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December 1, 1993

Screening Strategies for Lead Poisoning

JAMA. 1993;270(21):2555. doi:10.1001/jama.1993.03510210041013

To the Editor.  —The report by Gellert et al1 on childhood lead poisoning in Orange County, California, contrasts with our San Francisco experience. In 1991, a total of 1199 children younger than 6 years were screened. Like the Orange County study, our sampling was provider based, nonrandom, consecutive, and convenient. Ninety percent of our sampling was through Child Health and Disability Prevention program providers and met the low-income eligibility (Medicaid or income <200% of the federal poverty level).Our 8.26% overall prevalence of elevated blood lead level was similar to that in Orange County (7.25%), but the prevalence of the higher levels was 5.5-fold greater in San Francisco. A common source of exposure was lead-based paint: all eight children with blood lead levels of 1.20 μmol/L (25 μg/dL) or higher had paint-related exposures, including chewing on painted surfaces, home remodeling, or parents working in painting or construction; six also