Purpose This study investigates the persistent relationships between childhood lead exposure, repeat teen pregnancy, and tobacco use in a sample of teenage females in Syracuse, NY. Methods We analyzed the association of childhood lead poisoning with repeat pregnancy and tobacco use among 536 teens (aged 15–19 years) in Syracuse, NY, who received services at Syracuse Healthy Start between 1998 and 2002. Results The mothers’ childhood lead exposure, controlling for race, age, and Medicaid status, was associated with repeat teen pregnancy and tobacco use. Conclusion Long-term negative health outcomes associated with childhood lead exposure should not be underestimated. This study helps to shore up prior research that found lead poisoning to have a long-lasting impact on children’s functioning and healthy development. Policy efforts focused on neighborhood development and health education continue to be sorely needed.