{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T14:36:40Z","timestamp":1786631800951,"version":"build-2736575974"},"reference-count":34,"publisher":"American Chemical Society (ACS)","issue":"1","license":[{"start":{"date-parts":[[2017,12,29]],"date-time":"2017-12-29T00:00:00Z","timestamp":1514505600000},"content-version":"vor","delay-in-days":2950,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2010,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Prenatal and postnatal tobacco exposure have been reported to be associated with behavioral problems. However, the magnitude of the association with tobacco exposure at specific periods of exposure is unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We assessed the relative risk of behavioral problems in children who had been exposed to tobacco smoke in utero and postnatally.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed data from a prospective birth cohort study in two cities in Germany: the German Infant Nutrition Intervention. Our sample included 5,991 children born between 1995 and 1998 as well as their parents. We measured behavioral problems using the Strength and Difficulties Questionnaire (SDQ) at follow-up 10 years after birth. According to prespecified SDQ cutoff values, children were classified as \u201cnormal,\u201d \u201cborderline,\u201d or \u201cabnormal\u201d according to the subscales \u201cemotional symptoms,\u201d \u201cconduct problems,\u201d \u201chyperactivity\/inattention,\u201d \u201cpeer-relationship problems,\u201d and a total difficulties score. Smoke exposure and further covariates were assessed using parent questionnaires.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Compared with children not exposed to tobacco smoke, children exposed both pre- and postnatally to tobacco smoke had twice the estimated risk [95% confidence interval (CI), 1.4\u20133.1] of being classified as abnormal according to the total difficulties score of the SDQ at 10 years of age. Children who were only prenatally exposed had a 90% higher relative risk (95% CI, 0.9\u20134.0), whereas children who were only postnatally exposed had a 30% higher relative risk (95% CI, 0.9\u20131.9). These results could not be explained by confounding by parental education, father\u2019s employment, child\u2019s time spent in front of computer or television screen, being a single father or mother, or mother\u2019s age.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Prenatal exposure to tobacco smoke is associated with behavioral problems in school-age children. Although our findings do not preclude the influence of postnatal exposure, prenatal exposure seems to be more important.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1289\/ehp.0901209","type":"journal-article","created":{"date-parts":[[2009,12,1]],"date-time":"2009-12-01T12:41:08Z","timestamp":1259671268000},"page":"150-154","source":"Crossref","is-referenced-by-count":82,"title":["Prenatal and Postnatal Tobacco Exposure and Behavioral Problems in 10-Year-Old Children: Results from the GINI-plus Prospective Birth Cohort Study"],"prefix":"10.1021","volume":"118","author":[{"given":"Simon","family":"R\u00fcckinger","sequence":"first","affiliation":[{"name":"Ludwig-Maximilians University Munich, Institute of Social Pediatrics and Adolescent Medicine, Division of Epidemiology, Munich, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Rzehak","sequence":"additional","affiliation":[{"name":"Helmholtz Zentrum M\u00fcnchen \u2013 German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chih-Mei","family":"Chen","sequence":"additional","affiliation":[{"name":"Helmholtz Zentrum M\u00fcnchen \u2013 German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefanie","family":"Sausenthaler","sequence":"additional","affiliation":[{"name":"Helmholtz Zentrum M\u00fcnchen \u2013 German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sibylle","family":"Koletzko","sequence":"additional","affiliation":[{"name":"Ludwig-Maximilians-University of Munich, Dr. von Hauner Children\u2019s Hospital, Munich, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carl-Peter","family":"Bauer","sequence":"additional","affiliation":[{"name":"Technical University of Munich, Department of Pediatrics, Munich, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ute","family":"Hoffmann","sequence":"additional","affiliation":[{"name":"Technical University of Munich, Department of Pediatrics, Munich, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ursula","family":"Kramer","sequence":"additional","affiliation":[{"name":"Institut f\u00fcr Umweltmedizinische Forschung, IUF, University of D\u00fcsseldorf, D\u00fcsseldorf, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dietrich","family":"Berdel","sequence":"additional","affiliation":[{"name":"Marien-Hospital Wesel, Department of Pediatrics, Wesel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"von Berg","sequence":"additional","affiliation":[{"name":"Marien-Hospital Wesel, Department of Pediatrics, Wesel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Otmar","family":"Bayer","sequence":"additional","affiliation":[{"name":"Ludwig-Maximilians University Munich, Institute of Social Pediatrics and Adolescent Medicine, Division of Epidemiology, Munich, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.-Erich","family":"Wichmann","sequence":"additional","affiliation":[{"name":"Helmholtz Zentrum M\u00fcnchen \u2013 German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R\u00fcdiger","family":"von Kries","sequence":"additional","affiliation":[{"name":"Ludwig-Maximilians University Munich, Institute of Social Pediatrics and Adolescent Medicine, Division of Epidemiology, Munich, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim","family":"Heinrich","sequence":"additional","affiliation":[{"name":"Helmholtz Zentrum M\u00fcnchen \u2013 German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"316","published-online":{"date-parts":[[2009,12,1]]},"reference":[{"issue":"2","key":"2026080504131540600_micit1","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/S0091-3057(97)00408-5","article-title":"Prenatal nicotine exposure modifies behavior of mice through early development","volume":"59","author":"Ajarem","year":"1998","journal-title":"Pharmacol Biochem Behav"},{"issue":"1\u20132","key":"2026080504131540600_micit2","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.earlhumdev.2003.09.001","article-title":"Effect of antenatal exposure to maternal smoking on behavioural problems and academic achievement in 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