title: Association of environmental toxicants and conduct disorder in U.S. children: NHANES 2001-2004.
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.
authors.affiliation: Department of Epidemiology, University of North Carolina Chapel Hill, Chapel Hill, NC 27599-7435, USA. jmbraun@unc.edu
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Braun
authors.forename: Tanya E
authors.initials: TE
authors.lastname: Froehlich
authors.forename: Julie L
authors.initials: JL
authors.lastname: Daniels
authors.forename: Kim N
authors.initials: KN
authors.lastname: Dietrich
authors.forename: Richard
authors.initials: R
authors.lastname: Hornung
authors.forename: Peggy
authors.initials: P
authors.lastname: Auinger
authors.forename: Bruce P
authors.initials: BP
authors.lastname: Lanphear
mesh_terms: D000293:Adolescent; D002648:Child; D019955:Conduct Disorder / Q000139:chemically induced*; D003367:Cotinine / Q000097:blood; D003430:Cross-Sectional Studies; D004781:Environmental Exposure / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007854:Lead / Q000097:blood; D008297:Male; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*; D014481:United States
chemical_list: D014028:Tobacco Smoke Pollution; D007854:Lead; D003367:Cotinine