepare the location for cleaning by sprinkling with
wood shavings, or tiny pieces of paper to simulate lead dust.
For the Optional Demonstration, prepare a flat, hard surface such as a table or spot on
the floor using corn starch or flour to represent lead dust.
Edit the Module 2 Presentation Slides to incorporate relevant stories, images and
videos. Remove presentation slides that you do not plan to use during the session.
Review Module 4: Hiring Certified Lead Professionals for background information on
when to hire a certified lead professional to conduct lead-based paint inspections or
risk assessments.
Use the "Notes" boxes provided in the lesson plan for personal notes.
Instructor Note written in italics can be found throughout the lesson plan. These notes are
intended to guide the instructor through the discussion and presentation and are not meant to
be read out loud during the session.
During this module, emphasize that the household cleaning techniques described throughout
are specific to areas that may contain lead dust or lead-based paint chips.
-------
Notes:
Suggested Materials
Laptop and projector to display presentation slides
Module 2 Worksheet
Module 2 Key Messages
Module 2 Kids Activity Sheet
2 buckets or a double bucket with warm water
All-purpose cleaner
2 mops
Roll of paper towels
Sponges and cloths
Trash bags
Wood shavings, flour, corn starch or shredded paper
(to simulate lead dust)
Gloves (this is optional since participants will not be
cleaning up actual lead dust)
Pens or pencils
Hard copies of presentation slides to hand out to
participants (optional)
If access to technology is limited, you can use hard copies
of presentation slides.
Instructor Note: Consider using an all-purpose cleaner that
meets the EPA Safer Choice Standard. Search for products
using this website: https://www.epa.gov/saferchoice/products.
Outcomes
Upon the completion of Module 2, participants will be able to:
List three lead dust traps typically found in homes;
List three items used to clean lead dust in the home;
Demonstrate proper cleaning techniques; and
Explain how to prevent re-contaminating previously
cleaned areas of the home.
44 Lesson Plan - Module 2
-------
Outline
Notes:
Introduction (5 minutes)
46
II. Lead Dust Traps (15 minutes)
46
a. Potential Lead Dust Traps
III. Recommended Cleaning Techniques (20 minutes) 48
a. Cleaning Techniques to Reduce Indoor Lead Dust
i. Floors, Baseboards, Carpets and Rugs
ii. Windows and Window Sills
iii. Air Duct Covers and Radiators
iv. Doors, Door Frames, Walls and Other
Painted Surfaces
v. Stairs, Railings and Banisters
vi. Furniture
b. Group Activity: Lead Dust Clean-up
IV. Helpful Hints (10 minutes) 52
V. Conclusion (10 minutes) 53
VI. References 54
Lesson Plan - Module 2
45
-------
Notes:
Lead Dust
Lead in household dust results
from indoor sources, such as old
lead-based paint on surfaces
that are frequently in motion or
bump or rub together (referred
to as friction surfaces, such as
when doors or windows are
opened and closed), deteriorating
old lead-based paint on any
surface, home repair activities,
lead-contaminated soil tracked
from the outdoors into the indoor
environment, or even from lead
dust on clothina worn at a job site
(Ref. 2).
I. Introduction (5 minutes)
In Module 1: Understanding Lead, we learned about
potential sources of lead exposure; health effects of lead
exposure in children; potential impacts of lead on cultural
practices and wildlife; and actions that can minimize or
eliminate potential exposure to lead. Examples of these
actions include washing children's hands often and removing
shoes before entering your home to avoid tracking in lead
from soil, work sites and/or hobbies.
Do you think that cleaning your house using specific cleaning
techniques could help reduce potential exposure to lead?
Instructor Note: Allow participants a moment to think and
respond.
Yes! You can reduce your family's potential exposure to lead
in the home by using specific cleaning techniques that allow
you to safely remove lead dust and paint chips.
Lead dust can form when lead-based paint is scraped,
sanded or heated. It also forms when painted surfaces
containing lead bump or rub together (Ref. 1). For today's
discussion, lead dust is defined as household dust that
contains lead.
Today, we will discuss and practice some recommended
cleaning techniques for areas in the home where there is
peeling, chipping, deteriorating or cracking lead-based
paint and where lead dust is formed.
When areas with lead-based paint or lead dust are not
cleaned properly it may increase risks to families, especially
to children under age six and pregnant women. Therefore,
it is important to use the cleaning methods introduced in this
module to reduce your family's potential exposure to lead.
II. Lead Dust Traps (15 minutes)
A lead dust trap is a space or object where lead dust can
easily gather on, in or under. Many areas or surfaces in
homes could have lead dust. High-traffic areas where you
and your family spend most of their time within the home such
as the living room, kitchen and bedrooms are common places
where dust gathers. Surfaces that receive a lot of wear-and-
tear (use) can deteriorate lead-based paint into dust particles
and chips over time, causing these areas to be common
sources of lead dust.
46
Lesson Plan - Module 2
-------
Unfortunately, high-traffic areas also tend to be the favorite
spots for children to play. Babies and young children often
put their hands, feet or toys into their mouths, which may
result in swallowing or breathing in lead dust. Lead-based
paint has a "sweet" taste, which makes it appealing to young
children, so they may also lick or bite chewable lead-based
painted surfaces. Children's hands are small and can fit in
tight places that are often missed during cleaning.
By concentrating cleaning efforts on areas where lead dust
is commonly trapped, potential exposure to lead dust can be
dramatically reduced. Any lead dust missed during cleaning
or spread by using inappropriate cleaning techniques such
as dry sweeping or dusting can easily spread to other areas
of the home, including those that have already been cleaned,
and then be swallowed or breathed in by children and adults.
This means that thorough cleaning using effective techniques
is important. Cleaning is a great way to prevent potential lead
exposure.
a. Potential Dust Traps
Instructor Note: Give a copy of the Module 2 Worksheet,
Module 2 Key Messages and a pencil to each participant.
Here are two handouts we will use today, the worksheet and
key messages. We will use the worksheet during this session
as a discussion tool and to review what we learned together.
The key messages is a take-home resource that summarizes
information covered.
What are some areas in the home that could have high levels
of lead dust? Using the front of the worksheet, discuss with a
partner which areas in the home you think could be lead dust
traps. There are six areas in the home considered to be lead
dust traps. The home shown in the worksheet has at least six
lead dust traps. Find and circle them all. Instructor Note:
Allow participants several minutes to complete the activity and
then go over the answers below. Answers are provided upside
down on the bottom of the front page of the worksheet.
As we go over answers, make sure you have the correct
items circled on your worksheet. You can also use your
worksheet to take notes.
1. Floors and Baseboards - Lead dust can be dispersed
from deteriorated lead-based paint applied on floors
and baseboards. Carpets and rugs can contain lead
dust dispersed from deteriorated lead-based paint on
floors, baseboards and walls.
Notes:
Lesson Plan - Module 2
47
-------
Notes:
2. Windows and Window Sills - Lead-based paint on
windows, window sills and troughs (the area between
the interior window sill and the storm window frame)
can chip or flake as a home ages and after repeatedly
opening and closing, resulting in lead dust settling on
and around windows.
3. Air Duct Covers and Radiators - The surfaces or
covers of air ducts (areas along walls and floors
covered by metal grates) and radiators can be coated
with dust, although the concentration of lead dust in
this area generally is not as high as in other areas of
the home.
4. Doors and Door Frames - Dust from lead-based paint
can be dispersed into the air from painted walls,
windows and floors and then settle on doors and door
frames. Lead from outside sources may also stick
to the surface of exterior doors and then be tracked
inside the home.
5. Stairs, Railings and Banisters - Walking on stairs
painted with lead-based paint causes the paint to flake
and chip, which disperses lead dust on stairs, railings
and banisters.
6. Furniture - Lead dust dispersed into the air can settle
and collect on furniture, such as tables and couches,
and then re-enter the air when you vacuum, dust or
sweep.
Excessive clutter may prevent you from effectively cleaning
your home as various items in your home could be potential
lead dust traps.
III. Recommended Cleaning Techniques
(20 minutes)
Cleaning lead dust traps weekly can reduce your family's
exposure to lead. Windows, doors, floors, and furniture need
regular cleaning because lead dust is hard to completely
remove and can quickly re-collect.
What specific cleaning techniques do you think might be
important to incorporate into our cleaning habits to help safely
remove lead dust from the home? Instructor Note: Allow
participants a moment to think and respond before describing
the recommended techniques. While it is recommended to
have two buckets for wet washing, it is not required.
48
Lesson Plan - Module 2
-------
Wet washing, using wet or damp items, is the best way to
clean lead dust. Specifically, in the case of lead dust, this
means cleaning areas at least weekly with a mop, cloth or
sponge, warm water and a general all-purpose cleaner, using
two buckets (or a split bucket, if available). Two buckets
assist in preventing dust from being redistributed to newly
cleaned surfaces. Areas that should be wet washed include
windows, window sills and troughs, doors, floors, stairs,
furniture and air ducts. Remember: Never mix ammonia and
bleach products because they can form a dangerous gas.
Follow instructions on the label of all cleaning products used
and keep cleaning products out of the reach of children.
Follow these steps for wet washing when cleaning:
1. In bucket 1, mix general all-purpose cleaner and
warm water.
2. Fill bucket 2 with warm water - this will be your clean
rinse water to frequently rinse off mop heads, cloths
and sponges while cleaning.
3. Put on gloves.
4. Use a damp paper towel to remove loose paint chips
and debris and then place the used paper towel in a
garbage bag and seal for disposal.
5. Use a cloth, sponge or mop dipped in bucket 1 (the
cleaning solution) and clean all surfaces thoroughly.
6. Use a clean cloth, sponge or mop that has been
dipped in bucket 2 (the clean rinse water) to rinse the
newly cleaned area.
7. Thoroughly rinse mop heads, cloths and sponges
(preferably in a sink or area not used for food
preparation) when finished cleaning.
a. Cleaning Techniques to Reduce Indoor
Lead Dust
Wet washing is the general cleaning technique recommended
to reduce indoor lead dust in your home. For each of the
six lead dust traps mentioned earlier (and listed on your
worksheet) there are specific cleaning recommendations
we will discuss now.
Notes:
Safer Choice Standard
Consider an all-purpose cleaner
that meets the EPA Safer Choice
Standard. Search for products
using this website: https://www.
epa.gov/saferchoice/products.
Optional Demonstration
Demonstrate the benefits of wet
washing by using corn starch or
flour to represent lead dust:
1. Gather participants around a
flat, hard surface, such as a table
or a spot on the floor, and sprinkle
corn starch or flour across the
surface.
2. Divide the area in half. Clean
one-half with a dry cloth and the
other half with a wet cloth dipped
in bucket 1 (as described in step
1 of wet washing).
3. Show participants both cloths
and have them examine the
cleaned area. Ask participants:
which cleaning technique (wet or
dry) did the better job of cleaning
up the dust? Instructor Note: The
answer is the technique
using the wet cloth.
Lesson Plan - Module 2
49
-------
Notes:
i. Floors. Baseboards. Carpets and Rugs
Clean floors and baseboards with a clean wet mop, cloth or
sponge and a general all-purpose cleaner. Vacuum carpets
and rugs often using a vacuum cleaner equipped with a High
Efficiency Particulate Air (HEPA) filter, which traps extremely
small particles such as lead dust. Regular vacuum cleaners
not equipped with a HEPA filter can spread lead dust into the
air and disperse it around the home.
Do not use mops with a scrubber strip attached when
cleaning uncarpeted floors, as the scrubber strips will
wear away any painted surfaces.
Do not use powered buffing or polishing machines,
or vacuums with beater bars that may wear away the
painted surface of uncarpeted floors.
Do not dry sweep.
Do not shake or beat carpets and rugs, vacuum them
instead.
ii. Windows and Window Sills
Clean windows, window sills and troughs with a damp cloth
or sponge and a general all-purpose cleaner. Window sills
and troughs with large amounts of dust may require using a
vacuum cleaner equipped with a HEPA filter. After vacuum-
ing, follow up by cleaning with a damp cloth or sponge and a
general all-purpose cleaner. Standard vacuum cleaners may
be used if there is no visible dust or debris from chipping or
flaking paint (Ref. 3).
iii. Air Duct Covers and Radiators
Clean the surface of air duct covers (areas along walls and
floors covered by metal grates) and radiators monthly using
a clean wet cloth or sponge and a general all-purpose
cleaner. Frequently replace all air filters (including HEPA
filters) in the furnace or heating, ventilation and air
conditioning (HVAC) system.
iv. Doors. Door Frames. Walls and Other Painted
Surfaces
Wipe down doors, door frames, walls and other painted
surfaces with a clean, wet cloth or sponge and a general
all-purpose cleaner. Do not use:
Steel wool, scouring pads and abrasive cleaners;
Solvent cleaners that may dissolve paint; or
Excessive rubbing of spots, as this may wear away
any painted surfaces.
v. Stairs. Railings and Banisters
Clean stairs, railings and banisters with a wet mop, cloth or
sponge and a general all-purpose cleaner.
50
Lesson Plan - Module 2
-------
vi. Furniture
Dust furniture weekly with furniture polish to prevent the
spread of dust into the air. Upholstered furniture, such as
couches, do not generally have high concentrations of lead
dust that other surfaces do; however, regular cleaning with a
HEPA vacuum or a wet washing method is recommended.
b. Group Activity: Lead Dust Clean-Up
Now that we have discussed the recommended way to
clean lead dust, it is your turn to practice what you have just
learned. As a group we are going to clean this room as if we
think it has lead dust. Instructor Note: Break participants into
four groups, assigning each group specific steps in the wet
washing process discussed earlier
Group one will start by preparing the cleaning solution
in bucket one and filling bucket two with clean rinse
water;
Group two will then collect any visible loose "chips and
dust" using damp paper towels, placing them in
a garbage bag and sealing for disposal;
Group three will then mop or wipe up the area using a
damp mop, cloth or sponge dipped in bucket one; and
Group four will finish by rinsing the area using a
different damp mop, cloth or sponge dipped in bucket
two.
Encourage participants to pay attention to other groups. As
participants clean, check techniques and answer questions.
What are your initial thoughts after practicing the
recommended cleaning techniques for reducing lead dust?
Instructor Note: Allow participants time to think and respond.
Then ask the questions below:
1. How similar are these techniques to how you already
clean your home?
2. What might be hard about changing your cleaning
techniques and habits?
3. What wet washing step did we skip during the group
activity? Instructor Note: We skipped the last step of
thoroughly rinsing mop heads, cloths and sponges,
since we were not actually cleaning up lead dust, just
items that represented lead dust.
Notes:
Lesson Plan - Module 2
51
-------
Notes:
IV. Helpful Hints (10 minutes)
Imagine that you have just finished cleaning your home using
the techniques we just discussed and practiced. What should
we do to avoid re-contaminating the area? Instructor Note:
Allow participants time to think and respond, and then share
the information below.
We should:
Wash hands and cleaning supplies in a sink (or area)
that preferably is not used for food preparation.
Wash the sink itself after washing your cleaning
supplies, so that lead dust does not remain in the sink.
Wipe off your shoes after cleaning to avoid tracking
dust around your home.
Wash clothes and shoes worn while cleaning
separately from other laundry.
Shower and wash hair when you finish cleaning.
Some additional hints for cleaning:
Declutter your home.
Clean yourself out of a room by starting at the furthest
point within the room and work your way to the
doorway.
Clean from top to bottom in every room.
Wipe down walls and areas along the floor up to five
feet in either direction of the object you are cleaning in
case lead dust has blown around.
Remove and wash curtains and mini-blinds before you
wash the windows.
If using aerosols or sprays, spray onto the cloth rather
than directly onto furniture to avoid blowing lead dust
around.
Other things to keep in mind:
Wash toys, bottles, pacifiers and stuffed animals
regularly.
Keep children from chewing painted areas or old
painted toys.
Regularly check for paint chips or dust - if you see
some, remove carefully with a damp paper towel and
discard in the trash, then wipe the surface clean with a
wet paper towel. If renting a house or apartment, notify
the landlord of any cracked or peeling paint.
52
Lesson Plan - Module 2
-------
Clean faucet screens (also known as an aerator)
regularly by unscrewing it from the bottom of the faucet
and run water through the screen (holding it right side
up and upside down). Lead particulate and sediment
can build up behind faucet aerators and be a potential
source of exposure.
V. Conclusion (10 minutes)
During today's session, we focused on recommended
cleaning techniques to reduce potential exposure to lead
in our homes. Let's do a quick review of the information
we covered.
What are some lead dust traps in the home? Instructor
Note: Some possible answers may include windows,
doors, floors, air duct covers, stairways, toys, pacifiers,
stuffed animals, baby bottles, etc.
Turn your worksheet to the side labeled Lead Dust Cleaning
Techniques. Work with the person sitting next to you to match
each lead dust trap with recommended cleaning technique.
A cleaning technique can be matched to more than one
lead dust trap since the same technique is recommended
for cleaning more than one area in the home. Instructor
Note: Allow participants a few minutes to complete the
matching exercise and then review answers with the whole
group. Answers can be found upside down under the
Recommended Cleaning Technique column.
Look at the Helpful Hints section at the bottom of your
worksheet to finish our review. Instructor Note: Go through
the Helpful Hints questions together.
1. After cleaning your home using the recommended
cleaning techniques, what should you do to avoid
re-contaminating the area(s) you just cleaned?
Select all that apply.
~ Wash hands and cleaning supplies in a sink
(or area) that preferably is not used for food
preparation.
~ Wash the sink itself after washing your cleaning
supplies, so that lead dust does not remain in the
sink.
~ Shower and wash hair when you finish cleaning.
~ Wipe shoes off after cleaning to avoid tracking
lead dust around your home. Instructor Note: All
answers are correct.
Notes:
Lesson Plan - Module 2
53
-------
Notes:
2. True or False - I should remove and wash curtains
and mini-blinds AFTER I wash the windows. Instructor
Note: False, do this BEFORE washing the windows.
3. True or False - Many items in my home are potential
lead dust traps, and clutter could prevent me from
effectively cleaning my home. Instructor Note: True,
it is easier to clean when a home is not cluttered.
What are new cleaning techniques you will start using in your
home? Use the box at the bottom of your worksheet to write
down an answer. Instructor Note: If you have time, have a
few participants share what they wrote down.
Possible answers may include:
Cleaning windows, doors, floors, stairs and furniture
once a week.
Using a wet or damp cloth, sponge or mop.
Washing children's bottles, toys, pacifiers and stuffed
animals regularly.
Does anyone have any questions about today's topic?
If you would like more information about cleaning lead dust,
contact the National Lead Information Center (NLIC) at
1-800-424-LEAD, or your local health department or clinic.
Instructor Note: Participants can find this number on both
the worksheet and key messages.
Thank you for participating in this session. Here is the Module
2 Kids Activity Sheet for you to take home. The kids activity
sheet has several activities that teach children about what we
learned today. Instructor Note: Give each participant a copy
of the Module 2 Kids Activity Sheet.
VI. References
1. U.S. Environmental Protection Agency. Protect Your
Family from Lead in Your Home. 2017. Available at https://
www.epa.gov/lead/protect-vour-familv-lead-vour-home.
[Accessed March 4, 2020],
2. U.S. Environmental Protection Agency. Protect Your
Family from Exposures to Lead: Dust. 2017. Available at
https://www.epa.gov/lead/protect-your-farmily-exposures-
lead#sources. [Accessed March 4, 2020],
3. U.S. Environmental Protection Agency. Protect
Your Family from Exposures to Lead: Maintain You Home's
Condition. 2017. Available at https://www.epa.aov/lead/how-
rmake-vour-horme-lead-safe#Maintain. [March 4, 2020],
54
Lesson Plan - Module 2
-------
Worksheet I Module 2
Lead Awareness in Indian Country: Keeping our Children Healthy!
EFFECTIVE CLEANING TECHNIQUES
djnijujnj. g sjajsiueq pue 'Buijibj 'sjibis 'g seuiejj
joop PUB SJOOP p SJOJBipBJ pUB SJdAOO JOnp JIB ฃ S///S MOpUlM pUB SMOpUlM ฃ SpjBOqdSBq pUB 's6m 'SiedjBO 'SJOOj} I
SH3MSNV
LEAD DUST TRAPS
Lead in household dust (lead dust) can form when lead-based paint is scraped, sanded or heated, it also
forms when painted surfaces containing lead bump or rub together, A lead dust trap is a space or object
where lead dust can easily gather on, in or under.
Directions: This home has at least six lead dust traps. Find and circle them all.
-------
LEAD DUST CLEANING TECHNIQUES
Directions: Draw a line to match each lead dust trap with a recommended cleaning technique. A cleaning
technique can be matched to more than one lead dust trap since the same technique is recommended for
cleaning more than one area in the home.
1.
2.
3.
4.
5.
Lead Dust Tra
Floors, baseboards,
carpets and rugs
Windows and window
sills
Air duct covers and
radiators
Doors and door
frames
Stairs, railings and
banisters
i
A.
Recommended Cleaning Technique
Wet cloth or sponge and
all-purpose cleaner
B.
Wet mop, cloth or sponge
and all-purpose cleaner
or HEPA-filter vacuum
C.
Dust with furniture polish
and a cloth
D.
6. Furniture
Wet mop, cloth or sponge
and all-purpose cleaner
o 9 a '5 v pv ฃv z a 'i
SH3MSNV
HELPFUL CLEANING HINTS
1. After cleaning your house using the recommended techniques, what should you do to avoid
re-contaminating the area(s) you just cleaned? Select all that apply.
~ Wash hands and cleaning supplies in a sink (or area) that preferably is not used for food preparation.
~ Wash the sink itself after washing your cleaning supplies, so that lead dust does not remain in the sink.
~ Shower and wash hair when you finish cleaning.
~ Wipe off your shoes after cleaning to avoid tracking dust around your home.
2. TRUE or FALSE -1 should remove and wash curtains and mini-blinds AFTER I wash the windows.
3. TRUE or FALSE - Many items in my home are potential lead dust traps, and clutter could prevent me
from effectively cleaning my home.
J => y enjฑ ฆฃ ss/B-j g iosjjoo sjb i/b i
SU3MSNV
After today I am going to start using the following cleaning technique(s) in my home
56
Worksheet - Module 2
-------
Key Messages | Module 2
Lead Awareness in Indian Country: Keeping our Children Healthy!
EFFECTIVE CLEANING TECHNIQUES
You can reduce your family's potential exposure to lead dust in the home by using specific cleaning
techniques that allow you to safely remove lead dust particles and paint chips.
WHAT IS LEAD DUST?
Lead dust is household dust that contains lead. Lead
dust can form when lead-based paint is scraped, sanded
or heated. Lead dust also forms when painted surfaces
containing lead bump or rub together, such as when
windows are opened and closed, or from deteriorating old
lead-based paint.
WHAT IS A LEAD DUST TRAP AND WHAT ARE
SOME EFFECTIVE CLEANING TECHNIQUES?
A lead dust trap is a space or object where lead dust can
easily gather on, in or under. Many areas in your home
could be a potential lead dust trap. Wet washing weekly
with a mop, cloth or sponge, warm water and a general all-
purpose cleaner is the best way to clean up lead dust.
1
There are specific cleaning methods for different areas of
the home as detailed in the table below.
AREA OF THE
HOME
POTENTIAL LEAD DUST TRAP
RECOMMENDED
CLEANING TECHNIQUE
Floors, Baseboards,
Carpets and Rugs
Lead dust can be dispersed from
deteriorated lead-based paint applied
on floors and baseboards. Carpets and
rugs can contain lead dust dispersed
from deteriorated lead-based paint on
floors, baseboards and walls.
Clean floors and baseboards with
a clean, wet mop, cloth or sponge.
Vacuum carpets using a vacuum
cleaner equipped with a High Efficiency
Particulate Air (1II: PA) filter, which traps
extremely small particles such as lead
dust.
Windows and
Windowsills
Lead-based paint on windows, window
sills and troughs (area between the
interior window sill and the storm
window frame) can chip or flake as
a home ages and after repeatedly
opening and closing resulting in lead
dust settling on and around windows.
Clean windows, sills and troughs with a
clean, wet cloth or sponge. Window sills
and troughs with large amounts of dust
may require using a vacuum cleaner
equipped with a HEPA filter. After
vacuuming, follow up by cleaning with a
damp cloth or sponge.
Air Duct Covers and
Radiators
The surfaces or covers of air ducts
(areas along walls and floors covered
by metal grates) and radiators can
be covered with dust, although the
concentration of lead dust is generally
not as high as in other areas of the
home.
Wipe the surface of air ducts and
radiators monthly using a clean, wet
cloth or sponge. Frequently replace all
air filters (including HEPA filters) in the
furnace and heating, ventilation and air
conditioning (1IVAC) system.
57
-------
AREA OF THE
HOME
POTENTIAL LEAD DUST TRAP
RECOMMENDED
CLEANING TECHNIQUE
Doors, Doorframes,
Walls and other
Painted Surfaces
Dust from lead-based paint dispersed
into the air from painted walls, windows
and floors can settle on doors and
door frames. Lead from outside
sources may also stick to the surface
of exterior doors and then be tracked
inside the home.
Wipe down doors, door frames, walls
and other painted surfaces with a clean,
wet cloth or sponge.
Stairs, Railings and
Banisters
Walking on stairs painted with lead-
based paint causes the paint to flake
and chip, which disperses lead dust on
stairs, railings and banisters.
Clean stairs, railings and banisters with
a clean, wet mop, cloth or sponge.
Furniture
Lead dust dispersed into the air can
settle and collect on furniture, such as
tables and couches, and then re-enter
the air when you vacuum, dust or
sweep.
Dust furniture weekly with furniture polish
to prevent the spread of dust into the air.
Regularly clean upholstered furniture,
such as a couch, with a HERA vacuum
or with wet washing.
CLEANING HINTS:
Declutter your home.
Clean yourself out of a room by starting at the furthest point within the room and
work your way to the doorway.
Clean from top to bottom in every room.
Wash hands and cleaning supplies in a sink (or area) that preferably is not used
for food preparation.
WHERE CAN I LEARN MORE?
For more information, contact the National Lead Information Center (NLIC) at 1 800 424 l.[ AD (5323)
or visit www.epa.gov/lead.
58
Key Messages - Module 2
-------
Lead Awareness in Indian Country: Keeping our Children Healthy!
Kids Activity Sheet I Module 2 EFFECT|VE CLEANING TECHNIQUES
Crossword Puzzle
Down:
M
o
Across:
1.
Use the clues to the left to fill in
the crossword puzzle for areas in
your home where lead dust may
be found. Lead dust is dust that
contains lead.
2.
6ru :ssojoe p 'Mopuim :ssojdb ฃ 'joop :umop z 'sjib}s :u/v\op i :sje/v\suy
Connect the Dots
Wet washing uses a wet cloth,
sponge or mop for cleaning.
Join the dots starting and ending at
1 to discover two items you may use
when cleaning.
e;V
19 * o4t I
18 ^ 16 15
17
-------
Seek and Find
Cleaning weekly keeps our homes lead dust free. Can you find the supplies needed to clean
this home?
Bucket
Mop
Sponge
All-purpose
Cleaner
*
Cloth
ฆ
Furniture
Polish
HEPA
Vacuum
ALL
PURPOSE
Tell an adult if you find peeling paint
60
Kids Activity Sheet - Module 2
-------
Lead Awareness in Indian Country: Keeping our Children Healthy!
Module 3:
Personal Hygiene
& Nutrition
61
-------
62
-------
Lead Awareness in Indian Country: Keeping our Children Healthy!
Lesson Plan | Module PERSONAL HYGIENE AND NUTRITION
Module 3: Personal Hygiene and Nutrition focuses on the connections between personal
hygiene, nutrition for children and potential exposure to lead. Good personal hygiene and
healthy nutritional practices can limit absorption of and reduce exposure to lead in children.
By the end of Module 3 participants will:
Learn specific personal hygiene techniques that help reduce potential childhood lead
exposure;
Identify foods that contain calcium, iron, and vitamin C; and
Understand nutritional practices and foods that may limit the absorption of lead.
Instructor Preparation
To prepare for Module 3: Personal Hygiene and Nutrition, the instructor should take the
following steps:
Preview the lesson plan to identify sections where examples, stories and local
information may be inserted.
Reach out to tribal personnel and other resources to find local information and
partners, if possible.
Contact tribal leaders, elders, staff and other community members to compile a list
of your tribal community's local/traditional foods and snacks that are not listed in the
Module 3 Worksheet.
- Using Appendix A: Foods that Contain Calcium, Iron and Vitamin C and Appendix
D: Supplemental Resources, determine which of your tribal community's local/
traditional foods contain calcium, iron and/or vitamin C.
- On the blank Local/Traditional Foods slide in the presentation, add your tribal
community's local/traditional foods to the appropriate row - Calcium, Iron or
Vitamin C (or create a table on flipchart paper if needed).
- Compile a list of your tribal community's common snacks that contain calcium,
iron, and/or vitamin C.
- Find images of your tribal community's local/traditional foods and snacks (optional).
Make copies of Module 3 worksheet, key messages and kids activity sheet (1 copy per
participant).
Gather materials for the Handwashing Demonstration.
Gather foods and utensils needed for the Healthy Snack Activity.
Gather any materials needed for the optional demonstration and activities included in
Module 3:
- Black Light Activity; and
- Reading Food Nutrition Fact Labels.
Edit the Module 3 Presentation Slides to incorporate relevant stories, images and
videos. Remove presentation slides you do not plan to use during the session.
Use the "Notes" boxes provided in the lesson plan for personal notes.
Instructor Notes written in italics can be found throughout the lesson plan. These notes are
intended to help guide the instructor through the discussion and presentation and are not
meant to be read out loud during the session.
63
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Suggested Materials
Laptop and projector to display presentation slides
and videos
Flipchart and markers
Pens and pencils
Module 3 Worksheet
Module 3 Key Messages
Module 3 Kids Activity Sheet
Masking tape
Faucet with running water or buckets of water
Soap
Paper towels
Utensils and food to make a healthy snack
OPTIONAL black light kit (black light powder, black
light oil, ultraviolet lamp)
OPTIONAL nutrition facts labels
If access to technology is limited, you can use hardcopies
of presentation slides.
Outcomes
Upon the completion of Module 3, participants will be able to:
List three personal hygiene habits that can reduce
potential lead exposure in children;
List three healthy snacks for children that may help
reduce the impact of potential lead exposure;
Explain how meals and snacks can become
contaminated with lead during preparation; and
Discuss actions that can be taken in the home to
reduce potential exposure to lead.
Lesson Plan - Module 3
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Outline
Notes:
Introduction (10 minutes)
66
II. Personal Hygiene (15 minutes)
a. Handwashing in 6 Steps
67
b. Handwashing Demonstration
c. Outdoor Best Practices
III. Nutrition (25 minutes)
70
a. Eating a Healthy Diet with Key Nutrients to Reduce
Lead Absorption
i. Optional Activity: Reading Nutrition Facts
Labels
b. Meal Ideas
c. Healthy Snacks
d. Food Preparation
e. Outdoor Best Practices
f. Fish
IV. Conclusion (10 minutes) 79
V. References 80
Lesson Plan - Module 3
65
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Notes:
I. Introduction (10 minutes)
Good personal hygiene and healthy nutritional practices
may assist in reducing the absorption of lead in a child's
body. It is important that everyone, not just parents and
caregivers, understand the beneficial impacts that simple
actions, such as consistent hand washing and feeding
children healthy foods, can have to help reduce the risk of
lead exposure. Today, we will discuss simple actions we can
take to reduce potential exposure to lead by focusing on
personal hygiene and nutrition.
I am going to define a few words that will be used throughout
our discussion.
1. Hygiene - Actions taken to keep our bodies clean,
such as washing our hands or hair and taking a bath.
2. Nutrition - The process of consuming food or
beverages necessary for health and growth, which
our bodies need to stay alive and healthy.
3. Nutrient - A substance in food or beverages that
provides nourishment for growth and the maintenance
of life.
To better understand what we already know and think about
personal hygiene and nutrition, I have a few questions for the
group. If you do not know the answers, that is fine. We will
cover all the information shortly. Instructor Note: Depending
on time, ask one or all four questions. Record participants'
responses on flipchart paper and post them in a place that
will be visible throughout the session.
1. What are examples of good personal hygiene
behaviors for children? (Instructor Note: Answers
may include: washing hands after playing outside
and going to the bathroom; covering your mouth
when you cough or sneeze; brushing teeth twice
a day; bathing regularly.)
2. What foods do you think should be part of a
healthy diet for children? (Instructor Note:
Answers may include: fruits and vegetables.)
3. What are some nutrients that are important for our
health? (Instructor Note: Answers may include:
vitamins, minerals, calcium, magnesium, protein,
water and fiber.)
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Lesson Plan - Module 3
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4. What nutrients may limit the absorption of lead in
children's bodies? {Instructor Note: Answers include:
calcium, vitamin C and iron.)
Some of the personal hygiene and nutritional tips that we will
discuss today may be actions you already follow.
II. Personal Hygiene (15 minutes)
Taking care of our bodies and keeping ourselves and
surroundings clean and clutter-free are important to maintain
good health. To minimize the possibility of illness and reduce
children's potential exposure to lead, teaching children good
personal hygiene habits is essential. Adults can teach
children good personal hygiene by:
Making sure they wash their hands several times
a day.
Keeping their fingernails and toenails trimmed short.
Bathing them daily.
Pinning pacifiers to their clothes.
Washing bottles and pacifiers daily.
Washing toys often.
Washing clothes and shoes soiled by lead dust
or soil separately from other items.
One way young children ingest lead is through dust or
soil contaminated by lead-based paint or other sources of
lead that settles on their hands as they play. When children
put their hands in their mouths, they may swallow lead-
contaminated dust or soil, which can then get into their
bloodstream. Elements of good hygiene, such as consistent
handwashing, reduces the likelihood of this happening and
is the best way to reduce the number of germs on children's
hands in most situations. Children should wash their hands
with soap:
Before eating, drinking and sleeping;
After using the bathroom; and
After playing outdoors or with animals.
When children wash their hands, they should wash with
soapy water for at least 20 seconds, and then dry their hands
thoroughly with a clean towel or paper towel. While warm
water is preferred, cold water is better than not washing.
Hands should not be wiped off or dried on their clothes,
which could be contaminated. Six steps are recommended
for effective handwashing.
Notes:
Using Hand Sanitizer
There are differences between
washing hands with soap and
water and cleaning them with
hand sanitizer Alcohol-based
hand sanitizers do not kill all
types of germs and may not
remove harmful chemicals, such
as pesticides and heavy metals,
such as lead. Handwashing with
soap and water reduces the
amounts of all types of germs,
pesticides and metals on hands.
For more information, read
Handwashing and Hand Sanitizer
Use at Home, at Play, and Out
and About at https://www.cdc.gov/
handwashina/pdf/hand-sanitizer-
factsheet.pdf.
Lesson Plan - Module 3
67
-------
Notes:
Optional Black Light Activity
Before beginning the
demonstration, ask participants:
why is warm, soapy water
important? Then:
1. Show participants your
seemingly clean hands and ask
if they look dirty - you may even
want to walk around the room
to allow participants to get a
closer look.
2. Put black light powder on your
hands and then show them to
the participants. Explain that
the powder represents tiny
particles of lead. Now show
participants your hands under
the black light. The powder will
glow in areas where your hands
are dirty.
3. Run your hands quickly
under running water and then
show participants your hands
under the black light again.
Participants will see that the
black light powder is still
present, demonstrating that
simply running your hands
under water is not a good
method of hand washing as it
relates to lead.
4. Wash hands thoroughly
following the Handwashing in 6
Steps procedure outlined. End
the demonstration by showing
your clean hands under the
black light.
a. Handwashing in 6 Steps
Step 1: Wet hands with clean, running water.
Step 2: Add soap, then rub hands together making a soapy
lather. Do this away from the running water; be careful not to
wash the lather away.
Step 3: Scrub the front and back of hands, between fingers
and under nails. Wash for at least 20 seconds, the amount
of time it takes to sing the ABCs once or the Happy Birthday
song twice.
Step 4: Rinse hands from wrists to fingertips under clean,
running water. Let the water run back into the sink, not down
to your elbows.
Step 5: Dry hands thoroughly with a clean towel or paper
towel.
Step 6: Turn off the faucet with the used towel. Remember,
dirty hands turned on the faucet.
Following these six steps will ensure that children are getting
lead dust off their hands. This information is found in the key
messages handout, a take-home resource that summarizes
information covered today. Instructor Note: Give a copy of
the Module 3 Key Messages to each participant.
b. Handwashing Demonstration
Instructor Note: Use the six steps of handwashing outlined
above to have participants wash their hands. You will need
liquid hand soap, a faucet with running water, and paper
towels. If you do not have access to a faucet with running
water, you can use buckets for the demonstration: one bucket
for the faucet and one bucket for the sink. One participant
can pour water from a bucket into the other bucket simulating
a faucet while another participant washes their hands. If
possible, expand the demonstration to include the optional
Black Light Activity As an alternative you can show a video,
such as this one from the Centers for Disease Control and
Prevention: https://www.cdc.aov/cdctv/healthvlivina/hvaiene/
wash-vour-hands.html.
c. Outdoor Best Practices
This session mainly focuses on indoor activities. However,
we may be exposed to lead in our outdoor environments
through contaminated soil or breathing in dust containing
68
Lesson Plan - Module 3
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lead. Exterior lead-based paint from houses and buildings
can flake or peel, and then get into the soil. Past use of
leaded gasoline in cars, from industrial sources, or even
from contaminated sites, including former lead smelters,
can contaminate soil.
Some plants that grow in soils with a high lead concentration
can absorb lead from the soil with most of the lead remaining
in the roots and, in some rare cases, even making its way to
the aboveground parts of the plant. A certified professional
can remove (or partially remove) contaminated soil and
replace it with "clean" soil.
How can we reduce potential exposure to lead while outdoors
in areas suspected or known to be contaminated with lead?
How can we prevent lead from getting inside our homes?
Instructor Note: Allow participants time to think and share
with the group.
To reduce potential exposure to lead while outdoors we can:
Check the exterior of your home, including porches
and fences, for deteriorating paint.
Cover bare soil with grass, plants, gravel, or wood
chips, especially near the exterior walls of your home.
Play in grass and dirt not contaminated with lead, if
possible.
Wash outdoor toys and playground equipment
regularly using an outside faucet or hose.
Use designated picnic, camping, biking and hiking
areas.
To avoid tracking soil into your home:
Put doormats outside and inside all entryways.
Remove shoes before coming inside.
Wipe pet's paws prior to bringing them indoors.
Remove soil from clothes, toys, pets and equipment
outside, if possible.
Instructor Note: Give a copy of the Module 3 Worksheet and
a pencil to each participant. Go through the Personal Hygiene
questions together.
We will use the worksheet during this session as a discussion
tool and to review what we learned together. Look at the
Personal Hygiene section at the top of your worksheet.
1. List two personal hygiene habits that may assist
in reducing children's potential exposure to lead.
Notes:
Lesson Plan - Module 3
69
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Use Caution When Eating
Imported Foods
Use caution when consuming
internationai candies, spices and
other foods. On occasion, foods
and food products imported to the
United States have been found
to contain high ieveis of iead. Not
aii countries have set the same
standards to reduce the amount
of iead in paint, foods and other
products (Ref. 2).
Notes:
Instructor Note: Answers may include washing
children's hands several times a day; trimming
children's fingernails and toenails short; daily baths;
pinning pacifiers to their clothes; washing bottles
and pacifiers daily; washing toys often; and washing
clothes and shoes soiled by lead dust or soil
separately.
2. You should wash your hands with soapy water for at
least seconds. Instructor Note: The answer is 20.
III. Nutrition (25 minutes)
Instructor Note: Familiarize yourself with the lists of foods,
meals and snacks provided in the lesson plan and be
prepared to share examples to start the conversation. If you
need additional ideas, use Appendix A: Foods that Contain
Calcium, Iron and Vitamin C which is a list of over 150 general
and local/traditional foods that are known to contain calcium,
iron and/or vitamin C. Record participants' ideas on foods,
meals, and snacks, preferably on flip chart paper.
Specific nutritional choices you and your children make
are crucial. Proper nutrition is important for a child's overall
growth, development, learning and more. Creating healthy
eating habits will maintain our health and reduce the risk of
diseases. Everything we eat and drink matters, which is why
it is important to include a variety of vegetables, fruits, whole
grains, proteins and dairy products in our diets (Ref. 1).
a. Eating a Healthy Diet with Key Nutrients to
Reduce Lead Absorption
Eating a variety of foods gives children the vitamins and
minerals they need to grow up healthy. When children do
not have enough calcium or iron in their bodies, their bodies
may absorb lead instead of these nutrients. Calcium, iron
and vitamin C are natural blockers that may help reduce the
absorption of lead in the bloodstream.
A diet rich in important nutrients such as calcium, iron and
vitamin C plays an essential role in reducing the absorption
of lead:
Calcium helps bones stay strong and may keep lead
out. Foods that contain calcium include:
o Milk and milk products, such as yogurt and
cheese;
o Broccoli;
70
Lesson Plan - Module 3
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o Canned salmon and sardines; and
o Foods with added calcium, such as orange juice
and soy milk.
Iron may block lead from being absorbed. Foods that
contain iron include:
o Lean red meats, fish, chicken and eggs;
o Beans, peas, green leafy vegetables and lentils;
o Iron-fortified cereal, bread and pasta; and
o Dried fruit, such as raisins and apricots.
Vitamin C increases the absorption of iron, which may
decrease the absorption of lead. Foods that contain
vitamin C include:
o Citrus fruits, such as oranges and grapefruit;
o Kiwi, strawberries and melon; and
o Tomatoes, potatoes and peppers.
A couple of other important facts to understand regarding
children and preventing the absorption of lead are:
An overall unhealthy diet high in fat and oil may
increase the rate of lead absorption; and
A child with an empty stomach will absorb more lead.
What other foods, in addition to those already mentioned,
do you think we can provide our children to ensure they
are getting calcium, iron and/or vitamin C in their diets?
Instructor Note: Allow participants time to think and respond
before showing them the Foods that May Help Reduce
the Absorption of Lead table that is in the worksheet and
presentation. Foods are listed by the nutrient they contain
the most of: calcium, iron or vitamin C.
Look at the Foods that May Help Reduce the Absorption
of Lead table on your worksheet.
1. Did we mention any of these foods earlier?
2. Are any foods already in your family's diet?
Take a moment to carefully read through the General Foods
column and circle all the foods you and your family eat.
Notes:
Lesson Plan - Module 3
71
-------
Notes:
Foods that May Help Reduce the Absorption of Lead
Nutrients
General Foods
Calcium
(mineral needed to
build and maintain
strong bones)
almonds, bone broth, broccoli, canned
salmon, cheese, chia seeds, collard
greens, cottage cheese, crab, edamame,
figs, okra, milk, non-dairy milk, nopal
cactus pads, prickly pear, sardines,
seaweed, sweet potatoes, tofu, white
beans, whole wheat bread, yogurt
Iron
(mineral critical to
blood function)
apricots, asparagus, beans, beef,
bison, black walnuts, chicken, clams,
eggs, fish, fish eggs, hazelnuts, lentils,
liver, mushrooms, mussels, mustard
greens, oats, oysters, peanut
butter, peas, pine nuts, pumpkin
seeds, prunes, raisins, salmon,
scallops, shrimp, spinach, venison,
water potato, wild rice
Vitamin C
(vitamin that
protects the body
from disease and
increases the
absorption of iron)
apples, bananas, bell peppers, black-
berries, blueberries, brussels sprouts,
cabbage, cantaloupe, cauliflower,
chestnuts, citrus fruits, corn, green
beans, honeydew, huckleberries, kale,
kiwi, leeks, parsnips, pears, plums,
potatoes, raspberries, rhubarb,
squash, squid, strawberries, tomatoes,
turnips, watercress
Count the number of foods you circled and then record the
number in the box below the table. Instructor Note: Share
with participants the number of foods in the General Foods
column eaten in your home. Ask a few of the participants to
share the number of foods eaten in their home.
Do you think the table is missing any foods, specifically any
local/traditional foods eaten in our community? Take a few
minutes to compare your thoughts with others and write these
under the Local/Traditional Foods column on your worksheet,
listing them by the nutrient you think they contain the most of:
calcium, iron or vitamin C. Instructor Note: Allow participants
a few minutes to discuss; share your findings based on
Appendix A and your own research.
72
Lesson Plan - Module 3
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Based on my own research, this table lists some of our local/
traditional foods that contain these three nutrients. Each food
is listed by the nutrient it contains the most of: calcium, iron
or vitamin C.
Foods That May Help Reduce the Absorption of Lead
Nutrients
Local/Traditional Foods
Calcium
(mineral needed to
build and maintain
strong bones)
Instructor Note: Please include
your tribe's local/traditional, foods
that contain calcium here.
Iron
(mineral critical to
blood function)
Instructor Note: Please include
your tribe's local/traditional foods
that contain iron here.
Vitamin C
(vitamin that protects
the body from disease
and increases the
absorption of iron)
Instructor Note: Please include
your tribe's local/traditional foods
that contain vitamin C here.
i. Optional Activity: Reading Nutrition Facts Labels
Instructor Note: After discussing foods that contain calcium,
iron and vitamin C, you may want to conduct the optional
Reading Nutrition Facts Labels Activity. The purpose of this
activity is for participants to practice reading nutrition facts
labels to determine and compare the amount of calcium,
iron and vitamin C of foods available for purchase at local
stores. Nutrition facts labels are usually found only on
packaged foods (e.g., canned, frozen and dried foods) and
not fresh produce. You can use the labels provided or find
your own examples. For more information on reading and
understanding nutrition facts labels, visit: https://www.fda.aov/
food/nutrition-education-resources-materials/how-understand-
and-use-nutrition-facts-label.
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Frozen Green Beans
Purchasing fresh or minimally processed foods may not
always be an option depending on where you live. What
are some other forms in which we eat fruits, vegetables
and protein? Instructor Note: Answers may include:
frozen meals, canned goods, fruit juice or dried foods.
Frozen, canned and dried fruits and vegetables and
100% fruit and vegetable juices are delicious and provide
nutrients for a healthy diet. What are some advantages to
frozen, canned or dried foods? Instructor Note: Answers
may include: you can enjoy certain foods no longer in
season; and frozen, canned and dried foods do not spoil
as soon as fresh foods.
To understand the ingredients and nutrition content of
packaged foods, we need to read the nutrition facts label.
Does anyone read nutrition facts labels? What information is
included on nutrition facts labels? Instructor Note: Possible
answers include serving size, calories, total fat, sodium,
dietary fiber, sugars, calcium, etc.
There is a lot of information on these labels and today we are
going to review how we can use them to ensure our families
are getting calcium, iron and vitamin C in their diets, which
may prevent the absorption of lead. Where on the label can
we find information about vitamin and mineral content? If we
look at the bottom of the nutrition facts label, we will find a
list of the vitamins and minerals that this food contains and
the percent daily value (%DV) of each. The %DV shows how
much a nutrient in one serving of the food contributes to your
daily diet. The %DVs are based on the Daily Values for key
nutrients, which are the amounts of nutrients recommended
per day for Americans. The %DV provided on a nutrition facts
label are based on a 2,000 calorie diet, and the number of
calories recommended varies from individual to individual.
For example, most children 4 to 8 years old need only
between 1400 and 1600 calories a day.
Which of the three nutrients, calcium, iron or vitamin C, does
the tomato soup contain? Instructor Note: Allow participants
time to think. The answer is all three nutrients.
Which of the three nutrients do the frozen green beans
contain? Instructor Note: Allow participants time to think.
The answer is all three nutrients.
Which of these two foods contains the most calcium?
Instructor Note: Allow participants time to think. The answer
is a serving of frozen green beans, because it has a higher
%DV of calcium in one serving.
74
Lesson Plan - Module 3
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b. Meal Ideas
Instructor Note: A few sample meal ideas are Included
below (Ref. 3).
Here are a few meal ideas that contain calcium, iron and/or
vitamin C.
Breakfast:
Oatmeal, sliced banana and 100% orange juice.
Vegetable omelet, apple sauce and low-fat milk.
French toast, orange slices, yogurt and 100% fruit
juice.
Iron-fortified cereal with low-fat milk, topped with
raisins.
Wild rice porridge with berries.
Lunch:
Turkey & tomato sandwich, coleslaw and low-fat milk.
Tuna salad sandwich on whole-grain bread and pear
slices.
Lean cheeseburger on a whole-grain bun and 100%
cranberry juice.
Shrimp, squash and brussels sprouts.
Dinner:
Sloppy joe, watermelon and low-fat milk.
Macaroni and cheese, stewed tomatoes and melon
slices.
Chicken, rice, green beans and berries.
Salmon, rice and bell peppers.
What other meal ideas do you have that include all three
nutrients? Instructor Note: As participants share their ideas
with the group, record their answers on flipchart paper
If needed, extend the time for this part of the session to
accommodate a longer discussion.
Notes:
Lesson Plan - Module 3 75
-------
Notes:
Optional Healthy Snack
Preparation
Gather materials needed to
prepare a snack. Instruct
participants to wash their hands
before preparing.
Provide directions on how to
prepare the snack and explain
which of the three nutrients are
found within the snack.
When participants eat the snack,
ask them:
Do you think your child(ren)
would eat this snack?
Would you prepare this for your
family?
If the snack has cultural
significance, discuss those
benefits too.
c. Healthy Snacks
As mentioned earlier:
An overall unhealthy diet high in fat and oil may
increase the rate of lead absorption; and
A child with an empty stomach will absorb more lead.
We can provide children tasty healthy snacks that are part
of a nutritious diet. For example, a snack could be:
Air-popped popcorn;
Applesauce;
Fruit, such as: strawberries, melons, bananas, pears,
oranges or peaches;
Peanut butter on whole-grain crackers, apples or
celery;
Various jerky such as: salmon, venison, elk or beef;
Low-fat or fat-free yogurt topped with fruit and/or
iron-fortified cereal;
Frozen 100% fruit juice pops;
Cheese and whole-grain crackers;
Nuts, sunflower seeds and dried fruits, including
100% fruit leather; or
Hummus and raw vegetables.
What are other healthy snacks? On the worksheet, the
Healthy Snacks section lists examples of healthy snacks on
the left. Put an "X" in the box next to the snacks you already
feed your children or family, and a "star" next to those you
could easily add to their diet. Think about how you might
modify these snacks to better fit your family's needs and
preferences.
Next, work with a partner to write down other snack ideas on
the right side of the Healthy Snacks section. Instructor Note:
Have participants share their snack ideas with the group
while you write them down on the flipchart paper
As an option, prepare a healthy snack with the group.
d. Food Preparation
We should take extra precautions when preparing food for
children, as lead is nearly impossible to see or smell. Lead
can potentially make its way into our food.
Lead can enter tap water used to prepare and
wash food when plumbing materials that contain
lead corrode. We should use only cold water for
cooking and drinking as hot water will dissolve lead
more quickly than cold water and is likely to contain
76
Lesson Plan - Module 3
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increased lead levels. If hot water is needed, it should
be taken from the cold water tap and heated on a
stove or in a microwave oven. Boiling water does not
remove lead from water. Before drinking or cooking,
flush your home's pipes by running the tap, taking a
shower, doing laundry or doing a load of dishes. If you
use a filter certified to remove lead read the directions
to learn how to properly install and use your cartridge
and when to replace it. Using the cartridge after it has
expired can make it less effective at removing lead.
Canned goods in the U.S. are welded closed at the
seams and do not use lead; however, lead solder can
still be found in cans made in other countries (Refs. 5
and 6). Over time, lead solder may seep into the can
and mix with the food, contaminating it. Avoid buying
imported canned foods.
Crystal, glazed pottery and porcelain are all popular
items used for serving, heating or eating food, and can
also be a source of lead exposure. Do not eat food or
drink water cooked or stored in these items if they are
chipped or cracked. In general, try to avoid using any
crystal, pottery or porcelain made with a lead glaze.
Lead dust that settles on countertops can contaminate
food. Keep your kitchen clean, and wash countertops
with an all-purpose cleaner before preparing food.
e. Outdoor Best Practices
When preparing or eating food outdoors, there are some
actions we need to keep in mind to reduce potential exposure
to lead. Based on everything you have learned so far, what
could we do while outdoors to reduce potential exposure to
lead in areas that you suspect or know are contaminated?
Instructor Note: Allow participants time to think. After a
minute, have them share with the group. Below are possible
responses:
Use water from clean sources for drinking, cooking or
washing.
Eat on a clean surface such as a picnic table or
blanket.
Avoid eating food that falls on the ground.
Switch to non-lead ammunition and fishing tackle when
harvesting wild game and fish for food, when possible.
Clean utensils and surfaces where fish and game
meats will be dressed to prevent cross-contamination.
Notes:
Lead Solder
Solder is a metal that is melted
and used to connect other
pieces of metal together
(Ret 4).
In 1995, the United States
banned the use of lead solder
on all food cans, including
imported products. However,
lead solder is still used in other
countries and could be found
in cans imported to the United
States (Refs. 5 and 6).
Lesson Plan - Module 3
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Notes:
Lead and Hunting
Most ammunition contains lead,
which means both wildlife and
humans who consume them can
be exposed to lead (Ref. 7). In a
recent study completed in North
Dakota, participants who ate any
wild game had higher blood lead
levels than participants who did
not consume wild game (Ref. 8).
While it has been suggested that
you can limit lead exposure by
cutting around the site of the lead
bullet in animals and removing
the surrounding tissue, this is not
sufficient. Typically, hundreds of
metal fragments are dispersed
when a lead bullet is fired into
animal carcasses, making it
nearly impossible to remove all
the fragments.
Many households in Indian country consist of hunting families
that rely on the use of firearms to acquire food year-round.
Elevated lead exposure has been correlated with subsistence
hunting communities when game meat is harvested with
lead ammunition. High-velocity lead-core bullets explode
upon impact, sending out a plume of lead dust along
with hundreds of tiny fragments into the targeted animal,
ending up in game meat processed for consumption. High-
performance, non-lead ammunition has become increasingly
available in a wide range of brands and calibers. Using lead-
free ammunition is the best way to avoid potential exposure to
lead.
f. Fish
Instructor Note: FDA and EPA have issued advice regarding
eating fish, which is geared toward women who are or may
become pregnant, as well as breastfeeding mothers and
parents of young children, helping them make informed
choices when it comes to fish that is healthy and safe to
eat (Ref. 9). Keep in mind that while Reference 9 is focused
on mercury, the general information also applies to lead
and other contaminants. It is recommended that you also
investigate your area's fish consumption advisories that could
come from the federal, state, tribal and/or local government.
Fish is a high-quality source of protein. Unfortunately, lead
and other contaminants may accumulate in fish, meaning fish
could be a potential source of lead exposure. However, this
potential exposure to lead can be reduced by the way fish is
prepared, such as: removing their organs, fat and skin (where
lead and other contaminants may accumulate).
If you eat game fish, eat the smaller, younger fish (within legal
limits); they are less likely to contain contaminants than larger,
older fish. Eat panfish such as bluegill, perch, stream trout
and smelt. They feed on insects and other aquatic life and are
less likely to contain contaminants (Ref. 10).
Check federal, state, tribal, and/or local fish advisories for
recommendations on fish consumption for pregnant women,
children under 15 years of age and the general public. This
includes recommendations on numbers to be consumed per
month for specific fish and whether it is recommended to eat
only the fillet or the whole fish.
Instructor Note: You may choose to include a live
demonstration (done by you or someone else) on the proper
ways to clean fish and remove their skin, fat, and internal
organs.
78
Lesson Plan - Module 3
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IV. Conclusion (10 minutes)
Good personal hygiene and proper nutrition for children may
help in reducing their potential exposure to lead.
When children put their hands in their mouths, they may
swallow lead-contaminated dust or soil, which can get into
their bloodstream. Elements of good personal hygiene, such
as consistent handwashing and bathing, reduce potential
exposure to lead.
One of the easiest and most effective things that parents
and caregivers can do to reduce potential exposure to lead
is to teach children to wash their hands properly many times
throughout the day. Children should wash their hands or have
their hands washed:
Before eating, drinking and sleeping;
After using the bathroom; and
After playing, especially outdoors or with animals.
Eating a well-balanced diet is important for children's long-
term health and development. To help reduce the absorption
of lead, children should eat foods high in:
Calcium;
Iron; and
Vitamin C.
In summary, proper nutrition is important and eating a variety
of foods will give children the vitamins and minerals they
need to grow up healthy. When children do not have enough
calcium or iron in their bodies, their bodies may absorb lead
instead of these nutrients. An overall unhealthy diet high in fat
and oil may increase the rate of lead absorption.
Instructor Note: Below are questions that you may select to
gauge participants' understanding. Use their responses to
facilitate a discussion.
1. What are some examples of foods high in calcium,
iron and/or vitamin C?
2. Which of these foods, meals or snacks we covered
today are you going to add to your children's diet this
week? Write your answers on the worksheet.
3. Are there other meals and/or snacks high in calcium,
iron and vitamin C that you would prepare at home?
Write your answers on the worksheet.
Notes:
Lesson Plan - Module 3
79
-------
Notes:
4. What are some other actions we covered today that we
can do at home to reduce exposure to lead? Answers
may include some of the following:
Wash children's hands, bottles, pacifiers, and toys
often.
Use only cold water for drinking, cooking and making
baby formula.
Thank you for participating in this session. Does anyone
have any questions about the information covered? Here is
the Module 3 Kids Activity Sheet for you to take home. The
kids activity sheet has several activities that teach children
about what we learned today. Instructor Note: Give each
participant a copy of the Module 3 Kids Activity Sheet.
V. References
1. U.S. Department of Health and Human Services
and US Department of Agriculture. 2015 - 2020 Dietary
Guidelines for Americans. 8th Edition. 2015. Available
at https://health.aov/dietarvauidelines/2015/auidelines/.
[Accessed February 11, 2020].
2. Centers for Disease Control and Prevention.
Guidelines for the Identification and Management of
Lead Exposure in Pregnant and Lactating Women. 2010.
Available at http://www.cdc.gov/nceh/lead/publications/
Ieadandpregnancv2010.pdf. [Accessed February 11, 2020].
3. U.S. Environmental Protection Agency. Fight Lead
Poisoning with a Healthy Diet: Lead Poisoning Prevention Tips
for Families. 2019. Available at https://www.epa.gov/lead/
fight-lead-poisoning-healthv-diet [Accessed February 11,
2020].
4. Centers for Disease Control and Prevention. Lead
Poisoning: Words to Know from A to Z. (No date). Available at
https://www.cdc.gov/nceh/lead/tools/leadglossary 508.pdf.
[Accessed February 11, 2020].
5. U.S. Department of Agriculture. Shelf-Stable Food
Safety: Do cans contain lead? 2015. Available at https://www.
fsis.usda.gov/wps/portal/fsis/topics/food-safety-education/
get-answers/food-safetv-fact-sheets/safe-food-handling/shelf-
stable-food-safetv/CT Index . [Accessed February 11, 2020].
6. Agency for Toxic Substances and Disease Registry.
Case Studies in Environmental Medicine: Lead Toxicity:
Where is Lead Found? 2017. Available at https://www.atsdr.
cdc.gov/csem/csem.asp?csem=34&po=5. [Accessed
February 11, 2020].
80
Lesson Plan - Module 3
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7. Pain, D.J.; Cromie, R.L.; Newth, J.; Brown, M.J.;
Crutcher, E.; Hard man, P.; et al. Potential Hazard to Human
Health from Exposure to Fragments of Lead Bullets and Shot
in the Tissues of Game Animals. Plos One. 2010. Available
at http://iournals.plos.org/plosone/article7ick10.1371 /journal,
pone.0010315. [Accessed February 11, 2020].
8. Iqbal, S.; Blumenthal, W.-, Kennedy, C.; et. al. Hunting
with lead: Association between blood lead levels and wild
game consumption. Environmental Research. 2009. Vol.
109, pp. 952-959. Available at https://www.ncbi.nlm.nih.aov/
pubrmed/19747676. [Accessed February 11, 2020].
9. U.S. Food and Drug Administration and US
Environmental Protection Agency. Eating Fish: What Pregnant
Women and Parents Should Know. 2019. Available at https://
www.fda.gov/food/consumers/advice-about-eating-fish.
[Accessed February 11, 2020].
10. U.S. Environmental Protection Agency. Should I
Eat the Fish I Catch? Available at https://www.epa.gov/
choose-fish-and-shellfish-wiselv/should-i-eat-fish-i-catch-
brochure-2014. [Accessed February 11, 2020].
Notes:
Lesson Plan - Module 3
81
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82
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Worksheet I Module 3
Lead Awareness in Indian Country: Keeping our Children Healthy!
PERSONAL HYGIENE AND NUTRITION
PERSONAL HYGIENE
1. List two personal hygiene habits that may assist in reducing children's potential exposure to lead:
1 .
2
2. You should wash your hands with soapy water for at least, .seconds.
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NUTRITION: FOODS THAT MAY HELP REDUCE THE ABSORPTION OF LEAD
Providing children with healthy, nutritious meals and snacks that include calcium, iron and vitamin C
benefits their overall health and can limit the absorption of lead. A child with an empty stomach may
absorb more lead. Below is a chart of foods listed by the nutrient it contains the most of: calcium, iron
or vitamin C.
Directions:
1. In the General Foods column, circle foods you feed your family.
2. In the Local/Traditional Foods column, write other foods eaten in your community that contain
calcium, iron or vitamin C.
Nutrients General Foods Local/Traditional Foods
Calcium
(mineral, needed to
build and maintain
strong bones)
almonds, bone broth, broccoli, canned
salmon, cheese, chia seeds, collard greens,
cottage cheese, crab, edamame, figs, okra,
milk, non-dairy milk, nopal cactus pads, prickly
pear, sardines, seaweed, sweet potatoes, tofu,
white bearis, whole wheat bread, yogurt
Iron
(mineral, critical to
blood function)
apricots, asparagus, beans, beef, bison, black
walnuts, chicken, clams, eggs, fish eggs,
hazelnuts, lentils, liver, mushrooms, mussels,
mustard greens, oats, oysters, peanut butter,
peas, pine nuts, pumpkin seeds, prunes,
raisins, salmon, scallops, shrimp, spinach,
venison, water potato, wild rice
Vitamin C
(vitamin, protects
the body from
disease and
promotes the
absorption of iron)
apples, bananas, bell peppers, blackberries,
blueberries, brussels sprouts, cabbage,
cantaloupe, cauliflower, chestnuts, citrus fruits,
corn, green beans, honeydew, huckleberries,
kale, kiwi, leeks, parsnips, pears, plums,
potatoes, raspberries, rhubarb, squash, squid,
strawberries, tomatoes, turnips, watercress
In my home we eat (number) of the foods in the General Foods column.
83
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HEALTHY SNACKS
Directions: Below are examples of snacks that contain calcium, iron and/or vitamin C. Put an "x" in the box
next to the snacks you already feed your children or family and a ^ next to those you could easily add to
their diet. What are other healthy snacks that contain one or more of these nutrients? Write your ideas in the
blank spaces below.
~ Air-popped popcorn
~ Applesauce
~ Strawberries, melons, bananas, pears,
oranges or peaches
~ Peanut butter on whole-grain crackers, apples
or celery
~ Jerky such as: salmon, venison, elk or beef
~ Yogurt topped with fruit and/or iron-fortified
cereal
~ Frozen 100% fruit juice pops
~ Cheese and whole-grain crackers
~ Nuts and sunflower seeds
~ Dried fruits, including 100% fruit leather
~ Hummus and raw vegetables
~
~
~
~
~
~
~
~
~
~
~
~
~
0
This week, I am going to add
to my children's diet.
Other foods and snacks I would like to add to my children's diet include:
1
2
3
4
84
For more information, contact the National Lead Information Center (NLIC) at 1-800-424-LEAD (5323)
Worksheet - Module 3
-------
Lead Awareness in Indian Country: Keeping our Children Healthy!
Key Messages | Module 3 PERSONAL HYGIENE AND NUTRITION
Good personal hygiene habits and healthy nutritional practices can limit absorption of and reduce
exposure to lead.
WHAT ARE PERSONAL HYGIENE HABITS THAT CAN REDUCE POTENTIAL LEAD EXPOSURE?
One way young children ingest lead is through dust or soil that settles on their hands as they play When
children put their hands in their mouths, they may swallow lead-contaminated dust or soil, which can then
get into their bloodstream. Good personal hygiene habits, such as consistent handwashing, reduces the
likelihood of this happening and is the best way to reduce the number of germs on children's hands in
most situations. Children should wash their hands with soap several times a day using the Six Steps of
Handwashing.
Step 1: Wet hands with clean, running
water.
Step 2: Add soap, then rub hands
together making a soapy lather. Do
this away from the running water; be
careful not to wash the lather away.
Step 3: Scrub the front and back of
hands, between fingers and under
nails. Wash for at least 20 seconds,
the amount of time it takes to sing the
ABCs once or the Happy Birthday
song twice.
Step 4: Rinse hands from wrists to fingertips under clean, running water. Let the water run back into the
sink, not down to your elbows.
Step 5; Dry hands thoroughly with a clean towel or paper towel.
Step 6: Turn off the faucet with the used towel. Remember, dirty hands turned on the faucet.
HOW CAN WE REDUCE POTENTIAL EXPOSURE TO LEAD WHILE OUTDOORS?
Children may be exposed to lead in outdoor environments through contaminated soil or breathing in dust
containing lead. To reduce potential exposure to lead while outdoors we can:
Check the exterior of your home, including porches and fences, for deteriorating paint.
Wash outdoor toys and playground equipment regularly.
Use designated picnic, camping, biking and hiking areas,
Use water from clean sources for drinking, cooking or washing.
To avoid tracking soil into your home:
Put doormats outside and inside all entryways.
Remove shoes before corning inside.
Wipe pets' paws prior to bringing them indoors.
-------
HOW MAY NUTRITION ASSIST IN REDUCING THE ABSORPTION OF LEAD?
Eating a variety of foods gives children the
vitamins and minerals they need to grow up
healthy. When children do not have enough
calcium or iron in their bodies, their bodies
may absorb lead instead of these nutrients.
A diet that includes foods rich in calcium,
iron and vitamin C may assist in reducing the
absorption of lead.
Important facts to understand are:
An overall unhealthy diet high in fat
and oil may increase the rate of lead
absorption; and
A child with an empty stomach will
absorb more lead.
Review the Module 3 Worksheet for information on specific foods that contain calcium, iron
and vitamin C.
WHAT ARE SOME MEALS THAT CONTAIN CALCIUM, IRON AND/OR VITAMIN C?
BREAKFAST:
Oatmeal, sliced banana
and 100% orange juice
Vegetable omelet, apple
sauce and low-fat miik
French toast, orange slices,
yogurt and 100% fruit juice
Iron-fortified cereal with
low-fat milk, topped with
raisins
Wild rice porridge with
berries
LUNCH:
Turkey & tomato sandwich,
coleslaw and low-fat milk
Tuna salad sandwich on
whole-grain bread and
pear slices
Lean cheeseburger on a
whole-grain bun and
100% cranberry juice
Shrimp, squash and
brussels sprouts
DINNER:
Sloppy joe, watermelon
and low-fat milk
Macaroni and cheese,
stewed tomatoes and
melon slices
Chicken, rice, green
beans and berries
Salmon, rice and
bell peppers
WHERE CAN I LEARN MORE?
For more information, contact the National Lead Information Center (NLIC) at 1-800-424-LEAD (5323)
or visit www.epa.aov/iead.
86
Key Messages - Module 3
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Kids Activity Sheet | Module 3
Lead Awareness in Indian Country: Keeping our Children Healthy!
PERSONAL HYGIENE AND NUTRITION
Handwashing
Dust and soil can get on your hands when you play. You should wash your hands with soap
many times a day using the Six Steps of Handwashing;
1. WET your hands,.
2. Add SOAP and lather.
3. SCRUB and sing the
Happy Birthday song twice.
4 RINSE
5. DRY your hands
with a clean towel.
6. Turn OFF the water with
your towel.
Follow the Trail
Healthy foods with calcium, iron and vitamin C help our bodies grow. Follow the trails to find
delicious foods with calcium, iron or vitamin C.
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Kids Activity Sheet - Module 3
-------
Lead Awareness in Indian Country: Keeping our Children Healthy!
Module 4:
Hiring Certified Lead
Professionals
Ptaiaprovided by Shaun West Environmental Programs Manager, Cherokee Nation
89
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90
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Lead Awareness in Indian Country: Keeping our Children Healthy!
Lesson Plan | Module 4 HIRING CERTIFIED LEAD PROFESSIONALS
Module 4: Hiring Certified Lead Professionals emphasizes the importance of hiring a
certified lead professional who will use lead-safe work practices to reduce exposure to
lead when: (a) abating a home, child care facility or preschool built before 1978 to address
identified lead-based paint or lead-based paint hazards, or (b) disturbing paint in renovation,
repair and painting (RRP) projects in homes, child care facilities or preschools built before
1978. By the end of Module 4, participants will:
Understand the difference between a lead-based paint inspection and a lead
risk assessment;
Learn that renovation, repair and painting (RRP) jobs in a pre-1978 home with
lead-based paint creates lead dust;
Recognize the difference between lead abatement and renovation, repair and
painting projects; and
Understand what must be done by Lead-Safe Certified Firms when conducting
lead renovation activities.
Instructor Preparation
To prepare for Module 4: Hiring Certified Lead Professionals, the instructor should take the
following steps:
Preview the lesson plan to identify sections where examples, stories and local
information may be inserted.
Reach out to tribal personnel and other resources to find local information and
partners, if possible.
Locate and create a list of nearby certified lead abatement firms using one of the links
below (depending on where you live):
- EPA-authorized lead-based paint abatement programs include Cherokee Nation,
Upper Sioux Community, Lower Sioux Indian Community in the State of Minnesota,
Minnesota Chippewa Tribe - Bois Forte (Nett Lake), AL, AR, CA, CO, CT, DC, DE,
GA, HI, IN, IA, KS, KY, LA, ME, MD, MA, Ml, MN, MS, MO, NE, NH, NJ, NC, ND,
OH, OK, OR, PA, Rl, TN, TX, UT, VT, VA, WA, WV or Wl: https://www.epa.gov/lead/
lead-based-paint-activities-professionals#map
- EPA runs the lead-based paint abatement program where there is not an
EPA-authorized program (in states and areas of Indian country not listed above):
https://cfpub. epa. gov/flpp/pub/index. cfm?do=main. firmSearchAbatement
Locate and create a list of nearby certified lead RRP firms: https://cfpub.epa.gov/flpp/
pub/index, cfm ?do=main. firm Search
Research the range of costs for both lead abatement and RRP professionals in your
area.
Identify the name and contact information for the local tribal housing authority.
Watch the EPA Lead-Based Paint Safe Work Practices video at https://www. voutube.
com/watch?v=XqUssA-PsDO before leading the session.
Familiarize yourself with Appendix B: Renovation, Repair and Painting Program:
Do-lt-Yourselfers in case participants have questions about conducting small-scale
projects themselves.
-------
Notes:
Make copies of the Module 4 worksheet, key
messages and kids activity sheet (1 copy for each
participant).
Edit the Module 4 Presentation Slides to incorporate
relevant stories, images and videos. Remove
presentation slides you do not plan to use during the
session.
Use the "Notes" boxes provided in the lesson plan
for personal notes.
Instructor Notes written in italics can be found throughout
the lesson plan. These notes are intended to help guide the
instructor through the discussion and presentation and are
not meant to be read out loud during the session.
Suggested Materials
Laptop and projector to display presentation slides
and video
EPA Lead-Based Paint Safe Work Practices (YouTube)
video
Module 4 Worksheet
Module 4 Key Messages
Module 4 Kids Activity Sheet
Pencils or pens
The Lead-Safe Certified Guide to Renovate
Right (download at: https://www.epa.gov/lead/
renovate-right-irmportant-lead-hazard-inforrmation-
families-child-care-providers-and-schools')
If access to technology is limited, you can use hard copies
of presentation slides.
Outcomes
Upon the completion of Module 4, participants will be able to:
List three potential lead-based paint hazards;
Compare the difference between a lead-based paint
inspection and a lead risk assessment;
List three things that Lead-Safe Certified Firms do
when conducting renovation, repair and painting
activities; and
Explain how to find a Lead-Safe Certified Firm.
92
Lesson Plan - Module 4
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Outline
I. Introduction (10 minutes) 94
II. Deteriorating Lead-Based Paint Hazards (10 minutes) ....95
III. Testing Your Home for Lead (10 minutes) 97
a. Lead-Based Paint Inspection
b. Lead-Based Paint Risk Assessment
IV. Lead Abatement (10 minutes) 98
V. Renovation, Repair and Painting (RRP) Rule 100
(15 minutes)
VI. Lead Abatement Versus RRP Projects (10 minutes).... 103
VII. Conclusion (10 minutes) 105
VIII. References 107
Notes:
Lesson Plan - Module 4 93
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Notes:
I. Introduction (10 minutes)
In this session, we are going to discuss what to do if you are
concerned that your home, child care facility or preschool,
whether owned or rented, contains lead-based paint. In
1978, the federal government banned the residential use of
lead-based paint, which made residential lead-based paint
no longer available for purchase in stores. The focus of this
session will be on housing, child care facilities or preschools
built prior to 1978. Before we begin, I have a few questions
for the group to gain a better understanding of what you
already know:
1. Has anyone ever heard that you should hire a certified
lead professional to do work on your home? Instructor
Note: This can be as simple as having participants
raise their hands to respond with "yes" or "no" or you
can allow participants time to share.
2. When should we hire certified lead professionals?
3. How can you tell if your home has lead-based paint
and that you might need to hire a certified lead
professional?
4. Instructor Note: Show participants the two photos of
houses. Looking at these photos can you tell which
house has lead-based paint? Instructor Note: Allow
participants a moment to think and respond. It is not
possible to tell just by looking at these houses if they
have lead. We know there is lead in the house on the
left photo example because the paint was analyzed
and was found to contain lead. The other house was
built in 2007.
Throughout this session, I will use the phrase "pre-1978
homes" to refer to homes, child care facilities or preschools
built before 1978.
The federal government banned the sale of paint containing
lead for use in residential homes in 1978 to reduce children's
exposure to lead. If your home was built before 1978, it may
have lead-based paint on interior and/or exterior surfaces. In
some instances, lead-based paint may have been purchased
before it was banned, stored and then used years later.
Today, lead-based paint may still be present under layers of
paint in pre-1978 homes. If paint is kept intact and surfaces
are kept clean, children can live safely in a home containing
lead-based paint. However, when painted surfaces are not
94
Lesson Plan - Module 4
-------
properly maintained, paint can deteriorate, peel, chip, chalk
or crack, becoming a hazard. When lead-based paint is old
and worn or is subject to constant rubbing (as on doors and
window sills) lead-based paint chips and dust can scatter
and become a hazard. These hazards can be breathed in or
swallowed by children, residents and workers. Lead dust can
also be scattered when paint is disturbed during renovation,
repair or remodeling. In addition, lead-based paint chips,
dust and contaminated soil can end up on a child's hands
and toys which younger children put in their mouths, leading
to ingestion of lead.
If painted surfaces are deteriorating and you are concerned
that they may contain lead-based paint, what would be the
first step to take to reduce potential exposure to lead in your
home? Instructor Note: Allow participants a moment to think
and then ask them to share their answers with the group.
A good first step would be to check with the local tribal
housing authority or environmental department to get more
information. If you own your home, hire a certified lead
professional to conduct a lead inspection and/or a lead risk
assessment. Another possible first step is to clean using the
techniques, such as wet mopping, covered in Module 2. We
will discuss lead inspections and lead risk assessments in
more detail later.
When renovation, repair and painting (RRP) jobs occur in a
pre-1978 home with lead-based paint, the disturbance of the
paint creates lead dust, which can be inhaled or swallowed.
Even if you try to keep the work area neat and clean, lead
dust cannot be contained unless proper lead-safe work
practices are followed. Therefore, it is important to have a
Lead-Safe Certified Firm perform the work. We will discuss
this later.
II. Deteriorating Lead-Based Paint Hazards
(10 minutes)
Deteriorating lead-based paint (peeling, chipping, chalking
or cracking paint) is a hazard and needs immediate attention.
A lead-based paint hazard is any condition resulting from
deteriorating paint, which causes exposure to lead from paint,
dust or soil. Lead-based paint is usually not a hazard if it is in
good condition and is not on an impact or friction surface like
a window or door jamb or surfaces that children chew.
Instructor Note: Give a copy of the Module 4 Worksheet,
Module 4 Key Messages and a pencil to each participant.
Notes:
Maintain Your Home's
Condition
It is important to maintain the
lead-painted surfaces in your
home. Lead-based paint in good
condition is usually not harmful. If
your home was built before 1978:
Regularly check your home
for chipping, peeling or
deteriorating paint. Fix small
areas (under six square feet)
of damaged paint as soon as
possible.
Regularly check all painted
areas that rub together or get
lots of wear, like windows,
doors and stairways. You can
reduce the amount of lead dust
created by fixing areas in the
home that bump or rub together.
One example of this would be
adjusting a tight-fitting door to
reduce the chance of creating
lead dust.
Regularly check for paint chips
or dust - if you see some,
remove carefully with a damp
paper towel and discard in the
trash, then wipe the surface
using the wet washing method
discussed in Module 2. (Ref. 1)
Lesson Plan - Module 4
95
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Notes:
The home shown on the worksheet has eight lead-based
paint hazards. Using the worksheet, find and circle the areas
in the home where it looks like the paint is peeling, chipping,
chalking or cracking.
Let's review the answers and see if you found all eight
lead-based paint hazards. Instructor Note: The correct
answers are circled within the presentation slides and can
be found upside down at the bottom of the worksheet.
The lead-based paint hazards in this home, where the paint
is deteriorating, peeling, chipping, chalking or cracking are:
1. Door (bedroom)
2. Wall (bathroom)
3. Windows (kitchen)
4. Trim/door frame (living room)
5. House exterior
6. Soil
7. Railing (outside)
8. Stairs (outside)
Areas where lead-based paint is disturbed can become
dangerous when paint chips form and dust is created. Lead-
based paint chips and dust can settle on food preparation
surfaces, floors, rugs, furniture, children's toys, pets and
many other surfaces and objects.
Settled lead dust can also re-enter the air when the home
is vacuumed or swept, or when people walk through it.
Families have been exposed to and affected by lead after
scraping, sanding or heating (from a heat gun or torch) lead-
based paint, which releases lead dust into the air. Lead in
soil can also be a hazard when children play in bare lead-
contaminated soil or when people bring lead-contaminated
soil into their home on their shoes. Lead dust from RRP work,
if not conducted in a lead-safe manner, remains in a home
long after the work is completed.
Caring for painted surfaces in your home is important,
especially those surfaces that you suspect of having lead-
based paint. Owners and occupants should check for
deteriorating paint (peeling, chipping, chalking or cracking
paint) and monitor activities that may disturb painted
surfaces. Remember that lead-based paint is usually not a
hazard if it is in good condition and is not on an impact or
friction surface like a window, that can create dust when
the painted surfaces rub against each other when opened
or closed.
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Lesson Plan - Module 4
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Lead-based paint chips, which you can see, and lead dust,
which you may not be able to see, can both be hazards. The
only way to find out if paint, dust or soil lead hazards exist is
to test them, which is what we will be talking about next.
III. Testing Your Home for Lead
(10 minutes)
The only way to know if your home has lead-based paint in it
is to have it tested. Has anyone ever had their home tested
for lead-based paint? Instructor Note: If someone responds
yes, give them time to share their experience.
There are two options available to test your home for lead-
based paint: a lead-based paint inspection or a lead-based
paint risk assessment. For either option, you should hire
a certified lead professional. These professionals have
special training and are licensed to perform these types of
in-home tests. Lead inspections and lead risk assessments
are important steps to take to find out if your home has
lead-based paint, the results of which can help you make
decisions on managing lead-based paint and lead hazards.
If you are renting your home or apartment and think it may
contain lead-based paint or lead hazards, you should
contact your landlord or tribal housing authority about hiring
a certified lead professional. Instructor Note: Provide
participants with any landlord or tribal housing authority
contact information you find.
If you are purchasing a home, real estate contracts must
include a specific warning statement about lead-based
paint. Buyers have up to 10 days after signing the real
estate contract to check for lead. Instructor Note: For
more information on real estate disclosures about potential
lead hazards, visit: https://www. epa. gov/lead/real-estate-
disclosures-about-potential-lead-hazards.
a. Lead-Based Paint Inspection
A lead-based paint inspection is an activity that tells you if
your home has lead-based paint and where lead-based paint
is located. The inspection will not tell you whether your home
currently has lead hazards or how to deal with them. A trained
and certified lead inspector will inspect the paint in your
home using a portable X-ray fluorescence (XRF) instrument
or take small paint samples for laboratory analysis.
Notes:
XRF Instrument
An XRF instrument is a hand-held,
portable machine used to analyze
lead in paint. For most painted
surfaces, the XRF instrument can
determine whether or not iead-
based paint is present. It works
similar to an X-ray machine at the
doctor's office, but the process
is different. Instead of taking a
picture, the XRF instrument tells
how much lead is in the paint,
typically in milligrams of lead per
square centimeter of surface
(Ref. 2). Special training is
needed to operate the machine.
Lesson Plan - Module 4
97
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Notes:
Lead Test Kits
Lead test kits are another option
that can be used to determine
if reguiated iead-based paint is
absent (not present) in homes,
child care facilities or preschools.
EPA has recognized three lead
test kits to use when complying
with the RRP rule. When used
by a trained professional, these
kits can reliably determine that
regulated lead-based paint is
absent via a negative result.
The kits recognized by EPA
are the 3M LeadCheck,
D-Leadฎ and the State of
Massachusetts lead test kits. The
State of Massachusetts kit is only
available to Massachusetts state
certified risk assessors and lead
inspectors.
For more information visit: https://
www, epa. aov/lead/lead-test-kits.
A lead-based paint inspection is most helpful:
o When buying a home;
o When signing a lease; and
o Before renovating.
Instructor Note: If your tribe has access to an XRF
instrument, invite a trained operator to come to the session
and demonstrate how the XRF instrument works.
b. Lead-Based Paint Risk Assessment
A lead-based paint risk assessment is an activity that tells
you if your home has any lead hazards from lead in paint,
dust or soil and what actions to take to address those
hazards. A trained and certified lead risk assessor will collect
samples of deteriorated paint, dust and soil and send them to
a laboratory for analysis and/or may use an XRF instrument.
A lead-based paint risk assessment is most helpful:
o If your home is known or suspected to contain
lead-based paint; and
o To develop a plan to address existing hazards.
When you hire a certified lead professional to either conduct
a paint inspection or a risk assessment, you can expect to
receive the testing results anywhere from a few hours to a
few days.
IV. Lead Abatement (10 minutes)
Lead abatement is designed to permanently eliminate
existing lead-based paint hazards. There are four types
of lead abatement: replacement, removal, enclosure and
encapsulation. While replacement and removal completely
remove lead-based paint, enclosure and encapsulation
methods are applied on top of lead-based paint in good
condition without removing the lead-based paint.
The decision to conduct lead abatement in a home can be
determined by different parties, such as:
A tribal, state or local government may order lead
abatement if a child has been diagnosed with an
elevated blood lead level;
A certified lead professional recommends lead
abatement after a lead-based paint inspection or
risk assessment; or
The homeowner may choose lead abatement.
Lead abatement involves specialized techniques beyond the
training of most residential contractors, and you should hire a
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Lesson Plan - Module 4
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trained and certified lead abatement contractor. EPA requires
individuals and firms who perform lead abatement projects
in homes, child care facilities or preschools built before
1978 to be certified and follow specific work practices. Lead
abatement can create even more dangerous lead hazards if
done improperly. If lead abatement is necessary, you should
always use a lead abatement firm or professional who has
been trained and certified by a tribal, state or an EPA lead-
based paint program.
Currently, there are four tribes with EPA-authorized lead-
based paint programs: Cherokee Nation, Upper Sioux
Community, Lower Sioux Indian Community in the State
of Minnesota and Minnesota Chippewa Tribe - Bois Forte
(Nett Lake). Most states and two territories are authorized by
EPA to run their own lead-based paint abatement programs.
EPA administers the lead-based paint program only in areas
where tribes, states or territories are not authorized by EPA
to operate their own lead-based paint programs.
Lead-Based Paint Programs
EPA-authorized Lead-
Based Paint Programs
EPA-administered
Lead-Based Paint
Programs
Tribes
Cherokee Nation, Upper
Sioux Community, Lower
Sioux Indian Community
in the State of Minneso-
ta, Minnesota Chippewa
Tribe - Bois Forte
(Nett Lake)
All Other Tribes
States
AL, AR, CA, CO, CT, DC,
DE, GA, HI, IN, IA, KS,
KY, LA, ME, MD, MA, Ml,
MN, MS, MO, NE, NH,
NJ, NC, ND, OH, OK,
OR, PA, Rl, TN, TX, UT,
VT, VA, WA, WV, Wl
AK, AZ, FL, ID, MT,
NV, NM, NY, SC,
SD, WY
Territories
Puerto Rico,
Virgin Islands
American Samoa,
Guam, the Northern
Marianas
Websites
https://www.
epa.aov/lead/
lead-based-paint-activi-
ties-professional s#rmap
https://cfpub.epa.
aov/flpp/pub/index.
cfrm?do=rmain.firrm-
SearchAbaterment
Notes:
EPA-authorized versus
EPA-administered
EPA-authorized - Several federal
environmental laws authorize
EPA to provide the authority for
Indian tribes to implement and
manage certain environmental
programs. For more information,
visit: httpsJ/www.epa.gov/triba!/
tribal-assumption-federal-laws-
treatment-state-tas.
EPA-administered - EPA is
responsible for implementing
federal environmental statutes
in Indian country. In the
absence of a federally approved
tribal program, EPA retains
program implementation
authority. Currently, EPA
maintains responsibility for
the implementation of the vast
majority of federal environmental
statutes in Indian country.
Lesson Plan - Module 4
99
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Notes:
Instructor Note: If you have internet access, go to the
appropriate website and show participants how to find a lead
abatement firm in their area.
When a lead abatement takes place in your home, a certified
lead abatement professional will follow lead-safe work
practices, which include:
Relocating children and pregnant women away from
the home (or child care facility) until after the work is
completed;
Removing all furniture, carpets, drapes, etc.; and
Covering everything that remains with plastic drop
cloths.
V. Renovation. Repair and Painting (RRP)
Rule (15 minutes)
Before we begin our discussion about the Renovation, Repair
and Painting (RRP) Rule, let's watch a short EPA video that
discusses tribal lead-based paint safe work practices.
Instructor Note: Play EPA's Lead-Based Paint Safe Work
Practices (YouTube) video, https://www.voutube.com/
watch?v=XqUssA-PsDO.
Any time surfaces painted with lead-based paint are
disturbed during common renovation, repair and painting
(RRP) activities like sanding, cutting and replacing windows,
this can create hazardous lead dust and chips, which can be
harmful to both adults and children.
RRP projects are typically performed at the option of the
property owner for aesthetic or other reasons, or as interim
control actions (such as: repairing damaged painted surfaces
or planting grass to cover contaminated soil) to minimize
lead hazards. RRP projects are not designed to permanently
eliminate lead-based paint hazards.
The RRP rule requires firms to be certified and their
employees trained (either as a certified renovator or on-the-
job by a certified renovator) in the use of lead-safe work
practices that minimize occupants' exposure to lead hazards
by:
Containing the work area;
Minimizing the dust;
Cleaning up properly; and
Disposing of waste properly to prevent lead
contamination.
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Lesson Plan - Module 4
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Federal law requires that individuals receive a copy of the
EPA document, "The Lead-Safe Certified Guide to Renovate
Right" before renovating six square feet or more of painted
surfaces in a room for interior projects or more than twenty
square feet of painted surfaces for exterior projects. The law
applies to any project in a pre-1978 home involving window
replacement or demolition regardless of the size of the area
disturbed. Instructor Note: Show the slide with the picture
of the EPA document, "The Lead-Safe Certified Guide to
Renovate Right," to the participants: https://www.epa.aov/
lead/renovate-riaht-irmportant-lead-hazard-inforrmation-farmilies-
child-care-providers-and-schools. Additional requirements
may exist for federal assistance housing (see box).
In preparing for RRP projects in a pre-1978 home, Lead-Safe
Certified renovators may:
Take a paint chip sample and send it to a laboratory for
analysis or use an XRF instrument to determine if lead-
based paint is present;
Use EPA-recognized test kits (except in housing
receiving federal assistance); or
Presume that lead-based paint is present and use
lead-safe work practices.
If renovation, repair or painting is being conducted and lead-
based paint is present or in any pre-1978 home that has not
been shown to be lead-free, then the work is required to be
done by a Lead-Safe Certified firm who must:
Be approved by EPA or an EPA-authorized tribal or
state program;
Use qualified trained individuals who follow
specific lead-safe work practices to prevent lead
contamination; and
Provide you with a copy of EPA's lead
hazard information document, The
Lead-Safe Certified Guide to Renovate
Right (Mps://www.epa.gov/lead/
renovate-right-irmportant-lead-hazard-
inforrmation-farmilies-child-care-
providers-and-schools). before
conducting renovations in pre-1978
homes.
Notes:
The U.S. Department
of Housing and Urban
Development (HUD) Lead
Safe Housing Rule
HUD's Lead Safe Housing
Rule applies to most pre-1978
federally owned housing and
pre-1978 housing receiving
federal assistance. It does not
cover chiid-occupied facilities
outside of residential housing.
The requirements of HUD's rule
are similar to EPA's RRP Rule, but
there are some differences (Refs.
3 to 5). The main differences
between the RRP Rule and HUD's
Lead Safe Housing Rule are that
HUD's rule has:
More specific occupant
protection and worksite
preparation requirements;
Additional prohibited methods
of paint removal:
A smaller worker area requiring
lead safe work practices;
RRP certification for all workers
on the project;
Clearance testing that must be
completed by a certified lead
risk assessor or inspector; and
More specific occupant
notification requirements.
For more detailed information
visit: https://www. hud, go v!
program offices/healthy homes/
enforcement/lshr.
Lesson Plan - Module 4
101
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Notes:
One tribe and 14 states are EPA-authorized to run their
own RRP programs. EPA administers the RRP program
in most states, territories and tribes, as shown in the RRP
Programs table.
RRP Programs
EPA-authorized RRP
Programs
EPA-administered
RRP Programs
Tribes
Minnesota Chippewa
Tribe - Bois Forte (Nett
Lake)
All Other Tribes
States
AL, DE, GA, IA, KS, MA,
Ml, NC, OK, OR, Rl, UT,
WA, Wll
All Other States
Territories
None
All Territories
Websites
https://cfpub.epa. aov/flpp/pub/index.cfrm?do=-
rmain.firrmSearch
If you live in a pre-1978 home and need to hire a renovator
or contractor, make sure you use an EPA, tribal or state
Lead-Safe Certified renovation firm in your area. To find one,
visit EPA's website: https://cfpub.epa.gov/flpp/pub/index.
cfrm?do=rmain.firrmSearch. Instructor Note: If you have
internet access, go to the website and show participants
how they can find a Lead-Safe Certified firm in their area.
When hiring a Lead-Safe Certified
contractor to do RRP work on your home
or child care facility, make sure to look
for EPA's Lead-Safe Certified Firm logo.
Use a certified lead inspector or risk
assessor to check to see if there is lead paint in your home
prior to doing any RRP work yourself. If lead is present, you
should hire a Lead-Safe Certified firm to perform the RRP job.
The RRP Rule typically does not apply to homeowners
renovating, repairing or painting their own homes, unless the
home or a portion of the home is a rental or is used to provide
child care services. Do-it-yourself projects can easily create
dangerous lead dust. Protect your family and home - work
&EPA
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Lesson Plan - Module 4
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safely, control the dust and clean up completely. Instructor
Note: If participants want to discuss this further, then utilize
the list of safeguards identified in Appendix B: Renovation,
Repair and Painting Program: Do-lt-Yourselfers.
Please pull out and flip over your worksheet to the section
labeled Understanding Lead Terms. We are going to do a
quick review about the differences between a lead inspection,
lead risk assessment, lead abatement and the RRP rule. Write
the number of the term next to its definition and then we will
go over the correct answers as a group. Instructor Note:
The correct answers are at the end of the Important Lead
Terms to Know section on the worksheet.
VI. Lead Abatement Activities Versus RRP
Projects (10 minutes)
Lead abatement activities and RRP projects may sometimes
look similar, but they are two separate programs that require
different certifications and are regulated differently by EPA.
Lead abatement is a specialized activity designed to
eliminate lead-based paint hazards in pre-1978 homes. RRP
projects in pre-1978 homes are often undertaken for reasons
unrelated to lead issues. The differences and similarities
between the two activities are shown in the Lead Abatement
Activities Versus RRP Projects table. Instructor Note: This
table can also be found in the Module 4 Key Messages
handed out at the beginning of the session.
Notes:
Lesson Plan - Module 4 103
-------
Lead Abatement Activities Versus RRP Projects
Lead Abatement Activities
Similar
or Different
RRP Projects
Purpose
Permanently eliminate
existing lead-based paint
hazards
Different
Conduct renovations, repairs
or painting to reduce lead-
based paint hazards
Initiated By
Tribal, state or local
government
Voluntary request by
property owner
Different
Voluntary request by
property owner
Certifications
Individuals must be trained
and certified in lead
abatement activities
Firms must be certified to
conduct lead abatement
activities
Similar
Individuals must be trained
and certified in RRP activities
Firms must be certified to
conduct RRP activities
Occupant
Protection
Firms are required to make
sure occupants are out of
the home, child care facility
or preschool
Different
Firms are not required to
make sure occupants are
out of the home, child care
facility or preschool
Firms must distribute EPA's
The Lead-Safe Certified
Guide to Renovate Right
before starting renovation
work
Occupants should not be
present in the work area
Learn More
About lead abatement and
EPA's Lead-Based Paint Pro-
ararm at: https://www.epa.aov/
lead/lead-abaterment-inspec-
tion-and-risk-assessment
About EPA's RRP certifica-
tion and training program at:
https://www.epa.aov/lead/
renovation-repair-and-paint-
ina-proararm
To continue reviewing what we learned today, answer the questions in the Lead Abatement
and Renovation, Repair and Painting (RRP) Review section at the bottom of your worksheet.
Instructor Note: Allow participants time to answer the questions and then go over the correct
answers with the whole group. Correct answers can be found upside down at the bottom of
the worksheet.
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Lesson Plan - Module 4
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VII. Conclusion (10 minutes)
A lead-based paint hazard is any condition resulting from
deteriorating paint (peeling, chipping, chalking or cracking),
which potentially causes exposure to lead from paint, dust or
soil. We learned that lead-based paint hazards may be found
in common areas of homes that include:
1. Doors;
2. Walls;
3. Windows;
4. Trim/door frames;
5. House exterior;
6. Soil;
7. Railings; and
8. Stairs.
I have a few discussion questions for the group:
1. What are lead-based paint activities? Instructor
Note: Lead-based paint activities include lead-based
paint inspections, lead risk assessments and lead
abatements (elimination of lead-based paint hazards).
Lead inspections are designed to locate all lead-
based paint in a home and lead risk assessments are
designed to identify lead hazards and management
strategies. Individuals must be trained and certified to
conduct lead-based paint activities, and firms must
be certified.
2. What are lead abatement activities? Instructor Note:
Lead abatement activities are designed to permanently
eliminate existing lead-based paint hazards. They may
be ordered by a tribal, state or local government in
response to a lead-poisoned child or other reason or
may be undertaken voluntarily at any time.
There are four types of lead abatement: replacement,
removal, enclosure and encapsulation. While
replacement and removal completely remove lead-
based paint, enclosure and encapsulation methods are
applied on top of lead-based paint in good condition
without removing the lead-based paint.
Individual lead abatement contractors must be trained
and certified to conduct lead abatement jobs. Cherokee
Nation, Upper Sioux Community, Lower Sioux Indian
Community in the State of Minnesota, Minnesota
Chippewa Tribe - Bois Forte (Nett Lake) are four tribes
that have EPA-authorized lead-based paint programs.
Most states and two territories are authorized by EPA
Notes:
Lesson Plan - Module 4
105
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Notes:
to run their own lead-based paint programs. EPA
administers the lead-based paint program in areas
where states, territories or tribes are not authorized by
EPA to operate their own lead-based paint programs.
For help in locating a certified lead abatement firm in
your area, visit the EPA website.
3. What are RRP projects? Instructor Note:
RRP projects that involve renovation, repair
and painting activities like sanding, cutting and
replacing windows and are typically performed
at the option of the property owner They are not
designed to permanently eliminate lead-based
paint hazards. Individual renovators must be trained
and certified in lead-safe work practices, and firms
must be certified. One tribe, Minnesota Chippewa
Tribe - Bois Forte (Nett Lake), and 14 states are
EPA-authorized to run their own RRP programs.
EPA administers the RRP program in most states,
territories and tribes. To search for Lead-Safe
Certified RRP firms, visit the EPA website. When
hiring a Lead-Safe Certified contractor to do RRP
work make sure to look for EPA's Lead-Safe Certified
Firm logo.
Lead abatement and RRP activities may sometimes look
similar, but they serve different purposes and require
different certifications.
To receive general information about lead or ask questions,
you can call the National Lead Information Center (NLIC). The
NLIC provides the public and professionals with information
about lead, lead hazards and prevention. Call and speak
with a specialist Monday through Friday, 8:00 am to 6:00 pm
Eastern time (except federal holidays) at 1 (800) 424-LEAD
[5323], Hearing- or speech-challenged individuals may
access this number through TTY by calling the Federal Relay
Service at 1-800-877-8339.
Thank you for participating in this session. Does anyone have
any questions about the information covered? Instructor
Note: Give each participant a copy of the Module 4 Kids
Activity Sheet to take home with them.
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Lesson Plan - Module 4
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VIII. References
1. U.S. Environmental Protection Agency. How
to Make Your Home Lead-Safe: Maintain Your Home's
Condition. Available at https://www.epa.aov/lead/how-
rmake-your-horme-lead-safe#Maintain. [Accessed October
2, 2020]
2. U.S. Environmental Protection Agency. EPA Model
Lead-Based Paint Abatement Worker Training Course.
2004. Available at https://www.epa.gov/lead/epa-rmodel-
lead-based-paint-abatement-worker-training-course.
[Accessed March 2, 2020],
3. U.S. Environmental Protection Agency. Steps
to Lead Safe Renovation, Repair and Painting. 2011.
Available at https://www.epa.aov/lead/steps-lead-safe-
renovation-repair-and-paintinq-october-2011. [Accessed
March 2, 2020],
4. U.S. Department of Housing and Urban
Development. Guidelines for the Evaluation and Control of
Lead-Based Paint Hazards in Housing. 2012. Available at
https://www.hud.gov/program offices/healthv hormes/lbp/
hudauidelines. [Accessed March 2, 2020],
5. U.S. Environmental Protection Agency and US
Department of Housing and Urban Development. Lead
Safety for Renovation, Repair, and Painting: Model
Certified Renovator Initial Training Course: Student Manual.
2011. Available at https://www.epa.aov/sites/production/
files/2014-05/docurments/initial renovator-student
oct2011 O.pdf. [Accessed March 12, 2020],
Notes:
Lesson Plan - Module 4
107
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108
-------
Worksheet I Module 4
Lead Awareness in Indian Country: Keeping our Children Healthy!
HIRING CERTIFIED LEAD PROFESSIONALS
LEAD-BASED PAINT HAZARDS
A lead-based paint hazard is any condition resulting from deteriorating (peeling, chipping, chalking or
cracking) paint, which causes exposure to lead from paint, dust or soil.
Directions: This home has eight lead-based paint hazards. Find and circle areas in this home where it
looks like paint is peeling, chipping, chalking or cracking.
ooo
sjjBjs 8 Bui/ibj i ijos 9 }uied jouejxa esnotj g auuej} joop/uuui (uuooj Buiaii)'p smopuim usi/ayy ฃ hbm uiooji/jeq 'g joop uaoojpaq 'i
SH3MSNV
For more information, contact the National Lead Information Center (NLIC) at 1-800-424-LEAD (5323)
109
-------
UNDERSTANDING LEAD TERMS
Directions: Write the number of the term next to its definition.
Terms
1. Lead-based paint inspection
2. Lead-based paint risk assessment
3. Lead abatement
4. Renovation, Repair and Painting (RRP) Rule
Definitions
An activity designed to permanently eliminate lead-based paint hazards. There are four
options: replacement, removal, enclosure and encapsulation. Replacement and removal
activities completely remove lead-based paint. Enclosure and encapsulation methods are
applied on top of lead-based paint in good condition without removing the lead-based
paint.
An activity that tells you if your home has any lead hazards from lead in paint, dust or soil
and what actions to take to address those hazards. Most helpful if a home is suspected
or known to contain lead-based paint or to develop a plan to address existing hazards.
An activity that tells you if your home has lead-based paint and where lead-based paint is
located. Most helpful when buying a home, signing a lease and before renovating.
A federal law that requires firms that disturb painted surfaces in homes, child care facilities
and preschools, built before 1978 to be certified and their employees trained in the use of
lead-safe work practices that minimize occupants' exposure to lead hazards by: containing
the work area; minimizing dust; cleaning up properly; and disposing of waste properly to
prevent lead contamination.
<7 'z 'ฃ
SU3MSNV
LEAD ABATEMENT AND RENOVATION, REPAIR AND PAINTING (RRP) REVIEW
1. TRUE OR FALSE - Anytime you disturb surfaces painted with lead-based paint, even if the paint is
covered by layers of newer paint, you risk creating hazardous lead dust.
2. TRUE OR FALSE - Lead abatement projects are designed to permanently eliminate lead-based paint
hazards.
3. TRUE OR FALSE - RRP firms are not required to be trained and certified when working
pre-1978 homes.
4. TRUE OR FALSE -1 should look for this logo when hiring a contractor for RRP work.
5. A Lead-Safe Certified contractor must follow lead-safe work practices that (select all that apply):
~ Contain the work area.
~ Dispose of waste properly.
~ Clean up thoroughly.
~ Avoid generating large amounts of lead dust.
A/ddBUB ฆgSDUl 'PBSlVd 'ฃ BfliJl Z BflUl 'L
SU3MSNV
110
Worksheet - Module 4
-------
Lead Awareness in Indian Country: Keeping our Children Healthy!
Key Messages | Module 4 HIRING CERTIFIED LEAD PROFESSIONALS
Hire a certified lead professional to follow lead-safe work practices when: (a) abating a home, child
care facility or preschool built before 1978 to address identified lead-based paint or lead-based paint
hazards, or (b) disturbing paint in renovation, repair and painting projects in homes, child care facilities
or preschools built before 1978.
COULD MY HOME HAVE LEAD-BASED PAINT?
The federal government banned the sale of paint containing lead for use in residential homes in 1978 to
reduce children's exposure to lead. If your home was built before 1978, it may have lead-based paint on
interior and/or exterior surfaces or under layers of paint, in some instances, lead-based paint may have
been purchased before it was banned, stored and then used years later.
Children can live safely in a home if lead-based paint is kept intact and surfaces are kept clean.
However, when painted surfaces are not properly maintained, paint can deteriorate, peel, chip, chalk or
crack, becoming a hazard.
The only way to know for certain if your home has lead-based paint is to have painted surfaces tested.
HOW CAN I TEST MY HOME FOR LEAD?
There are two options available to test your home for lead: a lead-based paint inspection or a lead-
based paint risk assessment. For either option a certified lead professional should be hired, if you rent
your home or apartment and think it may contain lead-based paint or lead-based paint hazards (any
condition resulting from deteriorating paint, which causes exposure to lead from paint, dust or soil), you
should contact your landlord or tribal housing authority. If purchasing a home, real estate contracts must
include a specific warning statement about lead-based paint. Buyers have up to 10 days after signing
the real estate contract to check for lead.
WHAT IS A LEAD-BASED PAINT INSPECTION?
A lead-based paint inspection is an activity that tells you if your
home has lead-based paint and where lead-based paint is
located. A trained and certified lead inspector will inspect the
paint in your home using a portable X-ray fluorescence (XRF)
instrument (pictured to the right) or take small paint samples for
laboratory analysis.
WHAT IS A LEAD-BASED PAINT RISK ASSESSMENT?
A lead-based paint risk assessment is an activity that tells you if
your home has any lead hazards from lead in paint, dust or soil
and what action to take to address those hazards. A trained and
certified lead risk assessor will collect samples of deteriorated
paint, dust and soil and send them to a laboratory for analysis
and/or will use an XRF instrument.
REHDIN6
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WHAT SHOULD I DO IF I HAVE LEAD-BASED PAINT IN MY HOME?
A home that contains lead-based paint does not necessarily present a health risk. If lead-based paint is
in good condition, owners and occupants should regularly monitor and check for deteriorating (peeling,
chipping, chalking or cracking) paint. If painted surfaces are deteriorating, this may create a hazard that
reguires immediate attention and a certified lead professional should be hired.
HOW CAN I ELIMINATE LEAD-BASED PAINT FROM MY HOME?
Lead abatement is designed to permanently eliminate existing lead-based paint hazards. There are
four types of lead abatement: replacement, removal, enclosure and encapsulation. Replacement and
removal completely remove lead-based paint, while enclosure and encapsulation methods are applied
on top of lead-based paint in good condition without removing the lead-based paint. Hire a trained and
certified lead abatement contractor to perform a lead abatement. EPA reguires individuals and firms
who perform lead abatement projects in homes, child care facilities or preschools built before 1978 to
be certified and follow specific work practices.
Renovation, Repair and Painting (RRP) projects are typically performed at the reguest of the property
owner for aesthetic or other reasons, or as interim control actions (e.g., repairing damaged painted
surfaces or planting grass to cover contaminated soil) to minimize lead hazards. Contractors who
disturb painted surfaces in homes, child care facilities and preschools built before 1978 must be
trained and certified and follow lead-safe work practices.
Lead abatement activities and RRP projects may sometimes look similar, but they are two separate
programs that reguire different certifications and are regulated differently by EPA. The differences
and similarities between these two activities are shown in the table below.
LEAD ABATEMENT ACTIVITIES VERSUS RRP PROJECTS
Lead Abatement Activities
Similar or
Different
RRP Projects
Purpose
Permanently eliminate existing
lead-based paint hazards
Different
Conduct renovations, repairs or
painting to reduce lead-based paint
hazards
Initiated By
Tribal, State or local government
Property owner's voluntary request
Different
Property owner's voluntary request
Certifications
Individuals must be trained and
certified in abatement activities
Firms must be certified to
conduct abatement activities
Similar
Individuals must be trained and
certified in RRP activities
Firms must be certified to conduct
RRP activities
Occupant
Protection
Firms are required to make sure
occupants are out of the home,
child care facility, or preschool
Different
Firms are not required to make sure
occupants are out of the home,
child care facility or preschool
Firms must distribute EPA's The
Lead-Safe Certified Guide to
Renovate Right before starting
renovation work
Occupants should not be present
in the work area
WHERE CAN I LEARN MORE?
For more information, contact the National Lead Information Center (NLIC) at 1-800-424-LEAD (5323)
or visit www.epa.aov/lead.
112 Key Messages - Module 4
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Lead Awareness in Indian Country: Keeping our Children Healthy!
Kids Activity Sheet i Moduie4 FIRING CERTIFIED LEAD PROFESSIONALS
Color Time
Older houses and apartments may have lead-based paint. If you find peeling paint, tell an
adult. Color the houses and apartment building below using your favorite colors.
I.jj
113
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Color by Number
Trained and certified workers can help make your home safe for you and your family if your
home has lead-based paint. Color the picture according to the key:
1 - orange 2 - brown 3 - yellow 4 - white 5 - blue
KEEP
OUT
When someone works on a house or apartment with lead-based paint they will:
Wear coveralls, gloves and a mask.
Remove furniture, rugs and curtains.
Cover everything with plastic.
Ask everyone to stay out of the work area.
KEEP
OUT
Stay out of the work area until work is done.
114
Kids Activity Sheet - Module 4
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Lead Awareness in Indian Country: Keeping our Children Healthy!
APPENDIX A: FOODS THAT CONTAIN
CALCIUM, IRON & VITAMIN C
Over 150 foods that contain varying amounts of calcium, iron and/or vitamin C are listed
below. This table is an unofficial source (provided by tribal representatives) that provides
examples of local/traditional foods and items found in a grocery store that can be part of an
overall healthy diet. For more detailed information about nutrient content in the foods below,
please visit the U.S. Department of Agriculture's FoodData Central at https://fdc.nal.usda.gov/.
Instructor Note: Use this table to identify foods during Module 3.
Food
Calcium
Iron
Vitamin C
Acorns
X
X
Almonds
X
X
Amaranth
X
X
X
Antelope
X
Asparagus
X
Avocado
X
X
X
Bananas
X
X
X
Barnacles
X
X
Beach asparagus
X
X
X
Beans
X
X
Bear
X
Beech nuts
X
X
X
Bell peppers
X
X
X
Beluga whale
X
X
Biscuit root/Coush
X
X
Bison
X
Bitter root
X
Black walnuts
X
X
Blackberries
X
X
X
Blue camas bulb
X
X
X
Blueberries
X
X
X
Bone broth
X
X
Breadfruit
X
X
X
Broadleaf arrowhead/Water potato/Wapato leaf & root
X
X
X
Broccoli
X
X
X
Brussels sprouts
X
X
X
Butternuts
X
X
X
Cabbage
X
X
X
Cantaloupe
X
X
X
Caribou
X
-------
Food
Calcium
Iron
Vitamin C
Carrots
X
X
Cattail
X
X
X
Cauliflower
X
Cheese
X
Chestnuts
X
X
X
Chia seeds
X
X
Chicken
X
Chokecherries
X
X
X
Cholla buds
X
X
Cinnamon
X
X
Clam
X
X
Cloudberries
X
X
Corn
X
Collard greens
X
X
Cottage cheese
X
Cow parsnip/Indian celery/Indian rhubarb/Pushki
X
X
Crab
X
X
X
Dandelion greens
X
X
X
Dark green leafy vegetables
X
X
X
Duck
X
X
Edamame
X
X
X
Eggs
X
X
Elk
X
Fiddleheads
X
X
X
Figs
X
X
X
Fireweed/Ciilaaq leaves
X
X
X
Fish eggs
X
X
X
Fish liver
X
Garlic
X
X
Grapes
X
X
Grapefruit
X
X
Green beans
X
X
X
Green chile (New Mexico chile)
X
X
X
Hazelnuts
X
X
X
Hickory nuts
X
X
X
Honeydew
X
X
X
Huckleberries
X
X
X
Kale
X
X
Kiwi
X
Lamprey eel
X
X
X
116
Appendix A
-------
Food
Calcium
Iron
Vitamin C
Leeks
X
X
X
Lemon
X
X
Lentils
X
X
X
Lime
X
X
X
Liver
X
Maple syrup
X
Mesquite beans (flour)
X
X
X
Milk
X
Moose
X
X
Mushrooms
X
X
X
Mussels
X
X
X
Mustard greens
X
X
X
Nettles
X
X
Nodding onion
X
X
X
Non-dairy milk
X
X
Nopal
X
X
X
Oats
X
X
Okra
X
X
X
Oranges
X
X
Oysters
X
X
Parsnips
X
X
Peaches
X
X
Peanut butter
X
X
Pears
X
X
X
Peas
X
X
X
Pima lima beans
X
X
Pine needles
X
X
X
Pine nuts
X
X
Pistachios
X
X
Plums
X
X
X
Popcorn
X
Potatoes
X
Prairie turnips
X
X
X
Prickly pear
X
X
X
Pumpkin/Squash seeds
X
X
Purslane
X
X
X
Quail
X
X
Quinoa
X
X
Rabbit
X
Raisins
X
X
X
Appendix A
117
-------
Food
Calcium
Iron
Vitamin C
Ramp/Wild leek
X
X
X
Raspberries
X
X
X
Rhubarb
X
X
X
Rose hips
X
X
X
Salmon, fresh
X
Salmon, canned
X
X
Salmonberries
X
X
X
Sardines
X
X
Scallops
X
Sea cucumber
X
X
Sea lion
X
X
Sea urchins
X
X
X
Seaweed/lettuce
X
X
X
Seal liver
X
X
Seal meat
X
Sesame seeds
X
Shrimp
X
X
Smelt
X
Snails
X
Sochan
X
X
X
Spinach
X
X
X
Spruce tip tea
X
Squash
X
X
X
Squid
X
X
X
Squirrel
X
Strawberries
X
X
X
Sunflower seeds
X
X
Sweet potatoes
X
X
X
Tangerine
X
X
Taro
X
X
X
Tepary bean
X
X
Tofu
X
X
Tomatoes
X
X
X
Trout
X
Tuna fish
X
Tundra tea
X
X
X
Turkey
X
Turnip
X
X
X
Venison
X
Walrus
X
X
118
Appendix A
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Food
Calcium
Iron
Vitamin C
Watercress
X
Watermelon
X
X
X
White beans
X
X
Whole wheat bread
X
X
Wild raspberries
X
X
X
Wild rice
X
Willow leaves
X
X
X
Wocas/Yellow pond lily seeds and tuber
X
X
Yams
X
X
X
Yogurt
X
Appendix A
119
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120
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Lead Awareness in Indian Country: Keeping our Children Healthy!
APPENDIX B: RENOVATION, REPAIR AND PAINTING
PROJECTS FOR DO-IT-YOURSELFERS
The Lead Renovation, Repair and Painting (RRP) Rule typically does not apply to
homeowners renovating, repairing or painting their own homes, unless the home or a portion
of the home is a rental or is used to provide child care services. Do-it-yourself projects can
easily create dangerous lead dust. Protect your family and home - work safely, control the
dust and clean up completely.
Follow these safeguards to prevent lead dust from spreading throughout your home and
exposing your family to lead dust.
Work Safely
Remove all furniture, area rugs, curtains, food, clothing and other household items until
cleanup is complete.
Items that cannot be removed from the work area should be tightly wrapped with
plastic sheeting and sealed with tape,
Cover floors with plastic sheeting.
If working on a larger job, construct an airlock at the entry to the work area.
The airlock consists of two sheets of thick plastic. One sheet is completely taped
along all four edges,
The plastic sheet is then cut down the middle.
The second sheet is only taped along the top and acts as a flap covering the slit
in the first sheet of plastic.
Turn off forced-air heating and air conditioning systems. Cover vents with plastic
sheeting and tape the sheeting in place.
Close all windows in the work area.
If disturbing paint, when using a hand tool, spray water on lead-painted surfaces to
keep dust from spreading.
Get the Right Equipment
It is important to get the right equipment to protect you and your family from lead
exposure.
NIOSH-certified disposable respirator with a HEPA (High-Efficiency Particulate Air) filter
(N-100, R-100, or P-100).
HEPA filter-equipped vacuum cleaner. Regular household vacuums may release
harmful lead particles into the air.
Wet-sanding equipment (e.g., spray mister), wet/dry abrasive paper, and wet sanding
sponges for "wet methods."
Two buckets and all-purpose cleaner. Use one bucket for the cleaning solution and the
other bucket for rinsing. Change the rinse water frequently and replace rags, sponges
and mops often.
Heavy-duty plastic sheeting and heavy-duty plastic bags.
f/A. jjffSE& ' A - i
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Tape. Use tape to completely seal the plastic sheeting in place (e.g., covering furniture
and air vents to construct an airlock).
Protective clothing. To keep lead dust from being tracked throughout your home, wear
clothes such as coveralls, shoe covers, hats, goggles, face shields and gloves .
Follow Good Work Practices
Plan for and complete a home RRP project using lead-safe work practices as outlined in EPA's
Steps to Lead Safe Renovation, Repair and Painting: October 2011 found at https://www.epa.
aov/sites/production/files/2013-11 /documents/steps O.pdf.
Consider Hiring a Certified Lead Abatement Contractor or
Inspector
Anytime you cut into surfaces painted with lead-based paint, even if the paint is covered
by layers of newer paint, you risk creating hazardous lead dust. You can reduce the risk of
lead exposure in your home by hiring a certified lead inspector to check to see if there is
lead-based paint in your work area. If there is lead, then you may want to have a trained and
certified lead abatement contractor remove the lead from the area before you begin the work.
To locate contractors who perform lead abatement and inspection activities in your area, visit:
https://cfpub.epa.gov/flpp/pub/index.cfrm?do=rmain.firrmSearchAbaterment.
Consider Hiring a Certified RRP Contractor
If you have or think you may have lead-based paint in your home, it is best to hire a trained
lead-safe certified RRP contractor. These contractors have been trained in special methods to
minimize dust and clean up thoroughly to reduce the chance of lead contamination. To locate
contractors who are lead-safe certified in your area, visit: https://cfpub.epa.gov/flpp/pub/index.
cfrm?do=rmain.firrmSearch.
Call the National Lead Information Center at 1-800-424-LEAD (5323) for more information.
122
Appendix B
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Lead Awareness in Indian Country: Keeping our Children Healthy!
APPENDIX C: GLOSSARY
Blood lead level - The amount of lead in blood, measured in micrograms per deciliter ((jg/dl).
Blood lead test - Test that measures how much lead is in blood.
Elevated blood lead level - A single blood lead test at or above the U.S., Centers for Disease
Control and Prevention (CDC) blood lead reference value. For more information on CDC's
current blood lead reference value, visit: https://www.cdc.gov/nceh/lead/prevention/blood-lead-
levels.htm.
EPA-administered - In the absence of an EPA-authorized program, EPA retains program
implementation authority and directly implements programs under federal environmental
statutes in Indian country. Currently, EPA directly implements the vast majority of programs
under federal environmental statutes in Indian country.
EPA-authorized - Several federal environmental laws provide authority for EPA to authorize
eligible Indian tribes to administer environmental programs established under those statutes
in the same manner as states. For more information, visit: https://www.epa.gov/tribal/tribal-
assumption-federal-laws-treatment-state-tas.
High Efficiency Particulate Air (HEPA) filter - A special filter which traps extremely small
particles such as lead dust. For more information, visit: https: //www.e pa. aov/i ndoor-air-
quality-iaq/what-hepa-filter-1.
Hygiene - Actions taken to keep our bodies clean, such as washing our hands or hair and
taking a bath.
Lead - A naturally occurring element found in small amounts in the earth's crust.
Lead abatement - An activity designed to permanently eliminate lead-based paint hazards.
There are four options: replacement, removal, enclosure and encapsulation. Replacement
and removal activities completely remove lead-based paint. Enclosure and encapsulation
methods are applied on top of lead-based paint in good condition without removing the
lead-based paint.
Lead-based paint - Paint with lead levels greater than or equal to 1.0 milligram per square
centimeter (mg/cm2), or more than 0.5% by weight (as defined by the federal government).
Lead-based paint hazard - Any condition resulting from deteriorating (peeling, chipping,
chalking or cracking) paint, which causes exposure to lead from paint, dust or soil
Lead-based paint inspection - An activity conducted by a trained and certified lead-based
paint inspector that tells you if your home has lead-based paint and where lead-based paint
is located.
f/A. jjffSE& ' A - i
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Lead-based paint risk assessment - An activity conducted by a trained and certified lead-
based paint risk assessor that that tells you if your home has any lead hazards from lead in
paint, dust or soil and what actions to take to address those hazards.
Lead dust - Lead in household dust, formed when lead-based paint is scraped, sanded or
heated. It also forms when painted surfaces containing lead bump or rub together.
Lead dust trap - Space or object where lead dust can easily gather on, in or under.
Lead poisoning - Sickness caused by swallowing or breathing lead.
Lead-Safe Certified firm - Renovation firm certified by an EPA-approved training provider in
lead-safe work practices for renovation, repair and painting projects that disturb lead-based
paint in homes, child care facilities and preschools built before 1978.
Lead-safe work practices - A group of techniques that reduce the amount of dust produced
by renovation activities.
Minimally processed - Minimal processing may include: (a) those traditional processes
used to make food edible or to preserve it or to make it safe for human consumption, e.g.,
smoking, roasting, freezing, drying and fermenting, or (b) those physical processes which do
not fundamentally alter the raw product and/or which only separate a whole, intact food into
component parts, e.g., grinding meat, separating eggs into albumen and yolk and pressing
fruits to produce juices.
Nutrient - A substance in food or beverages that provides nourishment for growth and the
maintenance of life.
Nutrition - The process of consuming food or beverages necessary for health and growth,
which our bodies need to stay alive and healthy.
Pre-1978 home - (for the purposes of this curriculum) - Homes, child-occupied facilities or
preschools built before 1978.
Renovating. Repair and Painting (RRP) Rule - Requires that firms performing renovation,
repair and painting projects that disturb lead-based paint in homes, child care facilities and
preschools built before 1978 have their firm certified by EPA (or an EPA authorized state or
tribe), use certified renovators who are trained by EPA-approved training providers and follow
lead-safe work practices.
Wet washing - The use of wet or damp items (e.g., wash cloth, mop) for cleaning.
X-ray fluorescence (XRF) instrument - A hand-held, portable machine used to analyze
lead in paint.
124
Appendix C
-------
Lead Awareness in Indian Country: Keeping our Children Healthy!
APPENDIX D: SUPPLEMENTAL RESOURCES
The following is a list of resources containing additional information on the topics covered in
the Curriculum. Resources are categorized by topic.
Blood Lead Levels
1. Centers for Disease Control. Blood Lead Levels in Children. 2020. Available at https://
www.cdc.aov/nceh/lead/prevention/blood-lead-levels.htm. [Accessed March 30, 2020],
2. Centers for Disease Control. Recommended Actions Based on Blood Lead Level.
2019. Available at https://www.cdc.aov/nceh/lead/docs/lead-levels-in-children-fact-sheet-508.
pdf. [Accessed March 30, 2020],
Cleaning
1. Michigan Childhood Lead Poisoning Prevention Program. Safe Cleaning of Lead Paint
Chips and Dust. 2018. Available at https://www.michiaan.gov/documents/lead/Guide to
Cleaning Lead FINAL approved 547508 7.pdf. [Accessed March 30, 2020],
2. UCSF Institute for Health & Aging, UC Berkeley Center for Environmental Research
and Children's Health, Informed Green Solutions, and California Department of Pesticide
Regulation. 2013. Green Cleaning, Sanitizing, and Disinfecting: A Toolkit for Early Care
and Education. Available at https://www.epa.aov/sites/production/files/documents/ece
curriculumfinal.pdf. [Accessed March 30, 2020],
3. U.S. Environmental Protection Agency. Safer Choice. 2018, Available at https://www.
epa.aov/saferchoice. [Accessed March 30, 2020],
Exposure Sources
1. Chen, L. and Eisenberg J, Health hazard evaluation report: exposures to lead and
other metals at an aircraft repair and flight school facility. 2013. Available at https://www.cdc.
aov/niosh/hhe/reports/pdfs/2012-0115-3186.pdf. [Accessed June 30, 2020],
2. Contra Costa Health Services. Questions and Answers about Lead in Older Vinyl Mini
Blinds. (No date). Available at https://cchealth.ora/lead-poison/Ddf/miniblinds.pdf. [Accessed
August 24, 2020],
3. State of Alaska Epidemiology. 2001, Bulletin No. 17: Cottage Industry Causes Acute
Lead Poisoning. Available at http://epi.alaska.aov/bulletins/docs/b2001 17.pdf. [Accessed
August 24, 2020],
4. U.S. Consumer Product Safety Commission. Recall List. (No date). Available at https://
www.cpsc.gov/RecalIs. [Accessed March 30, 2020],
5. U.S. Environmental Protection Agency. Superfund. 2018. Available at https://www.epa.
gov/superfund. [Accessed March 30, 2020],
f/A. jjffSE& ' A - i
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General Information on Lead
1. Agency for Toxic Substances and Disease Registry. Case Studies in Environmental
Medicine: Lead Toxicity. 2017. Available at https://www.atsdr.cdc.aov/csem/csem.
asp?cserm=34&po=0. [Accessed August 20, 2020],
2. Centers for Disease Control and Prevention. Childhood Lead Poisoning Prevention.
20209. Available at https://www.cdc.aov/nceh/lead. [Accessed March 30, 2020],
3. Centers for Disease Control. Lead Poisoning: Words to Know from A to Z. (No date).
Available at https://www.cdc.gov/nceh/lead/tools/leadglossary 508.pdf. [Accessed March 30,
2020],
4. Head Start Early Childhood Learning & Knowledge Center. How to Protect Your
Children from Lead Poisoning. (No date), https://eclkc.ohs.acf.hhs.gov/sites/default/files/pdf/
lead-brochure-enalish.pdf. [Accessed March 30, 2020],
5. HealthyEnvironrments. How Mother Bear Taught the Children about Lead, part 1 of 2
video. 2010. Available at https://www.youtube.corm/watch?v=kOj9XYsjbS4. [Accessed July 9,
2020],
6. HealthyEnvironrments. How Mother Bear Taught the Children about Lead, part 2 of 2
video. 2010. Available at https://www.youtube.corm/watch?v=6QIWZpg50h0&feature=youtu.
be. [Accessed July 9, 2020],
7. Sesame Workshop. Lead Awareness: Lead Away! video. 2010. Available at https://
www.sesamestreet.org/toolkits/leadaway. [Accessed March 30, 2020], (video for children
about lead).
8. University of Connecticut. How Mother Bear Taught the Children about Lead. 2003.
Available at https://kids.niehs.nih.gov/activities/stories/mother-bear/index.htm. [Accessed July
9, 2020],
9. U.S. Environmental Protection Agency. Lead. 2020. Available at https://www.epa.gov/
lead. [Accessed March 30, 2020],
10. U.S. Environmental Protection Agency. Lead Laws and Regulations. 2019. Available at
https://www.epa.gov/lead/lead-laws-and-regulations. [Accessed March 30, 2020],
Hunting. Fishing and Wildlife
1. Haig, S.M.; D'Elia, J.; Eagles-Smith, C.; Fair, J.M.; Gervais, J.; Herring, G.; Rivers,
J.W.; and Schulz, J.H. The Persistent Problem of Lead Poisoning in Birds from Ammunition
and Fishing Tackle. The Condor. 2014. Volume 116, pp. 408-428. Available at https://doi.
org/10.1650/CQNDQR-14-36.1. [Accessed July 14, 2020],
2. Institute for Wildlife Studies. Alternatives to Lead: A Better Approach: Use Non-Lead
Bullets. 2011. Available at http://www.iws.ora/Alternativesto%20Lead 2011 final%20
draft 6.23.11 .pdf. [Accessed July 14, 2020],
3. National Park Service. Video Clips: Lead Bullets vs Non-lead Bullets. 2015. Available
at https://www.nps.aov/pinn/learn/nature/condor video.htm. [Accessed July 17, 2020],
4. Nez Perce Tribe. Hunter Stewardship Safety Program. (2020). Available at http://www.
nezperce.org/nez-perce-tribe-wildlife-division/hunter-safetv-stewardship-proararm/. [Accessed
August 24, 2020],
5. Nez Perce Tribe. Wildlife Division Expands Community Hunter Stewardship Program.
(2020) Available at https://nezperce.ora/wp-content/uploads/2020/06A/Vildlife-Division-
Expands-Cormrmunitv-Hunter-Stewardship-Proararm 6920.pdf. [Accessed July 14, 2020],
6. North American Non-Lead Partnership. North American Non-Lead Partnership
Partners. (No date). Available at http://nonleadpartnership.org/. [Accessed July 14, 2020],
126 Appendix D
-------
7. Oregon Zoo. Non-Lead Hunting Education Program. (No date). Available at https://
www.oreaonzoo.ora/conserve/non-lead-huntina-education-proaram. [Accessed July 14,
2020],
8. U.S. Environmental Protection Agency. Historical Advisories Where You Live. 2018.
Available at https://fishadvisorvonline.epa.aov/General.aspx. [Accessed March 30, 2020],
9. U.S. Fish and Wildlife Service. Non-Toxic Ammunition Frequently Asked Questions.
(No date) Available at https://www.fws.gov/midwest/refuges/FAQs.pdf. [Accessed March 30,
2020],
10. U.S. Fish and Wildlife Service. Deer Hunting & Lead Be Part of the Solution. (No
date). Available at https://www.fws.gov/rmidwest/refuges/Deer%20Hunting%20and%20Lead%
20fact%20sheet.pdf. [Accessed March 30, 2020],
Nutrition
1. Gebhardt, S.E. and Thomas, R.B. Nutritive Value of Foods. 2002. U.S. Department of
Agriculture, Agriculture Research Service, Home and Garden Bulletin 72. Available at https://
www.ars.usda.gov/is/np/NutritiveValueofFoods/NutritiveValueofFoods.pdf. [Accessed March
27, 2020],
2. Kuhnlein, H.V. and Humphries, M.M. Traditional Animal Foods of Indigenous Peoples
of Northern North America: The Contributions of Wildlife Diversity to the Subsistence
and Nutrition of Indigenous Cultures. 2017. Centre for Indigenous People's Nutrition and
Environment, McGill University, Montreal. Available at http://traditionalanimalfoods.org/
nutrients.aspx . [Accessed March 31, 2020],
3. National Native Network. Traditional Foods Resource Guide for Indian Health
Service Areas - Alaska, California, Great Plans and Portland. (No date). Available at http://
keepitsacred.itcrmi.org/wp-content/uploads/sites/5/2015/06/Traditional-Foods-Resource-
Guide.pdf. [Accessed March 31, 2020],
4. U.S. Department of Agriculture. Choose My Plate. (No date). Available at https://www.
choosemvplate.gov/. [Accessed July 27, 2020],
5. U.S. Department of Agriculture. Protect Against Lead Exposure with WIC Foods. (No
date). Available at https://wicworks.fns.usda.oov/resources/protect-aoainst-lead-exposure-
wic-foods. [Accessed July 27, 2020],
6. U.S. Department of Agriculture. Protect Against Lead Exposure with WIC Foods
- Sample Meals. (No date). Available at https://wicworks.fns.usda.aov/resources/protect-
against-lead-exposure-wic-foods-sarmple-rmeals. [Accessed July 27, 2020],
7. U.S. Department of Agriculture, Agriculture Research Service. FoodData Central.
2019. Available at https://fdc.nal.usda.aov/. [Accessed March 27, 2020],
8. U.S. Department of Health & Human Services: National Institutes of Health. Vitamin
C: Fact Sheet for Consumers. 2019. Available at https://ods.od.nih.gov/factsheets/VitarminC-
Consurmer/. [Accessed March 30, 2020],
9. U.S. Environmental Protection Agency. Fight Lead Poisoning with a Healthy Diet.
2019. Available at https://www.epa.gov/lead/fight-lead-poisoning-healthy-diet. [Accessed
March 30, 2020],
10. U.S. Food and Drug Administration. How to Understand and Use the Nutrition Facts
Label. 2020. Available at https://www.fda.gov/food/new-nutrition-facts-label/how-understand-
and-use-nutrition-facts-label. [Accessed March 27, 2020],
11. U.S. Food and Drug Administration. Nutrition Education Resources & Materials. 2020.
Available at https://www.fda.gov/food/food-labeling-nutrition/nutrition-education-resources-
materials. [Accessed March 31, 2020],
Appendix D
127
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12. U.S. Food and Drug Administration. Vitamins and Minerals Chart. 2020. Available at
https://www.accessdata.fda.aov/scripts/lnteractiveNutritionFactsLabel/assets/lnteractiveNFL
Vitarmins&MineralsChart March2020.pdf. [Accessed March 31, 2020],
13. U.S. Food and Drug Administration. The Lows and Highs of Percent Daily Value on the
New Nutrition Facts Label. 2020. Available at https://www.fda.gov/food/new-nutrition-facts-
label/lows-and-highs-percent-dailv-value-new-nutrition-facts-label. [Accessed July 27, 2020],
14. U.S. Food and Drug Administration and US Environmental Protection Agency. Eating
Fish: What Pregnant Women and Parents Should Know. 2019. Available at https://www.fda.
gov/food/consumers/advice-about-eating-fish. [Accessed February 11, 2020],
Personal Hygiene
1. Centers for Disease Control and Prevention. Handwashing and Hand Sanitizer Use at
Home, at Play, and Out and About. (No date). Available at https://www.cdc.gov/handwashing/
pdf/hand-sanitizer-factsheet.pdf. [Accessed November 6, 2018],
2. Centers for Disease Control and Prevention. Handwashing: Clean Hands Save Lives.
2019. Available at https://www.cdc.gov/handwashing/index.html. [Accessed March 27, 2020],
3. Centers for Disease Control and Prevention. Videos. Available at https://www.cdc.gov/
handwashing/videos.html. [Accessed March 27, 2020],
Renovation. Repair, and Painting (RRP) Rule
1. Hometime TV. Lead-Safe Certified Remodeling with Dean Johnson (video from
February 11, 2013). Available at https://www.voutube.com/watch?v=U-3U1 pcSlvg. [Accessed
July 7, 2020],
2. U.S. Environmental Protection Agency. Protect Your Family from Lead in Your Home.
2020. Available at https://www.epa.gov/lead/protect-vour-familv-lead-vour-home. [Accessed
March 30, 2020],
3. U.S. Environmental Protection Agency. The Lead-Safe Certified Guide to Renovate
Right. 2011. Available at https://www.epa.gov/lead/renovate-right-irmportant-lead-hazard-
inforrmation-farmilies-child-care-providers-and-schools.[Accessed March 30, 2020],
4. U.S. Department of Housing and Urban Development and U.S. Environmental
Protection Agency. EPA Certified Renovation Firms and Certified Renovators: Additional
Requirements of HUD's Lead Safe Housing Rule. 2011. Available at https://www.epa.gov/
sites/production/files/docurments/rrp-hud-req-oct11 .pdf. [Accessed March 30, 2020],
U.S. Department of Housing and Urban Development (HUD)
1. U.S. Department of Housing and Urban Development. Office of Lead Hazard Control
and Healthy Homes. (No date). Available at https://www.hud.gov/program offices/healthy
homes. [Accessed March 30, 2020],
2. U.S. Department of Housing and Urban Development. Office of Native American
Programs (ONAP). Available at https://www.hud.gov/program offices/public indian housing/
ih. [Accessed March 30, 2020],
128
Appendix D
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Water
1. U.S. Environmental Protection Agency. 3Tsfor Reducing Lead in Drinking Water
Toolkit. Available at https://www.epa.aov/around-water-and-drinkina-water/3ts-reducina-lead-
drinkina-water-toolkit. [Accessed March 30, 2020],
2. U.S. Environmental Protection Agency. 3Ts for Tribal Schools: A Training, Testing,
Taking Action Approach. (No date). Available at https://www.epa.aov/sites/production/
files/2018-09/docurments/3ts for tribes draft final 9 5 2018 508 O.pdf. [Accessed March
30, 2020],
3. U.S. Environmental Protection Agency. Basic Information about Lead in Drinking
Water. 2019. Available at https://www.epa.aov/around-water-and-drinkina-water/basic-
inforrmation-about-lead-drinking-water. [Accessed March 30, 2020],
4. U.S. Environmental Protection Agency. Private Drinking Water Wells. 2018. Available at
https://www.epa.aov/privatewells. [March 30, 2020],
Appendix D
129
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130
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Lead Awareness in Indian Country: Keeping our Children Healthy!
ACKNOWLEDGEMENTS
The Lead Awareness in Indian Country: Keeping our Children Healthy! Curriculum's
development was overseen by the Tribal Lead Curriculum Working Group (Working Group),
which consists of individuals from the National Tribal Toxics Council, the National EPA-Tribal
Science Council and the U.S. Environmental Protection Agency.
The Working Group thanks all of our tribal partners for their support, collaboration, dedication
and contributions to the content and design of these materials. Over 200 tribal representatives
have been involved in the Curriculum's development from beginning to end. They participated
in discussion sessions and pilots, reviewed drafts, shared stories, evaluated key messages
and drafted content, as well as reviewed the Curriculum at different stages of development.
The Working Group acknowledges the commitment of a sub-group of tribal representatives
who were major contributors in drafting the content, performing cover-to-cover reviews and/
or presenting and piloting the Curriculum to various audiences. This sub-group included
representatives from the following tribes and organizations:
Aroostook Band of Micmacs;
Cherokee Nation;
Cochiti Pueblo;
Coeur d'Alene Tribe;
Confederated Salish and Kootenai Tribes of the Flathead Reservation;
Eight Northern Indian Pueblos Council, Inc.;
Institute for Tribal Environmental Professionals;
LEAD Agency, Inc.;
Michigan Public Health Institute;
Michigan State University Extension - Health and Nutrition Institute;
Michigan State University - Lyman Briggs College of Science;
The Muscogee (Creek) Nation;
The Nez Perce Wildlife Division;
Oneida Environmental Health Safety and Land Management;
Oneida Community Health;
Passamaquoddy Tribe;
Quapaw Nation Environmental Office;
Quentin Burdick Health Facility;
Santo Domingo Tribe;
Shoshone-Bannock Tribes of the Fort Hall Reservation;
Tohono O'odham Nation; and
Turtle Mountain Band of Chippewa Indians of North Dakota,
The Working Group also appreciates the support provided by several federal agencies in
both the development and review of content.
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United States
Environmental Protection
Agency
For more information, contact the National Lead Information Center (NLIC)
at 1-800-424-LEAD (5323). Or visit www.epa.gov/lead.
EPA-744-B-20-001
October 2020
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