Childhood Blood Lead Surveillance in the State of Washington: Successes and Challenges (2016-2020)

Dr. James Marcus Arnaez, Washington Department of Health, Healthy Homes and Communities, Lead Surveillance Epidemiologist

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Background: Childhood lead poisoning is a serious, but preventable public health issue. The State of Washington recommends universal lead risk assessment with subsequent targeted lead testing of high-risk populations. Only Medicaid enrolled children have a federal regulation that requires universal testing. This presentation will cover our efforts looking at the data collected from 2016 and 2020 to identify trends in blood lead testing in Washington as well as data quality and outline our successes and challenges with data and what we are doing to improve data quality. Method: Descriptive analysis are performed to look at yearly frequencies of children tested, and children with ≥5µg/dL blood lead level by county. Data from the Child Blood Lead Registry (CBLR) were examined for data quality by finding the percentage of missing data for demographics. Results: From 2016 to 2020, on average, tests for ~26,400 children were reported to the state annually, with the majority (72%, ~18,900) under 3 years of age. While the annual childhood (<72 months of age) lead testing rate (~4.4%) in Washington remained unchanged from 2016 to 2020, it falls below the national average of 16%-18%. However, the percent of children tested at least once by age 3 increased from ~10.5% among children born in 2013 to ~18.6% among children born in 2017. Among those tested, the percent of children with a blood lead level of ≥5µg/dL is ~2.1%. Demographic data was missing at high levels for certain variables. Overall ~60%-70% tests are missing race and ethnicity (R/E) data. Components of patients’ addresses could be missing up to 20.5%. A pre-existing data sharing agreement with the Health Care Authority (HCA) enabled identification of tests billed to Medicaid despite enrollment not being a reported characteristic leading to the initiation of partnerships with other state agencies. Conclusion: While testing rates for children under three by birth cohort have shown improvement, low childhood lead testing rates and missing data pose challenges to developing an accurate assessment of blood lead levels in Washington as well as identifying vulnerable populations. Establishing data sharing agreements with other state agencies has shown promise in addressing current data shortcomings and other partnerships are underway. A future transition from the CBLR to the Washington Disease Reporting System (WDRS) for analysis and reporting offers opportunities for improved data quality as well as Medicaid status and race/ethnicity will become mandatory reporting fields for the system in 2023.

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Increasing Property Transfer Evaluations of Onsite Sewage Systems: Building a Baseline

Hayli Hruza, Whatcom County Health Department : Environmental Health Specialist

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Introduction: This project focuses on building an evidence-based approach to improve compliance related to required property transfer evaluations of septic systems in Whatcom County.
Methods: A baseline compliance rate was identified through review and analysis of local health department and assessor data to identify trends in property transfer evaluations for onsite septic systems. Then, interviews were completed based on the Theory of Planned Behavior to gauge homeowners’ attitudes, beliefs, and perceptions concerning OSS evaluations at the time of a property transfer. Interview results were organized into thematic categories within the constructs and influencing levels of the socioecological model.
Discussion: This survey highlights possible gaps in outreach and future key stakeholders relating to property transfer evaluations of OSS in Whatcom County. Historically, outreach has focused on compliance awareness and ensuring that an available operations and maintenance industry existed to support homeowners with evaluations. This project identified that some historical programmatic efforts are being met while identifying possible avenues for future work through partnership building, community education, and messaging.
 

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Whatcom County Solid Waste Landfill Buffer Mapping Project

Laurette Rasmussen, Whatcom County Health and Community Services, Environmental Health Specialist

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An accurate map of solid waste landfills is an important feature to review when siting a new water well. WAC 173-160-171 states that minimum set-back distances for water wells is one thousand feet from the boundary of a permitted landfill or the parcel boundary of other historical landfills. Using current permitted landfill boundary data and historical information from a 1971 Solid Waste Management report, a new GIS landfill layer was created that accurately shows the 1000 foot buffer of the 38 solid waste landfills in Whatcom County.

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Learning About the Health and Wellbeing Impacts of Coastal Planned Relocation in the US and Japan

Isabel Nerenberg, University of Washington, MS Environmental Health Student

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The effects of climate change (e.g., storm surge from extreme weather events, sea level rise) and other coastal hazards (e.g., earthquakes, tsunamis, land subsidence) are posing existential threats to coastal communities, resulting in a push for community-level changes. Some of these communities are considering “planned relocation,” “managed retreat,” or “uphill expansion.” For instance, the 2011 Great East Japan Earthquake and Tohoku tsunami prompted many communities to relocate inland, while in the Pacific Northwest, some communities on the Pacific Coast are in the process of relocating due to coastal erosion, sea level rise and anticipated tsunamis. Despite these experiences around the Pacific Rim, comparative studies of hazard-adaptive relocation are rare, especially when relocation is collectively planned rather than individually enabled, e.g., through residential buyouts as they are typically carried out in the U.S. Although buyout-enabled relocation has been demonstrated to exacerbate social inequality and vulnerability, there is a particular lack of evidence about the health and wellbeing impacts of different kinds of relocation decisions. Such evidence is necessary to understand the potential consequences of relocation and to inform plans and policies among communities to minimize these effects. The objective of this thesis is to identify information community leaders might need about the health and wellbeing impacts of managed retreat, in order to evaluate managed retreat as a disaster risk reduction strategy. Semi-structured interviews with managed retreat scholars and professionals will be conducted and analyzed to identify information needs related to the health and wellbeing impacts of managed retreat. This information can be used to prioritize future research, with the goal of informing current knowledge and practice of managed retreat.

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