Country kids: no letup from lead.

Traditional wisdom holds that children living in the country enjoy healthier lives and suffer less from environmental hazards than their city cousins. Not necessarily, cautions a report in the July Pediatrics. Dale A. Newton, a pediatrician at East Carolina University School of Medicine in Greenville, N.C., and his coauthors found that children living in rural areas of the state had elevated lead concentrations that matched or exceeded those of their urban counterparts.

Indeed, one does not readily associate the image of pristine air and streams with lead poisoning. But the air and streams aren't the problem, says Newton. "Lead poisoning is associated with poverty and old housing," he says. "A compounding issue is nutrition. Children Who eat a high-fat diet that's low in calcium and low in iron also absorb more lead."

The study looked at 20,720 North Carolina children age 6 months to 6 years between November 1992 and April 1993. The study's sample derived from children routinely screened for low-income programs and thus was not random.

In 1991, the Centers for Disease Control and Prevention (CDC) in Atlanta changed its guidelines for acceptable concentrations of lead in the blood. Prior to that time, it did not recommend medical intervention for concentrations less than 25 micrograms of lead per deciliter of blood. Responding to mounting evidence of lead toxicity at lower concentrations, CDC set 10 micrograms per deciliter as a dangerous amount.

The new study found that 20.2 percent of the children had readings between 10 and 15 micrograms; more black children than white ones exhibited concentrations of 15 micrograms per deciliter; and boys showed a slightly increased risk over girls. Thomas L. Schlenker of the Salt Lake City-County Health Department says, "This is a fairly substantial study.... Most of the work on lead poisoning has concentrated on urban areas.... It's important to note that rural areas shouldn't be ignored."