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Utility of a Risk Assessment Questionnaire in Identifying Children With Lead Exposure

Utility of a Risk Assessment Questionnaire in Identifying Children With Lead Exposure Abstract Objective: To evaluate the utility of the Centers for Disease Control and Prevention (CDC) Risk Questionnaire and a behavioral risk factor questionnaire in identifying children with blood lead concentrations of 0.48 μmol/L (10 μg/dL) or more. Design: Cross-sectional study of 463 urban Massachusetts children (6 to 72 months of age) screened for lead with venous blood. Results: Twenty-two percent of the children had elevated blood lead concentrations. Of the five CDC questions, only one was significantly associated with an increased adjusted odds ratio for elevated blood lead: having a sibling, house-mate, or playmate who was followed up or treated for lead poisoning (odds ratio, 2.7; 95% confidence interval, 1.7 to 4.2; P<.001). Children who had at least one positive or equivocal response to any of the five CDC questions (n=318 [68.7%]) were not at higher risk than were children who displayed a negative response to all five questions (odds ratio, 1.1; 95% confidence interval, 0.7 to 1.8; P=.69). Of nine behaviors surveyed, two were associated with an increased adjusted odds for elevated blood lead: use of a pacifier (odds ratio, 2.4; 95% confidence interval, 1.3 to 4.4; P=.01) and playing near the outside of the home (odds ratio, 3.4; 95% confidence interval, 2.0 to 5.8; P<.001). Conclusions: In this population of children, the CDC risk questionnaire did not identify a group at higher risk for lead exposure. We suggest that practitioners in urban communities screen all children according to the same schedule. We conclude that risk factors differ by community and no risk questionnaire developed at the national level should be applied across communities to target screening.(Arch Pediatr Adolesc Med. 1996;150:197-202) References 1. Schaffer S, Szilagyi P, Weitzman M. Lead poisoning risk determination in an urban population through the use of a standardized questionnaire . Pediatrics . 1994;93:159-163. 2. Binns H, LeBailly S, Poncher J, Kinsella T, Saunders S. Is there lead in the suburbs? Risk assessment in Chicago suburban pediatric practices . Pediatrics . 1994;93:164-171. 3. Roda S, Greenland R, Bornschein R, Hammond P. Anodic stripping voltammetry procedure modified for improved accuracy of blood lead analysis . Clin Chem . 1988;34:563. 4. Rothman K. Modern Epidemiology . Boston, Mass: Little Brown & Co; 1986. 5. Stata . College Station, Tex: Stata Corp; 1993. 6. Nordin J, Rolnick S, Griffin J. Prevalence of excess lead absorption and associated risk factors in children enrolled in a midwestern health maintenance organization . Pediatrics . 1994;93:172-177. 7. Rooney B, Hayes E, Allen B, Strutt P. Development of a screening tool for prediction of children at risk for lead exposure in a midwestern clinical setting . Pediatrics . 1994;93:183-187. 8. Tejeda D, Wyatt D, Rostek B, Solomon W. Do questions about lead exposure predict elevated lead levels? Pediatrics . 1994;93:192-194. 9. Johnson L. Sources of Residential Lead in Rural New England. Hanover, NH: Dartmouth College; 1993. Thesis. 10. Schilling R, Bain R. Prediction of children's blood lead levels on the basis of household-specific soil lead levels . Am J Epidemiol . 1988;128:197-205. 11. Walter S, Yankel A. Age-specific risk factors for lead absorption in children . Arch Environ Health . 1980;35:53-58.Crossref 12. Weitzman M, Aschengrau A, Bellinger D, Jones R, Hamlin JS, Beiser A. Lead-contaminated soil abatement and urban children's blood lead levels . JAMA . 1993;269:1647-1653.Crossref 13. Gilbert C, Tuthill R, Calabrese E, Peters H. A comparison of lead hazards in the housing environment of lead poisoned children versus nonpoisoned controls . J Environ Sci Health . 1979;A(14):145-168. 14. Johnson N, Tenuta K. Diets and blood levels of children who practice pica . Environ Res . 1979;18:369-376.Crossref 15. Mooty J, Ferrant C, Harris P. Relationships of diet to lead poisoning in children . Pediatrics . 1975;55:636-639. 16. Bellinger D, Leviton A, Rabinowitz M, Needleman H, Waternaux C. Correlates of low-level lead exposure in urban children at 2 years of age . Pediatrics . 1986; 77:826-833. 17. Sayre J, Charney E, Vostal J. House and hand dust as a potential source of childhood lead exposure . AJDC . 1974;127:167-170. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Pediatrics & Adolescent Medicine American Medical Association

Utility of a Risk Assessment Questionnaire in Identifying Children With Lead Exposure

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Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
1072-4710
eISSN
1538-3628
DOI
10.1001/archpedi.1996.02170270079012
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: To evaluate the utility of the Centers for Disease Control and Prevention (CDC) Risk Questionnaire and a behavioral risk factor questionnaire in identifying children with blood lead concentrations of 0.48 μmol/L (10 μg/dL) or more. Design: Cross-sectional study of 463 urban Massachusetts children (6 to 72 months of age) screened for lead with venous blood. Results: Twenty-two percent of the children had elevated blood lead concentrations. Of the five CDC questions, only one was significantly associated with an increased adjusted odds ratio for elevated blood lead: having a sibling, house-mate, or playmate who was followed up or treated for lead poisoning (odds ratio, 2.7; 95% confidence interval, 1.7 to 4.2; P<.001). Children who had at least one positive or equivocal response to any of the five CDC questions (n=318 [68.7%]) were not at higher risk than were children who displayed a negative response to all five questions (odds ratio, 1.1; 95% confidence interval, 0.7 to 1.8; P=.69). Of nine behaviors surveyed, two were associated with an increased adjusted odds for elevated blood lead: use of a pacifier (odds ratio, 2.4; 95% confidence interval, 1.3 to 4.4; P=.01) and playing near the outside of the home (odds ratio, 3.4; 95% confidence interval, 2.0 to 5.8; P<.001). Conclusions: In this population of children, the CDC risk questionnaire did not identify a group at higher risk for lead exposure. We suggest that practitioners in urban communities screen all children according to the same schedule. We conclude that risk factors differ by community and no risk questionnaire developed at the national level should be applied across communities to target screening.(Arch Pediatr Adolesc Med. 1996;150:197-202) References 1. Schaffer S, Szilagyi P, Weitzman M. Lead poisoning risk determination in an urban population through the use of a standardized questionnaire . Pediatrics . 1994;93:159-163. 2. Binns H, LeBailly S, Poncher J, Kinsella T, Saunders S. Is there lead in the suburbs? Risk assessment in Chicago suburban pediatric practices . Pediatrics . 1994;93:164-171. 3. Roda S, Greenland R, Bornschein R, Hammond P. Anodic stripping voltammetry procedure modified for improved accuracy of blood lead analysis . Clin Chem . 1988;34:563. 4. Rothman K. Modern Epidemiology . Boston, Mass: Little Brown & Co; 1986. 5. Stata . College Station, Tex: Stata Corp; 1993. 6. Nordin J, Rolnick S, Griffin J. Prevalence of excess lead absorption and associated risk factors in children enrolled in a midwestern health maintenance organization . Pediatrics . 1994;93:172-177. 7. Rooney B, Hayes E, Allen B, Strutt P. Development of a screening tool for prediction of children at risk for lead exposure in a midwestern clinical setting . Pediatrics . 1994;93:183-187. 8. Tejeda D, Wyatt D, Rostek B, Solomon W. Do questions about lead exposure predict elevated lead levels? Pediatrics . 1994;93:192-194. 9. Johnson L. Sources of Residential Lead in Rural New England. Hanover, NH: Dartmouth College; 1993. Thesis. 10. Schilling R, Bain R. Prediction of children's blood lead levels on the basis of household-specific soil lead levels . Am J Epidemiol . 1988;128:197-205. 11. Walter S, Yankel A. Age-specific risk factors for lead absorption in children . Arch Environ Health . 1980;35:53-58.Crossref 12. Weitzman M, Aschengrau A, Bellinger D, Jones R, Hamlin JS, Beiser A. Lead-contaminated soil abatement and urban children's blood lead levels . JAMA . 1993;269:1647-1653.Crossref 13. Gilbert C, Tuthill R, Calabrese E, Peters H. A comparison of lead hazards in the housing environment of lead poisoned children versus nonpoisoned controls . J Environ Sci Health . 1979;A(14):145-168. 14. Johnson N, Tenuta K. Diets and blood levels of children who practice pica . Environ Res . 1979;18:369-376.Crossref 15. Mooty J, Ferrant C, Harris P. Relationships of diet to lead poisoning in children . Pediatrics . 1975;55:636-639. 16. Bellinger D, Leviton A, Rabinowitz M, Needleman H, Waternaux C. Correlates of low-level lead exposure in urban children at 2 years of age . Pediatrics . 1986; 77:826-833. 17. Sayre J, Charney E, Vostal J. House and hand dust as a potential source of childhood lead exposure . AJDC . 1974;127:167-170.

Journal

Archives of Pediatrics & Adolescent MedicineAmerican Medical Association

Published: Feb 1, 1996

References