Environ Health Perspect

Background:The CDC recommends a targeted strategy for childhood blood lead screening based on participation in federal programs, such as Medicaid and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Yet, there is scarcity of data on blood lead levels (BLLs) among WIC participants.Objective:Our objective was to investigate whether children participating in WIC and not enrolled in Medicaid, who have not been targeted in the historical Medicaid-focused screening strategy, have higher BLLs than children in neither of these programs.Methods:The analysis included 3,180 children 1\u20135 y of age in the National Health and Nutrition Examination Surveys conducted in 2007\u20132014. Log-binomial regression, which allows direct estimation of prevalence ratios, was used to examine associations between WIC participation (in conjunction with Medicaid enrollment) and having BLLs 655\u3bcg/dL with adjustment for age (1\u20132 vs. 3\u20135 y).Results:The percentage of children participating in \u201cWIC only,\u201d \u201cMedicaid only,\u201d \u201cboth WIC and Medicaid,\u201d and \u201cneither\u201d were 18.9%, 10.8%, 25.4%, and 44.9%, respectively. \u201cWIC only,\u201d \u201cMedicaid only,\u201d and \u201cboth WIC and Medicaid\u201d children were more likely to have BLLs 655\u3bcg/dL than children who were not enrolled in either program, with adjusted prevalence ratios of 3.29 [95% confidence interval (CI): 1.19, 9.09], 4.56 (95% CI: 2.18, 9.55), and 2.58 (95% CI: 1.18, 5.63).Conclusions:Children participating in WIC but not Medicaid were more likely to have BLLs 655\u3bcg/dL than children who were not enrolled in either program. These findings may inform public health recommendations and clinical practice guidelines. https://doi.org/10.1289/EHP238429961657PMC608483