Updated 18 January 2016

Childhood ADHD linked to secondhand smoking

Kids exposed to second-hand smoke are up to three times more likely to have ADHD, according to a new study.


Children exposed to tobacco smoke at home are up to three times more likely to have ADHD as unexposed kids, according to a new study from Spain.

Stronger for kids with second-hand smoke exposure

The association was stronger for ADHD kids with one or more hours of second-hand smoke exposure every day, the authors found. And the results held when researchers accounted for parents' mental health and other factors.

"We showed a significant and substantial dose-response association between (second-hand smoke) exposure in the home and a higher frequency of global mental problems," the authors write in Tobacco Control.

According to the Centres for Disease Control and Prevention, two of every five children in the US are exposed to second-hand smoke regularly.

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Alicia Padron of the University of Miami Miller School of Medicine in Florida and colleagues in Spain analysed data from the 2011 to 2012 Spanish National Health Interview Survey, in which parents of 2,357 children ages four to 12 reported the amount of time their children were exposed to second-hand smoke every day.

The parents also filled out questionnaires designed to evaluate their children's mental health. According to the results, about eight percent of the kids had a probable mental disorder.

About seven percent of the kids were exposed to second-hand smoke for less than one hour per day, and 4.5 percent were exposed for an hour or more each day.

50 percent more likely to have a mental disorder

After taking the parent's mental health, family structure and socioeconomic status into consideration, children who were exposed to second-hand smoke for less than one hour per day were 50 percent more likely to have some mental disorder compared to kids not exposed at all.

And children who were habitually exposed to second-hand smoke for an hour or more each day were close to three times more likely to have a mental disorder.

In addition, kids exposed less than one hour per day were twice as likely to have ADHD as kids who weren't exposed, and children exposed for an hour or more on a daily basis were over three times more likely to have ADHD.

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"The association between second-hand smoke and global mental problems was mostly due to the impact of second-hand smoke on the attention-deficit and hyperactivity disorder," the authors write.

The study looks at a single point in time and cannot prove that second-hand smoke exposure causes mental health problems, the study team cautions.

Frank Bandiera, a researcher with the University of Texas Health Science Centre in Houston who was not involved in the study, liked that the researchers "controlled for parents' mental health in the new study because that could be a confounder."

Mental disorders not diagnosed by physicians

But, he added, the study might be limited because, although the questionnaires are thought to be valid, the mental disorders were not actually diagnosed by physicians.

"We're not sure if it's causal or not," Bandiera told Reuters Health.

"I think (the research) is still in the early stages and the findings are inconclusive."

But, he said, since second-hand hand smoke has been related to a lot of physical diseases, parents should avoid smoking around their kids.

"We need to sort it out more, so we're not sure yet, but just as a precaution, I don't think parents should smoke at home - they should keep their kids away from second-hand smoke," Bandiera said.

Lucy Popova, from the Centre for Tobacco Control Research and Education at the University of California, San Francisco, said there is a lot of evidence about the harms of second-hand smoke on physical wellbeing.

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"But research on effects of second-hand smoke on mental health have been really just emerging and this study really contributes to this growing body of evidence that exposure to second-hand smoke in children might be responsible for cognitive and behavioural problems," she said.

Popova, who wasn't involved in the study, said no amount of second-hand smoke is safe - any exposure is bad.

"So parents should not expose their children - the best thing to do is quit," she said. "And this will not only not expose their children to the second-hand smoke, but will also let them enjoy their life with their children longer."

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Dr Renata Schoeman has been in full-time private practice as a general psychiatrist (child, adolescent and adult psychiatry) since 2008, currently based in Oude Westhof (Bellville). Renata also holds appointments as senior lecturer in Leadership (USB) and as a virtual faculty member of USB Executive Development’s Neuroleadership programme. She serves on the advisory boards of various pharmaceutical companies, as a director of the Psychiatric Management Group (PsychMG) and is the co-convenor of the South African Society of Psychiatrist (SASOP) special interest group for adult ADHD, and co-founder of the Goldilocks and The Bear Foundation ( She is passionate about corporate mental health awareness and uses her neuroscience background to assist leaders in equipping them to become balanced, healthy and dynamic leaders that take their own and their team’s emotional, intellectual, social health and physical needs into account. Renata is academically active and enjoys research and collaborative work, has published in many peer-reviewed journals, and has presented at local and international congresses. She is regularly invited to present at conferences and to engage with the media. During her post-graduate studies, she trained at Harvard, Boston in neurocognition and neuroimaging. Her awards include, amongst others, the Young Minds in Psychiatry award from the American Psychiatric Association, the Discovery Foundation Fellowship award, a Thuthuka award from the NRF, and a MRC Fellowship. She also received the Top MBA student award and the Director’s award from USB for 2015. She was a finalist for the Businesswomen’s Association of South Africa’s Businesswoman of the Year Award for 2016, and received the Excellence in Media Work award from SASOP during 2016.

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