Abstract Objectives This study examined whether a self-reported history of childhood maltreatment (physical, emotional, and sexual abuse and physical and emotional neglect) is related to poor adult ...physical health through health risk behaviors (obesity, substance dependence, and smoking), adverse life events, and psychological distress. Methods Two hundred and seventy nine (279) women aged 31–54, primarily poor, urban, and African American with a history of substance use during pregnancy, were assessed for perceived physical health status using the Health Status Questionnaire (SF-36) and any reported chronic medical condition. Hierarchical multiple and logistic regression were used to test mediation, as well as to assess relative contributions of multiple mediators on physical health. Results More than two-thirds ( n = 195, 70%) of the sample reported at least 1 form of childhood maltreatment, with 42% ( n = 110) having a lifetime history of substance dependence and 59% ( n = 162) having a chronic medical condition. Controlling for age, education, and race, childhood maltreatment was related to increased likelihood of lifetime history of substance dependence (OR = 1.19, 95% CI = 1.01–1.39), more adverse life events ( β = .14), and greater psychological distress ( β = .21). Psychological distress and adverse life events partially mediated the relationship between childhood maltreatment and perceived physical health, accounting for 42% of the association between childhood maltreatment and perceived physical health. Adverse life events accounted for 25% of the association between childhood maltreatment and chronic medical condition. Conclusions Our findings provide additional evidence that the ill health effects associated with childhood maltreatment persist into adulthood. Adverse life events and psychological distress were key mechanisms shaping later physical health consequences associated with childhood maltreatment among relatively young urban women with a history of substance use. Practice implications Health care providers should be aware that childhood maltreatment contributes to adult health problems. Interventions aimed at preventing child maltreatment and addressing life stress and psychological distress will improve long-term physical health among abused children, adults with such histories, as well as children who are likely to be affected by maternal history of childhood maltreatment.
Abstract Objective Examined effects of prenatal cocaine exposure (PCE) on tobacco, alcohol, marijuana and cocaine use by age 15. Methods Adolescent ( n = 358; 183 PCE, 175 non-prenatally cocaine ...exposed; NCE) drug use was assessed using urine, hair, and/or blood spot samples and self-report (Youth Risk Behavior Surveillance System; YRBSS) at ages 12 and 15. Logistic regression assessed effects of PCE on drug use controlling for other drug exposures, environment and blood lead levels (BLL). Results Adjusted percentages of drug use (PCE vs. NCE) were: tobacco 35% vs. 26% ( p < .04), marijuana 33% vs. 23% ( p < .04), alcohol 40% vs. 35% ( p < .01), and any drugs 59% vs. 50% ( p < .005). PCE adolescents were twice as likely to use tobacco (OR = 2.02, 95% CI = 1.05–3.90, p < .04), 2.2 times more likely to use alcohol (OR = 2.16, 95% CI = 1.21–3.87, p < .01) and 1.8 times more likely to use marijuana (OR = 1.81, 95% CI = 1.02–3.22, p < .04) than NCE adolescents. A race-by-cocaine-exposure interaction ( p < .01) indicated PCE non-African American adolescents had greater probability of tobacco use (65%) than NCE non-African American youth (21%). PCE was associated with any drug use (OR = 2.16, CI = 1.26–3.69, p < .005), while higher BLL predicted alcohol use ( p < .001). Violence exposure was a predictor of tobacco ( p < .002), marijuana ( p < .0007) and any drug ( p < .04). Conclusions PCE and exposure to violence increased the likelihood of tobacco, marijuana or any drug use by age 15, while PCE and higher early BLL predicted alcohol use. Prevention efforts should target high risk groups prior to substance use initiation.
In a birth-cohort study, we followed offspring with prenatal cocaine exposure (PCE) to investigate longitudinal associations of PCE with self-reported behavioral adjustment from early adolescence to ...emerging adulthood (EA). Environmental pathways (family functioning, non-kinship care, maltreatment) were specified as potential mediators of PCE.
Participants were 372 (190 PCE; 47% male), primarily Black, low socioeconomic status, enrolled at birth. Internalizing and externalizing behaviors were assessed using Youth Self-Report at ages 12 and 15 and Adult Self-Report at age 21. Extended random-intercept cross-lagged panel modeling was used to account for potential bidirectional relationships between internalizing and externalizing behaviors over time, examining potential mediators.
Adjusting for covariates, significant indirect effects were found for each mediator at different ages. For family functioning, these were both internalizing (
= 0.83,
= 0.04) and externalizing behaviors (
= 1.58,
= 0.02) at age 12 and externalizing behaviors at age 15 (
= 0.51,
= 0.03); for non-kinship care, externalizing behaviors at ages 12 (
= 0.63,
= 0.02) and 15 (
= 0.20,
= 0.03); and for maltreatment, both internalizing and externalizing behaviors at ages 15 (
= 0.64,
= 0.02 for internalizing;
= 0.50,
= 0.03 for externalizing) and 21 (
= 1.39,
= 0.01 for internalizing;
= 1.11,
= 0.01 for externalizing). Direct associations of PCE with internalizing and externalizing behaviors were not observed, nor cross-lagged relationships between internalizing and externalizing behaviors.
Negative associations of PCE with behavioral adjustment persist into EA via environmental pathways, specifying intervention points to disrupt adverse pathways toward healthy development.
Prenatal cocaine exposure (PCE) has been linked to specific cognitive deficits and behavioral outcomes through early adolescence but there is little information on adult outcomes nor on the ...relationship of environmental interventions, such as foster/adoptive care, to outcomes.
At 21 years, data were available on 325 young adults, 163 PCE and 162 non-exposed (NCE), primarily African-American, with low SES, who were followed from birth in a prospective longitudinal cohort study. Participants were administered the Wechsler Abbreviated Scale of Intelligence (WASI-II) and surveyed regarding high school completion, problematic substance use, and incarceration/probation history. In the PCE group, 32 remained in non-kinship foster/adoptive care (PCE/FA) from early in life (< 4 years) to 17 years. Group differences were examined through t-tests, MANOVA/ MANCOVA with post-hoc analyses, comparing outcomes and environmental correlates of young adults with PCE vs. NCE, as well as outcomes of PCE young adults in non-kinship foster/adoptive care (PCE/ FA) vs. PCE in birth/kinship care and NCE young adults.
At 21 years, young adults with PCE had lower mean Full Scale (83.7 ± 10.4 vs. 87.3 ± 12.5, p < .01) and Perceptual Reasoning IQs (87.3 ± 11.5 vs. 91.4 ± 13.9, (p < .02), lower high school completion rates (75% vs. 86%, p < .02), and were marginally more likely to have been on probation than NCE young adults, but did not differ in Verbal IQ, self-report of problematic substance use or incarceration. Young adults with PCE in F/A had similar lower IQ scores but had better verbal skills and high school graduation rates that did not differ from NCE young adults (80.6 vs 86.2%, p > .05). They had higher drug exposure at birth and more experiences of maltreatment (p's < 0.05) but their home environment quality was better and lead levels lower (p's < 0.05) than those of young adults with PCE in birth/kinship care.
Young adults with PCE had lower Perceptual Reasoning and Full-Scale IQ scores, independent of caregiving placement, compared to non-exposed young adults. Young adults with PCE placed in non-kinship foster/adoptive care had lower lead levels, more stimulating home environments, better vocabulary skills and were more likely to graduate from high school than those in birth/kinship care,but were not different in their self-report of problematic substance use, or experiences of incarceration or probation. Our data suggest that some cognitive deficits observed in young adults with PCE may be biologically based, but that some functional outcomes can be modified through environmental interventions. Our data also reflect the complexity of disentangling the effects of teratologic exposures on long term outcomes across a variety of domains and the need for studies of children in the foster care system.
•At 21 years, prenatal cocaine exposure (PCE) was related to poorer perceptual reasoning skills.•PCE was also related to lower fullscale IQ, poorer verbalabstraction, and lower high school completion.•Young adults with PCE in nonkinship care were more likely to graduate from high school than those in kinship care.•They also had better verbal skills and lower lead levels than those in birth or kinship care.•They experienced more stimulating home environments than did those in birth/kinship care.
•Prenatal cocaine exposure (PCE) is associated with externalizing behavior problems.•Four trajectories of externalizing behavior were identified in children with PCE.•PCE and maternal psychological ...distress differentiated different trajectories.•Adolescent substance use and early sexual behavior differed by the trajectories.
Although prenatal cocaine exposure (PCE) has been linked with greater externalizing behavior, no studies have investigated heterogeneity of developmental trajectories in children with PCE to date. The present study aimed to: (1) identify developmental trajectories of externalizing problems in childhood by using a person-oriented analytic approach; (2) examine whether trajectories differ by PCE and other environmental and biological correlates; and (3) investigate how trajectories were associated with adolescent substance use and sexual behavior.
Adolescents (N = 386; 197 PCE, 187 non-cocaine exposed (NCE)), primarily African-American and of low socioeconomic status, were prospectively enrolled in a longitudinal study at birth. Externalizing problems were assessed with the Child Behavior Checklist (CBCL) at ages 4, 6, 9, 10, 11, and 12. Substance (tobacco, alcohol, marijuana) use, via self-report and biologic assays, and early (before age 15) sexual intercourse were assessed at age 15.
Latent class growth modeling indicated four distinctive developmental trajectories of externalizing behavior from ages 4 to 12: low-decreasing group (32%); moderate-decreasing group (32%); accelerated risk group (14%); and elevated-chronic group (22%). PCE and maternal psychological distress interactively differentiated developmental trajectories of externalizing behavior, which were related to subsequent adolescent substance use and early sexual behavior differently across gender.
The two high-risk trajectories (accelerated risk and elevated-chronic groups), comprising 36% of the sample, identified in the present study may reflect multi-causality of early substance use and perhaps greater risk for transition to substance use disorders later in development.
Prenatal cocaine exposure (PCE) has been associated with child and adolescent externalizing behaviors and early substance use, yet few studies investigated its association with substance use disorder ...(SUD) in emerging adults. The present study examined the association of PCE with SUD in emerging adulthood, and whether childhood externalizing behaviors and adolescent substance use mediated the relationship.
Participants were 367 (187 PCE; 53% female) adults at age 21, primarily urban African American who were recruited at birth. PCE and exposure to alcohol, tobacco, and marijuana were determined using biologic assays for drug metabolites and/or maternal self-report at birth. Offspring externalizing problems were assessed using the Youth Self-Report at age 12, substance use and substance use-related problems via biologic assays and/or self-report at age 15, and SUD determined using DSM-5 diagnostic criteria at age 21.
About 32.3% of the emerging adults were determined to have marijuana use disorder, 30.3% tobacco use disorder, and 15.5% alcohol use disorder. PCE was related to greater externalizing behaviors at age 12 (β = 0.12, p = .042), which in turn was related to SUD (β = 0.22, p = .008). PCE was also related to substance use, mainly marijuana, at age 15 (β = 0.22, p = .011), which was related to SUD (β = 0.51, p < .001). Total indirect effects including these two pathways were significant (β = 0.19, p = .002).
PCE may increase risk for SUD in emerging adulthood through childhood externalizing behaviors and adolescent substance use.
●Prenatal cocaine exposure (PCE) increased risk for SUD in emerging adulthood.●PCE was indirectly related to SUD at age 21 via adolescent substance use.●This study provides critical implication for reducing intergenerational continuity of SUD.
No known studies have investigated co-occurrence of psychopathology problems in adolescents with biologic and/or environmental susceptibility, including prenatal drug exposure. This study identified ...comorbidity patterns of psychopathology problems by utilizing data from urban, primarily African American, youth, majority of whom were at heightened risk for exposure to drugs in utero. The roles of Research Domain Criteria (RDoC)-informed behavioral constructs of the Negative Valence (irritability) and Social Process Systems (social disinhibition) as antecedents of the comorbidity patterns were further examined. Lastly, the predictive validity of the identified patterns was evaluated in relation to emerging adulthood outcomes. Participants were 358 urban adolescents, primarily African Americans, drawn from a 21-year prospective birth-cohort study of the effects of prenatal drug exposure. Psychopathology problems were assessed at age 15. Irritability and social disinhibition were self-reported at age 12. Emerging adulthood outcomes were measured at age 21. Latent class modeling indicated four patterns:
Normative
(57%),
substance-use
(SU; 24%),
mental-health-problems-without-substance-use
(MH; 11%), and
substance-use-and-other-mental-health-problems
(SUMH; 7%). Higher irritability increased the odds of developing the MH pattern, whereas higher social disinhibition increased the odds of developing the SU pattern. The odds of manifesting the SUMH pattern were higher for children with higher irritability. For children with higher social disinhibition, the odds of manifesting the SUMH pattern were higher at a trend level. Adolescent comorbidity patterns were differentially associated with problematic tobacco and marijuana use and clinically relevant mental health problems in emerging adulthood, and completion of high school education. Peri-pubertal identification of individual differences in irritability and social disinhibition may mitigate the emergence of adolescent psychopathology, which could influence emerging adulthood adjustment in this at-risk population.
Although there is a well-established link between child maltreatment and adolescent substance use, it remains unclear if and how longitudinal patterns of maltreatment experiences are associated with ...substance use in adolescence.
The purpose of the study was to examine how distinct patterns of longitudinal maltreatment experiences are associated with adolescent substance use.
The participants were 899 adolescents from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN).
We conducted repeated measures latent class analysis (RMLCA) to identify patterns of physical abuse, sexual abuse, and neglect from birth to age 17 and their relations to tobacco, alcohol, and marijuana use at age 18.
RMLCA identified three physical abuse classes (Stable low physical abuse; School age peak physical abuse; Physical abuse primarily in infancy/toddlerhood), two sexual abuse classes (Stable no/low sexual abuse; School age peak sexual abuse), and three neglect classes (High neglect in childhood; Neglect primarily in infancy/toddlerhood; Neglect primarily at school age). Adolescents in the school age peak physical abuse class showed greater alcohol, cigarette, and marijuana use, compared to other physical abuse classes. Similarly, adolescents in the school age peak sexual abuse class showed greater substance use than those in the stable no/low sexual abuse class. Lastly, adolescents in the neglect primarily in infancy/toddlerhood class showed significantly less substance use than those in the other two neglect classes.
Findings highlight the importance of early intervention and ongoing maltreatment prevention.
Prenatal cocaine exposure (PCE) has been associated with small but significant effects on language development in childhood and early adolescence. This study examined whether this association ...persists into later adolescence and what relationship language skills may have with reading proficiency in this population.
Enrolled were 338 (167 with PCE, 171 with NCE or no cocaine exposure) 17-year-olds recruited at birth who, together with their current caregiver, were seen as part of a 17-year follow-up. Participants were given assessments of reading achievement (WIAT-III), receptive and expressive language (CELF-IV), and phonological processing (CTOPP). Relationships between PCE status and language outcomes were modeled using multiple linear regression controlling for environmental and caregiver factors, and other prenatal substance exposures.
Adolescents with PCE scored lower in areas of phonological processing and reading related skills compared to adolescents with NCE. PCE by sex interactions were identified on language, memory and spoken language comprehension, with lower scores for girls with PCE compared to girls with NCE.
These findings suggest the persistence of PCE's relationship with phonological awareness well into adolescence. PCE was also associated with lower scores on measures of skills related to reading ability, which may be a manifestation of the observed deficits in phonological processing.
•Prenatal cocaine exposure (PCE) was associated with lower scores on phonological processing and reading related skills.•Sex moderated the association with PCE, girls with PCE scoring lower on language memory and spoken language comprehension.•These findings suggest the persistence of a PCE association with domains of language ability into late adolescence.
Abstract Purpose To assess the direct effects of prenatal cocaine exposure (PCE) on adolescent internalizing, externalizing, and attention problems, controlling for confounding drug and environmental ...factors. Method At 12 and 15 years of age, 371 adolescents (189 PCE and 182 noncocaine exposed), primarily African-American and of low socioeconomic status, participating in a longitudinal, prospective study from birth were assessed for behavioral adjustment using the Youth Self-Report. Results Longitudinal mixed model analyses indicated that PCE was associated with greater externalizing behavioral problems at ages 12 and 15 years and more attention problems at age 15, after controlling for confounders. PCE effects were not found for internalizing behaviors. PCE adolescents in adoptive/foster care reported more externalizing and attention problems than PCE adolescents in biological mother/relative care at age 12 or noncocaine-exposed adolescents at both ages. No PCE by gender interaction was found. Prenatal marijuana exposure, home environment, parental attachment and monitoring, family conflict, and violence exposure were also significant predictors of adolescent behavioral adjustment. Conclusions PCE is a risk factor for poor behavioral adjustment in adolescence.
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