Association for Public Policy Analysis & Management

Screening for environmental and health hazards can help governments target scarce resources for remediation whenever complete preventative abatement of pollutants and toxins is not cost-effective. For example, child lead poisoning prevention programs throughout the US first identify children exposed to lead through a blood test and then inspect homes to find and remediate exposure sources. Remediation helps mitigate cognitive and non-cognitive consequences for the exposed child, as well shield future residents from exposure.

The persistent disparities in utilization of preventative care across socioeconomic and racial groups in the US might weaken the effectiveness of screening as a secondary prevention policy. Barriers to information, scheduling challenges, and transportation costs could reduce screening among disadvantaged families. Similarly, lack of information about and access to treatment opportunities, might lead families to forego screening. This paper studies screening determinants and screening efficacy as a prevention tool by using data on over 1.7 million blood lead tests performed in Illinois between 2001 and 2016 and vital records for over 1.5 million children.

First, I estimate screening demand as a function of family characteristics, exposure risk, distance to providers, and access to remediation funding. Children with higher exposure risk are more likely to be screened. Being 15 minutes farther away from a provider appears to decrease the likelihood of screening by 1%. Moreover, funding availability for remediation increases screening by 2.8%.

Second, I exploit seasonal patterns in exposure to estimate the impact of detecting lead hazards at an address on future exposure using an instrumental variable approach. My findings suggest that improving screening could help prevent up to 2% of future exposure cases.