{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T08:19:06Z","timestamp":1783585146071,"version":"3.55.0"},"reference-count":59,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["acamh.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Child Adoles Ment Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Evidence on the association between paternal smoking and attention\u2010deficit hyperactivity disorder (ADHD) in offspring is inconsistent. We conducted a systematic review and meta\u2010analysis to synthesise the available evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This meta\u2010analysis was performed following the Preferred Reporting Items for Systematic Review and Meta\u2010analysis guidelines. The review protocol was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO). Pooled odds ratios with 95% confidence intervals (CIs) were calculated using a random\u2010effects meta\u2010analysis. The heterogeneity among studies was assessed using the\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      test. Publication bias and the presence of small study effects were evaluated using funnel plots and Egger's test. Sensitivity and subgroup analyses were also performed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty observational studies involving over 294,236 study participants from 16 different countries were included. We found that paternal smoking was associated with a 22% increased risk of ADHD in children (RR\u2009=\u20091.22, 95% CI: 1.12, 1.33). Our subgroup analysis revealed that this association was not evident among studies that accounted for maternal smoking (OR\u2009=\u20091.14, 95% CI: 0.98, 1.33), paternal alcohol use (OR\u2009=\u20091.02, 95% CI: 0.79, 1.33) and education (OR\u2009=\u20091.14, 95% CI: 0.98, 1.34).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The observed association between paternal smoking and the increased risk of ADHD in children may be confounded by maternal smoking, paternal education and other shared familial and socioeconomic factors. Future studies should incorporate maternal\u2013paternal comparisons to disentangle the independent and combined effects of parental smoking on ADHD risk in children, while more rigorously controlling for confounding.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/camh.70101","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T07:58:44Z","timestamp":1783583924000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Review: Paternal tobacco smoking and the risk of attention\u2010deficit hyperactivity disorder in children \u2013 a systematic review and meta\u2010analysis"],"prefix":"10.1111","author":[{"given":"Berihun","family":"Dachew","sequence":"first","affiliation":[{"name":"School of Population Health Curtin University  Perth WA Australia"},{"name":"enAble Institute Curtin University  Perth WA Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yitayish","family":"Damtie","sequence":"additional","affiliation":[{"name":"School of Population Health Curtin University  Perth WA Australia"},{"name":"Department of Public Health, College of Medicine and Health Science Injibara University  Injibara Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Getinet","family":"Ayano","sequence":"additional","affiliation":[{"name":"School of Population Health Curtin University  Perth WA Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa","family":"Alati","sequence":"additional","affiliation":[{"name":"School of Population Health Curtin University  Perth WA Australia"},{"name":"School of Public Health The University of Queensland  Brisbane Qld Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1007\/s10519-006-9081-8","article-title":"Assortative mating for cigarette smoking and for alcohol consumption in female Australian twins and their spouses","volume":"36","author":"Agrawal A.","year":"2006","journal-title":"Behavior Genetics"},{"key":"e_1_2_14_3_1","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1007\/s00787-009-0001-3","article-title":"Effects of maternal and paternal smoking on attentional control in children with and without ADHD","volume":"18","author":"Altink M.E.","year":"2009","journal-title":"European Child & Adolescent Psychiatry"},{"key":"e_1_2_14_4_1","doi-asserted-by":"crossref","DOI":"10.1176\/appi.books.9780890425596","volume-title":"Diagnostic and statistical manual of mental disorders","author":"American Psychiatric Association","year":"2013"},{"key":"e_1_2_14_5_1","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1177\/1087054714566076","article-title":"Long\u2010term outcomes of ADHD: Academic achievement and performance","volume":"24","author":"Arnold L.E.","year":"2020","journal-title":"Journal of Attention Disorders"},{"key":"e_1_2_14_6_1","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1016\/j.jad.2023.07.071","article-title":"The global prevalence of attention deficit hyperactivity disorder in children and adolescents: An umbrella review of meta\u2010analyses","volume":"339","author":"Ayano G.","year":"2023","journal-title":"Journal of Affective Disorders"},{"key":"e_1_2_14_7_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.psychres.2023.115449","article-title":"Prevalence of attention deficit hyperactivity disorder in adults: Umbrella review of evidence generated across the globe","volume":"328","author":"Ayano G.","year":"2023","journal-title":"Psychiatry Research"},{"key":"e_1_2_14_8_1","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.mrrev.2017.04.001","article-title":"From sperm to offspring: Assessing the heritable genetic consequences of paternal smoking and potential public health impacts","volume":"773","author":"Beal M.A.","year":"2017","journal-title":"Mutation Research, Reviews in Mutation Research"},{"key":"e_1_2_14_9_1","doi-asserted-by":"crossref","first-page":"1493","DOI":"10.1177\/1087054717690809","article-title":"Is paternal smoking at conception a risk for ADHD? 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