Lead poisoning is one of today’s most common and preventable pediatric health problems (Anderson, Whitwell, Snyder and Besunder, 1999). Lead is a known neurotoxin that adversely affects children’s behavior and development at levels as low as 10ug/dL, the lowest acceptable level of blood lead concentration established by the Centers for Disease Control in 1991 (CDC, 1991). The focus of lead poisoning is mainly on young children who live in contaminated environments that ingest significant amounts of lead dust through their hand-to-mouth behavior (Children’s Safety Network, April 1997).
Despite efforts to eradicate the problem of childhood lead poisoning, many urban areas continue to be plagued with childhood lead poisoning incidences (Binns and Mehta, 1998). Estimates are that one child in six suffers from lead poisoning with a total of 3-4 million children affected nationwide (Sum 10); 10% or approximately 2 million of them are preschool children (Sum 16). As many as 890,000 (8,9%) children in the United States today have levels high enough to affect learning and behavior (Sum 1-CDC, 1997).
In California, it is estimated that 0.4% of the population or 130,000 children between the ages of one and five have elevated blood lead levels (California State Auditor, 1999).
Los Angeles has more lead poisoning cases than any other county in California. It has been estimated that 12.7% of the population or 76,194 children between the ages of one and five have elevated blood lead levels, using the third National Health and Nutrition Examination Survey NHANES III, 1988-1991 (Pirkle et al., 1994). Since 1991, the Childhood Lead Poisoning Prevention Program (CLPPP) has identified 10,673 children with blood lead levels higher than 10ug/dL, including 4,635 children under the age of six. This information sets the stage for this graduate project since it reveals that approximately 58.6% of the children lead poisoned in the state of California reside in Los Angeles County (CLPPP HUD Grant, 2000).
This study will focus on the development and administration of a survey to assess parents’ knowledge regarding the risk of lead poisoning. A review of the literature points to a significant gap in lead surveys that are designed to properly assess parents’ knowledge regarding the risk of lead poisoning and lead poisoning prevention, specifically in Los Angeles County. Traditionally, it has been physicians as a group, not parents, that are most targeted through surveying (Goldman, Demissie, DiStefano, McNally and Rhoads, 1998). In addition, most studies using questionnaires and surveys are aimed at assessing the prevalence of lead poisoning in children in high-risk populations (Nordin, Rolnick, and Griffin, 1994) or are used to help identify children with elevated blood lead levels, not to test parents (Schaffer, Szilagyi, and Weitzman, 1994).
Unfortunately, in the limited studies that have been conducted on the subject, many parents are still unaware of the dangers of lead poisoning. Major gaps in parental knowledge regarding the risk of lead poisoning and lead poisoning prevention methods still exist. In one Chicago study titled, ‘What Do Parents Know About Lead Poisoning?’ Mehta and Binns (1998) showed that parents had limited knowledge about ways to prevent lead poisoning and the importance of good nutrition as a preventative measure. In a second lead related study conducted by Irene Mahon, R.N., M.P.H. (1997) with the Philadelphia Department of Public Health, a questionnaire was developed to assess the knowledge, perceptions, and behaviors of family caregivers of children under the age of eight. The survey was administered at pediatric clinics in two geographic areas of the city with documented severe and moderate lead poisoning rates. Results of the study found that caregivers of children in high-risk areas did not mention lead poisoning as a health concern. Only 15% of the parents in the study had identified lead paint dust as a source of lead poisoning and approximately 49% of the caregivers reported that they “never” or only “sometimes” perform recommended prevention activities.
Dalton, Sargent, and Stukel (1996) implemented a behavioral risk factor questionnaire to identify children with elevated blood lead levels. Parent participants
(N = 459) reported that approximately 15% of their children use a pacifier, and that approximately 55% of their children play within one yard of outside of the house, two risk factors found to be associated with elevated blood lead levels in young children. A large percentage of children were reported as “not always washing their hands before eating” (50.3%) or “after playing outside” (54%). Further, parents reported that 11.5% of the children put paint chips in their mouth and 14.8% eat dirt or sand (Dalton, Sargent, and Stukel, 1996).
Parents do not have much knowledge of ways to prevent childhood lead poisoning (Mehta and Binns, 1998). Understanding what parents know about the dangers of lead exposure can be helpful in curtailing the problem of childhood lead poisoning. Health professionals in the discipline of lead poisoning prevention may use the information derived from parent knowledge surveys to develop appropriate educational and intervention programs that address specific gaps in knowledge and thereby affect a decrease of lead exposure in children.
Statement of the Problem
More research is needed using surveys that have been properly designed and tested to assess parents’ knowledge regarding the risk of lead poisoning within specific high-risk populations. The literature revealed a gap in surveys addressing the association of parental knowledge and lead poisoning in children at high-risk. Existing surveys did not have the questions needed to address the problem comprehensively and did not have the questions needed to address the problem specifically for Los Angeles. This study will help ascertain what parents of children at high-risk for lead poisoning know and/or don’t know about lead poisoning and exposure. A comprehensive survey including questions pertaining to the target population will be designed and pilot-tested at the Watts Health Foundation WIC Clinic in the South Central Los Angeles Community. At the Watts Health Foundation WIC Clinic at Compton Avenue, there is a critical need for a survey that assesses parents’ knowledge regarding the risk of lead poisoning to help plan and develop more effective educational intervention programs for the community on the subject of lead poisoning prevention.
The Watts WIC Clinic is of particular interest to this project since it lies in a Lead Hot Zone and services five zip codes that lie in Lead Hot Zones, including 90011, the area with the highest number of lead poisoning cases, 504, reported to the Los Angeles Childhood Lead Poisoning Prevention Program (CLPPP), to date. CLPPP also has an invested interest in this project since they currently need a standardized survey to measure parents’ knowledge regarding the risk of lead poisoning. A standardized survey would be beneficial to all units comprising CLPPP: Epidemiology, Health Education, Case Management, and Environmental Health, as a means to obtain information about what parents know or do not know about the dangers of lead poisoning living in high-risk areas throughout Los Angeles County and as a means to target these populations with effective educational interventions that address the gaps in knowledge that exist. A standardized survey would also give CLPPP a chance to combine their efforts interdepartmentally to combat the problem of lead poisoning in these high-risk areas.
Purpose of Project
1. To query a selected panel of key informants with specific expertise in childhood lead poisoning using the Delphi Method and utilize the information derived for construction of a knowledge instrument.
2. To design a standardized instrument for measuring parents’ knowledge regarding the risk of lead poisoning to their children to be utilized by all units at the Los Angeles Department of Health Services, Childhood Lead Poisoning Prevention Program (CLPPP).
3. To pilot-test the instrument on a large sample of parents using services at the Watts WIC Clinic situated in a Lead Hot Zone- zip code 90011, in order to determine any knowledge deficits that parents may have regarding the risk of lead poisoning to their children.
4. To make recommendations for the development of more effective educational interventions at the Watts WIC Clinic for parents regarding the risk of lead poisoning to their children.
Limitations of the Study
· Specific target population investigated may not represent the general population
across Lead Hot Zones in LA County.
· Individuals participating may report inaccurate information.
Assumptions
Based on the literature review conducted and on informal interviews and observations made by the researcher within the last year working at LA County Childhood Lead Poisoning Prevention Program:
· Results will show knowledge deficits in parents regarding the risk of lead poisoning and lead poisoning prevention practices.
· Family practices surveyed will reflect problems across Lead Hot Zones throughout the County.
· Parents participating in study will answer questions accurately and to the best of their ability.
Definition of Terms
BLL A BLL refers to a blood lead level, which is the amount of lead concentrated in the blood. It is measured in micrograms per deciliter (mg/dL).
CDC Centers for Disease Control
CLPPP Childhood Lead Poisoning Prevention Program
LEAD HOT Are determined using Geographic Information Systems- GIS and
ZONES are defined by the percentage of pre-1960 housing, the percentage of children living in poverty, and the number of children living in the area under the age of six. Specifically, a Lead Hot Zone is a geographic area distinguished by these three characteristics and ranked in the top 25% by these measures.
Methodology Outline
I. Querying a Selected Panel of Individuals
A. Interview candidates and select a panel of individuals knowledgeable in Childhood Lead Poisoning.
B. Apply Delphi Method to panel members to help determine what types of questions should be included in the “Lead Poisoning Knowledge Survey”
II. Development of the “Lead Poisoning Knowledge Survey”
A. Review of the literature
B. Develop rationale for the use of a survey
C. Design the structure of the survey
1. Conceptualize format
2. Formulate and design pertinent questions expertly reviewed by panel members
3. Make appropriate modifications to the lead survey instrument
D. Select thesis committee chairs
E. Obtain human subjects approval
III. Identify Target Population to Participate in Study
F. Pinpoint geographical area of lead poisoning concern.
G. Identify locations where target population can be reached
H. Select target population
IV. Pilot-test the Lead Poisoning Knowledge Survey
A. Pilot-test the Lead Survey on a large sample of parents to see if it reveals knowledge deficits regarding the risk of lead poisoning to their children.
1. Determine sample size of target population to receive instrument
2. Determine exactly when they will be targeted
B. Develop plan describing how the Lead Survey will be administered
1. Develop protocol for administration of the Lead Survey
2. Mobilize facility staff to help administer the Lead Survey
V. Analysis of the Data
A. Provide information on parental barriers to levels of knowledge regarding the problem of childhood lead poisoning and lead poisoning prevention practices among the specific target population assessed
1. Create tables with illustrations of frequency and percentages for each item on questionnaire.
VI. Discussion of the Results
VII. Development of Recommendations
A. Make recommendations for improving the design of more effective educational interventions directed at parents using the Watts Health Foundation WIC services at Compton Avenue relative to their child’s risk of lead poisoning
Literature Review
I. Search Topics
· Studies conducted on parent’s knowledge regarding the risk of lead poisoning and lead poisoning prevention methods
· Surveys implemented on parents to assess their knowledge regarding lead
· Child and caretaker attributes associated with lead poisoning in children
· National, State, and Countywide estimates for incidence and prevalence rates of lead poisoning
· Sources of lead poisoning
· Symptoms of lead poisoning
· Impact of lead poisoning on young children
· Solutions to the problem of lead poisoning- preventative measures
· The cultural parameters of childhood lead poisoning
· Demographic characteristics of children who are lead poisoned
· Description of target populations affected by lead poisoning
· Blood lead levels in children in South Central Los Angeles
· Los Angeles County demographic data
· Age of housing in Los Angeles County
· Lead Hot Zones within the County of Los Angeles
· WIC services within Lead Hot Zones in Los Angeles County
· Survey design
I. Journals
· American Journal of Public Health
· Archives of Environmental Health
· Archives of Pediatric Adolescent Medicine
· Health Education Quarterly
· Journal of American Medical Association
· Journal of Environmental Health
· Journal of the National Medical Association
· Journal of Pediatric Health Care
· Pediatrics
· Pediatric Nursing
· Public Health Nursing
· Public Health Reports
III. Other Resources
· Alliance to End Childhood Lead Poisoning
· California Department of Health Services
· Centers for Disease Control
· Community based organizations
· Environmental Protection Agency (EPA)
· Los Angeles County census tract information
· Los Angeles County Childhood Lead Poisoning Prevention Program, Epidemiology, Case Management, Health Education, and Environmental units
· Medline
· National Health and Nutrition Examination Survey (NHANES III)
· National Research Council, 1993
· Other state and local Childhood Lead Poisoning Prevention Programs
· U.S. Census
· U.S. Department of Health and Social Services
· U.S. Housing and Urban Development
Projected Graduate Project Chapters
I. Introduction
A. Statement of the problem
B. Purpose of the project
C. Project Limitations
D. Assumptions
E. Definition of Terms
II. Review of the Literature
III. Methodology
IV. Results
V. Discussion
References
California State Auditor, Bureau of State Audits (April 1999), “Department of Health Services has made little progress in protecting California’s children from Lead poisoning.” [Internet address]: http://www.bsa.ca.gov/bsa/.
Centers for Disease Control and Prevention. (1991). Preventing lead poisoning in young children: A statement by the Centers for Disease Control. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. DHHS publication no. 5:37-304.
Children’s Safety Network at CSR, Maternal and Child Health Bureau, Health Resources and Services Administration, Public Health Service, U.S. Department of Health and Human Services, April 1997.
Dalton, MA, Sargent, JD, Stukel, TA. Utility of a risk assessment questionnaire in identifying children with lead exposure. Archives of Pediatric Adolescent Medicine, Vol. 150, p. 197-202.
Goldman, KD, Demissie K, DiStefano, D, Ty, A, McNally, K, Rhoads, GG. (1998). Childhood lead screening knowledge and practice. Results of a New Jersey physician survey. American Journal of Preventative Medicine, Vol. 15, No. 3 p. 228-234. Mahon, I. (1997). Caregivers’ knowledge and perceptions of preventing childhood lead poisoning. Public Health Nursing, Vol. 14, No. 3 p. 169- 182.
Mehta, S, Binns, HJ. (1998). What do parents know about lead poisoning? Archives of Pediatric Adolescent Medicine, Vol. 152. P. 1213-1218.
Nordin, J, Rolnick S, Griffin J. (1994). Prevalence of excess lead absorption and associated risk factors in children enrolled in a Midwestern health maintenance organization. Pediatrics, Vol. 93 p. 172-177.
Pirkle, JL, Brody, DJ, Gunter, EW, Kramer, RA, Paschel, DC, Flegal, KM, and Matte, TD. (1994). The decline of blood lead levels in the United States. The National Health and Nutrition Examination Survey (NHANES). Journal of the American Medical Association, Vol. 272 p284-291.
Schaffer, SJ, Szilagyi, PG, Weitzman, M. (1994). Lead poisoning risk determination in an urban population through the use of a standardized questionnaire. Pediatrics, Vol. 93, No. 2 p. 159-163.
0 comments:
Post a Comment