In 2003, Michael T. Martin, a research analyst for the Arizona School Boards Association, published “A Strange Ignorance: The Role of Lead Poisoning in Failing Schools”. The report concluded, among other things, that “for some reason the education community, even today, displays a strange ignorance of an entire spectrum of medical and psychiatric research demonstrating both the widespread prevalence of childhood lead poisoning and the horrible consequences of lead-induced brain damage”.

As Martin pointed out in his report, school boards then were under attack across the country for their “failing schools,” the “achievement gap,” student drug use and disruptive behavior. His conclusion, if I understand it correctly, was simple. We need to prevent children from being lead poisoned as infants and toddlers, because by the time they start school, the damage is done and the failing schools are but one symptom of the damage.

Schools and lead are back in the news again. A recent study of Detroit Public School (DPS) children confirms what Martin and people doing lead poisoning prevention work have known for decades – elevated lead levels in children interfere with a child’s ability to learn and are a significant contributor to poor student performance. “About 60% of DPS students who performed below their grade level on 2008 standardized tests had elevated lead levels. The higher the lead levels, the lower the MEAP scores, though other factors also may play a role”, according to an article in the May 16, 2010 Detroit Free Press article (http://www.freep.com/article/201005160300/NEWS01/5160413).  This is a shocking number when you understand the impact of lead on a child’s ability to learn.

Research into the exact effects of lead on children’s developing brains has demonstrated that there are permanent changes that impact executive function, fine motor skills, and reading ability.  It is clear that lead poisoning will inhibit a child’s ability to perform in school and that the effects continue to compound as they progress in grade levels.  Coupling this research with the affects of lead on a child’s ability to control impulse and aggression, the failure of lead poisoned children to achieve normal grade progression is severely limited and their behavior often gets them labeled in school as a behavior problem.  

Clearly, lead poisoning is a predictor for failure in school and as Martin foresaw a reason for schools’ failure to succeed.  Because schools do not usually know if a child has a history of lead poisoning, there is no proactive intervention.  Detroit Public Schools is one of the few school districts to actually tie lead poisoning data to educational achievement scores.  North Carolina’s Duke University has done extensive work in this area also.  However, what is to be done now that they know? 

The CDC has created a subgroup of their Lead Poisoning Prevention Advisory Council to study the issue of what should be done for children who have been diagnosed with lead poisoning at any level.  CLEARCorps/USA with several other national leaders requested the subgroup be established to provide guidance to education leaders, schools, the medical community and families with lead poisoned children.  Sue Gunderson, Executive Director of CLEARCorps/USA serves on the committee and states that their goal is to provide solutions so that when children are lead poisoned there is an immediate course of action that acknowledges the insult to their developing brains and begins an assessment and intervention process that allows that child to enter school ready to learn to the best of their ability. The Department of Education is also represented. Perhaps by bringing together educators and lead poisoning prevention experts, we can begin to address the issue of how to help lead poisoned children succeed in school and schools succeed in serving children with a history of lead poisoning.

In addition, CLEARCorps/USA is working to establish a pilot project that might demonstrate how intervention strategies aimed at executive function improvement could benefit lead poisoned children.  The challenge for assessment and intervention for lead poisoned children is that each child reacts to lead differently.  Compounding factors such as poor nutrition, family stress, and poverty all play a role in increasing the likelihood that lead’s impact will be higher. 

Childhood lead poisoning is on the decline in this country due a combination of public policy, education, and direct intervention by government, communities, and lead poisoning prevention experts.   Unfortunately, children living in pre 1978 housing in poor neighborhoods continue to be poisoned every day.  Schools serving these children will struggle to help them succeed. As the report from Detroit demonstrates, we need to hurry up and figure out solutions for families and schools that will allow success.

Martin concluded in 2003 that “public schools can no longer ignore the tragedy of lead poisoning. Environmental lead in low-income housing begins a conveyor-belt of tragedy that inevitably produces precisely the symptoms of “failing schools.” School officials, both administrators and governing board members, need to organize school and community resources in an effort to interdict the poisoning of children during their first three years of life, as well as to look for ways to ameliorate the consequences of lead poisoning in subsequent years. But up to now, schools have done nothing”. 

It is difficult to place blame on the schools when they are not even told that their students have a history of lead poisoning.  Perhaps we should start there.  Health officials, family, and educators need a standardized system that provides this information when the child enters school.  Then an assessment and intervention plan can be created that provides the best we have to offer right now.  Research on how to improve lead poisoned children’s performance in school to compensate for their brain’s dysfunction needs to be widely demonstrated so that other schools can offer these programs. 

As a country, we need to recognize that lead poisoning still affects many of our nation’s children living primarily in poverty.  Schools that serve these children are severely hampered by lack of knowledge, lack of adequate assessment and intervention strategies and dollars, and the political acknowledgement that maybe it is not the teachers or the curriculum that is making a school fail, but it is a combination of factors, one of which is lead poisoning that come together to prevent success.

Partners West Elmwood Neighborhood Development Corporation, CLEARCorps Rhode Island and The Childhood Lead Action Project have combined to clear over 120 units, most since July 1 2009, 70 between January and March alone (even given the winter and the recent floods!).  Over the course of the project, we have enrolled over 400 families and homeowners and have partnered with two municipalities, a housing organization, and the Department of Health for referrals and cost sharing.

Our goal is to complete 600 units total in just under two years.  We are very excited about this progress and look forward to more work to protect the potential of children, the children in most need, in Rhode Island. 

After a holiday and first of the year hiatus, the CLEARCorps Blog returns.

I have a question? What happens on December 31, 2010 if there are still significant numbers of children in this country with elevated blood lead levels?

 To understand the question, let us do a bit of time travel and flash back 10 years to February, 2000. Depending on your point of view the 21st century is either well under way to beginning or the 20th century is in its final throes of ending. Bill Clinton is President of the United States. The election of 2000, 9/11, and Katrina are future events waiting to happen. At the time an ambitious and admirable goal is laid out to eliminate children with elevated blood lead levels (EBLs) by 2010. Flash forward 10 years and it is now February 2010. Again depending on your point of view, it’s the beginning of the second decade or the end of the first decade of the 21st century. No matter what your perspective, there are just slightly more than 10 months remaining in the year. In 2000 eliminating children with EBLS by 2010 seemed a worthy and attainable goal. Now that we are actually at 2010, the question is, will we have achieved this goal and if so, how we will know we have?

Seen from a broader perspective, the push to end childhood lead poisoning has been a public health triumph. Compared to the numbers of lead poisoned children in the first seven decades of the 2oth century, the problem has been all but eliminated in the United States. We have seen the action level for EBLs drop from 40 to 25 to 10 µg/dl and yet even as the action levels were dropping, so were the number of children with EBLs. Today, children with EBLs have gone from the rule to the exception. As late as 1997, nearly 8% of American children tested had EBLs ? 10 µg/dl compared to the 250,000 that CDC estimates are elevated today. By any standard, a 90% reduction constitutes a major public health success. However, if by the end of 2010, there are still 250,000 children with EBLs, does it constitute achieving the goal of eliminating children with EBLs by 2010?

 The elimination of lead in gasoline, paint, and solder was a major contributor to the reduction in the number of children with EBLs. Education has also played a major role. Public health officials knew that as the major sources of lead were eliminated and the results began to reverberate throughout society that targeting the remaining population of children with EBLs would be more difficult. Massive education campaigns conducted over the past ten years have made today’s parents much more aware of the lead problem and how to prevent it than they were even 10 years ago.  More of today’s parents are aware of the dangers from lead in dust and the risks from hand to mouth contact. This has contributed to the drop in the number of children with EBLs.

 Yet, it seems that every year new EBL cases arise from sources other than dust. And until we are able to totally eliminate the auxiliary sources of lead exposures, I fear that totally eliminating children with EBLs will not happen. For instance, how many Consumer Product Safety warnings have been issued in the past few years regarding dangers from lead in jewelry, candy, and toys manufactured and imported from other countries. The question I raise, then, is what happens on December 31, 2010 regarding the 2010 goal? Perhaps more importantly, the question on January 1, 2011 is what direction will the campaign take next?

Last weekend I was doing some shopping at a local party store. I was in search of a specific color of napkins and coordinating table cloth when I wandered into the isle with the party favors and trinkets. My eyes widened like a kid in a candy store, only I was thinking wow…wall to wall, floor to ceiling LEAD!!! I was almost taken aback by the sheer number of cheap trinkets and lead-laden items that adorned the shelves and racks. While I was walking towards the other end of the isle, a mom and her young daughter turned the corner. The little girl was about 4 or so and they were shopping for her birthday party. Clearly a princess theme because their cart was very pink and full of napkins, plates, cups, balloons and other items fit for royalty. They were looking for party favors. “Mami, pink necklaces!” “Mami, princess rings!” “Mami, sparkly magic wands!” Her eyes filled with glee as she planned her party. The lead educator in me reared it’s head and I thought, is this the time and place for lead education? Should I say something? What should I do? While I contemplated my next steps, I heard mom say something that was music to my ears. “Honey, those things are dangerous for little princesses. They have lead and it can hurt you.” WOW! I was so impressed and happy! Yea mom! Yea mom! Yea! I smiled at her and went on my merry way. Three cheers for lead-free birthday parties!

New Year’s Day marks the start of  year 18 working with lead poisoning prevention and as I think about this milestone, it puts me in mind of the French saying that goes something to the effect that the more things change, the more they stay the same. There have been a lot of changes in the field over the past 17 years to be sure. When I started, the Centers for Disease Control and Prevention (CDC) had just recently lowered the blood lead action level for children from 25 to 10 µg/dl, the level still in effect today. Lead poisoning was front and center in the national consciousness. Congress had just passed the “Lead Based Paint Hazard Reduction Act” (1992) or Title X as it is more commonly known. As a result of these and other acts, the numbers of children with levels of 10 µg/dl and above have decreased dramatically from the numbers in 1993.

Today, however, evidence continues to mount that significant damage occurs at levels below 10 µg/dl and there have been strong suggestions that the national action level be lowered from 10 µg/dl to at least 5 µg/dl. Some local governments have reduced or are considering reducing their action levels to 5 µg/dl, and they are to be commended for that. At the national level, however, the level remains at 10.

We know lead is toxic at levels below 10 µg/dl, but the action level remains at 10 µg/dl. The military has a term collateral damage, a euphemism used whenever they kill or wound non-combatant civilians in a military campaign. If we don’t lower the action level, do children with levels between 5 and 10 µg/dl then become collateral damage, an unfortunate but acceptable outcome of the current campaign? I sincerely hope not.  

Yes, there have been a lot of positive outcomes for children since 1993. However, we’ve yet to eliminate lead poisoning and 2010 is just months away. There are still a significant number of children with elevated blood lead levels and if the level is lowered to 5 µg/dl, there will be tens, perhaps hundreds of thousands more. If we don’t lower the federal action level, what will happen to those children? Has the time now come to consider lowering the current standard? We know that the evidence mounts as to how toxic lead is at levels below 10 µg/dl? I believe the science says yes.

About a week ago, I went to the Symposium on “New Insights Into the Effects of Lead Poisoning On Children and Adults” in Philadelphia that presented some very interesting background information and new research about lead poisoning.  Presenting that morning were: 

1. John Rosen, MD Montefiore Hospital and Medical Center
2. Jay Schneider, Ph.D  – Thomas Jefferson University College of Medicine
3. Theodore Lidsky, Ph. D – New York State Institute for Basic Research in Developmental Disabilities.
4. Leann C. Howell, Founder and President – American Lead Poisoning Help Association.  

Overview:

The panel was framed by Leann’s story of her son’s lead poisoning as a result of improper rehab techniques on an old house.  She’d met Rosen, Schneider, and Lidsky in her journey to understand the disease and garner help in working with the schools as her son, who was rated to have a very high IQ (135) began to fail as he entered middle school. Over time, she contacted each of these specialists, and needed all of them to lobby for her with her school district to get proper modifications for her son.  (He is now performing well).  Rosen, Schneider, and Lidsky were introduced to present their research and findings about lead’s effects on the brain, brain development, and explained new findings on the mechanism for lead’s damage at a molecular level.

Some of the more exciting findings:

• Lead effects the brain deleteriously in many ways: (at much lower levels than 10)
  • It effects both structure and function – Fewer cells, more confused structure.
  • It alters the proliferation and differentiation of stem cells and can alter the expression of stem cells
  • Lead alters the transmission of signals between neurons (affecting in some cases both neurotransmitter production and reception).
  • Childhood lead poisoning is correlated with decreased brain volume in adults.
• Epigenetics is thought to be the common thread that ties together the mechanism of how lead poisons such a broad range of organs and systems. This means that at a molecular level lead is effecting the expression of certain genes (not mutating them -turning them on or off) in just the specific focused areas that we see with lead poisoning – hypertension, kidney disease, attention, regulation of emotion, memory retrieval, etc.  It is called DNA Methylation – methyl groups attach to DNA to alter the function and under or over express the gene as it was meant to be expressed. For example, one gene was found to be hypermethylated (activity is decreased) that is a gene for a gluco-cortisoid receptor that mediates the HPA Axis in the brain (hypothalmus) – that receptor mediates response to stress. Lead poisoning, at the genetic level, lowers the switch to power this receptor.
• Males have twice the susceptibility as females – at the genetic level, boys demonstrate twice the number of effected genes as girls with the same level of exposure.
• IQ tests are terrible measures of brain injury – they are too broad. 
• All had the conclusion – there is no threshold for the adverse effects of lead (some of the effects on brain structure, loss of complexity, confusion of transmission, etc happened at very low levels -1/1000th of a dose that would cause cell death).
• Rosen confirms strongly that only safe intervention is a primary intervention to remove all lead.

This was a very rich presentation.  They will post it to their website (a video was taken). We will Tweet when the link is available.

The mind is a strange thing. I woke up this morning around 3:30 with lead on my mind. We are rapidly nearing 2010, the supposed goal point for the elimination of lead poisoning, and I was wondering what the future holds in terms of lead poisoning prevention. If the current action level of 10 µg/dl holds, will we decide that the current number of children considered lead-affected is acceptable and declare victory. Or will the level be lowered from 10 µg/dl to 5 µg/dl, in which case the number of lead-affected children will increase dramatically, and then will we set a new target date for eliminating lead?

The other thought that I had as I reflected upon the events since 2000 when the 2010 goal was set, was why getting lead awareness was so difficult. Yes, there is the occasional story on the news or in print, but there has never been what I consider a major sustained national emphasis on eliminating the lead problem. What spurred this line of thinking is the almost relentless media blitz around the H1N1 Flu. We are in the midst of a pandemic, so pull out all of the stops to get the word out. Report ad nauseam on the number of cases and really hype the vaccine. I am not sure what the definition of a pandemic is, but if it involves thousands, perhaps millions of people affected worldwide, then should we not have considered lead poisoning worthy of pandemic status and pulled out all stops to eliminate it. Why did not, and why has not this happened?

I really do not have any answers, but one possible thought did cross my mind. Lead does not bring in big dollars for the pharmaceutical industry. There are times when I think if I hear one more commercial for Lipitor, Cialis, Viagra, or Ambien, I will scream. There are no comparable drugs with the same profit potential in dealing with lead. There are also no vaccines to prevent lead poisoning, and while I do not question the reality of the need for the H1N1 vaccine, let us at least admit that the drug companies stand to make financial gains from the pandemic. Is it possible that had there been moneymaking possibilities in lead poisoning prevention, we might be closer to reaching our 2010 goal than we are? It is just a thought.  

Safe is a tricky word. We all want safety for our children in all areas of their environment: mold free, accident safe, zero pesticide, and lead-safe.  But what does it mean to be truly safe?  What amount of risk is acceptable or even desirable.  Since the drop of the “safe” or “actionable level” of lead in blood from 25ug/dl to 10µg/dl, have our children been kept safe?

Recent study outlined in a BBC article shows that in Britain, more than one out of four children tested had a lead blood level over 5 ug/dl. That is a large group of kids… 27%. Is that safe?

No.  That study, along with others, show significant dangers, particularly in learning and behavior that can impede the success of the child.  The study goes on to note that for children who have levels of 5 – 9 µg/dl adverse effects were noted in reading scores and writing scores. Levels at 10 increase issues of impulsivity, attention, and test scores. This study adds to other previous studies on the topic:

Other research in this area:

• Recent Development in Low-Level Lead Exposure and Intellectual Impairment in Children
• Low-Level Environmental Lead Exposure and Children’s Intellectual Function: An International Pooled Analysis

We know from other research that this safety level is in question. That the arbitrary level of 10 µg/dl to designate safe from harmful continues to demand scrutiny and rigorous research.  It is becoming clear just how arbitrary this number is, and how it has little to do with “safety”.  Even half that level, 5 µg/dl  correlates with serious effects for children, families and our society at large.

When will this research lead to governmental action?  Are we truly governing for safety in this instance?

We have spent the last week in Washington DC at the National AmeriCorps Meetings and I have to say I am inspired and impressed by the amazing work that the AmeriCorps members across the country are doing and energized by the Corporation for National Service. Just imagine the positive impact that 2.2 million volunteers managed or mobilized by AmeriCorps in 2008 had on this country. The Call for Community Service has grown by leaps and bounds with the new administration and thousands more will fight poverty, protect children’s health, and defend the environment this year alone. The Corporation for National Service has invested $5.7 billion dollars in nonprofit, community, educational, and faith-based community groups since 1994. An impressive amount of money with a priceless outcome in our communities. I think it’s important these days to turn up the positive news and give credit where credit is due. Hats off to you AmeriCorps members for making our country a better place to live. You are Getting Things Done for America.

As AmeriCorps affiliates, we all rely on the spirit of Americans to volunteer and participate in their communities, for each of us to find the best part of ourselves to be engaged and active in the improving the well-being of those around us and who come after us. 

 A recent study in Volunteering in America (commissioned by the Corporation for National Service) investigated many of the particulars of volunteering: which geographic areas have the most hours?  The longest term commitment? Which cities have the most widespread volunteer committments?  Which socioeconomic groups and racial cohorts volunteer the most and in what areas? (I leave these all as questions so you can go find the answers on the Volunteering America website. 

 One area that the study highlights is volunteerism in a faith based context.  The study shows that 91% of faith-based organizations report that congregation members serve on programs and activities  (social service, neighborhood organizing, and community development.  It noted that volunteers who serve through faith based organizations are more likely to continue serving and that charities that partner with faith based organizations have a greater range and scope of volunteers.

 With all of this information, it begs the question: Are we maximizing our potential partnerships with faith-based organizations to serve our communities? What are the opportunities for us to partner with faith based organizations to introduce volunteers to the area of lead poisoning and healthy homes education, the need and practice for screening, referral sources for remediation, etc?

 Some ways we might use this information:

• Assign someone in your organization to develop a plan to recruit faith-based volunteers.

• Approach local churches, mosques, synagogs, temples and college groups that have a mission for serving in the community.  Discuss your goals and focus, find out what theirs is.  Partner if possible.

• Research how the issues of lead poisoning, asthma, and other healthy homes issues impact a community.

• Be persistent: The study shows 46% of Faith-Based Organizations need volunteer management.

• Offer a variety of opportunities – varied in content and in length of opportunity. Perhaps sponsor a day with events to see the various opportunities. 

• Be transparent about the organizations plans and goals and where the work long-term connects to volunteers.

 With all of our belts tightening, now is the time to explore as many partnerships and collaborations as possible and based on this research, take a leap of faith…