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Mona Saraiya, MD, MPH, Susan T. Cookson, MD, Paul Tribble, MA, Benjamin Silk, MPH, Robert Cass, RN, PHN, Shameer Poonja, MPH, Marva Walting, MPH, Noelle Howland, RN, MS, Edwin A. Paz, MD, Jennifer Cochran, MPH, Kathleen S. Moser, MD, Margaret J. Oxtoby, MD and Nancy J. Binkin, MD, MPH

At the time of this study, Mona Saraiya was with the Division of Tuberculosis Elimination, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Ga. Susan T. Cookson and Paul Tribble are with the Division of Quarantine, National Center for Infectious Diseases, Centers for Disease Control and Prevention. Benjamin Silk and Edwin A. Paz are with the San Francisco Department of Public Health, San Francisco, Calif. Robert Cass and Kathleen S. Moser are with the San Diego County Health and Human Services Agency, San Diego, Calif. Shameer Poonja and Jennifer Cochran are with the Massachusetts Department of Public Health, Boston. Marva Walting, Noelle Howland, and Margaret J. Oxtoby are with the New York State Department of Health, Albany. Nancy J. Binkin is with the Division of Tuberculosis Elimination, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention.

Correspondence: Requests for reprints should be sent to Mona Saraiya, MD, MPH, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Epidemiology Branch, Mail Stop K-55, 4770 Buford Hwy NE, Atlanta, GA 30341 (e-mail: yzs2{at}cdc.gov).

Objectives. This study sought to determine adherence of physicians to tuberculosis (TB) screening guidelines among foreign-born persons living in the United States who were applying for permanent residency.

Methods. Medical forms of applicants from 5 geographic areas were reviewed, along with information from a national physician database on attending physicians. Applicant and corresponding physician characteristics were compared among those who were and were not correctly screened.

Results. Of 5739 applicants eligible for screening via tuberculin skin test, 75% were appropriately screened. Except in San Diego, where 11% of the applicants received no screening, most of the inappropriate screening resulted from the use of chest x-rays as the initial screening tool.

Conclusions. Focused physician education and periodic monitoring of adherence to screening guidelines are warranted.

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