At a glance
CDC supports Arizona 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 Arizona received $310,390 through cooperative agreement EH21-2102 from the Centers for Disease Control and Prevention (CDC) in FY 2022. The funds address childhood lead poisoning prevention and surveillance programmatic activities being conducted from September 30, 2022, to September 29, 2023.
The strategies focus on:
- Ensuring blood lead testing and reporting
- Enhancing blood lead surveillance
- Improving linkages to recommended services
To learn more about these efforts in Arizona, contact the program below.
Arizona Department of Health Services
150 North 18th Avenue, Suite140
Phoenix, AZ 85007
Phone: 602-542-1025
Note:
Success story: funding year 3
Expanding home investigations in Arizona
Challenge
Historically, the Arizona Childhood Lead Poisoning Prevention Program (AZ CLPPP) only completed a limited number of environmental investigations annually due to limited staff and resources. Home investigations are important because they help families identify and reduce or eliminate their exposure to lead. However, between 2019 and 2022, the program only conducted an average of four home investigations a year. Children with high blood lead levels (BLL) are at increased risk of health impacts if exposure in their home environment is not reduced or eliminated.
In addition, AZ CLPPP has encountered challenges with the sensitivity of testing tools and staff capacity. The program has historically utilized 3M Lead Check Swabs for testing paint and hard surfaces in homes, despite their occasional lack of accuracy. While these swabs are cost-effective and require minimal training, they do not provide quantitative measurements of lead content. Additionally, program staff expressed a need for further training in home investigations, as their success rate in identifying lead sources was approximately 60%.
Intervention
In 2023, AZ CLPPP took the following steps to improve the quality and quantity of home investigations:
- Offered home investigations for all children with a confirmed BLL ≥10 µg/dL.
- The program's epidemiologists enrolled in the Environmental Protection Agency (EPA) Lead Risk Assessor training.
- The program purchased an X-ray Fluorescence (XRF) lead paint analyzer in 2022 via a collaborative effort with the Arizona State Public Health Laboratory.
Impact
In 2023, AZ CLPPP completed 13 home investigations and aims to conduct at least 20 annually moving forward. The program is now able to assist three times as many families compared to previous years. Lead sources were confirmed in 85% of the investigations conducted in 2023, marking a 42% improvement from prior years.
Using the XRF analyzer, AZ CLPPP was able to determine if lead-based paint was present in the home, even if the paint is not deteriorating, when previously, the program could not determine the presence of lead without collecting a paint samples for lab analysis. In addition, the program's capacity was enhanced by developing a home investigation standard operating procedure and training protocols. The epidemiologists created a training presentation to facilitate knowledge transfer to the rest of AZ CLPPP staff with the goal of conducting home investigations in a consistent and comprehensive manner. As a result of the EPA lead risk assessor training, the team became more knowledgeable in identifying lead-based paint hazards and proper sampling techniques for both soil and paint.
Funding for this work was made possible in part by NUE2EH001471 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
Ensuring refugee children receive follow-up testing for lead in Arizona
Challenge
In 2022, the Arizona Childhood Lead Poisoning Prevention Program (AZ CLPPP) observed a sharp increase in the number of refugee children with blood lead levels (BLLs) above CDC's blood lead reference value (BLRV) of 3.5 µg/dL. There were 205 cases in 2022 compared to only 21 in 2021. It is important to note that in 2021 the BLRV was 5 µg/dL. Arizona adopted the new BLRV of 3.5 µg/dL in 2022. The majority of the refugees in 2022 were from Afghanistan. AZ CLPPP encountered several challenges when providing case management for these children.
Newly arrived refugee infants, children, adolescents, and pregnant and lactating women and girls are tested for lead during their initial health screening exam within 30 to 90 days of arriving in Arizona at a local refugee medical clinic. However, the follow-up test would need to be scheduled by the primary care provider. AZ CLPPP provided case management for children 16 years and younger. Many (41% of) children and adolescents who had a BLL at or above the BLRV during the initial exam did not receive follow-up tests.
Other challenges included communicating lead poisoning prevention messages due to language barriers and the inability to identify the resettlement agency assigned to the child. Identifying the resettlement agency assigned to each case is important to address these challenges.
Intervention
In the spring of 2022, AZ CLPPP began to address these challenges by reestablishing relationships with the resettlement agencies and the local medical clinics that serve refugee populations. To address the information gap, the program requested that refugee clinics include the resettlement agency information and primary language for each child when reporting BLL results to the health department. Since most children who are recently arrived refugees are covered by Medicaid, the program also formed relationships with managed care organizations (MCOs) to get healthcare provider information and access translation services when contacting families by phone.
Once the child's healthcare provider is identified, AZ CLPPP will fax the healthcare provider to let them know that the child is overdue for a blood lead test. Additionally, AZ CLPPP translated health education materials into specific languages to distribute to refugees and provided educational resources to resettlement agencies for inclusion in the medical orientation for newly arrived refugee families. The program also updated its case management protocol for refugees to ensure routine follow-up of their cases.
Impact
MCOs currently provide the program with missing provider information and send follow-up testing reminders to families. This effort is still underway; however, AZ CLPPP anticipates that this effort will lead to improved follow-up testing among children who are refugees and expanded messaging with the refugee communities throughout Arizona about lead poisoning prevention.
Funding for this work was made possible in part by NUE2EH001471 from the Centers for Disease Control and Prevention (CDC). The views expressed in this material do not necessarily reflect the official policies of the CDC; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.
Success story: funding year 1
Arizona's interactive tool to map lead exposure risk
Challenge
Arizona uses a targeted screening approach to identify children who are at risk for lead exposure. The Arizona Childhood Lead Poisoning Prevention Program (AZ CLPPP) has traditionally targeted high-risk zip codes to focus blood lead testing efforts. However, risk can vary greatly from one neighborhood to the next within a single zip code. Therefore, a tool was needed to help families and providers assess a child's risk, and to provide a better and more representative recommendation based on a child's neighborhood rather than the zip code.
Intervention
The AZ CLPPP collaborated with the Arizona Environmental Public Health Tracking Program to develop an interactive, web-based neighborhood-level mapping tool. To help identify high-risk zip codes, that tool was implemented statewide in the 2018 Targeted Lead Screening Plan, effective January 1, 2018. The interactive map allows users to enter an address and receive screening recommendations for children living in that neighborhood. The mapping tool is compatible with smart phones for easy access.
Impact
The tool empowers parents and allows them to be more informed and engaged in their child's healthcare needs. The tool has been used over 3,500 times to provide screening recommendations since it went live January 1, 2018.
Funding for this work was made possible in part by EH14-1408 from the Centers for Disease Control and Prevention (CDC). The views expressed in this material do not necessarily reflect the official policies of the CDC; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.