1. Deval L. Patrick, Governor Timothy P. Murray, Lieutenant Governor Suzanne M. Bump, Secretary Laura Marlin, Commissioner, Division of Occupational Safety COMMUNITY HEALTH CENTERS and BLOOD LEAD TESTING of IMMIGRANT HOUSE PAINTERS Richard Rabin Occupational Lead Poisoning Registry Division of Occupational Safety

2. INTRODUCTION Lead Exposure of House Painters Community Health Center (CHC) Blood Lead Testing Blood Lead Data Outreach to Community Health Centers

3. MASSACHUSETTS OCCUPATIONAL LEAD POISONING REGISTRY Laboratory blood lead reports of adults Follow-up with workers, physicians, employers Data analysis, reports One of almost 40 state lead registries in US

5. PAINTERS’ BLOOD LEADS MASSACHUSETTS OCCUPATIONAL LEAD REGISTRY => 25 mcg/dl (2001 – 2007) Painters306 (37%) Others524 (63%) Total830 (100%)

6. BLL SCREENING OF BRAZILIAN PAINTERS (N=61) BLL (µg/dl) Freq. % < 10 39 64 10 – 14 7 12 15 – 24 5 8 25 – 39 5 8 >= 40 5 8 Adapted from: COBWEB, “A Report on Brazilian Immigrant Workers in Massachusetts,” 2009

7. OSHA LEAD STANDARD, CONSTRUCTION Blood lead testing Medical exams Lead exposure monitoring Lead exposure controls Respirators, PPE Training

9. Difficulties of Surveillance (BL testing) Small size of employers – lack of knowledge of, and ability & desire to comply with, regulations Immigrants - language - lack of knowledge of rights (ex: OSHA) - fear of retaliation - immigration authorities

10. House Painters Low income Uninsured Immigrant Limited English-speaking Irregular employment

11. Community Health Centers Primary medical care Auxiliary health services Sliding fee scale 90 – 100 in Massachusetts Patients Low income Non-English speakers No health insurance Don’t know workplace rights

12. COMMUNITY HEALTH CTR PATIENTS Percentage of patients unaware of OSHA by place of origin Place of Origin Never Heard of OSHA United States (471) 41% Puerto Rico (101) 68% Other Country (834) 75% All patients (1,406) 63% Source, Occupational Health and CHC Patients, MDPH, 2007

13. COMMUNITY HEALTH CTR PATIENTS Percentage of patients unaware of Workers’ Compensation, by place of origin United States (483) 15% Puerto Rico (101) 42% Other country (838) 52% All patients (1,422) 39% Source, Occupational Health and CHC Patients, MDPH, 2007

14. COMMUNITY HEALTH CENTER SERVICES “Our providers offer a wide variety of services for the whole family including prenatal care and deliveries. “ Primary Services: Pediatric, Adult and Senior Primary Care Obstetrics and Gynecology including prenatal care

15. COMMUNITY HEALTH CENTER SERVICES Multiple languages, incl. Portuguese Other Services: HIV testing and counseling Family planning Nutrition services Mental Health services (from clinic network’s website)

16. COMMUNITY HEALTH CENTERS AND HOUSE PAINTERS: A PERFECT FIT?

17. Community Health Center Blood Lead Testing Minimal Except, one network of ~ 15 CHCs

18. OBSTACLES TO DEALING WITH OCCUPATIONAL HAZARDS Worker’s compensation Dealing with employer Other personal, social issues Lack of training in medical school

19. REASONS FOR BLOOD LEAD TESTS 2001 – 2007 (%) ReasonCS Network Other All Others Painters Symptoms 18 (20) 53 (24) 19 (4) Pt. Request 21 (24) 80 (37)54 (10) Med. Mon. 1 (1) 45 (21)432 (82) Doctor 43 (48) 27 (12)11 (2) Unknown 6 (7) 12 (6) 8 (2) Total 89 (100) 217 (100) 524 (100)

20. WHAT’S DIFFERENT ABOUT CHC¹ NETWORK? Occupational med. doctors – outreach If house painter, order blood lead (BL) test If BL elevated, refer to occupational medicine clinic 1 - network of chc in greater Boston area

21. PRESENTATIONS TO COMMUNITY HEALTH CENTERS TOPICS Sources of lead exp. – esp. painters Health effects OSHA lead standard Lead Registry data Need for BLL testing

22. PRESENTATIONS TO COMMUNITY HEALTH CENTERS REACTIONS CHCs have painters, other Pb-exposed Were not thinking about lead exposure How to follow-up if BLL elevated

23. KEYS TO SUCCESS Raise awareness Information/training Easy to deal with individual cases –Specifics of each case –Workers’ compensation –Contact with employer