Inequities in Childhood Life-Course Lead Exposure and Academic and Neurobehavioral Outcomes (I-CLEAN)

Santa Ana in Orange County (OC), California (CA) is a predominantly low-income city that is bound by multiple freeways, has a large industrial corridor, and has 65% of houses built prior to 1960. Residents of Santa Ana have identified lead (Pb) exposure as a major health concern. Responding to the problem, we established the Lead-Free Santa Ana! participatory research partnership to characterize Pb levels in soil in Santa Ana since 2017. In this study, we propose to investigate how lead exposure impacts children’s health and academic performance using a participatory research approach. We will also address important gaps in previous Pb research and practice, including 1) limited consideration of both life course exposure and susceptible time window for chronic low-level Pb exposure; 2) lack of research based on repeated outcome measures; 3) few studies on synergistic effect of metal mixtures; 4) few studies on multi-level (e.g., household, school, neighborhood) solutions; and 5) lack of research devoted to leveraging knowledge to inform effective solutions for reducing soil-based Pb exposure to ensure the exposed children have an opportunity for academic achievement. Our overarching goal is to examine associations of life course and current Pb exposures with children’s academic performance and neurobehavioral outcomes, identify harmful patterns and functional implications of current Pb exposure, and develop and implement a prevention and improvement plan (PIP), with particular attention to health solutions. The study population involves 600 children 6-10 years old at enrollment and their primary caregiver. Individual-level exposure to Pb and other metals will be estimated from: 1) deciduous tooth-based exposure at a weekly resolution from the 2nd trimester of gestation up to the 1st year of life and every 6-months from age 1 up to the time when the tooth is shed; 2) blood and saliva for current exposure. Repeated outcomes include 5 years of academic performance and 3 years of behavior outcomes based on the validated Child Behavior Checklist (CBCL) questionnaire. We will examine associations of academic performance and behavioral outcomes with deciduous teeth-based early life Pb exposure (Aim 1) and current blood Pb exposure (Aim 2). Further, we will develop, disseminate, pilot, and evaluate a multi-level (e.g. household, school, neighborhood, city, county) prevention and improvement plan (PIP), with a focus on solutions (Aim 3). The strengths of this study include: bridging participatory methods and implementation science by leveraging results from Aims 1-2 of this study and practice-based evidence to inform the PIP, strong neighborhood and university leadership, life course measurements of Pb and metal mixtures, a large prospective cohort with longitudinal measurements of both exposure and outcomes, and multiple levels of assessments (i.e. household, school, neighborhood) that advance the science on children’s health irregularities to develop, evaluate, and pilot action plans and solution-driven interventions. We will advance knowledge on how low levels of Pb exposure over the life course adversely affect children’s school performance and behavioral outcomes. The practice-based value of this study is noteworthy, as it integrates etiologic data and practice-based evidence to a solutions-oriented multi-level action strategy to improve child academic and neurodevelopmental outcomes.