Early Childhood Lead Exposure in Cuyahoga County: Screening, Prevalence, and the Impact on Kindergarten Readiness Elizabeth Anthony, PhD, Stephen Steh, MA, Meghan Salas Atwell, PhD, and Rob Fischer, PhD Center on Urban Poverty and Community Development, CWRU Shawna Rohrman, PhD, and Rebekah Dorman, PhD Invest In Children / Cuyahoga County Office of Early Childhood Note: The birth and lead data used in this report come from the Ohio Department of Health. This should not be considered an endorsement of this study or these conclusions by the Ohio Department of Health.
Situating This Work in the Broader Context Today’s presentations will focus on secondary and tertiary prevention, but primary prevention is critical. 2
Overview of Presentation 1. To what extent are children in Cuyahoga County being tested for lead? 2. What is the prevalence of elevated blood lead levels among children in Cuyahoga County? 3. How does an elevated blood lead level affect children’s kindergarten readiness? 3
To what extent are children in Cuyahoga County being tested for lead? 4
Lead Testing Rates by Age and Birth Cohort for Children Born in Cuyahoga County by Age 1 by Age 2 by Age 3 by Age 4 by Age 5 100.0% 90.0% 81.2% Proportion of Birth Cohort Test for Lead 80.0% 70.0% 47.9% 60.0% 50.0% 70.3% 40.0% 30.0% 20.0% 10.0% 0.0% Birth Cohort 5
Lead Testing Rates among Children Covered by Medicaid for the First Two Years of Life Medicaid requirement is 100% 100% 90.0% 90% 80% 70% 60% 50.0% 50% 40% 34.6% 30% 21.5% 20% 10% 0% Tested at age 1 Tested at age 2 Tested at ages 1 & 2 Tested by KG entry Sample consisted of kindergarteners attending public schools in Cleveland and 11 inner-ring suburban districts from 2011-12 to 2016-17, N=35,334. Of these, 18,070 were covered by Medicaid for the first two years of life. 6
What is the prevalence of elevated blood lead levels (EBLLs) among children in Cuyahoga County? 7
In 2016, Cuyahoga County accounted for 14% of Ohio's lead tested children , but 41% of Ohio children with elevated blood lead levels . 8
Annual Percent of Children (ages 0-5) with an EBLL by Year 45% 42.2% 40% 34.6% 35% 28.7% 30% 25% 22.2% 21.4% 22.7% 20% 13.9% 14.2% 15% 16.5% 11.6% 16.1% 10% 9.8% 10.3% 8.2% 5% 0% 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 EBLL = 5 or more micrograms of lead per deciliter of blood (≥5 μ g/dL) 9
Cumulative Percent of Children in Each Birth Cohort Who Ever Had an EBLL by Age 5 45% Cuyahoga County City of Cleveland 40% 35% 31.4% 30% 25% 22.3% 20% 952 22.1% 16.7% children 15% 16.0% 1,237 10% 10.7% children 5% 0% 2004 2005 2006 2007 2008 2009 2010 2011 2012 Birth Cohort EBLL = 5 or more micrograms of lead per deciliter of blood (≥5 μ g/dL) 10
Annual Lead Testing and EBLL Rates By Race 100% 85.1% 85.1% 90% 80% 70% 66.8% 60% 65.9% 50% 40% 32.9% 20.4% 30% 20% 10% 19.8% 13.3% 0% 2012 2013 2014 2015 2016 2017 % screened at least once - Black/African American % screened at least once - White % with EBLL - Black/African American % with EBLL - White 11
How does an elevated blood lead level affect children’s kindergarten readiness? 12
Descriptive (unadjusted) Results Sample consisted of kindergarteners attending public schools in Cleveland and 11 inner-ring suburban districts from 2011-12 to 2016-17, who also attended high-quality preschool for 18+ months. N=1,478 85% of children had no history of EBLLs or had not been tested. More than On-track Not on-track half were ‘on - track’ for 53.8% 46.2% language and literacy when they entered kindergarten. Among the 15% who had a On-track Not on-track history of EBLLs, only 25.6% 74.4% one- fourth were ‘on - track’. 0% 20% 40% 60% 80% 100% 13
Logistic Regression Results After controlling for a variety of individual, family and neighborhood level covariate factors, results confirm that children with an EBLL history are less prepared for kindergarten than their peers: Children with an EBLL history had 0.5 times the odds of scoring ‘on - track’ for language and literacy. They also scored approximately 10 points lower on the social foundations for learning domain of the KRA. 14
What about children with an EBLL history who scored ‘On - track’? • 26% of children with an EBLL history scored ‘on - track’ for language and literacy • They had the same average blood lead level as their peers who were ‘not on - track’ • But fewer of the children ‘on - track’ had experienced adverse events in the early childhood period, such as: • Being born premature or at low birth weight • Prolonged exposure to poverty • Residential mobility 15
Key Takeaways • Although testing rates have improved in recent years, rates for children on Medicaid are far below the mandate at critical early ages. • 4 in 10 Ohio children with an EBLL live in Cuyahoga County. Nearly 11% of Cuyahoga children born in 2012 had an EBLL by age 5. • Black children have higher rates of EBLL than white children do. • Even among children receiving a high dose of high- quality preschool, an EBLL has a substantial impact on kindergarten readiness. 16
Thank you! Elizabeth Anthony, PhD Center on Urban Poverty and Community Development, CWRU exa136@case.edu Shawna Rohrman, PhD Invest In Children / Cuyahoga County Office of Early Childhood shawna.rohrman@jfs.ohio.gov
Study Design and Sampling Approach SAMPLE Kindergarten Readiness - Language & literacy 3 rd grade Quality - Social On-time reading Dose foundations matriculation proficiency Preschool at 3 & 4 Kindergarten Cohorts Kindergarten Outcomes 1 st grade Outcomes 3 rd grade Outcomes 2011-2012 Controlling for 2012-2013 individual, 2013-2014 family, and 2014-2015 neighborhood 2015-2016 factors 2016-2017 18
Italicized text = • Prenatal care • Infant mortality In progress of obtaining • Birth characteristics • Lead levels • Cause of death • Electronic Medical Records Birth/Death Child Medical Certificates Data • Housing condition • Medicaid • Tax delinquency • SNAP • Foreclosure • TANF Public • Homelessness • Child support Assistance & Housing & • Public Housing enforcement Family Neighborhood residency Supports ChildHood Integrated • Attendance Longitudinal Data • School readiness • Home visiting (CHILD) System Educational • Proficiency test scores • Child care Services Records • Disability status • UPK • Graduation test • Special needs • Charter Schools child care • Early childhood mental health Child Welfare Employment Justice • Ohio Means Jobs System • Unemployment • Wage records • Abuse/neglect reports • Juvenile court • Out of home placements • Jail involvement 19
Kindergarten Readiness Outcome • Kindergarten Readiness Assessment – Literacy (KRA-L) • 2011-12 to 2013-14 • Kindergarten Readiness Assessment (KRA) • 2014-15 to 2016-17 • For comparability, State created a crosswalk between two versions of assessment for language and literacy component • Raw scores grouped into ‘On - track’ and ‘Not on - track’ categories that are intended to predict a child’s likelihood of passing a reading diagnostic assessment requirement at third grade 20
Percent of children on Medicaid with at least one lead screen by age, N=16,263 30.00 75% by 50% by 20 mons 13 mons 25.00 20.00 15.00 10.00 5.00 0.00 <1 2 4 6 8 10121416182022242628303234363840424446485052545658606264666870 Age (in months) 21
Percent of children on Medicaid with a second lead screen by age, N=12,620 14.00 50% by 75% by 12.00 27 mons 39 mons 10.00 8.00 6.00 4.00 2.00 0.00 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58 60 62 64 66 68 70 Age (in months) 22
Recommend
More recommend
