New Hampshire

In 2015, 660 (5%) children under the age of 6 in New Hampshire were reported to have blood lead levels (BLLs) ≥ 5µg/dL, the level then recommended for public health action by the Centers for Disease Control and Prevention (CDC). Yet, statewide, only 53% of one-year-olds and 26% of two-year-olds were tested in 2015, suggesting that the actual number of children under 6 years old with elevated blood lead levels (BLLs) is likely much higher.

Using state blood lead surveillance data, the New Hampshire’s Healthy Homes and Lead Poisoning Prevention Program (HHLPPP) identified the five largest communities with lowest testing rates: Concord, Dover, Nashua, Manchester, and Rochester. The program then worked with the New Hampshire Chapter of the American Academy of Pediatrics (NH-AAP) and pediatric healthcare providers to identify barriers to blood lead testing and opportunities to improve testing rates for one- and two-year-olds. Through collaboration with providers, the HHLPPP discovered two major obstacles to blood lead testing of young children: (1) a heavy reliance on venous blood lead testing and (2) a lack of understanding in the medical community about the importance of blood lead testing.

To address these obstacles, the HHLPPP developed a collaborative partnership with the NH-AAP to educate pediatric healthcare providers about current surveillance data and testing rates, BLL testing options, information about the best practices in clinical evaluation, and guidance for medical management of children with elevated BLLs. Additionally, HHLPPP held four regional pediatric medical education dinners from July 2016 through April 2018. These dinners were held in the five communities mentioned above and featured medical experts.

As a result of the intervention, HHLPPP educated 375 medical and public health professionals, resulting in an increase of BLL testing rates in the five target communities for one- and two-year-olds: a 10% and 12% increase in these ages in Manchester, respectively; a 16% and 41% increase in these ages in Nashua, respectively; a 13% and 73% increase in these ages in Concord, respectively; an 84% and 184% increase in these ages in Dover, respectively; and a 3% and 16% increase in these ages in Rochester, respectively.