Improved participation for blood lead screening with in-home phlebotomy.

Both nationally and within the State of California, it is unlikely that those children most susceptible to lead exposure are adequately screened for blood lead levels. New and creative approaches are necessary to reach these individuals. In-home phlebotomy was employed to test blood lead levels of 128 San Diego households containing Latino children aged 12-71 months. As part of a lead exposure study, these households were randomly selected from 12 census tracts in the downtown area during February-July, 2006. By employing a bicultural/bilingual phlebotomist, the participation rate for in-home phlebotomy was 89% among enrolled study participants. This rate is substantially higher than estimates for customary testing of similar underserved groups through physicians, has the advantage of reaching individuals without medical insurance, and contrasts favorably ($45 per individual test) with typical office visit costs. Culturally appropriate in-home phlebotomy may be a useful method for medical screening to meet the needs of underserved communities. Editors' Strategic Implications: The authors provide an excellent example of the importance of bringing prevention services to clients, literally in terms of the home visitation format but also with respect to the comfort level that may come from interacting with a bicultural and bilingual professional.