Lead is a global health hazard and reducing environmental exposures to lead is becoming increasingly important as negative health impacts are documented at lower levels of exposure. Soils, an important source of lead exposure in children, represent a largely untested reservoir of accumulated past and present lead contamination retained in the surface. Concentrations of soil lead are very spatially heterogeneous, however, and testing is required to identify whether site-specific soils present a hazard. In this dissertation I outline the several ways to increase testing and awareness about soil-lead contamination to provide individuals with the information needed to prevent exposure to soil lead. Chapter one presents a new field procedure for use by the general public to screen soils for hazardous levels of lead that is based on determining bioaccessible lead. Chapter two describes the delineation of soil-lead hotspots in four mining-impacted towns in Peru and reveals that parents using the field procedure identified a hotspot missed by previous testing. In this study, we find child blood lead information is associated with parent cleanliness, which may represent a pathway for child exposure to dust and soil lead, although no associations are seen directly with soil lead concentrations. In chapter three, Peruvian high school students use the field procedure in their science classes to identify hotspots of soil lead and share this information with their community. Finally, chapter four highlights that extremely elevated concentrations of soil lead are not limited to far-off mining communities but are also present locally in New York City. Soil core data collected does not reveal a single source or blanket atmospheric inputs, but rather highlights the variability of deposition that requires widespread testing.

Indiana University-Purdue University Indianapolis (IUPUI) / Children are at increased risk for harmful lead exposure due to their behavior and the increased percentage of lead absorption. While lead levels and the possible adverse health effects vary by age and level absorbed, the medical field agrees that lead is a persistent public health issue of the first order. Importantly, Hoosier children are at an increased risk for possible negative side effects because of the small percentage of children who are being tested; despite the AAP’s recommendation. The Health Belief Model (HBM) provided a strong and appropriate framework for guiding this formative research about parents’ perceptions of blood lead testing. This study aimed to answer two research questions based on HBM concepts and utilized both quantitative and qualitative methods to help answer them. Using snowball and convenience sampling, 14 Hoosier parents were recruited to participate in this study during the spring of 2020. Parents were recruitment from four counties across the state with known high rates of lead and/or low rates of blood lead testing among babies and small children. The findings from this study yield broad suggestions for future work within the field of communication research and specific suggestions for applied communication campaign research and clinical interventions within the state of Indiana. This study suggests we still have a long way to go as a state in addressing the dangers of lead toxicity and increasing regular testing among Hoosier children.

A lack of consistent, evidence-based practices for blood lead testing of children existed in a local public health department (LHD). No known blood lead level is safe, and toxicity can result in behavioral and cognitive impairments. The purpose of this project was to develop and analyze a clinical practice guideline to establish blood lead testing procedures in the LHD to improve testing procedures and enhance future testing within the jurisdiction. The RE-AIM framework was used to address the reach, effectiveness, adoption, implementation, and maintenance of the clinical practice guideline. Five experts evaluated the guideline using the Appraisal of Guidelines for Research and Evaluation instrument. The assessment results indicated 96.4% agreement across all domains. The experts agreed unanimously to recommend adoption of the clinical practice guideline. Implementation of the guideline might advance nursing practice and patient care in the LHD through incorporation of evidence-based practices. Implementation might also lead to early identification of lead-burdened children and may provide the opportunity for treatment to mitigate cognitive and behavioral deficits related to lead toxicity, thereby improving child health and decreasing related health care costs. Engagement of the clinical practice guideline will support positive social change through the empowerment of public health nurses to provide optimal care to a population of children at risk of deleterious and long-term side effects of lead exposure.