CDC Recommendations for Lead Poisoning Prevention in Newly Arrived Refugee ChildrenResettlement Worker Module

U.S. Department of Health and Human Services

Centers for Disease Control and Prevention

Refugee Assistance:Module Outline

What is the problem?

Effects on the refugee population

Sources of lead exposure

What can you do?

Resources

Childhood Lead Poisoning

Lead poisoning is a common and preventable childhood health problem

Lead is everywhere in the environment due to industrialization

Lead exposure is measured in children by blood lead testing

Blood Lead Levels in the

U.S. Population 1976-2002 (NHANES)

0

2

4

6

8

10

12

14

16

1976-1980 1988-1991 1991-1994 1999-2002

Year

Blo

od

Le

ad L

eve

ls (µ

g/d

L)

2.7

3.6

1.9

14.9

Why are Children at High Risk?

Children’s nervous systems are still developing

Young children have more hand-to-mouth activity than older children

Children absorb more lead than adults

Children’s Health RisksRelated to lead exposure

Reductions in IQ and attention span

Behavioral problems (e.g., hyperactivity)

Impaired growth and hearing loss

At very high levels, seizures, coma, and even death

Refugee Assistance:Module Outline

What is the problem?

Effects on the refugee population

Sources of lead exposure

What can you do?

Resources

Refugee Migration

Elevated Blood Lead Levels (BLLs)in Refugee Children Newly arrived refugee children are twice as likely

as U.S. children to have elevated BLLs Some sub-populations of refugee children are

12-14.5 times more likely to have elevated BLLs Data suggest that refugee children are also at risk

for elevated BLLs after resettlement in the U.S.

Risk Factors for Elevated BLLsAmong Refugees Living in older homes

Presence of lead hazards

Cultural practices and traditional medicines

Lack of awareness about the dangers of lead

Compromised nutritional status

Refugee Assistance:Module Outline

What is the problem?

Effects on the refugee population

Sources of lead exposure

What can you do?

Resources

Most lead hazards come from lead paint chips that have been ground into tiny bits.

These tiny bits of lead become part of the dust and soil in and around our homes.

Lead Hazard Sources

U.S. Housing

24 million housing units (25% of the nation’s housing) have significant lead-based paint hazards

1.2 million homes with significant lead-based paint hazards housed low income families with children under the age of 6 years

Environmental Sources of Childhood Lead Exposure

Refugee Assistance:Module Outline

What is the problem?

Effects on the refugee population

Sources of lead exposure

What can you do?

Resources

Environmental Assessment

Educatepopulation

Assuremedical

interventions

ResettlementWorker

Environmental AssessmentThe four components are:

Pre-assessment

Visual interior assessment

Visual exterior assessment

Summary assessment

Property Pre-Assessment

Was the property built before 1978?

Can the property owner provide a current certification that the property is lead safe or lead free?

Visual Interior Assessment

Walls

Windows

Steps

Visual Exterior Assessment

Exterior windows and doors

Porch and/or steps

Roof, gutters, and downspouts

Summary Assessment

The summary assessment is where you will use your findings from the interior and exterior assessments to make a determination of the high risk status of the property.

Medical Assurance: Screening1) Nutritional evaluations

2) Initial blood lead test

3) Repeat blood lead test

Medical Assurance: Screening

Initial blood lead test Within 90 days of arrival

into the United States

Repeat blood lead test 3 to 6 months after

placed in permanent residence

Considered a “medical necessity”

Medical Assurance: Case Management What is case management?

Who provides case management?

Consult www.cdc.gov/nceh/lead for specific case management information

Medical Assurance:Nutrition

Educate Populations

Provide education to newly arrived refugee families Routine medical care Proper nutrition House cleaning strategies

CDC Health Education Resource Database

Refugee Assistance:Module Outline

What is the problem?

Effects on the refugee population

Sources of lead exposure

What can you do?

Resources

Federal Organizations

U.S. Department of Health and Human Services Centers for Disease Control and Prevention

http://www.cdc.gov/nceh/lead/lead.htm http://www.cdc.gov/ncidod/dq/

Office of Global Health Affairs http://www.globalhealth.gov/

Office of Refugee Resettlement http://www.acf.dhhs.gov/programs/orr/

U.S. Department of State Bureau of Population, Refugees, and Migration

http://www.state.gov/g/prm/

Additional Federal Resources

U.S. Department of Housing and Urban Development

(HUD) Office of Healthy Homes and Lead Hazard Control

http://www.hud.gov/offices/lead/

U.S. Environmental Protection Agency (EPA) Office of Pollution and Prevention and Toxics

http://www.epa.gov/opptintr/lead/index.html