Association between postnatal second-hand smoke exposure and ADHD in children: a systematic review and meta-analysis
Abstract
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder which is caused by the interplay of genetic and environmental risk factors such as second-hand smoke (SHS). The association between postnatal exposure to SHS and ADHD risk in children was still inconclusive. We performed a systematic review and meta-analysis to explore the definite association. We searched for relevant studies from PubMed, Embase, Ovid, and Web of Science databases up to January 2020. We used random effect models to calculate pooled odds ratio (OR) with 95% confidence interval (CI). Subgroup analyses and sensitive analyses were also performed to solve the heterogeneity. According to our inclusion criteria, 9 studies including 6 cross-sectional studies, 2 cohort studies, and 1 case-control study were included in the final analysis. Postnatal exposure to SHS increased the risk of ADHD in children (OR: 1.60; 95% CI: 1.37-1.87). Children who exposed to SHS were found a slight risk for conduct problems (OR: 1.33, 95% CI: 1.00-1.77). Among the studies which used cotinine as a biomarker for SHS exposure, a lower pooled OR (OR = 1.16, 95%CI = 1.01, 1.33) was observed between cotinine and ADHD in children. Our meta-analysis results suggested that SHS exposure may be a risk factor for ADHD. We also found that SHS exposure may be associated with some adverse behavioral outcomes. More prospective studies should be conducted to confirm the relationship between SHS exposure and ADHD in childre…
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Secondhand smoke exposure in childhood is linked to 60% higher odds of ADHD.
“A meta-analysis of nine studies spanning three continents and over 100,000 participants found that childhood exposure to secondhand cigarette smoke was associated with a 60% greater likelihood of ADHD.”
From The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder (2021) · cites this paper as Huang et al., 2020
Whether the secondhand-smoke association is causal or confounded remains uncertain.
“It was unclear to what extent the association was causal versus due to confounders”
From The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder (2021) · cites this paper as Huang et al., 2020
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Faraone, S. V., Banaschewski, T., Coghill, D., Zheng, Y., Biederman, J., Bellgrove, M. A., Newcorn, J. H., Gignac, M., Al Saud, N. M., Manor, I., et al. (2021) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2021.01.022 · Cited by 1,545 · see citing works
“It was unclear to what extent the association was causal versus due to confounders (Huang et al., 2021).”
- Authors
- Huang, A., Wu, K., Cai, Z., Lin, Y., Zhang, X., & Huang, Y.
- Affiliations
- Shantou University (CN)
- Corresponding author
- Wu, Kusheng
- Huang, Yanhong
- Venue
- Environmental Science and Pollution Research
- Published
- 2020-10-23
- Volume
- 28
- Issue
- 2
- Pages
- 1370-1380
- ISSN
- 0944-1344 (ISSN-L)
- 1614-7499
- OpenAlex
- W3094610675
- Cited by
- 48
- References
- 7
- Citations by year
- 2026: 10 · 2025: 10 · 2024: 9 · 2023: 6 · 2022: 6 · 2021: 6 · 2020: 1
- FWCI
- 0.79
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Environmental Science and Pollution Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Yanhong Huang, M.D (190827075265313, 190823105264087, 2019ST005)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
- Keywords
- passive smoking, attention deficit hyperactivity disorder, children, postnatal exposure, environmental risk factors, conduct problems, cotinine, biomarkers of exposure, neurodevelopmental disorders
- MeSH terms
- Attention Deficit Disorder with Hyperactivity, Child, Cross-Sectional Studies, Humans, Prospective Studies, Tobacco Smoke Pollution, Case-Control Studies
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