Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 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
Free PMC article

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

Joe M Braun et al. Environ Health Perspect. 2006 Dec.
Free PMC article

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.

PubMed Disclaimer

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.
See this image and copyright information in PMC

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.

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

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

Publication types