Prenatal exposure to lead and tobacco has been shown to cause long-term adverse effects to the fetus and child, including decreased birthweight and premature delivery. These effects have been shown even at very low exposure levels. Since both exposures can be modified, many experts recommend screening for and counseling to prevent or reduce these exposures as part of routine prenatal care. The high infant mortality in the District of Columbia (DC) (10.2 deaths per 1,000 live births, versus 6.2 deaths per 1,000 births nationally) is incompletely understood, but disparities in health and healthcare access for minority populations, premature delivery, and low birthweight are likely contributors. Several studies and prevention programs have addressed smoking by and secondhand tobacco smoke (SHS) exposure of pregnant women living in DC in an effort to reduce the infant mortality rate, but none have addressed elevated blood lead levels (BLL) or the effects of exposure to both elevated BLL and SHS. Since DC children have high rates of both elevated BLL and SHS exposure, compared to the US population, we hypothesize that pregnant women in DC have similar high rates of elevated BLL and SHS exposure, AND that these exposures contribute to the high rates of low birthweight and decreased gestational age, and therefore to the rate of infant mortality in DC. The primary aim of this study is to determine the effectiveness of a screening and secondary prevention intervention for elevated blood lead and SHS exposure of low income, pregnant women living in Washington, DC.