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Second-hand Smoke Exposure and Blood Lead Levels in U.S. Children

Mannino, David M.*; Albalak, Rachel; Grosse, Scott; Repace, James§

doi: 10.1097/01.EDE.0000081998.02432.53
Original Article

Background: Lead is a component of tobacco and tobacco smoke, and smokers have higher blood lead levels than do nonsmokers.

Methods: We examined the relation between second-hand smoke exposure and blood lead levels in a nationally representative sample of 5592 U.S. children, age 4–16 years, who participated in the Third National Health and Nutrition Examination Survey (1988–1994). Linear and logistic regression modeling was used to adjust for known covariates.

Results: Geometric mean blood lead levels were 1.5 μg/dL, 1.9 μg/dL, and 2.6 μg/dL for children with low, intermediate, and high cotinine levels, respectively. The adjusted linear regression model showed that geometric mean blood lead levels were 38% higher (95% confidence interval [CI] = 25–52%) in children with high cotinine levels compared with children who had low cotinine levels. The logistic regression models showed that children with high cotinine levels were more likely to have blood lead levels ≥10 μg/dL than were children with low cotinine levels (odds ratio [OR] = 4.4; CI = 1.9–10.5).

Conclusions: Second-hand smoke could be associated with increased blood lead levels in U.S. children aged 4-16 years.

From the *Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, †Surveillance and Epidemiology Branch, Division of Tuberculosis Elimination, National Center for HIV, STD and TB Prevention, ‡Office of the Director, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA; and §Repace Associates, Bowie, MD.

Submitted 23 August 2002; final version accepted 23 May 2003.

Correspondence: David M. Mannino, National Center for Environmental Health, Centers for Disease Control and Prevention, 1600 Clifton Road, MS E-17, Atlanta, GA 30333. E-mail:

© 2003 Lippincott Williams & Wilkins, Inc.