KU Medical Center researchers working to address lead exposure prevention in southeast Kansas

Lead is a toxic metal that is harmful if inhaled or swallowed and can pose serious health risks, particularly to children. It can damage the brain and nervous system, slow growth and development, cause learning and behavior problems and impair hearing and speech.

Young children in Kansas have more than twice the rate (6.9%) of elevated blood-lead levels (EBLL) than the national average for their peers (3.2%), according to a 2022 study published in the Kansas Journal of Medicine. It’s worse for children in rural areas of Kansas, who have greater lead exposure than kids in urban parts of the state. And Kansas is predominately a rural state: 85 of its 105 counties are classified as rural.

The area hit hardest was southeast Kansas, which has an EBLL rate of 13.5%. Along with northeast Oklahoma and southwest Missouri, southeast Kansas was part of a mining area known as the Tri-State District that, for a hundred years, was one of the world’s major producers of lead and zinc. When the last of the Tri-State mines closed near Baxter Springs, Kansas, in 1970, it marked the end of an era. But the waste products and drainage from mining activities and from abandoned mines created a legacy of contamination and harmful lead exposure.

“Lead in the soil, as well as in the air and the water — a lot of that has been uncovered but not yet remediated,” said Christina Pacheco, J.D., MPH, assistant professor in the Department of Family Medicine and Community Health at the University of Kansas Medical Center. “Also, with the age of the housing in this area, lead paint is a big issue. It’s kind of a perfect storm of exposure, and those most at risk are youth.”

Studies show that residents in the Tri-State District are more likely to have a stroke, chronic kidney disease, hypertension, heart disease, skin cancer and anemia, in addition to neurological disorders in children.

Meanwhile, efforts at lead prevention at the state level have waned in recent years, with low levels of testing and some education at the county level. The study published in 2022, which was conducted by researchers at KU School of Nursing, was the first descriptive study looking at lead levels in children in approximately three decades.

Along with her partners in the Communities Organizing to Promote Equity (COPE) project, Pacheco would like to change that. Led by faculty at KU Medical Center and directed by Pacheco, COPE aims to engage with communities across the state to improve health equity issues.

The Healthy Bourbon County Action Team, one of the COPE partners that works with five counties in southeast Kansas, recently received a $50,000 mini-grant from the National Center for Healthy Housing to increase rural community capacity for lead poisoning prevention and inform policy changes.

The grant will be used to address lead exposure in the COPE southeast region of Kansas, which includes locations designated by the Environmental Protection Agency as Superfund sites because of their high levels of lead. Although southeast Kansas is the focus of the work, improved policies can benefit the entire state, Pacheco said.

Policies related to lead prevention cover such things as such as provider education, lead disclosures for rentals and selling of properties and mandatory blood lead-level testing.

At KU Medical Center, Kara Knapp, MPH, a research associate in the Department of Family Medicine and Community Health, is leading the policy mapping for the project, which involves using LawAtlas.org, an online portal that lets users explore variation in laws across states and over time, to map out existing regulations, local ordinances and state laws related to lead poisoning. They will then work with the Kansas Department of Health and Environment (KDHE) to map the average EBLL to these policies and understand their impact in Kansas. Knapp and Pacheco also will look at policies in other areas.

“I spoke with KDHE, and some of the states they pointed out were Maryland and Massachusetts, which have more strict lead poisoning laws and regulations and have seen improvements in their testing levels and in some children with high blood-lead levels,” said Knapp. “And then we will also be looking at states that are similar to Kansas in that they're mostly rural.”

Working closely with Jody Love, MBA, president and CEO of the Healthy Bourbon County Action Team, the researchers plan to use what they learn to create a lead poisoning prevention policy toolkit.

The hope is that the toolkit will lead to policy discussions and ultimately action to address lead exposure in the state. “We know that lead is a problem, and yet it's very expensive to fix,” Pacheco said. “And so, I think, that’s going to be the next big push: how do we actually make our environments safe? Wyandotte County currently has funding for remediation for families that have this issue. Unfortunately, that's just one of our 105 counties.”