Interim REPORT

Centers for Disease Control and Prevention CDC-RFA-EH06-602Under CDC Grant #1 H64EH000145-01

IN NEVADA, CHILDREN RUN BETTER UNLEADED

Anthem Blue Cross Blue Shield Partnership Plan

Board of Clark County Commissioners

Carson City Health and Human Services

City of Las Vegas

Clark County

Clark County Medical Society

Environmental Protection Agency

HealthInsight

LUCES (Latinos Unidos Celebrando Salud)

Nevada Cancer Institute

Nevada State Legislature

Nevada State Medical Association

Nevada State Health Division

Sierra Health Services

Southern Nevada Health District

Southern Nevada Area Health Education Center

State and Local Housing Authority

State of Nevada Division of Health Care Financing and Policy

U.S. Department of Housing and Urban Development

University of Nevada, Las Vegas Nevada Institutefor Children’s Research and Policy

University of Nevada, Las Vegas Harry Reid Centerfor Environmental Studies

University of Nevada, Las Vegas School of Public Health

Washoe County

Washoe County District Health Department

Women, Infants & Children (WIC) Program

CLPPP Participants/Supporters

This report is a collaborative effort between the UNLV Nevada Institute for Children’s Research and Policyand the Southern Nevada Health District.

Introduction

In July 2006, the SouthernNevada Health District(SNHD) was awarded a

grant from the Centers forDisease Control and Prevention(CDC) to establish acomprehensive, statewidescreening, surveillance andprimary prevention outreachand education program toeliminate childhood leadpoisoning as a pediatric publichealth problem in Nevada. Thiscreated the Childhood LeadPoisoning Prevention Program(CLPPP). The purpose of thecurrent document is tohighlight the need for thisprogram in the state of Nevada,information regarding thedangers of lead exposure,current and future directions ofthe program, and necessaryimprovements for a successfulprogram. It is our hope thatcommunity members within thestate of Nevada will worktogether as a team to reduceand eliminate lead exposure inNevada’s children.

Currently, there is little to nodata to suggest that Nevadadoes or does not have aproblem concerning lead.Individuals in Nevada have aright to know if a lead problemexists in the state, where theproblem is, and how to

eliminate the problem. Thereare several uniquecharacteristics in the state ofNevada, and Clark County inparticular, that justified theneed to explore sources ofpossible lead exposureincluding population growth,immigration, and poverty.

POPULATION GROWTHSince 1994, Nevada has beenone of the fastest growing statesin the country, with over 70percent of the state’s populationresiding in Clark County. Thisrapid and significantpopulation explosion hasstretched state and countyresources, which in turn, limitsthe ability to meet increasingdemands for health and socialservices.

In addition to the rapidpopulation growth, the state ofNevada and Clark County faceissues of poverty, poor housingconditions and lack of adequatelead screening resources,particularly for children.According to 2006 U.S. Censusdata, there are approximately137,000 children under the ageof 5 in Clark County alone.

IMMIGRATIONMinorities constitute nearly halfof Clark County’s population,and approximately 27 percentof the population is of Hispanic

origin. Population estimatesindicate that over 60 percent ofthe foreign-born population inClark County are not citizens.This demographic patternpresents concerns for publichealth initiatives and leadexposure prevention. Thesegment of the non-citizenpopulation who are illegalimmigrants typically do nothave medical insurance, occupyolder housing, earn lowerwages, and suffer priorexposure to lead.

POVERTYOne challenge of a largepopulation influx is theincreasing number of peopleliving in poverty. In 1999,nearly 15 percent of familieswith children under the age of 5years in Clark County livedbelow the poverty level. Lowincome families may not be ableto afford insurance, and maynot receive preventive medicalcare, such as blood leadscreening. As the population ofuninsured residents increases,so does the number ofunscreened children.

Another factor associated withincome is enrollment inMedicaid. Medicaid programsrequire that children bescreened for lead. As a result, alarge portion of lower-incomechildren qualify for free

Interim REPORT

Southern Nevada Health District Childhood Lead Poisoning Prevention Program

screening. Previously it hasbeen difficult to determine howmany children in Nevada’sMedicaid programs receivedblood lead testing. Through thecollaborative efforts of CLPPPstaff and partners, Medicaid isnow providing relevant data toassist the project’s screeningefforts.

Impact of LeadExposure on ChildDevelopmentLead is a metallic element thatcan be absorbed by the body,usually through ingestion orinhalation. A person maybreathe in or swallow dust orchemicals that contain lead, oreat foods or other itemscontaminated with lead. Once inthe body, lead enters the bloodand travels to tissues andorgans, i.e., the liver, kidneys,lungs, brain and muscles. Afterseveral weeks, lead moves intothe bones and teeth.

Young children are exposed tomore lead hazards compared toadults and because they absorblead more easily and rapidly,they are at a greater risk ofelevated blood lead levels(EBLLs). Children under theage of 6 years often play on thefloor or ground, where they canswallow or breathe lead thatcan be found in dirt, dust orsand. Also, dirt or dust onchildren’s hands, toys and otheritems may contain lead particlesin it. The normal hand-to-mouth activity of children andbabies increases theirvulnerability.

Lead poisoning can result fromthe gradual accumulation oflead in the body after repeatedexposure or by ingesting one

large quantity. Smaller amountsof lead ingested by children canbe harmful because 45-50percent of the lead ingested willbe absorbed into the child’sblood stream compared to only10-15 percent in adults.Additionally, because certainparts of the nervous system arestill in early stages of develop-ment, children are moresusceptible to the toxic effects oflead. Unborn babies are alsosusceptible to the adverseeffects of lead, as it crosses theplacenta during pregnancy.Once lead is in the body, it canremain for over 30 years in thebones and teeth and canredeposit into the blood streamfrom the extraction of calciumin the bones. This continualrelease can also have negativeeffects.

Lead exposure can affect nearlyevery system in the body. Atincreasingly high levels ofexposure, a child may sufferkidney damage, becomementally retarded, fall into acoma, and even die from leadpoisoning. However, even lowlevels of exposure to lead canresult in IQ deficits, learningdisabilities, behavioral problems,stunted or slowed growth, andimpaired hearing. Because of

this, there is no safe blood leadlevel for children.

Symptoms of lead exposure orpoisoning in children and adultsmay not be the same. In fact,most children and adults maynot have any noticeablesymptoms. It is common thatlead exposure goes unnoticeduntil later in life when cognitiveabilities are already impaired.The only way to determine if achild has been exposed to lead isto test the child’s blood leadlevel. This test measures theamount of micrograms of lead ineach deciliter of his/her blood.In 1991 the CDC determinedthat if a child has a blood leadlevel of 10 micrograms perdeciliter (10 μg/dL) or higher,public health attention should beinitiated. In November of 2007,the CDC conceded that there isevidence that children can beaffected by any blood lead levelsabove zero.

TREATMENTCurrently, there is no effectivetreatment to eliminate leadfrom the body. Treatment, inthe form of chelation therapy, isprovided only when someonehas dangerously high levels oflead in his or her blood.Chelation therapy introducesdrugs into the body that bindwith lead in the bloodstreamand cause it to be flushed fromthe body in urine and bile morerapidly than would happennaturally. The purpose of thistreatment is to lower levels ofblood in the body and does notprevent future exposure. Thistreatment is not recommendedfor individuals with blood leadlevels below 45 μg/dL. Sincelead can be harmful at levelsmuch lower than 45 μg/dL, andthe only known treatment

cannot be administered,prevention of lead exposurebecomes of prime importance.

Screening inNevada

All children should be tested atages 12 and 24 months. Also, ifa child is less than 6 years ofage and has never been testedfor lead, he or she should alsobe tested. This simple blood testis covered by most insurancecompanies, including Medicaidand Medicare.

The U.S. Census Bureauestimates that almost 137,000children under the age of 5years resided in Clark Countyin 2006. That year, SNHDreceived less than 5,000reported lead screenings forchildren in this age group. Thismeans that less than 1 percentof children under the age of 5were screened for lead in 2006.

Lack of blood lead testreporting has been a problem inClark County and Nevada. In2007, the Southern NevadaDistrict Board of Health passedlocal regulations mandatinglaboratories and medicalpersonnel to report cases ofEBLLs to the local healthauthority. Regulations also

require reporting blood testresults indicating any leadexposure, even if they are notconsidered “high.”

Currently, there is no statelegislation requiring blood leadresults be reported in otherjurisdictions in the state outsideof Clark County. For thisreason, it is difficult todetermine the number ofchildren who are beingscreened for lead statewide.

In the past three years,screenings have steadilyincreased in Clark County, mostnotably by 47 percent from 2005to 2006 and continuing at a

steady rate through 2007. Basedon current screening data notedin Table 1, almost 25 percent ofthe children screened in ClarkCounty were exposed to lead.Hispanic children areparticularly at risk, accountingfor over 50 percent of allchildhood lead exposureincluding cases with blood leadlevels above the level of concern(10 μg/dL). The table belowshows ethnicity data, but racedata is not available due tocurrent reporting methods inplace. Collaboration with majorlaboratories in Southern Nevadacontinues to obtain thisinformation.

Table 1. Screening Results for Children Ages 0-72 Months (August 2006-December 2007)

Childhood Lead Poisoning Prevention Program, Screening Results for Children Ages 0-72 months*

August 2006 through December 2007 Total Hispanic Non-Hispanic Unknown Male Female UnknownTotal # of children age 0-72 months screened 8561 4806 3755 0 4378 4182 1

Number of children age 0-72 months with BLL ≥10 µg/dL ** 13 7 6 0 5 8 0Number of children age 0-72 months with BLL from 5 μg/dL to 9 µg/dL 141 72 69 0 74 67 0Number of children age 0-72 months with BLL from 1 μg/dL to 4 µg/dL 2127 1213 914 0 1122 1004 1

* Children between 72 and 73 months are not included in the figures above

** Four children who initially tested with a BLL ≥10 μg/dL are not counted above due to subsequent inconclusive blood lead results

Note: Due to limitations by which the blood lead data was recorded in August and September 2006, the age, sex and ethnicity information for approximately 900 children between the ages of 0 and 72 months who tested with a blood lead level of 0 is not available. These children are not represented in the table, however they should be taken into consideration when calculating the number of children who demonstrated an exposure to lead versus the total number of children screened.

Ethnicity Sex

PUBLIC HEALTH RESPONSEThe SNHD Office ofEpidemiology receives bloodlead test results for childrenscreened in Clark County.Blood lead levels of 10 μg/dLor higher in children under theage of 6 years prompt a publichealth response by the healthdistrict.

When this occurs, the child’slegal guardian is contacted toarrange an environmentalinvestigation and a publichealth nurse is assigned as acase manager for the child.

Case ManagementPublic health case managementconsists of coordinating careand follow-up of children, ages0-72 months, with blood leadlevels of 10 μg/dL or higher. Atrained public health nursemonitors medical care, educatesthe family and coordinatesservices.

Environmental InvestigationsEnvironmental investigationsare performed by investigators,who are EPA-certified lead riskassessors, in cases where a childhas a blood lead level of10 μg/dL or higher. Theinvestigator researches sourcesof exposure by conductinginterviews to determine wherethe child may have beenexposed to lead and testingpotential sources. SNHDnotifies and educates the familyand landlord about theidentified lead hazards.Recommended actions aremade to help control leadhazards in the home andprevent further exposure.

IMPROVEMENTS TOENHANCE SCREENING

EFFORTSWhile screening rates havesignificantly increased over thepast year, there are still severalimprovements needed to ensurethe program’s success:

• More accurate lab reporting

• Increased communicationwith Medicaid

Laboratory TestingIt is extremely important thataccurate data is reported to thehealth district by thelaboratories analyzing bloodlead levels. Problems with labreporting occur as a result ofinconsistent reporting formats.Specific information is neededto determine if an exposureproblem exists in Clark County,and eventually Nevada. Inaddition it is necessary to betteridentify risk factors for leadexposure and vulnerable

populations. To understand thisproblem as a whole,information such as race, ZIPCode, Medicaid enrollmentstatus, and the type of bloodtest conducted (capillary orintravenous) are all crucialpieces of information that arenot consistently reported.

This problem is in part due tolack of mandatory reportinglaws as well as funds for labs toreprogram the reporting formatto include the informationneeded. This information wouldallow us to detect whetherefforts by SNHD and Medicaidwere effective in increasingscreening, if certain races or ZIPCodes had higher blood leadlevels, and to identify certainraces and areas that are still notbeing screened.

Medicaid

Program members haveinitiated collaboration withMedicaid officials to increaseblood-lead screening, educationand outreach among Medicaidrecipients. Efforts to obtainMedicaid screening data havebeen successful and willcontinue.

Lead Sources inNevada

In the past lead was widelyused in such things ashousehold paint, gasoline, pipesand pesticides. The use of leadhas been restricted in these andmany other products, but aperson may still be exposed tolead from a variety of sources.The following is a list ofcommon lead sources:

• Paint chips from interiorand exterior paint in homesbuilt before 1978

• Soil, especially in denseurban areas andplaygrounds

• Household dust ,and debrisfrom buildings built before1978 undergoingremodeling or renovation

• Imported cosmetics, candyand toys

• Traditional Hispanic homeremedies, such as Greta andAzarcon, an orange powderused to treat upset stomachor “empacho”

• Pottery and ceramics

• Work and hobby activities,such as construction,remodeling, radiator repair,pottery making or the useof an indoor firing range

INVESTIGATING LEADSOURCES

In order to address potentiallead hazards in a child’senvironment, an investigatorwho is an EPA-certified leadrisk assessor performs aninvestigation of the child’shome. The investigatorexamines the painted surfacesfor evidence of lead-basedpaint, as well as buildingconditions that may contributeto paint deterioration. Theinvestigation requirementsinclude dust, soil and watersampling. In Clark County, the

risk assessor typically examinesother potential sources, such asglazed tile, bean pots, importedcandies and folk remedies. Theoccupation or hobby of a parentor caregiver may also beconsidered.

During the past 18 months,teams of lead investigators fromSNHD and lead inspectors fromthe University of Nevada, LasVegas conducted environmentalinvestigations and leadinspections. Preliminary datawas collected from 58 homescompleted between April 2006and December 2007. Forty-threewere environmentalinvestigations for children withlead exposure, while 15 wererisk assessments performed inhomes built before 1978 withouta child exposed to lead.Potential lead sources werecategorized as either painthazards (i.e., dust and soilcontaminated by lead-basedpaint), or non-paint hazards

Figure 1. Potential Sources of Lead in Clark County

Potential Sources of Lead in Clark County Investigations April 2006-December 2007

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Analysis of the results revealedthat a majority of potential leadhazards arise from non-paintsources. The three mostfrequently found potential leadhazards not related to paintinclude tile, imported candies,and parent occupation (Figure1). It is important to recognizethat all of these could becomehazards if ingested (i.e. if thetile were to chip, it would be ahazard because a child couldeat pieces of tile on floor orchipping could cause dust withlead which could be inhaled).

LOCATING CHILDREN INCLARK COUNTY WITH

REPORTED LEADEXPOSURE

Screening results in ClarkCounty indicate that 2,281children 0-72 months old haddetectable blood lead levels(BLL>0). Of the approximate 86ZIP Codes in Clark County,children exposed to lead havebeen identified in 66 ZIP Codes(Figure 2) indicating that leadexposure is occurring acrossClark County. However, thereare certain ZIP Codes whereexposure is more prominent.ZIP Codes 89110, 89101, 89115all contain over 100 test resultsthat indicate lead exposure. TheZIP Code with the highestnumber of children is 89030with 216 test results thatindicate lead exposure. This

information is used to targetareas for screening andoutreach activities that will helpfind children exposed to leadand to prevent future exposuresto lead hazards. Due tolimitations in reportingmethods (no address listed),33 percent of children with testresults indicating lead exposureare not included in the map.Improvements in reportingrequirements, as previouslydiscussed, will assist withaccurate identification of leadexposure in Nevada.

It is important to note that atthis time, this is not enoughdata to determine if specificneighborhoods are at higherrisk of exposure or to make adetermination regardingspecific sources of exposure ineach ZIP Code. This data does

Figure 2. Clark County Map of ZIP Codes Highlighting Lead Exposure

not indicate that lead exposureis due to housing in those ZIPCodes. These results could bedue to an increase inparticipation in screening inthese areas. This demonstratesthe importance of having anactive CLPPP in the state ofNevada. As this projectcontinues, it is hoped that thedata will give more explicitinformation on these vitalquestions.

PREVENTING LEADEXPOSURE

The most effective ways toprevent lead exposure inNevada’s children includemonitoring imported goods thatmay contain lead, educating thepublic about products that maycontain lead, performingabatement of buildingscontaining lead, and using lead-safe work practices whenrenovating or remodeling.

ProgramActivities andAccomplishments

STRATEGIC ADVISORYCOALITION

In 2006, the Strategic AdvisoryCoalition (SAC) was establishedto advise and support SNHD inthe development andimplementation of a five-yearelimination plan that providesdirection for CLPPP activities.

The SAC membership iscomposed of a cross-section ofregional, state, county and

community environmental andchildren’s health stakeholdersfrom the public and privatesectors that have an interest ineliminating childhood leadpoisoning. Members arecommitted to public health andthe well-being of thecommunity, and receive nofinancial compensation.

ELIMINATION PLANThe Elimination Plan preciselyoutlines strategies and activitiesto eliminate lead exposure as apublic health concern inNevada’s children by 2010. Theplan was developed inconjunction with the SAC inmid-2007. A copy of this plan,along with the annual report,can be viewed on the SNHDwebsite.

LEGISLATIVE ACTIVITIESThe Legislative AffairsWorkgroup developed aresolution called “ChildhoodLead Poisoning PreventionProgram.” It was forwarded tolobbyists and provided to theNevada Legislature on Feb. 7,2007. The resolution was passedas a proclamation. Thisproclamation serves as a formalrecognition of the efforts of theCLPPP to eliminate leadpoisoning in Nevada.

MANDATORY LABREPORTING

On Nov. 16, 2006, the SouthernNevada District Board ofHealth approved a proposedregulation that mandated allblood screening resultsindicating an exposure to lead

in Clark County be reported tothe health district.Subsequently, the Nevada StateBoard of Health also voted infavor of the proposedregulation on Dec. 8, 2006.

PUBLIC OUTREACHDuring the past year, thePrimary Prevention Workgroupinitiated a public awarenesscampaign on the dangers oflead exposure. Workgroupmembers attended health fairsto distribute approximately 300-500 brochures and fact sheets inEnglish and Spanish. Membersalso participated in numeroustelevision and radio interviews.More than 9,000 leadprevention bookmarks wereincluded in information packetsprovided to new mothers bySierra Health Services.Additionally, the workgroupreceived funding from theSierra Community HealthcareFoundation to develop awebsite and create a bilingualpublic service announcement(PSA) about sources of lead,screening and pre-1978 housingrisk assessments.

Presentations in English andSpanish were developed toeducate the public, and arecurrently used by the AreaHealth Education Center.Collaborating with the State’sWomen, Infants and Children(WIC) program resulted in leadpoisoning prevention trainingthrough WIC’s updatedcurriculum.

In December 2007HealthInsight, the partner

Detailed program information is available on the SNHD website:http://www.SouthernNevadaHealthDistrict.org/clppp/index.htm

organization that providesmedical consultation for theproject, trained almost 40 keystaff members of the NevadaWIC clinics on lead poisoningprevention.

COLLABORATIONWITH HEALTH CARE

PROFESSIONALSMedical education and outreachis being provided to health careprofessionals by Dr. BillBerliner of HealthInsight, whois also part of the PrimaryPrevention Workgroup. Thisphysician-to-physicianinteraction serves to breakdownpotential communicationbarriers while encouragingscreening efforts. A continuingeducation course on lead wasdeveloped and presented inJune 2007 to medicalprofessionals by Dr. DavidBellinger, a renowned Harvardprofessor. In October 2007, anonline course on lead becameavailable to physicians.

Current andFuture ProgramActivities

All groups will continue toexpand program activitiesthroughout the year. Emphasiswill be placed on buildingrelationships with Medicaidproviders, housing authoritiesand other organizations tostrengthen community supportin eliminating lead exposure asa public health concern inNevada.

IMPROVED SCREENINGSNHD will introduce theLeadCare II, the only CLIAwaived blood lead system, to thestate of Nevada. This device

improves on the original LeadCare, presently the most widelyused blood-lead testing systemin the world. Developed withthe funding from the CDC, LeadCare II will improve patients’health outcomes by performingrapid tests onsite rather thansending samples to an outsidelab.

Its waived status will expandthe potential sites where leadtesting can be performed, suchas community health centers,mobile clinics or health fairs.This device benefits patientsand providers because there is agreater chance to test thosechildren most at risk, and itprovides quantitative bloodlead results equivalent to thosereported by outside laboratoriesin just three minutes. TheCLPPP will work in closecollaboration with the SNHDChildhood Immunizationprogram to conduct outreachand screening activities.

PRIMARY PREVENTION Activities from thesupplemental grant from theSierra Community HealthcareFoundation will be completedduring the 2008 project year.The CLPPP will exploreopportunities to broadcast theEnglish and Spanish publicservice announcements on bothradio and television. Theprogram will also promote thewebsite as a source of updatedinformation for the generalpublic and professionals.

HOUSING-BASEDPREVENTION

A crucial component of theCLPPP involves preventingexposure to lead. Historically,the major environmental sourceof lead has been lead-based

paint. Deteriorating lead-basedpaint creates dust, which maysettle in buildings and in soil.Since the use of lead-basedpaint in residences was bannedin the U.S. in 1978, the focus ofhousing-based prevention is onhouses constructed before 1978.

A lead inspection will beconducted in the pre-1978homes of people volunteeringto have a lead investigation.The lead inspection, performedby an EPA-certified riskassessor, is an onsite visualinspection and environmentalsampling of paint, dust and soilto determine the existence,nature, severity and location ofa lead-based paint hazard. Therisk assessor will provide areport explaining theinvestigation results, suggestways to reduce or eliminatelead-based paint hazards andrecommend acceptablestrategies for controlling anyhazards identified.

Lead inspections may beperformed in any buildingoccupied by children, includingsingle-family homes, multi-family housing units, pre-schools, child care centers andschools.

Legislativeand PolicyConsiderations

The CLPPP Legislative AffairsWorkgroup is tasked withidentifying necessary legislativeand policy changes to helpeliminate childhood leadpoisoning in Nevada. As one ofthe last states to start a CLPPP,Nevada is able to review andidentify model legislation fromother states with more mature

programs. Since there arecurrently no state laws orregulations related to theprevention of childhood leadpoisoning in Nevada, theCLPPP is working with a cleanslate to identify laws andregulations that best serve theneeds of our children. Areascurrently under considerationfor legislation and/or policydevelopment include:

• Screening Laws:Mandatory screening lawshave been implemented inmany states to ensure thatchildren are routinelyscreened for lead. Somestates require screening forall children (e.g., screeningrequired before entry intochild care setting and/orschool), while othersmandate screening for onlysome children (e.g., those inhigh-risk settings and/orwho have been exposed tolead). Consideration willalso be given to ease theprocess for allowing healthdepartments to conductscreenings using a mobileunit.

• Reporting Laws:Mandatory reporting lawsallow health authorities totrack lead exposures,provide necessary casemanagement and performenvironmental screenings to

identify potential sources.Under such laws,laboratories would berequired to electronicallysubmit specific data on allEBLLs to the appropriatehealth authority.

• Education: This componentaddresses the need toeducate parents, health careproviders and othercaregivers about thedangers of lead exposure inchildren and theimportance of screening.

• Environmental Screenings:These screenings arenecessary to identifypotential sources of leadexposure, particularly inhomes, child care settingsand other buildingsfrequented by youngchildren. Environmentalscreenings may beconducted in response tocertain identified riskfactors (i.e., pre-1978 home)or to potentially identify thesources of lead exposure forchildren with EBLLs.

• Remediation: Legislationand/or regulations addressremediation of housingand/or buildings identifiedwith potential lead hazards,particularly for the lower-income population. Thiscomponent may alsoaddress mandatory

remediation by propertyowners, particularly forrental properties and childcare facilities.

• Program Sustainability:Currently, the CLPPP isfunded through a 5-yeargrant from the CDC. Effortswill be made to securefunding through state,federal and private sourcesto continue and expand theefforts of the projectstatewide.

Future Focus

Even though the program’sprimary activities started inClark County, CLPPP plans toexpand statewide. Memberswill work to establish statewidescreening and outreachactivities appropriate forNevada’s three geographicareas: north, south and rural.The activities will most likelyvary to accommodate theunique and diverse needs ofeach population base.

The CLPPP will continue topromote awareness of leadpoisoning, identify risk factorsand appropriate controlmethods to eliminate childhoodlead poisoning. Many stateshave implemented programsthat can be modified to use inNevada, such as Lead SafeBabies, Lead Abatement StrikeTeam and Lead Safe WorkTrainings.

• Lead Safe Babies is ahealth prevention programwith the lofty goal ofensuring that childrennever become leadpoisoned. The programprovides new mothers withnecessary education and

materials to protect theirchildren from leadpoisoning. Results haveshown a statisticallysignificant increase inknowledge about leadpoisoning amongparticipants.

• The Lead Abatement StrikeTeam (LAST) wasdeveloped in 2002 inresponse to thecommunity’s increasedawareness of leadpoisoning and concernabout the lack ofenvironmental remediationfor identified lead hazardsin homes occupied bychildren with EBLLs. Theprogram’s efforts led tonew appropriations forremediation and newenforcement codes.

• Lead Safe Work Trainingincludes training forcommunity members whoplan to remodel theirhomes, or for businessesthat work with leadhazardous materials. Thetraining educatesindividuals about the risksof exposure, sources ofcontamination and lead-safepractices.

In order to implementeducation and preventionactivities throughout Nevada, itis essential to understandsources of lead exposure and at-risk populations. Throughoutthis report several barriers tocollecting this information havebeen specified. Programmembers will work to resolvethese issues throughout thecourse of the grant period, andwill aim to expand datacollection that includes allhealth care agencies, collectionof information on minoritycommunities and prevalence ofcultural practices with potentialfor lead exposure. They willalso establish criteria toinvestigate communities atgreater risk of lead exposure.

HEALTHY HOMESNevada should maintain aChildhood Lead PoisoningPrevention Program to ensurethat lead poisoning iseradicated. The program’ssuccess depends on manyfactors including funding. Onesource of funding that shouldbe explored is HUD HealthyHomes grants. HUD grantsprovide funds for remediationwork in partnership at city andcounty levels. Healthy Homesprograms provide funds to

investigate all home hazards:physical, chemical andbiological. In the future movingto a Healthy Homes model,which includes lead as acomponent, is a holisticapproach to ensure thatNevada’s residents, inparticular children, are living ina safe, healthy environment. Byconsidering Healthy Homesnow, Nevada will be headingtowards national goals ofHealthy People 2010.

ConclusionSince its inception, the CLPPPhas established a solidfoundation to expand theprogram statewide. Thus far,the program has successfullymade progress towardsaccomplishing the outlinedgoals and objectives, and manytasks were completed beyondthe scope of the plan.

Support from local and statepolicy makers, and thecommunity is necessary tosustain the program andultimately, eliminate the threatof lead poisoning in Nevada’schildren.

IN NEVADA,CHILDREN RUN BETTERU N L E A D E D