Childhood lead screening knowledge and practice. Results of a New Jersey physician survey.

Context: As the nation moves toward targeted childhood lead screening, CDC continues to recommend universal screening in states with no childhood lead poisoning prevalence data.

Objective: The study was conducted, prior to the new universal screening state law, to determine physician screening practices and their consistency with key CDC recommendations as a basis for future education activities.

Design/setting/participants: A statewide cross-sectional self-administered multiple choice survey of 541 randomly selected New Jersey pediatricians and family practitioners.

Outcome Measures: Risk assessment, screening and case management practices and their consistency with CDC recommendations.

Results: We obtained 333 usable responses (69.4%). Most respondents reported confirming blood lead level, initiating case management, and identifying medical emergencies at blood lead levels lower than recommended by CDC. More than half reported not assessing the risk of the majority of their patients. At least one third were not screening infants, children between 1 and 2 years, or children between 2 and 6 years of age. Physicians who assessed risk tended to screen high-risk children in all age groups. Only 42% of pediatricians and 24% of family practitioners said they screened the majority of the children in their practice by age 2 years. About 60% of all respondents reported not providing lead exposure education to half their patients.

Conclusions: Passing a universal screening law, as New Jersey has done, is one way to obtain baseline childhood lead poisoning prevalence data. Private practice-targeted physician education led by preventive medicine specialists may also be helpful.