Building Community Capacity: Minority and Immigrant Populations : Minority and Immigrant Populations [1 ed.] 9781620810323, 9781620810224

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Copyright © 2012. Nova Science Publishers, Incorporated. All rights reserved. Caron, Rosemary M., and Joav Merrick. Building Community Capacity: Minority and Immigrant Populations : Minority and Immigrant Populations, Nova

Copyright © 2012. Nova Science Publishers, Incorporated. All rights reserved. Caron, Rosemary M., and Joav Merrick. Building Community Capacity: Minority and Immigrant Populations : Minority and Immigrant Populations,

HEALTH AND HUMAN DEVELOPMENT

BUILDING COMMUNITY CAPACITY

Copyright © 2012. Nova Science Publishers, Incorporated. All rights reserved.

MINORITY AND IMMIGRANT POPULATIONS

No part of this digital document may be reproduced, stored in a retrieval system or transmitted in any form or by any means. The publisher has taken reasonable care in the preparation of this digital document, but makes no expressed or implied warranty of any kind and assumes no responsibility for any errors or omissions. No liability is assumed for incidental or consequential damages in connection with or arising out of information contained herein. This digital document is sold with the clear understanding that the publisher is not engaged in rendering legal, medical or any other professional services. Caron, Rosemary M., and Joav Merrick. Building Community Capacity: Minority and Immigrant Populations : Minority and Immigrant Populations,

HEALTH AND HUMAN DEVELOPMENT JOAV MERRICK - SERIES EDITOR – NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT, ISRAEL

Adolescent Behavior Research: International Perspectives Joav Merrick and Hatim A. Omar (Editors) 2007. ISBN: 1-60021-649-8 Complementary Medicine Systems: Comparison and Integration Karl W. Kratky (Editor) 2008. ISBN: 978-1-60456-475-4

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Pain in Children and Youth Patricia Schofield and Joav Merrick (Editors) 2008. ISBN: 978-1-60456-951-3 Challenges in Adolescent Health: An Australian Perspective David Bennett, Susan Towns and Elizabeth Elliott (Editors) 2009. ISBN: 978-1-60741-616-6 Health and Happiness from Meaningful Work: Research in Quality of Working Life Soren Ventegodt and Joav Merrick (Editors) 2009. ISBN: 978-1-60692-820-2

Living on the Edge: The Mythical, Spiritual, and Philosophical Roots of Social Marginality Joseph Goodbread (Editors) 2009. ISBN: 978-1-60741-162-8 Alcohol-Related Cognitive Disorders: Research and Clinical Perspectives Leo Sher and Joav Merrick (Editors) 2009. ISBN: 978-1-60741-730-9 Children and Pain Patricia Schofield and Joav Merrick (Editors) 2009. ISBN: 978-1-60876-020-6 Conceptualizing Behavior in Health and Social Research: A Practical Guide to Data Analysis Said Shahtahmasebi and Damon Berridge (Editors) 2010. ISBN: 978-1-60876-383-2 Chance Action and Therapy: The Playful Way of Changing Uri Wernik (Editor) 2010. ISBN: 78-1-60876-393-1

Obesity and Adolescence: A Public Health Concern Hatim A Omar, Donald E. Greydanus, Dilip R. Patel and Joav Merrick (Editors) 2009. ISBN: 978-1-60692-821-9

Adolescence and Chronic Illness. A Public Health Concern Hatim Omar, Donald E. Greydanus and Dilip R. Patel (Editors) 2010. ISBN: 978-1-60876-628-4

Poverty and Children: A Public Health Concern Alexis Lieberman and Joav Merrick (Editors) 2009. ISBN: 978-1-60741-140-6

Pediatric and Adolescent Sexuality and Gynecology: Principles for the Primary Care Clinician Hatim A Omar, Artemis K. Tsitsika and Joav Merrick (Editors) 2010. ISBN: 978-1-60876-735-9

Caron, Rosemary M., and Joav Merrick. Building Community Capacity: Minority and Immigrant Populations : Minority and Immigrant Populations,

Bone and Brain Metastases: Advances in Research and Treatment Arjun Sahgal, Edward Chow and Joav Merrick (Editors) 2010. ISBN: 978-1-61668-365-8

International Aspects of Child Abuse and Neglect Howard Dubowitz and Joav Merrick (Editors) 2011. ISBN: 978-1-60876-703-8

International Aspects of Child Abuse and Neglect Howard Dubowitz and Joav Merrick 2010. ISBN: 978-1-61122-049-0

Positive Youth Development: Evaluation and Future Directions in a Chinese Context Daniel T. L. Shek, Hing Keung Ma and Joav Merrick (Editors) 2011. ISBN: 978-1-60876-830-1

Human Development: Biology from a Holistic Point of View Søren Ventegodt and Tyge Dahl Hermansen (Editors) 2011. ISBN: 978-1-61470-441-6

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Social and Cultural Psychiatry Experience from the Caribbean Region Hari D. Maharajh and Joav Merrick (Editors) 2011. ISBN: 978-1-61668-506-5 Environment, Mood Disorders and Suicide Teodor T. Postolache and Joav Merrick (Editors) 2011. ISBN: 978-1-61668-505-8 Behavioral Pediatrics, 3rd Edition Donald E. Greydanus, Dilip R. Patel, Helen D. Pratt and Joseph (Editors) 2011. ISBN: 978-1-60692-702-1 Rural Child Health: International Aspects Erica Bell and Joav Merrick (Editors) 2011. ISBN: 978-1-60876-357-3 Advances in Environmental Health Effects of Toxigenic Mold and Mycotoxins Ebere Cyril Anyanwu (Editor) 2011. ISBN: 978-1-60741-953-2

Understanding Eating Disorders: Integrating Culture, Psychology and Biology Yael Latzer, Joav Merrick and Daniel Stein (Editors) 2011. ISBN: 978-1-61728-298-0 Alternative Medicine Yearbook 2009 Joav Merrick (Editor) 2011. ISBN: 978-1-61668-910-0 Advanced Cancer, Pain and Quality of Life Edward Chow and Joav Merrick (Editors) 2011. ISBN: 978-1-61668-207-1 Positive Youth Development: Implementation of a Youth Program in a Chinese Context Daniel T .L Shek, Hing Keung Ma and Joav Merrick (Editors) 2011. ISBN: 978-1-61668-230-9 Living on the Edge: The Mythical, Spiritual, and Philosophical Roots of Social Marginality Joseph Goodbread (Editor) 2011. ISBN: 978-1-61122-986-8 Public Health Yearbook 2009 Joav Merrick (Editor) 2011. ISBN: 978-1-61668-911-7

Caron, Rosemary M., and Joav Merrick. Building Community Capacity: Minority and Immigrant Populations : Minority and Immigrant Populations,

Child Health and Human Development Yearbook 2009 Joav Merrick (Editor) 2011. ISBN: 978-1-61668-912-4s Narratives and Meanings of Migration Julia Mirsky 2011. ISBN: 978-1-61761-103-2 Self-Management and the Health Care Consumer Peter William Harvey 2011. ISBN: 978-1-61761-796-6 Sexology from a Holistic Point of View Soren Ventegodt and Joav Merrick 2011. ISBN: 978-1-61761-859-8

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Principles of Holistic Psychiatry: A Textbook on Holistic Medicine for Mental Disorders Soren Ventegodt and Joav Merrick 2011. ISBN: 978-1-61761-940-3 Clinical Aspects of Psychopharmacology in Childhood and Adolescence Donald E. Greydanus, Joseph L. Calles Jr., Dilip P. Patel, Ahsan Nazeer and Joav Merrick (Editors) 2011. ISBN: 978-1-61122-135-0 Climate Change and Rural Child Health Erica Bell, Bastian M. Seidel and Joav Merrick (Editors) 2011. ISBN: 978-1-61122-640-9 Rural Medical Education: Practical Strategies Erica Bell, Craig Zimitat and Joav Merrick (Editors) 2011. ISBN: 978-1-61122-649-2

The Dance of Sleeping and Eating among Adolescents: Normal and Pathological Perspectives Yael Latzer and Orna Tzischinsky (Editors) 2011. ISBN: 978-1-61209-710-7 Child and Adolescent Health Yearbook 2010 Joav Merrick (Editors) 2011. ISBN: 978-1-61209-788-6 Drug Abuse in Hong Kong: Development and Evaluation of a Prevention Program Daniel TL Shek, Rachel CF Sun and Joav Merrick (Editors) 2011. ISBN: 978-1-61324-491-3 Understanding Eating Disorders: Integrating Culture, Psychology and Biology Yael Latzer, Joav Merrick and Daniel Stein (Editors) 2011. ISBN: 978-1-61470-976-3s Positive Youth Development: Evaluation and Future Directions in a Chinese Context Daniel T. L. Shek, Hing Keung Ma and Joav Merrick (Editors) 2011. ISBN: 978-1-62100-175-1 Child and Adolescent Health Yearbook 2009 Joav Merrick (Editor) 2012. ISBN: 978-1-61668-913-1 Chance Action and Therapy: The Playful Way of Changing Uri Wernik 2012. ISBN: 978-1-61122-987-5

Caron, Rosemary M., and Joav Merrick. Building Community Capacity: Minority and Immigrant Populations : Minority and Immigrant Populations,

Child Health and Human Development Yearbook 2010 Joav Merrick (Editor) 2012. ISBN: 978-1-61209-789-3 Public Health Yearbook 2010 Joav Merrick (Editor) 2012. ISBN: 978-1-61209-971-2 The Astonishing Brain and Holistic Consciousness: Neuroscience and Vedanta Perspectives Vinod D. Deshmukh 2012. ISBN: 978-1-61324-295-7

Translational Research for Primary Healthcare Erica Bell, Gert P. Westert and Joav Merrick (Editors) 2012. ISBN: 978-1-61324-647-4

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Treatment and Recovery of Eating Disorders Daniel Stein (Editor) 2012. ISBN: 978-1-61470-259-7 Randomized Clinical Trials and Placebo: Can You Trust the Drugs are Working and Safe? Søren Ventegodt and Joav Merrick 2012. ISBN: 978-1-61470-067-8

Building Community Capacity: Minority and Immigrant Populations Rosemary M Caron and Joav Merrick (Editors) 2012. ISBN: 978-1-62081-022-4 Human Immunodeficiency Virus (HIV) Research: Social Science Aspects Hugh Klein and Joav Merrick (Editors) 2012. ISBN: 978-1-62081-293-8 Applied Public Health: Examining Multifaceted Social or Ecological Problems and Child Maltreatment John R. Lutzker and Joav Merrick (Editors) 2012. ISBN: 978-1-62081-356-0 AIDS and Tuberculosis: Public Health Aspects Daniel Chemtob and Joav Merrick (Editors) 2012. ISBN: 978-1-62081-382-9 Public Health Yearbook 2011 Joav Merrick (Editor) 2012. ISBN: 978-1-62081-433-8 Alternative Medicine Research Yearbook 2011 Joav Merrick (Editor) 2012. ISBN: 978-1-62081-476-5

Our Search for Meaning in Life: Quality of Life Philosophy Soren Ventegodt and Joav Merrick 2012. ISBN: 978-1-61470-494-2 Alternative Medicine Yearbook 2010 Joav Merrick (Editor) 2012. ISBN: 978-1-62100-132-4

Caron, Rosemary M., and Joav Merrick. Building Community Capacity: Minority and Immigrant Populations : Minority and Immigrant Populations,

Copyright © 2012. Nova Science Publishers, Incorporated. All rights reserved. Caron, Rosemary M., and Joav Merrick. Building Community Capacity: Minority and Immigrant Populations : Minority and Immigrant Populations,

HEALTH AND HUMAN DEVELOPMENT

BUILDING COMMUNITY CAPACITY MINORITY AND IMMIGRANT POPULATIONS

ROSEMARY M CARON Copyright © 2012. Nova Science Publishers, Incorporated. All rights reserved.

AND

JOAV MERRICK EDITORS

Nova Science Publishers, Inc. New York Caron, Rosemary M., and Joav Merrick. Building Community Capacity: Minority and Immigrant Populations : Minority and Immigrant Populations,

Copyright © 2012 by Nova Science Publishers, Inc. All rights reserved. No part of this book may be reproduced, stored in a retrieval system or transmitted in any form or by any means: electronic, electrostatic, magnetic, tape, mechanical photocopying, recording or otherwise without the written permission of the Publisher. For permission to use material from this book please contact us: Telephone 631-231-7269; Fax 631-231-8175 Web Site: http://www.novapublishers.com NOTICE TO THE READER The Publisher has taken reasonable care in the preparation of this book, but makes no expressed or implied warranty of any kind and assumes no responsibility for any errors or omissions. No liability is assumed for incidental or consequential damages in connection with or arising out of information contained in this book. The Publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or reliance upon, this material. Any parts of this book based on government reports are so indicated and copyright is claimed for those parts to the extent applicable to compilations of such works.

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Independent verification should be sought for any data, advice or recommendations contained in this book. In addition, no responsibility is assumed by the publisher for any injury and/or damage to persons or property arising from any methods, products, instructions, ideas or otherwise contained in this publication. This publication is designed to provide accurate and authoritative information with regard to the subject matter covered herein. It is sold with the clear understanding that the Publisher is not engaged in rendering legal or any other professional services. If legal or any other expert assistance is required, the services of a competent person should be sought. FROM A DECLARATION OF PARTICIPANTS JOINTLY ADOPTED BY A COMMITTEE OF THE AMERICAN BAR ASSOCIATION AND A COMMITTEE OF PUBLISHERS. Additional color graphics may be available in the e-book version of this book.

Library of Congress Cataloging-in-Publication Data Building community capacity: minority and immigrant populations/editors, Rosemary M Caron and Joav Merrick. p. cm. Includes index. ISBN: H%RRN 1. Health promotion. 2. Health policy. 3. Health education. 4. Preventive health services. 5. Community development. I. Caron, Rosemary M. II. Merrick, Joav, 1950RA427.8B85 2011 362.1--dc23 2012002176

Published by Nova Science Publishers, Inc. † New York Caron, Rosemary M., and Joav Merrick. Building Community Capacity: Minority and Immigrant Populations : Minority and Immigrant Populations,

Contents Foreword Chapter I

xiii Lessons learned in building community capacity: Minority and immigrant populations Rosemary M Caron and Joav Merrick

1

Public Health Aspects of Minority and Immigrant Populations Chapter II

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Chapter III

Chapter IV

Chapter V

Chapter VI

Chapter VII

Policy and community partnerships as public health management tools for childhood lead poisoning Rosemary M Caron and Jessica D Ulrich Developmental delay in children with blood lead levels between 5 and 9 µg/dl Edmond A Hooker, Marilyn Goldfeder, Jeff Armada, Monica Burns, Nicholas Lander and Aaron Senich

5

23

Environmental public health education partnerships: Successes and challenges Mary O Dereski and Lisa Pietrantoni

29

Tribal capacity building as a complex adaptive system: New insights, new lessons learned Michelle Chino

43

Against the current: Strategies for addressing public health concerns in a Native American community through partnership Joy Doll, Linda Ohri, Teresa Cochran, Caroline Goulet, Ann Ryan Haddad and Wehnona Stabler Issues to consider when adapting evidence-based physical activity interventions with and within racial/ethnic minority communities Elizabeth A Baker, Freda Motton and E Yvonne Lewis

Caron, Rosemary M., and Joav Merrick. Building Community Capacity: Minority and Immigrant Populations : Minority and Immigrant Populations,

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x Chapter VIII

Chapter IX

Chapter X

Chapter XI

Chapter XII

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Chapter XIII

Chapter XIV

Chapter XV

Chapter XVI

Contents Promoting youth physical activity and health career awareness in an African-American faith community Judy B Springer, Jeffrey A Morzinski and Melissa DeNomie The relationship between diabetes, obesity and iris markings in African-Americans in Montgomery County, Alabama Peggy Valentine, Jiangmin Xu, Tatiana Jones, Hermon Laila Haile, Myrtle Goore, Jane Smolnik and Marceline Egnin Lessons learned from adaptation and evaluation of home visitation services for Latino communities Arthur H Owora, Jane F Silovsky, Lana O Beasley, Patty DeMoraes-Huffine and Ivelisse Cruz Lessons learned from the protección en construcción (PenC) community research partnership Linda Sprague Martinez, Uchenna J Ndulue and Maria J Brunette Roles of Hispanic service organizations in tuberculosis education and health promotion Sue Gena Lurie, Stephen E Weis and Guadalupe Munguia Project salud: Using community-based participatory research to culturally adapt an HIV prevention intervention in the Latino migrant worker community Jesús Sánchez, Claudia A Serna and Mario de La Rosa Strategies for facilitating the recruitment of Latinas in cancer prevention research Monica Rosales, Patricia Gonzalez and Evelinn Borrayo Success of “Promotores de Salud” in identifying immigrant Latino smokers and developing quit plans Natalia Suarez, Lisa Sanderson Cox, Kimber Richter, Irazema Mendoza, Cielo Fernández, Susan Garrett, Isabel Scarinci, Edward F Ellerbeck and A Paula Cupertino About the editors

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Chapter XVII About the Department of Health Management and Policy, College of Health and Human Services, University of New Hampshire, USA

175

Chapter XVIII About the National Institute of Child Health and Human Development in Israel

177

Caron, Rosemary M., and Joav Merrick. Building Community Capacity: Minority and Immigrant Populations : Minority and Immigrant Populations,

Contents Chapter XIX

About the book series “Health and human development”

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Index

Caron, Rosemary M., and Joav Merrick. Building Community Capacity: Minority and Immigrant Populations : Minority and Immigrant Populations,

xi 181 185

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Foreword “It takes a village” and “When you’ve seen one health department, you’ve seen one health department.” Two clichés often used when describing public health at the local level. Public health is an interesting discipline, and how one defines public health and the practice of public health is usually skewed by his/her view of what lies before them. I believe that local public health is where the rubber meets the road. Success is earned by understanding the unique needs of populations and neighborhoods and by devising strategies that are complementary to those needs. Every community is different, every neighborhood is different, and no one public health agency can do it alone. If marked improvements in health are to be made in any community, it does take a village. The City of Manchester, New Hampshire is the largest New England city north of Boston. An old industrial town, it was once home to Amoskeag Industries, the largest textile manufacturing complex in the world. Manchester has a rich history of welcoming immigrants, most of whom worked in the Amoskeag mills. Whether from Canada, Ireland, Greece or Germany, thousands flocked to Manchester during the turn of the last century in search of a better life for themselves and their families. Today, the textile mills have closed, replaced by high technology companies, law offices and educational institutions. However, Manchester still welcomes immigrants and refugees and, as it did over one hundred years ago, strives to assure that they have the chance to achieve optimal health. This book, Building Community Capacity: Minority and Immigrant Populations, coedited by Rosemary Caron and Joav Merrick, builds upon the concepts mentioned above. If public health efforts are to be successful, they must be carried out at the community level, they must understand and incorporate the unique needs of the population they are serving, and they must be inclusive. Contained in the chapters of this book is example after example of how to build community capacity by engaging populations and sub-populations around the health issues that are important to them. Then and only then will you have demonstrated success in improving the health of those you serve. Timothy M Soucy, MPH, REHS Public Health Director Manchester Health Department Manchester, New Hampshire E-mail: [email protected]

Caron, Rosemary M., and Joav Merrick. Building Community Capacity: Minority and Immigrant Populations : Minority and Immigrant Populations,

Copyright © 2012. Nova Science Publishers, Incorporated. All rights reserved. Caron, Rosemary M., and Joav Merrick. Building Community Capacity: Minority and Immigrant Populations : Minority and Immigrant Populations,

In: Building Community Capacity Editors: Rosemary M Caron and Joav Merrick

ISBN: 978-1-62081-022-4 © 2012 Nova Science Publishers, Inc.

Chapter I

Lessons learned in building community capacity: Minority and immigrant populations Rosemary M Caron, PhD, MPH1, and Joav Merrick, MD, MMedSc, DMSc2,3,4,5

Copyright © 2012. Nova Science Publishers, Incorporated. All rights reserved.

1

Department of Health Management and Policy, College of Health and Human Services, University of New Hampshire, Durham, New Hampshire, US 2 National Institute of Child Health and Human Development, Jerusalem, Israel 3 Division of Pediatrics, Hadassah Hebrew University Medical Centers, Mt. Scopus Campus, Jerusalem, Israel 4 Office of the Medical Director, Health Services, Division for Intellectual and Developmental Disabilities, Ministry of Social Affairs and Social Services, Jerusalem, Israel 5 Kentucky Children’s Hospital, University of Kentucky, Lexington, US

Advances in science, innovations in business, technological development in the last century and the continued rapid pace of change in these areas have created an environment in the world today in the twenty-first century that knows few boundaries. Health care is a field that has been enhanced and able to expand as a result of progress in these diverse yet integrated areas. However, for all of the improvement that new drugs, health care re-organization and focused delivery, and accessible electronic medical records, for example, can afford to many of the “haves” in society, there still remains a significant segment of the population in the industrialized world, and certainly in developing countries, who comprise



Correspondence: Rosemary M Caron, PhD, MPH, University of New Hampshire, College of Health and Human Services, Department of Health Management and Policy, #319 Hewitt Hall, 4 Library Way, Durham, New Hampshire, United States. E-mail: [email protected].

Caron, Rosemary M., and Joav Merrick. Building Community Capacity: Minority and Immigrant Populations : Minority and Immigrant Populations,

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2

Rosemary M. Caron and Joav Merrick

the “have nots” and who do not benefit from this progress. This disparity in health among populations across the globe has existed for decades despite our advances in health care. The inequality of access to affordable, quality health care is experienced by many populations on a daily basis, yet we have witnessed an increase in the life expectancy of many populations of industrialized countries this past century, primarily due to advances in public health practice. If we are living longer today than ever before, what is the quality of that life? What health issues are we experiencing? How does where we live impact our health? How are those health issues being addressed? What interventions are being implemented and how are they being evaluated? For all of our advances in health care and achievements in public health that have contributed to an increased life expectancy, there still remain persistent problems in one’s community that are public health in origin. These persistent public health problems are well studied from an academic standpoint, yet they evade a solution that is practical, economical, and socially just. These are complex, community-based, public health problems that disproportionally impact minority and immigrant populations. Often, the stakeholders that comprise the public health system hold opposing views on not only whether there is a public health problem in the community, but who “owns” or is responsible for addressing this problem. Furthermore, those community residents are often not invited to join the discussion and be a part of the solution. This book explores this topic in greater detail. Specifically, what have we, as public health academicians and practitioners, learned when partnering with minority and immigrant community members to help them address persistent public health issues that affect them and their families on a daily basis? These are lessons that need to be shared so disadvantaged populations can build their capacity to address and solve persistent public health problems in their communities. Every segment of the population, regardless of where they live, deserves to enjoy the health care and public health advances of the last century and the rapid improvements currently occurring. It is our hope that these lessons will help to decrease the global prevalence of health disparities that are grounded in complex public health issues.

Caron, Rosemary M., and Joav Merrick. Building Community Capacity: Minority and Immigrant Populations : Minority and Immigrant Populations,

Copyright © 2012. Nova Science Publishers, Incorporated. All rights reserved.

Public Health Aspects of Minority and Immigrant Populations

Caron, Rosemary M., and Joav Merrick. Building Community Capacity: Minority and Immigrant Populations : Minority and Immigrant Populations,

Copyright © 2012. Nova Science Publishers, Incorporated. All rights reserved. Caron, Rosemary M., and Joav Merrick. Building Community Capacity: Minority and Immigrant Populations : Minority and Immigrant Populations,

In: Building Community Capacity Editors: Rosemary M Caron and Joav Merrick

ISBN: 978-1-62081-022-4 © 2012 Nova Science Publishers, Inc.

Chapter II

Policy and community partnerships as public health management tools for childhood lead poisoning Rosemary M Caron and Jessica D Ulrich Department of Health Management and Policy, College of Health and Human Services and Department of Sociology, College of Liberal Arts, University of New Hampshire, Durham, New Hampshire, US

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Abstract The gradual decline in childhood lead poisoning in the United States is widely regarded as a public health accomplishment. Yet, a significant number of children under the age of six years in the United States continue to be poisoned by lead paint each year. New England residents face a greater risk of lead poisoning due to the area’s older housing stock containing lead paint. Primary prevention methods that eliminate the potential risk for disease or disability have focused on addressing housing as the main source of lead exposure. However, primary prevention methods with respect to housing, such as lead abatement, although cost effective in the long term, are often prohibitively expensive in the short term. We highlight health policy and academic-community partnerships as two potential complementary tools to assist in the management of this persistent, complex public health issue that affects numerous, diverse communities across the country. The former tool may integrate educational policy, housing policy, and occupational policy to achieve protection of a vulnerable population. The latter tool calls upon the knowledge, expertise, and resources of academic and community partners to develop interventions that are tailored to the community’s identified needs. Previous work and issues for consideration regarding each of these approaches is presented. Furthermore, although the public health management tools described are based in work conducted in New England,



Correspondence: Rosemary M Caron, PhD, MPH, University of New Hampshire, College of Health and Human Services, Department of Health Management and Policy, #319 Hewitt Hall, Durham, New Hampshire, USA. E-mail: [email protected].

Caron, Rosemary M., and Joav Merrick. Building Community Capacity: Minority and Immigrant Populations : Minority and Immigrant Populations,

6

Rosemary M Caron and Jessica D Ulrich we propose that they can serve as models for other communities who are working to address childhood lead poisoning, especially in a time of budget and resource constraints.

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Introduction The environmental causes, toxic neurocognitive and physiological effects, and clinical management of lead poisoning have been well documented in the peer-reviewed literature (13). Briefly, lead poisoning dates back to the time of the Romans (and some believe earlier), who documented its effects (4). The discovery of lead poisoning in children was first identified over a century ago in 1892, in Australia (5). It was not until 1914, that the first case of childhood lead poisoning was diagnosed in the United States in Baltimore, Maryland by Thomas and Blackfan (6). The primary sources of lead poisoning in the United States are from past uses of lead including dust and paint chips from deteriorating lead-based paint used on the interior and exterior of older housing stock; dust and soil that contain lead from gasoline and paint; folk remedies and products imported from countries without regulation on the use of lead-based paint (7, 8). The clinical identification of lead poisoning in children, as a result of the abovementioned exposures, can be challenging since the signs and symptoms can be non-specific and may include gastrointestinal effects, growth retardation, and neurological issues (2). Yet, young children are extremely susceptible to the effects of lead due to their low body weight, hand-to-mouth activity, developmental stage, and in many cases, their iron deficiency and poor nutritional status (9, 10). Epidemiologic studies have found that children’s intellectual functioning decreases at low blood lead concentrations, thus prompting the Centers for Disease Control and Prevention (CDC) to repeatedly lower its action level of concern. The CDC’s current screening guidelines for lead exposure in children is ten micrograms of lead per deciliter of blood (10µg/dl) (9). Bellinger (2004) states that this screening guideline “is a risk management tool and should not be interpreted as a threshold for toxicity. No threshold has been identified, and some data are consistent with effects well below 10.”

Source of exposure - housing Regardless of the public health advances associated with removing lead from gasoline, household paint, food canning, industrial emissions and drinking water, exposure to lead is a persistent environmental hazard for children in many regions of the United States (9, 10). Sargent et al. (1999) stated “Despite these gains, hazards to children from exposure to lead paint in older, deteriorating housing continues to be a problem, especially in the Northeast and the Midwest.” Most elevated blood lead levels (EBLLs) in children are a result of exposure to deteriorating lead-based paint in older housing. Children in New Hampshire, as in other areas of the Northeast, are at particular risk for lead poisoning due to this region’s prevalence of older housing (12). New Hampshire has some of the oldest housing stock in the nation. For example, approximately 77 percent of housing units in the state’s largest city, Manchester, were built prior to the 1978 federal ban on lead paint, and in some areas the quality of the housing stock is extremely poor (13, 14).

Caron, Rosemary M., and Joav Merrick. Building Community Capacity: Minority and Immigrant Populations : Minority and Immigrant Populations,

Policy and community partnerships as public health management tools ...

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Primary prevention An estimated 2.2% (434,000) children, ages one to five years, in the United States have an EBLL (15). Yet, childhood lead poisoning prevention in the United States is regarded by many local health departments and federal health agencies, including the CDC and Environmental Protection Agency, as a public health success story (16, 17). Jacobs, Kelly, and Sobolewski (18) state that “Although this progress is substantial, it should be tempered by the realization that it took nearly a century to develop the necessary infrastructure to begin to solve the problem, and that far too many children will be poisoned unnecessarily by lead in the coming years unless additional action is taken.” Needleman argues that this additional action should be in the form of primary prevention, which involves acting before harm occurs in a population (1, 14). Many efforts in primary prevention have focused on addressing the major source of lead exposure for many—housing—via establishing, implementing, and evaluating housing policy that reduces or eliminates children’s lead exposure. Much work in this area has been conducted in New England due to its historical use of lead paint and older housing stock. Several articles have studied the relationship between socio-demographic and housing characteristics and housing policies on childhood lead poisoning. Sargent et al. (19) examined childhood lead poisoning data in urban, suburban, and rural communities in Massachusetts. The authors found childhood lead poisoning cases in all types of communities but concluded that “those children living in communities with high rates of poverty, single-parent families, and pre-1950s housing and low rates of home ownership were seven to ten times more likely to have lead poisoning.” Based on this work, the authors “suggest that legislative efforts requiring abatement of lead-based paint directed toward pre-1950s houses that are not owner occupied would confer the greatest benefit to children in terms of lead poisoning prevention.” Sargent et al. (11) also examined the effectiveness of household lead abatement policies in Massachusetts and Rhode Island in reducing childhood lead exposure. The authors’ findings were that the policy in Massachusetts, which places the liability for childhood lead poisoning on property owners and requires the abatement of lead in children’s homes, was effective in reducing cases of childhood lead poisoning in the state compared to Rhode Island, which lacked a similar policy (11). Additional work in this area by Brown et al. (20), examined the effectiveness of housing policies in reducing children’s lead exposure in two Northeastern states. The authors found that the enforcement of housing policies can mitigate repeated lead exposure from housing units (20). Lead abatement, a form of primary prevention, from at-risk housing units has been demonstrated to lower the risk of childhood lead exposure (11, 14-16). Although lead abatement programs are quite costly, the benefits are estimated to outweigh the costs. For example, “the cost of lead hazard control was estimated to be $253 million, but the benefits were estimated to be $1.1 billion” in subsidized housing in the United States (18). Needleman (14) stated “that the reduction of exposure yields huge economic as well as health benefits are strong warrants for a systematic program of abatement of lead from the single remaining major source: lead in older homes.” The expense of this primary prevention method may result in reducing and potentially eliminating this persistent public health problem.

Caron, Rosemary M., and Joav Merrick. Building Community Capacity: Minority and Immigrant Populations : Minority and Immigrant Populations,

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Rosemary M Caron and Jessica D Ulrich

New England: health policy to prevent childhood lead poisoning As a region with a disproportionate amount of its population at risk of exposure to lead poisoning, New England is an important place to examine health policies with the goal of reducing lead exposure (11, 12). In this section, we outline national and state policies aimed at the primary prevention of childhood lead poisoning (see Table 1). On top of those required at the national level, each state has additional policies that vary in focus and requirements. New England states also have policies in place considered secondary or tertiary prevention strategies such as screening children for lead poisoning, conducting property inspections, or introducing safety standards for children’s products. Thus, unlike primary prevention strategies, these strategies do not actively try to prevent lead poisoning from occurring, rather they address the problem after realizing its existence.

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National primary prevention policy In 1992, Congress passed the Residential Lead-Based Paint Hazard Reduction Act (also known as Title X). Although lead-based paint legislation has existed since the 1970s, Title X represents the first national policy aimed at preventing lead-based paint hazards. Recognizing the need for a comprehensive strategy aimed at reducing exposure to lead, and in particular, preventing childhood lead poisoning, this law directed the Environmental Protection Agency (EPA) and the Department of Housing and Urban Development (HUD) to require disclosure of information concerning lead upon the transfer of residential property. As required by Title X, the EPA and HUD jointly issued the Lead Based Disclosure Rule (or Lead Safe Housing Rule) in 1996. This rule ensured that renters and buyers would have the proper information about lead hazards in their housing unit before agreeing to purchase or rent pre-1978 housing. In 2008, the EPA issued the Repair, Renovation, and Painting Rule (RRP). This rule acknowledged the risks associated with common renovation activities (e.g., sanding, cutting, demolition) in exposing children and adults to hazardous lead dust and chips. The RRP Rule requires that paid renovation work be done by EPA certified renovators in pre-1978 housing, childcare facilities, and schools. Notably missing from federal policy are rules and regulations aimed at addressing lead exposure in public or commercial buildings.

Primary prevention policies in New England states Connecticut - In 1992, the state of Connecticut enacted the Lead Poisoning and Prevention Control Regulations giving increased authority and power to the state and local health authorities to enforce investigation and abatement standards. For instance, these regulations require that residential units with children under the age of six that contain toxic levels of lead be properly abated. Connecticut also requires licensing and certification for lead abatement

Caron, Rosemary M., and Joav Merrick. Building Community Capacity: Minority and Immigrant Populations : Minority and Immigrant Populations,

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Policy and community partnerships as public health management tools ...

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contractors and lead activities professionals, in order to ensure that the removal of lead from homes is completed effectively and safely. Maine - The Act to Ensure Safe Abatement of Lead Hazards was enacted in Maine in 1997, to ensure the safe and permanent removal of lead hazards in residential buildings and child-occupied facilities. The act requires that the state’s Department of Environmental Protection adopt more stringent procedures and requirements for the certification and licensing of people engaged in lead-based activities. Additionally, in order to increase state resources dedicated to the primary prevention of lead poisoning, in 2009, the Maine State Legislature established the Lead Poisoning Prevention Fund, which requires that paint manufacturers pay $0.25 for every gallon of paint that they sell in the state. Massachusetts - The Commonwealth of Massachusetts enacted one of the nation’s first state laws geared toward the primary prevention of lead poisoning in 1971. The Massachusetts Lead Law requires that property owners update housing units to be lead-safe when children under the age of six reside in the unit. Since 1971, a number of updates to the law—including, upgrading requirements regarding the training and licensing of contractors, expanding the number of units in compliance by providing financial assistance for owners, and universal blood lead screening—have made the Massachusetts Lead Law an effective tool at preventing childhood lead poisoning. New Hampshire - The state of New Hampshire enacted the Lead Paint Poisoning and Prevention and Control Act in 1993. This law requires that all lead inspectors and abatement professionals be certified or licensed, that any laboratory performing blood lead analysis report the test results to the Childhood Lead Poisoning Prevention Program (CLPPP), and that requires that the CLPPP investigate all cases of lead poisoning in children under the age of six whose venous blood lead level is =20µg/dl. Rhode Island - In 1993, Rhode Island enacted the Air Pollution Control Regulation No. 24. Although only setting forth standards for the removal of lead-based paint from exterior surfaces, these regulations were a step forward for the state in primary prevention. In effect since 2005, the Lead Hazard Mitigation Law is an effort to give all Rhode Islanders access to housing that is uncontaminated by lead. This law requires that property owners of units built before 1978 meet a number of requirements including taking lead awareness classes, fixing lead hazards on their rental properties, and getting their properties regularly inspected. Vermont - Vermont enacted the Lead Law in 1996, to prevent childhood lead poisoning in rental housing and childcare facilities. The Vermont Lead Law requires that sellers disclose lead information and provide state-approved educational materials when conducting real estate transactions for all pre-1978 housing. It also requires that owners of residential rental units built before 1978 perform or have performed “Essential Maintenance Practices” (EMPs). EMPS are approved work safety practices conducted by trained persons who aim to safely remove lead hazards from residential units and childcare facilities. With the exception of the Massachusetts Lead Law enacted in 1971, the majority of New England states implemented primary prevention policies during the 1990s, around the same time national policies were coming into effect. Today, most policies in New England focus on the disclosure of lead information for housing units, the proper certification and training of people working with lead-based paint, and the abatement of lead-based paint in housing units with children under the age of six. Although progress has been made in lowering the incidence of childhood lead poisoning in New England, more comprehensive strategies such as universal abatement could alleviate this public health issue altogether.

Caron, Rosemary M., and Joav Merrick. Building Community Capacity: Minority and Immigrant Populations : Minority and Immigrant Populations,

Table 1. National and New England Policies on Primary Prevention of Childhood Lead Poisoning Policy/Law

Goal/Aim

Requirements

Implemented

Lead-Based Disclosure Rule (or the Lead Safe Housing Rule)

Ensure that potential tenants and homebuyers have adequate information necessary to protect themselves and their families from lead-based paint hazards prior to their purchase or rental of pre-1978 housing. Reduce the risk of lead poisoning in common renovation activities in pre-1978 housing, childcare facilities, and schools. Prevention of lead poisoning by giving increased authority and power to the state and local health authorities to enforce investigation and abatement standards.

Landlords, property managers, real estate agents, and sellers must inform potential lessees and purchasers of the presence of lead-based paint and lead-based paint hazards in pre-1978 housing. (www.epa.gov; www.hud.gov)

1996

Requires that paid renovation work be done by EPA certified renovators in pre-1978 housing, childcare facilities, and schools. (www.epa.gov) Requires the proper abatement of defective interior and exterior surfaces that contain toxic levels of lead in residential dwellings with children