At a glance
CDC supports Tennessee 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 Tennessee received $515,000 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 these efforts in Tennessee, contact the program below.
Tennessee Department of Health
State Childhood Lead Poisoning Prevention Program
710 James Robertson Pkwy
64 Andrew Johnson Tower
Nashville, TN 37243
Phone: (615) 532-8462
Note:
Success story: funding year 3
Tennessee publishes childhood lead poisoning public facing data dashboard
Challenge
Prior to July 2023, the Tennessee Childhood Lead Poisoning Prevention Program (TN CLPPP) shared data with the public by periodically publishing factsheets and responding to requests. Fulfilling these requests was labor-intensive and required an approval process each time prior to information dissemination. In recent years, childhood lead poisoning has gained more attention from both the public and the program's internal and external partners. So, comprehensive access to timely lead surveillance data has become more important. A public facing dashboard emerged as the top choice for the program to meet the ever-growing lead data needs.
Intervention
In January 2022, a multi-disciplinary team of TN CLPPP staff began developing a public facing dashboard in Tableau to meet the ever-growing lead data needs. Tableau is a digital application for data visualization. The dashboard home page displays a map detailing childhood lead poisoning testing data by county for the most complete calendar year. Four key performance indicators are listed:
- Number of children tested for blood lead
- Number of initial cases exceeding the blood lead reference value (BLRV)
- Number of confirmed cases exceeding the BLRV
- Rate of children exceeding the BLRV
Additional data pages include
- Statewide and county-level monthly testing rate trends
- Statewide and county-level yearly and quarterly blood lead levels (BLL) rates and trends above CDC's BLRV
- Testing and higher BLL age distributions and trends
- County and regional rankings for testing rates
- Confirmed higher BLL rates
- Loss to follow-up rates for children with an initial capillary BLL above CDC's BLRV
The dashboard was published on July 6, 2023.
Impact
First, the availability of the public facing dashboard reduces both the volume of data requests the program receives and the time staff members needed to respond to them. For example, inquiries from Davidson and Hamilton Counties have been satisfied through a referral to the data dashboard. Secondly—and perhaps more significantly—the dashboard allows for much more timely and efficient dissemination of data.
Furthermore, the interactive features of the dashboard allow users to customize their own data analysis. TN CLPPP is aggressively promoting the dashboard among partners and anticipates improved external engagement on current trends in lead testing and exposure throughout Tennessee because of this easily accessed, customizable, and interactive tool.
Funding for this work was made possible in part by 1 NUE2EH001434-01-00 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
Using vital records matching to reduce missing demographic data in Tennessee
Challenge
Historically, the Tennessee Childhood Lead Poisoning Prevention Program (TN CLPPP) has had difficulty identifying race-based disparities in lead testing and blood lead level rates due to high percentages of children missing race information in the surveillance database, LeadTRK. Race was missing for 72% of the 498,145 Tennessee children younger than age 6 who received a blood lead test from January 1, 2015–September 30, 2022. From 2019–2021, about 39% and 87% of all submitted results for children younger than age 6 listed race as "unknown" for provider-submitted LeadCare II results and laboratory-submitted results, respectively. High levels of missing race data made it difficult to identify discrepancies in lead exposure burden and testing access along racial lines. Reducing missing race data would provide valuable insight into existing barriers to health equity and allow the program to formulate strategies to overcome them.
Intervention
The TN CLPPP epidemiologist matched records in LeadTRK with birth file records accessed through the Tennessee Office of Vital Records for 2009–2021 to populate the race variable. Comparing race data from birth file and LeadTRK among 110,060 matched records with known LeadTRK race indicated the following discrepancies in the race variable: 6% for White, 4% for African American/Black, 1% for Asian, 0.5% for American Indian/Alaska Native, and 0.7% for Native Hawaiian/Pacific Islander. TN CLPPP decided to replace race information in LeadTRK with data from the birth file for all successfully matched records, based on the belief that race information in the birth file is more accurate than that reported by providers and laboratories.
From 2015–September 30, 2022, a total of 379,029 (76%) children were successfully linked to a birth file record. Among these children, 268,969 (71%) had unknown race in LeadTRK. After matching, 89,065 children had unknown race in LeadTRK, which accounted for only 18% of all children during 2015–2022.
Impact
By populating the LeadTRK race field with the values from the birth file records, TN CLPPP was able to reduce the number of children with an "Unknown" race value by 75%. This resulted in a significant improvement in data completion and will allow TN CLPPP to analyze racial disparities in exposure burden and access to testing. Going forward, TN CLPPP will perform quarterly data matches to maintain the integrity of LeadTRK race data for newly tested children. TN CLPPP anticipates that this new procedure will create exciting new opportunities for focused outreach and efficient resource allocation to populations who are at higher risk throughout the state.
Funding for this work was made possible in part by 1 NUE2EH001434-01-00 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
Establishing a referral system to early intervention services in Tennessee
Challenge
Traditionally, the Tennessee Childhood Lead Poisoning Prevention Program (TN CLPPP) nurse case managers only contacted the primary care providers of children with elevated blood lead levels (BLLs) greater than or equal to 5μ/dL to provide CDC recommended guidelines for follow up blood lead testing. However, they did not have direct contact with early intervention services. Furthermore, TN CLPPP staff were unaware that a child with an elevated BLL greater than or equal to 10μg/dL met the diagnostic criteria for infants and toddlers to be enrolled in the Department of Education's Tennessee Early Intervention System (TEIS), as mandated in Part C of the Individuals with Disabilities Education Act (IDEA). Since 2013, an average of 244 children per year under the age of three had elevated BLLs greater than or equal to 10μg/dL in Tennessee. Children with elevated BLLs may have had limited access to specialized resources, such as early intervention services due to underreporting.
Intervention
TN CLPPP worked with TEIS to develop a protocol for nurse case managers to refer children with confirmatory blood lead tests greater than or equal to 10 μg/dL to TEIS and establish a data exchange procedure that ensures staff from both programs can adequately fulfill and receive each data request.
Through this exchange, TN CLPPP compiles quarterly lists of referrals and submits them to TEIS. Based on the results of the child's developmental assessment and medical records, TEIS determines if the child is eligible to receive early intervention services through TEIS. Eligible families have the option to enroll their child in the voluntary TEIS program up to the age of three.
Impact
From September 30, 2018, to August 31, 2019, TN CLPPP submitted nine monthly TEIS referral lists, including referrals for 48 children that met diagnostic criteria for early intervention services. Since this collaboration, TEIS staff are more knowledgeable about childhood lead exposure and its toxic effects, and TN CLPPP has established a formal partnership with TEIS to continue referring children.
Funding for this work was made possible in part by the Cooperative Agreement Number [NUE2EH001385] 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.