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Utility of a risk assessment questionnaire in identifying children with lead exposure
M A Dalton1, J D Sargent, T A Stukel
1Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Insights
The Centers for Disease Control and Prevention (CDC) Risk Questionnaire was not effective in identifying children with elevated blood lead levels. Researchers suggest universal screening for all children in urban communities due to differing risk factors.
Area of Science:
- Pediatric Environmental Health
- Toxicology
- Public Health
Background:
- Childhood lead exposure remains a significant public health concern.
- Identifying children at risk for elevated blood lead concentrations is crucial for timely intervention.
- Existing screening tools, like the CDC Risk Questionnaire, aim to target high-risk populations.
Purpose of the Study:
- To assess the effectiveness of the CDC Risk Questionnaire and a behavioral risk factor questionnaire.
- To determine if these tools can accurately identify children with blood lead concentrations of 0.48 µmol/L (10 µg/dL) or higher.
- To inform targeted lead screening strategies in pediatric populations.
Main Methods:
- A cross-sectional study was conducted involving 463 urban children aged 6 to 72 months.
- Children were screened for lead exposure using venous blood samples.
- Data from the CDC Risk Questionnaire and a behavioral risk factor survey were analyzed.
Main Results:
- Twenty-two percent of the children exhibited elevated blood lead levels.
- Only one CDC question, concerning a sibling, housemate, or playmate with lead poisoning, showed a significant association (OR, 2.7).
- Pacifier use (OR, 2.4) and playing near the home's exterior (OR, 3.4) were significant behavioral risk factors.
Conclusions:
- The CDC Risk Questionnaire did not effectively identify children at higher risk for lead exposure in this urban population.
- Risk factors for lead exposure appear to vary significantly between communities.
- Universal screening schedules for all children in urban settings are recommended over community-specific risk questionnaires.
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 mumol/L (10 micrograms/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, housemate, 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.