Children exposed to tobacco smoke at home are up to three times more likely to have attention-deficit/hyperactivity disorder (ADHD) as unexposed kids, according to a new study from Spain.

The association was stronger for kids with one or more hours of secondhand smoke exposure every day, the authors found. And the results held when researchers accounted for parents’ mental health and other factors.

Alicia Padron of the University of Miami Miller School of Medicine in Florida and colleagues in Spain analyzed data from the 2011 to 2012 Spanish National Health Interview Survey, in which parents of 2,357 children ages four to 12 reported the amount of time their children were exposed to secondhand smoke every day.

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