Published online January 4, 2006
PEDIATRICS Vol. 117 No. 1 January 2006, pp. 147-153 (doi:10.1542/peds.2004-2880)
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ARTICLE

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

Mary Jean Brown, ScD, RNa, Pat McLaine, RN, MPHb, Sherry Dixon, PhDb and Peter Simon, MD, MPHc

a Lead Poisoning Prevention Branch, Division of Emergency and Environmental Health Services, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
b National Center for Healthy Housing, Columbia, Maryland
c Department of Family Health, Rhode Island Department of Health, Providence, Rhode Island

OBJECTIVE. 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.

METHODS. We conducted a community-based, randomized trial of comprehensive education and home visiting for families of children with BLLs 15 to 19 µg/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.

RESULTS. 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 µg/dL for intervention versus comparison group children, respectively.) After 1 year, nearly half of enrolled children had BLLs ≥10 µg/dL.

CONCLUSIONS. 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.

Key Words: lead poisoning • home visiting • case management

Abbreviations: BLL—blood lead level • NCATS—Nurse Child Assessment Satellite Teaching Scale • GM—geometric mean • CI—confidence interval

Accepted Jun 27, 2005.


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