Children at Risk: Gaps in State Lead Screening Policies
States With Universal Childhood Lead Testing Policies
Application of policy
Requires proof of lead test for non-Head Start program, school?
State law requires insurance to cover testing, separate from ACA coverage? [A]
Reporting req. for kids < 72 mo.
% of kids < 36 mo. tested
(2014 unless noted)
% of kids < 72 mo. tested
(2015 unless noted)
% of kids tested in target age range [B]
|MA||Univ. (between 9 and 12 mo., at 2 y. & 3 y.)||Kindergarten||All policies||All||58%||47%||76%|
|VT||Univ. (at 12 and 24 mo.)||No; insurance covers all or most||All||52%
|RI||Univ. (between 9-15 mo., 21-27 mo.)||Public/private child care facilities, early childhood education programs, pre-K, kindergarten||All non-supplemental policies||All||50%||40%||55%, 78%|
|CT||Univ. (annually 9 through 35 mo.)||2 Local Health Departments: both kindergarten, one also pre-K||Most broad individual and group policies||All [C]||50%||30%||53%, 97%|
|DC||Univ. (between 6- 14 mo., 22-26 mo.)||Daycare, early childhood programs, pre-K, kindergarten, first grade||All||44%||34%
|IA||Univ. (children seeking to enter kindergarten, by 6 y. or right after)||Kindergarten||All||39%
|26% [D]||82%, 100.5%|
|NY||Univ. (at or around 1 y. and 2 y.)||Child care, nursery schools, pre-K||All||36%
|MD||For kids born in 2015 and after: Univ. (at 12 & 24 mo.), as of 2016 for 3 y.; For older kids: Required (targeted testing)||Child care facilities, public pre-K, kindergarten, first grade [F]||No; most reimburse||All||36% [F]||25% [F]|
|NJ||Univ. (around 12 and 24 mo.)||Group health policies||All||35%
|LA||Univ. (at 12 and 24 mo.)||All||28% [G]||18% [G, H]
|DE||Univ. (at or around 12 mo.)||Child care, nursery schools, pre-K, kindergarten||Most broad individual and group policies||All||Complete data not available after 2010 [I]||18%|
Notes for Tables 1.A, 1.B., 1.C, and 1.D
A – See Section V.; “Covering the Cost of Lead Testing,” for more details on Affordable Care Act coverage of lead tests.
MA: 76% is the percentage of children 9 months to 47 months who were tested in 2015, shown here because Massachusetts requires tests around age 1 and at ages 2 and 3. Massachusetts Childhood Lead Poisoning Prevention Program, “Screening and Prevalence of Childhood Blood Lead Levels for Children 9 months to less than 4 years of age by Community, Calendar Year 2015,” p. 24, August 25, 2016, http://www.mass.gov/eohhs/docs/dph/environmental/lead/stats/screening-and-prevalence-statistics-by-community-cy-2015.pdf
VT: 80% of children aged 1 and 68% of children aged 2 were tested for lead in 2015. These percentages reflect only one test per child by age, but may include more than one test per child for the reporting year. Chen MD, Harry, “Lead Poisoning Prevention: Report on 2015 Program Outcomes and Activities,” April 15, 2016, p. 6, http://legislature.vermont.gov/assets/Legislative-Reports/Lead-Poisoning-Prevention-4.15.16.pdf
RI: Out of children who turned 36 months in 2015, 55% had been tested twice at least 12 months apart and 78% of those children received at least one test by 18 months. Kollett-Almeida, Michelle et al., “CDC Site Visit, June 2016,” Rhode Island Department of Health, p. 23.
CT: Out of children born in 2011, 53% were tested around ages 1 and 2 and 97% were tested at least once through 35 months of age. State of Connecticut Department of Public Health, “2014 Annual Disease Surveillance Report,” June 9, 2016, p. 9, http://www.ct.gov/dph/lib/dph/environmental_health/lead/pdf/2014_Annual_Lead_Surveillance_Report_Final.pdf
DC: By July 1, 2015, 31% of children 24 to 35 months old were reported to have received lead tests in both of the statutorily required age ranges and 91% had been tested at least once in their lifetimes. Both pieces of data were obtained via email on July 18, 2016 from staff in the Lead and Healthy Housing Division of the District of Columbia Department of Energy and Environment. DC staff preferred this data, but the 34% is shown in the chart for ease of comparison with other states.
IA: 82% is the percentage of children born in 2012 and tested up to age 3. 100.5 % is the percentage of children born in 2009 and tested before age 6, per state law. One explanation for a percentage over 100 is that children moved into the state after 2009, so there were more children to be tested than the number born in 2009. Also, staff mentioned that they recently combined a large number of databases into one, and a small amount of duplication still exists. Iowa Department of Public Health, Iowa Public Health Tracking Portal, “Birth Cohort Children Under 6 > State Measures,” Retrieved on October 24, 2016, https://pht.idph.state.ia.us/Dashboards/Dashboards/Birth%20Cohort%20Children%20Under%206/State%20Measures.aspx; Iowa Department of Public Health, Iowa Public Health Tracking Portal, “Birth Cohort Children Under 3 > State Measures,” Retrieved on October 24, 2016, https://pht.idph.state.ia.us/Dashboards/Dashboards/Birth%20Cohort%20Children%20Under%203/State%20Measures.aspx; Iowa Department of Public Health staff, Personal Communication, July 7, 2016
NY: 56% of children born in 2011 received at least two lead tests by 36 months. New York State Department of Health, “Percentage of children born in 2011 with at least two lead screenings by 36 months,” Revised August 2016, https://www.health.ny.gov/statistics/chac/general/g27.htm
NJ: 75% of children who turned three during the period July 2013 to June 2014 had at least one lead test. New Jersey Department of Health, “Childhood Lead Poisoning in New Jersey Annual Report, Fiscal Year 2014,” p. 9, http://www.nj.gov/health/fhs/documents/childhoodlead2014.pdf
C – Staff in the Connecticut Department of Public Health specifically stated that regulatory action can be taken against the license of a laboratory if a laboratory refuses to report in line with the state’s reporting law. Connecticut Department of Public Health, Personal communication, July 22, 2016
D – The percentage of Iowa children under 72 months who were tested for lead in 2015 is taken from the state’s data portal as opposed to CDC’s National Surveillance Data table. That table only had complete data for Iowa as recent as 2011 (32%). Iowa’s data portal shows a similar percentage of children (31%) tested in 2011, but the rest of the state’s data shows a decline into 2015. Iowa Department of Public Health, Iowa Public Health Tracking Portal, “Annual Testing Children Under 6 > State Measures,” Retrieved on October 27, 2016, https://pht.idph.state.ia.us/Dashboards/Dashboards/Annual%20Testing%20Children%20Under%206/State%20Measures.aspx
E – Safer Chemicals, Healthy Families (SCHF) found that on CDC’s National Surveillance Data table, the 2010 population of the row labeled “New York (Excl. NYC)” appears to include all of New York State based on comparisons to 2010 Census data. We assumed that this was the case for the other years of population data and that all of the screening numbers for “New York (Excl. NYC)” and “New York City” were properly labeled. Therefore, this percentage was calculated by adding the screening numbers from both of those categories but only using the population in the row labeled “New York (Excl. NYC)” for the denominator.
F – The testing rates are from 2014 and 2015, respectively for columns E and F, before the state instituted universal testing in 2016.
Also, in Maryland, parents are only required to provide proof of a lead test to enroll their child in the programs listed in column B where the child currently lives or previously lived in an “at-risk” area. The state defines this as all areas of the state for children born in and after 2015, but only specific at-risk zip codes for those born before 2015.
G – The percentages in columns E and F do not reflect any children who were tested between birth and 6 months. The percentage in column F may reflect children tested at 72 months.
Additionally, the numerator for the percentage in column E was taken from the 2014 state report because CDC’s Environmental Public Health Tracking Program (Tracking Program) currently does not display Louisiana data for 2014. The denominator is from 2010 Census population data. To obtain the population of children aged 6 mo. through 11 mo., because screening numbers were not provided for children from birth to 6 months, we divided the census population for children under age 1 in half. Huynh, Ngoc, “Louisiana Healthy Homes and Lead Poisoning Surveillance System Report, 2014,” November 20, 2015, p. 0, http://www.dhh.louisiana.gov/assets/oph/Center-PHCH/Center-PH/genetic/LEAD/SurvellianceData/DHHLeadSurveillanceReport2014.pdf
H – The percentages of children tested under 72 months were taken from publicly available state reports for these states because CDC data was not complete or available: Alaska, Illinois, Louisiana, Nebraska, and Texas. Wyoming’s data was provided directly to SCHF by staff. Iowa’s data also comes from a state report but for different reasons than these states, so it is discussed in note D above.
I – The Tracking Program does display the percentage of Delaware children reported to be tested for lead under 36 months in 2011. However, the annual number of children tested used to derive that percentage was not consistent with either National Surveillance Data or state data for 2011, so it is not shown here.
J – Missouri Department of Health and Senior Services staff confirmed via email message on November 1, 2016 that 2013 was the most recent and complete year for annual numbers of Missouri children tested under 36 months in the Tracking Program’s portal. Accordingly, the table shows the percentage from 2013.
K – This percentage was taken from the 2014 Illinois state surveillance report rather than the Tracking Program data because the annual testing numbers in this portal, on which the percentages are based, looked consistent with CDC National Surveillance Data that was labeled incomplete.
L – Virginia’s reporting requirements were amended effective October 20, 2016 to require laboratories and doctors to report all detectable BLLs in children under 15; previously only levels at 10 μg/dL and above were required to be reported. 33:2 VA.R. September 19, 2016; 12VAC5-90, http://register.dls.virginia.gov/details.aspx?id=5917
M – Staff in the California Department of Public Health mentioned by email on July 21, 2016 that the Report of Health Examination required for entry into first grade has a space for the result of a blood lead test, but said it wasn’t a “specific requirement.”
N – The Tracking Program does provide the percentage of West Virginia children under 36 months reported to be tested for lead in 2011 through 2014. The annual numbers of children tested used to derive that percentage were consistent with the state’s data, but not with National Surveillance Data. Staff in the state’s Office of Maternal, Child and Family Health could not explain the difference between state data and National Surveillance Data due to recent staff turnover, and we considered the National Surveillance Data to be more reliable since CDC had put it through various screens. Therefore, we do not display the Tracking Program data for West Virginia.
O – Pennsylvania defines “lead poisoning” as a result of ≥ 20 μg/dL, or 2 or more venous levels of 15-19 μg/dL (inclusive) at least 3 months apart. 27 Pa. Code § 34(b)
P – Oklahoma State Department of Health staff said over a few phone conversations that the state requires universal testing of all children aged 12 and 24 months, and they tell this to doctors, but the rules do not clearly reflect that. The state tells providers the testing is required but most only end up testing children living in the high-risk zip codes that are actually meant to determine who needs additional testing before or after 12 or 24 months of age. Oklahoma State Department of Health staff, Telephone interviews, late May 2016, June 30, 2016, August 5, 2016
Q – Since the National Surveillance Data table did not show numbers for South Carolina, the percentage in column D reflects data from CDC’s Tracking Program, relative to 2010 census data.
R –In terms of a statewide reporting requirement, NRS 442.700, 3 states: “Each qualified laboratory that conducts a blood test for the presence of lead in a child who is under 18 years of age shall . . . submit a report of the results of the test to the appropriate health authority in accordance with regulations adopted by the State Board of Health” (emphasis added). However, staff with the Nevada Department of Health and Human Services, Division of Public and Behavioral Health stated by email on August 31, 2016 that they were not aware of any such regulations, indicating that this is an empty requirement.
S – Utah did provide data on its website, and the CDC’s Tracking Program also contained data for Utah. However, Utah has only required universal reporting since 2015; prior to that time, Utah required only results at or above 10 μg/dL to be reported. The website states that despite the limited previous requirement, most labs reported all results except for one large lab, which only reported as required. Since data from 2014 and earlier would not provide anywhere near a complete picture of the testing actually done in the state, the percentages are not provided here. Utah Admin. Code r. 386-703-3(1)(h); Utah Department of Health, Environmental Public Health Tracking, “Query Results for Query Module for Blood Lead Levels by County,” see under “Data Notes,” http://epht.health.utah.gov/epht-view/query/result/bll/BLLMain/Count.html.
T – Although SCHF found a 2012 Montana Public Health document with testing recommendations, this was not posted on what appeared to be the current Montana Lead Poisoning Prevention website. This website did not have any state recommendations and staff did not respond to questions about the current recommendations. Montana DPHHS, “Lead Poisoning Prevention,” accessed October 24, 2016, http://dphhs.mt.gov/publichealth/cdepi/diseases/lead.aspx; “Childhood lead poisoning: preventable exposure to lead continues in Montana,” Montana Public Health Prevention Opportunities Under the Big Sky, Vol. 7, Issue 12, December 2012, http://dphhs.mt.gov/Portals/85/publichealth/documents/MPH/MPH%202012/2012-12MPH.pdf
Read the Full Report
- III.Federal Testing Policies and Funding
- IV.State Lead Screening Policies and Reporting Requirements
- V.State Policies for Testing Medicaid-enrolled Children
- VI.Best Practices: Highlights From Successful Programs
- VII.Universal versus Targeted Screening
- VIII.Conclusion and Recommendations
- X.Table 1.A
- XI.Table 1.B
- XII.Table 1.C
- XIII.Table 1.D
- XIV.Table 2