Association between Bone Lead Concentration and Aggression in Youth from a Sub-Cohort of the Birth to Twenty Cohort

Nonhlanhla Tlotleng, Nisha Naicker, Angela Mathee, Andrew C. Todd, Palesa Nkomo, Shane A. Norris

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


Background: An association between blood-lead levels and aggression has been demonstrated in children and adolescent youth in South Africa. However, there are limited studies that have assessed aggression as an outcome for cumulative lead exposure using bone lead concentration. This study aims to assess the association between bone lead concentration and aggressive behaviour among a sample of youth in South Africa. Methods: Bone lead in 100 participants (53 males and 47 females) recruited and followed in the Birth to Twenty (BT20) Cohort were measured using 109 Cd-based, K-shell X-ray fluorescence (KXRF). The Buss–Perry Aggression questionnaire was used to measure aggressive behaviour. Linear regression models were fitted to determine the association between aggression score for physical, verbal, anger and hostility and bone lead, adjusting for known confounders. Results: A one-microgram-per-gram increase in bone lead was found to increase the score for all four scales of aggression, but significantly only for anger (β = 0.2 [95% CI 0.04–0.370]). Psychosocial factors such as a history of family violence and exposure to neighbourhood crime were significant predictors for aggression. Conclusions: The study provides a preliminary overview of the relationship between cumulative lead exposure and behavioural problems such as aggression. A larger sample, across exposed communities, may prove more definitive in further investigating the association between these two important public health factors and to maximize generalizability.

Original languageEnglish
Article number2200
JournalInternational Journal of Environmental Research and Public Health
Issue number4
Publication statusPublished - 1 Feb 2022


  • Aggression
  • BT20 cohort
  • Blood lead
  • Bone lead
  • KXRF
  • Late adolescence
  • South Africa

ASJC Scopus subject areas

  • Pollution
  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis


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