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To the Editor: We read with interest the article by Dr Singer et al¹ concerning the cognitive outcomes of preschool children with prenatal exposure to cocaine. The authors make a concerted effort to control for multiple confounding variables, including sex, intelligence of caregivers, and degree of cocaine exposure. They also stress the importance of the environment in which the children are placed as a determinant of their cognitive outcome. However, they do not address lead levels, an important environmental variable known to be strongly associated with both socioeconomic status and development of cognitive ability.^2-5 We believe that the absence of this information may weaken their conclusions.

Howard A. Greller, MD
hgreller@nyc.rr.com

Robert S. Hoffman, MD
New York City Poison Control
New York, NY

1. Singer LT, Minnes S, Short E, et al. Cognitive outcomes of preschool children with prenatal cocaine exposure. JAMA. 2004;291:2448-2456. FREE FULL TEXT 2. Tong S, McMichael AJ, Baghurst PA. Interactions between environmental lead exposure and sociodemographic factors on cognitive development. Arch Environ Health. 2000;55:330-335. ISI | PUBMED 3. Blood lead levels in young children—United States and selected states, 1996-1999. MMWR Morb Mortal Wkly Rep. 2000;49:1133-1137. PUBMED 4. Mendelsohn AL, Dreyer BP, Fierman AH, et al. Low-level lead exposure and cognitive development in early childhood. J Dev Behav Pediatr. 1999;20:425-431. ISI | PUBMED 5. Tong S, Baghurst PA, Sawyer MG, Burns J, McMichael AJ. Declining blood lead levels and changes in cognitive function during childhood: the Port Pirie Cohort Study. JAMA. 1998;280:1915-1919. FREE FULL TEXT

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2004;292:1021.

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