Trends in tobacco smoke exposure and blood lead levels among youths and adults in the United States: the National Health and Nutrition Examination Survey, 1999-2008

Prev Chronic Dis. 2013 Dec 19;10:E213. doi: 10.5888/pcd10.130056.


Introduction: Tobacco smoke is a source of exposure to thousands of toxic chemicals including lead, a chemical of longstanding public health concern. We assessed trends in blood lead levels in youths and adults with cotinine-verified tobacco smoke exposure by using 10 years of data from the National Health and Nutrition Examination Survey.

Methods: Geometric mean levels of blood lead are presented for increasing levels of tobacco smoke exposure. Regression models for lead included age, race/ethnicity, poverty, survey year, sex, age of home, birth country, and, for adults, alcohol consumption. Lead levels were evaluated for smokers and nonsmokers on the basis of age of residence and occupation.

Results: Positive trend tests indicate that a linear relationship exists between smoke exposure and blood lead levels in youths and adults and that secondhand smoke exposure contributes to blood lead levels above the level caused by smoking.

Conclusion: Youths with secondhand smoke exposure had blood lead levels suggestive of the potential for adverse cognitive outcomes. Despite remediation efforts in housing and the environment and declining smoking rates and secondhand smoke exposure in the United States, tobacco smoke continues to be a substantial source of exposure to lead in vulnerable populations and the population in general.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Cotinine / blood
  • Emigration and Immigration / statistics & numerical data
  • Emigration and Immigration / trends
  • Environmental Exposure*
  • Female
  • Humans
  • Lead / blood*
  • Linear Models
  • Male
  • Middle Aged
  • Nutrition Surveys
  • Poverty / ethnology
  • Poverty / statistics & numerical data
  • Residence Characteristics
  • Sex Factors
  • Smoking / adverse effects*
  • Smoking / epidemiology
  • Tobacco Smoke Pollution / statistics & numerical data*
  • United States / epidemiology
  • Young Adult


  • Tobacco Smoke Pollution
  • Lead
  • Cotinine