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RESEARCH PAPER
Association between household secondhand smoke exposure and ADHD in US children aged 4–15 years: Evidence from NHANES 1999–2004
1
Department of Otorhinolaryngology, Changzhou Third People's Hospital, Changzhou, 213001, China
2
Changzhou Clinical College, Xuzhou Medical University, Changzhou, China
3
Department of Radiology, the People’s Hospital of Wuqia, Kezhou, China
4
Department of Eye and ENT, the People’s Hospital of Wuqia, Kezhou, China
These authors had equal contribution to this work
Submission date: 2026-03-30
Final revision date: 2026-05-12
Acceptance date: 2026-05-22
Publication date: 2026-07-16
Corresponding author
Zhibang Hu
Department of Otorhinolaryngology, Changzhou Third People's Hospital, Changzhou, 213001, China
Department of Otorhinolaryngology, Changzhou Third People's Hospital, Changzhou, 213001, China
Tob. Induc. Dis. 2026;24(July):112
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Household tobacco smoke (or secondhand smoke, SHS) exposure is a common type of environmental exposure among children, and it may be associated with the development of attention deficit hyperactivity disorder (ADHD); however, current findings remain inconsistent. This study aimed to examine the association between household SHS exposure and ADHD among US children, and to provide an epidemiological foundation for ADHD prevention and tobacco-control interventions targeting pediatric populations.
Methods:
This is a secondary analysis of pooled secondary data from the National Health and Nutrition Examination Survey (NHANES) 1999–2004. ADHD cases were identified through questionnaire-based assessments, and participants were categorized into exposed and non-exposed groups according to whether or not any household member smoked inside the home. Weighted multivariate logistic regression models were employed to evaluate the association between household SHS exposure and ADHD. In addition, subgroup and sensitivity analyses were conducted.
Results:
A total of 6790 children were included in the analysis, of whom 452 (7.97%) were classified as having ADHD. The prevalence of household SHS exposure was significantly higher among children with ADHD compared to those without (36.25% vs 22.77%, p<0.001). After adjustment for multiple confounding variables, household SHS exposure remained significantly associated with ADHD (OR=1.583; 95% CI: 1.166–2.150). Subgroup analyses stratified by sex, age, race, poverty–income ratio (PIR), body mass index (BMI), and birth weight showed that the association remained generally consistent across all strata (all p for interaction >0.05). Sensitivity analyses further confirmed the positive association between household SHS exposure and ADHD (all p<0.05).
Conclusions:
Household SHS exposure was significantly associated with ADHD among US children within our cross-sectional analysis. Future prospective investigations are required to clarify the causal relationship underlying this association.
Household tobacco smoke (or secondhand smoke, SHS) exposure is a common type of environmental exposure among children, and it may be associated with the development of attention deficit hyperactivity disorder (ADHD); however, current findings remain inconsistent. This study aimed to examine the association between household SHS exposure and ADHD among US children, and to provide an epidemiological foundation for ADHD prevention and tobacco-control interventions targeting pediatric populations.
Methods:
This is a secondary analysis of pooled secondary data from the National Health and Nutrition Examination Survey (NHANES) 1999–2004. ADHD cases were identified through questionnaire-based assessments, and participants were categorized into exposed and non-exposed groups according to whether or not any household member smoked inside the home. Weighted multivariate logistic regression models were employed to evaluate the association between household SHS exposure and ADHD. In addition, subgroup and sensitivity analyses were conducted.
Results:
A total of 6790 children were included in the analysis, of whom 452 (7.97%) were classified as having ADHD. The prevalence of household SHS exposure was significantly higher among children with ADHD compared to those without (36.25% vs 22.77%, p<0.001). After adjustment for multiple confounding variables, household SHS exposure remained significantly associated with ADHD (OR=1.583; 95% CI: 1.166–2.150). Subgroup analyses stratified by sex, age, race, poverty–income ratio (PIR), body mass index (BMI), and birth weight showed that the association remained generally consistent across all strata (all p for interaction >0.05). Sensitivity analyses further confirmed the positive association between household SHS exposure and ADHD (all p<0.05).
Conclusions:
Household SHS exposure was significantly associated with ADHD among US children within our cross-sectional analysis. Future prospective investigations are required to clarify the causal relationship underlying this association.
CONFLICTS OF INTEREST
The authors have each completed and submitted an ICMJE form for disclosure of potential conflicts of interest. The authors declare that they have no competing interests, financial or otherwise, related to the current work. W. Zhang reports that since the initial planning of the work all the payment for the present manuscript was made from the Tianshan Talent Cultivation Program of
Xinjiang Uygur Autonomous Region (2024TSYCJC0065).
FUNDING
This work was supported by Tianshan Talent Cultivation Program of
Xinjiang Uygur Autonomous Region (2024TSYCJC0065).
ETHICAL APPROVAL AND INFORMED CONSENT
Ethical approval and informed consent were not required for this study
as it is a secondary analysis of existing data.
DATA AVAILABILITY
The data supporting this research are publicly available from the
National Health and Nutrition Examination Survey (NHANES, http://
www.cdc.gov/nchs/nhanes/).
AUTHORS' CONTRIBUTIONS
YB, WZ and CW: collection and/or assembly of data. YB, WZ and XZ:
data analysis and interpretation. YB: writing the manuscript. WZ, CW,
XZ, XH and ZH: critical revision of the manuscript. ZH: research concept
and design. All authors read and approved the final version of the
manuscript.
ADDITIONAL INFORMATION
SUPPLEMENTARY FILE DISCLAIMER
The content has been provided by the author(s) and has not been reviewed, verified, or endorsed by European Publishing. It may not have undergone peer review. The views, opinions, and recommendations expressed are solely those of the author(s) and do not necessarily reflect the position of European Publishing. European Publishing accepts no responsibility or liability for any consequences arising from the use of, or reliance on, this content.
+ Co-first authors
PROVENANCE AND PEER REVIEW
Not commissioned; externally peer reviewed.
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