| Exposures to Environmental Toxicants and Attention Deficit Hyperactivity Disorder in U.S. Children Joe M. Braun,1 Robert S. Kahn,2,3 Tanya Froehlich,3,4 Peggy Auinger,5 and Bruce P. Lanphear2,3 1College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA; 2Division of General and Community Pediatrics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; 3Cincinnati Children's Environmental Health Center, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; 4Division of Developmental Behavioral Pediatrics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; 5Department of Pediatrics, University of Rochester School of Medicine, Rochester, New York, USA 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. Key words: ADHD, attention deficit hyperactivity disorder, blood lead, children, environmental tobacco smoke, lead poisoning, NHANES, prenatal tobacco exposure, tobacco. Environ Health Perspect 114:1904–1909 (2006) . doi:10.1289/ehp.9478 available via http://dx.doi.org/ [Online 19 September 2006]
Address correspondence to B.P. Lanphear, Mail location 7035, 2800 Winslow Ave., Cincinnati OH 45206 USA. Telephone: (513) 636-3778. Fax: (513) 636-4402. E-mail: bruce.lanphear@cchmc.org This research was supported by grants from the National Institute of Child Health and Human Development HD40362 (R.S.K.) , HD41141 (R.S.K.) , National Research Service Award 1T32PE10027 (T.F.) , National Institutes of Health and U.S. Environmental Protection Agency PO1-ES11261 (B.P.L.) . The authors declare they have no competing financial interests. Received 1 July 2006 ; accepted 18 September 2006.
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