Lead Sources Library: A Web-based Tool to Inform Professionals and Communities about Emerging Sources of Lead

Background: Approximately 150,000 at-risk children under 6 years old are tested for elevated blood lead levels each year in North Carolina. Most children are tested because they live in homes built before 1978 or because testing is required for Medicaid-enrolled children. However, recent surveillance reports show an increase in elevated blood lead levels among children who may be exposed to lead through spices, ceremonial powders and home remedies. With a growing immigrant population (over 730,000 in 2009-2013), public health agencies are working to help parents who use these culturally important items understand the potential risks for exposure to lead. Furthermore, the NC Childhood Lead Poisoning Prevention Program (NC CLPPP) is positioning itself as a leader in addressing emerging sources of lead, publishing results of 2011-2018 lead investigations in MMWR (Gaetz et al, 2018), developing a questionnaire used during lead investigations, and leading a working group of CDC grantees who are exploring policy, surveillance and outreach measures to address lead in spices.

Program background: The NC CLPPP and the University of North Carolina’s Institute for the Environment (UNC IE) have developed resources that inform public health professionals and families about spices and other sources, including the online “Lead Sources Library.” Using images taken by UNC Greensboro Public Health Education students, UNC IE developed a database of dozens of spices, home remedies and ceremonial worship items identified as potential sources of lead exposure. Each entry includes a description of the product’s uses, where it is produced and alias names. There is frequent updating to this site, as new, relevant information becomes available, including federal recalls and warnings of some products. In this presentation, we will feature the online library and the NC CLPPP fact sheet “Lead in Spices, Herbal Remedies, Ceremonial Powders and Cosmetics,” highlighting how public health professionals are informing families about the risk of using contaminated consumer products.

Evaluation Methods and Results: We are in the early stages of using these materials and gathering evaluation data. We are reviewing the number of hits on the website and requests for the fact sheets. Thus far, in the past year, NC CLPPP has presented these materials at a national meeting of CDC-funded childhood lead poisoning prevention program managers. UNC IE has featured these materials in 4 Lead and Healthy Homes trainings of immigrant health organizations and in an article for Saathee Magazine, which is distributed to Southeast Asian immigrants living in the southeastern US.

Conclusions: The preliminary interest in our materials and an increasing presence of emerging sources of lead among a growing immigrant population in North Carolina and beyond has confirmed that these outreach materials are useful resources. Next steps include continuing to build the “Lead Sources Library” and translating the fact sheet into languages besides English and Spanish.

Implications for research and/or practice: Thousands of public health professionals conduct lead investigations for children and pregnant women in the US. The “Lead Sources Library” can serve as a model for web-based tools that can be used on-site at lead investigations to help identify and document potential sources of lead exposure previously unfamiliar to investigators.