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Open AccessArticle

Hemoglobin Status and Externalizing Behavioral Problems in Children

Department of Neurology, The Jintan Hospital Affiliated to Jiangsu University, 16 Nanmen Street, Jintan, Changzhou 213200, China
Schools of Nursing and Medicine, University of Pennsylvania, 418 Curie Blvd., Room 426, Claire M. Fagin Hall, Philadelphia, PA 19104, USA
Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Room #508, 87, DingJiaqiao, Nanjing 210096, China
Author to whom correspondence should be addressed.
These authors contributed equally to this work and are acknowledged as co-first authors.
Academic Editors: Katherine P. Theall and Carolyn C. Johnson
Int. J. Environ. Res. Public Health 2016, 13(8), 758;
Received: 16 May 2016 / Revised: 7 July 2016 / Accepted: 22 July 2016 / Published: 26 July 2016
(This article belongs to the Special Issue Environmental Influences on Maternal and Child Health)
Background: Still considered one of the most prevalent nutritional problems in the world, anemia has been shown in many studies to have deleterious effects on neurobehavioral development. While most research efforts have focused on investigating the effects of anemia on social and emotional development of infants by using a cross-sectional design, research is still needed to investigate whether early childhood anemia, beyond infantile years, is linked with behavioral problems. Objective: This study assessed whether (1) hemoglobin (Hb) levels in early childhood are associated with externalizing behavior; and (2) this relationship is confounded by social adversity. Methods: Hemoglobin levels were taken from children (N = 98) of the China Jintan Cohort Study at age 4 years, and externalizing behaviors (attention and aggression) were assessed with the Child Behavior Checklist (ASEBA-CBCL) at age 6 years (mean age 5.77 ± 0.39 years old). Results: Compared with other children in the sample, children with relatively lower Hb levels at age 4 had more behavioral problems in both attention and aggression at age 6, independent of social adversity. For boys, this association was significant for attention problems, which did not interact with social adversity. For girls, the association was significant for aggression, which interacted with social adversity. While girls on average exhibited higher social adversity than boys, the main effect of Hb was only significant in girls with low social adversity. Conclusions: These results indicate that there is an inverse association between hemoglobin levels and later behavioral problems. Findings of this study suggest that regular monitoring of children’s hemoglobin levels and appropriate intervention may help with early identification of behavioral problems. View Full-Text
Keywords: aggression; attention problems; Chinese children; externalizing behavior; hemoglobin aggression; attention problems; Chinese children; externalizing behavior; hemoglobin
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MDPI and ACS Style

Su, J.; Cui, N.; Zhou, G.; Ai, Y.; Sun, G.; Zhao, S.R.; Liu, J. Hemoglobin Status and Externalizing Behavioral Problems in Children. Int. J. Environ. Res. Public Health 2016, 13, 758.

AMA Style

Su J, Cui N, Zhou G, Ai Y, Sun G, Zhao SR, Liu J. Hemoglobin Status and Externalizing Behavioral Problems in Children. International Journal of Environmental Research and Public Health. 2016; 13(8):758.

Chicago/Turabian Style

Su, Jianhua; Cui, Naixue; Zhou, Guoping; Ai, Yuexian; Sun, Guiju; Zhao, Sophie R.; Liu, Jianghong. 2016. "Hemoglobin Status and Externalizing Behavioral Problems in Children" Int. J. Environ. Res. Public Health 13, no. 8: 758.

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