Serving Substance Abuse Professionals Since 1993

Last Update: 11.03.09

C O R K O N L I N E

powerpoint presentations
CORK database search
resource materials
bibliographies
clinical tools
user services
newsletters
about cork
home

CORK Bibliography: Children of Substance Abusers

67 citations. March 2008 to present

Prepared: March 2009

Amaro H; McGraw SA; Larson MJ; Marillis-Lopez L; Nieves R; Marshall B. Boston consortium of services for families in recovery: A trauma-Informed intervention model for women's alcohol and drug addiction treatment. Alcoholism Treatment Quarterly 22(3/4): 95-119, 2004

Through collaboration among the service agencies collectively known as the Boston Consortium of Services for Families in Recovery, the Boston Public Health Commission implemented an integrated model of trauma-informed services that is culturally and linguistically appropriate to its service population of primarily poor urban Latina and African American women. The enhanced intervention was implemented in five Consortium-affiliated alcohol and drug addiction treatment programs providing outpatient, residential, and methadone services. Programs adopted trauma-informed service system enhancements and offered study participants a package of trauma-specific and trauma-informed clinical services. The assessment and consensus-building processes, enhanced model components, implementation process, challenges and lessons learned are described.

Asanbe CB; Hall C; Bolden CD. The methamphetamine home: Psychologyogical impact on preschoolers in rural Tennessee. Journal of Rural Health 24(3): 229-235, 2008. (22 refs.)

Context: A growing number of children reside with methamphetamine-abusing parents in homes where the illicit drug is produced. Yet, the effects of a methamphetamine environment on psychological child outcome are still unknown. Purpose: To examine whether preschoolers who lived in methamphetamine-producing homes are at increased risk for developing psychological problems. Methods: The participants were 58 white children between the ages of 4 and 5 years; 31 with a history of living in methamphetamine-producing homes and 27 children who live in non-methamphetamine producing homes in rural Tennessee. The groups were similar in age, gender, and socioeconomic background. The groups were compared for behavioral and emotional adjustment using the behavior assessment system for children-parent rating scale-preschool (BASC-PRS-P) form. Biological or custodian parents completed a rating on their preschoolers that provided information about the children's pattern of behavior and feelings. Findings: Preschoolers from the methamphetamine-producing homes showed more externalizing problems than their peers, but were comparable on internalizing problems. On specific behaviors, the data indicate that preschoolers in the methamphetamine group showed higher aggression symptoms than their peers from non-methamphetamine-producing homes. Conclusions: These findings, if replicated, point to the need for mental health screening when a child is removed from a methamphetamine-producing home.

Ashford J; van Lier PAC; Timmermans M; Cuijpers P; Koot HM. Prenatal smoking and internalizing and externalizing problems in children studied from childhood to late adolescence. Journal of the American Academy of Child and Adolescent Psychiatry 47(7): 779-787, 2008. (42 refs.)

Objective: To study whether prenatal smoking only relates to externalizing problems or whether it is associated with both internalizing and externalizing problems from childhood into late adolescence. Method: Child Behavior Checklist-derived, parent-reported internalizing and externalizing problems of 396 children were longitudinally assessed at ages 5, 10 to 11, and 18 years. The influence of self-reported prenatal smoking on the course of internalizing and externalizing problems over these ages was assessed, controlling for the co-occurrence of internalizing and externalizing problems and co-occurring pre- and perinatal risk factors, demographic characteristics, maternal mental health, and child social and attention problems. Results: Children whose mothers had smoked during pregnancy had increased levels of both internalizing and externalizing problems over the period of ages 5 to 18 years when compared with children whose mothers did not smoke during pregnancy. These associations remained significant after controlling internalizing for externalizing and vice versa and possible confounding variables. Conclusions: Maternal smoking during pregnancy is a predictor of internalizing as well as externalizing psychopathology in offspring. The association between prenatal smoking and internalizing and externalizing problems persists throughout childhood and late adolescence.

Backett-Milburn K; Wilson S; Bancroft A; Cunningham-Burley S. Challenging childhoods: Young people's accounts of 'getting by' in families with substance use problems. Childhood 15(4): 461-479, 2008. (37 refs.)

Concern is increasing about children growing up in families where there are substance use problems but relatively little is known about the perspectives of the children themselves. This article reports on a qualitative study with young people who grew up in such families, exploring their accounts of their daily lives at home, school and leisure. The study focuses on the everyday interactions, practices and processes the young people felt helped them to 'get by' in their challenging childhoods, showing how the protective factors thought to promote 'resilience' were seldom in place for them unconditionally and without associated costs.

Bada HS; Langer J; Twomey J; Bursi C; Lagasse L; Bauer CR et al. Importance of stability of early living arrangements on behavior outcomes of children with and without prenatal drug exposure. Journal of Developmental and Behavioral Pediatrics 29(3): 173-182, 2008. (43 refs.)

Objective: We evaluated whether living arrangements of children with or without prenatal drug exposure would be associated with their behavior outcomes and adaptive functioning. Methods: A total of 1388 children with or without prenatal cocaine or opiate exposure were enrolled in a longitudinal cohort study at I month of age, were seen at intervals, tracked over time for their living situation, and evaluated for behavior problems and adaptive functioning at 3 years of age. The Child Behavior Checklist and Vineland Adaptive Behavior Scales were administered. Using multiple regression models, we determined the factors that would predict behavior problems and adaptive functioning. Results: Of the children enrolled, 1092 children were evaluated. Total and externalizing behavior problems T scores of children in relative care were lower (better) than those in parental care; externalizing behavior scores were lower than those in nonrelative care (p < .05). Total behavior problem scores increased 2.3 and 1.3 points, respectively, with each move per year and each year of Child Protective Services involvement. Compared to children in nonrelative care, those in parental or relative care had higher (better) scores in the Vineland Adaptive Behavior Scales total composite (p < .023), communication (p < .045), and daily living (p < .001). Each caretaker change was associated with a decrease of 2.65 and 2.19 points, respectively, in communication and daily living scores. Conclusion: Children's living arrangements were significantly associated with childhood behavior problems and adaptive functioning. The instability of living situation was also a significant predictor of these outcomes. While family preservation continues to be the goal of the child welfare system, expediting decision toward permanency remains paramount once children are placed in faster care.

Baldwin JN; Scott DM; Agrawal S; Bartek JK; Davis-Hall RE; Reardon TP et al. Assessment of alcohol and other drug use behaviors in health professions students. Substance Abuse 27(3): 27-37, 2007

Alcohol and other drug (AOD) use behaviors of health professions students (HPS) were assessed by surveying both university-based HPS and other nursing programs in a Midwestern state in 1999. Response was 2,646 (56.4%) of surveyed students. Family history of alcohol-related and drug-related problems were reported by 39.8% and 13.9%, respectively, with 42.6% of respondents reporting one or both. Among nursing respondents, 48.1%, 19.2% and 51.1%, respectively, reported family problems with alcohol, drugs, or one or both. Past-year alcohol use was comparable to undergraduate college students (UCS) nationally (83%); heavy drinking, tobacco and recreational drug use by HPS were lower. Past year drug use was highest among medical students. Marijuana was the predominant illicit drug; medical students and males most often reported use. Health professions educational systems should proactively address student AOD prevention, education and assistance needs.

Beratis NG; Asimacopoulou A; Varvarigou A. Association of secondary sex ratio with smoking and parity. Fertility and Sterility 89(3): 662-667, 2008. (51 refs.)

Objective: To assess the sex ratio in offspring of smoking and nonsmoking mothers in relationship to parity. Design: Prospective study. Setting: University hospital. Patient(s): The authors studied 2,108 term singleton neonates born between 1993 and 2002, 665 from smoking mothers and 1,443 from nonsmoking mothers. Intervention(s): A prospective recording of maternal age, parity and smoking status, and gender of neonates delivered over a 10-year period. Main Outcome Measure(s): Secondary sex ratio in regard to maternal smoking and parity. Result(s): The offspring sex ratio in the total sample studied was 1.09; in the offspring of smoking and nonsmoking mothers, it was 1.26 and 1.03, respectively, a statistically significant difference. In the offspring of smoking women who had parity 1, 2, and >= 3, it was 1.47, 1.35, and 0.92, whereas in those of nonsmoking women, it was 1.04, 1.00, and 1.03, respectively (the differences of the parity 1 and 2 groups between the offspring of smoking and nonsmoking mothers were statistically significant). Logistic regression analysis showed that the possibility of a boy being delivered by a mother who smoked was significantly greater in primiparous women than in women who had parity 3, independent of the maternal age. Conversely, parity did not affect significantly the sex ratio in the offspring of nonsmoking women. Conclusion(s): The findings suggest that among women who smoked, significantly more male than female offspring are born from primiparous women, whereas women who had parity 3 gave birth to more female offspring; F biparous women give birth to significantly more male offspring, but the offspring sex ratio declined with the number of cigarettes when the mothers smoked >= 10 cigarettes per day.

Bernard M. Drug Addiction and Families. London: Jessica Kingsley Publishers, 2007

Drug problems on individuals have an impact on family members. This book, draws upon interviews conducted by the author in Great Britain, with drug users and extended family members. It begins with an examination of the responses of families -- the process of discovery, adaptation, and expulsion -- exploring the feelings of anger, sadness, anxiety, shame and loss that are commonly experienced by the extended family. The book also examines the effects of drug use on family dynamics and relationships, including possible social and emotional costs, as well as the costs on physical and mental health. The role of parenting is examined, along with the often overlooked role of grandparents in protecting the children of drug users. The lives of children are examined and the problems which proliferate. It is emphasized that the current service system, in treating the problem drug user in isolation, fails to address the needs of drug-affected families, and misses the opportunity to develop family-oriented support and treatment.

Best CM; Sun K; de Pee S; Sari M; Bloem MW; Semba RD. Paternal smoking and increased risk of child malnutrition among families in rural Indonesia. Tobacco Control 17(1): 38-45, 2008. (24 refs.)

Objective: To determine whether paternal smoking is associated with an increased risk of child malnutrition among families in rural Indonesia. Methods: The relation between paternal smoking and child malnutrition was examined in a population-based sample of 438 336 households in the Indonesia Nutrition and Health Surveillance System, 2000-2003. Main outcome measures were child underweight (weight-for-age Z score <-2) and stunting (height-for-age Z score <-2) and severe underweight and severe stunting, defined by respective Z scores <-3, for children aged 0 59 months of age. Results: The prevalence of paternal smoking was 73.7%. The prevalence of underweight and stunting was 29.4% and 31.4%, and of severe underweight and severe stunting was 5.2%, and 9.1%, respectively. After adjusting for child gender, child age, maternal age, maternal education, weekly per capita household expenditure and province, paternal smoking was associated with an increased risk of underweight (odds ratio (OR) 1.03, 95% confidence interval (CI) 1.01 to 1.05, p=0.001) and stunting (OR 1.11, 95% CI 1.09 to 1.13, p < 0.001) and severe underweight (OR 1.06, 95% CI 1.01 to 1.10) p=0.020) and severe stunting (OR 1.12, 95% CI 1.08 to 1.16, p < 0.001). Conclusions: Paternal smoking is associated with an increased risk of child malnutrition in families living in rural Indonesia.

Bonder BR; Hulisz D; Marsh S; Bonaguro J. Community-based substance abuse training: Helping children living in families with substance-abusing adults. Substance Abuse 26(3/4): 27-30, 2006

Elementary school staff requested and were provided with strategies for helping students and a resource guide to services for students living with substance-abusing adults. (This is one of a series of 10 case studies.)

Borchers AT; Keen CL; Gershwin ME. Smoking cessation: Significance and implications for children. (review). Clinical Reviews in Allergy and Immunology 34(2): 231-249, 2008. (149 refs.)

A number of people in the USA who are still current smokers remain a staggering figure. Although this number continues to decrease, there is still a considerable amount of second-hand smoke. More importantly and for the purpose of this review, the detrimental effects of passive smoke in children is significant. We will not review the specific health effects of passive smoke, but for pediatricians, in particular, it is important to place in perspective programs that are available to influence the parents of children to stop smoking. Indeed, approximately 25% of all children aged 3-11 live in a household with at least one smoker. Despite the increasing number of communities in the states that have instituted restrictions or complete bans on smoking in the workplace and in many public areas, the principal site of smoking remains the home.

Brook I; Gober AE. Recovery of potential pathogens in the nasopharynx of healthy and otitis media-prone children and their smoking and nonsmoking parents. Annals of Otology Rhinology, and Laryngology 117(10): 727-730, 2008. (11 refs.)

Objectives: Exposure to smoking is associated with colonization with pathogenic bacteria. This study investigated the frequency of isolation of potential pathogens in the nasopharynx of healthy and otitis media-prone (OMP) children and their smoking or nonsmoking parents. Methods: Posterior nasopharynx cultures were taken from 40 healthy and 40 OMP children and one of their parents. Twenty parents in each group were smokers. Potential pathogenic organisms were identified. Results: In the healthy children whose parents smoked, 15 potential pathogens were isolated from the parents and 13 were recovered from their children. Among the healthy children whose parents were nonsmokers, 3 potential pathogens were isolated from 2 parents (p < 0.005, compared to the parents and children in the smoking group) and 7 were recovered from their children. In the OMP children whose parents smoked, 16 potential pathogens were isolated from the parents and 19 were found in their children. Among the OMP children with nonsmoking parents, 3 potential pathogens were isolated from the parents (p < 0.001, compared to the parents and children in the OMP smoking group and the healthy children in the nonsmoking parents group) and 17 were recovered from their children. Conclusions: Parents who smoke are more often colonized with pathogens than those who do not smoke. The nasopharynx of healthy children of smokers harbors a high number of pathogens that are similar to the flora found in their parents and OMP children. Pathogenic organisms were found more often in OMP children of both smoking and nonsmoking parents, as compared to healthy children whose parents were nonsmokers. Concordance with pathogens in the parent was high among the OMP children of smoking parents, but this was not observed in the OMP children of nonsmokers.

Cadiz S; Savage A; Bonavota D; Hollywood J; Butters E; Neary M; Quiros L. The Portal Project: A layered approach to integrating trauma into alcohol and other drug treatment for women. Alcoholism Treatment Quarterly 22(3/4): 121-139, 2004

Palladia, Inc. is a not-for-profit, multi-service agency, located in New York City, serving primarily African-American and Latino communities. Palladia's Portal Project, in collaboration with the evaluation team from Hunter College School of Social Work (HCSSW), participated in the national Women, Co-Occurring Disorders and Violence study. We studied 270 women with co-occurring issues of alcohol and other drug (AOD) problems and mental illness, who had histories of violence, and were high end users of service. Palladia built an integrated system of care and implemented a comprehensive trauma-informed intervention that is designed to put trauma and safety first to assist women in remaining in treatment. Primacy of trauma in the early stages of treatment constitutes a major philosophical shift within the traditional residential drug treatment setting. The focus of the engagement and treatment process is on the role of trauma in the woman's life and its relationship to patterns of AOD abuse and mental illness. Another key feature of the Portal model is the emphasis on normalizing the adaptations which the women have made in response to interpersonal traumatic life events. The women feel less stigmatized and isolated. They are encouraged to see their former coping and adaptive behaviors as strengths rather than maladaptive weaknesses, deficiencies or character flaws. Support for the women in their parenting and family roles and attention to their individual perceptions of culture are also part of the intervention. Portal blends service intervention, policy development, research, and evaluation for effective service delivery. The collaborative work of this project has produced a replicable model that configures specific direct service enhancements and service system improvements, using the active involvement of consumers, practitioners, service providers and policy makers.

Carlsen KH; Carlsen KCL. Respiratory effects of tobacco smoking on infants and young children. Paediatric Respiratory Reviews 9(1): 11-20, 2008. (78 refs.)

Second-hand smoke (SHS) and tobacco smoke products (TSPs) are recognised global risks for human health. The present article reviews the causal role of SHS and TSPs for respiratory disorders in infants and young children. Several studies have shown an effect of TSPs exposure during pregnancy upon lung function in the newborn infant and of SHS on symptoms and lung function after birth. From 1997 to 1999 a set of systematic reviews concerning the relationship between second-hand exposure to tobacco smoke and respiratory health in children was published in Thorox by Cook and Strachan, covering hundreds of published papers. The evidence for a causal relationship between SHS exposure and asthmatic symptoms and reduced lung function is quite strong, whereas the evidence related to the development of allergy is much weaker. There is recent evidence relating to an interaction between TSP exposure and genetic ploymorphisms, demonstrating that certain individuals are more susceptible to the effect of TSP exposure on lung health. In the present review, an overview is given for the effects of TSP exposure and SHS upon lung health in children, with a focus on infants and young children. There is a need for intervention to reduce TSP exposure in young children, by educating parents and adolescents about the health effects of TSP exposure. Recent legislation in many European countries related to smoking in the workplace is of great importance for exposure during pregnancy. Studies are needed to identify possible critical periods for TSPs to induce harmful effects upon lung health in young children and on environment-gene interactions in order to prevent harm.

Chatzimicael A; Tsalkidis A; Cassimos D; Gardikis S; Spathopoulos D; Tripsianis GA et al. Effect of passive smoking on lung function and respiratory infection. Indian Journal of Pediatrics 75(4): 335-340, 2008. (34 refs.)

Objective. To study the effect of environmental tobacco smoke to children's health and more specifically to the development of respiratory tract infections and also its influence to their respiratory function. Methods. We studied 586 children from the district of west Thrace in Greece aged 5-14 years, randomly selected from 20 primary and 10 secondary schools in regards their exposure to tobacco smoke, and its possible relation with respiratory tract infections. We assessed respiratory function by spirometry. Epidemiologyogical data were also analysed. Results. Children who were exposed to environmental tobacco smoke had higher risk for upper and lower respiratory tract infections in comparison to children who lived in a smoke free environment (3 fold and 2 fold, respectively}. Their lung function was also reduced with decreased values of FEV1, FEF50, PFR (values p<0.001). Conclusion. Passive smoking has an unfavorable effect in respiratory function of children and predisposes them to respiratory tract infections. Every effort should be undertaken in order to avoid exposure of children to environmental tobacco smoke.

Cleaver H; Nicholson D; Tarr S; Cleaver D. Child Protection, Domestic Violence and Parental Substance Abuse, Family Experiences and Effective Practice. London: Jessica Kingsley, 2007. (147 refs.)

This book presents findings from a government commissioned study. The group of children and young people studied over a two-year period are those who have lived with domestic violence and/or whose parents/carers have abused substances (alcohol and/or drugs). The goal was to identify how children's social care responds to families where problems require the intervention by both adult and children's services; identify the factors that enable different agencies to work together successfully together at the various stages of assessment, planning and service delivery and review; and finally to examine children and parents' experiences of professional interventions. The book has six chapters (apart from the introduction and conclusions), each of which presents findings from the different data-sets. Overall, findings, whilst not surprising, are very relevant to social work. For example, 50 per cent of parents had �severe difficulty in relation to their parenting capacity� and 81 per cent had �problems in relation to with family history and functioning�. One key finding is the extent of the problems that occurred in inter-agency collaboration with managers reporting confidentiality, a lack of resources, a lack of trust and preconceptions of parents as factors that hindered multi-agency collaboration.

Collins CC; Lippmann BM; Lo SJ; Moolchan EI. Time spent with smoking parents and smoking topography in adolescents. Addictive Behaviors 33(12): 1594-1597, 2008. (15 refs.)

Although the relationship between parental and adolescent smoking has been linked to health consequences of smoking, limited study has explored the specific association between exposure to smoking and adolescent smoking topography (the way a cigarette is smoked). As a first step in this line of enquiry, smoking topography measures were collected from 67 adolescent dependent smokers. Participants smoked one cigarette of their own brand while being monitored by a computer-based smoking-topography unit and completed questionnaires about their time spent daily with parents who smoke. Pearson's correlation analysis revealed that time spent daily with parents who smoke was significantly associated with maximum puff velocity (r=0.285, p=.019), a parameter predicting later pulmonary morbidity. ANOVAs, after a median split, were consistent with correlation analyses. There was a significant group effect on puff velocity (F(2,66)=5.197, p=.008); no significant relationship was found with puff volume (F(2,66)=.617) or puff duration (F(2,66)=.776). A post hoc Tukey HSD test indicated puff velocity was higher in the "high time spent" (M=54.37, SD=12.03) than in the "low time spent" group (M=45.59, SD=9.91) and in the group with non-smoking parents (M=44.96, SD=10.17). Future research with a larger non-treatment seeking sample of adolescents aimed at preventing tobacco smoking related diseases should further examine parental influences on adolescent smoking, including potential modeling effects.

Delpisheh A; Kelly Y; Rizwan S; Brabin BJ. Salivary cotinine, doctor-diagnosed asthma and respiratory symptoms in primary schoolchildren. Maternal and Child Health Journal 12(2): 188-193, 2008. (37 refs.)

Due to impaired airway function, children are at risk for adverse respiratory symptoms if exposed to environmental tobacco smoke (ETS). A community-based, cross-sectional study of 425 children (5-11 years) attending 15 primary schools in a low socio-economic area of Merseyside/UK was undertaken to investigate the association of adverse respiratory symptoms and ETS exposure using a parent-completed questionnaire and children's salivary cotinine measurements. Overall, 28.9% of children had doctor-diagnosed asthma (DDA) and 11.3% a history of hospital admission for respiratory illnesses. The symptom triad of cough, wheeze and breathlessness (C+W+B+) occurred in 12.6% of children. The geometric mean cotinine level was 0.37 ng/ml (95% CI, 0.33-0.42 ng/ml) and it was estimated that 45.6% of children were ETS exposed. A history of asthma in the family was reported for 9.2% of fathers and 7.2% of mothers. Salivary cotinine level was significantly increased in children with DDA compared to those without (P = 0.002). Cotinine-validated levels [adjusted odds ratio (AOR), 1.8; 95% CI, 1.4-2.5), low socio-economic (disadvantaged) status (AOR, 1.4; 1.1-2.9), child's male gender (AOR, 1.6; 1.1-2.5) and maternal smoking (AOR, 2.2; 1.4-3.1) were significantly associated with DDA. The cotinine-validated level (AOR, 1.4; 1.1-2.9) as well as maternal smoking (AOR, 1.8; 1.1-2.5), were also independently associated with C+W+B+. The use of salivary cotinine as an indicator of ETS exposure could be used to inform parents of exposure risk to their asthmatic children and may help re-enforce deterrent efforts to reduce childhood parental smoking exposure.

Fagnano M; Conn KM; Halterman JS. Environmental tobacco smoke and behaviors of inner-city children with asthma. Ambulatory Pediatrics 8(5): 288-293, 2008. (44 refs.)

Objective.-To explore the relationship between environmental tobacco smoke (ETS) exposure and behavior among inner-city children with significant asthma. Methods.-We analyzed baseline data for 200 children 4 to 10 years old who were enrolled in an asthma program. Environmental tobacco smoke exposure was measured by the child's salivary cotinine level. Caregivers completed the 28-item Behavior Problem Index (BPI). Positive responses were summed for a total BPI score, and children with scores > 14 were considered to have significant behavior problems. We conducted Student t tests and multivariate regression analyses to determine the association of children's cotinine levels with BPI scores. Results.-Overall, 56% of children were male, 65% were black. and 72% had Medicaid. Mean cotinine level was 1.47 ng/mL. Overall, 30% of children had total BPI scores >14. Children with cotinine values > 1.47 ng/mL had significantly higher scores compared with children with lower cotinine values on total BPI (12.5 vs 10.2), as well as externalizing (9.0 vs 7.2), antisocial (2.3 vs 1.7), and immature (2.1 vs 1.6) subscales. In a multivariate model, log cotinine remained independently associated with externalizing (P = .04). headstrong (P = .04), and antisocial behavior (P = .04). Conclusions.-Cotinine levels are independently associated with problem behaviors among this sample of urban children with asthma.

Feske U; Tarter RE; Kirisci L; Gao ZC; Reynolds M; Vanyukov M. Peer environment mediates parental history and individual risk in the etiology of cannabis use disorder in boys: A 10-year prospective study. American Journal of Drug and Alcohol Abuse 34(3): 307-320, 2008. (58 refs.)

Previous research has shown that a trait termed neurobehavior disinhibition (ND) measured in childhood predicts substance use disorder by young adulthood. The present investigation extends these findings by determining the degree to which peer environment mediates the association between ND and development of cannabis use disorder (CUD). ND was measured in a sample of 216 boys 10-12 years of age. The peer environment was assessed at age 16. Current CUD was determined at age 22. Paternal and maternal SUD predicted son's ND which, in turn, predicted son's peer environment and, subsequently, son's cannabis use frequency and CUD. Peer environment mediated the association between ND and cannabis use and ND and CUD. Maternal and paternal SUD predicted the peer environment. Parental SUD, son's ND, and son's peer environment predicted CUD at age 22 with 84% accuracy.

Fuchs W; Martens MS; Verthein U. Opioid addicted parents with dependent children - Life situation and risk indicators (German). Suchttherapie 9(3): 130-135, 2008. (21 refs.)

This study aims to empirically explore the connection between parenthood and addiction in terms of the best interest and welfare of the children. Three groups of opioid addicts are compared with regard to fifteen risk indicators (concerning drug use, traumatic live experiences, social circumstances and health): parents who do have care of their children, parents not living with their children and drug users without children. The data set is derived from the documentary system of the Hamburg outpatient drug treatment services (n=4971). 30.3% of the patients have children. Only 35.9% of the parents live together with their children and exercise parenthood. Parents with children at home showed the lowest, parents with children living elsewhere the highest prevalence for almost all of the risk indicators. More appropriate help should be offered to drug using parents in order to empower them to keep their children. However, top priority must be given to the best interest and welfare of the children.

Gilman SE; Rende R; Boergers J; Abrams DB; Buka SL; Clark MA et al. Parental smoking and adolescent smoking initiation: An intergenerational perspective on tobacco control. Pediatrics 123(2): E274-E281, 2009. (67 refs.)

OBJECTIVE. Adolescence is an important period of risk for the development of lifelong smoking behaviors. Compelling, although inconsistent, evidence suggests a relationship between parental smoking and the risk of smoking initiation during adolescence. This study investigates unresolved issues concerning the strength and nature of the association between parent smoking and offspring smoking initiation. METHODS. We enrolled 564 adolescents aged 12 to 17, along with 1 of their parents, into the New England Family Study between 2001 and 2004. Lifetime smoking histories were obtained from parents and their adolescent offspring. Discrete-time survival analysis was used to investigate the influence of parental smoking histories on the risk of adolescent smoking initiation. RESULTS. Parental smoking was associated with a significantly higher risk of smoking initiation in adolescent offspring. In addition, the likelihood of offspring smoking initiation increased with the number of smoking parents and the duration of exposure to parental smoking, suggesting a dose-response relationship between parental smoking and offspring smoking. Offspring of parents who had quit smoking were no more likely to smoke than offspring of parents who had never smoked. The effects of parental smoking on offspring initiation differed by sex (with a stronger effect of fathers' smoking on boys than girls), developmental period (with a stronger effect of parental smoking before the adolescent was age 13 than afterward), and residence of parents (with effects of fathers' smoking being dependent on living in the same household as the adolescent). Parental smoking was also associated with stronger negative reactions to adolescents' first cigarette, a potential marker of the risk of progression to higher levels of use. CONCLUSIONS. Parental smoking is an important source of vulnerability to smoking initiation among adolescents, and parental smoking cessation might attenuate this vulnerability.

Goodwin RD. Intergenerational transmission of chronic physical disease via chronic mental disorders: The potential role of addictive behaviors. Addictive Behaviors 33(11): 1432-1440, 2008. (86 refs.)

There has been growing evidence of a link between chronic respiratory diseases, asthma in particular, and mental disorders among youth. The mechanism for this link remains unknown. Several studies have empirically addressed the question of this pathway, and accumulating results may shed new light on the nature of this association. The goal of the current paper is to provide an integrative summary of the literature to date and to present a new interdisciplinary hypothesis for one possible mechanism explaining the link between asthma and anxiety/depression among youth. This hypothesis posits that comorbid anxiety/depression and nicotine dependence among adults, may be one pathway leading to the comorbidity of asthma and anxiety/depression among youth. We propose this mechanism operates via exposure to environmental tobacco smoke and/or prenatal tobacco use, which confers an increased risk for asthma, and parental anxiety/depression which confers increased risk of anxiety/depression among offspring via familial transmission. We predict that further testing of this hypothesis will help to reveal the largely neglected problem of nicotine dependence especially among women and the far-reaching impact of this addiction on the health of children.

Goodwin RD; Cowles RA. Household smoking and childhood asthma in the United States: A state-level analysis. Journal of Asthma 45(7): 607-610, 2008. (31 refs.)

Background. The reason for the substantial geographic variation in the prevalence of childhood asthma is not known. Objective. To investigate the association between exposure to cigarette smoking in the home and childhood asthma at the state-level, toward improving current understanding of geographic variation in childhood asthma rates. Methods. Data were drawn from the National Children's Health Survey (NCHS, 2003), a representative sample (n = 102, 000) of youth 0 to 17 years of age in the United States. Household smoking and asthma in children were reported by parents. Air quality for each state was obtained from Environmental Protection Act (EPA) reports, and state-level poverty reports were obtained from the US Department of Agriculture. Results. Household smoking was associated with a statistically significant increase in risk of asthma among children at the state level (p = 0.026). This association did not appear to be influenced by outdoor air quality at the state level or socioeconomic position. Conclusions. These results are the first to show a link between cigarette smoking in the home and childhood asthma at a state-level in the United States.

Haggerty KP; Fleming CB; Catalano RF; Petrie RS; Rubin RJ; Grassley MH. Ten years later: Locating and interviewing children of drug abusers. Evaluation and Program Planning 31(1): 1-9, 2008. (27 refs.)

Longitudinal studies require high follow-up rates in order to maintain statistical power, reduce bias, and enhance the generalizability of results. This study reports on locating and survey completion for a 10-year follow-up of the Focus on Families project, an investigation of 130 families headed by parents who were enrolled in methadone treatment for opiate addiction. Despite having no contact with participants in the study for at least 10 years, the project successfully located nearly 99% of parent participants and 98% of their children. Twenty-four percent of the parents and one child had died before the follow-up. Of the surviving sample, 91% of parents and 86% of the children completed the follow-up interview. Multiple techniques were used to locate study participants, including internet searches, researching court and public records, collaborating with government and service agencies, and contacting family and social networks. For more than half of the sample, costly efforts were required to locate individual participants.

Haggerty KP; Skinner M; Fleming CB; Gainey RR; Catalano RF. Long-term effects of the Focus on Families project on substance use disorders among children of parents in methadone treatment. Addiction 103(12): 2008-2016, 2008. (60 refs.)

This study examines the efficacy of the Focus on Families project (currently called Families Facing the Future), a preventive intervention to reduce substance use disorders among children in families with a parent in methadone treatment. One hundred and thirty families were assigned randomly to a methadone clinic treatment-as-usual control condition or treatment-as-usual plus the Focus on Families intervention between 1991 and 1993. Participants were recruited from two methadone clinics in the Pacific Northwest. This study examines the development of substance use disorders among the 177 children (56.84% male) involved in the program using data from a long-term follow-up in 2005, when these participants ranged in age from 15 to 29 years. The intervention was delivered through group parent-training workshops at the methadone clinics and through individualized home-based services. The intervention taught parenting skills and skills for avoiding relapse to drug abuse. At long-term follow-up, substance use disorders were measured by the Composite International Diagnostic Interview (CIDI). Survival analyses were used to assess intervention versus control differences in the hazard of developing substance use disorders. Overall, intervention and control participants did not differ significantly in risk of developing substance use disorders. However, there was evidence of a significant difference in intervention effect by gender. There was a significant reduction in the risk of developing a substance use disorder for intervention group males compared to control group males (hazard ratio = 0.53, P = 0.03), while intervention versus control differences among females were non-significant and favored the control condition. Results from this study suggest that helping parents in recovery focus on both reducing their drug use and improving their parenting skills may have long-term effects on reducing substance use disorders among their male children. However, the overall long-term benefits of this program are not supported by the results for female children.

Halterman JS; Borrelli B; Tremblay P; Conn KM; Fagnano M; Montes G; Hernandez T. Screening for environmental tobacco smoke exposure among inner-city children with asthma. Pediatrics 122(6): 1277-1283, 2008. (42 refs.)

OBJECTIVES. The goals were (1) to develop an index measure of environmental tobacco smoke based on parent self-report of smoking behaviors and (2) to determine whether the index score was associated with children's present and future cotinine levels. METHODS. Data were drawn from a community intervention for inner-city children with persistent asthma (N = 226; response rate: 72%). Measures of child salivary cotinine levels and parent self-reported environmental tobacco smoke-related behaviors were obtained at baseline and 7 to 9 months later. To develop the index score, we used a 15-fold cross-validation method, with 70% of our data, that considered combinations of smoke exposure variables and controlled for demographic features. We chose the most parsimonious model that minimized the mean square predictive error. The resulting index score included primary caregiver smoking and home smoking ban status. We validated our model with the remaining 30% of the data. Analysis of variance and multivariate analyses were used to determine the association of the index score with children's cotinine levels. RESULTS. Fifty-four percent of children with asthma lived with >= 1 smoker, and 51% of caregivers reported a complete home smoking ban. The children's mean baseline cotinine level was 1.55 ng/mL (range: 0.0-21.3 ng/mL). Children's baseline and follow-up cotinine levels increased as scores on the index measure increased. In a linear regression, the index score was significantly positively associated with children's cotinine measurements at baseline and 7 to 9 months later. CONCLUSION. An index measure with combined information regarding primary caregiver smoking and household smoking restrictions helped to identify children with asthma with the greatest exposure to environmental tobacco smoke and could predict which children would have elevated cotinine levels 7 to 9 months later.

Heckman J; Hutchins FA; Thom J; Russell L. Allies: Integrating women's alcohol, drug, mental health and trauma treatment in a county system. Alcoholism Treatment Quarterly 22(3/4): 161-180, 2004

Allies, one of nine sites participating in the Substance Abuse Mental Health Services Administration's Women, Co-occurring Disorders and Violence Study, was developed through collaboration between California's San Joaquin County Health Care Services and ETR Associates. Allies was charged with developing and implementing integrated services for women with ADM disorders and abuse histories within the County. Stakeholders identified service enhancements that were implemented in alcohol and drug treatment programs: integrated case management, trauma groups, and integrated parenting classes. Approximately 400 providers attended training activities; 174 women participated. Allies experienced barriers and successes. Lessons learned may be useful for future change efforts.

Henderson AJ. The effects of tobacco smoke exposure on respiratory health in school-aged children. Paediatric Respiratory Reviews 9(1): 21-28, 2008. (71 refs.)

The effects of tobacco smoke exposure on the respiratory health of school-aged children relate to persisting effects of exposure to tobacco smoke during pregnancy and early infancy, passive exposure to environmental tobacco smoke in the home and elsewhere, and active smoking during later childhood. Much of the current evidence comes from cross-sectional and longitudinal observational studies and suggests that, for asthma and pulmonary function outcomes, the strongest associations are with smoke exposure in pregnancy and early childhood, although independent effects of later exposure are reported. Exposure in later childhood to environmental tobacco smoke is associated with increased respiratory symptoms, although for some of these, the effect appears to diminish with increasing age of the child. There is currently a paucity of evidence on the long-term adverse respiratory consequences of active smoking by children and adolescents, but such evidence there is suggests that these may be substantial.

Hill SC; Liang L. Smoking in the home and children's health. Tobacco Control 17(1): 32-37, 2008. (18 refs.)

Objectives: We estimate for young children the annual excess health service use, healthcare expenditures, and disability bed days for respiratory conditions associated with exposure to smoking in the home in the United States. Methods: Health service use, healthcare expenditures and disability bed days data come from the 1999 and 2001 Medical Expenditure Panel Survey (MEPS). Reported smoking in the home comes from the linked National Health Interview Survey, from which the MEPS sample is drawn. Multivariate statistical analysis controls for potential confounding factors. The sample is 2759 children aged 0-4. Results: Smoking in the home is associated with an increase in the probability of emergency department visits for respiratory conditions by five percentage points and the probability of inpatient use for these conditions by three percentage points. There is no relation between indoor smoking by adults and either ambulatory visits or prescription drug expenditures. Overall, indoor smoking is associated with $117 in additional healthcare expenditures for respiratory conditions for each exposed child aged 0-4. Indoor smoking is also associated with an eight percentage point increase in the probability of having a bed day because of respiratory illness for children aged 1-4. Conclusions: Despite the significant progress made in tobacco control, many children are still exposed to secondhand smoke in their home. Reducing exposure to smoking in the home would probably reduce healthcare expenditures for respiratory conditions and improve children's health.

Holdsworth C; Robinson JE. 'I've never ever let anyone hold the kids while they've got ciggies': moral tales of maternal smoking practices. Sociology of Health & Illness 30(7): 1086-1100, 2008. (42 refs.)

Smoking in the home is, potentially, the next frontier in tobacco control in the developed world. As smoking regulations in public space are extended, attention is turning to private spaces and the contribution of parental, particularly maternal, smoking to children's health and socio-economic inequalities in family health. Yet relatively little is known about mothers' smoking practices within the home and the social meanings of smoking that are constructed by these practices. In this paper we explore how mothers who smoke construct moralities of their smoking behaviour, particularly in relation to where and with whom they smoke. Drawing on in-depth Biographic Narrative Interpretative Method, in interviews with 12 smoking mothers, and their partners, we consider how these moral tales involve comparisons with other smokers and the importance of community endorsement of smoking practices, particularly around children. We also consider the role of children in the home and how children are actively involved in the regulation of smoking behaviours. Finally, we consider the implications of these moral tales for interventions around smoke-free homes.

Hugg TT; Jaakkola MS; Ruotsalainen RO; Pushkarev VJ; Jaakkola JJK. Parental smoking behaviour and effects of tobacco smoke on childrens health in Finland and Russia. European Journal of Public Health 18(1): 55-62, 2008. (45 refs.)

Background: There is little information on potential differences in smoking behaviour of parents between Finland and Russia and on the effects of environmental tobacco smoke (ETS) exposure on allergic and respiratory diseases among Finnish and Russian children. The aim of the study was to compare the smoking behaviour of parents and school children and to assess the relations of tobacco smoke exposure during pregnancy and childhood with occurrence of allergic diseases and respiratory infections among school children. Methods: We conducted a population-based cross-sectional study in the neighbour towns across the border of Imatra in Finland and Svetogorsk in Russia. The study population consisted of 512 Finnish and 581 Russian school children aged 7-16 years (response rate 79%). Results: Childrens tobacco smoke exposure differed markedly between Finland and Russia. The risk of asthma was particularly related to high maternal smoking exposure during pregnancy (adjusted OR 3.51, 95% CI 1.00-12.3), infancy (3.34, 1.23-9.07) and currently (3.27, 1.26-8.48), and the risk of common cold was related to high combined parental smoking during infancy (1.83, 1.06-3.17) in Finnish children. Among Russian children allergic conjunctivitis was related to maternal smoking during infancy (4.53, 1.49-13.8) and currently (2.82, 1.07-7.44). Conclusions: Smoking behaviour of parents and ETS exposure during childhood differed markedly between Finland and Russia. Asthma was particularly increased in relation to high exposure to maternal smoking in Finland. The results suggest that more efforts should be directed to reducing tobacco smoke exposure of children in both Finland and Russia.

Huijbregts SCJ; Warren AJ; de Sonneville LMJ; Swaab-Barneveld H. Hot and cool forms of inhibitory control and externalizing behavior in children of mothers who smoked during pregnancy: An exploratory study. Journal of Abnormal Child Psychology 36(3): 323-333, 2008. (73 refs.)

This study examined whether children exposed to prenatal smoking show deficits in "hot" and/or "cool" executive functioning (EF). Hot EF is involved in regulation of affect and motivation, whereas cool EF is involved in handling abstract, decontextualized problems. Forty 7 to 9-year-old children (15 exposed to prenatal smoking, 25 non-exposed) performed two computerized tasks. The Sustained Attention Dots (SA-Dots) Task (as a measure of "cool" inhibitory control) requires 400 non-dominant hand and 200 dominant hand responses. Inhibitory control of the prepotent response is required for dominant hand responses. The Delay Frustration Task (DeFT) (as a measure of "hot" inhibitory control) consists of 55 simple maths exercises. On a number of trials delays are introduced before the next question appears on the screen. The extent of response-button pressing during delays indicates frustration-induced inhibitory control. Prenatally exposed children showed poorer inhibitory control in the DeFT than non-exposed children. A dose-response relationship was also observed. In addition, prenatally exposed children had significantly higher (dose-dependent) conduct problem- and hyperactivity-inattention scores. There were no significant group differences in inhibitory control scores from the SA-Dots. These results indicate that children exposed to prenatal smoking are at higher risk of hot but not cool executive function deficits.

Ip P; Chan WT; Lee YT; Chow CB. Early intervention program for pregnant heroin users and their young children: Hong Kong's experience. Hong Kong Journal of Pediatrics 13(2): 99-109, 2008. (14 refs.)

Objectives: To achieve early identification of pregnant heroin users and their young children and to provide adequate support, modify important risk factors and monitor the welfare of their children. Methodology: Pregnant heroin users were identified during early pregnancy by social workers in a major methadone centre in Kowloon West and referred to a district hospital for early assessment, counselling, management of drug addiction and formulation of child care plan. Their infants and young children were followed up and closely monitored by a paediatrician and staff in a local maternity and child health centre. Results: Fifty-eight heroin users and their families (69 children) were recruited in the Kowloon West District from May 2006 to April 2007, among which 9 (15.5%) underwent successful detoxification and 38 (65.5%) became stable methadone users, which were significantly higher than the 7% successful detoxification rate and 14% stable methadone user rate found in the baseline study before the program. Vaccination compliance of their young children was 94%, which was higher than the 77% compliance rate found in the surveillance study before the program. Conclusions: Modification of risk factors of pregnant heroin abusers and their young children could be achieved by an early intervention program through enhanced work of health care and social service workers.

Jaddoe VWV; de Ridder MAJ; van den Elzen APM; Hofman A; Uiterwaal CSPM; Witteman JCM. Maternal smoking in pregnancy is associated with cholesterol development in the offspring: A 27-years follow-up study. Atherosclerosis 196(1): 42-48, 2008. (29 refs.)

Objective: To examine the associations of maternal smoking in pregnancy with development of cholesterol levels from childhood to adulthood. Methods: Total cholesterol, high-density lipoprotein (HDL) cholesterol and low-density lipoprotein (LDL) cholesterol were measured annually from 1975 to 1993 and in 2002 in 350 subjects aged 5-19 years at baseline who participate in a prospective cohort study. Pregnancy and birth data were obtained through questionnaires sent to the parents. Results: Children of mothers who smoked in pregnancy showed a higher annual change in total cholesterol of 0.12 mmol/l per 10 years (95% confidence interval (CI): 0, 0.23) compared to children whose mothers did not smoke in pregnancy. Larger effect estimates were found in children with moderate overweight (0.39 mmol/l per 10 years (95% CI: 0.14, 0.63). HDL-cholesterol and LDL-cholesterol showed tendencies towards a decrease and increase, respectively, in children of mothers who smoked in pregnancy compared to children whose mothers did not smoke in pregnancy. Adjustment for potential confounders did not materially change the effect estimates. Conclusion: This study suggests for the first time that maternal smoking in pregnancy is associated with an increased rise in total cholesterol levels and a tendency towards an adverse lipoprotein profile in the offspring

Kelley ML; Fals-Stewart W. Treating paternal drug abuse using Learning Sobriety Together: Effects on adolescents versus children. Drug and Alcohol Dependence 92(1/3): 228-238, 2008. (51 refs.)

The focus of this study was whether couples-based treatment for substance abuse had comparable secondary benefits on the internalizing and externalizing behaviors of adolescent versus child siblings living in their homes. Couples took part in a couples-based treatment for substance abuse that combines Behavioral Couples Therapy and individual counseling (i.e., Learning Sobriety Together). During a 17-month assessment period, the relationship between parents' functioning (i.e., fathers' drug use as determined by percent days abstinent and parents' dyadic adjustment) as rated by mothers, fathers, and children's teachers and internalizing behavior (as rated by mothers' only) was stronger for children than their adolescent siblings, particularly in terms of children's externalizing behaviors. Interventions that reduce paternal drug use and improve couple functioning may reduce internalizing and externalizing symptoms for children in their homes; however, adolescents may need more intensive interventions to address internalizing and externalizing symptoms.

Kwok MK; Schooling CM; Ho LM; Leung SSL; Mak KH; McGhee SM et al. Early life second-hand smoke exposure and serious infectious morbidity during the first 8 years: evidence from Hong Kong's "Children of 1997" birth cohort. Tobacco Control 17(4): 263-270, 2008. (34 refs.)

Background: Second-hand smoke (SHS) exposure is a modifiable cause of ill health. Despite the smoking ban in public places introduced in Hong Kong in 2007, infants and children continue to be exposed within the home. Aims: To determine the critical windows of SHS exposure and the duration of its impact on serious infectious morbidity in the first 8 years of life. Methods: The Hong Kong "Children of 1997'' birth cohort is a prospective, population-based study of 8327 children comprising 88% of all births in April and May 1997, of whom 7402 (89%) were followed up until their eighth birthday in 2005. We used multivariable Cox regression to assess the relation between postnatal SHS exposure and risk of first admission to public hospitals (together accounting for.95% total bed-days overall) for respiratory, other and all infections from birth to 8 years of age, for all individuals and for vulnerable subgroups. Results: Overall, household SHS exposure within 3 metres in early life was associated with a higher risk of admission for infectious illness up until 8 years of age ( hazard ratio 1.14, 95% CI 1.00 to 1.31), after adjustment for sex, birthweight, gestational age, feeding method, maternal age, highest parental education and proxies of preferred service sector. The association was strongest in the first 6 months of life (HR 1.45, 95% CI 1.15 to 1.83). In vulnerable subgroups such as premature babies, the association held through to 8 years of age (HR 2.00, 95% CI 1.08 to 3.72). Infants exposed to SHS in the first 3 months of life were most vulnerable to infectious causes of hospitalisation. Conclusion: Household SHS exposure in early infancy increases severe infectious morbidity requiring hospital admission. Reducing SHS exposure in infants and particularly in more vulnerable infants will lower the bed-days burden due to infectious causes.

Landau LI. Tobacco smoke exposure and tracking of lung function into adult life. Paediatric Respiratory Reviews 9(1): 39-44, 2008. (44 refs.)

Maternal smoking during pregnancy leads to abnormal lung function in infancy that tracks through to later childhood and continues into adult life. This is associated with transient wheezing illnesses through early childhood. Both social and physiological factors are likely to predispose those exposed to passive smoke to become active smokers. Adult smokers demonstrate an increased decline of lung function with age. The effects of passive smoke exposure vary with genetic factors, gender, race and exposure to other pollutants. Exposure to environmental tobacco smoke and subsequent active smoking both aggravate symptoms and have a negative effect on lung function in those with asthma.

Leonard NR; Gwadz MV; Cleland CM; Vekaria PC; Ferns B. Maternal substance use and HIV status: Adolescent risk and resilience. Journal of Adolescence 31(3): 389-405, 2008. (79 refs.)

We examined the risk and protective factors and mental health problems of 105 low SES, urban adolescents whose mothers were coping with alcohol abuse and other drug problems. Approximately half of the mothers were also HIV-infected. As hypothesized, there were few differences between adolescents of HIV-infected and HIV-uninfected mothers in background characteristics, mental health issues and current substance use risk behaviors. In addition to maternal substance abuse, youth in both groups experienced similar risk factors including early foster care placement and high levels of maltreatment. Current patterns of emerging risk behaviors were evident among youth in both groups as well as signs of resiliency including high levels of school attendance. These results underscore the importance of interventions for youth of substance abusing mothers, particularly those living in urban poverty.

Leroy R; Hoppenbrouwers K; Jara A; Declerck D. Parental smoking behavior and caries experience in preschool children. Community Dentistry & Oral Epidemiology 36(3): 249-257, 2008. (34 refs.)

Objectives: The study aimed to explore the association between parental smoking behavior and caries experience in young children, taking into account the socioeconomic status and oral health-related behavior. Methods: Cross-sectional data from 1250 3-year-old and 1283 5-year-old children from four geographical areas in Flanders (Belgium) were analyzed. Children were examined at school by trained dentist-examiners, using standard criteria and calibrated examination methodology. Data on oral hygiene and dietary habits, oral health behavior, sociodemographic variables, and parental smoking behavior were obtained through structured questionnaires, completed by the parents. Results: Visible caries experience (i.e. d(3)mft > 0) was seen in 7% of 3-year olds and 31% of 5-year olds. In both age groups, 30% of the parents reported smoking behavior. Univariable logistic regression analysis with caries prevalence as the dependent variable, revealed that parental smoking was a significant independent variable. After controlling for age, gender, sociodemographic characteristics, oral hygiene, and dietary habits, the effect of family smoking status was no longer significant in 3-year-old children (OR = 1.98; 95% CI: 0.68-5.76). In 5-year olds the significant relationship between parental smoking behavior and caries experience persisted after adjusting for the other evaluated variables (OR = 3.36; 95% CI: 1.49-7.58). Conclusion: The results of this study illustrate the existence of a significant association between parental smoking behavior and caries experience in 5-year-old children.

Meara E; Greenfield S. The relationship between substance use patterns and economic and health outcomes among low-income caregivers and children. Psychiatric Services 59(9): 974-981, 2008. (44 refs.)

Objective: This study estimated how patterns of substance use are related to work status, public program use, and well-being among a sample of female caregivers and children. Methods: This study assessed work, public program use, and well-being measures as a function of substance use among 1,623 female caregivers of children aged zero to four or ten to 14 who participated in the Welfare of Children and Families study and lived in low- and moderate-income neighborhoods in Boston, Chicago, and San Antonio. Data were analyzed from baseline interviews that were conducted from March through December 1999 and from follow-up interviews that were conducted 11 to 26 months after baseline (average of 16 months). Substance use patterns were placed into three categories: light or no substance use reported in both interviews, moderate or heavy substance use (that is, moderate or heavy use in both interviews or increased substance use during the study period), and reduced substance use during the study period. Results: Among caregivers who reduced their substance use, measures of work status, receipt of income assistance, mental health symptoms, and reports of child behavior problems were not significantly different at follow-up from those of caregivers with light or no substance use. At follow-up, compared with caregivers with light or no substance use, those with moderate or heavy substance use were significantly less likely to experience improvements in mental health symptoms and to see improvements in their children's behavioral problems. Caregivers with moderate or heavy substance use were more likely to be "detached" (p=.051) -- that is, neither working nor collecting income assistance -- although this difference was only marginally significant. Conclusions: Caregivers with increased substance use fared poorly on measures of well-being and work. Policies that promote, rather than impede, reductions in substance use are more likely to promote self-sufficiency and well-being.

Mills AM; Rhodes KV; Follansbee CW; Shofer FS; Prusakowski M; Bernstein SL. Effect of household children on adult ED smokers' motivation to quit. American Journal of Emergency Medicine 26(7): 757-762, 2008. (34 refs.)

Objective: We hypothesized adult parenting smokers in the emergency department (ED) have a higher interest in quitting and may be more amenable to tobacco cessation counseling than smokers without children. Study Design: Cross-sectional survey study of adult smokers in 8 US academic EDs. Results: One thousand one hundred sixty-eight smokers enrolled, 441 (37.8%) with household children (total of 973 exposed children). Compared to smokers without household children, smokers with children were younger (mean age, 37.4 vs 42.8 years), more female (60.3% vs 40.3%), and nonwhite (57.5% vs 44.5%) (all P < .006). Groups did not differ in nicotine addiction (median Fagerstrom score, 4 vs 4; P = .31). Parenting smokers were more interested in quitting (rnean Ladder of Contemplation score, 4.8 vs 5.1 [P = .02]), felt it more important to quit (median score, 9 vs 8 [P = .01]), and more confident to quit (7 vs 6 [P = .004]) than nonparenting smokers. Smoking inside the home was banned by 45% of smokers with children vs 30% without household children (P < .001). Conclusions: Adult ED parenting smokers are interested in quitting and taking steps to limit their children's secondhand smoke exposure. Asking adult ED smokers about household children may enhance motivation to quit.

Oken E; Levitan EB; Gillman MW. Maternal smoking during pregnancy and child overweight: systematic review and meta-analysis. International Journal of Obesity 32(2): 201-210, 2008. (85 refs.)

Objective: Perform a systematic review of studies reporting on the association between maternal prenatal cigarette smoking and child overweight. Design: Meta-analysis of observational studies. Data sources: Medline search and review of reference lists among studies published through June 2006. Review methods: Included studies reported an association between maternal smoking during pregnancy and risk of overweight among children at least 2 years of age. We did not include in the meta-analysis studies that provided only a continuous measure of adiposity, although those studies are discussed separately. Results: Based on results of 84 563 children reported in 14 observational studies, children whose mothers smoked during pregnancy were at elevated risk for overweight (pooled adjusted odds ratio (OR) 1.50, 95% CI: 1.36, 1.65) at ages 3-33 years, compared with children whose mothers did not smoke during pregnancy. The pooled estimate from unadjusted odds ratios (OR 1.52, 95% CI: 1.36, 1.69) was similar to the adjusted estimate, suggesting that sociodemographic and behavioral differences between smokers and nonsmokers did not explain the observed association. Although we observed evidence for publication bias, simulating a symmetric set of studies yielded a similar estimate (OR 1.40, 95% CI: 1.26, 1.55). Conclusions: Prenatal smoking exposure appears to increase rates of overweight in childhood. In parts of the world undergoing the epidemiologic transition, the continuing increase in smoking among young women could contribute to spiraling increases in rates of obesity-related health outcomes in the 21 st century.

Orte C; Touza C; Ballester L; March M. Children of drug-dependent parents: Prevention programme outcomes. Educational Research 50(3): 249-260, 2008. (19 refs.)

Background: This paper is the result of our interest in preventing adaptation problems (delinquency, academic failure and absenteesim at school, drug use, etc.) in young children and adolescents at risk, as well as the need to develop effective programmes adapted to the population in the Balearic Islands (Spain). Purpose: The objective of this paper was to describe the characteristics and outcomes obtained in the Family Competence Programme (FCP), which is an adaptation of the Strengthening Families Programme (SFP) for the population of the Balearic Islands (Spain). Programme description: Like the SFP, the FCP is a multi-component programme that aims to reduce the influence of risk factors associated with alcohol and drug use while increasing children's resilience by reinforcing the main protective factors. The programme combines training in parenting skills, work with the entire family and children's social skills during 14 weekly sessions. The sessions were led by group leaders with long-standing experience in handling groups and working with populations undergoing treatment and who were also trained specifically to apply the programme. Sample: Two applications of the programme were implemented. The final sample was made up of 58 adults men and women (28 in experimental groups and 30 in control groups) who attended treatment or their partners; their average age was 39. A total of 35 children who were 10.6 years of age on average took part in the programme (19 in experimental groups and 16 in control groups). There were 31 families in all (15 in experimental groups and 16 in control groups). All the participants in the experimental groups live in Mallorca (Spain), while the control groups lived in other cities in Spain. Design and methods: We used a quasi-experimental design with an unmatched control group and pre- and post-treatment measures. The subjects were not randomly assigned to the experimental (EG) and control (CG) groups. The first application took place between 28 January 2005 and 13 May 2005. The second application began on 7 October 2005 and concluded on 27 January 2006. We used participant self-reports together with information supplied by the children's teachers. The instruments included those employed in the SFP and others that had been validated for the Spanish population. The ANOVA, t-test and Cohen's d were used to analyse the data obtained. In addition, we recorded the programme attendance. Results: Percentages for programme attendance were very high and remained high during all 14 sessions. Family relationships, parental education skills, children's behavior and their social skills all improved. Conclusions: Our study indicates that the FCP and its capacity to achieve its objectives are effective, although further research with a larger sample is needed.

Osborne C; Berger LM. Parental substance abuse and child well-being: A consideration of parents' gender and coresidence. Journal of Family Issues 30(3): 341-370, 2009. (34 refs.)

Parental substance abuse is associated with adverse health and developmental outcomes for children. Existing research, however, has not fully explored the relative magnitude of the associations between maternal, paternal, and both parents' substance abuse and child outcomes, nor has it examined these associations in regard to substance abuse among nonresident fathers. We use data from the Fragile Families and Child Wellbeing Study (N = 3,027) to explore these issues among a cohort of 3-year-old children. We find that children living with a substance-abusing parent are at considerable risk for poor health and behavior outcomes, that such risk is not moderated by parent gender, and that it is substantially larger when both parents have substance abuse problems. Moreover, children with substance-abusing fathers are at a potentially higher risk of health and behavior problems when their fathers live with them, although this risk is still substantial when they do not.

Paul SL; Blizzard L; Patton GC; Dwyer T; Venn A. Parental smoking and smoking experimentation in childhood increase the risk of being a smoker 20 years later: the Childhood Determinants of Adult Health Study. Addiction 103(5): 846-853, 2008. (20 refs.)

To examine the long-term effects of childhood smoking experimentation and exposure to parental smoking on adult smoking risk. Data were from a 20-year follow-up of 9-15-year-olds who completed questionnaires in the 1985 Australian Schools Health and Fitness Survey (n = 6559). The relative risks (RR) of adult current smoking in 2004-05 for childhood exposure to smoking experimentation (never, a few puffs, < 10 cigarettes, > 10 cigarettes) and parental smoking (none, father, mother, both parents) in 1985, with adjustment for confounders, were estimated by log binomial modelling. Analyses were stratified by age (9-13 and 14-15 years) and sex. Participation at follow-up was 54% (n = 3559). Childhood smoking experimentation increased the risk of being a current smoker particularly for 14-15-year-old experimenters of more than 10 cigarettes [males, RR 2.72, 95% confidence interval (CI) 1.74-4.25; females, RR 6.39, 95% CI 2.85-14.33]. Parental smoking was associated with adult current smoking risk, particularly for 9-13-year-olds with two smoking parents (males, RR 1.53, 95% CI 1.19-1.96; females, RR 1.99, 95% CI 1.52-2.61) and older males with smoking mothers (RR 1.82, 95% CI 1.22-2.73). Parental smoking was not associated with childhood smoking experimentation. These findings suggest that any childhood smoking experimentation increases the risk of being a smoker 20 years later. As exposure to parental smoking predicted current smoking, parents should be aware of the association between their own smoking behaviour and that of their children.

Prescott SL. Effects of early cigarette smoke exposure on early immune development and respiratory disease. Paediatric Respiratory Reviews 9(1): 3-10, 2008. (85 refs.)

Exposure to tobacco constituents during early development remains a common but avoidable toxic exposure, which has been clearly linked with decreased lung growth and subsequent wheezing illness. There is also now emerging evidence that tobacco smoke can influence early immune function. This includes alterations in cytokine production by the fetoplacental unit, as detected ex vivo in cord blood, as well as in patterns of fetal mononuclear cell responses in vitro. Recent studies also suggest that the newborns of smoking mothers have altered signalling through Toll-like receptors (TLRs) that are essential for innate microbial responses. This may be implicated in the increased predisposition to infection in exposed infants. TLR-mediated innate response pathways are also believed to be important in promoting regulatory pathways that inhibit allergic immune responses. However, although a number of studies have documented associations between early cigarette smoke exposure and subsequent allergic disease, this remains controversial. This review explores the consequences of smoking on these important aspects of early development, including potential mechanisms, interactions with predisposing asthma genes and a potential role in epigenetic regulation. Although parental smoking may not be the primary factor in the changing prevalence of asthma and respiratory disease, we propose that it is an important contributor, with significant potential to interact with other genetic factors and environmental risk factors to influence disease propensity.

Priest N; Roseby R; Waters E; Polnay A; Campbell R; Spencer N et al. Family and carer smoking control programmes for reducing children's exposure to environmental tobacco smoke. (review). Cochrane Database of Systematic Reviews 4(article CD001746), 2008. (125 refs.)

Background: Children's exposure to other people's cigarette smoke (environmental tobacco smoke, or ETS) is associated with a range of adverse health outcomes for children. Parental smoking is a common source of children's exposure to ETS. Preventing exposure to cigarette smoke in infancy and childhood has significant potential to improve children's health worldwide. Objectives: To determine the effectiveness of interventions aiming to reduce exposure of children to ETS. Search strategy: We searched the Cochrane Tobacco Addiction Group trials register and conducted additional searches of two health and education databases not included in this specialised register. Date of the most recent search: October 2007. Selection criteria: Interventions tested using controlled trials with or without random allocation were included in this review if the interventions addressed participants (parents and other family members, child care workers and teachers) involved with the care and education of infants and young children (aged 0-12 years). All mechanisms for reduction of children's environmental tobacco smoke exposure, and smoking prevention, cessation, and control programmes were included. These include smoke-free policies and legislation, health promotion, social-behavioural therapies, technology, education and clinical interventions. Data collection and analysis: Two authors independently assessed studies and extracted data. Due to heterogeneity of methodologies and outcomes, no summary measures were possible and results were synthesised using narrative summaries. Main results: Thirty-six studies met the inclusion criteria. Four interventions were targeted at populations or community settings, 16 studies were conducted in the 'well child' healthcare setting and 13 in the 'ill child' healthcare setting. Two further studies conducted in paediatric clinics do not make clear whether the visits are to well or ill children, and another includes both well and ill child visits. Nineteen of these studies are from North America and 12 in other high income countries. Five studies are from low- or middle-income countries. In 17 of the 36 studies there was reduction of ETS exposure for children in both intervention and comparison groups. In only 11 of the 36 studies was there a statistically significant intervention effect. Four of these successful studies employed intensive counselling interventions targeted to smoking parents. We found little evidence of difference in effectiveness of interventions between the well infant, child respiratory illness and other child illness settings as contexts for parental smoking cessation interventions. One successful intervention was in the school setting, targeting the ETS exposure of children from smoking fathers. Authors' conclusions: While brief counselling interventions have been identified as successful for adults when delivered by physicians, this cannot be extrapolated to adults as parents in child health settings. However, there is limited support for more intensive counselling interventions for parents in such contexts. There is no clear evidence of differences between the respiratory, non-respiratory ill child, well child and peripartum settings as contexts for reduction of children's ETS exposure.

Raherison C; Penard-Morand C; Moreau D; Caillaud D; Charpin D; Kopferschmitt C et al. Smoking exposure and allergic sensitization in children according to maternal allergies. Annals of Allergy, Asthma, & Immunology 100(4): 351-357, 2008. (29 refs.)

Background: Although the negative impact of environmental tobacco smoke (ETS) on airway diseases in children is well known, the effect of ETS on allergic sensitization is still debated. Objective: To evaluate how maternal allergies modulate the effect of tobacco exposure on allergic sensitization in childhood. Methods: Of 9,000 children in grades 4 and 5 selected in 6 cities in France, 7,798 participated in a survey that consisted of an epidemiologic questionnaire, skin prick testing to common allergens, and skin examination for eczema. Tobacco exposure was obtained from parent questionnaires. Results: Twenty-five percent of the children had allergic sensitization, 25.2% had eczema, 11.6% had allergic rhinitis, 9.9% had asthma, and 8.3% had exercise-induced asthma. Twenty percent of the children were exposed to tobacco in utero. Maternal exposure had a greater impact than paternal exposure on children's allergic sensitization. Prenatal exposure was more associated with sensitization than postnatal exposure. Children with maternal allergies and exposure to maternal ETS during pregnancy were at higher risk for sensitization to house dust mite (25.7% vs 14.0%; odds ratio, 1.95; 95% confidence interval, 1.19-3.18; P = .006). In contrast, sensitization to food allergens was not associated with tobacco exposure. Conclusions: Children exposed to maternal smoking had a higher risk of sensitization to house dust mite, especially when the mothers were allergic.

Rainio SU; Rimpela AH. Home smoking bans in Finland and the association with child smoking. European Journal of Public Health 18(3): 306-311, 2008. (35 refs.)

Background: Few studies in Europe have investigated home smoking bans and their association with child smoking. Methods: A nationwide survey of 12 to 18-year olds in 2005 (n = 6503, response rate 66%) was used to study home smoking bans in Finland. Multinomial logistic regression analyses were used to study association of home smoking bans and child smoking. Results: Of the respondents, 58% reported a total ban, 27% a partial ban, 4% reported no ban and 10% chose the option 'I cannot say'. The lack of total ban was strongly associated with living in non-intact families, parents' lower educational level, parental smoking and parents' permissive attitude towards child smoking. Moreover, partial or no ban increased the likelihood of being a daily smoker. In the multinomial logistic regression model, the odds ratios (ORs) for children's daily smoking, adjusted for sociodemographic factors, parental smoking and their permissive attitude, were OR 2.9 [ 95% confidence interval (CI) 2.3-3.6] for partial ban and OR 14.3 (8.6-23.7) for no ban. In families where both parents smoked, the adjusted ORs were correspondingly 1.5 (95% CI 0.7-3.0) and 2.9 (95% CI 1.1-7.8). Conclusions: Home smoking bans will contribute towards a reduced risk of child smoking even when parents smoke. Tobacco control legislation needs to be enhanced with measures promoting awareness of the benefits achievable through strict home smoking bans. Families characterized by lower socioeconomic status and smoking parents are particular target groups.

Reynolds B; Leraas K; Collins C; Melanko S. Delay discounting by the children of smokers and nonsmokers. Drug and Alcohol Dependence 99(1-3): 350-353, 2009. (9 refs.)

This research compared delay discounting in mothers and their children(12 or 13 years of age). Half of the mothers( n = 15) were current smokers, and the other half (n = 15) reported never smoking. Considerable research has shown that adult smokers discount more by delay than nonsmokers, and that parent smoking is a risk factor for adolescent smoking. Thus, it was hypothesized that the mothers who smoked would discount more by delay than the mothers who had never smoked. Also, it was expected that children at increased risk for smoking (i.e., mother is smoker) would discount more by delay than children at lower risk for smoking (i.e., mother is nonsmoker). The results confirmed these hypotheses: mothers who smoked discounted significantly more than nonsmoking mothers: and, in a parallel fashion, children with mothers who smoked discounted significantly more than children of nonsmokers. These findings indicate that delay discounting may be a behavioral risk factor for adolescent cigarette smoking that predates any substantial use of nicotine.

Riggs NR; Chou CP; Pentz MA. Protecting against intergenerational problem behavior: Mediational effects of prevented marijuana use on second-generation parent-child relationships and child impulsivity. Drug and Alcohol Dependence 100(1-2): 153-160, 2009. (71 refs.)

Background: The aims of the study were to identify pathways from parent marijuana use to child problem behavior and parent-child relationships, and to evaluate whether effects of an earlier prevention program delivered to parents when they themselves were early adolescents would have a protective effect on these relationships one generation later. Methods: Structural equation models were applied to the data of a second-generation study of a drug abuse prevention trial. Models assessed whether there were sustained marijuana prevention effects on adults who had at least one school-age child at the end of the emerging adulthood period (age 26, n = 257), and whether these effects mediated subsequent parent-child relationships and child impulsivity when parents were between the ages of 28 and 34. Results: Participants originally assigned to the program group used significantly less marijuana in early adulthood than did controls. In turn, parental marijuana use was positively related to child impulsivity and negatively to parental warmth, but not significantly related to parental aggression. Conclusions: Results suggest both a direct relationship from parental marijuana use to child impulsivity, as well as indirect relationships through parent-child interactions. Results also strongly support a role for early adolescent prevention programs for drug use, both for participants' own long-term benefit, as well as for the benefit of their future children.

Scaife VH. Maternal and paternal drug misuse and outcomes for children: Identifying risk and protective factors. (review). Children & Society 22(1): 53-62, 2008. (34 refs.)

There are estimated to be 250 000-350 000 children of problem drug users in the UK. The Government's Every Child Matters Programme seeks to ensure that vulnerable children affected by parental drug misuse are enabled to achieve their full potential in life. This article critically reviews recent national and international research examining the impact of parental drug misuse on children; focusing on the extent to which within-family risk and protective factors are related to parental gender. The article calls for greater research focus on paternal drug-misusers parenting strategies and makes recommendations.

Schepis TS; Desai RA; Smith AE; Cavallo DA; Liss TB; McFetridge A; Potenza MN; Krishnan-Sarin S. Impulsive sensation seeking, parental history of alcohol problems, and current alcohol and tobacco use in adolescents. Journal of Addiction Medicine 2(4): 185-193, 2008. (41 refs.)

Objectives: This study attempted to evaluate whether impulsive sensation seeking mediated the relationship between parental alcohol problems and offspring alcohol and tobacco use. Methods: Participants were Connecticut high school students (n = 2733) completing a survey of high-risk behaviors. Variables of interest included past month alcohol use, past month binge alcohol use, frequency of past month alcohol use, past month tobacco use, having a biologic parent with an alcohol problem, and score on the Impulsive Sensation Seeking scale (ImpSS) from the Zuckerman-Kuhlman Personality Questionnaire-Form III. Results: ImpSS scores were elevated in past month users of alcohol, binge users of alcohol, users of both tobacco and alcohol, and they increased with increasing frequency of past month alcohol use. Also, parental history of alcohol use increased the likelihood of past month alcohol use, binge use, use of both tobacco and alcohol, and higher levels of past month alcohol use. Mediational analyses did not seem to support the hypothesis that impulsive sensation seeking mediates the relationship between parental history of alcohol problems and alcohol and tobacco use in offspring. Conclusions: Impulsive sensation seeking and parental history of alcohol problems seem to be independent factors that contribute to the co-occurrence of alcohol and tobacco use in adolescents. These findings can inform prevention and treatment efforts.

Serane VT; Kurian O. Neonatal abstinence syndrome. Indian Journal of Pediatrics 75(9): 911-914, 2008. (14 refs.)

Objective. To study the substance misuse in pregnant mothers and its impact on their newborns. Methods. Case note review of the study population was undertaken. Infants of mothers who had taken substance of mrly using Finnegan's score and treatment initiated based on a pre-existing protocol. The parameters that were studied included maternal drug habits, antenatal problems, and neonatal epidemiology with particular reference to growth, Neonatal Abstinence Syndrome (NAS), its severity and management Results. Out of 32 neonates, 28 had developed neonatal withdrawal requiring treatment. The earliest presentation of NAS was at six hours and the average time of presentation of NAS was 26 hours. The dose of methadone taken by the mother related well with the likelihood of development of NAS. The most common symptoms noted at the time of diagnosis were irritable cry, increased tone, tachypnea, sleeplessness and tremor Conclusion. Majority of neonates born to mothers on methadone exhibit neonatal abstinence syndrome and require pharmacological treatment. Neonates who had not exhibited symptoms of drug withdrawal within the first 3 days of life are unlikely to present with NAS requiring treatment.

Sharma AJ; Cogswell ME; Li RW. Dose-response associations between maternal smoking during pregnancy and subsequent childhood obesity: Effect modification by maternal race/ethnicity in a low-income US cohort. American Journal of Epidemiology 168(9): 995-1007, 2008. (54 refs.)

Studies suggest that children exposed to cigarette smoke in utero are at risk of becoming obese. Few researchers have evaluated the dose-response association between maternal smoking during pregnancy and childhood obesity or whether this association varies by maternal race/ethnicity. The authors obtained retrospective cohort data by linking records from the Pregnancy Nutrition Surveillance System and the Pediatric Nutrition Surveillance System on 155,411 low-income children born during 1995-2001 in 9 US states and 2 tribal nations. The authors examined maternal smoking status, duration of smoking, quantity of smoking, and both duration and quantity combined. Childhood obesity was based on a body mass index greater than or equal to the 95th percentile for sex and age, assessed at age 2-4 years. Maternal race/ethnicity modified the association between smoking during pregnancy and childhood obesity. Among non-Hispanic White mothers, both duration and quantity of smoking were positively associated with childhood obesity in a dose-response manner. Among non-Hispanic Black mothers, only heavy smoking was positively associated with childhood obesity. Among Hispanics, American Indians/Alaska Natives, and Asians/Pacific Islanders, smoking was not associated with childhood obesity. The inconsistent association between smoking during pregnancy and childhood obesity across race/ethnicity categories merits further investigation into potential explanations for this variation, which may include confounding, reporting bias, or unexplored biologic mechanisms.

Sharpe TT. Behind the Eight Ball: Sex for Crack Cocaine Exchange and Poor Black Women. Binghamton NY: Haworth, 2005. (Chapter refs.)

This volume is organized into 10 chapters. Chapter 1 deals with social and economic precursors of crack use in inner cities. Chapter 2 discusses gender roles among the inner-city poor, along with the legacy of slavery, segregation and share-cropping. Chapters 3 through 6 describe the crack culture, including the dominant roles, the lives of women who exchange sex for crack, and the sexual risk taking this entails. Chapters 7 to 10 focus upon the pregnancies and children born to women involved in sex-for-crack culture, the life circumstances of these children, their relationships with family members, and the problems of mothering, abuse/neglect and abandonment. The concluding chapters describes the methodology of the study, the ethnograpy, and data analysis.

Shelton A; Harvin S; White J. Substance abuse prevention program for children and adolescents in a community-based clinic. Substance Abuse 26(3/4): 21-25, 2006

This paper describes a community-based substance abuse prevention program utilizing a cognitive-behavioral curriculum for children and adolescents affected by a substance use disorder in a parent or caretaker.

Strohsnitter WC; Hatch EE; Hyer M; Troisi R; Kaufman RH; Robboy SJ et al. The association between in utero cigarette smoke exposure and age at menopause. American Journal of Epidemiology 167(6): 727-733, 2008. (24 refs.)

Menopause onset, on average, occurs earlier among women who smoke cigarettes than among women who do not smoke. Prenatal smoke exposure may also influence age at menopause through possible effects on follicle production in utero. Smoking information was obtained from the mothers of 4,025 participants in the National Cooperative Diethylstilbestrol Adenosis (DESAD) Project, a US study begun in 1975 to examine the health effects of prenatal diethylstilbestrol exposure. Between 1994 and 2001, participants provided information on menopausal status. Cox proportional hazards modeling compared the probability of menopause among participants who were and were not prenatally exposed to maternal cigarette smoke. Participants prenatally exposed to maternal cigarette smoke were more likely than those unexposed to be postmenopause (hazard ratio = 1.21, 95% confidence interval: 1.02, 1.43). The association was present among only those participants who themselves had never smoked cigarettes (hazard ratio = 1.38, 95% confidence interval: 1.10, 1.74) and was absent among active smokers (hazard ratio = 1.03, 95% confidence interval: 0.81, 1.31). In this cohort of participants predominantly exposed to diethylstilbestrol, results suggest that prenatal exposure to maternal cigarette smoke may play a role in programming age at menopause. The possibility that active cigarette smoking modifies this effect is also suggested.

Tager IB. The effects of second-hand and direct exposure to tobacco smoke on asthma and lung function in adolescence. Paediatric Respiratory Reviews 9(1): 29-38, 2008. (50 refs.)

Cigarette smoking still is quite common in many parts of the world. In parallel, exposure to second-hand smoke continues to be common despite declines in smoking in developed countries and despite evidence of serious health effects in infants and children. This paper focuses on the effects of second-hand and direct exposure (personal smoking) on the respiratory health of adolescents, in particular effects on the occurrence of asthma and on lung function. Published data indicate that, in addition to whatever effects direct and postnatal second-hand tobacco smoke exposure have on the occurrence of asthma and impaired levels and growth of lung function in adolescents, there is an underlying alteration in the prenatal and early postnatal development of the structural and mechanical characteristics of the lung that contribute substantially to these deficits. These developmental effects may be important contributors to the future risks for impaired pulmonary function.

Toro R; Leonard G; Lerner JV; Lerner RM; Perron M; Pike GB et al. Prenatal exposure to maternal cigarette smoking and the adolescent cerebral cortex. Neuropsychopharmacology 33(5): 1019-1027, 2008. (75 refs.)

Smoking during pregnancy is associated with long-term consequences on offspring behavior. We measured thickness of the cerebral cortex using magnetic resonance images obtained in 155 adolescents exposed in utero to maternal smoking and compared them with 159 non-exposed subjects matched by maternal education. Orbitofrontal, middle frontal, and parahippocampal cortices were thinner in exposed, as compared with non-exposed, individuals; these differences were more pronounced in female adolescents. In exposed females, the thickness of the orbitofrontal cortex correlated negatively with a self-rated assessment of caring, one of the components of a model of positive youth development. These findings provide evidence of the long-term impact of prenatal environment on a neural substrate of cognition and social behavior.

VanDeMark N; Brown E; Borneman A; Williams S. New Directions for Families: A family-oriented intervention for women affected by alcoholism and other drug abuse, mental illness and trauma. Alcoholism Treatment Quarterly 22(3/4): 141-160, 2004

In conjunction with the SAMHSA-funded Women with Co-Occurring Disorders and Violence Study, Arapahoe House refined and evaluated an intervention integrating treatment for substance dependence, mental illness, and trauma for women and their dependent children. The New Directions for Families program combines comprehensive residential and outpatient treatment with parenting and self-sufficiency skills development. The program provides gender-specific, culturally sensitive, and strengths-oriented services for families in a two-phase program over eight months. Services include treatment for individual recovery in each of the three problem areas-mental health, alcohol and other drug abuse, trauma; basic needs of the family including employment; and social and family support systems. Consumers are involved in all aspects of the project -- in designing and implementing the intervention and evaluation and in governing the project through participation on the project's local and national steering committees.

Wamboldt FS; Balkissoon RC; Rankin AE; Szefler SJ; Hammond SK; Glasgow RE et al. Correlates of household smoking bans in low-income families of children with and without asthma. Family Process 47(1): 81-94, 2008. (28 refs.)

Exposure to secondhand smoke (SHS) harms all children's health, especially children with asthma. Yet, children with asthma are as likely to live with smokers as healthy children. Household smoking bans are being advocated to reduce children's harm from SHS. To measure the effect of household smoking bans on child SHS exposure and to examine correlates of strict smoking bans in a low-income, diverse sample, 91 children with asthma were matched to 91 healthy children. All had at least one smoker living in their homes. Nicotine dosimeters, child cotinine assays, and maternal reports quantified child SHS exposures. Maternal reports of household smoking rules, behaviors, and beliefs, and other family characteristics were also gathered. The presence of a strict household smoking ban vastly reduced children's SHS exposures and was associated with fewer cigarettes smoked by the mother and by other family members, the belief that SHS was a personal health risk, having children with asthma, and living in a single-family home. Many children are exposed to high levels of SHS at home. Strict household smoking bans greatly decrease, but do not eliminate children's SHS exposure. Even in disadvantaged families, mutable factors were associated with strict smoking bans. Increased dissemination and use of established public health strategies are needed to reduce children's SHS exposures.

Weinsheimer RL; Yanchar NL. Impact of maternal substance abuse and smoking on children with gastroschisis. Journal of Pediatric Surgery 43(5): 879-883, 2008. (14 refs.)

Background/Purpose: Conflicting information exists regarding the effects of maternal substance abuse on gastroschisis. The objectives of this study are to determine if maternal smoking is associated with an increased risk of gastroschisis and whether substance abuse is associated with the severity of gastroschisis. Methods: The Canadian Pediatric Surgery Network (CAPSNET) database was evaluated for associations between maternal substance abuse and the severity of the gastroschisis. We also compared smoking rates from this group to overall Canadian maternal smoking rates. Results: One hundred fourteen cases of gastroschisis acquired over IS months were evaluated. After adjusting for covariates, illicit drug use was associated with bowel necrosis (OR, 9.4; 95% Cl, 1.3-70) and marijuana use with matting of the intestines (OR, 4.0; 95% Cl, 1.0-16). Functional outcomes assessment revealed that slower initiation of enteral feeds was associated with maternal smoking (OR, 3.8; 95% Cl, 1.4-10). The overall maternal smoking rate in this cohort (30.7%) was significantly higher than the known Canadian rate (13.4%). This may be accounted for by the considerably higher smoking rate of mothers 20 to 24 years of age in our cohort (48.9%). Conclusions: Substance abuse and smoking are associated with a greater severity of gastroschisis in terms of both the degree of intestinal injury and functional outcomes. High smoking rates among young mothers may be putting children with gastroschisis at risk for poor outcomes.

Whitbeck LB; Crawford DM. Gestational risks and psychiatric disorders among indigenous adolescents. Community Mental Health Journal 45(1): 62-72, 2009. (69 refs.)

This study reports on the effects maternal prenatal binge drinking, cigarette smoking, drug use, and pregnancy and birth complications on meeting criteria for psychiatric disorders at ages 10-12 and 13-15 years among 546 Indigenous adolescents from a single culture in the northern Midwest and Canada. Adolescent DSM-IV psychiatric disorders were assessed with the Diagnostic Interview Schedule for Children-Revised (DISC-R). Results indicate that maternal behaviors when pregnant have significant effects on adolescent psychiatric disorders even when controlling for age and gender of adolescent, family per capita income, living in a single mother household, and adolescent reports of mother's positive parenting.

Winickoff JP; Friebely J; Tanski SE; Sherrod C; Matt GE; Hovell MF et al. Beliefs about the health effects of "Thirdhand" smoke and home smoking bans. Pediatrics 123(1): E74-E79, 2009. (37 refs.)

OBJECTIVE. There is no safe level of exposure to tobacco smoke. Thirdhand smoke is residual tobacco smoke contamination that remains after the cigarette is extinguished. Children are uniquely susceptible to thirdhand smoke exposure. The objective of this study was to assess health beliefs of adults regarding thirdhand smoke exposure of children and whether smokers and nonsmokers differ in those beliefs. We hypothesized that beliefs about thirdhand smoke would be associated with household smoking bans. METHODS. Data were collected by a national random-digit-dial telephone survey from September to November 2005. The sample was weighted by race and gender within Census region on the basis of US Census data. The study questions assessed the level of agreement with statements that breathing air in a room today where people smoked yesterday can harm the health of children. RESULTS. Of 2000 eligible respondents contacted, 1510 (87%) completed surveys, 1478 (97.9%) answered all questions pertinent to this analysis, and 273 (18.9%) were smokers. Overall, 95.4% of nonsmokers versus 84.1% of smokers agreed that secondhand smoke harms the health of children, and 65.2% of nonsmokers versus 43.3% of smokers agreed that thirdhand smoke harms children. Strict rules prohibiting smoking in the home were more prevalent among nonsmokers: 88.4% vs 26.7%. In multivariate logistic regression, after controlling for certain variables, belief that thirdhand smoke harms the health of children remained independently associated with rules prohibiting smoking in the home. Belief that secondhand smoke harms the health of children was not independently associated with rules prohibiting smoking in the home and car. CONCLUSIONS. This study demonstrates that beliefs about the health effects of thirdhand smoke are independently associated with home smoking bans. Emphasizing that thirdhand smoke harms the health of children may be an important element in encouraging home smoking bans.

Wipfli H; Avila-Tang E; Navas-Acien A; Kim S; Onicescu G; Yuan J et al. Secondhand smoke exposure among women and children: Evidence from 31 countries. American Journal of Public Health 98(4): 672-679, 2008. (24 refs.)

Objectives. We sought to describe the range of exposure to secondhand smoke (SHS) among women and children living with smokers around the world and generate locally relevant data to motivate the development of tobacco control policies and interventions in developing countries. Methods. In 2006, we conducted a cross-sectional exposure survey to measure air nicotine concentrations in households and hair nicotine concentrations among nonsmoking women and children in convenience samples of 40 households in 31 countries. Results. Median air nicotine concentration was 17 times higher in households with smokers (0.18 mu g/m(3)) compared with households without smokers (0.01 mu g/ m(3)). Air nicotine and hair nicotine concentrations in women and children increased with the number of smokers in the household. The dose-response relationship was steeper among children. Air nicotine concentrations increased an estimated 12.9 times (95% confidence interval =9.4, 17.6) in households allowing smoking inside compared with those prohibiting smoking inside. Conclusions. Our results indicate that women and children living with smokers are at increased risk of premature death and disease from exposure to SHS. Interventions to protect women and children from household SHS need to be strengthened.