Douglas County, Nebraska, is home to a large immigrant and refugee population whose children are at an increased risk of lead poisoning due to using unregulated imported spices. In 2021, 78% of elevated blood lead levels in children under 7 years old living in Douglas County were of Hispanic, Asian, or African origin. In 2021, lead in spices was identified as the second leading cause of lead poisoning in Douglas County, accounting for 19% of exposure sources. The Douglas County Health Department (DCHD) has been testing spices for lead since 2016 to determine lead exposure in underserved populations with the cultural use of imported spices. At that time, we also began to build partnerships with refugee/immigrant-serving community agencies to increase awareness about the potential presence of lead in regularly consumed spices. Methods used included education in homes of people directly affected by lead poisoning, staff serving these populations, and clinicians screening children.

In 2022, we collaborated with the University of Nebraska - Omaha to further improve the community's awareness as part of a chemistry service-learning project. Chemistry students tested a variety of spices bought from local specialty and big box stores to evaluate the lead levels present. Sixty-four students presented their results in a public forum, where community members were invited. This project received attention from the media and highlighted the findings and the need for improved regulations regarding the manufacturing/processing of spices for human consumption. This presentation will also identify the types of spices from 2018-2022 that were more often associated with high lead levels, both imported and locally obtained, that DCHD tested. Promising outreach strategies, including multi-sectoral collaborations, will also be discussed, as well as the impact of the pandemic on our efforts.

Many young children spend a majority of their waking hours consuming water, formula, and food from tap water at over 634,000 U.S. child care facilities. Nevertheless, most U.S. facilities have still not tested for lead at each tap. In North Carolina, we analyzed lead levels at 25,119 drinking and food preparation taps in 4,558 child care facilities via a grant-funded, participatory science testing program. Facilities received online training on how to properly enroll, collect, and ship water samples for subsequent laboratory analysis via EPA Method 200.8 with a 0.1 part per billion (ppb) detection limit. Mitigation was recommended or required at taps above 1 ppb and 10 ppb, respectively. Multiple logistic regression analysis and machine-learned Bayesian network modeling was conducted to analyze risk factors.

We identified lead above the 1 ppb American Academy of Pediatrics’ reference level and above 10 ppb in 25% and 3% of samples, respectively. One or more taps exceeded 1 ppb and 10 ppb at 56% and 12% of facilities, respectively. There was large variability in lead levels between tap water sources within the same facility. Well water reliance was the largest risk factor, followed by Head Start programs and building age. Overall, we found that tap water is commonly a potential lead exposure source in U.S. child care facilities. To address the disproportionate impacts that childhood lead exposure has, especially in underserved communities and communities of color, testing should prioritize facilities with known risk factors, along with facilities with more than 50% non-white and/or free/reduced lunch students. Scientifically rigorous child care water testing programs paired with comprehensive water infrastructure improvements could eliminate early childhood exposure to lead in tap water and further advance school readiness, social emotional development, lifetime potential, and a healthier future.

Background

Adverse childhood experiences (ACEs) are of great public health interest in the United States. Despite theoretical and empirical data indicating that children with ACE exposures are more likely to suffer from negative developmental outcomes, there is growing interest in protective factors that promote successful adaptation despite the early exposure to the hardships. To date, such research has mainly focused on individual-level characteristics with limited exploration of family- and community-level influences on outcomes for ACE-exposed children. To address this gap in research, this study aimed to identify environmental predictors of child and family resilience in children who had ACEs.

Methods

Data were drawn from the 2019 National Survey of Children’s Health (NSCH). Parental reports of child flourishing and family resilience measures were used to create a categorical outcome variable with four different types of child and family resilience: neither child flourishing nor family resilience, child flourishing only, family resilience only, both child flourishing and family resilience. Multinomial logistic regression was performed to identify environmental factors of child and family resilience among children who had ACEs, after controlling for cumulative ACEs exposures.

Results

The results indicate that 47.3% were classified as both child flourishing and family resilience; 28.2% were family resilience only group, 14.0% were neither child flourishing nor family resilience, and 10.5% were child flourishing only group. School safety, supportive neighborhood, and access to health care were positively associated with the resilience status. Conversely, male, other race/ethnicity, older age, parenting stress, and 3 and 4 or more ACEs exposures were negatively associated with the resilience status.

Conclusions

Children and families can thrive despite adversity with appropriate access to healthcare, managing parenting stress, and safe school and neighborhood environments. Promotion of healthy development among children with ACEs will benefit from multi-level prevention and intervention strategies that address all contexts in which children function.

Background:

Since 2010, the number of major power outages across the United States has increased. Evidence suggests outages affecting 50,000+ people increase the risk of carbon monoxide (CO) poisoning, particularly among children. However, studies have not examined the association of smaller, localized, but more frequent outages with CO poisoning. We address this gap by leveraging a multi-year power outage database with fine geospatial resolution and children’s emergency department visits in New York State.

Methods:

We used a case-crossover study design, obtaining hourly outage data from January 2017 to December 2020 from the New York Department of Public Service. We identified CO poisoning cases of children <18 years from the New York Statewide Planning and Research Cooperative System (SPARCS). The block group of each patient’s residence was linked the power operating locality (POL, a sub-county unit; n = 1,865). The number of outage-hours occurring over 48 hours (case day and day prior) represented the exposure. To differentiate across levels of outage severity, we defined an outage-hour as ≥10% (least severe), ≥20%, and ≥50% (most severe) of customers within the POL without power. We employed non-linear conditional logistic regression models, controlling for block group-level daily precipitation and minimum temperature using North American Land Data Assimilation System data.

Results: We identified 917 pediatric emergency department visits for CO poisoning. The majority occurred in the winter (37%) and fall (29%). The visits were significantly associated with outage exposure at the 10% threshold (OR=1.09, 95% CI: 1.06-1.12), at the 20% threshold (OR=1.17, 95% CI: 1.08-1.26), and at the 50% threshold (OR = 1.21, 95%: 1.06-1.38).

Conclusion: Smaller-scale outages represent a risk for CO poisoning in children. Even at the least severe threshold, for each outage-hour, children have a nine percent increase in their odds of an emergency department visit for CO poisoning.

Statement of Problem: Per- and polyfluoroalkyl substances (PFAS) are chemicals that are widely used in consumer goods and some industries. This has led to PFAS being found in drinking water throughout the US and risking children's health. Many public health professionals and health care providers do not have the knowledge necessary to address this environmental health risk to protect their pediatric populations.

Approach: Using the 2022 National Academies of Sciences, Engineering and Medicine (NASEM), Guidance on PFAS Exposure, Testing, and Clinical Follow-Up, a 6-part webinar series was offered using the Project ECHO framework. The sessions were: what is PFAS, decision making in uncertainty, potential health effects of PFAS, PFAS exposure assessment, exposure reduction, and using the NASEM recommendations to improve public health.

Product/Outcome: The dyadic education and interactive learning of Project ECHO created an engaged online community that enhanced “all teach, all learn” pedagogy. Participants were from across the US and represented a variety of health professions. There was consistent attendance by participants of the ECHO sessions and participants reported increased learning regarding PFAS risk and satisfaction with the online learning format.

Implications: The Project ECHO model enhanced health professionals’ knowledge to address the public health threat of PFAS. This model could be used for other new and emerging environmental health threats to children.