Page 81 - Encyclopedia of Nursing Research

48 n CHILD–LEAD EXPoSURE EFFECTS

increase in adolescents’ risk exposure.
Longitudinal study is needed to determine Child–lead exposure eFFeCts
C if effects (reduced youth delinquency and
substance use) will hold over time. A second
study phase is in place currently. Childhood lead poisoning is recognized as
Research has been making incremental the most important preventable pediatric
steps toward unraveling the complexities environmental health problem in the United
resulting in outcomes of youthful offend- States, and the adverse health effects of lead
ing. Research has clearly demonstrated that exposure in early childhood are well docu-
youth are developmentally different than mented. Lead poisoning is defined as expo-
adults. Brain imaging research revealed sure to environmental lead that results in
that the brain systems that govern impulse whole blood lead concentrations ≥10 μg/dl
control, planning, and thinking ahead are (Centers for Disease Control [CDC], 1991,
still developing well beyond age 18 years 2005). However, there is no safe level of lead
(MacArthur Foundation, 2008). Behavioral exposure because factors such as age dur-
studies confirm that youth are less able to ing exposure, environmental characteristics
gauge risks and consequences, to control of the home, and duration of exposure need
impulses, to handle stress, and to resist peer to be considered, and adverse neurological
pressure than adults (Malbin, Boulding, & effects can occur at blood lead levels (BLLs)
Brooks, 2010). Research also reveals that well below the 10-μg/dl mark (Bellinger,
most young offenders will cease lawbreak- 2004). Exposure to environmental lead
ing as part of the normal maturation process begins in the prenatal period when physio-
(Elliott, 1994), and for the few children with logic stress mobilizes lead from its storage in
long-term pathways through delinquency, maternal bone into the blood, where it eas-
assessment and prevention strategies are ily crosses the placenta and is deposited in
even more important. The implications are to fetal tissue (Cleveland, Minter, Cobb, Scott, &
implement developmentally appropriate pol- German, 2008a, 2008b). Depending on the
icies and interventions to address our under- level of lead present in the environment, the
standing of these research findings. exposure can continue as infants and chil-
Research has also shown that a reduc- dren develop. Absorption of lead is depen-
tion of secure confinement and an increase dent on age and nutritional status; young
in reliance on effective community-based children and those who have diets high in
services have better outcomes (Holman & fats are most susceptible, as are those who
Ziedenberg, 2006), but implementation and are poor and live in deteriorating housing
sustainability of this approach have yet to (American Academy of Pediatrics Committee
be achieved (Annie E. Casey Foundation, on Environmental Health, 2005). Lead is
2008). As evidenced by the growing focus most commonly ingested through exposure
on implementation science, fidelity strate- to lead- contaminated paint and the resulting
gies, and community-based methodologies, dust, soil, and paint chips. once ingested,
the future lies in science translation. Most lead is distributed in the blood and eventu-
aptly stated in a recent report by the Annie E. ally is deposited in bone and teeth.
Casey Foundation (2008), “. . . juvenile justice Whole BLLs greater than 10 μg/dl put
has probably suffered the most glaring gaps children at risk for developing a variety of
between best practice and common practice, health problems. At high-level exposures
between what we know and what we most (BLL > 20 μg/dl), damage to the nervous,
often do” (p. 1). hematopoietic, endocrine, and renal systems
can occur. At lower level exposures, these
Deborah Shelton health problems include altered cognitive and