{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T20:47:00Z","timestamp":1791838020660,"version":"4.3.4"},"reference-count":53,"publisher":"American Chemical Society (ACS)","issue":"6","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000066","name":"National Institute of Environmental Health Sciences","doi-asserted-by":"publisher","award":["P30ES000002"],"award-info":[{"award-number":["P30ES000002"]}],"id":[{"id":"10.13039\/100000066","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000066","name":"National Institute of Environmental Health Sciences","doi-asserted-by":"publisher","award":["P42ES030990"],"award-info":[{"award-number":["P42ES030990"]}],"id":[{"id":"10.13039\/100000066","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000066","name":"National Institute of Environmental Health Sciences","doi-asserted-by":"publisher","award":["R01ES031943"],"award-info":[{"award-number":["R01ES031943"]}],"id":[{"id":"10.13039\/100000066","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Introduction: Early lead exposure is linked to cognitive function in later adulthood. In animal studies, enriched environments appear to protect against adverse effects of lead exposure, but there has been limited exploration in humans. Our objective was to assess whether engagement in cognitively stimulating activities in childhood modifies the association between early lead exposure and later adult cognitive function. Methods: Participants come from the St. Louis Baby Tooth \u2013 Later Life Health Study (SLBT), a cohort study which recruited beginning in 2021. SLBT is composed of individuals primarily from the St. Louis, USA area who donated deciduous (baby) teeth to a prior study, the Baby Tooth Survey, in 1958\u20131972. Participants who completed a survey and cognitive testing were selected through stratified random sampling for tooth lead analysis. Prenatal and postnatal tooth dentin lead concentrations were measured in the donated teeth using laser ablation inductively coupled plasma mass spectrometry. A summary cognitive function score was derived from z-scored outcomes on six cognitive tests completed online through the TestMyBrain platform. Participation in cognitively stimulating activities at ages 6, 12, and 18 years was retrospectively assessed at the time of cognitive testing with the Rush Alzheimer\u2019s Disease Center Lifetime Cognitive Activities scale. Results: From 4236 participants who completed the survey and cognitive tests, 717 had tooth metals analyzed, from which 704 had non-outlying lead measures and sufficient survey information. Participants were on average 62 years (SD = 3.6) at the time of cognitive testing, and 376 (53%) were female. The level of cognitively stimulating activities averaged across childhood modified the effect of second-trimester lead exposure on later adulthood cognitive function. For those with less-frequent childhood cognitively stimulating activities, 1 ppm higher second-trimester lead was associated with 0.34 (95% CI: \u22120.52, \u22120.16) SD lower later adulthood cognitive function, while the association among those with high cognitively stimulating activities was null (\u22120.02 SD, 95% CI: \u22120.12, 0.07). Results were robust to adjustment for additional childhood socioeconomic characteristics and restriction to white non-Hispanic race. Conclusions: Our work supports the hypothesis that engaging in cognitively stimulating activities in childhood, after earlier lead exposure, could buffer its deleterious effects on later adult cognitive function.<\/jats:p>","DOI":"10.1021\/ehp.6c00105","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T06:16:17Z","timestamp":1788243377000},"page":"699-706","source":"Crossref","is-referenced-by-count":0,"title":["The Impact of Childhood\nCognitively Stimulating Activities\non the Association between Prenatal and Early Postnatal Lead Exposure\nand Later Adulthood Cognitive Function"],"prefix":"10.1021","volume":"134","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2856-9509","authenticated-orcid":true,"given":"Ruby","family":"Hickman","sequence":"first","affiliation":[{"name":"Harvard T.H. Chan School of Public Health , , , , ,","place":["Boston, Massachusetts, United States, 02115"]},{"name":"Emory Rollins School of Public Health , , , , ,","place":["Atlanta, Georgia, United States, 30322"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joyce JY","family":"Lin","sequence":"additional","affiliation":[{"name":"Harvard T.H. Chan School of Public Health , , , , ,","place":["Boston, Massachusetts, United States, 02115"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaleigh A.","family":"McAlaine","sequence":"additional","affiliation":[{"name":"Harvard T.H. Chan School of Public Health , , , , ,","place":["Boston, Massachusetts, United States, 02115"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tracy","family":"Punshon","sequence":"additional","affiliation":[{"name":"Dartmouth College , , , , ,","place":["Hanover, New Hampshire, United States, 03755"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian P.","family":"Jackson","sequence":"additional","affiliation":[{"name":"Dartmouth College , , , , ,","place":["Hanover, New Hampshire, United States, 03755"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew N.","family":"Barr","sequence":"additional","affiliation":[{"name":"Dartmouth College , , , , ,","place":["Hanover, New Hampshire, United States, 03755"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felicitas B.","family":"Bidlack","sequence":"additional","affiliation":[{"name":"ADA Forsyth Institute, Inc. , , , , ,","place":["Somerville, Massachusetts, United States, 02143"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Germine","sequence":"additional","affiliation":[{"name":"Albert Einstein College of Medicine , , , ,","place":["New York, United States, 10461"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott M.","family":"Bartell","sequence":"additional","affiliation":[{"name":"University of California Irvine , , , , ,","place":["Irvine, California, United States, 92617"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph J.","family":"Mangano","sequence":"additional","affiliation":[{"name":"Radiation and Public Health Project , , , ,","place":["Ocean City, New Jersey, United States, 08226"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Farmer","sequence":"additional","affiliation":[{"name":"Harvard T.H. Chan School of Public Health , , , , ,","place":["Boston, Massachusetts, United States, 02115"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel D.","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Harvard T.H. Chan School of Public Health , , , , ,","place":["Boston, Massachusetts, United States, 02115"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajarshi","family":"Mukherjee","sequence":"additional","affiliation":[{"name":"Harvard T.H. Chan School of Public Health , , , , ,","place":["Boston, Massachusetts, United States, 02115"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan A.","family":"Korrick","sequence":"additional","affiliation":[{"name":"Harvard T.H. Chan School of Public Health , , , , ,","place":["Boston, Massachusetts, United States, 02115"]},{"name":"Brigham and Women\u2019s Hospital and Harvard Medical School , , , , ,","place":["Boston, Massachusetts, United States, 02115"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc G.","family":"Weisskopf","sequence":"additional","affiliation":[{"name":"Harvard T.H. Chan School of Public Health , , , , ,","place":["Boston, Massachusetts, United States, 02115"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"316","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"2026101215563442300_cit1","unstructured":"ACCLP.\n          .  Low Level Lead Exposure Harms Children: A Renewed Call\nfor Primary Prevention. US Department of\nHealth & Human Services, Centers for Disease Control and Prevention,\nAdvisory Committee on Childhoood Lead Poisoning Prevention.2012."},{"issue":"6","key":"2026101215563442300_cit2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000214616","article-title":"Prenatal and Early Postnatal Lead Exposure and Later Adulthood Cognitive\nFunction in the St. Louis Baby Tooth - Later Life Health Study","volume":"106","author":"Hickman","year":"2026","journal-title":"Neurology."},{"key":"2026101215563442300_cit3","doi-asserted-by":"publisher","first-page":"101037","DOI":"10.1016\/j.ssmph.2022.101037","article-title":"Effect of childhood proximity to\nlead mining on late life cognition","volume":"17","author":"Lee","year":"2022","journal-title":"SSM - Population\nHealth."},{"issue":"45","key":"2026101215563442300_cit4","doi-asserted-by":"publisher","DOI":"10.1126\/sciadv.abn5164","article-title":"Childhood lead exposure\nis associated with lower cognitive functioning at older ages","volume":"8","author":"Lee","year":"2022","journal-title":"Sci. Adv."},{"issue":"12","key":"2026101215563442300_cit5","doi-asserted-by":"publisher","first-page":"1244","DOI":"10.1001\/jama.2017.1712","article-title":"Association of Childhood\nBlood Lead Levels With Cognitive Function and Socioeconomic Status\nat Age 38 Years and With IQ Change and Socioeconomic Mobility Between\nChildhood and Adulthood","volume":"317","author":"Reuben","year":"2017","journal-title":"JAMA"},{"key":"2026101215563442300_cit6","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1186\/1476-069X-10-24","article-title":"Low-level environmental lead exposure in childhood\nand adult intellectual function: a follow-up study","volume":"10","author":"Mazumdar","year":"2011","journal-title":"Environ. Health."},{"issue":"3","key":"2026101215563442300_cit7","doi-asserted-by":"publisher","first-page":"e145","DOI":"10.1016\/S2542-5196(20)30278-3","article-title":"Blood lead\nlevels in low-income and middle-income countries: a systematic review","volume":"5","author":"Ericson","year":"2021","journal-title":"Lancet Planetary Health."},{"issue":"12","key":"2026101215563442300_cit8","doi-asserted-by":"publisher","first-page":"1252","DOI":"10.1001\/jamapediatrics.2021.3518","article-title":"Individual- and\nCommunity-Level Factors Associated With Detectable and Elevated Blood\nLead Levels in US Children: Results From a National Clinical Laboratory","volume":"175","author":"Hauptman","year":"2021","journal-title":"JAMA Pediatrics."},{"issue":"1","key":"2026101215563442300_cit9","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1542\/peds.114.1.19","article-title":"Effect of Chelation\nTherapy on the Neuropsychological and Behavioral Development of Lead-Exposed\nChildren After School Entry","volume":"114","author":"Dietrich","year":"2004","journal-title":"Pediatrics."},{"issue":"19","key":"2026101215563442300_cit10","doi-asserted-by":"publisher","first-page":"1421","DOI":"10.1056\/NEJM200105103441902","article-title":"The Effect of Chelation\nTherapy with Succimer on Neuropsychological Development in Children\nExposed to Lead","volume":"344","author":"Rogan","year":"2001","journal-title":"New England Journal of Medicine."},{"issue":"8","key":"2026101215563442300_cit11","doi-asserted-by":"publisher","first-page":"085002","DOI":"10.1289\/EHP12371","article-title":"Neurotoxicity\nand Outcomes from Developmental Lead Exposure: Persistent or Permanent?","volume":"131","author":"Schneider","year":"2023","journal-title":"Environmental Health Perspectives."},{"issue":"1","key":"2026101215563442300_cit12","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1002\/ana.10399","article-title":"Environmental enrichment\nreverses cognitive and molecular deficits induced by developmental\nlead exposure","volume":"53","author":"Guilarte","year":"2003","journal-title":"Ann. Neurol."},{"issue":"1","key":"2026101215563442300_cit13","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1016\/S0006-8993(00)03249-2","article-title":"Enriched\nenvironment during development is protective against lead-induced\nneurotoxicity","volume":"896","author":"Schneider","year":"2001","journal-title":"Brain Res."},{"issue":"9","key":"2026101215563442300_cit14","doi-asserted-by":"publisher","DOI":"10.1002\/brb3.70040","article-title":"Influences\nof quality of maternal care and environmental enrichment on associative\nmemory function in rats with early life lead exposure","volume":"14","author":"Schneider","year":"2024","journal-title":"Brain and Behavior."},{"issue":"3","key":"2026101215563442300_cit15","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1002\/dev.20287","article-title":"Enriched environment\nrestores impaired\nhippocampal long-term potentiation and water maze performance induced\nby developmental lead exposure in rats","volume":"50","author":"Cao","year":"2008","journal-title":"Developmental\nPsychobiology."},{"issue":"1","key":"2026101215563442300_cit16","doi-asserted-by":"publisher","first-page":"11937","DOI":"10.1038\/s41598-022-15861-9","article-title":"Altered genome-wide hippocampal gene expression profiles\nfollowing early life lead exposure and their potential for reversal\nby environmental enrichment","volume":"12","author":"Singh","year":"2022","journal-title":"Sci. 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Rep."},{"issue":"5","key":"2026101215563442300_cit18","doi-asserted-by":"publisher","first-page":"623","DOI":"10.1001\/archneurol.2011.2748","article-title":"Association\nof Lifetime\nCognitive Engagement and Low \u03b2-Amyloid Deposition","volume":"69","author":"Marks","year":"2012","journal-title":"Arch Neurol."},{"issue":"10","key":"2026101215563442300_cit19","doi-asserted-by":"publisher","first-page":"1217","DOI":"10.1001\/jamaneurol.2020.1941","article-title":"Association of Early-Life Cognitive Enrichment With\nAlzheimer Disease Pathological Changes and Cognitive Decline","volume":"77","author":"Oveisgharan","year":"2020","journal-title":"JAMA Neurol."},{"key":"2026101215563442300_cit20","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/j.neuro.2012.10.004","article-title":"The conjoint influence\nof home enriched environment and lead exposure on children\u2019s\ncognition and behaviour in a Mexican lead smelter community","volume":"34","author":"Moodie","year":"2013","journal-title":"NeuroToxicology."},{"key":"2026101215563442300_cit21","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1016\/j.neuro.2025.04.010","article-title":"Infant cognitive home environment\nas a moderator for the association of prenatal lead on child language","volume":"108","author":"Wylie","year":"2025","journal-title":"NeuroToxicology."},{"key":"2026101215563442300_cit22","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1289\/ehp.90895","article-title":"Antecedents and correlates\nof improved\ncognitive performance in children exposed in utero to low levels of\nlead","volume":"89","author":"Bellinger","year":"1990","journal-title":"Environ. Health Perspect."},{"issue":"3491","key":"2026101215563442300_cit23","doi-asserted-by":"publisher","first-page":"1669","DOI":"10.1126\/science.134.3491.1669","article-title":"Strontium-90\nAbsorption by Deciduous Teeth","volume":"134","author":"Reiss","year":"1961","journal-title":"Science."},{"issue":"4","key":"2026101215563442300_cit24","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1097\/EDE.0b013e31806462d3","article-title":"An efficient sampling\nand inference procedure for studies with a continuous outcome","volume":"18","author":"Zhou","year":"2007","journal-title":"Epidemiology."},{"key":"2026101215563442300_cit25","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1016\/j.chemosphere.2017.02.114","article-title":"Heavy metals in human\nteeth dentine: A bio-indicator of metals exposure and environmental\npollution","volume":"176","author":"Asaduzzaman","year":"2017","journal-title":"Chemosphere."},{"key":"2026101215563442300_cit26","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1016\/j.jflm.2013.12.002","article-title":"A method of calculating\nhuman deciduous crown formation\ntimes and of estimating the chronological ages of stressful events\noccurring during deciduous enamel formation","volume":"22","author":"Birch","year":"2014","journal-title":"Journal of Forensic and Legal Medicine."},{"key":"2026101215563442300_cit27","doi-asserted-by":"publisher","first-page":"1000","DOI":"10.1038\/s41370-024-00652-3","article-title":"Quantified retrospective\nbiomonitoring of fetal and infant elemental exposure using LA-ICP-MS\nanalysis of deciduous dentin in three contrasting human cohorts","volume":"34","author":"Punshon","year":"2024","journal-title":"J. Expo Sci. Environ. Epidemiol."},{"issue":"3","key":"2026101215563442300_cit28","first-page":"220","article-title":"Effect of the birth process on the\nneonatal line in primary tooth enamel","volume":"11","author":"Eli","year":"1989","journal-title":"Pediatr\nDent."},{"issue":"5","key":"2026101215563442300_cit29","doi-asserted-by":"publisher","first-page":"634","DOI":"10.1076\/jcen.25.5.634.14572","article-title":"Assessment of lifetime participation\nin cognitively stimulating activities","volume":"25","author":"Wilson","year":"2003","journal-title":"J. Clin\nExp Neuropsychol."},{"issue":"8","key":"2026101215563442300_cit30","doi-asserted-by":"publisher","first-page":"786","DOI":"10.1080\/13803395.2021.2002269","article-title":"The TestMyBrain\nDigital\nNeuropsychology Toolkit: Development and Psychometric Characteristics","volume":"43","author":"Singh","year":"2021","journal-title":"Journal of Clinical and Experimental Neuropsychology."},{"issue":"10","key":"2026101215563442300_cit31","doi-asserted-by":"publisher","first-page":"S319","DOI":"10.1016\/j.biopsych.2019.03.810","article-title":"Digital Cognitive Assessment: Results\nfrom the TestMyBrain NIMH Research Domain Criteria (RDoC) Field Test\nBattery Report","volume":"85","author":"Germine","year":"2019","journal-title":"Biological Psychiatry"},{"issue":"9","key":"2026101215563442300_cit32","doi-asserted-by":"publisher","first-page":"1497","DOI":"10.1177\/0956797615594896","article-title":"Sustained attention\nacross the lifespan in a sample of 10,000: Dissociating ability and\nstrategy","volume":"26","author":"Fortenbaugh","year":"2015","journal-title":"Psychol Sci."},{"issue":"1","key":"2026101215563442300_cit33","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1080\/13854046.2020.1811893","article-title":"Construct validity, ecological validity and acceptance\nof self-administered online neuropsychological assessment in adults","volume":"35","author":"Chaytor","year":"2021","journal-title":"Clinical Neuropsychologist."},{"issue":"1","key":"2026101215563442300_cit34","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1037\/h0046743","article-title":"Theory\nof fluid and crystallized intelligence: A critical experiment","volume":"54","author":"Cattell","year":"1963","journal-title":"Journal of Educational Psychology."},{"issue":"3","key":"2026101215563442300_cit35","doi-asserted-by":"publisher","first-page":"037003","DOI":"10.1289\/EHP7932","article-title":"Blood Lead Levels\nin U.S. Children Ages 1\u201311 Years, 1976\u20132016","volume":"129","author":"Egan","year":"2021","journal-title":"Environ. Health Perspect."},{"issue":"4","key":"2026101215563442300_cit36","doi-asserted-by":"publisher","first-page":"400","DOI":"10.1017\/S1355617705050459","article-title":"Early and late life\ncognitive activity and cognitive\nsystems in old age","volume":"11","author":"Wilson","year":"2005","journal-title":"Journal of the International\nNeuropsychological Society."},{"issue":"7","key":"2026101215563442300_cit37","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1093\/aje\/kwx155","article-title":"Contribution of\nSocioeconomic Status at 3 Life-Course Periods to Late-Life Memory\nFunction and Decline: Early and Late Predictors of Dementia Risk","volume":"186","author":"Marden","year":"2017","journal-title":"American Journal of Epidemiology."},{"issue":"2","key":"2026101215563442300_cit38","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1111\/j.0006-341X.2002.00413.x","article-title":"A Semiparametric Empirical Likelihood\nMethod for Data\nfrom an Outcome-Dependent Sampling Scheme with a Continuous Outcome","volume":"58","author":"Zhou","year":"2002","journal-title":"Biometrics."},{"key":"2026101215563442300_cit39","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v015.i02","article-title":"The R Package\ngeepack for Generalized\nEstimating Equations","volume":"15","author":"H\u00f8jsgaard","year":"2006","journal-title":"Journal of Statistical\nSoftware."},{"issue":"1","key":"2026101215563442300_cit40","doi-asserted-by":"publisher","first-page":"101","DOI":"10.3102\/10769986211017480","article-title":"Analyzing\nCross-Sectionally Clustered Data Using Generalized Estimating Equations","volume":"47","author":"Huang","year":"2022","journal-title":"Journal of Educational and Behavioral Statistics."},{"key":"2026101215563442300_cit41","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v045.i03","article-title":"mice: Multivariate\nImputation by Chained Equations\nin R","volume":"45","author":"Buuren","year":"2011","journal-title":"Journal of Statistical Software."},{"key":"2026101215563442300_cit42","unstructured":"R Core Team.\n          . R: A Language and\nEnvironment for Statistical Computing. 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