| Association of Environmental Toxicants and Conduct Disorder in U.S. Children: NHANES 2001–2004 Joseph M. Braun,1 Tanya E. Froehlich,2,3,4 Julie L. Daniels,1 Kim N. Dietrich,5 Richard Hornung,2,3 Peggy Auinger,2 and Bruce P. Lanphear2,3 1Department of Epidemiology, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA; 2Division of General and Community Pediatrics, Department of Pediatrics, 3Cincinnati Children's Environmental Health Center, Department of Pediatrics, and 4Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; 5Division of Epidemiology and Biostatistics, The University of Cincinnati College of Medicine and Academic Health Center, Cincinnati, Ohio, USA Abstract
Objective: The purpose of this study was to examine the association of tobacco smoke and environmental lead exposure with conduct disorder (CD) . Methods: The National Health and Nutrition Examination Survey (NHANES) 2001–2004 is a nationally representative cross-sectional sample of the noninstitutionalized U.S. population. We examined the association of prenatal tobacco, postnatal tobacco, and environmental lead exposure with CD in children 8–15 years of age (n = 3,081) . We measured prenatal tobacco exposure by parent report of cigarette use during pregnancy, and postnatal tobacco using serum cotinine levels. We assessed lead exposure using current blood lead concentration. Parents completed the Diagnostic Interview Schedule for Children to determine whether their children met criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) for CD. Results: Overall, 2.06% of children met DSM-IV criteria for CD in the past year, equivalent to 560,000 U.S. children 8–15 years of age. After adjustment, prenatal tobacco exposure was associated with increased odds for CD [odds ratio (OR) = 3.00 ; 95% confidence interval (CI) , 1.36–6.63]. Increased blood lead levels (fourth vs. first quartile) and serum cotinine levels (fifth vs. first quintile) were associated with an 8.64-fold (95% CI, 1.87–40.04) and 9.15-fold (95% CI, 1.47–6.90) increased odds of meeting DSM-IV CD criteria. Increasing serum cotinine levels and blood lead levels were also associated with increased prevalence of CD symptoms (symptom count ratio, lead: 1.73 ; 95% CI, 1.23–2.43 ; symptom count ratio, cotinine: 1.97 ; 95% CI, 1.15–3.40) . Conclusions: These results suggest that prenatal tobacco exposure and environmental lead exposure contribute substantially to CD in U.S. children. Key words: conduct disorder, cotinine, epidemiology, lead poisoning, NHANES, tobacco smoke. Environ Health Perspect 116:956–962 (2008) . doi:10.1289/ehp.11177 available via http://dx.doi.org/ [Online 11 March 2008]
Address correspondence to J. Braun, CB# 7435, McGavran-Greenberg Hall, Chapel Hill, NC 27599-7435 USA. Telephone: (919) 951-8519. Fax: (919) 966-2089. E-mail: jmbraun@unc.edu We thank C. Rogers of the National Centers for Health Statistics for his assistance in accessing data. This work was supported by National Research Service Award 1T32PE10027 (T.E.F.) and National Institutes of Health and U.S. Environmental Protection Agency grant PO1-ES11261 (B.P.L.) . The authors declare they have no competing financial interests. Received 16 December 2007 ; accepted 10 March 2008.
Correction In Tables 3 and 4, the value for Age in Total no. of cases was incorrect in the manuscript originally published online ; it has been corrected here.
The full version of this article is available for free in HTML or PDF formats. |
