The effect of lead exposure on behavior problems in preschool children.

Wasserman, Gail A.; Staghezza-Jaramillo, Beatriz; Shrout, Patrick E.; Popovac, D; Graziano, Joseph H.

doi:10.2105/ajph.88.3.481

Cited by 123 publications

(72 citation statements)

References 31 publications

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“…The eventual result of this cycle might be child behavior that is sufficient to meet criteria for ADHD, conduct disorder, or some other diagnosis. This is relevant to lead studies because increased exposure has been associated with less optimal behavior in very young children (Sciarillo et al, 1992;Wasserman et al, 1998) and with increased aggression, oppositional behaviors, and juvenile delinquency in older children (Needleman et al, 1996;Needleman et al, 2002). What happens to the developmental environment as a lead-exposed child ages has largely been ignored, specifically the possibility that parenting behaviors changed over time, at least in part, as a result of a child's early lead exposure.…”

Section: Conceptual and Analytical Issues Germane To The Role Of Ses mentioning

confidence: 99%

Lead neurotoxicity and socioeconomic status: Conceptual and analytical issues

Bellinger

2008

NeuroToxicology

130

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Socioeconomic status (SES) is usually considered to be a potential confounder of the association between lead exposure and children's neurodevelopment, but experimental and epidemiological data suggest that SES might also modify lead neurotoxicity. The basis of this effect modification is uncertain, but might include differences among SES strata in co-exposures to other neurotoxicants, genetic susceptibilities, environmental enrichment, and stress. The role of SES in the causal nexus is likely to include other dimensions, however. It conveys information about lead exposure opportunities as well as about predictors of child outcome that are correlated with but causally independent of lead. Failure to distinguish these aspects of SES will lead to an underestimate of lead's contribution, and might even result in attributing to SES health effects that should be attributed to lead. Conventional models, which treat SES and SES-related factors solely as potential confounders, do not capture the possibility that a child's early lead exposure alters the behaviors that the child elicits from others. Failure to model lead's contribution to such time-varying covariates will also tend to bias estimates of lead neurotoxicity toward the null. On a transgenerational level, low SES might be a proxy for vulnerability to lead. To estimate the burden of lead-associated neurotoxicity on a population level, we need to apply analytical approaches that model a child's development and its context as a complex system of interdependent relationships that change over time.Socioeconomic status (SES) has played a central role in efforts to characterize the magnitude of the risk that lead poses to children. Because exposure is often greater among children of low SES (Baghurst et al., 1999) and low SES is a powerful predictor of neurodevelopment (Tong et al., 2007), it has long been recognized that due consideration must be given to the possibility that any observed association between lead exposure and neurodevelopment is, in part, an artifact of residual confounding, and thus reflects a Type I error of inference. Indeed, adjusting for SES and related covariates can result in reductions of 50% or more in the magnitude of lead's regression coefficient (e.g., Bellinger et al., 1992). Whether an investigator adequately handled this issue, avoiding a Type I error of inference, became one of the central determinants of whether the inferences drawn from a lead study were viewed as credible.The role of SES in lead studies is likely to be much more complex than that of solely a confounder, however. Two dimensions of this issue are discussed in this paper. The first section summarizes epidemiologic and experimental findings suggesting that SES and SES-related aspects of a child's social environment modify the neurotoxicity of lead such that children of

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Section: Conceptual and Analytical Issues Germane To The Role Of Ses mentioning

confidence: 99%

Lead neurotoxicity and socioeconomic status: Conceptual and analytical issues

Bellinger

2008

NeuroToxicology

130

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“…Our data indicate that prenatal and childhood exposure to environmental Pb is associated with a wide range of health outcomes, induding decrements in intelligence (14,20,30), increases in blood pressure (21), higher risks of proteinuria, increases in behavior problems (40), and perturbed hematopoiesis .…”

Section: Discussionmentioning

confidence: 89%

The Yugoslavia Prospective Study of environmental lead exposure.

Factor-Litvak

Wasserman

Kline

et al. 1999

Environ Health Perspect

Self Cite

103

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The Yugoslavia Prospective Study of environmental lead exposure has studied the associations between exposure to lead and pregnancy outcomes; childhood neuropsychological, behavioral, and physical development; and hematologic, renal, and cardiovascular function. The cohort comprises 577 children born to women recruited at midpregnancy in two towns in Kosovo, Yugoslavia; one town is the site of a lead smelter, refinery, and battery plant and the other is 25 miles away and relatively unexposed. A sample of these children has been followed at 6-month intervals through 7.5 years of age. Blood lead concentrations ranged from 1 to 70 microg/dl. Exposure to lead was not associated with adverse pregnancy outcomes. Exposure was associated with modest decrements in intelligence, small increases in blood pressure, higher risks of proteinuria, small increases in behavior problems, and perturbed hematopoiesis. Only at low level exposures (i.e., <16 microg/dl) were small associations with decreased height found. We discuss methodological problems that may hinder causal interpretation of these data, namely, use of blood lead concentration as an exposure measure, confounding, and town-specific associations. We conclude that while reported associations are small, collectively they lend support to the notion that lead is a toxicant with numerous adverse health effects. Images Figure 1

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“…In both towns combined, PbB measured concurrently with the Child Behavior Checklist was associated with small increases in behavioral problems, which the authors considered small compared with the effects of social factors (Wasserman et al 1998). In a subsequent publication, Wasserman et al (2000a) observed that while postnatal elevations that occurred before the age of 2 years and continued afterwards were associated with the largest decrements in IQ (50% increase in postnatal lead associated with 2.71 point IQ loss), elevations in PbB that occurred only after the age of 2 years were also associated with decrements.…”

Section: Health Effectsmentioning

confidence: 99%