Snohomish County, Washington

About the program

Snohomish County received $387,645 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.

To learn more about these efforts in Snohomish County, contact the program below.

Snohomish Health District

Children and Youth with Special Health Care Needs

3021 Rucker Ave

Everett, WA 98201

Phone: 425-339-8652

Success story: funding year 3

Engaging with the Snohomish County community to inform lead prevention education

Challenge

Much of the potential exposure to lead in Snohomish County, Washington, comes from the large number of homes built before the 1978 ban of lead in residential paint and the Everett Asarco Smelter Site, an area of land contaminated by a former metal smelter. Though local lead exposure risks are common, in 2019, only about 3.5% of children younger than 6 years old were tested for lead. In 2022, the Snohomish County Health Department (SCHD) performed a baseline community survey to assess knowledge, attitudes, practices, and barriers to childhood lead poisoning prevention in the county. Because non-Hispanic Black children and those who fall below the federal poverty line are disproportionately affected by lead poisoning, the survey prioritized regions of the county that have a higher percentage of these populations. The majority (90%) of respondents were from low-income communities. The survey found that about

• 76% of respondents reported little to no knowledge about lead and children;
• 66% of respondents did not have any knowledge of lead sources in Snohomish County; and
• 33% of respondents said a lack of general awareness among parents is a barrier to protecting children from lead exposure and/or to getting them tested.

This information showed Snohomish County needed educational interventions tailored to priority populations.

Intervention

The SCHD team used a participatory design framework to engage with several community partners to create educational messages for the community and address the low childhood blood lead testing rates. The team shared the survey results and used feedback on design and content from partners to share lead poisoning prevention information in an attractive, easy-to-read pamphlet known as a zine. The zine used wording and language tailored to families with young children who live in locations that are high risk. The zine was finalized and translated into 10 languages including Spanish, Russian, Vietnamese, Arabic, Korean, Dari, Marshallese, Ukrainian, Pashto, and Amharic. Partners who participated in designing the intervention work with childcare providers and licensors, schools, families in the smelter site region, and families with low income. They included

• Everett Housing Authority and Housing Authority of Snohomish County
• Washington State Department of Children, Youth, and Families
• University of Washington Pediatric Environmental Health Specialty Unit
• Washington State Department of Health Choose Safe Places Program and Water Infrastructure Improvement for the Nation
• Washington State Department of Ecology

Impact

Engaging with partners resulted in the creation of an educational intervention for both parents/guardians and community organizations that serve them. Additionally, this collaboration strengthened relationships with partners. Dissemination began with 258 English copies and 34 copies in other languages distributed at health fairs, neighborhood association meetings, childcare sites, community presentations, and through partners between July and September of 2023. It has also been approved to be used by 7 clinic locations with large percentages of patients with incomes below the poverty level and who are non-White. The zine continues to be well received.

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

Establishing a Snohomish County childhood lead poisoning prevention program collaborative

Challenge

Snohomish County is the third most populous county in Washington state with more than 840,000 residents. A smelter site operated in the county from 1894 to 1912 that resulted in lead-contaminated soil which was first identified in 1990. When compared with the general population of Snohomish County, a disproportionate number of children who are minorities, children whose caregiver speaks a language other than English, and children who are eligible for Medicaid have been identified as having higher blood lead levels (BLLs). In 2019, Snohomish County's childhood blood lead testing rate of children younger than 6 years old was 3.4%. The Snohomish County Health Department (SHD) wanted to increase the number of children identified as high risk and get them tested so they can be connected to services.

Intervention

As one of the first steps to reduce BLL inequities, the Snohomish County Childhood Lead Poisoning Prevention Program (CLPPP) invited 15 agencies or groups involved in lead poisoning prevention to participate in a collaborative to identify common goals and improve system linkages. Key program partners include state level agencies such as the Washington State Department of Health (DOH) and the Washington State Department of Ecology; local organizations like local housing authorities, childcare service agencies, and community health centers; and the regional Pediatric Environmental Health Specialty Unit (PEHSU).

The inaugural meeting occurred in March 2022 with 23 individuals from nine agencies in attendance, representing all the major sectors. Although many of these agencies had been working to reduce the burden of lead poisoning, they may not have been working together. Three meetings were held in 2022, and four are scheduled for 2023.

Impact

Each agency shared how they are involved in childhood lead poisoning prevention and offered ideas on how to collaborate. As a direct result of this collaboration, agencies found ways to

• Share materials, which saves efforts of having to create new resources
• Impart knowledge through discussions and presentations
• Identify additional children they serve (e.g., in child care settings, in low-income housing, within the Everett Smelter Site area) who are at higher risk to receive targeted educational campaigns to promote blood lead testing. The goal is for community-level interventions to result in an increase in requests for testing with a statistically significant increase in testing rates as a long-term outcome.
• Develop new partnership activities such as these:
  • DOH and SHD held joint public educational events with soil testing for childcare facilities and families.
  • The housing authority assisted SHD in surveying low-income housing residents to assess lead knowledge. Department of Ecology helped get surveys to smelter plume residents.
  • DOH and SHD are working together to create a training for childcare providers.
  • SHD, DOH, and PEHSU are developing a state-wide training for healthcare providers.

These meetings will continue at least quarterly with additional partners joining the collaborative as they are identified. Agencies will continue to have opportunities to share data and brainstorm ways in which groups can work together to reach the common goal of lowering the number of children adversely affected by lead poisoning in Snohomish County.

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 the CDC; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.