Investigators at the University of Maryland School of Nursing, Johns Hopkins School of Public Health, and Department of Health, Providence, Rhode Island, evaluated the relationship between reading readiness test scores for children attending public kindergarten in Providence, RI, and state health department records of blood lead levels (BLLs). The median geometric mean BLL was 4.2 mcg/dL and 20% of children had at least 1 venous BLL >10 mcg/dL. Compared with children with BLLs <2 mcg/dL, increasing BLLs resulted in progressive decreases in phonological awareness literacy screening scores (PALS-K). Compared with children with BLLs <5 mcg/dL, the adjusted prevalence ratios for failing to achieve the national benchmark for reading readiness were 1.21 and 1.56 for children with BLLs of 5 to 9 and >10 mcg/L, respectively. Reading readiness scores decreased by 4.5 and 10 points for children with BLLs of 5 to 9 and >10 mcg/dL, respectively, compared with BLLs <5 mcg/dL. 
COMMENT. Lead exposure at levels well below 10 mcg/dL contributes to decreased reading readiness at kindergarten entry in an urban school district 59% Hispanic, with no evidence of a threshold. The authors recommend further investigation in other high-risk US populations, utilizing collaboration between public health, education, and community data providers. The Rhode Island Department of Health recommends annual testing for BLLs for children 9 to 72 months of age.