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Laboratories that test New York State (NYS) employees and adult residents for lead exposure are required to report blood lead test results to the NYS Department of Health's Heavy Metals Registry. This registry is used to monitor exposures and to identify new high-risk occupational and nonoccupational activities.We used interviews conducted with people having blood lead levels of ≥25 micrograms/deciliter (μg/dL) reported to the Heavy Metals Registry to determine the primary source of lead exposure. We reviewed this information, together with demographic information, for the years 1994 through 2006.While overall there has been an increase in the number of tests being conducted on NYS residents since 1994, the vast majority of the increase is among those with the lowest blood lead levels (<10 μg/dL). Conversely, there has been a decline in the number of adults tested with blood lead levels of ≥25 μg/dL in NYS due primarily to occupational exposures. However, nonoccupational exposures do represent a relatively large percentage of the individuals with severely elevated blood lead levels (≥60 μg/dL).Although a surveillance system based on blood lead levels cannot identify the true magnitude of adult lead poisoning, the NYS Heavy Metals Registry has proven to be an important tool for identifying situations in which adult lead poisoning is occurring, and assists in guiding lead poisoning prevention among adults.