San Francisco childhood lead prevention program : data evaluation, 1991-1997

98 Pages·1998·3.6 MB·English

by  Ahmad, Haroon

San Francisco Childhood Lead Prevention Program
Data Evaluation
1991-1997
Surveillance Data Analysis by Haroon Ahmad, M.P.H.
Senior Research Associate, CLPP
Environmental Data Analysis by Christine Martin, M.P.H.
Senior Research Associate, CLPP
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DOCUMENTS
REF
615.9256 APR 2 01998
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TABLE OF CONTENTS
INTRODUCTION
I
EXECUTIVE SUMMARY
II
PART EVALUATION OF SCREENING AND SURVEILLANCE DATA
1: 1
Limitations to Data Analysis 2
A. LackofUniversalReporting 2
B. Incompleteness ofData 2
C. Blood Lead Data BelowLaboratoryDetectionLimit 2
Screening and Case Finding Trends per Year 3
Discussion 5
Program Case Management Services 6
Age Analysis 7
Race/Ethnicity Analysis 10
Zip Code Analysis 15
Explanation ofCaseDistribution 16
HighestProportion ofCases byDistrict 1
Institutional Analysis 19
Medical Provider Outreach 22
Screening Increase at Community Health Network Clinics 22
PART 2: EVALUATION OF ENVIRONMENTAL DATA 25
Primary Cause of Childhood Lead Poisoning 26
Identification of Lead Hazards 26
Environmental Investigations 27
Sample Collection 28
Determining the amount of lead in paint, dust, and soil 30
Using Environmental Data as an Estimator of Risk/Exposure 31
Lead in Paint 32
Interiorversus ExteriorPaint 32
Interior Surfaces/Components 33
Exterior Surfaces/Components 35
Lead in Dust 37
Lead in Soil 38
Lead in Water 38
Environmental Source Identification 39
Discussion 41
ii
3 1223 04647 7635
S.F. PUBLIC LIBRARY
Data Analysis Editorial Committee
Haroon Ahmad, M.P.H; Christine Martin, M.P.H; Karen Cohn, M.S, C.I.H; Gail Herrick, B
M.P.H; Susan Solstice, BA; Libby Knight, M.P.H; and Jennifer Mann, M.P.H
Identification of Lead Hazards
Environmental Investigations
Sample Collection
Determining the amount of lead in paint, dust, and soil
Using Environmental Data as an Estimator of Risk/Exposure
Lead in Paint
Interiorversus ExteriorPaint
InteriorSurfaces/Components
ExteriorSurfaces/Components
Lead in Dust
Lead in Soil
Lead in Water
Environmental Source Identification
Discussion
ii
3 1223 04647 7635
S.F. PUBLIC LIBRARY
I
Committee
Data Analysis Editorial
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REF 615.9256 Ah51s
Ahmad, Haroon.
San Francisco childhood
lead prevention program
[1998?]
INTRODUCTION
The San Francisco Department ofPublic Health (DPH) has regularly collected childhood blood
lead screening and surveillance data since 1991. Data collected and analyzed by the DPH has
previously been presented intwo reports published inthe San Francisco Epidemiologic Bulletin
in 1992 and 1995.
This current reportpresents the findings ofa comprehensive analysis ofblood lead
screening/surveillance data (1/91-12/96) and environmental data (7/91- 6/97). Analysis and
evaluation ofthis datawas conducted in orderto:
1. Fulfill the mandates ofthe Comprehensive Lead Poisoning Prevention Ordinance, as
incorporated into San Francisco Health Code, Article 26:
• Section 1620: Data ManagementSystem: The Director shall maintain a data
management system designed to collect and analyze information regarding elevated blood
lead level children, primary prevention and screening activities.
• Section 1621: Blood TestReporting Every physician and clinical laboratory shall
:
promptly report all results ofblood leadtests to the County Health Officer on forms
devised by that Officer and such demographic information as the forms require.
• Section 1622: LeadPoisoning TestReports: The Director shall prepare a report every
six months in language designedto be understood by the general public describing the
results ofall lead tests obtained by the Department for San Francisco residents, including
the test level, age, sex, ethnicity and general area ofresidence ofeach case ofchildhood
lead poisoning. The Director shall prepare the report in those languages that he or she
deems appropriate in orderto communicate the information effectively. (This current
report will help create atemplate forthe bi-annual report required by this section).
2. Analyze screening and case finding trends overtime.
3. Have areport readily available for data requests received by the staffofthe Childhood Lead
Prevention Program (CLPP) from the public, other sections ofthe Health Department, and
other city and state agencies.
4. Assistthe medical community and the Department ofPublic Health to develop an effective
blood lead screening policy for the City and County ofSan Francisco.
5. Analyze environmental data to provide evidence ofthe extent oflead-paint hazards in the
City and use this data to promote policy and legislation that reduce sources oflead hazards.
I
EXECUTIVE SUMMARY
Each year from 1991 through 1996, the San Francisco Childhood Lead Prevention Program
(CLPP) has identified approximately 50 to 100 children under six years ofage with blood lead
levels high enough (>15(j.g/dL) to warrant case management services from the Department of
Public Health (DPH). Case management services include education ofthe child's
parents/guardians about the sources, effects, and prevention ofleadpoisoning and nutritional
counseling. Children with blood lead levels >20(ig/dL, orpersistent at 15-19ug/dL, also receive
an environmental investigation to identify sources oflead intheir home.
A total of460 children received case management services from the DPH from 1991 through
1996. The number oflead-poisoned children (blood lead level >15ug/dL) identified in San
Francisco peaked in 1995 at 106 children, but dropped significantly in 1996. This decline
follows national trends and is suggestive ofthe factthat extensive education and outreach efforts
by the CLPP and community activists have had apositive impact onreducing childhood lead
poisoning in San Francisco.
In addition to education and outreach, other factors which we suspect contributed to the decline
in case findings from 1995 to 1996 include: 1) detection ofonly new (incident) cases ratherthan
both new and previously existing (prevalent) cases, and 2) adrop inthe number ofchildren
screened from certain high risk groups (specifically, Caucasian and African-American children).
The analyses inthis report are based on datareportedto CLPP by San Francisco institutions and
laboratories serving those institutions. Although there has been an increase in the number of
screenings performed and reported in San Francisco, universal data reporting has not yet been
achieved. Therefore, the results ofthis report should notbe generalized beyond the sample
population presented.
CLPP surveillance data has been analyzed to determine the proportion ofnew cases among
children receiving initial blood lead tests each year. New cases are defined as ^15|ug/dL. The
range ofcase findings has been 1.9 to 4.4 percent oftotal tested per year.
CLPP also analyzed age, race/ethnicity, zip code and institution in orderto identify trends
between 1991 and 1995. Among the age variable, two-year-olds followed by one-year-olds
yielded the highest proportion ofcases. Race/ethnicity analysis revealed Caucasian and African
American children to be most at risk, eventhough numbers tested among both groups have
significantly dropped in recent years. The highest numbers for screening and case finding were
observed in the Mission District (94110 zip code), where the older housing and greatest number
ofmajor medical institutions are situated. MissionNeighborhood Health Clinic (MNHC) and
San Francisco General Hospital (SFGH) together account for 52.8% ofthe total screening
reported from various institutions in the city.
II