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College of Arts & Sciences
Hazards & Vulnerability Research Institute

Factors Influencing Geographic Variability of Children's Vulnerability to Lead Hazards

Deborah S. K. Thomas

Advisor: Dr. Susan L. Cutter



This dissertation identified and examined factors that contribute to the vulnerability of children to lead hazards in South Carolina. It specifically investigated the spatial distribution of lead risk and the factors that explain the geographic pattern. The study focused on three research questions: 1) How do national lead guidelines and policies correspond with those in South Carolina; 2) What is the lead risk to children in South Carolina; and 3) Do national and state lead screening guidelines correspond with lead screening practices at the local level in South Carolina? Using a modified model of vulnerability derived from existing models as a framework, social contexts and environmental threats were considered from the macro to the micro scales.

On paper, the South Carolina Department of Health and Environmental Control’s (DHEC) guidelines corresponded closely with the 1991/1997 Centers for Disease Control (CDC) guidelines on most major points. Further analysis, however, revealed that practice deviated from recommendations. In fact, lead prevention in South Carolina did not meet many of the CDC recommendations.

The utility of using GIS to identify areas of potential concern was also illustrated for assessing lead risk. In terms of differential impacts on children, an initial examination of TRI facilities releasing lead and children’s environmental equity contributed some evidence of environmental inequities. However, the inquiry revealed minimal differential impacts when race and income were considered, although white, higher income children were slightly more likely to live in proximity of a TRI facility reporting lead.

Lead screening data were also considered in order to determine the level of risk. Some very distinct patterns arose, with rural areas in the northeastern portion of the state and the urban counties, particularly Charleston, exhibiting high levels of activity. The distribution of confirmed lead cases followed a similar pattern. Because of the limitations of the data, however, this did not represent risk to children from lead. Instead, the geographic distribution of high screening activity and elevated blood lead levels related directly to the CDC grant counties. The results were a reflection of policy and resource allocation, not risk.

A survey of 42 lead nurses across the state indicated that lead is not a priority in many counties throughout the state. Nurses did generally have some understanding of the risks of lead to children, but did not necessarily find it to be a threat in their counties. In almost all cases, Medicaid patients received questionnaire screening, although the level of blood tests and lead education varied considerably. Almost no counties conducted public education. Clearly, attitudes and actions of local health care professionals can have an effect on whether or not children receive lead screening.

KEYWORDS: Hazards, Vulnerability, Lead, Children