South Carolina

Childhood lead exposure is often closely correlated with social determinants of health such as poverty and minority status. National data suggests that one-third of Native American children live below the Federal Poverty Level, defined as a family of four living on $26,500 or less annually, have decreased access to resources and tend to live in home built before 1978, which increases their risk of lead exposure. The Catawba Indian Nation (CIN) is the only federally recognized tribe in South Carolina. Over 3,000 enrolled members of the tribe and other Native and non-Native American family members that do not meet the strict criteria for tribal enrollment live across South Carolina. Governmental, medical, and social services for enrolled tribal members and non-enrolled family members are provided to South Carolina residents and bordering North Carolina residents by the Indian Health Services (IHS) Clinic and other governmental and non-governmental entities. However, no other governmental, philanthropic, or similar organization provides services to the CIN population on tribal lands.

The South Carolina Childhood Lead Poisoning Prevention Program (SC CLPPP) collaborated with the CIN tribal government to enhance surveillance of blood lead levels among tribal children, identify geographic areas and subpopulations at higher risk for lead exposure, and provide lead hazard education to enrolled members and their communities. SC CLPPP used CDC funds to help CIN to enhance their childhood lead surveillance and outreach activities in February 2019. These included developing educational materials, attending community events, training staff to conduct prevention activities, and establishing data sharing processes with SC CLPPP.

By September 2019, CIN staff had accomplished the following

• Obtained a list of all tribal-enrolled children younger than six years of age to initiate outreach activities.
• Met with their Head Start program director and distributed lead education at a Head Start open house.
• Identified three facilities that serve CIN enrolled members to ensure they are electronically interfaced with IHS for electronic lab reporting.
• Initiated a survey to determine the extent of existing pre-1978 housing occupied by enrolled tribal members.
• Identified seventeen pre-1978 houses that enrolled tribal members occupy and verified that nine children live in four of these households.
• Set up EPA Lead Risk Assessor training for CIN staff to conduct risk assessments on pre-1978 housing.
• Featured a public service announcement for 30 days about take-home lead in the IHS Clinic.
• Wrote an article for the tribal newsletter about health risks associated with lead exposure.
• Met with the tribal executive to obtain permission to share the database on enrolled children birth through six years of age with SC CLPPP.
• Attended the 2019 Southeastern Lead Consortium Annual Meeting.
• Distributed lead educational information at tribal community events, the IHS clinic, a tribal Back-to-School event, Little Peoples Academy, Catawba Indian Nation Family Services, and Camp Kic-A-Way.

The CIN has taken early and impactful steps to enhance surveillance, identify areas and groups at higher risk for lead exposure and provided lead hazard education to a population that has not received these services before.