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Public health nurses (PHN) are critical to ensuring the health of communities. Absent the most basic information on the PHN workforce in our state, we conducted interviews with 21 PHN and school health nurse (SHN) leaders and an online survey of PHNs and SHNs practicing in Maryland (N = 491). Our study identified an older, very experienced, and well‐educated workforce. Both the interviews and survey identified similar barriers: low salaries, recruitment and hiring challenges, limited funding for public health programs, and no opportunities for education or career advancement. Survey participants also identified barriers of inadequate leadership, recognition, and communication including PHNs not being represented at decision‐making tables or at the state leadership level. Strategies to promote public health nursing from leaders and survey participants were similar: increasing awareness about what public health and PHNs do and their value; improving advocacy and stakeholder engagement; improving access and availability of services; improving PHN leadership representation at the state level; a improving PHN salaries and benefits including tuition reimbursement. Although results were similar to national studies, comprehensive, granular workforce data is critical to ensure the public health workforce can meet current and emerging public health needs and that public health infrastructure and services are appropriately funded. [ABSTRACT FROM AUTHOR]

OBJECTIVE. The objective of this study was to measure the effectiveness of intensive case management to reduce blood lead levels (BLLs) in children. Lead poisoning remains a common, preventable pediatric condition despite advances in reducing children's BLLs in the United States. Substantial evidence implicates lead paint-contaminated house dust as the most common high-dose source of lead in children's environments. Housekeeping and parental supervision also may contribute to risk for lead exposure. METHODS. We conducted a community-based, randomized trial of comprehensive education and home visiting for families of children with BLLs 15 to 19 g [micro]/dL. BLLs after 1 year of follow-up were compared for intervention group children, whose families received individualized education that was designed to address specific risks factors in a child's environment, and comparison group children, whose families received customary care, usually 1 or 2 educational visits. Environmental samples were collected at baseline and after 1 year of follow-up for intervention group children and compared with those of comparison group children, collected only at the end of study. RESULTS. During the follow-up period, parents of intervention group children (n -92) successfully decreased dust lead levels and significantly improved parent-child interaction and family housekeeping practices compared with comparison group children (n = 83). Overall geometric mean BLLs declined by 47%, and the difference in BLL by group was not significant (9 vs 8.3 g [micro]/dL for intervention versus comparison group children, respectively.) After 1 year, nearly half of enrolled children had BLLs [greater than or equal to]10 g [micro]/dL. CONCLUSIONS. Until a reservoir of lead-safe housing is created, programs that educate families to reduce environmental exposure are needed. Although providing families with quantitative information regarding lead contamination may have a role in short-term efforts to prevent lead exposure, these null findings suggest that it has little benefit once BLLs are elevated. www.pediatrics.org/cgi/doi/10.1542/ peds.2004-2880 doi:10.1542/peds.2004-2880 The findings and conclusions in this report are those of the author(s) and do not necessarily represent the views of the funding agency. Key Words Lead poisoning, home visiting, case management Abbreviations BLL--blood lead level NCATS--Nurse Child Assessment Satellite Teaching Scale GM--geometric mean CI--confidence interval, THE SERIOUS CONSEQUENCES of lead exposure during childhood have been reviewed systematically since 1943, when Byers and Lord (1) first presented data on school failure for 20 children who had [...]

To the Editor.-- The recent report by Brown et al (1) regarding the effectiveness of a randomized, controlled trial of an in-home intervention in reducing the blood lead level (BLL) [...]

A response by Mary Jean Brown to a letter to the editor about her article "A Randomized, Community-Based Trial of Home Visiting to Reduce Blood Lead Levels in Children," in a 2005 issue is presented.