A Randomized, Community-Based Trial of Home Visiting to Reduce Blood Lead Levels in Children

• Published in: Pediatrics (Evanston) 2006-01, Vol.117 (1), p.147-153
• Main Authors: Brown, Mary Jean, McLaine, Pat, Dixon, Sherry, Simon, Peter
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Blood; Blood accusation; Care and treatment; Case management; Child; Child, Preschool; Children; Children & youth; Community Health Nursing; Dust - analysis; Effectiveness studies; Environmental Pollutants - analysis; General aspects; Health Education; Housekeeping; Humans; Lead - analysis; Lead - blood; Lead poisoning; Lead Poisoning - prevention & control; Medical sciences; Pediatrics; Powers and duties
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2004-2880

The objective of this study was to measure the effectiveness of intensive case management to reduce blood lead levels (BLLs) in children. Lead poisoning remains a common, preventable pediatric condition despite advances in reducing children's BLLs in the United States. Substantial evidence implicates lead paint-contaminated house dust as the most common high-dose source of lead in children's environments. Housekeeping and parental supervision also may contribute to risk for lead exposure. We conducted a community-based, randomized trial of comprehensive education and home visiting for families of children with BLLs 15 to 19 microg/dL. BLLs after 1 year of follow-up were compared for intervention group children, whose families received individualized education that was designed to address specific risks factors in a child's environment, and comparison group children, whose families received customary care, usually 1 or 2 educational visits. Environmental samples were collected at baseline and after 1 year of follow-up for intervention group children and compared with those of comparison group children, collected only at the end of study. During the follow-up period, parents of intervention group children (n = 92) successfully decreased dust lead levels and significantly improved parent-child interaction and family housekeeping practices compared with comparison group children (n = 83). Overall geometric mean BLLs declined by 47%, and the difference in BLL by group was not significant (9 vs 8.3 microg/dL for intervention versus comparison group children, respectively.) After 1 year, nearly half of enrolled children had BLLs > or = 10 microg/dL. Until a reservoir of lead-safe housing is created, programs that educate families to reduce environmental exposure are needed. Although providing families with quantitative information regarding lead contamination may have a role in short-term efforts to prevent lead exposure, these null findings suggest that it has little benefit once BLLs are elevated.