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Updated: Jun 15, 2026

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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Maternal cigarette smoking during pregnancy and offspring externalizing behavioral problems: a propensity score
Brian B Boutwell1, Kevin M Beaver
1College of Criminal Justice, Sam Houston State University, Huntsville, TX 77341-2296, USA. bbb03@fsu.edu
Summary
Prenatal exposure to tobacco smoke is not directly linked to childhood behavioral issues. Confounding factors, not the smoke itself, explain the observed associations in this study.
Area of Science:
- Developmental Psychology
- Public Health
- Behavioral Science
Background:
- Empirical research links prenatal tobacco smoke exposure to adverse outcomes like cognitive deficits and behavioral problems.
- These associations are often interpreted as causal, but emerging evidence suggests they may be spurious.
- Understanding the true impact of prenatal smoke exposure is crucial for public health interventions.
Purpose of the Study:
- To investigate the association between prenatal cigarette smoke exposure and externalizing behavioral problems.
- To determine if confounding factors fully account for the observed relationship.
- To inform policy and research regarding prenatal smoke exposure and child behavior.
Main Methods:
- Analysis of data from the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B).
- Statistical examination of the relationship between prenatal smoke exposure and externalizing behaviors.
- Control for potential confounding variables.
Main Results:
- The association between prenatal cigarette smoke exposure and externalizing behavioral problems was fully explained by confounding factors.
- No direct causal link was found between prenatal smoke exposure and these behavioral issues.
- Confounding variables play a significant role in the observed association.
Conclusions:
- The link between prenatal tobacco smoke exposure and externalizing behavioral problems appears to be spurious.
- Policy and research should consider the impact of confounding factors, not solely focus on direct causality.
- Re-evaluation of existing research and intervention strategies may be necessary.

