Rural-Urban Blood Lead Differences in North Carolina Children

Objective. To examine the prevalence of and risk factors for having a blood lead elevation among young children in a predominantly rural state. Methods. 20 720 North Carolina children at least 6 months and <6 years of age were screened between November 1, 1992 and April 30, 1993 using either capillary or venous measurements of blood lead. Children were tested through routine screening programs that target low-income families and, hence, were not randomly selected. Eighty-one percent of the children were screened through local public health departments, and 19% were tested at private clinics. Results. The estimated prevalences of having an elevated blood lead level among those tested were: 20.2% (≥10 µg/dL), 3.2% (≥15 µg/dL), and 1.1% (≥20 µdL). Black children were at substantially increased risk of having a blood lead ≥15 µ/dL (odds ratio (OR) 2.1, 95% confidence interval (CI) 1.7 to 2.5). Children aged 2 years old had an elevated risk (OR = 1.4, 95% CI 1.1 to 1.7) compared to 1-year-olds, and males were at slightly increased risk (OR = 1.2, 95% CI = 1.0 to 14). Living in a rural county was nearly as strong a risk factor as race (OR = 1.9, 95% CI = 1.6 to 24). The effect of rural residence was even greater among certain subgroups of children already at highest risk of having an elevated blood lead. The type of clinic (public vs private) where a child was screened was not associated with blood lead outcome. These same trends were seen for children with blood lead levels ≥20 µ/dL. Conclusions. Among children screened from rural communities, the prevalence of elevated blood lead is surprisingly high. Though few physicians have embraced universal lead screening, these data support the need for greater awareness of lead exposure in children living outside of inner-cities.

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Predictors of Chronic Opioid Use: A Population-level Analysis of North Carolina Cancer Survivors Using Multi-Payer Claims

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djab082 ◽

2021 ◽

Author(s):

Devon K Check ◽

Christopher D Bagett ◽

KyungSu Kim ◽

Andrew W Roberts ◽

Megan C Roberts ◽

...

Keyword(s):

North Carolina ◽

Substance Use ◽

Cancer Survivors ◽

Low Income ◽

Opioid Therapy ◽

Adjusted Relative Risk ◽

Opioid Use ◽

Chronic Opioid Therapy ◽

Increased Risk ◽

Chronic Opioid Use

Abstract Background No population-based studies have examined chronic opioid use among cancer survivors who are diverse with respect to diagnosis, age group, and insurance status. Methods We conducted a retrospective cohort study using North Carolina (NC) cancer registry data linked with claims from public and private insurance (2006–2016). We included adults with non-metastatic cancer who had no prior chronic opioid use (N = 38,366). We used modified Poisson regression to assess the adjusted relative risk of chronic opioid use in survivorship (>90-day continuous supply of opioids in the 13–24 months following diagnosis) associated with patient characteristics. Results Only 3.0% of cancer survivors in our cohort used opioids chronically in survivorship. Predictors included younger age (adjusted risk ratio [aRR], 50–59 vs 60–69 = 1.23, 95% confidence interval [CI] = 1.05–1.43), baseline depression (aRR = 1.22, 95% CI = 1.06–1.41) or substance use (aRR = 1.43, 95% CI = 1.15–1.78) and Medicaid (aRR vs Private = 1.93, 95% CI = 1.56–2.40). Survivors who used opioids intermittently (vs not at all) before diagnosis were twice as likely to use opioids chronically in early survivorship (aRR = 2.62, 95% CI = 2.28–3.02). Those who used opioids chronically (vs intermittently or not at all) during active treatment had a nearly 17-fold increased likelihood of chronic use in survivorship (aRR = 16.65, 95 CI = 14.30–19.40). Conclusions Younger and low-income survivors, those with baseline depression or substance use, and those who require chronic opioid therapy during treatment are at increased risk for chronic opioid use in survivorship. Our findings point to opportunities improve assessment of psychosocial histories and to engage patients in shared decision-making around long-term pain management, when chronic opioid therapy is required during treatment.

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Increased Risk of Sub-Clinical Blood Lead Levels in the 20-County Metro Atlanta, Georgia Area—A Laboratory Surveillance-Based Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18105163 ◽

2021 ◽

Vol 18 (10) ◽

pp. 5163

Author(s):

Carmen M. Dickinson-Copeland ◽

Lilly Cheng Immergluck ◽

Maria Britez ◽

Fengxia Yan ◽

Ruijin Geng ◽

...

Keyword(s):

At Risk ◽

Geographical Area ◽

Central Area ◽

Blood Lead ◽

Blood Lead Levels ◽

Children At Risk ◽

Multilevel Regression ◽

Screening Programs ◽

Increased Risk ◽

Lead Levels

Lead (Pb) is a naturally occurring, highly toxic metal that has adverse effects on children across a range of exposure levels. Limited screening programs leave many children at risk for chronic low-level lead exposure and there is little understanding of what factors may be used to identify children at risk. We characterize the distribution of blood lead levels (BLLs) in children aged 0–72 months and their associations with sociodemographic and area-level variables. Data from the Georgia Department of Public Health’s Healthy Homes for Lead Prevention Program surveillance database was used to describe the distribution of BLLs in children living in the metro Atlanta area from 2010 to 2018. Residential addresses were geocoded, and “Hotspot” analyses were performed to determine if BLLs were spatially clustered. Multilevel regression models were used to identify factors associated with clinical BBLs (≥5 µg/dL) and sub-clinical BLLs (2 to <5 µg/dL). From 2010 to 2018, geographically defined hotspots for both clinical and sub-clinical BLLs diffused from the city-central area of Atlanta into suburban areas. Multilevel regression analysis revealed non-Medicaid insurance, the proportion of renters in a given geographical area, and proportion of individuals with a GED/high school diploma as predictors that distinguish children with BLLs 2 to <5 µg/dL from those with lower (<2 µg/dL) or higher (≥5 µg/dL) BLLs. Over half of the study children had BLLs between 2 and 5 µg/dL, a range that does not currently trigger public health measures but that could result in adverse developmental outcomes if ignored.

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Question Regarding Need for Treatment

PEDIATRICS ◽

10.1542/peds.56.4.621b ◽

1975 ◽

Vol 56 (4) ◽

pp. 621-622

Author(s):

Arthur W. Kaemmer ◽

Byron R. Johnson

Keyword(s):

Mass Screening ◽

Lead Poisoning ◽

Blood Lead ◽

Blood Lead Levels ◽

Elevated Blood ◽

Screening Programs ◽

Environmental Lead ◽

Need For Treatment ◽

Lead Levels ◽

Elevated Blood Lead Levels

Dr. Greensher and his colleagues are to be congratulated for bringing to the readers' attention a most unusual source of lead poisoning. Inasmuch as many localities are initiating city-wide lead screening programs, it is obvious that pediatricians in this country will be seeing many children with abnormally elevated blood lead levels, and in many cases diligent efforts such as this will have to be undertaken to determine the exact source of the environmental lead. biggest problems with mass screening programs for lead poisoning are well outlined by Moriarty's article.2

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Blood Lead Screening Practices Among US Pediatricians

PEDIATRICS ◽

10.1542/peds.98.3.372 ◽

1996 ◽

Vol 98 (3) ◽

pp. 372-377

Author(s):

James R. Campbell ◽

Stanley J. Schaffer ◽

Peter G. Szilagyi ◽

Karen G. O'Connor ◽

Peter Briss ◽

...

Keyword(s):

Primary Care ◽

Blood Lead Level ◽

Lead Level ◽

Blood Lead ◽

Blood Lead Levels ◽

Elevated Blood ◽

Control And Prevention ◽

Lead Levels ◽

Primary Care Pediatricians ◽

Elevated Blood Lead Levels

Objectives. In 1991, the Centers for Disease Control and Prevention (CDC) decreased the blood lead level of concern to 10 µg/dL (0.48 µmol/L) and recommended universal screening. Because these guidelines continue to provoke controversy, we conducted a study to:1) estimate the proportion of pediatricians who are members of the American Academy of Pediatrics (AAP) who report screening for elevated blood lead levels; 2) describe their clinical practices regarding screening for elevated blood lead levels; 3) compare attitudes of universal screeners, selective screeners, and nonscreeners; and 4) identify characteristics of pediatricians who universally screen. Design. Confidential, cross-sectional survey of a nationally representative random sample of 1610 pediatricians conducted through the AAP Periodic Survey. Subjects. The study included 1035 responders (64% response rate). Analysis was limited to the 734 pediatricians who provide well-child care (ie, primary-care pediatricians). Results. Fifty-three percent of pediatricians reported screening all their patients aged 9 to 36 months, 39% reported screening some, and 8% reported screening none. Among those who screen, 96% use a blood lead assay. The primary risk factors for which selective screeners screen are: history of pica (94%); living in an older home with recent renovations (92%); living in an older home with peeling paint (93%); and having a sibling who had an elevated blood lead level (88%). Among primary-care pediatricians, 73% agree that blood lead levels ≥10 µg/dL should be considered elevated, and 16% disagree. However, 89% of primary-care pediatricians believe that epidemiologic studies should be performed to determine which communities have high proportions of children with elevated blood lead levels, and 34% of primary-care pediatricians believe that the costs of screening exceed the benefits. Conclusions. Three years after the Centers for Disease Control and Prevention issued new guidelines for the management of elevated blood lead levels, a slight majority of primary-care pediatricians in the United States who are members of the AAP report that they universally screen their appropriately aged patients, while most of the remaining pediatricians report screening high-risk patients. Many pediatricians may want additional guidance about circumstances under which selective screening should be considered.

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Assessment of Using Heat Pumps for Heating in Mobile Homes: A Case Study from North Carolina

Journal of Green Building ◽

10.3992/jgb.4.3.135 ◽

2009 ◽

Vol 4 (3) ◽

pp. 135-142

Author(s):

Hussein Abaza

Keyword(s):

North Carolina ◽

Thermal Comfort ◽

Low Income ◽

Field Measurements ◽

Heating System ◽

Heat Pumps ◽

Mobile Homes ◽

Indoor Thermal Comfort ◽

The North ◽

Low Income Families

This paper presents the results of “Upgrade and Save”, a program to upgrade the standard electric furnaces and air-conditioning units in Mobile Homes for energy-efficient heat pumps. This program is implemented in North Carolina, USA and pays about $700 through a rebate provided by the North Carolina State Energy Office to the Mobile Homes' owners. The goal of this project is to subsidize low-income families by lowering their heating cost in the winter as well as improving their homes' indoor thermal comfort. More than 300 mobile homes have participated in this program. Field measurements, meter readings of the actual electrical consumption, and annual building energy simulation were used to measure the dollar saving and the indoor thermal comfort improvement in the mobile homes after the heating system upgrade. This research proved that the dollar saving of using the heat pump for heating in mobile homes ranges from $51 to $128 annually.

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Chronic renal disease among lead-exposed workers

Occupational and Environmental Medicine ◽

10.1136/oemed-2019-106363 ◽

2020 ◽

Vol 77 (6) ◽

pp. 415-417 ◽

Cited By ~ 1

Author(s):

Kyle Steenland ◽

Vaughn Barry

Keyword(s):

Renal Disease ◽

Cox Regression ◽

Chronic Renal Disease ◽

Lead Level ◽

Blood Lead ◽

Positive Trend ◽

High Exposure ◽

Increased Risk ◽

Average Maximum

BackgroundVery high exposure to inorganic lead causes serious kidney damage. We have studied workers with occupational exposure and data on blood lead.MethodsWe extended follow-up for 7 more years, for a previously studied cohort of 58 307 male workers who were part of a surveillance programme in 11 different states. Mortality was assessed using the National Death Index, and end-stage renal disease (ESRD) incidence was assessed using the US Renal Data System. We conducted internal analyses via Cox regression adjusting for age, calendar time and race.ResultsThe cohort was followed for a median of 18 years and had 524 cases of ESRD and 6527 deaths. Average maximum blood lead was 26 µg/dL; the mean year of first blood lead test was 1997. No trends by lead level were seen overall or when restricting to those with 15+ years follow-up. Among non-Caucasians with >15 years of follow-up, there was a positive but inconsistent trend (Rate ratios (RRs) 1.00, 2.10, 1.33, 2.20 and 2.76 for maximum blood lead categories of <20 µg/dL, 20–29 µg/dL, 30 to <40 µg/dL, 40 to ≤50 µg/dL and >50 µg/dL, respectively (p for linear trend 0.26). Those with >15 years of follow-up and birth year <1941 showed a positive trend with increased blood lead (RRs 1.00, 1.14, 1.18, 1.46, 1.66, p trend=0.26).ConclusionsWe found no association between higher lead exposure and ESRD. There were positive but not statistically significant trends of increased risk for non-Caucasians with >15 years of follow-up and for older men with >15 years of follow-up.

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Should Children With Constipation Undergo Blood Lead Level Screening?

Clinical Pediatrics ◽

10.1177/0009922819832029 ◽

2019 ◽

Vol 58 (6) ◽

pp. 627-632

Author(s):

Vikram Kalathur Raghu ◽

Andrew J. Nowalk ◽

Arvind I. Srinath

Keyword(s):

Confidence Interval ◽

Disease Control ◽

Odds Ratio ◽

Blood Lead Level ◽

Lead Level ◽

Blood Lead ◽

Routine Screening ◽

Elevated Blood ◽

Population Prevalence ◽

Control And Prevention

This study aimed to compare the prevalence of elevated blood lead level in children with constipation to the population prevalence. We reviewed the charts of 441 children who were screened with a blood lead level on presenting to the gastroenterology clinic at UPMC Children’s Hospital of Pittsburgh for evaluation of constipation. The prevalence of blood lead level greater than 5 µg/dL was 1.36% (6/441; 95% confidence interval = 1.23% to 1.49%), which is significantly lower than the 4.01% prevalence in the population reported by the Center for Disease Control and Prevention. No patients had a blood lead level greater than 10 µg/dL. Age under 5 years old showed an increased odds of lead level greater than 5 µg/dL (odds ratio = 7.5; 95% confidence interval = 1.2 to 47.3, P < .05). We concluded that children seen in the gastroenterology clinic for constipation are unlikely to have an elevated blood lead level on routine screening.

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Blood lead levels in North Carolina painters

Human & Experimental Toxicology ◽

10.1177/096032719501400512 ◽

1995 ◽

Vol 14 (5) ◽

pp. 456-461 ◽

Cited By ~ 1

Author(s):

Fanny K Ennever ◽

Daniel J Zaccaro ◽

Reshan A Fernando ◽

Bradley T Jones

Keyword(s):

North Carolina ◽

Geometric Mean ◽

Lead Level ◽

Blood Lead ◽

Blood Lead Levels ◽

Personal Protection ◽

Statistical Association ◽

Work History ◽

Lead Levels ◽

Paint Removal

1 Blood lead levels were examined in 127 housepainters in North Carolina between April and September, 1993. Each participant filled out a questionnaire and gave a blood sample. The questionnaire covered the individual's work history, concentrating on paint-removal activities and personal protection, and also covered potential non- occupational sources of lead exposure. Blood samples were analysed for lead content using atomic absorption spectroscopy. 2 The geometric mean blood lead level was 0.33 μmol L-1 (6.8 jg dL-1). No blood lead samples were found to exceed the occupational standard of 1.93 μmol L-1 (40 μg dL-1). The three highest samples had levels between 0.97 and 1.45 μmol L-1 (20 and 30 μg dL-1); this represented 2.4% of the study sample. 3 No statistical association was found between blood lead levels in these painters and their painting activities, including using dust masks for personal protection. 4 Current painting practices in this group of North Carolina painters do not appear to elevate blood lead lev els above the occupational standard.

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Teacher Mobility, School Segregation, and Pay-Based Policies to Level the Playing Field

Education Finance and Policy ◽

10.1162/edfp_a_00040 ◽

2011 ◽

Vol 6 (3) ◽

pp. 399-438 ◽

Cited By ~ 47

Author(s):

Charles T. Clotfelter ◽

Helen F. Ladd ◽

Jacob L. Vigdor

Keyword(s):

North Carolina ◽

Minority Students ◽

Teacher Quality ◽

Low Income ◽

Teaching Profession ◽

Teacher Mobility ◽

School Segregation ◽

Playing Field ◽

Retaining Teachers ◽

Low Income Families

Research has consistently shown that teacher quality is distributed very unevenly among schools, to the clear disadvantage of minority students and those from low-income families. Using North Carolina data on the length of time individual teachers remain in their schools, we examine the potential for using salary differentials to overcome this pattern. We conclude that salary differentials are a far less effective tool for retaining teachers with strong preservice qualifications than for retaining other teachers in schools with high proportions of minority students. Consequently large salary differences would be needed to level the playing field when schools are segregated. This conclusion reflects our finding that teachers with stronger qualifications are both more responsive to the racial and socioeconomic mix of a school's students and less responsive to salary than are their less-qualified counterparts when making decisions about remaining in their current school, moving to another school or district, or leaving the teaching profession.

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