Cited by 234Attention Deficit Hyperactivity DisorderHeavy Metal Exposure and ToxicityPrenatal Substance Exposure Effects

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Association of Tobacco and Lead Exposures With Attention-Deficit/Hyperactivity Disorder

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Froehlich, Tanya E., Lanphear, Bruce P., Auinger, Peggy, Hornung, Richard, Epstein, Jeffery N., Braun, Joe, Kahn, Robert S.·2009·Pediatrics

DOI 10.1542/peds.2009-0738PMC PMC2853804

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Abstract

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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Landrigan, P. J., Fuller, R., Acosta, N. J. R., Adeyi, O., Arnold, R., Basu, N. (., Baldé, A. B., Bertollini, R., Bose-O'Reilly, S., Boufford, J. I., et al. (2018) · The Lancet · doi:10.1016/s0140-6736(17)32345-0 · Cited by 4,929
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The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder
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
“3 times more likely to have ADHD compared with those in the bottom third (Froehlich et al., 2009).”
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Practitioner Review: What have we learnt about the causes of ADHD?
Thapar, A., Cooper, M., Eyre, O., & Langley, K. (2013) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2012.02611.x · Cited by 701
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Larson, K., Russ, S. A., Kahn, R. S., & Halfon, N. (2011) · Pediatrics · doi:10.1542/peds.2010-0165 · Cited by 580
Self-citation
Prevention of Childhood Lead Toxicity
Lanphear, B. P., Lowry, J. A., Ahdoot, S., Baum, C. R., Bernstein, A. S., Bole, A., Brumberg, H. L., Campbell, C. C., Lanphear, B. P., Pacheco, S. E., et al. (2016) · PEDIATRICS · doi:10.1542/peds.2016-1493 · Cited by 320
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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: Froehlich, Tanya E.
Lanphear, Bruce P.
Auinger, Peggy
Epstein, Jeffery N.
Braun, Joe
Kahn, Robert S.
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
DOI: 10.1542/peds.2009-0738
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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Association of Tobacco and Lead Exposures With Attention-Deficit/Hyperactivity Disorder

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