Lessons from a primary-prevention program for lead poisoning among inner-city children.

* A host of educational materials on lead-poisoning prevention are available in the form of publications, videos, slides, and mass media endeavors.

* The key problem seems to be that the people for whom these materials are intended do not use them effectively.

* The challenge, therefore, is to create programs that can have greater audience appeal as well as stimulate behavioral change.

* This study evaluated the impact on childhood lead poisoning of an educational-intervention program targeted at pregnant women in St. Louis, Missouri.

* The women were predominantly poor and of African-American, Hispanic, Asian, and Caucasian backgrounds.

* It was hypothesized that the probability of lead poisoning would be reduced among children whose mothers received the interventions.

* Contrary to expectations, none of the interventions reduced the likelihood of lead poisoning.

* This outcome underscores the significance of the challenges to successful prevention efforts in communities at the lowest end of the socioeconomic scale:

--Data gathering was severely undermined by difficulties in accessing homes--no telephones, frequent changes of address, and wrong addresses.

--It was very common for participants to move out of the area and across counties without any notification of a change of address.

--Individuals who initially appeared willing to participate later refused to allow home visits, called to cancel appointments, or simply were not present when caseworkers went to the given addresses.

--Fear and intimidation played a significant role.

--Husbands or significant others of 142 women would not allow the women to let the intervention team into their homes.

--Similarly, several women expressed concerns about being evicted by landlords if they allowed anybody in for a lead inspection.

--Motivating participants remained a challenge; most were young teenage mothers.

* The investigators came away with the general impression that these families did not see lead poisoning as a priority.

* Practically all participating families were operating within a culture of poverty.

* For each of these families, the key daily challenge is survival.

* The priority is meeting basic human needs--food, water, shelter, and transportation.

* In this context, a child without noticeable symptoms of lead poisoning cannot be treated differently from his or her siblings.

* It was plausible, therefore, for the mothers/families not to follow up on the recommended activities for reducing exposure to lead.

* Consequently, no real behavior change took place.

* These results suggest that public health educational interventions of this type may not be "best practice."

* Further work in this area merits careful consideration and contingency planning.

This department, Practical Stuff! originated from you, our readers. Many of you have expressed to us that one of the main reasons you read the Journal of Environmental Health is to glean practical and useful information for your everyday work-related activities. In response to your feedback, we dedicate this section to you with salient points to remember about two to three articles in each issue.