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Early childhood lead exposure is associated with numerous adverse health effects. Eliminating blood lead poisoning is a national health objective for 2020.To assess temporal trends in childhood elevated blood lead level (EBLL) rates.Laboratory surveillance data were collected from 1997 to 2011 and analyzed in 2013 using linear regression to assess trends in confirmed EBLL rates among children aged6 years in the U.S., New York State ([NYS], excluding New York City), and Monroe County NY. Monroe County was also examined as a case study of local public health efforts to reduce childhood lead exposures. Blood lead screening and home lead hazard inspection data were collected from 1990 to 2012 and analyzed in 2013.The prevalence of EBLL≥10 μg/dL per 100 tested children decreased from 13.4 to 1.1 in Monroe County, 6.3 to 1.0 in NYS, and 7.6 to 0.6 in the U.S. between 1997 and 2011. The absolute yearly rate of decline in Monroe County (slope=-0.0083, p0.001) occurred 2.4-fold faster than that in NYS (slope=-0.0034, p0.001) and 1.8-fold faster than that in the U.S. (slope=-0.0046, p0.001). The childhood blood lead testing rate was consistently higher in Monroe County than in NYS and the U.S.; however, testing increased for all three areas (all slopes0, p0.05), with greater improvements observed for U.S. children overall (slope=0.0075, p0.001).In addition to national and statewide policies, local efforts may be important drivers of population-based declines in childhood EBLL rates.