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Open AccessArticle

Exposure to Toenail Heavy Metals and Child Behavior Problems in Nine-Year-Old Children: A Cross-Sectional Study

Faculty of Medicine, University of Queensland, Herston, QLD 4006, Australia
Ko awatea, Counties Manukau Health, Private Bag 93311, Auckland 1640, New Zealand
School of Public Health and Psychosocial Studies, Auckland University of Technology, Auckland 0627, New Zealand
Department of Chemistry FEPS, University of Surrey, Guildford, Surrey GU2 7XH, UK
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2020, 17(11), 4120;
Received: 22 May 2020 / Revised: 29 May 2020 / Accepted: 8 June 2020 / Published: 9 June 2020
(This article belongs to the Special Issue Feature Papers in Children's Health)
Behavioral problems are multifactorial and includes perinatal, maternal, family, parenting, socio-economic and personal risk factors, but less is known about the association of postnatal heavy metals on children’s behavioral problems in Pacific Island children. Methods: A cohort of eligible nine-year-old children within a Pacific Island Families longitudinal study were recruited for a cross-sectional study. Child behavior problems were assessed using the child behavior checklist. Heavy metals (including Ni, Cu, Pb, Al, Cr and Cd) were determined in toenails, after acid digestion and analyzed using inductively coupled plasma mass spectrometry. Other factors such as lifestyle (smoking in pregnancy), health outcomes (obesity, health status), demographics (gender, ethnicity, parents’ marital status) and socioeconomic status (household income levels) were also collected. The statistical analysis included t-tests for independent sample and Mann–Whitney U-test, and chi-square or Fisher’s exact tests of independence for comparisons of the proportions. Regression models tested the hypothesized risk factors for behavior outcomes. Results: This observational study enrolled 278 eligible Pacific Island children living in Auckland, New Zealand. The prevalence of behavioral problems in the clinical range was high (22%) but there was no significant association between heavy metals in toenails and adverse behavioral outcomes. Conclusion: Regular monitoring and assessments of children for environmental risk factors, as well as social and lifestyle factors for behavior problems, continues. Alternative indicators of exposure to heavy metal should be evaluated. View Full-Text
Keywords: behavior problems; nail biomarker; heavy metals behavior problems; nail biomarker; heavy metals
MDPI and ACS Style

Karatela, S.; Coomarasamy, C.; Paterson, J.; Ward, N.I. Exposure to Toenail Heavy Metals and Child Behavior Problems in Nine-Year-Old Children: A Cross-Sectional Study. Int. J. Environ. Res. Public Health 2020, 17, 4120.

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