Barriers to pediatric lead screening: A web-based survey of Vermont pediatricians

The pernicious effects of lead on the health of children are well documented. Currently, the Vermont Department of Health (VDH) recommends screening all 12 and 24 month-old children for elevated blood lead levels (BLLs). However, in 2006, only 41.4% of 24 month-old Vermont children were screened. To identify barriers to screening, a web-based survey was distributed to all Vermont primary care pediatricians. Childhood lead and immunization registries were used to divide VT pediatricians into higher and lower blood lead screening groups. 73.5% (72) of VT pediatricians responded to the survey, with the most common reported barrier to screening being parental opposition (79.2%). VT pediatricians were more likely to be in the lower screening group if they reported negative health outcomes began with BLLs >10μg/dL (OR 3.64, 95%CI 1.12-11.99), reported practicing in Chittenden County (OR 3.34, 95%CI 1.14-9.78), or reported disagreeing with the VDH universal blood lead screening recommendation (OR 4.90, 95%CI 1.66-15.50). Adjusted analysis indicated the most significant determinants of lower screening rates were male sex, a perceived dangerous BLL >10μg/dL and low self-reported Medicaid population. While the underlying causes of these associations are not entirely understood, 87.5% of VT pediatricians reported using the VDH as a primary source of information and guidance when establishing office policy. Thus, the VDH has an opportunity to increase BLL screening by VT pediatricians of all 24 month-old children by redesigning its physician education to emphasize significant health risks associated with BLLs ≤10μg/dL.