Investigation of Trends in Lead Contacts Amongst the US Pediatric Environmental Health Specialty Units (PEHSU) Network

Abstract

Background: The Pediatric Environmental Health Specialty Units (PEHSU's) were created in 1998 by US EPA and ATSDR. In the early 1990's, two widespread incidents occurred in which environmental toxicants went largely undetected by local clinicians. The PEHSU program was born out of this critical need for environmental health expertise. Currently, there are 12 regional US PEHSU sites, each affiliated with an academic center and include an environmental medicine physician and pediatrician. The mission of the PEHSU program is to consult with patients or other clinicians on environmental hazards, provide referrals and build capacity by educating medical providers on children's environmental health. PEHSU's can be contacted by clinicians, nurses, public health practitioners, school officials, media representatives, parents or the public. Aim: To investigate trends in US PEHSU lead contacts Methods: A retrospective study analyzed 7,512 total PEHSU contacts between 1/1/2007-12/31/2012. Seasonal and regional trends in lead contacts were analyzed along with patterns in location of lead exposure, route of exposure, patient geographic location, referral source, patient age and gender. Results: During the study period, lead was overwhelmingly the primary topic of concern for which the US PEHSU's were contacted (between 27-35% of the yearly contacts). It is of particular policy interest that the Region 1-New England PEHSU continually saw the greatest number of lead contacts, as much as 53% of their caseload. Conclusion: Despite the significant strides in lead policy and toxicity prevention, it remains a serious threat to children's health. This study demonstrated that a significant portion of the PEHSU lead contacts were coming from within the medical and public health community indicating many lingering lead care questions which need to be addressed. Moreover, this study showed that the PEHSU network is a valuable resource for evaluating patterns in children's environmental health and should be expanded to include further international members.