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Association of Tobacco and Lead Exposures With Attention-Deficit/Hyperactivity Disorder
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OBJECTIVE: The study objective was to determine the independent and joint associations of prenatal tobacco and childhood lead exposures with attention-deficit/hyperactivity disorder (ADHD), as defined by current diagnostic criteria, in a national sample of US children. METHODS: Data are from the 2001–2004 National Health and Nutrition Examination Survey, a cross-sectional, nationally representative sample of the US population. Participants were 8 to 15 years of age (N = 2588). Prenatal tobacco exposure was measured by report of maternal cigarette use during pregnancy. Lead exposure was assessed by using current blood lead levels. The Diagnostic Interview Schedule for Children was used to ascertain the presence of ADHD in the past year, on the basis of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. RESULTS: A total of 8.7% (95% confidence interval [CI]: 7.3%–10.1%) of children met criteria for ADHD. Prenatal tobacco exposure (adjusted odds ratio [aOR]: 2.4 [95% CI: 1.5–3.7]) and higher current blood lead concentrations (aOR for third versus first tertile: 2.3 [95% CI: 1.5–3.8]) were independently associated with ADHD. Compared with children with neither exposure, children with both exposures (prenatal tobacco exposure and third-tertile lead levels) had an even greater risk of ADHD (aOR: 8.1 [95% CI: 3.5–18.7]) than would be expected if the independent risks were multiplied (tobacco-lead exposure interaction term, P < .001). CONCLUSIONS: Prenatal tobacco and childhood lead exposures are associated with ADHD in US children, especially among those with both exposures. Reduction of these common toxicant exposures may be an important avenue for ADHD prevention.
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“those with blood lead levels in the top third were 2.3 times more likely to have ADHD compared with those in the bottom third”
From The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder (2021) · cites this paper as Froehlich et al., 2009
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Metadata
- Authors
- Froehlich, T. E., Lanphear, B. P., Auinger, P., Hornung, R., Epstein, J. N., Braun, J., & Kahn, R. S.
- Affiliations
- Cincinnati Children's Hospital Medical Center (US)
- University of North Carolina at Chapel Hill (US)
- ORCID
- Venue
- Pediatrics
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2009-12-01
- Volume
- 124
- Issue
- 6
- Pages
- e1054-e1063
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- PMC
- PMC2853804
- OpenAlex
- W2158418624
- Semantic Scholar
- 7de415720fe8926449c3fe675e6655eee30fdb13
- Cited by
- 234
- References
- 85
- Citations by year
- 2026: 3 · 2025: 13 · 2024: 13 · 2023: 7 · 2022: 9 · 2021: 9 · 2020: 14 · 2019: 8 · 2018: 17 · 2017: 12 · 2016: 10 · 2015: 20 · 2014: 20 · 2013: 22 · 2012: 19
- FWCI
- 9.98
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- PEDIATRICS (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
- UNC Libraries
- Funders
- U.S. Department of Health and Human Services
- National Institutes of Health
- Centers for Disease Control and Prevention
- National Institute of Mental Health (K23MH083881)
- National Institute of Child Health and Human Development
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (T32HD052468, K12HD028827)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Heavy Metal Exposure and Toxicity
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
- Keywords
- attention deficit hyperactivity disorder, prenatal tobacco exposure, lead exposure, blood lead levels, childhood lead poisoning, smoking during pregnancy, combined toxicant exposure, exposure interactions, ADHD prevention, children
- MeSH terms
- Adolescent, Attention Deficit Disorder with Hyperactivity, Child, Cross-Sectional Studies, Female, Health Surveys, Humans, Infant, Newborn, Lead, Lead Poisoning, Male, Pregnancy, Prenatal Exposure Delayed Effects, Smoking, United States, Causality
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