Studying Lead to Safeguard Communities

Lead exposure is a risk to any human, but children are most vulnerable to the element’s neurotoxicity. It can contribute to a variety of health problems, including developmental delays and cardiovascular and renal disease later in adulthood. Although nationwide, the number of young children with elevated blood lead levels is declining, there are still areas with high numbers.

For instance, Lancaster County, which is just outside Philadelphia, has the fourth-highest rate of childhood lead poisoning in Pennsylvania according to the Centers for Disease Control and Prevention. One contributing factor is that the majority of houses in the area were built before lead-based paint was banned in 1978. Another factor is the lack of knowledge about the sources and effects of lead.

Since 2017, Harriet Okatch, PhD, a public health researcher and associate professor in the College of Population Health, has partnered with the community in Lancaster and others globally to increase awareness about lead exposure and lead poisoning. In her role as a member and founding co-chair of the Lead-Free Promise Project, she also works to secure funding for lead remediation and early screenings for children before age 2. In this conversation, Dr. Okatch discusses her research and advocacy work to prevent and mitigate lead exposure. 

In the United States, 500,000 children age 6 years or less have an elevated blood lead level. This is important because exposure to lead has significant negative health impacts across the life course. Lead exposure can lead to delays in reaching developmental milestones in children, lower IQ and poor educational attainment. In adolescence, childhood lead exposure is associated with school suspensions, higher dropout rates and juvenile delinquency. In adulthood, childhood lead exposure is associated with lower productivity, cardiovascular and renal disease. Recent research suggests that lead exposure in geriatric populations is associated with neurological conditions such as dementia and Alzheimer’s disease. Globally, 1 in 3 children has an elevated blood lead level and in developed countries, 1 in 2 children has an elevated blood level.

My work focuses on education and awareness, identifying sources of lead and developing interventions to minimize lead exposure. 

In 2017, as a visiting assistant professor at Franklin and Marshall College in Lancaster, I was looking for a research project that I could start and complete within my one-year contract. I started reading the local Lancaster newspapers to identify public health issues important to the community. I read an article that reported how the County of Lancaster had received funding for residential lead remediation, but only two families had applied for the funds. Usually, public health problems exist, but there is no funding to address the issue. Here the funding exists, but residents were not motivated to apply for the funding. Immediately, my thought was, ‘What is going on here?’

I researched and discovered that rates of elevated blood lead levels in the City of Lancaster were at least twice the rates in the entire state of Pennsylvania. Thus, my first project in this space came about; I set out to conduct qualitative interviews to hear from residents and professionals offering healthcare and social welfare services to families about why they thought the rates of elevated blood levels were high and why families were not applying for the federal funds for residential lead remediation. 

I interacted with residents in different settings: community fairs, back-to-school nights and knocked on doors to recruit research participants. In each of these interactions, either by invitation or opportunity, I talked about lead exposure and lead poisoning as an important health issue.  One day, as I was knocking on doors to invite folks to join a study to investigate the long-term effectiveness of residential lead remediation, a gentleman across the street called out and said, “Hey, I know you, you are the lead lady!”

I was so pleased to see that the work we were doing was recognized and remembered. I had a conversation with the gentleman and reiterated the importance of the work. 

I have chosen to continue working in Lancaster because of the momentum that we already have going there. It feels unethical to move and start work in Philadelphia and leave Lancaster. Recently, I conducted two projects there:  

I developed a curriculum for middle school-aged children on lead. The weeklong curriculum was delivered to students at a summer camp at Bright Side Opportunities Center. We evaluated their level of lead knowledge before and after the program using a test with 22 questions. When the students were given the pre-test, they only got four questions correct. But when they retook the test after the program, that number increased to 17 questions. So, on average, the scores on the test increased from 18% to 77%. 

I also conducted a survey to assess whether individuals in Lancaster consider lead when considering food safety. In this project we are also quantifying lead in several foods – we have looked at spices, honey and are now assessing lead in herbs. 

In addition to the ongoing work in Lancaster, I am investigating the prevalence of blood lead levels in Consuelo, Dominican Republic. We are also assessing the risk factors of lead in the community of Consuelo, including parental lead knowledge level, occupational lead exposures and environmental factors. I am currently working with current and former MPH students to finalize a comprehensive systematic review of lead research on the continent of Africa. Specifically, we are starting a project in Botswana to investigate the impact of maternal iron and calcium supplementation on childhood blood lead levels. 

What I continually find surprising is how little individuals know about lead, its effects and the magnitude of the problem. The groups of people who don’t know are on a wide spectrum: families, legislators, non-pediatric doctors, business owners who might need to ensure to avoid products with lead and fellow researchers. The other thing I find surprising is that the sources of lead seem to be endless, so continuous monitoring is critical.

Relationships (family, friends, colleagues, students), basketball, traveling and giving my time to help others. 

There is no single role model or person who has shaped my journey. God has placed in my life content-rich individuals, experienced persons, emotionally supportive folks, financially generous people and curious students and families who have contributed to the research and cheerleaders and for that I am grateful. 

My advice to young researchers is that certain aspects of this work are not easy, e.g., grant writing, identifying great collaborators, receiving an email to say your manuscript has been rejected, recruiting participants (if you choose to conduct research with human subjects); however, the work is immensely rewarding. There is such liberation and fulfillment in designing a research question, collecting and analyzing the data and providing findings that have positive impacts. May the end be the motivation.