Barriers to pediatric lead screening: implications from a web-based survey of Vermont pediatricians

Area of Science:

• Pediatric Public Health
• Environmental Health
• Epidemiology

Background:

• Lead exposure poses significant risks to child health.
• The Vermont Department of Health (VDH) recommends universal blood lead level (BLL) screening for 12- and 24-month-old children.
• Screening rates in Vermont fell short of recommendations in 2006.

Purpose of the Study:

• To identify barriers preventing pediatricians from performing recommended blood lead screening.
• To compare factors associated with higher and lower screening rates among Vermont pediatricians.

Main Methods:

• A survey was distributed to Vermont primary care pediatricians.
• Pediatricians were categorized into higher and lower screening groups.
• Statistical analysis, including odds ratios and confidence intervals, was used to identify determinants of lower screening rates.

Main Results:

• Pediatricians perceiving negative health outcomes starting at BLL >10 microg/dL were more likely to be lower screeners (OR = 3.64).
• Practicing in Chittenden County (OR = 3.34) and disagreeing with VDH recommendations (OR = 4.90) were also associated with lower screening.
• Adjusted analysis revealed male gender, a perceived dangerous BLL threshold of >10 microg/dL, and a low self-reported Medicaid population were significant determinants of lower screening.

Conclusions:

• Physician perception of dangerous blood lead levels (BLL) at >10 microg/dL is a significant barrier to screening.
• Targeted educational initiatives by the VDH emphasizing risks associated with BLL < or = 10 microg/dL could increase screening rates.