At a glance
CDC supports Alabama and other state and local health departments, or their bona fide agents, through cooperative agreements to support childhood lead poisoning prevention activities. Read about the program's successes.
About the program
The State of Alabama received $350,000 through cooperative agreement EH21-2102 from the Centers for Disease Control and Prevention (CDC) in the third funding year. The funds address childhood lead poisoning prevention and surveillance programmatic activities being conducted from September 30, 2023, to September 29, 2024.
The strategies focus on:
- Ensuring blood lead testing and reporting
- Enhancing blood lead surveillance
- Improving linkages to recommended services
To learn more about the efforts in Alabama, contact the program below.
Alabama Department of Public Health
Childhood Lead Poisoning Prevention Program
The RSA Tower
201 Monroe Street, Ste 1050
Montgomery, AL 36104
Phone: 334-206-3883
Note:
Success story: funding year 3
Increased education and outreach improve blood lead testing and reporting rates in Alabama
Challenge
The Alabama Department of Public Health (ADPH) Alabama Childhood Lead Poisoning Prevention Program (ACLPPP) recommends blood lead testing for all children at one and two years of age and mandates reporting of all blood lead test results to the ADPH. Despite data indicating 116,258 combined live births in 2019 and 2020, only 35,548 (31%) children younger than three years were reported to have received blood lead testing in 2021. Because less than a third of children received testing, the need for more education and outreach was apparent. After the blood lead reference value was updated from 5 µ/dL to 3.5 µ/dL in October 2021, it became especially important to identify children who required case management at lower blood lead levels (BLLs).
Intervention
In January 2022, ACLPPP added a nurse coordinator position to perform case management and provide lead exposure education and outreach. Although focused on medical providers, the program provided education and reached families with young children through community events, face-to-face meetings, and individualized presentations.
From April through November 2022, the nurse coordinator provided educational materials to over 1,500 pediatric healthcare providers across Alabama. The materials included ACLPPP recommendations, program brochures, and a request to include the ACLPPP in any local health promotion events. The resulting invitations allowed the ACLPPP to share lead poisoning prevention information with more than 500 families. The program provided additional face-to-face follow-up with about 500 providers in 2022 through professional conferences and office visits.
Impact
By the end of 2022, ACLPPP experienced a significant increase in blood lead testing and reporting rates. The number of children younger than three years of age with a reported blood lead result increased by 17% to 41,694 in 2022, which exceeded the program's annual goal of 5%. Educational initiatives will be expanded and continue to engage providers and empower parents to advocate for their children's health.
Funding for this work was made possible in part by [CDC-RFA-EH21-2102] from the Centers for Disease Control and Prevention (CDC). The views expressed in this material do not necessarily reflect the official policies of CDC; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.
Success story: funding year 2
Alabama increases services to hundreds of children exposed to lead
Challenge
In 2020, tests showed that 13,984 Alabama children younger than 6 years of age had lead in their blood. To qualify for a public health intervention, children must have a blood lead result of 5 µg/dL or higher. Only 759 (5%) children qualified to receive the intervention. Because childhood lead poisoning can have serious physical and social consequences, the Alabama Childhood Lead Poisoning Prevention Program (ACLPPP) needed to increase the number of children who qualified for public health intervention.
Intervention
ACLPPP sought to increase linkages to services for more children affected by lead exposure. In January 2022, ACLPPP aligned its guidance with CDC's updated blood lead reference value (BLRV). As a result, children with a blood lead test result of 3.5 µg/dL or higher qualified for public health interventions. Interventions include parent education, case management, and environmental testing. As the primary referral source for developmental evaluation and services in Alabama, the Alabama Early Intervention System (AEIS) adopted the updated criteria in April 2022.
In addition, the Alabama Department of Public Health updated its case management protocol. They began to refer children younger than age 3 years to AEIS for interventions. They also began referring children aged 3 years and older to local departments of education for evaluation and developmental services, based on individual needs.
Impact
By incorporating the protocol and procedure changes above, ACLPPP increased the number of children referred for case management. From 2020 to 2022, referrals increased by 103%. As of December 16, 2022, a total of 1,540 children met the new criteria for case management services. This increase in children eligible to receive services allowed more families to receive one-on-one education about lead poisoning prevention. In addition, more homes were evaluated for sources of lead exposure. By working with AEIS to align criteria, more children can now be referred to receive evaluation and establish developmental services.
Funding for this work was made possible in part by NUE2EH001413 from the Centers for Disease Control and Prevention (CDC). The views expressed in this material do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.
Success story: funding year 1
Alabama increases blood lead testing in children through provider outreach
Challenge
The Alabama Department of Public Health Childhood Lead Poisoning Prevention Project’s (AL CLPPP) data showed many providers were either not testing for lead or not reporting blood lead levels (BLLs) as required by the Alabama Department of Public Health Administrative Code 420-4-1. Additionally, data indicated that many children were not receiving appropriate follow-up testing when there was an elevated BLL.
Intervention
To increase awareness of the state's blood lead testing and reporting requirements, AL CLPPP launched a campaign to educate Alabama pediatric medical providers. AL CLPPP also issued new state blood lead guidelines, which aligned with CDC's Recommended Actions Based on Blood Lead Level, to address common blood lead screening and follow-up testing issues identified in the pediatric healthcare community including state BLL reporting requirements and testing kit recalls.
Impact
There is evidence of increased BLL reporting since the development and initial distribution of the guidelines and educational campaign. From 2017 through 2018, the number of BLL results provided to AL CLPPP increased by 6.6%, from 43,806 blood lead results to 46,683 results. In addition, the number of children tested, as reported to AL CLPPP, increased by 3.1%, from 38,218 in 2017 to 39,404 in 2018. This increase in blood lead testing and reporting is expected to continue as the guidelines are shared with more providers and one-on-one education and other technical assistance are provided. Through testing, providers and families alike can monitor and address lead exposure, even at low levels, before a child has potentially permanent life-altering neurological damage. In addition to providing important information for individual children's follow-up care, accurate and complete reporting of BLLs helps the AL CLPPP identify and address geographical areas and populations most at risk for lead exposure in the state.
Funding for this work was made possible in part by NUE2EH001358 from the Centers for Disease Control and Prevention (CDC). The views expressed in this material do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.