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. 2006 Dec;114(12):1904-9.
doi: 10.1289/ehp.9478.

Exposures to environmental toxicants and attention deficit hyperactivity disorder in U.S. children

Joe M Braun  1 , Robert S Kahn, Tanya Froehlich, Peggy Auinger, Bruce P Lanphear
Affiliations

Exposures to environmental toxicants and attention deficit hyperactivity disorder in U.S. children

Joe M Braun et al. Environ Health Perspect. 2006 Dec.

Abstract

Objective: The purpose of this study was to examine the association of exposures to tobacco smoke and environmental lead with attention deficit hyperactivity disorder (ADHD).

Methods: Data were obtained from the National Health and Nutrition Examination Survey 1999-2002. Prenatal and postnatal tobacco exposure was based on parent report; lead exposure was measured using blood lead concentration. ADHD was defined as having current stimulant medication use and parent report of ADHD diagnosed by a doctor or health professional.

Results: Of 4,704 children 4-15 years of age, 4.2% were reported to have ADHD and stimulant medication use, equivalent to 1.8 million children in the United States. In multivariable analysis, prenatal tobacco exposure [odds ratio (OR) = 2.5; 95% confidence interval (CI), 1.2-5.2] and higher blood lead concentration (first vs. fifth quintile, OR = 4.1; 95% CI, 1.2-14.0) were significantly associated with ADHD. Postnatal tobacco smoke exposure was not associated with ADHD (OR = 0.6; 95% CI, 0.3-1.3; p = 0.22). If causally linked, these data suggest that prenatal tobacco exposure accounts for 270,000 excess cases of ADHD, and lead exposure accounts for 290,000 excess cases of ADHD in U.S. children.

Conclusions: We conclude that exposure to prenatal tobacco and environmental lead are risk factors for ADHD in U.S. children.

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Figures

Figure 1
Figure 1
AOR for ADHD among U.S. children, NHANES 1999–2002, by blood lead concentration (μg/dL). The model was adjusted for child’s age, sex, race/ethnicity, preschool attendance, serum ferritin, prenatal ETS exposure, smoker in the household, and insurance status. p-value for trend = 0.012.
Figure 2
Figure 2
AOR for ADHD among U.S. children by prenatal ETS exposure and sex. The risk for ADHD among ETS-exposed children was greater in females; females who were prenatally exposed to tobacco were at 4.6-fold higher risk for ADHD compared with unexposed females (OR = 4.6; 95% CI, 1.7–12.4), whereas exposed males were at 2-fold higher risk for ADHD compared with unexposed males (OR = 2.1; 95% CI, 0.9–4.7) (p = 0.141 for sex by prenatal ETS exposure interaction). Model adjusted for race/ethnicity, sex, age, blood lead level, ferritin level, presence of a smoker in the home, preschool attendance, and insurance status.
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Comment in

  • Lead and neuroprotection by iron in ADHD.
    Konofal E, Cortese S. Konofal E, et al. Environ Health Perspect. 2007 Aug;115(8):A398-9; author reply A399. doi: 10.1289/ehp.10304. Environ Health Perspect. 2007. PMID: 17687422 Free PMC article. No abstract available.
  • Environmental exposures and ADHD.
    Brondum J. Brondum J. Environ Health Perspect. 2007 Aug;115(8):A398; author reply A399. doi: 10.1289/ehp.10274. Environ Health Perspect. 2007. PMID: 17687423 Free PMC article. No abstract available.

References

    1. APA 1994. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington DC:American Psychiatric Associations.
    1. Bellinger D, Hu H, Titlebaum L, Needleman HL. Attentional correlates of dentin and bone lead levels in adolescents. Arch Environ Health. 1994;49(2):98–105. - PubMed
    1. Bellinger DC, Needleman HL. Intellectual impairment and blood lead levels. N Engl J Med. 2003;349(5):500–502. - PubMed
    1. Bernert JT, Jr, McGuffey JE, Morrison MA, Pirkle JL. Comparison of serum and salivary cotinine measurements by a sensitive high-performance liquid chromatography-tandem mass spectrometry method as an indicator of exposure to tobacco smoke among smokers and nonsmokers. J Anal Toxicol. 2000;24(5):333–339. - PubMed
    1. Burns JM, Baghurst PA, Sawyer MG, McMichael AJ, Tong SL. Lifetime low-level exposure to environmental lead and children’s emotional and behavioral development at ages 11–13 years. The Port Pirie Cohort Study. Am J Epidemiol. 1999;149(8):740–749. - PubMed

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