Screening, Prevalence, and the Impact on Kindergarten Readiness - - PowerPoint PPT Presentation

Early Childhood Lead Exposure in Cuyahoga County: Screening, Prevalence, and the Impact on Kindergarten Readiness

Elizabeth Anthony, PhD, Stephen Steh, MA, Meghan Salas Atwell, PhD, and Rob Fischer, PhD Center on Urban Poverty and Community Development, CWRU Shawna Rohrman, PhD, and Rebekah Dorman, PhD Invest In Children / Cuyahoga County Office of Early Childhood

Note: The birth and lead data used in this report come from the Ohio Department of Health. This should not be considered an endorsement of this study or these conclusions by the Ohio Department of Health.

Situating This Work in the Broader Context

Today’s presentations will focus on secondary and tertiary prevention, but primary prevention is critical.

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Overview of Presentation

• 1. To what extent are children in Cuyahoga County

being tested for lead?

• 2. What is the prevalence of elevated blood lead levels

among children in Cuyahoga County?

• 3. How does an elevated blood lead level affect

children’s kindergarten readiness?

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To what extent are children in Cuyahoga County being tested for lead?

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70.3% 47.9% 81.2% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0% Proportion of Birth Cohort Test for Lead Birth Cohort by Age 1 by Age 2 by Age 3 by Age 4 by Age 5

Lead Testing Rates by Age and Birth Cohort for Children Born in Cuyahoga County

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Sample consisted of kindergarteners attending public schools in Cleveland and 11 inner-ring suburban districts from 2011-12 to 2016-17, N=35,334. Of these, 18,070 were covered by Medicaid for the first two years of life.

Lead Testing Rates among Children Covered by Medicaid for the First Two Years of Life

50.0% 34.6% 21.5% 90.0% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Tested at age 1 Tested at age 2 Tested at ages 1 & 2 Tested by KG entry

Medicaid requirement is 100%

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What is the prevalence of elevated blood lead levels (EBLLs) among children in Cuyahoga County?

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In 2016, Cuyahoga County accounted for 14% of Ohio's lead tested children, but 41% of Ohio children with elevated blood lead levels.

34.6% 22.7% 16.1% 16.5% 9.8% 10.3% 8.2% 42.2% 28.7% 22.2% 21.4% 13.9% 14.2% 11.6% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Annual Percent of Children (ages 0-5) with an EBLL by Year

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EBLL = 5 or more micrograms of lead per deciliter of blood (≥5 μg/dL)

22.1% 16.0% 10.7% 31.4% 22.3% 16.7% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 2004 2005 2006 2007 2008 2009 2010 2011 2012

Birth Cohort

Cuyahoga County City of Cleveland

Cumulative Percent of Children in Each Birth Cohort Who Ever Had an EBLL by Age 5

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EBLL = 5 or more micrograms of lead per deciliter of blood (≥5 μg/dL)

952 children 1,237 children

Annual Lead Testing and EBLL Rates By Race

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85.1% 85.1% 65.9% 66.8% 32.9% 20.4% 19.8% 13.3% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 2012 2013 2014 2015 2016 2017 % screened at least once - Black/African American % screened at least once - White % with EBLL - Black/African American % with EBLL - White

How does an elevated blood lead level affect children’s kindergarten readiness?

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Descriptive (unadjusted) Results

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Sample consisted of kindergarteners attending public schools in Cleveland and 11 inner-ring suburban districts from 2011-12 to 2016-17, who also attended high-quality preschool for 18+ months. N=1,478

85% of children had no history of EBLLs or had not been tested. More than half were ‘on-track’ for language and literacy when they entered kindergarten.

On-track 53.8% Not on-track 46.2%

Among the 15% who had a history of EBLLs, only

• ne-fourth were ‘on-track’.

On-track 25.6% Not on-track 74.4%

0% 20% 40% 60% 80% 100%

After controlling for a variety of individual, family and neighborhood level covariate factors, results confirm that children with an EBLL history are less prepared for kindergarten than their peers:

Logistic Regression Results

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Children with an EBLL history had 0.5 times the odds

• f scoring ‘on-track’ for language and literacy.

They also scored approximately 10 points lower on the social foundations for learning domain of the KRA.

What about children with an EBLL history who scored ‘On-track’?

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• 26% of children with an EBLL history scored ‘on-track’

for language and literacy

• They had the same average blood lead level as their

peers who were ‘not on-track’

• But fewer of the children ‘on-track’ had experienced

adverse events in the early childhood period, such as:

• Being born premature or at low birth weight
• Prolonged exposure to poverty
• Residential mobility

Key Takeaways

• Although testing rates have improved in recent years,

rates for children on Medicaid are far below the mandate at critical early ages.

• 4 in 10 Ohio children with an EBLL live in Cuyahoga
• County. Nearly 11% of Cuyahoga children born in 2012

had an EBLL by age 5.

• Black children have higher rates of EBLL than white

children do.

• Even among children receiving a high dose of high-

quality preschool, an EBLL has a substantial impact on kindergarten readiness.

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Thank you!

Elizabeth Anthony, PhD Center on Urban Poverty and Community Development, CWRU exa136@case.edu Shawna Rohrman, PhD Invest In Children / Cuyahoga County Office of Early Childhood shawna.rohrman@jfs.ohio.gov

Preschool at 3 & 4 Kindergarten Cohorts Kindergarten Outcomes 1st grade Outcomes 3rd grade Outcomes

• Language &

literacy

• Social

foundations 3rd grade reading proficiency

SAMPLE

On-time matriculation 2011-2012

2012-2013 2013-2014 2014-2015 2015-2016 2016-2017

Kindergarten Readiness Dose Quality

Controlling for individual, family, and neighborhood factors

Study Design and Sampling Approach

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ChildHood Integrated Longitudinal Data (CHILD) System Public Assistance & Family Supports

• Prenatal care
• Birth characteristics
• Cause of death
• Infant mortality
• Lead levels
• Electronic Medical Records
• Housing condition
• Tax delinquency
• Foreclosure
• Homelessness
• Public Housing

residency

• Juvenile court
• Jail involvement
• Ohio Means Jobs
• Unemployment
• Wage records
• Attendance
• School readiness
• Proficiency test scores
• Disability status
• Graduation test
• Charter Schools
• Home visiting
• Child care
• UPK
• Special needs

child care

• Early childhood

mental health

• Abuse/neglect reports
• Out of home placements
• Medicaid
• SNAP
• TANF
• Child support

enforcement Birth/Death Certificates Child Medical Data Educational Records Housing & Neighborhood Services Justice System Child Welfare Employment Italicized text = In progress of obtaining 19

Kindergarten Readiness Outcome

• Kindergarten Readiness Assessment – Literacy (KRA-L)
• 2011-12 to 2013-14
• Kindergarten Readiness Assessment (KRA)
• 2014-15 to 2016-17
• For comparability, State created a crosswalk between

two versions of assessment for language and literacy component

• Raw scores grouped into ‘On-track’ and ‘Not on-track’

categories that are intended to predict a child’s likelihood of passing a reading diagnostic assessment requirement at third grade

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0.00 5.00 10.00 15.00 20.00 25.00 30.00 <1 2 4 6 8 10121416182022242628303234363840424446485052545658606264666870

75% by 20 mons 50% by 13 mons

Percent of children on Medicaid with at least one lead screen by age, N=16,263

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Age (in months)

0.00 2.00 4.00 6.00 8.00 10.00 12.00 14.00 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58 60 62 64 66 68 70 Age (in months)

50% by 27 mons 75% by 39 mons

Percent of children on Medicaid with a second lead screen by age, N=12,620

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