E-Health

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Levels of lead pollution have been decreasing overall across the country. The EPA’s

regulation which reduced the lead content in gasoline for on-road motor vehicles played a major

role in decreasing national lead levels when air quality trends were analyzed. In fact, these

efforts resulted in a 98% decrease in lead air levels between 1980 and 2014 (EPA, 2019).

Studies involving the Stege Marsh in San Francisco Bay, an area heavily affected by man-made

lead pollution supports this trend, as well as other research which focuses on improved water

quality lead levels (Hwang et al., 2009). However, the potential for toxicity is still high along

with the probability of experiencing adverse effects. Environmental lead levels are predicted to

decline continuously but the rate at which this decline is occurring is decreasing. It will still take

several decades before the levels of lead are low enough that potential toxicity is no longer a

public health issue. By analyzing the historical trend of lead pollution, one can better predict

future lead pollution trends to determine if additional efforts are needed to decrease these levels.

The social ecological model would be a good approach to use in predicting future lead

level trends. This model focuses on several levels of influence including the individual,

interpersonal, organizational, community, and public policy (National Institutes of Health, n.d.).

From an individual standpoint, it is important to assess the public’s current knowledge of lead

and if they believe that it is a significant public health issue. From an organizational standpoint,

it is important to determine whether local organizations are aware of this issue and if they are

amenable to changing their practices and/or supporting those organizations that do so. The

community involves the interactions between these organizations, individuals, and local leaders.

Local public health officials need to ensure that companies and organizations are taking the

proper steps to reduce man-made lead pollution and to enforce current regulations.

Community partnership and accountability leads to creation of new local government regulations and laws that must be followed. Non-compliance with these laws result in heavy fines for these

companies. By analyzing the trends in these levels of influence, one can get a better picture of

how that local community is faring in their fight against lead pollution. If a city’s citizens are

well aware of lead’s effects and the city has drastically decreased their pollution levels through

community efforts and public policy, then there is a high probability that this city will continue

to experience reduced lead pollution. From a statistical standpoint, it may even be possible to

predict how many years or decades away the city is to achieving lead levels that cause little to no

adverse health effects. The FAST start initiative in Flint, Michigan aimed to decrease lead water

levels by replacing lead lines throughout the city. Samples taken from homes with lead lines still

in place had higher levels of lead while those that did not had decreased levels. The quantity of

lead in water consumed by children at homes without the lead lines decreased a very significant

93% over 74 weeks (Zahran et al., 2019).

The Health Belief Model is another public health theory that can be used to predict future

lead pollution trends. This model emphasizes the perceived susceptibility individuals have of

lead contamination, the perceived barriers to combating this public health issue, cues to action,

and self-efficacy (National Institutes of Health, n.d.). Perceived susceptibility can be the belief

that since one is not a child, they cannot ever be in danger of lead exposure. Perceived barriers

can be delaying going to the physician for a lead screening simply because life is too hectic.

Cues to action can result from simply reading an article highlighting the dangers of lead

pollution, having a loved one negatively affected by lead contamination, or receiving a reminder

from the pediatrician to have your child screened for lead exposure. Self-efficacy is the individual’s belief in being able to execute a behavior. In this case, self-efficacy examples could

be assuming that since they are elderly there is no point in caring about their lead levels or going

to their physician to request screening if exposed to lead. Public health practitioners can predict

future trends through research by surveying individuals and gauging where the majority of the

population stands with each aspect of the Health Belief Model and overall. When the majority of

the population shows trends of being well-informed and pro-active, future trends can be

predicted to show decrease in lead exposure levels. However, if the opposite is true, proactive

solutions need to be implemented to change the course of a predicted unfavorable trend.

These predicted environmental health trends can help inform the development of

proactive solutions to lead pollution. Some of these proactive solutions can be, as mentioned

above, implementing new laws regarding acceptable lead levels in air and water. The Clean Air

Act sets National Ambient Air Quality Standards for six principal pollutants, including lead.

This regulation sets the maximum air lead level at 0.15ug/m3 as of 2008. By comparison, the

maximum level was set at a much higher 1.5ug/m3 in 1978 (EPA, 2019). Another law could

include the enforced regulation or banning of lead-containing products seen in cosmetics,

jewelry, silverware, and cleaning products. The FDA, under The federal Food, Drug, and

Cosmetic Act regulates the safety of cosmetic products (EPA, 2019). In fact, infant lead

poisoning has been linked to tiro, an eye cosmetic from Nigeria, and Asian tongue powder

(Warley, 1968; Wolf et al., 2008). In regards to childhood lead exposure, having clear clinical

guidelines as to when screening for elevated lead levels should occur is necessary. Currently,

since lead trends are predicted to decrease but continue to exist in levels that cause negative

health outcomes, clinical guidelines should continue to be enforced with special attention to

screening those individuals who are at-risk. These at-risk individuals, for the most part, are

children under 6 living in pre-1950 homes. However, individuals who have been exposed to lead

consistently should all be considered at-risk. Winslow (2016) delineates this process of following

national pediatric testing guidelines for collecting lead samples of those most at risk for blood

lead exposure. Continued education of avoidance of potential sources of lead, the negative

health effects of lead, and non-pollutant alternatives are critical in ensuring that these declining

anthropologic lead levels continue to do so at an acceptable rate. The ultimate public health

victory would be achieving measured lead levels insignificant enough to not cause any harmful

health consequences.

References

Hwang, H., Green, P. G., & Young, T. M. (2009). Historical trends of trace metals in a sediment core from a contaminated tidal salt marsh in San Francisco Bay. ​ Environmental Geochemistry and Health, 31 ​ (4), 421-431.

National Institutes of Health. (n.d.). https://obssr.od.nih.gov/wp-content/uploads/2016/05/Social-and-Behavioral-Theories.pdf

Warley, M. A., Blackledge, P., & O'Gorman, P. (1968). Lead poisoning from eye cosmetic.

British Medical Journal 1 ​, 117.

Winslow, A. (2016, November). Testing those most at risk for blood lead exposure. ​Medical Laboratory Observer, 48 (11), 34,36. Woolf, A. D., Hussain, J., McCullough, L., Petranovic, M., & Chomchai, C. (2008). Infantile leadpoisoning from an Asian tongue powder: A case report & subsequent public health inquiry. ​Clinical Toxicology 46 ​ , 841–4.

Zahran, S., Mushinski, D., McElmurry, S. P., & Keyes, C. (2019, November). Water lead exposure risk in Flint, Michigan after switchback in water source: Implications for lead service line replacement policy. ​Environmental Research, 181 ​ , 1-16. doi:10.1016/j.envres.2019.108928