who have blood lead testing as recommended by the Centers for Disease Control and Prevention (CDC).

CDC (1991) recommends universal screening of children at 12 months of age using a blood lead test, except in communities where no childhood lead poisoning problem exists. Children at high risk should receive earlier and more frequent testing. This recommendation is consistent with those of many organizations. For example, the American Academy of Pediatrics (1993) guidelines recommend that (a) all children should be screened for lead exposure at 12 months and again at 24 months of age; (b) providers should take a history of lead exposure for children between the ages of 6 months and 6 years to identify children living in high-risk situations; and (c) parents should receive educational materials on safe environmental, occupational, nutritional, and hygiene practices to protect their children from lead exposure. In addition, Medicaid's Early Periodic Screening, Diagnostic, and Treatment Program, which provides services to many poor innercity children in high-risk environments, requires periodic screening of children with a blood lead measurement.

The American Medical Association, the American Academy of Family Physicians, and the Canadian Task Force on the Periodic Health Examination are consistent and recommend less in the way of testing than CDC and the groups mentioned above. The three organizations recommend blood lead testing for children who are at high risk of exposure (as found through history taking) as opposed to all children. The U.S. Preventive Services Task Force (1996) considered this option and decided against it, concluding that there is insufficient evidence to recommend a specific community prevalence level below which targeted screening can be substituted for universal screening.

2. Proportion and number of employees who have blood lead testing as recommended by the Occupational Safety and Health Administration (OSHA).

Occupational lead exposures are associated most commonly with work at battery manufacturing plants, smelting operations, construction sites, radiator repair shops, ceramics production shops, firing ranges, and foundries (Pirkle et al., 1985; CDC, 1988). OSHA has developed standards (29 CFR 1910.1025 and 29 CFR 1926.62) that provide medical surveillance guidelines for groups that are exposed to lead in the workplace (e.g., California Department of Health Services, 1995). In any workplace where



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