Stigma hampers kids’ blood testing in Silver Valley

Stigmas associated with “being leaded” discourage parents living in the Bunker Hill Superfund site from getting their children tested for lead exposure, says a new study from the Johns Hopkins Bloomberg School of Public Health.

Parents felt “blame, shame and guilt” if their kids had elevated blood-lead levels, the research indicated. They also feared that a child identified as having a high blood-lead level would become a target of public ridicule.

“Being leaded” is a derogatory term in the Silver Valley, where some families have worked in the mining industry for five or six generations. Anonymity is difficult in small towns, and kids with high blood-lead levels could be stigmatized, the study said.

“People were quite candid with me,” said Sue Moodie, a toxicologist who interviewed 94 caregivers for the study. “When they started talking about knowing people who were ‘leaded,’ I realized that people really can identify those health effects in their families and friends.”

Over the past decade, the number of children screened each year for lead exposure has dropped from hundreds to a handful. In 2007, only eight children living inside “the Box” – a 21-square-mile area that received the brunt of historic mining pollution – were tested for lead exposure.

The low screening rates should be a concern, Moodie said. Children 6 and younger, who are at greatest risk from lead exposure through household dust, aren’t being tested.

The Box is much cleaner than it was 30 years ago, when the Bunker Hill Smelter belted out lead emissions. But many other areas of the Coeur d’Alene Basin where families camp, fish or ride all-terrain vehicles remain highly contaminated, Moodie noted. And even cleaned areas can be recontaminated through flooding, she said.

Early childhood lead exposure has been linked to lowered IQ and behavior problems. No amount of lead exposure is considered safe.

Moodie’s work was published in the scientific journal Elsevier. An official from the U.S. Environmental Protection Agency who reviewed the study found it interesting but didn’t agree with all of the conclusions.

Marc Stifelman, a human health risk assessor, said that the number of children screened for lead exposure dropped after 2002, when the federal government stopped paying a $20 incentive for parents inside the Box to get their kids tested. At that time, 95 percent of the children tested during the three previous years had blood levels of 10 milligrams per deciliter or less. That’s the Centers for Disease Control and Prevention’s threshold for public health action.

The declines in children’s blood-lead levels corresponded with more than $50 million worth of Superfund cleanup in the Box, Stifelman said. Over two decades, contaminated soil was stripped from residential yards and public areas and replaced with clean dirt.

As lead exposure dropped, Stifelman said parents had less incentive to get their kids tested.

“Once we got kids on clean play areas, those blood-lead levels just plummeted,” said Jerry Cobb, a program manager with the Panhandle Health District in Kellogg. But since lead dust is a frequent pathway for childhood exposure, the EPA continues to monitor lead dust levels within the Box, Stifelman said.

About half of the 94 households Moodie surveyed in Kellogg and neighboring Wardner had never taken part in the free blood-lead screening offered through the health district.

Some parents said they didn’t think lead exposure was a problem anymore. Others didn’t want to put their kids through the pain of a blood test.

Moodie, a doctoral student who’s studied mining towns in Canada and Australia, also detected conflicted attitudes toward testing during the survey. Parents felt responsible if their kids had tested high for lead exposure. They feared that they’d be judged as bad parents.

The perception was that “they were dirty people and didn’t take care of their kids,” one survey respondent told Moodie.

A retired nurse participating in the survey reiterated that view. She recalled watching her neighbors’ children eating dirt.

“The children who were not well kept by their parents were the ones who got lead poisoning,” the nurse said.

Children from families with incomes less than $10,000 were more likely to have been screened. That might reflect extensive outreach to low-income families or influence from the earlier $20 payments, the study said. Screening rates were also higher for boys than girls.

As a public health matter, Moodie said the community should stop blaming parents and embrace continued lead screening for children. Public outreach for testing should be done in a way that reduces parents’ feelings of blame, she said.

“It’s a fairly new thing to have this kind of large-scale cleanup happen,” Moodie said. “If you’re not going to continue to monitor people’s exposure, you really don’t have a good idea that you’re continuing to be effective in cleanup.”

Barbara Miller, an advocate for childhood lead screening, applauded the study’s conclusions.

“She has hit upon a sensitivity and a reality that exists in the community,” said Miller, who heads the Silver Valley Community Resource Center in Kellogg. “People aren’t getting the right information. They don’t understand why they need to get their kids tested.”

Cobb, the Panhandle Health District manager, said he understands how deeply embedded beliefs could influence parents’ decisions about testing. Thirty years ago, when the lead dust from the Bunker Hill Smelter was almost inescapable, some families thought they could combat it with soap, he said.

Children who are bathed daily, have clean clothes, good nutrition and wash their hands before they eat are at lower risk for lead exposure, Cobb said. But those steps alone don’t always prevent it.

The Panhandle Health District continues to offer free blood-lead testing and lead education through the schools. Though the $20 payments have stopped within the Box, the health district does pay families in outlying areas to get their children screened. Cleanup work is still taking place in those communities. In 2008, 73 children from outlying areas were tested.

“I do believe that people should come in and get their kids checked, but you can’t force people to do it,” Cobb said.

Shane Stancik and his wife, Kathy, recently decided to get their 3-year-old son screened for lead exposure. Stancik worked on Moodie’s survey. He said it drove home the importance of regular blood-lead screening for Shane Jr., who hasn’t been tested since he was a baby.

Stancik, 30, grew up in Smelterville and now lives in Wardner. He remembers the pervasive outfall from the smelter stack.

“I grew up with kids who had trouble with high blood-lead levels,” he said. “It was all over here.”