title: Globalization, binational communities, and imported food risks: results of an outbreak investigation of lead poisoning in Monterey County, California.
abstract: OBJECTIVE
  Although the burden of lead poisoning has decreased across developed countries, it remains the most prevalent environmental poison worldwide. Our objective was to investigate the sources of an outbreak of lead poisoning in Monterey County, California.
  
  
  METHODS
  An investigation in 3 county health department clinics in Monterey County, California, was conducted between 2001 and 2003 to identify risk factors for elevated blood lead levels (> or = 10 microg/dL) among children and pregnant women.
  
  
  RESULTS
  The prevalence of elevated blood lead levels was significantly higher in 1 of the 3 clinics (6% among screened children and 13% among prenatal patients). Risk factors included eating imported foods (relative risk [RR]=3.4; 95% confidence interval [CI]=1.2, 9.5) and having originated from the Zimatlan area of Oaxaca, Mexico, compared with other areas of Oaxaca (RR=4.0; 95% CI=1.7, 9.5). Home-prepared dried grasshoppers (chapulines) sent from Oaxaca were found to contain significant amounts of lead.
  
  
  CONCLUSIONS
  Consumption of foods imported from Oaxaca was identified as a risk factor for elevated blood lead levels in Monterey County, California. Lead-contaminated imported chapulines were identified as 1 source of lead poisoning, although other sources may also contribute to the observed findings. Food transport between binational communities presents a unique risk for the importation of environmental hazards [corrected]
authors: Department of Family Medicine and Community Medicine, University of California, San Francisco 94110, USA. handleym@fcm.ucsf.edu
authors: Margaret A
authors: MA
authors: Handley
authors: Celeste
authors: C
authors: Hall
authors: Eric
authors: E
authors: Sanford
authors: Evie
authors: E
authors: Diaz
authors: Enrique
authors: E
authors: Gonzalez-Mendez
authors: Kaitie
authors: K
authors: Drace
authors: Robert
authors: R
authors: Wilson
authors: Mario
authors: M
authors: Villalobos
authors: Mary
authors: M
authors: Croughan
mesh_terms: D000328:Adult; D000818:Animals; D002140:California; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003132:Commerce; D004196:Disease Outbreaks; D005260:Female; D005506:Food Contamination; D006110:Grasshoppers / Q000737:chemistry; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007391:International Cooperation; D007855:Lead Poisoning / Q000453:epidemiology*; D008800:Mexico; D011247:Pregnancy; D012307:Risk Factors