Iowa

Iowa’s annual statewide childhood blood lead testing goal is 75% for children ages 1 and 2 years. Since a mandatory blood lead testing law was passed in 2008, there was an initial increase in testing as healthcare providers became compliant with the law. Since then, Iowa has seen a steady decline in the overall prevalence of testing, especially among children under 3 years of age. From the 2009 peak testing year (35.2%), the rate has steadily declined from 33.2% in 2010 to 22.5% in 2021. In 2021, 71% and 38% of children 1 and 2 years of age received a blood lead test, respectively. Blood lead testing guidelines established by Medicaid, the American Academy of Pediatrics (AAP), and Iowa’s Childhood Lead Poisoning Prevention Program (CLPPP) require blood lead testing of children at their 1- and 2-year-old well-child visits. Some of the guidelines applied to just children who are enrolled in Medicaid. However, healthcare providers are not consistently following these guidelines.

In 2019, the Iowa CLPPP surveyed healthcare providers to gain a better understanding of their blood lead testing practices. The survey revealed healthcare providers were following different blood lead testing guidelines established by Medicaid, AAP, CDC, and the Iowa CLPPP. Survey responses indicated some language between the different guidelines was confusing and may be contributing to the low testing rates for some age groups, like 2-year-olds. Other barriers included parents not following through with lab orders, lack of a point-of-care system for onsite testing, and provider and parent beliefs that no further testing was needed if the initial test at 1 year was below CDC’s blood lead reference value and there was no change in the child’s environment.

To address issues identified by the survey and increase testing rates for children ages 1 and 2 years, the Iowa Childhood Lead Advisory Workgroup (CLAW) updated Iowa’s blood lead testing guidelines and screening tool. The updated guidelines better aligned with national testing requirements and those established by states bordering Iowa. The updated Iowa blood lead testing guidelines and screening tool were posted online and distributed to providers and clinics through the CLAW member provider networks.

In October 2021, the University of Iowa Health Care (UIHC) System incorporated the updated screening tool into their electronic health records system in 18 pediatric and family health clinics in Iowa. The tool’s updated risk questionnaire provides more guidance to healthcare providers and was applicable to children younger than age 6 years. Six months after implementing the updated screening tool and blood lead testing guidelines, UIHC increased testing for 1- and 2-year-old children by 31% and 18%, respectively.

Funding for this work was made possible in part by NUE2EH001464 from the Centers for Disease Control and Prevention (CDC). The views expressed in this material do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

From 2010 through 2018, the number of counties served by the Iowa Childhood Lead Poisoning Prevention Program (IA CLPPP) has more than doubled from 21 to 51 counties. At the same time, staffing levels, program funding, and resources available to increase blood lead testing and respond to elevated blood lead levels (BLLs) have declined. As a result of reduced capacity and an increased workload, IA CLPPP needed to leverage resources in areas of the state with a high risk of elevated BLLs in children. IA CLPPP determined the best way to maximize their outreach efforts was through a lead awareness campaign targeted to the eight highest risk counties in Iowa.

In 2016, IA CLPPP partnered with the Iowa Environmental Public Health Tracking Program to develop a lead risk formula to identify counties with the highest risk of childhood lead exposure using poverty status, age of housing, blood lead test confirmation rates, and prevalence of elevated BLLs as the risk indicators. A lead awareness campaign was then developed to provide messaging about blood lead testing and preventing lead exposure, with the key message stating, “Check-Up Coming Up! Test Your Toddler for Lead.” The campaign was launched in October 2018 in Polk, Scott, Woodbury, Black Hawk, Linn, Lee, Des Moines, and Clinton Counties. Messaging was delivered via social media, Pandora radio ads, billboards, web banners, and brochures. They were directed toward parents with children between one and three years of age. Following the October campaign’s success, Iowa CLPPP re-launched the campaign in the same eight counties from April through June 2019 without the radio ads.

Since launching the campaign, IA CLPPP’s web page visits increased from 152 in October 2018 to 281 in November 2018 and ultimately reached 605 visits in April 2019, a 298% increase since the start of the campaign. During the first campaign, four of the eight high-risk counties showed increases in blood lead testing rates during 2017–2018: Linn County (14%), Clinton County (9%), Woodbury County (8%), and Scott County (5%).

After the second campaign, blood lead testing data from five counties showed further increases in blood lead testing rates during the three months that the campaign was running, compared to the same period in 2018. The largest increase in testing occurred in Scott County (16%), followed by Woodbury County (12%), Black Hawk County (11%), Des Moines County (9%), and Linn County (2%). Overall, these results indicated that both lead awareness campaigns successfully educated parents and increased blood lead testing rates in Iowa’s high-risk counties.

Funding for this work was made possible in part by the Cooperative Agreement Number [NUE2EH001367] from the Centers for Disease Control and Prevention (CDC). The views expressed in this material do not necessarily reflect the official policies of the Department of Health and Human Services;