Date of Award

6-2026

Degree Type

Thesis

First Advisor

Autumn Dye, DO

Second Advisor

Kristen Berry, DO

Third Advisor

Farzaneh Daghigh, PhD

Abstract

Elevated blood lead levels (EBLLs) are an ongoing public health crisis predominantly affecting children under six in low-income communities located in major cities across the United States (Zartarian et al. 2024). Chronic lead exposure due to outdated housing, polluted water, and contaminated soil is especially harmful in early childhood. Frequent hand to mouth contact at this age increases the risk of ingesting particulate matter containing lead (CDC). EBLLs can predispose children to neurocognitive deficits, cardiovascular disease, and epigenetic modifications to gene expression patterns (Collin et al. 2022). While precautionary measures and timely screening protocols greatly reduce the risk of developing severe disease, families within these communities continue to experience significant barriers to care. These include patient hesitancy to perform conventional methods of blood lead level (BLL) screening through intravenous (IV) blood draw, inadequate access to less invasive screening procedures, and gaps in patient-provider communication (Boreland et al. 2015). To address these barriers to care, less invasive screening procedures such as point-of-care capillary testing can be an effective alternative to traditional IV draws given its reported accuracy of 87% to 91% sensitivity (Cantor et al. 2018). Additionally, coupling the procedure with consistent communication strategies to enhance the patient-provider relationship can further increase testing compliance. The Philadelphia College of Osteopathic Medicine (PCOM) Community Health Center located on Lancaster Avenue in the heart of Western Philadelphia serves a diverse pediatric population reflective of these risk factors and has similarly observed low screening participation rates without access to alternative screening methods.

This prospective longitudinal cohort study uses an electronic medical record review to evaluate whether implementing point-of-care capillary BLL testing improves BLL screening participation. This study also examines whether targeted patient-provider communication strategies are more effective than conventional BLL screening methods. In doing so, the findings may provide a replicable framework for clinics serving similar high-risk communities to improve pediatric BLL screening participation and reduce the disproportionate burden of lead exposure among children in underserved communities. Preliminary findings of this study have suggested that accessible point-of-care capillary testing combined with targeted patient-provider communication practices may enhance the overall BLL screening participation for eligible pediatric patients.

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