A randomized trial of education to prevent lead burden in children at high risk for lead exposure: efficacy as measured by blood lead monitoring.

In this article we report on the effectiveness of a community-based, culture-specific, controlled trial of intensive peer education aimed at preventing lead burden in children 0-36 months of age within a neighborhood with high risk for lead exposure. Mothers (n = 594) were randomly assigned to control or intervention groups. Offspring blood lead levels were assessed every 4 months. All participants received brochures on basic lead prevention strategies. Intervention participants were offered 20 bi-weekly educational sessions by same-ethnicity peer educators over the course of 1 year, and quarterly booster sessions for 2 years afterward. The intervention group's educational curriculum included information on lead sources (e.g., paint, dust, water, soil, and risks from home repairs and remodeling), health consequences of lead burden, and strategies to reduce lead exposure, including household cleaning, hygiene, safe use of water, and nutritional recommendations. Results indicated that of the 378 children contributing sufficient blood data for analysis, 23% had blood lead levels > 10 micro g/dL before 3 years of age. Intervention participants were more likely to maintain blood lead levels < 10 micro g/dL than were controls (81% vs. 73%; p = 0.08). Multivariate analyses demonstrated that the intervention reduced the risk of blood lead levels > 10 micro g/dL by approximately 34%. We conclude that although intensive education resulted in a lower proportion of children with elevated lead levels, education alone cannot be relied upon to prevent lead burden.