Jianghong Liu1, Xianchen Liu2, Wei Wang3, Linda McCauley4, Jennifer Pinto-Martin1, Yingjie Wang5, Linda Li5, Chonghuai Yan6, Walter J Rogan7. 1. School of Nursing, University of Pennsylvania, Philadelphia2School of Medicine, University of Pennsylvania, Philadelphia. 2. School of Medicine, Indiana University, Indianapolis4School of Public Health, Shandong University, Jinan, China. 3. Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 4. Nell Hodgson School of Nursing, Emory University, Atlanta, Georgia. 5. School of Nursing, University of Pennsylvania, Philadelphia. 6. Xinhua Hospital, MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai Jiaotong University School of Medicine, China. 7. National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland.
Abstract
IMPORTANCE: The association between lead exposure and children's IQ has been well studied, but few studies have examined the effects of blood lead concentrations on children's behavior. OBJECTIVE: To evaluate the association between blood lead concentrations and behavioral problems in a community sample of Chinese preschool children with a mean blood lead concentration of less than 10 µg/dL. DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study was conducted at 4 preschools in Jintan, Jiangsu province of China. Participants included 1341 children aged 3 to 5 years. EXPOSURES: Lead. MAIN OUTCOMES AND MEASURES: Blood lead concentrations were measured in children aged 3 to 5 years. Behavioral problems were assessed using Chinese versions of the Child Behavior Checklist and Caregiver-Teacher Report Form when children were aged 6 years. RESULTS: The mean (SD) blood lead concentration was 6.4 (2.6) µg/dL, with the 75th and 90th percentiles being 7.5 and 9.4 µg/dL, respectively. General linear modeling showed significant associations between blood lead concentrations and increased scores for teacher-reported behavioral problems. A 1-µg/dL increase in the blood lead concentration resulted in a 0.322 (95% CI, 0.058 to 0.587), 0.253 (95% CI, 0.016 to 0.500), and 0.303 (95% CI, 0.046 to 0.560) increase of teacher-reported behavior scores on emotional reactivity, anxiety problems, and pervasive developmental problems, respectively (P < .05), with adjustment for parental and child variables. Spline modeling showed that mean teacher-reported behavior scores increased with blood lead concentrations, particularly for older girls. CONCLUSIONS AND RELEVANCE: Blood lead concentrations, even at a mean concentration of 6.4 µg/dL, were associated with increased risk of behavioral problems in Chinese preschool children, including internalizing and pervasive developmental problems. This association showed different patterns depending on age and sex. As such, continued monitoring of blood lead concentrations, as well as clinical assessments of mental behavior during regular pediatric visits, may be warranted.
IMPORTANCE: The association between lead exposure and children's IQ has been well studied, but few studies have examined the effects of blood lead concentrations on children's behavior. OBJECTIVE: To evaluate the association between blood lead concentrations and behavioral problems in a community sample of Chinese preschool children with a mean blood lead concentration of less than 10 µg/dL. DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study was conducted at 4 preschools in Jintan, Jiangsu province of China. Participants included 1341 children aged 3 to 5 years. EXPOSURES: Lead. MAIN OUTCOMES AND MEASURES: Blood lead concentrations were measured in children aged 3 to 5 years. Behavioral problems were assessed using Chinese versions of the Child Behavior Checklist and Caregiver-Teacher Report Form when children were aged 6 years. RESULTS: The mean (SD) blood lead concentration was 6.4 (2.6) µg/dL, with the 75th and 90th percentiles being 7.5 and 9.4 µg/dL, respectively. General linear modeling showed significant associations between blood lead concentrations and increased scores for teacher-reported behavioral problems. A 1-µg/dL increase in the blood lead concentration resulted in a 0.322 (95% CI, 0.058 to 0.587), 0.253 (95% CI, 0.016 to 0.500), and 0.303 (95% CI, 0.046 to 0.560) increase of teacher-reported behavior scores on emotional reactivity, anxiety problems, and pervasive developmental problems, respectively (P < .05), with adjustment for parental and child variables. Spline modeling showed that mean teacher-reported behavior scores increased with blood lead concentrations, particularly for older girls. CONCLUSIONS AND RELEVANCE: Blood lead concentrations, even at a mean concentration of 6.4 µg/dL, were associated with increased risk of behavioral problems in Chinese preschool children, including internalizing and pervasive developmental problems. This association showed different patterns depending on age and sex. As such, continued monitoring of blood lead concentrations, as well as clinical assessments of mental behavior during regular pediatric visits, may be warranted.
Authors: Jianghong Liu; Linda A McCauley; Yang Zhao; Hanzhe Zhang; Jennifer Pinto-Martin Journal: Int J Epidemiol Date: 2009-05-11 Impact factor: 7.196
Authors: Jianghong Liu; Linda McCauley; Patrick Leung; Bo Wang; Herbert Needleman; Jennifer Pinto-Martin Journal: Int J Nurs Stud Date: 2011-05-23 Impact factor: 5.837
Authors: David C Bellinger; Howard Hu; Kartigeyan Kalaniti; Naveen Thomas; Pradeep Rajan; Sankar Sambandam; Padmavathi Ramaswamy; Kalpana Balakrishnan Journal: Int J Occup Environ Health Date: 2005 Apr-Jun
Authors: Bruce P Lanphear; Richard Hornung; Jane Khoury; Kimberly Yolton; Peter Baghurst; David C Bellinger; Richard L Canfield; Kim N Dietrich; Robert Bornschein; Tom Greene; Stephen J Rothenberg; Herbert L Needleman; Lourdes Schnaas; Gail Wasserman; Joseph Graziano; Russell Roberts Journal: Environ Health Perspect Date: 2005-07 Impact factor: 9.031
Authors: Xia Huo; Lin Peng; Xijin Xu; Liangkai Zheng; Bo Qiu; Zongli Qi; Bao Zhang; Dai Han; Zhongxian Piao Journal: Environ Health Perspect Date: 2007-07 Impact factor: 9.031
Authors: Joseph Murray; Yulia Shenderovich; Frances Gardner; Christopher Mikton; James H Derzon; Jianghong Liu; Manuel Eisner Journal: Crime Justice Date: 2018-03-26
Authors: Rebecca L Ruebner; Stephen R Hooper; Carisa Parrish; Susan L Furth; Jeffrey J Fadrowski Journal: Pediatr Nephrol Date: 2019-07-20 Impact factor: 3.714
Authors: Joseph M Braun; Richard Hornung; Aimin Chen; Kim N Dietrich; David E Jacobs; Robert Jones; Jane C Khoury; Stacey Liddy-Hicks; Samantha Morgan; Suzette Baez Vanderbeek; Yingying Xu; Kimberly Yolton; Bruce P Lanphear Journal: JAMA Pediatr Date: 2018-10-01 Impact factor: 16.193
Authors: Jianghong Liu; Siyuan Cao; Zehang Chen; Adrian Raine; Alexandra Hanlon; Yuexian Ai; Guoping Zhou; Chonghuai Yan; Patrick W Leung; Linda McCauley; Jennifer Pinto-Martin Journal: Int J Epidemiol Date: 2015-08-31 Impact factor: 7.196