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CORK Bibliography: Children of Substance Abusers

32 citations. January 2007 to present

Prepared: March 2008

Al Mamun A; O'Callaghan FV; Alati R; O'Callaghan M; Najman JM; Williams GM et al. Does maternal smoking during pregnancy predict the smoking patterns of young adult offspring? A birth cohort study. Tobacco Control 15(6): 452-457, 2006. (32 refs.)

Objective: To examine the association between maternal smoking during pregnancy and the development of smoking behaviour patterns among young adult offspring. Method: Data were from the Mater- University of Queensland Study of Pregnancy (MUSP), a birth cohort of 7223 mothers and children enrolled in Brisbane, Australia, in 1981. The development of smoking behaviours (early or late onset, or combination of onset and prevalence patterns) among offspring at age 21 years with different patterns of maternal smoking (never smoked, smoked before or after pregnancy but not during pregnancy, or smoked during pregnancy) were compared. Maternal smoking information was derived from the prospectively collected data from the beginning of pregnancy until the child was 14 years of age. Analyses were restricted to the 3058 mothers and children whose smoking status was reported. Results: The proportion of young adults who smoked regularly, either with early onset or late onset, was greater among those whose mothers had smoked during pregnancy compared with those whose mothers had never smoked. The smoking patterns among those adolescent offspring whose mothers stopped smoking during pregnancy, but who then smoked at other times during the child's life, were similar to those whose mothers had never smoked. This association was robust to adjustment for a variety of potential covariates. Conclusions: The findings provide some evidence for a direct effect of maternal smoking in utero on the development of smoking behaviour patterns of offspring and provide yet another incentive to persuade pregnant women not to smoke.

Brook JS; Duan T; Brook DW. Fathers who abuse drugs and their adolescent children: Longitudinal predictors of adolescent aggression. American Journal on Addictions 16(5): 410-417, 2007. (57 refs.)

This longitudinal study examines the relationship between earlier paternal drug abuse, environmental factors, paternal child-rearing practices, and adolescent vulnerable personality attributes and later adolescent aggressive behavior. Data were collected at two points in time, one year apart, via individual, structured interviews. Structural Equation Modeling (SEM) was used to assess the interrelationship of the earlier factors with respect to later adolescent aggression. Interviews took place in an inner- city community, within the schools and the participants' homes. Participants included low- income, predominantly African American and Hispanic adolescents (N = 296) whose fathers abused drugs. The fathers were recruited from drug- abuse treatment programs in several U. S. cities. The outcome measure was adolescent aggressive behavior at Time 2 (T2). The findings showed that paternal drug abuse, environmental factors, and paternal child- rearing practices were mediated by the adolescent's vulnerable personality attributes. The adolescent's vulnerable personality attributes were the most proximal constructs to later adolescent aggressive behavior. Both paternal drug abuse and environmental factors were mediated by paternal child- rearing practices. The findings suggest that earlier environmental stresses, paternal drug abuse, paternal child-rearing practices, and adolescent vulnerable personality attributes are associated with later adolescent aggression.

Castro FG; Garfinkle J; Naranjo D; Rollins M; Brook JS; Brook DW. Cultural traditions as "protective factors" among Latino children of illicit drug users. Substance Use & Misuse 42(4): 621-642, 2007. (54 refs.)

Family bonding was examined among Hispanic adolescents whose fathers are illicit drug users to ascertain whether such adolescents maintain close affective family ties or alienate themselves from their families given their father's use of illicit drugs and referral to a drug screening and treatment program. It was hypothesized that high levels of paternal drug use would be associated with the youth's alienation from the family. In addition, it was postulated that the adolescent's endorsement of traditional cultural values and social responsibility would protect her or him against this effect in relation to family bonding. These hypotheses are based on prior research that suggests that youth bonding to prosocial institutions, such as family, school, church, and community organizations, can be "protective" against drug use. More specifically, our analyses examined the role of level of acculturation in middle school, family traditionalism, American orientation, Latino orientation, and social responsibility in predicting adolescents' family bonding. Results indicated that the father's level of marijuana and/or methamphetamine use was unrelated to youth family bonding. Additionally, Latino and American cultural orientations and level of acculturation in middle school were not associated with family bonding. By contrast, social responsibility (the youth's citizenship and responsibility to the community) and family traditionalism (endorsing conservative cultural values regarding the maintenance of family traditions and respect for elders and family) were significantly associated with family bonding. In other words, among children of Latino illicit drug users, the youth's conservative family values and a responsible attitude toward community traditions were dual factors related to family bonding, perhaps operating also as sources of "protection" against youth problem behaviors.

Collins RL; D'Angelo S; Stearns SD; Campbell LR. Training pediatric residents to provide smoking cessation counseling to parents. TheScientificWorldJOURNAL 5(May): 410-419, 2005. (15 refs.)

The objective was to assess the effectiveness of a smoking cessation educational program on pediatric residents' counseling. Residents were randomly selected to receive the intervention. Residents who were trained were compared to untrained residents. Self-reported surveys and patient chart reviews were used. Measures included changes in self-reported knowledge, attitudes and behaviors of residents, and differences in chart documentation and caretaker-reported physician counseling behaviors. The intervention was multidimensional including a didactic presentation, a problem-solving session, clinic reminders, and provision of patient education materials. Results showed that residents who were trained were more likely to ask about tobacco use in their patients' households. They were also more likely to advise caretakers to cut down on or to quit smoking, to help set a quit date, and to follow up on the advice given at a subsequent visit. Trained residents were more likely to record a history of passive tobacco exposure in the medical record. These residents also reported improved confidence in their counseling skills and documented that they had done such counseling more often than did untrained residents. Caretakers of pediatric patients who smoke seen by intervention residents were more likely to report that they had received tobacco counseling. Following this intervention, pediatric residents significantly improved their behaviors, attitudes, and confidence in providing smoking cessation counseling to parents of their pediatric patients.

Derauf C; LaGasse LL; Smith LM; Grant P; Shah R; Arria A et al. Demographic and psychosocial characteristics of mothers using methamphetamine during pregnancy: Preliminary results of the Infant Development, Environment, and Lifestyle Study (IDEAL). American Journal of Drug and Alcohol Abuse 33(2): 281-289, 2007. (20 refs.)

This study describes the psychological characteristics and caretaking environments of 131 women enrolled in the first longitudinal study of prenatal methamphetamine (MA) exposure and child development. Prenatal MA use was associated with lower maternal perceptions on quality of life, greater likelihood of substance use among family and friends, increased risk for ongoing legal difficulties, and a markedly increased likelihood of developing a substance abuse disorder. Our preliminary findings suggest that MA using women are more likely to have multiple, intertwined psychosocial risks that may result in maladaptive parenting and caregiving. These factors may impact the developmental outcomes of affected children.

Dorea JG. Maternal smoking and infant feeding: Breastfeeding is better and safer. Maternal and Child Health Journal 11(3): 287-291, 2007. (52 refs.)

The rise in smoking rates among young women has implications for children's health aggravated in lower social strata where infant morbidity and mortality rates are higher. The protection afforded by breastfeeding is beneficial to infants in rich and poor countries alike. Women (especially when young, uneducated, and unsupported) who are smokers constitute a risk group for abandoning breastfeeding; moreover, their bottle-fed newborns run a greater risk of morbidity and mortality. Bottle-feeding is attendant on maternal cigarette smoking. The advantages of breastfeeding over bottle-feeding are discussed with regard to systemic effects and the specific effects of cyanide (which can affect the iodine metabolism of infants) and nicotine derived from food and maternal smoking. Despite great strides in bans on smoking, public health policies should be designed to keep in perspective that breastfeeding is an effective tool to counterbalance the health disadvantages that under-privileged infants of smoking mothers face. This paper argues that infants born to smoking parents are better protected by breastfeeding than by formula feeding. Therefore, if public health policies cannot stop addicted mothers from smoking during pregnancy it is fundamental not to miss the chance of encouraging and supporting breastfeeding. The food and health inequalities of socially disadvantaged groups demand well crafted public-health policies to reduce the incidence of diseases and compress morbidity: these policies need to make it clear that breastfeeding is better and safer.

Forrester D. Patterns of re-referral to social services: A study of 400 closed cases. Child & Family Social Work 12(1): 11-21, 2007. (22 refs.)

The last 10 years have seen considerable government focus on effective initial assessment processes in the UK. This has been given added impetus by research that found that more than 97% of referrals are closed without allocation for long-term work. Yet there is little research on referrals that are closed and no British study of patterns of re-referral for such children. The current study looks at 400 consecutive referrals to three local authority Social Services Departments in London that were closed rather than being allocated for long-term work. It investigates how many children were re-referred in the 27 months after closure and identifies factors statistically associated with re-referrals. The study found that a third of closed cases were re- referred (36.5%), with most re-referrals happening relatively rapidly. A small proportion of families accounted for most re-referrals: 8.5% of families had 52% of subsequent referrals. There was very wide variation between local authorities in the number of referrals and re-referrals received. Other factors associated with increased likelihood of a re-referral were: previous referrals, neglect, parental capacity issues (particularly drug misuse) and parent/child relationship problems. The implications of the findings for practitioners, policy-makers and researchers are discussed.

Hennigan KM; O'Keefe M; Noether CD; Rinehart DJ; Russell LA. Through a mother's eyes: Sources of bias when mothers with co-occurring disorders assess their children. Journal of Behavioral Health Services & Research 33(1): 87-104, 2006. (64 refs.)

Mothers are the principal informants on children's emotional and behavioral functioning. Maternal assessments of child functioning can be influenced by a mother's own psychological state. The magnitude and valence of distortion in maternal assessments associated with current maternal mental health and substance abuse symptoms were explored in a clinical sample of 253 mothers with co-occurring disorders and histories of trauma. Analyses estimated the correlation between current maternal symptoms and child assessments after controlling for maternal history of disorders, child's history of service utilization for emotional and behavioral problems, and demographic characteristics. Current maternal psychological distress was associated with more pessimistic assessments on the problem-focused Child Behavior Checklist, whereas current maternal substance abuse problems were associated with more optimistic assessments on both problem-focused and strength-based measures. Clinicians and researchers may choose to take distortion into account when treatment plans or measures of change are based on maternal assessments.

Jaffee SR; Caspi A; Moffitt TE; Polo-Tomas M; Taylor A. Individual, family, and neighborhood factors distinguish resilient from non-resilient maltreated children: A cumulative stressors model. Child Abuse & Neglect 31(3): 231-253, 2007. (82 refs.)

Objective: Children who are physically maltreated are at risk of a range of adverse outcomes in childhood and adulthood, but some children who are maltreated manage to function well despite their history of adversity. Which individual, family, and neighborhood characteristics distinguish resilient from non-resilient maltreated children? Do children's individual strengths promote resilience even when children are exposed to multiple family and neighborhood stressors (cumulative stressors model)? Methods: Data were from the Environmental Risk Longitudinal Study which describes a nationally representative sample of 1, 116 twin pairs and their families. Families were home-visited when the twins were 5 and 7 years old, and teachers provided information about children's behavior at school. Interviewers rated the likelihood that children had been maltreated based on mothers' reports of harm to the child and child welfare involvement with the family. Results: Resilient children were those who engaged in normative levels of antisocial behavior despite having been maltreated. Boys (but not girls) who had above-average intelligence and whose parents had relatively few symptoms of antisocial personality were more likely to be resilient versus non-resilient to maltreatment. Children whose parents had substance use problems and who lived in relatively high crime neighborhoods that were low on social cohesion and informal social control were less likely to be resilient versus non-resilient to maltreatment. Consistent with a cumulative stressors model of children's adaptation, individual strengths distinguished resilient from non-resilient children under conditions of low, but not high, family and neighborhood stress. Conclusion: These findings suggest that for children residing in multi-problern families, personal resources may not be sufficient to promote their adaptive functioning.

Keskinoglu P; Cimrin D; Aksakoglu G. Relationships between cotinine, lower respiratory tract infection, and eosinophil cationic protein in children. European Journal of Pediatrics 166(5): 455-459, 2007. (26 refs.)

Introduction: The aim of this study was to investigate the effect of passive smoking on urine eosinophil cationic protein (u-ECP) in children with lower respiratory tract infections (LRTI). Method: This was a case-control study. The study cohort consisted of 150 children with LRTI (case group) and 150 healthy children (control), all from a urban setting. The statistical parameters were: a minimum of 139 children for a 95% confidence interval (95% CI), 80% power, and a possible exposure prevalence of 50%. The u-cotinine and u-ECP levels were measured by radioimmunoassay and fluoroimmunoassay methods, respectively. Data were analyzed by the McNemar chi-square test, t-test, and Pearson correlation. Results: When the generally accepted cut-off level of 30 ng/mg urinary cotinine/creatinine was applied, 87.3% of the children with LRTI and 84.7% of healthy children were passive smokers. Using a cut-off level of 60 ng/mg, passive smoking increased the prevalence of LRTI by 4.7-fold (p=0.000). The mean u-ECP values were significantly higher in the case group than in the healthy control group (p=0.018). A positive association was found between u-cotinine and u-ECP values in children with LRTI (p=0.034). Conclusion: The results of this study indicate that passive smoking may play an important role in the development of respiratory infections and can cause airway inflammation in children with existing LRTI.

Kovesi T; Gilbert NL; Stocco C; Fugler D; Dales RE; Guay M; Miller JD. Indoor air quality and the risk of lower respiratory tract infections in young Canadian Inuit children. Canadian Medical Association Journal 177(2): 155-160, 2007. (47 refs.)

Background: Inuit infants have the highest reported rate of hospital admissions because of lower respiratory tract infections in the world. We evaluated the prevalence of reduced ventilation in houses in Nunavut, Canada, and whether this was associated with an increased risk of these infections among young Inuit children. Methods: We measured ventilation in 49 homes of Inuit children less than 5 years of age in Qikiqtaaluk (Baffin) Region, Nunavut. We identified the occurrence of lower respiratory tract infections using a standardized questionnaire. Associations between ventilation measures and lower respiratory tract infection were evaluated using multiple logistic regression models. Results: The mean number of occupants per house was 6.1 people. The mean ventilation rate per person was 5.6 L/s ( standard deviation [SD] 3.7); 80% (37/46) of the houses had ventilation rates below the recommended rate of 7.5 L/s per person. The mean indoor carbon dioxide (CO2) concentration of 1358 ( SD 531) ppm was higher than the recommended target level of 1000 ppm. Smokers were present in 46 homes (94%). Of the 49 children, 27 (55%) had a reported history of lower respiratory tract infection. Reported respiratory infection was significantly associated with mean CO2 levels (odds ratio [ OR] 2.85 per 500-ppm increase in mean indoor CO2, 95% confidence interval [CI] 1.23 - 6.59) and occupancy ( OR 1.81 for each additional occupant, 95% CI 1.14 - 2.86). Interpretation: Reduced ventilation and crowding may contribute to the observed excess of lower respiratory tract infection among young Inuit children. The benefits of measures to reduce indoor smoking and occupancy rates and to increase ventilation should be studied.

Kroll B. A family affair? Kinship care and parental substance misuse: Some dilemmas explored. Child & Family Social Work 12(1): 84-93, 2007. (67 refs.)

Both the Children Act 1989 and the Human Rights Act 1998 support the principle that children should remain within their birth families wherever possible and that this option must be considered when children are unable to live with their parents. Where parental substance misuse is an issue, family placements, whether formally or informally arranged, are increasingly being used and the support of grandparents, in particular, has been identified as a significant protective factor for children. This paper examines some of the issues that can arise with such placements, particularly in view of the part that substance misuse may play within the wider family system, the impact of parental drug and alcohol use on attachment and child development, and the complex dynamics that can ensue. Drawing on themes emerging from parental substance misuse literature and kinship care research, some practice dilemmas will be explored. While acknowledging the complex aetiology of substance misuse and the dangers of pathologizing family systems in which it is found, some hypotheses about potential risks and challenges will be debated. It will be argued that, although such placements can often provide children with a safe haven, they may demand a specic type of support and monitoring, if children's welfare is to be safeguarded.

Landsman MJ; Hartley CC. Attributing responsibility for child maltreatment when domestic violence is present. Child Abuse and Neglect 31(4): 445-461, 2007. (40 refs.)

Objective: The purpose of this study was to examine factors that influence how child welfare workers attribute responsibility for child maltreatment and child safety in cases involving domestic violence. Methods: The study used a factorial survey approach, combining elements of survey research with an experimental design. Case vignettes were constructed by randomly assigning characteristics to vignettes believed to be related to assessments about responsibility for child maltreatment. Public child welfare workers were systematically sampled and asked to rate vignettes on male and female caregivers' responsibility for child maltreatment and concerns for safety. Results: The presence of domestic violence significantly affected workers' assessments of the attribution of responsibility and concern for child safety, more so than variables related to child maltreatment. Responsibility for exposing a child to domestic violence differed for males and females, with more factors explaining female responsibility. Substance use by either caregiver was significant in attributing responsibility for physical harm, not watching the child closely enough, and concern for child safety, but not for exposure to domestic violence. Conclusions: Domestic violence appeared to heighten workers' assessments of responsibility for child maltreatment and concerns about child safety, taking precedence over the characteristics of the child maltreatment itself. Battering tends to work against the domestic violence victim in terms of the attribution of responsibility. A greater number of factors affect female responsibility for exposing a child to domestic violence than male responsibility, even though in every case the male was the designated domestic violence batterer.

Lorber W; Morgan DY; Eisen ML; Barak T; Perez C; Crosbie-Burnett M. Patterns of cohesion in the families of offspring of addicted parents: Examining a nonclinical sample of college students. Psychological Reports 101(3, Part 1): 881-895, 2007. (55 refs.)

This study was designed to examine patterns of family functioning among college students who are offspring of addicted parents. 218 undergraduate psychology students were administered a series of measures assessing family functioning, dissociation, parental addiction, and a history of child abuse. As predicted, offspring of addicted parents reported significantly lower Cohesion in their families of origin (F-1,F-161 = 10.16, p =.002), and described significantly greater dissatisfaction with the cohesion they experienced in their families of origin, when compared to their college peers (F-1.135 = 10.24, p =.002). However, these groups reported comparable Adaptability in their families of origin (F-1,F-161 = 1.74, ns). These data show that, although offspring of addicted parents college students appear to share commonalities with their student peers in terms of the adaptability in their families of origin, they still share some key characteristics with clinical populations of offspring of addicted parents, which distinguish them as a group.

Luthar SS; Sexton CC. Maternal drug abuse versus maternal depression: Vulnerability and resilience among school-age and adolescent offspring. Development and Psychopathology 19(1): 205-225, 2007. (66 refs.)

In this study of 360 low-income mother-child dyads, our primary goal was to disentangle risks linked with commonly co-occurring maternal diagnoses: substance abuse and affective/anxiety disorders. Variable- and person-based analyses suggest that, at least through children's early adolescence, maternal drug use is no more inimical for them than is maternal depression. A second goal was to illuminate vulnerability and protective processes linked with mothers' everyday functioning, and results showed that negative parenting behaviors were linked with multiple adverse child outcomes. Conversely, the other parenting dimensions showed more domain specificity; parenting stress was linked with children's lifetime diagnoses, and limit setting and closeness with children's externalizing problems and everyday competence, respectively. Results are discussed in terms of implications for resilience theory, interventions, and social policy.

Mezzich AC; Bretz WA; Day BS; Corby PM; Kirisci L; Swaney M; Cornelius JR et al. Child neglect and oral health problems in offspring of substance-abusing fathers. American Journal on Addictions 16(5): 397-402, 2007. (58 refs.)

This study examined ( 1) orodental ( OD) problems in 10 - 19-year-old children of substance use disorder (SUD) (n = 127) and non- SUD fathers (n = 111) and (2) the moderating effect of child's substance use ( SU) involvement in the associations of paternal SUD and neglectful parenting with OD problems in the offspring. The results showed that periodontal problems differentiated between groups and the interactions between child's SU involvement and paternal SUD and neglectful parenting were respectively associated with hard/soft tissue lesions and carious lesions in the offspring, indicating that SU involvement increases risk for OD due to paternal SUD and neglectful parenting.

Mezzich AC; Tarter RE; Kirisci L; Feske U; Day BS; Gao Z. Reciprocal influence of parent discipline and child's behavior on risk for substance use disorder: A nine-year prospective study. American Journal of Drug and Alcohol Abuse 33(6): 851-867, 2007. (78 refs.)

Aim: This study aimed at determining the association of father's and mother's (parental) substance use disorder (SUD) and discipline styles and son's neurobehavior disinhibition (ND) with son's SUD from childhood (age 10-12) to young adulthood ( age 19). It was hypothesized that (1) parental discipline styles and son's ND mediate the association between parental SUD and son's SUD, ( 2) son's ND mediates the association between parental discipline styles and son's SUD, and ( 3) parental discipline styles mediate the association between ND and SUD in the son. Methods: Two-hundred-sixty-three families including a 10-12 year-old son and both parents participated in the study. Results: ( 1) mother's discipline styles predicted father's discipline styles, ( 2) son's ND predicted mother's instilling guilt positively and father's punishment negatively, ( 3) son's ND mediated the association between father's SUD and punishment and son's SUD, and ( 4) mother's SUD predicted son's ND and SUD. Conclusions: The reciprocal prediction between son's ND and father's punishment and prediction of father's punishment by mother's punishment point to the need for family-based interventions that take into account the quality of specific dyadic interactions pertaining to discipline behaviors that amplify the risk for SUD in male children.

Nilsson P; Kohler M; Ostergren PO; Khan FA. Children exposed to environmental smoking have a higher antibiotic consumption. Vaccine 25(13): 2533-2535, 2007. (16 refs.)

In order to investigate what factors influence antibiotic prescribing, a questionnaire answered by 8700 parents to 4-year-old children in Malmo between 1999 and 2004 was analyzed. 51.3% of the 4-year-old children had been treated with antibiotics. Exposure to environmental smoking, attending day care centers, employment of parents and parents born in Sweden was found to be statistically significant risk factor for antibiotic prescribing. The association between environmental smoking and antibiotic treatment found in this study could be used in information campaigns which might not only lead to a decreased antibiotic prescribing among the children, but also future positive health effects for their parents.

Ondersma SJ. Introduction to the second special section on substance abuse and child maltreatment. (commentary). Child Maltreatment 12(2): 111-113, 2007. (11 refs.)

Ostler T; Haight W; Black J; Choi GY; Kingery L; Sheridan K. Case series: Mental health needs and perspectives of rural children reared by parents who abuse methamphetamine. Journal of the American Academy of Child and Adolescent Psychiatry 46(4): 500-507, 2007. (32 refs.)

Objective: This case-based, mixed-methods study was undertaken to understand the perspectives and mental health needs of rural children exposed to parental methamphetamine abuse. Method: Participants were 23 children involved with a state child protective agency because of parental methamphetamine abuse. A semistructured interview provided information on children's perspectives of their families. Information on children's mental health needs was obtained from the Child Behavior Checklist and Trauma Symptom Checklist. Case records and caseworker reports provided information on children's family experiences. Results: Children described emotional pain; few social resources for coping with emotions, problem solving, or talking about their experiences; and avoidant or passive coping skills. Sixty-five percent of children evidenced significant dissociative or posttraumatic symptoms on standardized assessments; 57% had other significant emotional and behavioral problems. Challenges to understanding children's perspectives included children's perceptions that talking about methamphetamine abuse was taboo and underreporting of significant symptoms on the Trauma Symptom Checklist. Conclusions: The high rate of mental health problems suggests the need for nontraditional strategies for services delivery in rural areas that are targeted toward these vulnerable children. Early identification and treatment of mental health problems should be a priority. Clinicians should be alert to the complexities in assessing children's mental health needs.

Pirsaraee HY. When parents use drugs: Key findings from qualitative research on parenting and children in Iran. Child & Family Social Work 12(2): 113-122, 2007. (34 refs.)

This paper reports on the finding of a grounded theory study on drug dependency and parenting in Iran. This study is qualitative in nature; data were obtained through semi-structured interviews. The grounded theory method was used to guide the analysis. Interviews with 41 opium- and heroin-dependent parents selected from a treatment centre in Rasht, Iran provided detailed information on the impact of drug dependency on parenting. The study focused on drug dependency and parenting and explored the links between them in order to understand the impact of drug dependency on parental duties and responsibilities. The findings showed that parental drug dependency affects various aspects of parenting, including children's material needs and basic requirements; parent-child relationships; parent-child communication; and the disciplinary strategies of parents. The results showed that children's material needs and basic requirements may be overshadowed by parents' drug dependency. It was also discovered that abuse of children by drug-dependent parents was manifested in three major forms. This study also found that the bonds within families of drug-dependent parents tended to weaken and that control over children almost disappeared in many cases. Intervention and prevention programmes should be offered to the children of drug-dependent parents.

Shankaran S; Lester BM; Das A; Bauer CR; Bada HS; Lagasse L et al. Impact of maternal substance use during pregnancy on childhood outcome. Seminars in Fetal & Neonatal Medicine 12(2): 143-150, 2007. (42 refs.)

The impact of maternal substance abuse is reflected in the 2002-2003 National Survey on Drug Use and Health. Among pregnant women in the 15-44 age group, 4.3%, 18% and 9.8% used illicit drugs, tobacco and alcohol, respectively. Maternal pregnancy complications following substance use include increases in sexually transmitted disorders, placental abruption and HIV-positive status. Effects on the neonate include a decrease in growth parameters and increases in central nervous system and autonomic nervous system signs and in referrals to child protective agencies. In childhood, behavioral and cognitive effects are seen after prenatal cocaine exposure; tobacco and alcohol have separate and specific effects. The ongoing use of alcohol and tobacco by the caretaker affects childhood behavior. Therefore, efforts should be made to prevent and treat behavioral problems as well as to limit the onset of drug use by adolescent children born to women who use drugs during pregnancy.

Sheinkopf SJ; Lagasse LL; Lester BM; Liu J; Seifer R; Bauer CR et al. Prenatal cocaine exposure: Cardiorespiratory function and resilience. Annals of the New York Academy of Sciences: Resilience in Children 1094: 354-358, 2006. (8 refs.)

Cardiac vagal tone (VT) was studied as a resilience factor in children prenatally exposed to cocaine and nonexposed controls (n = 550). A cumulative risk index was derived and used to classify children as high versus low risk. VT was measured during mildly stressful observations at 1 and 36 months of age. Children were classified as having consistently high, consistently low, or fluctuating VT. Risk and VT interacted to predict adaptive behaviors. For high-risk children, low VT was related to higher ratings of adaptive behaviors. This finding suggests that regulatory functioning, as indexed by VT, may be a protective factor in prenatal CE.

Steinhausen HC; Dal Mas S; Ledermann; Metzke CW. Risk factors for the development of emotional and behavioural problems in children born to drug-dependent mothers. European Child and Adolescent Psychiatry 15(8): 460-466, 2006. (28 refs.)

Objective: The study of biological and psychosocial risk factors for the development of emotional and behavioural problems in children of drug-dependent mothers. Method: In a sample of 52 children and drug-dependent mothers participating in a residential intervention programme emotional and behavioural problems were studied in the children by use of the Child Behaviour Checklist (CBCL). The Symptom-Checklist Revised (SCL-90-R) served to assess mental problems in the mother. Drug exposure during pregnancy, various psychosocial risk factors due to the drug-career, and educational status of the mother were assessed by maternal interview. A brief assessment of intelligence of the mother was included. Results: Among the various biological and psychosocial risk factors, maternal mental health problems, maternal educational status, and a small number of close social relationships correlated significantly with child outcome variables. Multiple regression analyses identified maternal mental health factors as the main predictors of child behaviour. Conclusion: Assisting drug-dependent mothers in overcoming the psychosocial sequelae of drug abuse implies also assistance to the children in terms of prevention of emotional and behavioural problems.

Suchman NE; Rounsaville B; DeCoste C; Luthar S. Parental control, parental warmth, and psychosocial adjustment in a sample of substance-abusing mothers and their school-aged and adolescent children. Journal of Substance Abuse Treatment 32(1): 1-10, 2007. (37 refs.)

Parenting interventions for substance-abusing adults have been broadly based on two approaches, one emphasizing parental control as a means to managing children's behavior and the second emphasizing parental warmth and sensitivity as means to fostering children's psychological development. In this investigation, we examined associations of parental control and parental warmth, respectively, with children's behavioral and psychological adjustment in a sample of 98 women enrolled in methadone maintenance and their school-aged and adolescent children. Using collateral data collected during the baseline phase of a randomized clinical trial (Luthar, S. S., Suchman, N. E., & Altomare, M. [in press). Relational Psychotherapy Mothers Group: A randomized clinical trial for substance abusing mothers [in preparation]), we tested predictions that (a) parental control would be more strongly associated with children's behavioral adjustment and (b) parental warmth would be more strongly associated with children's psychological adjustment. Both predictions were generally confirmed, although some crossover among parenting and child dimensions was also evident. Results support the theoretical stance that parental limit setting and autonomy support, as well as nurturance and involvement, are important factors, respectively, in children's behavioral and psychological adjustment.

Tracy EM; Martin TC. Children's roles in the social networks of women in substance abuse treatment. Journal of Substance Abuse Treatment 32(1): 81-88, 2007. (48 refs.)

This study examined the status of children and the types of support available from children as reported by women in substance abuse treatment. Findings indicate that children are viewed as sources of social support to women on treatment. Children were viewed as providing as much sobriety support to respondents as that provided by adult network members. In addition, both children living with the respondent and children in the care of others were viewed as providers of specific types of social support. Implications are drawn for practice and research.

Vanderploeg JJ; Connell CM; Caron C; Saunders L; Katz KH; Tebes JK. The impact of parental alcohol or drug removals on foster care placement experiences: A matched comparison group study. Child Maltreatment 12(2): 125-136, 2007. (46 refs.)

Research has established the coincidence of parental alcohol and other drug (AOD) use and child maltreatment, but few studies have examined the placement experiences and outcomes of children removed because of parental AOD use. The present study examines demographic characteristics and placement experiences of children removed from their homes because of parental AOD use (n = 1,333), first in comparison to the remaining sample of children in foster care (n = 4,554), then in comparison to a matched comparison group of children in foster care who were removed for other reasons (n = 1,333). Relative to the comparison sample, children removed for parental AOD use are less likely to experience co-occurring removal because of neglect and physical or sexual abuse and are more likely to be placed in relative foster care. In addition, these children remain in care longer, experience similar rates of reunification, and have significantly higher rates of adoption.

Wang HC; McGeady SJ; Yousef E. Patient, home residence, and neighborhood characteristics in pediatric emergency department visits for asthma. Journal of Asthma 44(2): 95-98, 2007. (17 refs.)

Objective. To identify patient, home residence, and neighborhood characteristics of children with asthma-related emergency department visits. Methods. Medical records of children with one (group A) or more than one (group B) asthma-related pediatric emergency department visit were reviewed. Results. A significantly higher percentage of group B had Medicaid insurance (p = 0.04), history of asthma-related hospitalizations (p 0.04), and passive tobacco smoke exposure (p = 0.03). Neighborhood characteristics were similar between the two groups. Conclusions. Smoking cessation counseling and close monitoring of patients with a history of asthma-related hospitalizations and patients with Medicaid insurance may be helpful in decreasing emergency department visits.

Westermeyer J; Yoon G; Thuras P. Psychiatric morbidity and parental substance use disorder. American Journal of Drug and Alcohol Abuse 32(4): 607-616, 2006. (26 refs.)

Objective: To assess psychiatric morbidity associated with having no, one, or two parents with Substance Use Disorder (SUD), among patients receiving SUD care. Design: Two measures of psychiatric morbidity included (a) current psychopathology and (b) lifetime use of psychiatric treatment. Settings: Alcohol-drug treatment programs were located in two university medical centers. Subjects: Four hundred ninety-five voluntary patients aged 18 and older and non-adopted. Results: Parental SUD was directly related to (a) more current psychiatric symptoms, both self-rated and psychiatrist-rated and (b) greater likelihood of ever having ever received psychiatric treatment. Among those who had ever received psychiatric care, the number of psychotropic medications was related to parental SUD. Number of admissions, venues, visits/days, and cost of psychiatric care were not associated with parental SUD. Conclusions: Extent of parental SUD was related to increased psychiatric morbidity.

Whu R; Cirilo G; Wong J; Finkel ML; Mendez HA; Leggiadro RJ. Risk factors for pediatric asthma in the south Bronx. Journal of Asthma 44(10): 855-859, 2007. (38 refs.)

We identified main asthma risk factors for children living in the South Bronx, where asthma rates are eight times higher than the national average. This case-control study enrolled 261 children at Lincoln Medical and Mental Health Center from 2002 to 2003. We questioned the mothers on medical history and home environment. The most important risk factors for asthma in the South Bronx pediatric population are Hispanic ethnicity, family history of asthma, and exposure to tobacco smoke. South Bronx children limited to breast-feeding during the first 3 months of age are less likely to develop asthma.

Wilson SE; Kahn RS; Khoury J; Lanphear BP. The role of air nicotine in explaining racial differences in cotinine among tobacco-exposed children. Chest 131(3): 856-862, 2007. (38 refs.)

Objective: African-American children have higher rates of tobacco-associated morbidity. Few studies have objectively measured racial differences in the exposure of children to tobacco smoke. The objective of this study was to test whether African-American children have higher levels of cotinine compared to white children while accounting for ambient measures of tobacco smoke. Setting: Community-based sample of asthmatic children (n = 220) enrolled in an environmental tobacco smoke (ETS) reduction trial. Participants: A biracial sample (55% African American) of children with asthma aged 5 to 12 years who were routinely exposed to ETS. Measurements: We measured cotinine levels in serum and hair samples at baseline, 6 months, and 12 months. We measured the level of ETS exposure over a 6-month period by placing air nicotine dosimeters in the homes of the children at baseline and at 6-month study visits. Results: African-American children had significantly higher levels of cotinine at all time points in the study. At the 12-month visit, African-American children had higher levels of serum cotinine (1.39 mu g/dL vs 0.80 mu g/dL, p = 0.001) and hair cotinine (0.28 ng/mg vs 0.08 ng/mg, p < 0.0001) when compared with white children. In a repeated-measures analysis, African-American children had significantly higher levels of serum cotinine (beta = 0.28, p = 0.04) and hair cotinine (beta = 1.40, p < 0.0001) compared with white children. Air nicotine levels and housing volume were independently associated with higher levels of cotinine. Conclusions: Among children with asthma, African-American children have higher levels of serum and hair cotinine compared with white children.

Wu F; Takaro TK. Childhood asthma and environmental interventions. Environmental Health Perspectives 115(6): 971-975, 2007. (42 refs.)

BACKGROUND: Contaminants encountered in many households, such as environmental tobacco smoke, house dust mite, cockroach, cat and dog dander, and mold, are risk factors in asthma. Young children are a particularly vulnerable subpopulation for environmentally mediated asthma, and the economic burden associated with this disease is substantial. Certain mechanical interventions are effective both in reducing allergen loads in the home and in improving asthmatic children's respiratory health. RESULTS: Combinations of interventions including the use of dust mite-impermeable bedding covers, improved cleaning practices, high-efficiency particulate air vacuum cleaners, mechanical ventilation, and parental education are associated with both asthma trigger reduction and improved health outcomes for asthmatic children. Compared with valuated health benefits, these combinations of interventions have proven cost effective in studies that have employed them. Education alone has not proven effective in changing parental behaviors such as smoking in the home. CONCLUSIONS: Future research should focus on improving the effectiveness of education on home asthma triggers, and understanding long-term children's health effects of the interventions that have proven effective in reducing asthma triggers.