The Inequities in Childhood Life Course Lead Exposure and Academic and Neurobehavioral Outcomes (I-CLEAN) study continued recruitment and data collection of participants by connecting with Santa Ana families in city-hosted events.
UCI Public Health researchers initiated the study in 2023 through partnership with Orange County Environmental Justice (OCEJ) and Getting Residents Engaged in Exercise and Nutrition-Madison Park Neighborhood Association. Expected to span five years, the study researches potential negative neurobehavioral and health effects of low-level lead, or Pb, exposure on children ages 7-10 years old in Santa Ana. It does this by analyzing lead exposure in blood samples and shed baby teeth from participating children. After “identify[ing] risk factors of current Pb exposure,” the study aims to develop a public health equity action plan focused on environmental justice and improved health outcomes.
According to Julia Mangione, UCI research project coordinator for the I-CLEAN study, the research team works with the city of Santa Ana and their Neighborhood Initiatives and Environmental Services program to reach local families. During the school year, the I-CLEAN team recruited families at elementary schools. While school is not in session, researchers take advantage of local events. At the city of Santa Ana Movie in the Park series, study representatives directly approach and inform families by hosting educational booths, handing out flyers detailing the study’s goals and compensation opportunities, and giving toys to children.
Locally, promotores de salud, or community health workers, serve a key role in recruitment efforts, according to Mangione. Promotores de salud work to bridge the gap between researchers and participants by speaking with families at recruitment events like the Movie in the Park series, schools and neighborhoods as they go from door to door.
UCI professor Jun Wu, a principal investigator of the study, identified existing challenges to recruiting 600 participants, including undocumented families’ concerns of potential exposure to the government. Melissa Retana, rising junior at Wellesley College and I-CLEAN student research intern, spoke to New University about additional considerations regarding recruitment.
“Historically, communities of color haven’t been treated well in clinical trials,” Retana said. “First, we want to build a network between us and the community … [so] that they can trust us with their children when coming into the study.”
Mangione highlighted the informed consent process for participating families — defined by I-CLEAN researchers as one caregiver and child — to ensure participants understand the study’s parameters. Researchers provide information about the study’s goal, compensation for participants, what type of data will be collected, and more.
“We really do a deep dive into that consent document [and] all of the potential risks,” Mangione said. “We’re asking families to consent to, in addition to participating in the study, that we can store part of the child’s blood sample for future epigenetics analysis.”
I-CLEAN researchers also employ an assent process, a “more child-friendly” version of the consent process per Mangione for potential participating children. The process gives them information on the study and the right to deny participation even if the child’s parents want to participate. According to Mangione, the research team completes year-round training that includes the ethics of involving children in the research study.
“It’s a challenge for us to … demonstrate our commitment to that [trust]. But [it’s] really understandable that community members are wary, especially about giving bio specimen,” Mangione said. “I mean, donating your child’s baby teeth or giving your child’s blood sample is a big ask, and we are very aware of that.”
After participants give informed consent to participate, researchers begin data collection of teeth and blood samples. Families then complete surveys regarding their child’s “potential in utero exposures to lead” and the child’s eating habits, one pathway to lead exposure, to understand potential impacts of exposure on communities, according to Mangione.
“Diet has a lot to do with how much lead the body absorbs. This is directly related to food insecurity, for example,” Mangione said. “We know that kids with empty stomachs absorb more lead.”
According to the I-CLEAN Study website, a ThinkProgress piece raised concerns about lead exposure in Santa Ana communities in 2017. In 2018, the ¡Plo-NO! Santa Ana! campaign, created in collaboration with the OCEJ, UCI Department of Public Health, UCI Community Resilience and Jóvenes Cultivando Cambios, tested lead levels throughout the city by analyzing over 1,500 soil samples. The campaign revealed dangerous lead concentrations in Santa Ana, with approximately half (51.8%) of soil samples from residential areas exceeding California guidelines defining soil lead risk. Some samples contained lead concentrations over 30 times greater than those guidelines.
Juan Manuel Rubio, a Mellon Humanities Faculty Fellow in the UCI School of Humanities at UCI, theorized gasoline as a major source of lead contamination in Santa Ana. Rubio used maps and analysis of the soil samples to find elevated levels of lead in soil near the oldest parts of the city and historical roadways.
Mangione spoke on the demand for answers about the risks of lead exposure from city residents.
“Community members are saying, ‘We want data about how that exposure is impacting our kids,’”Mangione said.
In the ¡Plo-NO! study, OCEJ found that lead contamination disproportionately affects populations of low-income, immigrant and Latino residents and children, as researchers found elevated soil lead levels in associated areas. Retana highlighted the role of the children participating in the study.
“It’s something super moving to watch, how tough [the participating children] are, how resilient they are, despite the circumstances they’re in and despite what the research represents — the environmental racism and the lack of movement done by the government,” Retana said. “Their community has fought for this to happen, and they’re out here putting themselves in the front lines.”
Recruitment and data collection events will continue to occur throughout the summer.
Inga Chilingaryan is a News Intern for the summer 2024 quarter. She can be reached at chilingi@uci.edu.
Edited by Jaheem Conley.