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Herbert L. Needleman, MD; Julie A. Riess, PhD; Michael J. Tobin, PhD; Gretchen E. Biesecker; Joel B. Greenhouse, PhD

JAMA. 1996;275(5):363-369.

Abstract
Objective.
—To evaluate the association between body lead burden and social adjustment.

Design.
—Retrospective cohort study.

Setting.
—Public school community.

Participants.
—From a population of 850 boys in the first grade at public schools, 503 were selected on the basis of a risk scale for antisocial behavior. All of the 850 boys who scored in the upper 30th percentile of the distribution on a self-reported antisocial behavior scale were matched with an equal number drawn by lot from the lower 70% of the distribution. From this sample, 301 students accepted the invitation to participate.

Exposure Measure.
—K x-ray fluorescence spectroscopy of tibia at subjects' age of 12 years.

Main Outcome Measures.
—Child Behavior Checklist (CBCL), teachers' and parents' reports, and subjects' self-report of antisocial behavior and delinquency at 7 and 11 years of age.

Results.
—Subjects, teachers, and parents were blind to the bone lead measurements. At 7 years of age, borderline associations between teachers' aggression, delinquency, and externalizing scores and lead levels were observed after adjustment for covariates. At 11 years of age, parents reported a significant lead-related association with the following CBCL cluster scores: somatic complaints and delinquent, aggressive, internalizing, and externalizing behavior. Teachers reported significant associations of lead with somatic complaints, anxious/depressed behavior, social problems, attention problems, and delinquent, aggressive, internalizing, and externalizing behavior. High-lead subjects reported higher scores in subjects' self-reports of delinquency at 11 years. High-lead subjects were more likely to obtain worse scores on all items of the CBCL during the 4-year period of observation. High bone lead levels were associated with an increased risk of exceeding the clinical score (T>70) for attention, aggression, and delinquency.

Conclusion.
—Lead exposure is associated with increased risk for antisocial and delinquent behavior, and the effect follows a developmental course.

(JAMA. 1996;275:363-369)

Author Affiliations
From the Department of Psychiatry, University of Pittsburgh (Pa) School of Medicine (Drs Needleman and Riess and Ms Biesecker); Graduate School of Public Health, University of Pittsburgh (Pa) (Dr Tobin); and Department of Statistics, Carnegie Mellon University, Pittsburgh, Pa (Dr Greenhouse).

Footnotes
Reprint requests to University of Pittsburgh Medical Center, Suite 305, Iroquois Bldg, 3600 Forbes Ave, Pittsburgh, PA 15213 (Dr Needleman).

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