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CORK Bibliography: Maternal Drug Use

84 citations. 2003 to present

Prepared: June 2011

Abreu-Villaca Y; Seidler FJ; Slotkin TA. Does prenatal nicotine exposure sensitize the brain to nicotine-induced neurotoxicity in adolescence? Neuropsychopharmacology 29(8): 1440-1450, 2004. (62 refs.)

Offspring of women who smoke during pregnancy are themselves more likely to take up smoking in adolescence. We evaluated neurotoxicant effects of prenatal and adolescent nicotine exposure in developing rats to evaluate whether these contribute to a biological basis for this relationship. Rats were given nicotine or vehicle throughout pregnancy and the offspring then again received nicotine or vehicle during adolescence (postnatal days PN30-47.5); this regimen reproduces the plasma nicotine levels found in smokers. Indices of neural cell number (DNA concentration and content), cell size (protein/DNA ratio), and cell membrane surface area (membrane/total protein) were then evaluated in brain regions during adolescent nicotine administration (PN45) and up to I month post-treatment. By itself, prenatal nicotine administration produced cellular alterations that persisted into adolescence, characterized by net cell losses in the midbrain and to a lesser extent, in the cerebral cortex, with corresponding elevations in the membrane/total protein ratio. The hippocampus showed a unique response, with increased DNA content and regional enlargement. Adolescent nicotine treatment alone had similar, albeit smaller effects, but also showed sex-dependence, with effects on protein biomarkers preferential to females. When animals exposed to nicotine prenatally were then given nicotine in adolescence, the net outcome was worsened, largely representing summation of the two individual effects. Our results indicate that prenatal nicotine exposure alters parameters of cell development lasting into adolescence, where the effects add to those elicited directly by adolescent nicotine; neurotoxicant actions may thus contribute to the association between maternal smoking and subsequent smoking in the offspring.

Afifi RA; Yeretzian JS; Rouhana A; Nehlawi MT; Mack A. Neighbourhood influences on narghile smoking among youth in Beirut. European Journal of Public Health 20(4): 456-462, 2010. (42 refs.)

Background: Increasingly neighbourhoods are identified as influencing health. Neighbourhood characteristics have been linked to cigarette use. In Lebanon, the water pipe (narghile) use is most frequent among youth. The current study is aimed at identifying differential neighbourhood influences on smoking narghile among youth. Methods: A quantitative interview was completed with 1294 adolescents, 13-20 years, in three urban disadvantaged neighbourhoods of Beirut. Individual and social factors, suggested by the literature, were associated with smoking narghile. The neighbourhood variation in the influence of these factors was then explored. Bivariate and stratified logistic regression analysis were conducted, neighbourhood being the stratification variable. Results: About 60% of respondents had ever tried a narghile, about one-fifth continued to smoke. Several individual-level and social variables predicted narghile smoking bivariately. The influences on narghile smoking varied by neighbourhood. Neighbourhood differences persisted at the multivariate level. Consistently across neighbourhoods, the influence of friends was the predominant predictor of narghile smoking. In one neighbourhood, maternal smoking was a risk factor for narghile smoking of youth, in another paternal smoking. Being female seems to be protective in two of the three neighbourhoods. Other factors also differentially influence narghile use by neighbourhood. Conclusions: The mechanisms of influence of neighbourhoods on health are not clearly understood, but a transactional paradigm seems most fitting with the results found in this research. Interventions to prevent the narghile smoking should address multiple levels of influence; and must be tailored to the particular aspects of neighbourhoods which are influential in the uptake of this behaviour.

Agee MD; Crocker TD. Children's health benefits of reducing environmental tobacco smoke exposure: evidence from parents who smoke. Empirical Economics 32(1): 217-237, 2007. (55 refs.)

This paper uses data from the 1991 National Maternal and Infant Health Survey to estimate propositions derived from a model of intrahousehold allocation, wherein parents engage in a consumption activity (smoking) that produces own utility, while generating environmental tobacco smoke (ETS) that harms their children's health. We find a statistically significant negative association between sample mothers' assessed health of their children and the children's daily exposures to ETS. Mothers' average annual willingness-to-pay (WTP) for a 1-hour-per-day reduction in child ETS exposure (about a 17% decrease in daily exposure) is about $150. WTP estimates for respondent mother and child health status further suggest that smoking mothers on average value their child's health roughly 55% higher than their own health.

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.

Banwell C; Bammer G. Maternal habits: Narratives of mothering, social position and drug use. International Journal of Drug Policy 17(6): 504-513, 2006. (62 refs.)

Concerns are frequently voiced about harms to children of mothers who use drugs. We explored the subjective socio-cultural experiences of childrearing by women using illicit drugs (heroin mainly and amphetamines) and compared them to those of three other groups of women. Two comparison groups mirrored correlates of illicit drug use, namely: women on low incomes (who did not use these drugs) and women who are mobile, and therefore likely to be socially isolated (these had partners employed in the Australian Defence Forces). The third group reflected the desired social norm, i.e. women with medium and higher incomes who did not use illicit drugs. In-depth interviews were conducted with purposive samples, totaling 70 women with children aged five and below residing in Canberra, Australia. All women, irrespective of their drug use, found living on a low income, social isolation or being at home with young children difficult, at least sometimes. However, women who use illicit drugs are often blamed for these difficulties in ways that other groups of women are not. They also do not receive the same levels of social support that other women enjoy.

Bartu A; Sharp J; Ludlow J; Doherty DA. Postnatal home visiting for illicit drug-using mothers and their infants: A randomised controlled trial. Australian & New Zealand Journal of Obstetrics & Gynaecology 46(5): 419-426, 2006. (15 refs.)

Background: Postnatal home-visiting programs for illicit drug-using mothers have reported some success in reducing harms in some areas but there is a lack of data on their impact on breastfeeding and immunisation rates. Aims: To investigate the effect on breastfeeding, immunisation and parental drug use. The hypothesis was that the outcomes of the home-visiting group (HVG) would be superior to the control group (CG). Method: One hundred and fifty-two illicit drug-using women were recruited at 35-40 weeks gestation from King Edward Memorial Hospitalital, Perth, Western Australia and randomised after delivery to the HVG or the CG. The HVG had eight home visits; the CG had telephone contact at two months and a home visit at six months. The HVG received education and support for parenting, breastfeeding and child development. This was not provided by the research midwives for the CG. Results: The main drugs were heroin, amphetamines, cannabis and benzodiazepines. Immunisation rates were similar for each group. Median duration of breastfeeding for the HVG was eight weeks (95% CI, 3.8-12.2); for the CG ten weeks (95% CI, 7.3-12.7). Drug use was reduced during pregnancy but increased by six months post-partum in both groups. The retention rates were: HVG 93%; CG 86%. Conclusion: The hypothesis for this study was not supported. Long-term studies are urgently required to assess the effects of parental drug use on infant and child development.

Baska T; Warren CW; Hudeckova H; Ochaba R; Stastny P; Lea V et al. The role of family background on cigarette smoking among adolescent school children in Slovakia: Findings from the 2007 Slovakia Global Youth Tobacco Survey. International Journal of Public Health 55(6): 591-597, 2010. (26 refs.)

To analyse Global Youth Tobacco Survey (GYTS) data to determine the role of family background on cigarette smoking among adolescents in Slovakia. The GYTS is a school-based survey of students aged 13-15 years developed by the World Health Organization and the Centers for Disease Control and Prevention. The GYTS was conducted in Slovakia in 2007. Students from families where one or more parents were smokers were significantly more likely to report lifetime smoking, current cigarette smoking and signs of nicotine dependence (only girls). Socioeconomic status of parents as measured by parent educational level and employment status was not statistically associated with students' smoking status. Girls from families with lower socioeconomic status showed more frequently positive attitudes regarding smoking of their peers. Considering family background, parental smoking plays the most important role in smoking of their children regardless of employment status and educational level. The findings suggest that the tobacco control program effort in Slovakia needs to focus on implementation and enforcement for those policies already in place as well as expansion into additional measures.

Bisgaard H; Loland L; Holst KK; Pipper CB. Prenatal determinants of neonatal lung function in high-risk newborns. Journal of Allergy and Clinical Immunology 123(3): 651-657, 2009. (43 refs.)

Background: Neonatal lung function is suspected to be associated with wheezy disorders, but little is known about risk factors for the early lung function. Objectives: To study prenatal determinants of neonatal lung function. Methods: This is a clinical, prospective birth cohort study of 411 newborns, the Copenhagen Prospective Study on Asthma in Childhood, in a single-center research clinic dedicated solely to this longitudinal birth cohort study. Lung function was determined at I month of age by infant spirometry (the raised volume rapid thoraco-abdominal compression technique) and bronchial responsiveness to methacholine by transcutaneous oxygen measurements. Risk factor analyses included anthropometrics; demographics; socioeconomic factors; parental atopic history; previous deliveries; exposures during the third trimester to the mother's smoking, alcohol, and medicines; third trimester pregnancy complications including mother's asthma status; and mode of delivery. Results: Lung function was determined in 404 neonates, age 6 weeks. Neonates with body mass index in the upper quartile had 14% lower baseline forced expiratory volume at 0.5 second, and neonates of mothers smoking during the third trimester had 7% lower baseline forced expiratory volume at 0.5 second. Sex or parental atopic disease did not affect the neonatal lung function and bronchial responsiveness. Maternal intake of paracetamol during the third trimester was associated with doubling of the bronchial responsiveness in the neonates, but the statistical significance may have been driven by outliers. Bronchial responsiveness exhibited a parabola development with tripling of bronchial responsiveness reaching the nadir at 3 months of age, but this needs replication in a study with repetitive measurements within individuals. Conclusion: High body mass index in newborns and mothers smoking is associated with reduced neonatal lung function. This suggests that the association between body proportion and wheezing disorders may be a result of shared genes or prenatal nutrition.

Bisgaard H; Loland L; Holst KK; Pipper CB. Prenatal determinants of neonatal lung function in high-risk newborns. Journal of Allergy and Clinical Immunology 123(3): 651-657, 2009. (43 refs.)

Brady TM; Visscher W; Feder M; Burns AM. Maternal drug use and the timing of prenatal care. Journal of Health Care for the Poor and Underserved 14(4): 588-607, 2003. (77 refs.)

This paper explores the role of maternal drug use and the timing of prenatal care. The study data were collected from women delivering live births at eight participating hospitals in the Washington, D.C., Metropolitan Area Drug Study. An estimated 16.9 percent of the women in this sample initiated prenatal care in their third trimester or received no prenatal care. After adjusting for age, race/ethnicity, education, parity, and attitude toward pregnancy, cocaine use was strongly associated with the timing of prenatal care. Using multivariable ordinal logistic regression, the data suggest significant barriers to prenatal care for substance abusers, especially cocaine users. Increasing access to prenatal care continues to be an important public health policy objective, particularly in urban areas where substance abuse is prevalent. Health services research must test strategies that address the timing of prenatal care among drug-dependent, urban women.

Braillon A; Bewley S; Dubois G. Tobacco harm to the developing child. (editorial). European Journal of Pediatrics 169(12): 1565-1567, 2010. (13 refs.)

Breslau N; Paneth N; Lucia VC; Paneth-Pollak R. Maternal smoking during pregnancy and offspring IQ. International Journal of Epidemiology 34(5): 1047-1053, 2005. (40 refs.)

Background: Maternal smoking in pregnancy lowers birthweight. It is unclear, however, whether smoking during pregnancy lowers offspring IQ, and, if it does, whether it is through the smoking effect on fetal growth. Method: Representative samples of low birthweight (< 2500 g) and normal birthweight children born in 1983-85 from inner-city and suburban communities in southeast Michigan, USA were assessed at ages 6, 11, and 17, using Wechsler intelligence tests. Smoking during pregnancy was ascertained from mothers at the first assessment; and smoking at any time was ascertained at the first and second assessment. Generalized estimating equation models were used, with children's IQ at all three assessments as outcomes (n = 798). Results Without adjustment, offspring of mothers who smoked during pregnancy scored 6.8 IQ points lower than offspring of mothers who never smoked, on average. Low birthweight children scored 5.4 IQ points lower than normal birthweight children, on average. The statistical association of maternal smoking with offspring IQ was confounded by maternal characteristics, chiefly, maternal cognitive ability as measured by IQ and education; adjustment for these factors eliminated the association. By contrast, adjustment for maternal IQ and education as well as smoking during pregnancy had a negligible effect on the low birthweight-related IQ deficit. Low birthweight did not mediate the association of smoking and lowered IQ in offspring. Conclusion: Maternal smoking during pregnancy is a proxy for a matrix of vulnerabilities for adverse child cognitive development and has no direct causal effect on child's IQ. The relationship of low birthweight and IQ is independent of maternal smoking and maternal cognitive abilities.

Brodsky JL; Viner-Brown S; Handler AS. Changes in maternal cigarette smoking among pregnant WIC participants in Rhode Island. Maternal and Child Health Journal 13(6): 822-831, 2009. (44 refs.)

Objectives: To describe the relationship between the timing of entry into the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) among pregnant women in Rhode Island (RI) and changes in maternal cigarette smoking (MCS) during pregnancy. Methods MCS data gathered by WIC were analyzed for pregnant women who self-identified as smokers at the onset of pregnancy between the years 2001-2005. Bivariate and multivariate analyses were performed to examine the relationship between timing of WIC entry and both increased and decreased/quit MCS during pregnancy. Results Self-reports from smokers indicated that 9.5% quit smoking, 24.6% decreased MCS, 26.8% experienced no change, 33.5% increased MCS, and 5.6% attempted to quit MCS but failed during pregnancy. The adjusted odds ratio for smokers with 1st trimester WIC entry and increased MCS was 0.64 (95% CI 0.52, 0.79). Among smokers with 1st trimester PNC entry, the adjusted odds ratio for smokers with 1st trimester WIC entry and decreased/quit MCS was 1.51 (95% CI 1.17, 1.96). Conclusions Early WIC entry appears to be associated with improvements in MCS. Participants who entered WIC in the first trimester of pregnancy were less likely to increase smoking during pregnancy, and if they also had first trimester prenatal care, were more likely to decrease/quit smoking compared to those who entered WIC later. Programs that increase the rates of first trimester WIC entry may contribute to lower rates of MCS in the WIC population.

Brown EJ; Smith FB. Place and space: The where and why of drug-use location among rural African American women. Journal of Family Nursing 12(2): 185-200, 2006. (15 refs.)

Increasing drug use among rural African American women and its effect on children warrants investigation. This article describes drug-use locations of rural African American women who use cocaine and construct their lives to conceal it from children. During 4 years, a 30-respondent ethnography was conducted. Data from in-depth interviews and field notes were analyzed for recurrent themes and patterns of drug-use location using NVivo. Most respondents with children used most often outside their households. One third (n = 10) used within their households when children were away or in designated spaces off limits to children. More respondents (n = 11) without children at home used in non-designated spaces; in contrast, few respondents (n = 2) with children at home used in non-designated spaces within the household. Most respondents thought they were successful at concealing their cocaine use. Implications for choice of space and place of drug use for themselves and their children are discussed.

Cash SJ; Wilke DJ. An ecological model of maternal substance abuse and child neglect: Issues, analyses, and recommendations. American Journal of Orthopsychiatry 73(4): 392-404, 2003. (53 refs.)

This study examined an ecological model of maternal substance abuse and child neglect. Data are presented that identified an interplay among family history, interpersonal risk factors, current family functioning, and community networks in examinations of child neglect in a sample of substance-abusing women entering treatment.

Cattapan O; Grimwade J. Parental illicit drug use and family life: Reports from those who sought help. Australian and New Zealand Journal of Family Therapy 29(2): 77-87, 2008. (23 refs.)

Family histories of abuse and neglect are common among persons with substance addictions. Clearly such family backgrounds impact on future lifestyle choices. How this early life experience then impacts on the substance user as a parent and on their children has not been considered in the literature in any detail. Clients of local community drug services were invited to participate in a study evaluating the family life of parents who were dependent on illicit substances. Fifteen parents participated in a qualitative, longitudinal study about their family life, treatment and drug of choice. Four aspects of parental perception of family life were examined: the perceived impact of the family of origin on the parent drug user, self-perception, the impact of parental illicit drug use on the family environment, the impact of parental illicit drug use on children. For parents struggling with a substance addiction, it would seem that recovery has much to do with differentiation and gaining a sense of agency.

Chapple CL; Hope TL; Whiteford SW. The direct and indirect effects of parental bonds, parental drug use, and self-control on adolescent substance use. Journal of Child & Adolescent Substance Abuse 14(3): 17-38, 2005. (65 refs.)

Research indicates that parenting has important effects on adolescent substance use. However, the indirect effect of parenting on adolescent substance use via self-control is less understood. Gottfredson and Hirschi's General Theory of Crime has been extensively tested by researchers in the field of criminology, but the theory rarely has been used to predict adolescent substance use. Although Goffredson and Hirschi clearly assume that self-control is predicated on parenting, its mediating effect is rarely assessed. We find direct effects of self-control and maternal marijuana use on substance use and also find that self-control mediates the relationship between other parenting variables and adolescent substance use.

Clark DB; Cornelius J; Wood DS; Vanyukov M. Psychopathology risk transmission in children of parents with substance use disorders. American Journal of Psychiatry 161(4): 685-691, 2004. (39 refs.)

Objective: Children of fathers with substance use disorders are at increased risk for psychopathology, including conduct disorder, attention deficit hyperactivity disorder (ADHD), major depressive disorder, and anxiety disorders. This study examined the distinct influences of parent substance use disorder and other psychopathology in the transmission of the risk for psychopathology to their children. Method: The subjects were 1,167 children (ages 6-14 years; 62% were male, 38% were female) from 613 families recruited according to a high-risk paradigm. Of these families, 294 had fathers with a substance use disorder (high-risk group), and 319 had fathers without a substance use disorder or other mental disorder (low-risk group). In all families, father, mother, and children were directly assessed. Mixed-effects ordinal regression analyses controlled for the nested data structure. Results: For conduct disorder, ADHD, major depression, and anxiety disorders, the results indicated that the predominant predictor of specific mental disorders in offspring was a history of the corresponding disorders in both parents. Conclusions: These results support specific parent-child transmission for childhood psychopathology.

Dahal GP; Johnson FA; Padmadas SS. Maternal smoking and acute respiratory infection symptoms among young children in Nepal: Multilevel analysis. Journal of Biosocial Science 41(6): 747-761, 2009. (23 refs.)

The association between maternal smoking and adverse child health outcomes has not been systematically explored In less developed countries, especially in Nepal where over a quarter of women of reproductive age smoke tobacco products. This study aims to quantify the effect of maternal smoking on acute respiratory infection (ARI) symptoms among children aged below five years, using the 2001 Nepal Demographic and Health Survey. It is hypothesized that children born to mothers who smoke frequently are at higher risk of developing ARI symptoms. Four-level random intercept logistic regression models were used to disentangle the independent effect of maternal smoking on children's ARI symptoms, controlling for potential biological, socioeconomic, seasonal and spatial variables. Maternal smoking status had a significant effect on children's ARI symptoms; the effects were significantly higher (adjusted OR 1.41; 95% CI 1.02-1.96) among those born to mothers who smoked more frequently than their counterparts. Furthermore, a strong spatial pattern was evident in the prevalence of ARI symptoms, after adjusting for maternal smoking and relevant control variables. The findings underscore the importance of designing exclusive public health intervention measures to prevent tobacco smoking within households, for example through awareness campaigns highlighting the adverse effect of maternal smoking on child health.

Davidson-Arad B; Englechin-Segal D; Wozner Y; Gabriel R. Why social workers do not implement decisions to remove children at risk from home. Child Abuse and Neglect 27(6): 687-697, 2003. (45 refs.)

Objectives: The study explores why social workers do not always implement their decisions to remove children at risk from their homes. Method: Social workers in Israel filled out questionnaires for 96 children at risk at two points of time: When they began to consider whether or not to remove the child, they completed questionnaires tapping their own, the parents', and the children's features. Six months later, they reported their decision, whether or not they had carried it out, and if not, why not. Results: Some 21% of the workers' decisions were not implemented, almost all of them decisions to remove. The main reasons given were the objections of the parents and/or the child. Decisions were implemented for all the children whose mothers were alcohol or drug addicts. Implementation was lower for older children, children who were uncooperative with the social worker, and for children whose parents were uncooperative. It was also lower among experienced workers than novices. Conclusions: Further study is required to examine the generalizability of these findings to other countries, to understand better the reasons for the non-implementation, and to follow-up on the consequences of the non-implementation.

De La Rosa M; Dillon FR; Rojas P; Schwartz SJ; Duan R. Latina mother-daughter dyads: Relations between attachment and sexual behavior under the influence of alcohol or drugs. Archives of Sexual Behavior 39(6): 1305-1319, 2010. (61 refs.)

Associations among mother-daughter attachment, mother and daughter substance abuse, and daughter's sexual behavior under the influence of drugs and alcohol were investigated among 158 adult U.S. Latina daughters. Latina daughters were sampled from four mother-daughter dyad types: substance abusing mother and daughter, substance abusing mother only, substance abusing daughter only, and non-substance-abusing mother and daughter. Substance abusing daughters with substance abusing mothers, and daughters who were less strongly attached to their mothers, reported more sex under the influence of drugs. Age, marital status, substance abuse, and mother's substance abuse all influenced the daughter's sex under the influence of alcohol. An unexpected positive association between attachment and sex under the influence of alcohol was found for daughters who were more closely attached to a substance abusing mother. Implications for future research, and HIV/AIDS and drug prevention and treatment programs for Latinas are discussed.

Donohue B. Coexisting child neglect and drug abuse in young mothers: Specific recommendations for treatment based on a review of the outcome literature. (review). Behavior Modification 28(2): 206-233, 2004. (106 refs.)

Although perpetrators of child neglect often abuse illicit substances, treatment outcome evaluations in drug-abusing young mothers who have been found to neglect their children are conspicuously absent. Problem-solving interventions and family-based therapies that include skill acquisition components have demonstrated effectiveness in substance-abusing adolescents and child-neglecting mothers. The purpose of this article is (a) to review studies that have examined the relationship of drug abuse and child neglect, (b) to review clinical treatments that appear to be effective in both perpetrators of child neglect and drug-abusing adolescents, and (c) to integrate empirically validated drug abuse and child neglect interventions for use in adolescent mothers who have been found to abuse drugs and neglect their children.

Dunlap E; Johnson BD; Sanabria H; Sturzenhofecker G. Mothers and daughters: The intergenerational reproduction of violence and drug use in home and street life. Journal of Ethnicity in Substance Abuse 3(2): 1-23, 2004

In many inner-city households, children are simultaneously exposed to substance use, violence, and sexual exploitation. Sadly, these youths often seek solace and escape in the inner-city street subculture, only to find the same problems there. As young adults, these persons typically reproduce the household norms and the street subculture they experienced in their own childhoods. Researchers illustrate the processes behind these interconnected phenomena based on detailed ethnographic accounts of two generations of females' experiences from two separate households.

Elkins IJ; McGue M; Malone S; Iacono WG. The effect of parental alcohol and drug disorders on adolescent personality. American Journal of Psychiatry 161(4): 670-676, 2004. (36 refs.)

Objective: The relationship of parental alcohol or drug diagnosis to offspring personality was examined in a population-based sample of 17-year-old twins (568 girls and 479 boys) participating in the Minnesota Twin Family Study. Whether offspring personality characteristics 1) are specific to the type of substance use disorder in parents (alcohol versus drug) and 2) are found in high-risk offspring without substance use disorders as well as in offspring with substance use disorders was investigated. Method: Personality was assessed with the Multidimensional Personality Questionnaire; substance use disorders were assessed in person through diagnostic interviews. Results: In both male and female offspring, parental history of alcohol dependence was associated with greater negative emotionality, aggression, stress reaction, and alienation but lower well-being; parental history of drug disorders was associated with lower constraint, control, harm avoidance, and traditionalism but higher social potency. Excluding offspring with a substance use disorder had virtually no effect on the statistical significance of these findings. Conclusions: In contrast to findings in some adult samples, personality characteristics associated with a family history of substance use disorders are found even in adolescent offspring who have not yet developed these disorders themselves, suggesting that personality might be one indicator of familial risk for substance use disorders during this developmental stage. Personality profiles of offspring of parents with substance use disorders also show some diagnostic specificity, with constraint associated with parental drug abuse and negative emotionality with parental alcoholism.

Fajemirokun-Odudeyi O; Lindow SW. Obstetric implications of cocaine use in pregnancy: A literature review. (review). European Journal of Obstetrics, Gynecology and Reproductive Biology 112(1): 2-8, 2004. (56 refs.)

Prenatal cocaine use is a serious problem in our society today. There is an increase in the incidence of cocaine use in pregnancy, which is a direct reflection of increase in use in the general population. Cocaine use in pregnancy is associated with many ill effects to the mother and her baby. Extra efforts should be directed at identify women who are using cocaine in pregnancy and give them the necessary education, support and encouragement to enables them make an informed positive choice during this crucial phase in their reproductive life. This review covers: literature search strategy, historic background of cocaine use, epidemiology of cocaine use in pregnancy, forms of cocaine, pharmacokinetics of cocaine, metabolism of cocaine in pregnancy, pharmacological effects of cocaine, cocaine use and addiction, Notable characteristics of cocaine users in pregnancy, polydrug use, and the impact on prenatal care, weight gain in pregnancy, sexually transmitted disease, obstetric complications of cocaine use during pregnancy, placental abruption, preterm labour and preterm delivery, spontaneous abortion, congenital malformation, intra-uterine growth restriction (IUGR), abnormal CTG tracing, neonatal abstinence syndrome, neurodevelopmental disorders, and Implications to clinical obstetrics.

Fortune S; Seymour F; Lambie I. Suicide behaviour in a clinical sample of children and adolescents in New Zealand. New Zealand Journal of Psychology 34(3): 164-170, 2005. (38 refs.)

Treating young people at high risk for suicide has been identified as a priority area for development in mental health services. This study aimed to establish the prevalence of suicide ideation and suicidal behaviour in a child and adolescent mental health service and examine if children and adolescents with deliberate self-harm (DSH) were different from those who had not engaged in DSH in terms of individual and family risk factors. A file audit was conducted of 100 clients in a South Auckland service. Just under half of the clients (48%, N = 48) had engaged in DSH at the time of initial assessment, a further 16% (N = 16) had expressed suicide ideation without DSH. Children and adolescents who had engaged in DSH and/or had suicide ideation were older, had more maternal substance abuse, more family history of offending, were more likely to have been sexually abused, used more substances themselves, and were more likely to have previous episodes of DSH.

Fossum B; Arborelius E; Bremberg S. Evaluation of a counseling method for the prevention of child exposure to tobacco smoke: An example of client-centered communication. Preventive Medicine 38(3): 295-301, 2004. (43 refs.)

Background: Environmental tobacco smoke (ETS) is an important risk factor. The aim of this study is to evaluate effects of the counseling method "Smoke-free children" that focuses on protection of infants. Method: The counseling method, "Smoke-free children", has been developed and implemented at Swedish child health centers. The counseling method's point of departure is based upon a client-centered approach. Saliva cotinine samples from the mothers were collected when the child was 1 - 4 weeks and 3 months of age. Interviews regarding mothers' smoking habits and self-reported maternal smoking were also carried out. Results: Forty-one mothers participated in the study, 26 in the intervention group and 15 in the control group. Cotinine was collected from 22 subjects in the intervention and 8 in the control group. Before the intervention, the mean cotinine level was 185 ng/mL in the intervention group and 245 ng/mL in the control group. After the intervention, cotinine levels were reduced in the intervention group (165 ng/mL) and increased in the control group (346 ng/mL). Yet, after the intervention, the mothers themselves reported more smoking in the intervention group than in the control group. Only weak correlations were found between self-reported smoking and cotinine. Conclusions: The statistical analysis supports the view that a client-centered intervention, aimed at increasing self-efficacy, exerts a positive effect on maternal smoking in the prevention of infant exposure to ETS, when applied in a routine clinical setting.

Gilchrist G; Taylor A. Drug-using mothers: Factors associated with retaining care of their children. Drug and Alcohol Review 28(2): 175-185, 2009. (51 refs.)

Introduction and Aims. Research suggests that upwards of 50% of drug users do not live with their children, yet little is known about these children's living arrangements or the variables associated with mothers retaining care of their children. Design and Methods. This cross-sectional study examined the number of pregnancies and children born to female drug users receiving and not receiving treatment, the living arrangements of their children and the variables associated with not living with their children. Results. Data on 185 mothers from a study on psychiatric morbidity among drug users in Glasgow, Scotland were analysed. Participants had given birth to 327 children, 44% (132/297) of children were living with their mother; 26% (78/297) were being cared for by a family member and 20% (59/297) were in local authority care or had been adopted. 49% (87/179) of participants did not live with any of their children. Stepwise multiple forward logistic regression found that current depressive symptoms [odds ratios (OR) 3.90, 95% confidence intervals (CI) 1.78-8.55], lifetime involvement in prostitution (OR 3.12, 95% CI 1.41-6.93), lifetime history of homeless (OR 2.96, 95% CI 1.13-6.39), living with a drug user (OR 2.71, 95% CI 1.30-5.65) and ever being incarcerated (OR 2.47, 95% CI 1.17-5.21) were associated with participants not living with any of their children versus living with at least one of their children. Discussion and Conclusions. Access to drug treatment, mental health treatment and parent craft education should be enhanced for female drug users to assist them retain care of their children where possible.

Gilchrist G; Taylor A. Drug-using mothers: Factors associated with retaining care of their children. Drug and Alcohol Review 28(2): 175-185, 2009. (51 refs.)

Gillmore MR; Gilchrist L; Lee J; Oxford ML. Women who gave birth as unmarried adolescents: Trends in substance use from adolescence to adulthood. Journal of Adolescent Health 39(2): 237-243, 2006. (27 refs.)

Purpose: To determine whether adolescent childbearing mothers "mature out" of substance use as they transition into adulthood, how their substance use compares to that of typical young women of the same ages, and whether there are different patterns of substance use evident in this vulnerable population. Methods: The data come from an ongoing longitudinal study of 240 young women who were unmarried, pregnant, and under age 18 at enrollment. They have been interviewed regularly from pregnancy through 11.5 years postpartum. The data are based on self-reported substance use verified by random urinalysis for drug metabolites. Results: Substance use did not decline during the transition to adulthood nor into early adulthood. With the exception of alcohol, the prevalence of substance use was higher than that of a nationally representative sample of same-aged women. Three distinct patterns of substance use were identified: licit users (cigarettes and/or alcohol), marijuana users, and "hard" drug users. Conclusions: Clinicians should routinely assess substance use among young mothers who bore children as teenagers, and make referrals for appropriate treatment. Cigarette smoking is especially a cause for concern, given its widespread use and harmful effects for both mothers and their children. Although only a small proportion (about 5%) of young mothers used hard drugs consistently over time, this group will likely require comprehensive interventions that address multiple issues such as mental health and contextual factors to be effective. Future research should address reasons for continued substance use in this population.

Gittler J. The American drug war, maternal substance abuse and child protection: A commentary. Journal of Gender, Race & Justice 7(Spring): 237+, 2003. (117 refs.)

The war on drugs has affected one especially vulnerable disadvantaged group. This group is comprised of children who suffer harm because of maternal use of illegal drugs, which includes the use of drugs by parenting and pregnant women, both adults and adolescents. n4 The subject of maternal illegal drug use, child protection, and the drug war raises extremely complicated empirical, public policy, and legal issues. Since an in depth examination of this subject is not feasible in this short commentary, my goal is simply to provide an introduction to this subject. Part One describes the protection of children from maltreatment through the juvenile justice and child welfare systems. Part Two presents a brief summary of what is known about the effects of drug use by mothers on the parenting of children. Part Three presents a brief summary of what is known about the effects of prenatal exposure to drugs, stemming from drug use by pregnant women, on child health and development. Part Four offers a few observations about maternal illegal drug use and child protection in the context of the war on drugs. Part Five discusses the need for substance abuse prevention and treatment for parenting and pregnant women. Finally, in Part Six, I discuss the development of community-based services for these women and their children.

Goldman GD; Ryan SD. Direct and modifying influences of selected risk factors on children's pre-adoption functioning and post-adoption adjustment. Children and Youth Services Review 33(2): 291-300, 2011. (83 refs.)

Child adoption outcomes are influenced by child's behavior and parents' expectations (Haugaard & Hazan, 2003). Pre-adoption risk factors, such as prenatal alcohol, tobacco and/or other drug (ATOD) exposure, male sex, sexual abuse, and multiple out-of-home placements have been linked to increased externalizing (acting out) behaviors that are difficult to manage and are most closely associated with adoption disruption (Barth, 1991, 2001 Rosenthal & Groze, 1991; Smith & Howard, 1999). However, adoption researchers have found that positive outcomes (fewer externalizing behaviors) are possible for children who have been exposed to pre-adoption risk factors, suggesting that adoptive families provide protective environments that allow healing (Barth, 1991, 1993; Barth & Brooks, 2000). The current study sought to increase understanding of the influence of these pre-adoption risk factors on adoption outcome with attention to the influence of prenatal alcohol, tobacco, and/or other drug (ATOD) exposure. Results indicated that pre-adoption functioning was significantly influenced by prenatal ATOD exposure, but post-adoption adjustment was not. Structural equation modeling then was used to analyze both the direct and moderating influences of the identified risk factors on the relationship between the child's pre-adoption functioning and post-adoption adjustment. Negative influences of the risk factors on the child's externalizing behavior, individually and additively, in both direct effects and moderation analyses, were not found, with one exception. The only model to have a statistically significant effect was the moderation analysis containing the interaction of all four risk factors. Child development, child welfare, addiction professionals, and adoptive families will find this information to be of value in their quest to facilitate successful adoptions and growth of healthy children and families.

Graham AW; Schultz TK; Mayo-Smith MF; Ries RK; Wilford BB, eds. Principles of Addiction Medicine. Chevy Chase MD: American Society of Addiction Medicine, 2003. (Chapter refs.)

This volume is a comprehensive text on addictions. It is organized into 14 major sections, each of which has multiple chapters. There are over 200 contributors. The sections deal with the following themes: basic science and core concepts; pharmcology; diagnosis, assessment and early intervention; overview of addiction treatment; management of intoxication and withdrawal; pharmacologic interventions; behavioral interventions; 12-step programs and other recovery-oriented interventions; alcohol and drug problems in the workplace; medical disorders and complications of addiction; co-occurring addictive and psychiatric disorders; pain and addiction; and children and adolescents. There are also six appendices.

Groner J; Wadwa P; Hoshaw-Woodard S; Hayes J; Klein J; Koren G et al. Active and passive tobacco smoke exposure: A comparison of maternal and child hair cotinine levels. Nicotine & Tobacco Research 6(5): 789-795, 2004. (31 refs.)

The objective of this study was to compare tobacco smoke exposure in mothers and their healthy children less than 3 years old using hair cotinine (HC) levels as an objective long-term measure of exposure. Hair samples were obtained from mother/child pairs recruited from the Columbus Children's Hospital Primary Care Center, and were analyzed by radioimmunoassay to compare HC levels. Mothers were both self-reported smokers and nonsmokers. Contributing and confounding variables were assessed based on questionnaires completed by participants. Exclusion criteria for children were prematurity and presence of chronic cardiopulmonary disease. Hair samples and questionnaires were obtained from 104 mother/child pairs. Child and maternal HC levels were correlated for both self-reported maternal smokers (R-2 = .13, p < .013) and self-reported maternal nonsmokers (R-2 = .54, p < 001). Child HC levels were higher than maternal HC levels (1.18 ng/mg vs. .78 ng/mg, p < .001). Children of nonsmokers had higher HC levels than their mothers (.77 ng/mg vs. .35 ng/mg, p < .001), while HC levels of smokers and their children were no different (1.91 ng/mg vs. 1.92 ng/mg, p = .978). The relationship between child and maternal HC did not differ by child age, gender, or race. In conclusion, environmental tobacco smoke exposure in young children as reflected by HC is higher than expected based on prior studies of biomarkers and passive tobacco smoke exposure in adult nonsmokers.

Hayatbakhsh MR; Sadasivam S; Mamun AA; Najman JM; Williams GM; O'Callaghan MJ. Maternal smoking during and after pregnancy and lung function in early adulthood: A prospective study. Thorax 64(9): 810-814, 2009. (29 refs.)

Background and aims: There is a paucity of evidence about whether exposure to antenatal smoking impacts on offspring's lung function in early adulthood. This study aimed to examine whether (1) in utero exposure to maternal smoking is related to poorer respiratory functioning in early adulthood; (2) the impact of prenatal smoking is independent of postnatal maternal smoking; and (3) the link between prenatal smoking and a young adult's lung function is explained by the child's birth weight, smoking or history of asthma. Methods: Data were from a 21-year follow-up of mothers and their children recruited into the Mater University of Queensland Study of Pregnancy, a longitudinal prebirth cohort. The study is based on 2409 young adults (1185 males and 1224 females) who had prospective data available on respiratory function at 21 years and maternal smoking during and after pregnancy. A Spirobank G spirometer system was used to measure forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) and forced expiratory flow between 25% and 75% of FVC (FEF25-75). Results: In utero exposure to maternal smoking was associated with a reduction in FEV1 and FEF25-75 in males (regression coefficient, -0.16; 95% CI, -0.30 to -0.02), after accounting for maternal smoking after pregnancy. At least part of the effect of in utero smoking on young adults' lung function was explained by the child's birth weight and subsequent asthma. Conclusions: Adverse effects of antenatal smoking on development of airway growth may persist into early adulthood. Gender differences noted in this longitudinal cohort need to be explored further.

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.

Hien DA; Miele GM. Emotion-focused coping as a mediator of maternal cocaine abuse and antisocial behavior. Psychology of Addictive Behaviors 17(1): 49-55, 2003. (40 refs.)

A great deal of data implicate parental drug use as a potential risk factor for child abuse, however, theories for understanding the links between maternal drug use and antisocial behavior have yet to be examined empirically. This case-control study investigated correlates of adult antisocial behavior among 279 inner-city mothers in 3 comparison groups: drug abusers, (n = 112), depressed mothers (n = 73), and nonsubstance abusing controls (n = 94). Using hierarchical regression techniques and mediational analyses controlling for ethnicity, current depression, and family history of substance abuse, support was provided for an emotion-focused coping style as a link between addictive and antisocial behavior. These results highlight the importance of focusing on emotion regulation models in the prevention and treatment of violence in drug-abusing women.

Horne RSC; Franco P; Adamson TM; Groswasser J; Kahn A. Influences of maternal cigarette smoking on infant arousability. Early Human Development 79(1): 49-58, 2004. (54 refs.)

Since the reduction in the incidence of the prone sleeping position, maternal cigarette smoking has become the strongest modifiable risk factor for Sudden Infant Death Syndrome (SIDS). This risk is dose dependent. Various mechanisms have been postulated to explain the increased risk of SIDS associated with maternal smoking, among these, impairment of arousal from sleep. This paper reviews the effects of maternal smoking on infant arousability from sleep, cardiorespiratory controls and sleep architecture. Infants exposed to maternal smoking have been shown to have both decreased spontaneous and evoked arousability from sleep. Such impairment of arousal has been demonstrated to be associated with changes in control of autonomic cardiac function. Sleep architecture appears not to be altered by smoking. During arousal, heart rate, blood pressure and breathing movements increase, while gross body movements occur to avoid the stimulus. Any impairment in arousability from sleep could occur when infants are exposed to maternal cigarette smoking, and could possibly contribute to the final pathway to SIDS.

Jaakkola JJK; Gissler M. Maternal smoking in pregnancy, fetal development, and childhood asthma. American Journal of Public Health 94(1): 136-140, 2004. (19 refs.)

Objectives. We examined the relationships among maternal smoking in pregnancy, fetal development, and the risk of asthma in childhood. Methods. We conducted a population-based cohort study, where all 58841 singleton births were followed for 7 years using nationwide registries. Results. Maternal smoking increased the risk of asthma (adjusted odds ratio = 1.35; 95% confidence interval = 1.13, 1.62 for high exposure). Low birthweight and preterm delivery increased the risk of asthma at the age of 7, whereas being small for gestational age did not.Conclusions. Maternal smoking in pregnancy increases the risk of asthma during the first 7 years of life, and only a small fraction of the effect seems to be mediated through fetal growth.

James C; Klenka H; Manning D. Sudden infant death syndrome: Bed sharing with mothers who smoke. Archives of Disease in Childhood 88(2): 112-113, 2003. (10 refs.)

Aim: To examine the sleeping arrangements of sudden infant death syndrome (SIDS) cases on the Wirral. In particular to determine the prevalence of bed sharing with mothers who smoke, a known risk factor for SIDS. Methods: Retrospective study of postmortem determined cases of SIDS from 1995 to 2000 on the Wirral peninsula (population 350 000, 3500 annual births). Ambulance crew reports, case notes, health visitor reports, postmortem reports, and case discussion records were studied for each case. Results: There were 25 cases of SIDS in the postneonatal age group over the six year period. In nine cases the baby was bed sharing with the mother, of whom seven were smokers. Five of these mothers reported using alcohol or illicit drugs on the night of their infant's death. In two further cases the baby slept on a sofa with a parent. Conclusions: Bed sharing and smoking remain important risk factors for SIDS. Mothers should be advised ante-and postnatally of this combination of risk factors. Such advice should also include a recommendation not to sleep with their baby if under the influence of alcohol or illicit drugs, and never to sleep on a sofa with their baby. All "Child Health Record" books given to parents on the Wirral now include this advice. "Reduce the Risk" advice leaflets given to parents pre- and postnatally also now carry the recommendation, and health visitors and midwives have been educated with respect to these additions.

Jones L. The prevalence and characteristics of substance abusers in a child protective service sample. Journal of Social Work Practice in the Addictions 4(2): 33-50, 2004. (31 refs.)

The purpose of this research was to identify characteristics of substance abusers in a child protective services caseload. The random sample of 443 children was drawn from an urban county from all children with a substantiated abuse case. Files of children were reviewed to derive data. Sixty-eight percent of the children had mothers who abused alcohol or drugs, and 37 percent of them had mothers who abused both. Substance abuse, service contacts, public assistance, homelessness, and household conditions in the service plan were all associated with child removal from the home. These findings suggest that the risks associated with substance abuse are not necessarily ameliorated with social work intervention.

Karmaus W; Dobai AL; Ogbuanu I; Arshard SH; Matthews S; Ewart S. Long-term effects of breastfeeding, maternal smoking during pregnancy, and recurrent lower respiratory tract infections on asthma in children. Journal of Asthma 45(8): 688-695, 2008. (62 refs.)

The effect of breastfeeding on asthma is controversial, which may be explained by related and interacting early childhood risk factors. We assessed the joint effects of a risk-triad consisting of maternal smoking during pregnancy, breastfeeding for less than 3 months, and recurrent lower respiratory tract infections (RLRTI) on physician-diagnosed childhood asthma. The association was assessed in the Isle of Wight birth cohort study (1989-1990) using a repeated measurement approach with data collection at birth, and at ages 1, 2, 4, and 10 years. The population consists of 1,456 children recruited between January 1989 and February 1990. Prenatal smoking, breastfeeding for less than 3 months, and recurrent lower respiratory infections (RLRTI) were combined into eight risk-triads. Relative risks (RR) and 95% confidence intervals were estimated with a log-linear model. The risk-triad involving RLRTI in infancy, maternal smoking during pregnancy, and breastfeeding for less than 3 months showed a stronger association with asthma at ages 4 and 10 compared to other risk-triads (RR of 5.79 for any asthma at ages 1, 2, 4, and 10; and 3.1 for asthma at ages 4 and 10). Of the three individual risk factors, RLRTI appeared to be the major driver of the combined effects in the risk-triads. The effect of RLRTI on asthma was modified by breastfeeding. Breastfeeding for >= 3 months also attenuated the effect of prenatal smoking on asthma in children without RLRTI. A high proportion of asthma cases in childhood can be prevented by promoting breastfeeding, by preventing smoking during pregnancy, and by avoidance of recurrent lower respiratory tract infections in early childhood.

Kerwin ME. Collaboration between child welfare and substance-abuse fields: Combined treatment programs for mothers. (review). Journal of Pediatric Psychology 30(7): 581-597, 2005. (125 refs.)

Objective: To review collaboration between child welfare and drug-abuse fields in providing treatment to mothers who abuse drugs and maltreat their children. Methods: Literature review of studies examining effects of maternal drug abuse on parenting skills and outcomes of interventions for both maternal drug abuse and parenting skills. Results: Parenting skills differ between mothers who do and do not abuse drugs, but these studies are primarily limited to mothers of infants and preschoolers. The evidence base for interventions to address both substance use and parenting in these mothers is growing, but more well-controlled studies are needed. Opportunities for improved collaboration between fields are presented. Conclusion: Progress has been made toward collaboration to address drug abuse and parenting skills of mothers who abuse drugs, but more integrated strategies are needed, especially for mothers who use drugs and maltreat their children.

Kumpfer KL; Fowler MA. Parenting skills and family support programs for drug-abusing mothers. Seminars in Fetal & Neonatal Medicine 12(2): 134-142, 2007. (58 refs.)

Children born to drug-using mothers can suffer from fetal alcohol or drug syndrome (FAS/FDS) or fetal alcohol or drug effect (FAE/FDE). Such children have a greater likelihood of developing acute or chronic physical, cognitive and behavioral problems. In-utero exposure to tobacco, alcohol or drugs impact on the developing fetus and, after birth, the family environment and family system exert effects on the infants and children of substance-abusing parents. Evidence-based prevention and maternal drug treatment programs focus on enhancing parental childcaring abilities, supporting parent-child attachment and encouraging family support systems to improve children's health and cognitive outcomes. FAS/FDS prevention programs, as well as selective and indicated prenatal and postnatal interventions, can improve the support given both to mother and to child, and evidence-based, in-home parenting and family-skills-training approaches are particularly useful.

Kunins HV; Bellin E; Chazotte C; Du E; Arnsten JH. The effect of race on provider decisions to test for illicit drug use in the peripartum setting. Journal of Women's Health 16(2): 245-255, 2007. (33 refs.)

Background: Testing for illicit drugs may expose women who test positive to severe legal and social consequences. It is unknown whether racial disparities in drug testing practices underlie observed disparities in legal and social consequences of positive tests. Methods: Using administrative hospital and birth certificate data, we analyzed factors associated with both receipt and results of illicit drug testing among women with live births during 2002 - 2003. We assessed the independent association of race and other sociodemographic factors with both receipt of a drug test by the mother or her newborn infant and positive maternal or neonatal toxicology results, after controlling for obstetrical conditions and birth outcomes associated with maternal substance abuse. Results: Of the 8487 women with live births, 244 mother-newborn pairs (3%) were tested for illicit drug use. Black women and their newborns were 1.5 times more likely to be tested for illicit drugs as nonblack women in multivariable analysis. However, race was not independently associated with a positive result. Conclusions: We identified racial differences in rates of testing for illicit drug use between black and nonblack women. We found equivalent positivity rates among tested black and nonblack women. The prevalence of drug use among untested women is unknown, however, so although tested women had equivalent rates of substance use detected, whether black and nonblack substance users are equally likely to be identified in the course of peripartum care remains uncertain.

Kyu HH; Georgiades K; Boyle MH. Maternal smoking, biofuel smoke exposure and child height-for-age in seven developing countries. International Journal of Epidemiology 38(5): 1342-1350, 2009. (36 refs.)

Background: Children are at high risk of exposure to environmental tobacco smoke and biofuel smoke at home in developing countries. This study examines whether exposure to cigarette and biofuel smoke is associated with height-for-age of children (0-59 months) in seven developing countries. Methods: The data are from Demographic and Health Surveys conducted in Cambodia, Dominican Republic, Haiti, Jordan, Moldova, Namibia and Nepal between 2005 and 2007. The respondents were women (15-49 years) and their children in seven countries (n = 28 439), and men (15-59 years) from four countries. The outcome is a physical measurement of child height-for-age in standard deviation units. Results Multilevel regression analysis showed that the country of residence modified the association between maternal smoking and child height-for-age. Exposure to maternal smoking was associated negatively with child height-for-age in Cambodia, Namibia and Nepal, whereas it was not in other countries. Multilevel regression analysis revealed that biofuel smoke exposure was associated with a decrease in child height-for-age [b = -0.13, 95% confidence interval (CI) = -0.19 to -0.07, P < 0.001]. No interaction was found between country of residence and biofuel smoke exposure. Multinomial logistic regression results showed that biofuel smoke exposure was associated with both stunting [odds ratio (OR) = 1.25, 95% CI = 1.08-1.44, P = 0.002) and severe stunting (OR = 1.27, 95% CI = 1.02-1.59, P = 0.04), after controlling for covariates. Conclusion: The findings suggest that exposure to maternal smoking and biofuel smoke may contribute to growth deficiencies in young children. Programmes are needed to ensure smoke-free home environments for children.

Linnet KM; Dalsgaard S; Obel C; Wisborg K; Henriksen TB; Rodriguez A et al. Maternal lifestyle factors in pregnancy risk of attention deficit hyperactivity disorder and associated behaviors: Review of the current evidence. (review). American Journal of Psychiatry 160(6): 1028-1040, 2003. (103 refs.)

Objective: The purpose of this review was to examine the literature assessing the relationship between prenatal exposure to nicotine, alcohol, caffeine, and psychosocial stress during pregnancy to the risk of developing behavioral problems related to attention deficit hyperactivity disorder (ADHD) in childhood. Method: PubMed, MEDLINE, EMBASE, and PsycINFO were searched systematically. Studies using DSM diagnostic criteria and other validated diagnostic or screening instruments for ADHD and those examining ADHD symptoms were included. A narrative approach was used because the studies differed too much in methods and data sources to permit a quantitative meta-analysis. Results: Twenty-four studies on nicotine (tobacco smoking), nine on alcohol, one on caffeine, and five on psychosocial stress were identified. All were published between 1973 and 2002. in spite of inconsistencies, the studies on nicotine indicated a greater risk of ADHD-related disorders among children whose mothers smoked during pregnancy. Contradictory findings were reported in the alcohol studies, and no conclusion could be reached on the basis of the caffeine study. Results from studies on psychological stress during pregnancy were inconsistent but indicated a possible modest contribution to ADHD symptoms in the offspring. Many studies suffered from methodological shortcomings, such as recall bias, crude or inaccurate exposure assessments, low statistical power, and lack of or insufficient control of confounders. A general lack of information on familial psychopathology also limited the interpretations. Conclusions: Exposure to tobacco smoke in utero is suspected to be associated with ADHD and ADHD symptoms in children. Other maternal lifestyle factors during pregnancy may also be associated with these disorders. Further studies are needed to reach conclusions.

Lussier K; Laventure M; Bertrand K. Parenting and maternal substance addiction: Factors affecting utilization of child protective services. Substance Use & Misuse 45(10): 1572-1588, 2010. (58 refs.)

The purpose of this study is to identify which personal, familial, environmental, and social factors are associated with the utilization of child protection services, including parental support programs, by mothers who misuse illicit substances. Participants are 56 mothers with substance use and addiction-related problems, of whom 32 were receiving, voluntarily or otherwise, child protection services while 24 mothers had psychotropic drug use-related problems but were receiving no psychosocial services. Data were collected in the province of Quebec, Canada, between August 1998 and August 1999. Results indicate that mothers who receive services are younger, have fewer interpersonal resources, live in lower socioeconomic conditions, and have greater family dysfunction (less parental supervision and more inconsistent discipline) than mothers who do not receive services from child protection agencies. However, there are no significant differences between groups with regards to maternal childhood trauma, psychological distress, antisocial behavior and the quality of the parent-child bond. The results of this study suggest that although both groups misuse drugs and have personal difficulties, some mothers will not need support from social services to take care of their children. Implications of these findings for prevention are discussed. The study's limitations are noted.

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.

McComish JF; Greenberg R; Ager J; Essenmacher L; Orgain LS; Bacik WJ. Family-focused substance abuse treatment: A program evaluation. Journal of Psychoactive Drugs 35(3): 321-331, 2003. (54 refs.)

Until recently, few programs were available for children whose mothers are in recovery. A refinement of the gender-specific model of substance abuse treatment, the "family-focused" approach, has placed increased emphasis on the needs of children and other family members. However, because these programs are relatively new, little is known about the effectiveness of this type of treatment for either the mother or her children. This article presents findings from a three-year evaluation of a family-focused residential treatment program for women and their children. Longitudinal assessment of the mothers indicated that their psychosocial status and parenting attitudes improved over time. Additionally, the mothers remained in treatment longer. At intake, as a group, the children who were birth to three years of age did not exhibit developmental delay. However, developmental concerns were identified for some children in the areas of motor and/or language development. The results reported here provide beginning evidence that family-focused treatment improves retention, psychosocial functioning, and parenting attitudes. of pregnant and parenting women. It also provides a mechanism for early identification and intervention for children.

Mizutani T; Suzuki K; Kondo N; Yamagata Z. Association of maternal lifestyles including smoking during pregnancy with childhood obesity. Obesity 15(12): 3133-3139, 2007. (32 refs.)

Objective: To examine the extent to which maternal smoking during early pregnancy and other prepregnancy lifestyle habits are associated with obesity and overweight in 5-year-old Japanese children. Research Method and Procedures: We studied 1417 mother-child pairs enrolled in Project Enzan-a prospective cohort study. The dependent variables, childhood overweight and obesity, were defined with an international cut-off value. Maternal smoking during early pregnancy and other prepregnancy lifestyle habits were used as independent variables. Results: Maternal smoking habits were associated with overweight in the 5-year-old children [adjusted odds ratio (OR): 2.15; 95% confidence interval (CI): 1.12 to 4.11]. Maternal sleep duration of >= 8 h/d negatively affected childhood overweight (adjusted OR: 0.71; 95 % CI: 0.49 to 1.04). Children whose mothers skipped breakfast were likely to become overweight (adjusted OR: 1.78; 95% CI: 1.14 to 2.77). The results of childhood obesity analysis were similar to those of childhood overweight analysis. Discussion: The results of this study suggest that there are effects of smoking during early pregnancy and other maternal lifestyle habits on the onset of childhood obesity in Japan. Therefore, interventions in maternal lifestyle habits are required to prevent childhood obesity, and these interventions should be initiated before pregnancy.

Moller M; Karaskov T; Koren G. Opioid detection in maternal and neonatal hair and meconium: Characterization of an at-risk population and implications to fetal toxicology. Therapeutic Drug Monitoring 32(3): 318-323, 2010. (46 refs.)

Identification of maternal opioid abuse in pregnancy is often difficult to ascertain in the absence of a reliable self-report. We aimed to characterize an at-risk neonatal population for opioid exposures as well as other drugs of abuse and alcohol. From June 2007 to January 2009, 563 neonatal hair and 1318 meconium specimens were assessed for opioids and were positive in 11.4% and 17.0%, respectively. Neonates testing positive for opioids in hair or meconium analysis were also more likely to test positive for other licit and illicit substances (odds ratiohair, 1.75; 95% confidence interval, 1.03-2.97; odds ratiomeconium, 1.61; 95% confidence interval, 1.16-2.22). Specifically, a positive neonatal hair test for opioids also predicted a positive result for oxycodone. In addition, a positive meconium test result for opioids was associated with positive results for cocaine, oxycodone, methadone, benzodiazepines, and fatty acid ethyl esters (alcohol). Finally, there was a significant correlation between maternal and neonatal hair test results for opioids (Spearman rank rho = 0.657, P = 0.03). Understanding the addiction profiles of these women may lead to better clinical and social management and may largely benefit an at-risk population.

Mowbray CT; Bybee D; Oyserman D; Allen-Meares P; MacFarlane P; Hart-Johnson T. Diversity of outcomes among adolescent children of mothers with mental illness. Journal of Emotional and Behavioral Disorders 12(4): 206-221, 2004. (71 refs.)

Children of parents with mental illness are an at-risk population according to research on psychiatric outcomes using White, middle-class samples of depressed parents and infants and preschool children. The current study expands this evidence by exploring within-group heterogeneity across psychosocial outcomes, in a racially diverse, low-income sample of adolescent children of mothers with mental illness (N = 166). Using measures of mental health, academics, behavior problems, and social relationships-and employing cluster analysis methodology-we identified five meaningful subgroups of these youth. Two of five identified clusters evidenced mental health symptoms (15%) or possible behavioral problems (27%). The largest cluster (30%) appeared quite socially and academically competent; another cluster (22%) presented as average in their functioning but adult-oriented. A final small cluster (4.8%) was distinguished by members' social isolation. Cluster membership related to maternal substance abuse history, father's relationship to youth, and social support available to mothers. Implications for planning preventive interventions are discussed.

Mucci LA; Granath F; Cnattingiusi S. Maternal smoking and childhood leukemia and lymphoma risk among 1,440,542 Swedish children. Cancer Epidemiology, Biomarkers & Prevention 13(9): 1528-1533, 2004. (35 refs.)

Possible in utero effects of maternal smoking on hemopoietic cancer in the offspring have been addressed previously, although the results are inconclusive. In this investigation, we take advantage of population-based registers in Sweden to examine maternal smoking during pregnancy and childhood risk of leukemia and lymphoma. Prospective data were available from 1,440,542 Swedish children born between 1983 and 1997. Proportional hazard models were used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI) controlling for potential confounders. In the study base, 750 hemopoietic cancers occurred across 11 million person-years. Incidence rates per 100,000 person-years were 4.7 for acute lymphocytic leukemia (ALL), 0.45 for acute myelogenous leukemia, and 0.76 for non-Hodgkin's lymphoma. Maternal smoking was associated with a lower risk of ALL (HR, 0.73; 95% CI, 0.58-0.91). On the other hand, there was a higher risk of acute myelogenous leukemia (HR, 1.41; 95% CI, 0.74-2.67) particularly among heavy (greater than or equal to10 cigarettes per day) smokers (HR, 2.28; 95% CI, 1.05-4.94). The data also suggested a small excess risk of non-Hodgkin's lymphoma. (HR, 1.25; 95% CI, 0.76-2.04). Evidence from this large cohort suggests that maternal smoking affects the risk of childhood leukemia and lymphoma in the offspring. The Swedish registries provide unique opportunities to examine this research question, with a design inherently free of selection and recall biases. The apparent protective effect with ALL needs to be explored further and in no way supports maternal smoking as beneficial, given its adverse association with common pregnancy outcomes.

Newcomb MD; LockeTF. Childhood adversity and poor mothering: Consequences of polydrug abuse use as a moderator. (rapid communication). Addictive Behaviors 30(5): 1061-1064, 2005. (7 refs.)

Drug abuse consequences have been typically examined as a direct or main effect on various later outcomes. Drug abuse may also serve as a consequence that alters (moderates) critical developmental trajectories. This study examined the relationship between childhood adversity factors (parent alcohol and drug-related problems, childhood maltreatment) and future parenting practices through an analysis of the moderating effects of polydrug problems. Data from a community sample of mothers was divided into two groups based on the median split level of polydrug problems (alcohol, marijuana, cocaine) that they reported (low, N=123; high, N=114). Confirmatory factor models (CFAs) were developed for the two groups and compared with multiple group analyses (MGAs). Results revealed that mothers who had parents with alcohol or drug-related problems were more likely to become poor parents, if they themselves used drugs and had problems related to drug use.

O'Callaghan FV; O'Callaghan M; Najman JM; Williams GM; Bor W; Alati R. Prediction of adolescent smoking from family and social risk factors at 5 years, and maternal smoking in pregnancy and at 5 and 14 years. Addiction 101(2): 282-290, 2006. (46 refs.)

Aims: This study examines associations between maternal smoking and family, social or child risk factors when the child is aged 5 and adolescent smoking. The influence of mothers who smoke in pregnancy or continue to smoke at 14 years was also examined. Design The Mater-University of Queensland Study of Pregnancy is a prospective cohort study. Participants Participants included 8556 women enrolled between 1981 and 1984 at their first antenatal visit. Completed questionnaires were obtained for 7223 offspring, comprising the study birth cohort. Of the 7223 eligible children a total of 4541 had information on both maternal smoking when the child was aged 5 years and adolescent smoking at 14 years. Measurements Measures included maternal smoking during pregnancy and when the child was aged 5 and 14 years, child smoking at 14 years, maternal alcohol use, child behaviour problems and social and demographic variables. Findings Adolescent smoking was predicted by a risk score at 5 years involving maternal smoking and alcohol use, non-married status, having a partner who had ever been arrested, having four or more children in the household, and child aggression at 5 years. Continued maternal smoking from 5 to 14 years was associated strongly with adolescent smoking. There was also evidence that smoking in late pregnancy may exert an independent effect on adolescent smoking. Conclusions: The results suggest the possibility of a direct effect of prenatal smoking on adolescent smoking and highlight a set of environmental risk factors in the development of adolescent smoking. These risk factors may be used as early warning signs that intervention may be needed, and given the similarities with risk factors for other adverse childhood outcomes, the benefits of early intervention may extend beyond smoking to other problem behaviours. The possibility of being able to predict other disorders, because of these associations, also warrants further investigation.

Ondersma SJ; Delaney-Black V; Covington CY; Nordstrom B; Sokol RJ. The association between caregiver substance abuse and self-reported violence exposure among young urban children. Journal of Traumatic Stress 19(1): 107-118, 2006. (41 refs.)

This study examined the relative importance of caregiver substance abuse as a correlate of child-reported exposure to violence. A total of 407 female African-American primary caregivers and their children age 6 to 7 were evaluated. The association between child report of violence and exposure to substance abuse by others (both within and outside the home) was considered after controlling for variance accounted for by child characteristics, caregiver characteristics, home environment, and neighborhood environment (including neighborhood crime). Caregiver alcohol abuse, children witnessing of drug use in the home, and children witnessing of drug deals all explained significant additional variance in violence exposure. These findings suggest that for early elementary-age children, meaningful prevention of violence exposure may be possible via addressing their exposure to substance abuse in their home and community.

Ornoy A. The impact of intrauterine exposure versus postnatal environment in neurodevelopmental toxicity: Long-term neurobehavioral studies in children at risk for developmental disorders. Toxicology Letters 140(Special Issue): 171-181, 2003. (38 refs.)

Various investigators have shown that enriched environment may positively affect the early brain development of experimental animals. Environment was also shown to positively affect the development of young children born to mothers of low socio-economic class (low SES). It is unknown, however, to what extent can an enriched environment improve the developmental outcome of children born with slight brain damage. We studied the development of preschool and early school age children born to heroin dependent parents raised at home or adopted in comparison to children suffering only from environmental deprivation (low parental SES) and to controls. They were examined by several professionals, using standard, age appropriate, neurological and psychological tests. Similar evaluations were performed on a group of early school age children born to mothers with pregestational or with gestational diabetes and on a group of children born prematurely, with a birth weight of less than 1500 g using various developmental tests. Young children born to heroin dependent mothers and fathers raised at home and children of low SES had, in comparison to controls, lower intellectual skills and a higher rate of inattention. This persisted at school age, too. Children born to heroin dependent mothers adopted at a young age and hence being raised in a good environment had normal intellectual function but a high rate of inattention and behavioral problems. We also examined the school age children for possible presence of ADHD and found a high rate of ADHD among all children born to heroin dependent parents including those adopted, as well as in the children with low parental SES. Similar findings regarding the strong positive influence of an enriched environment were observed in children born to diabetic mothers, where the intellectual abilities of the children were directly related with parental education. The cognitive abilities of the children born prematurely were also strongly associated with parental education and not with the degree of perinatal complications. In conclusion, in all groups of children at high risk for developmental problems was found that the environment has a strong influence on their intellectual abilities but not on motor skills or attention span. A good environment (high parental SES) may significantly improve the outcome.

Parsiow PM; Cranage SM; Adamson TM; Harding R; Horne RSC. Arousal and ventilatory responses to hypoxia in sleeping infants: Effects of maternal smoking. Respiratory Physiology and Neurobiology 140(1): 77-87, 2004. (31 refs.)

Our aim was to determine whether maternal cigarette smoking affects arousal and ventilatory responses to hypoxia in infants. Infants born to non-smoking (NS, n = 15) and smoking mothers (SM, n = 9) were studied at 2-5 weeks, 2-3 and 5-6 months. Ventilatory responses to 15% O-2 were determined preceding, arousal. At each age and in both groups, infants aroused more frequently and earlier to hypoxia in active sleep (AS) than quiet sleep (QS). Arousal latency was longer in SM infants (in QS) at 5-6 months (P < 0.05). Baseline respiratory parameters were not different between groups, except that, at 2-3 months, SM infants had higher Sp(O2), during AS than NS infants. Maternal smoking did not affect ventilatory responses preceding hypoxia-induced arousal in either sleep-state at any age. We conclude that mild hypoxia stimulates ventilation and arousal in infants up to 6 months and that arousability is depressed in SM infants at 5-6 months; however, ventilatory responses preceding arousal are not adversely affected by smoking.

Reichman NE; Teitler JO. Effects of psychosocial risk factors and prenatal interventions on birth weight: Evidence from New Jersey's HealthStart program. Perspectives on Sexual and Reproductive Health 35(3): 130-137, 2003. (30 refs.)

CONTEXT: Many states developed and implemented multifaceted Medicaid prenatal care programs in the late 1980s in response to expansions in Medicaid eligibility. Although these new programs were based on the presumed relationships between psychosocial risk factors, early prenatal care, prenatal interventions and birth outcomes, research has not verified all of these linkages. METHODS., Data were collected on 90,117 women who took part in New Jersey's comprehensive prenatal care program, Health Start, between 1988 and 1996. The impact of psychosocial risk factors and prenatal interventions on mean birth weight and the odds of low birth weight (less than 2,500 g) was assessed using ordinary least-squares regression and logistic regression, respectively. RESULTS: After controls were introduced for social and demographic, psychosocial and behavioral factors, as well as the woman's county of residence and the year of her baby's birth, smoking, drinking and using hard drugs (but not marijuana) during pregnancy were independently associated with reductions in mean birth weight (of 123 g, 29 g and 137 g, respectively) and with increases in the odds of low birth weight (odds ratios, 1.4, 1.2 and 1.7, respectively). However, according to the fully adjusted model, which also controlled for medical risk factors and prenatal services, the interventions designed to reduce those behaviors had no favorable effects on birth weight. In contrast, the receipt of services in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) was associated with an increase in mean birth weight of 22 g (and of 48 g among inadequately nourished women only), and with a reduction in the risk of low birth weight (odds ratio, 0.87).CONCLUSION. Referrals to WIC services should be a key feature of prenatal care programs for poor women.

Richardson HL; Walker AM; Horne RSC. Maternal smoking impairs arousal patterns in sleeping infants. Sleep 32(4): 515-521, 2009. (39 refs.)

Objective: Impairment of the arousal process from sleep is thought to be involved in the pathogenesis of sudden infant death syndrome (SIDS). We hypothesized that a greater propensity for cortical arousal in the prone position may, in a normal infant, be a protective mechanism to promote complete arousal in a vulnerable sleeping position, a protection that is absent in SIDS victims. We aimed to examine the arousal process in a group of infants exposed to maternal smoking, who are thus at higher risk for SIDS. Design: Twelve healthy, full-term infants born to smoking mothers were studied using daytime polysomnography at 2 to 4 weeks, 2 to 3 months and 5 to 6 months postnatal age. Data were compared with 13 healthy infants born to nonsmoking mothers. Arousal was induced by pulsatile air-jet stimulation to the nostrils during active and quiet sleep, in both supine and prone positions. For each stimulus, physiologic and electroencephalogram changes were visually assessed and arousal responses were classified as sub-cortical activation or cortical arousal. Results: In smoke-exposed infants, the progression from sub-cortical activation to cortical arousal was depressed at 2 to 4 weeks and 5 to 6 months. There was no effect of maternal smoking observed at 2 to 3 months; however, a significant dose-dependent relationship between cortical activation proportions and urinary cotinine levels was present in both supine and prone positions. Conclusion: We have shown that maternal smoking is associated with impaired arousal processes to trigeminal stimulation that may increase the risk for SIDS. This further highlights the importance of public education of the risks of maternal smoking.

Richardson HL; Walker AM; Horne RSC. Maternal smoking impairs arousal patterns in sleeping infants. Sleep 32(4): 515-521, 2009. (39 refs.)

Robinson M; Oddy WH; Li JH; Kendall GE; de Klerk NH; Silburn SR. Pre- and postnatal influences on preschool mental health: A large-scale cohort study. Journal of Child Psychology and Psychiatry 49(10): 1118-1128, 2008. (50 refs.)

Background: Methodological challenges such as confounding have made the study of the early determinants of mental health morbidity problematic. This study aims to address these challenges in investigating antenatal, perinatal and postnatal risk factors for the development of mental health problems in pre-school children in a cohort of Western Australian children. Methods: The Raine Study is a prospective cohort study of 2,868 live born children involving 2,979 pregnant women recruited at 18 weeks gestation. Children were followed up at age two and five years. The Child Behaviour Checklist (CBCL) was used to measure child mental health with clinical cut-points, including internalising (withdrawn/depressed) and externalising (aggressive/destructive) behaviours (n = 1707). Results: Multinomial logistic regression analysis showed that the significant risk factors for behaviour problems at age two were the maternal experience of multiple stress events in pregnancy (OR = 1.20, 95% CI = 1.06, 1.37), smoking during pregnancy (OR = 1.30, 95% CI = 1.06, 1.59) and maternal ethnicity (OR = 3.34, 95% CI = 1.61, 6.96). At age five the experience of multiple stress events (OR = 1.17, 95% CI = 1.08, 1.27), cigarette smoking (OR = 1.19, 95% CI = 1.03, 1.37), male gender (OR = 1.43, 95% CI = 1.02, 2.00), breastfeeding for a shorter time (OR = .97, 95% CI = .94, .99) and multiple baby blues symptoms (OR = 1.08, 95% CI = 1.02, 1.14) were significant predictors of mental health problems. Conclusions: Early childhood mental health is significantly affected by prenatal events in addition to the child's later environment. Interventions targeting adverse prenatal, perinatal and postnatal influences can be expected to improve mental health outcomes for children in the early years.

Schuetze P; Eiden RD; Dombkowski L. The association between cigarette smoking during pregnancy and maternal behavior during the neonatal period. Infancy 10(3): 267-288, 2006. (89 refs.)

This study examined the association between maternal smoking during pregnancy and maternal behavior during mother-infant interactions during the neonatal period. Participants included 84 mother-infant dyads (43 cigarette-exposed and 41 nonexposed) who were recruited after birth and assessed at 2 to 4 weeks of infant age. Results indicated that mothers who smoked during pregnancy had higher levels of maternal insensitivity (MI) and lower levels of maternal warmth (MW) during interactions with their infant even after controlling for demographics and pregnancy alcohol use. Maternal anxiety and hostility mediated the association between smoking and MI and maternal anger mediated the association between smoking and reduced MW. In addition, there was an interaction between infant gender and maternal smoking for MW with smokers displaying less warmth to boys during interactions.

Shrestha A; Nohr EA; Bech BH; Ramlau-Hansen CH; Olsen J. Smoking and alcohol use during pregnancy and age of menarche in daughters. Human Reproduction 26(1): 259-265, 2011. (44 refs.)

BACKGROUND: We assessed whether exposure to prenatal smoking or alcohol accelerates age of menarche (AOM) in offspring. METHODS: We studied a Danish cohort of 3169 singleton females born in April 1984-April 1987. Linear regressions were conducted to examine associations between prenatal smoking or alcohol exposure and offspring's AOM on: (i) the daughters who provided data on both month and the year of menarche (n = 1634) and (ii) the entire sample that provided at least the year of menarche (n = 3169). We also examined associations between only pre-pregnancy smoking or childhood exposure to smoking and AOM. The full model was adjusted for maternal pre-pregnancy body mass index, maternal age at childbirth, parental socio-economic status, parity, consumption of milk products during pregnancy and marital status. RESULTS: Among those who provided both year and month, AOM was accelerated by 2.8 months (95% CI in months: -5.3, -0.4) among those exposed to 10+ cigarettes/day throughout pregnancy and by 4.1 months (95% CI in months: -7.7, -0.5) among those with mothers who quit smoking sometime during pregnancy, compared with the unexposed group after adjustment for covariates. Similar, but much weaker, associations were observed among girls whose mothers smoked 1-9 cigarettes/day throughout pregnancy or whose fathers smoked compared with their unexposed counterparts after adjustment for covariates [-0.8 months (95% CI: -2.6, 1.0)]. No associations were observed between AOM and only pre-pregnancy smoking or only childhood exposure or prenatal alcohol exposure. CONCLUSIONS: Our study indicates that heavy smoking throughout the pregnancy may be important in prenatal programming of AOM.

Simmons LA; Havens JR; Whiting JB; Holz JL; Bada H. Illicit drug use among women with children in the United States: 2002-2003. Annals of Epidemiology 19(3): 187-193, 2009. (40 refs.)

PURPOSE: Given research that shows youth exposed to maternal addiction have increased rates of cognitive, socioemotional, and behavioral problems, we examined the prevalence and correlates of past year illicit drug abuse or dependence among women with children younger than 18 years of age in the home to identify maternal risk factors. METHODS: Data were from the 2002 and 2003 National Survey on Drug Use and Health, a nationally representative sample of the U.S. civilian population. The current analysis utilized a subsample of women (N = 19,300) who reported having children younger than 18 years in the home. Past year abuse or dependence on cocaine, heroin, marijuana, stimulants, and hallucinogens as well as nonmedical use of prescription medications were assessed. RESULTS: The prevalence of illicit drug abuse or dependence was 1.9%. Mothers reporting drug abuse or dependence had increased odds of being unmarried, controlling for other demographics. They also were more likely to report stress, poorer health status, and meet the criteria for serious mental illness (SMI). CONCLUSIONS; Prevention and intervention strategies should focus on developing and testing methods to screen for both risk factors associated with maternal drug abuse and actual substance abuse in primary and emergency care settings to reduce youth exposure and improve child developmental outcomes.

Simmons LA; Havens JR; Whiting JB; Holz JL; Bada H. Illicit drug use among women with children in the United States: 2002-2003. Annals of Epidemiology 19(3): 187-193, 2009. (40 refs.)

PURPOSE: Given research that shows youth exposed to maternal addict ion have increased rates of cognitive, socioemotional, and behavioral problems, we examined the prevalence and correlates of past year illicit drug abuse or dependence among women with children younger than 18 years of age in the home to identify maternal risk factors. METHODS: Data were from the 2002 and 2003 National Survey on Drug Use and Health, a nationally representative sample of the U.S. civilian population. The current analysis utilized a subsample of women (N = 19,300) who reported having children Younger than 18 years in the home. Past year abuse or dependence on cocaine, heroin, marijuana, stimulants, and hallucinogens as well as nonmedical use of prescription medications were assessed. RESULTS: The prevalence of illicit drug abuse or dependence was 1.9%. Mothers reporting drug abuse or dependence had increased odds of being unmarried, controlling for other demographics. They also were more likely to report stress, poorer health status, and meet the criteria for serious mental illness (SMI). CONCLUSIONS; Prevention and intervention strategies should focus on developing and tooting methods to screen for both risk factors associated with maternal drug abuse and actual substance abuse in primary and emergency care settings to reduce youth exposure and improve child developmental outcomes.

Skorge TD; Eagan TML; Eide GE; Gulsvik A; Bakke PS. The adult incidence of asthma and respiratory symptoms by passive smoking in utero or in childhood. American Journal of Respiratory and Critical Care Medicine 172(1): 61-66, 2005. (41 refs.)

The effects of pre- or postnatal passive smoking on the adult incidence of asthma have not been reported previously. Between 1985 and 1996/1997, we conducted an 11-year community cohort study on the incidence of asthma and respiratory symptoms in Western Norway. The cohort included 3,786 subjects aged 15 to 70 years, of which 2,819 were responders at both baseline and follow-up. The incidence of asthma and five respiratory symptoms by self-reported exposure to maternal smoking in utero and in childhood, as well as smoking by other household members in childhood, was examined. After adjustment for sex, age, education, hay fever, personal smoking, and occupational exposure, maternal smoking was associated with asthma, phlegm cough, chronic cough, dyspnea grade 2, attacks of dyspnea, and wheezing, with odds ratios (95% confidence intervals [Cl]) of 3.0 (1.6, 5.6), 1.7 (11.11, 2.6), 1.9 (1.2, 3.0), 1.9 (1.2, 3.0), 2.0 (1.3, 3.0), and 1.4 (0.9, 2.2), respectively. The adjusted attributable fractions (95% Cl) of the adult incidence of asthma were 17.3% (5.2, 27.9) caused by maternal smoking and 9.3% (95% Cl, -23.2, 33.2) caused by smoking by other household members. Exposure to pre- and postnatal smoking carries a substantial risk for developing adult asthma and respiratory symptoms.

Stavrou EP; Baker DF; Bishop JF. Maternal smoking during pregnancy and childhood cancer in New South Wales: A record linkage investigation. Cancer Causes and Control 20(9): 1551-1558, 2009. (78 refs.)

Following linkage between the NSW Central Cancer Registry (CCR) and the NSW Midwives Data Collection, an investigation of the association between maternal smoking during pregnancy and the risk of childhood cancer in their offspring was undertaken. Children born in NSW between 1994 and 2005, inclusive of 1,045,966 babies, were matched to 948 cancer cases in the CCR. After adjustment for maternal age, gestational age, baby's gender, birth weight, remoteness index, socioeconomic disadvantage and maternal health factors, no association (OR = 0.96, 95% CI 0.81-1.15, p = 0.68) was found with childhood cancer between mothers who smoked (81/100,000) and those who did not smoke during pregnancy (99/100, 000). Maternal smoking was, however, significantly associated with retinoblastoma (OR = 2.20, 95% CI 1.19-4.09, p = 0.01). Association between maternal smoking and preterm birth and low birth weight was significant. Maternal smoking during pregnancy is significantly associated with retinoblastoma and adverse birth outcomes. These results should be highlighted to expectant mothers through antitobacco-smoking campaigns.

Strathearn L; Mayes LC. Cocaine addiction in mothers: Potential effects on maternal care and infant development. Annals of the New York Academy of Sciences. Addiction Reviews 2 1187: 172-183, 2010. (106 refs.)

Maternal cocaine addiction is a significant public health issue particularly affecting children, with high rates of reported abuse, neglect, and foster care placement. This review examines both preclinical and clinical evidence for how cocaine abuse may affect maternal care and infant development, exploring brain, behavioral, and neuroendocrine mechanisms. There is evidence that cocaine affects infant development both directly, via in utero exposure, and indirectly via alterations in maternal care. Two neural systems known to play an important role in both maternal care and cocaine addiction are the oxytocin and dopamine systems, mediating social and reward-related behaviors and stress reactivity. These same neural mechanisms may also be involved in the infant's development of vulnerability to addiction. Understanding the neuroendocrine pathways involved in maternal behavior and addiction may help facilitate earlier, more effective interventions to help substance-abusing mothers provide adequate care for their infant and perhaps prevent the intergenerational transmission of risk.

Street K; Whitlingum G; Gibson P; Cairns P; Ellis M. Is adequate parenting compatible with maternal drug use? A 5-year follow-up. Child Care Health and Development 34(2): 204-206, 2008. (2 refs.)

Introduction: This prospective, cohort study compares child protection outcomes over the first 5 years of life in a group of children born to self-declared drug-using mothers recruited during pregnancy (cases) and a group of children matched for gestational age, chronological age, maternal neighbourhood and place of delivery whose mothers made no such declaration of problematic drug use (controls). Methodology We monitored local child protection registers to identify cohort members who came to the attention of the local authority. Results Of the 71 original cases and 142 original controls, 55 (77%) and 96 (68%) remained in the area enrolled in local schools at 5 years of age. In total, 26 (47.3%) of the case children were subject to child protection procedures compared with 18 (18.8%) of the control children. This risk difference of 28.5% (95% CI 13.2% to 43.9%) has increased marginally since our previous report in this journal of child protection outcomes at 18 months of age (32% vs. 7%). However, the level of intervention deemed necessary to protect the child has increased significantly with six cases (compared with one control child) taken into the care of the local authority. Conclusions: Despite early maternal intentions and multiple supportive interventions, 27% of children born to women with significant substance abuse problems in our area required child protection during the pre-school years. Child protection risk assessment procedures need to weigh problematic maternal drug use heavily. Intervention studies with child welfare outcomes are needed to identify the most effective harm reduction strategies and inform public debate on how we can minimize child abuse related to substance misuse.

Suchman NE; McMahon TJ; Zhang HP; Mayes LC; Luthar S. Substance-abusing mothers and disruptions in child custody: An attachment perspective. Journal of Substance Abuse Treatment 30(3): 197-204, 2006. (33 refs.)

Using an attachment framework, we examined (1) whether substance-abusing mothers' perceptions of how they were patented were related to the severity of their substance abuse and psychological maladjustment and (2) whether these two factors mediated the association between mothers' perceptions of how they were parented and their children's placement out of home. There were 108 mothers of 248 children who completed interviews upon admission to a methadone maintenance program for women. Measures included lifetime risk composite scores derived from the Addiction Severity Index, the Parental Bonding Instrument, and a demographics questionnaire. A multilevel modeling approach was used to model effects of the hierarchically organized data (e.g., children nested within families). Findings are consistent with an attachment perspective on parenting suggesting that the internal psychological processes of a parent play a critical role in the continuity of parenting.

Suzuki K; Sato M; Tanaka T; Kondo N; Yamagata Z. Recent trends in the prevalence of and factors associated with maternal smoking during pregnancy in Japan. Journal of Obstetrics and Gynaecology Research 36(4): 745-750, 2010. (21 refs.)

Aim: To compare the prevalence of maternal smoking during pregnancy and the correlations between maternal smoking and other maternal lifestyle or pregnancy factors between the years 1996-2001 and 2001-2006. Methods: The participants were pregnant women who responded to questionnaires while registering their pregnancies between 1 April 1996 and 31 March 2001 (Group 1), and between 1 April 2001 and 31 March 2006 (Group 2). The odds ratios were calculated with a 95% confidence interval for maternal smoking during early pregnancy by using a logistic multivariate regression analysis based on maternal factors. Results: In Group 1, 1051 pregnant women responded to the questionnaire administered at pregnancy registration, and 86 (8.2%) mothers reported smoking during early pregnancy. In Group 2, 1022 pregnant women responded, and 91 (8.9%) mothers reported smoking during early pregnancy. There was no significant difference between the groups. In both groups, partner smoking and skipping breakfast were significantly associated with maternal smoking. In Group 2, unintended pregnancy was significantly associated with maternal smoking. Conclusions: To prevent maternal smoking during pregnancy, it is necessary to carefully monitor pregnant women who report partner smoking, skipping breakfast, and unintended pregnancy.

Tanaka K; Miyake Y; Sasaki S; Ohya Y; Hirota Y. Maternal smoking and environmental tobacco smoke exposure and the risk of allergic diseases in Japanese infants: The Osaka Maternal and Child Health Study. Journal of Asthma 45(9): 833-838, 2008. (33 refs.)

Purpose. It remains controversial whether environmental tobacco smoke increases the risk of allergic diseases. The present prospective cohort study examined whether in utero exposure to maternal smoking and postnatal exposure to environmental tobacco smoke were associated with the development of wheeze, asthma, and atopic eczema in Japanese infants. Methods. Study subjects included 763 infants. Data were obtained through the use of questionnaires completed by the mother during pregnancy and at 2 to 9 and 16 to 24 months postdelivery. Information regarding maternal smoking during pregnancy and postnatal exposure to environmental tobacco smoke was collected at 2 to 9 months postdelivery, and information on allergic symptoms was collected when the infant was between 16 to 24 months of age. Cases were defined according to criteria of the International Study of Asthma and Allergies in Childhood for wheeze and atopic eczema. Additionally, doctor-diagnosed asthma and atopic eczema were identified. Adjustment was made for maternal age, family income, maternal and paternal education, parental history of asthma, atopic eczema, allergic rhinitis, indoor domestic pets, baby's older siblings, baby's sex, birth weight, and time of surveys. Results. The cumulative incidence of wheeze, atopic eczema, doctor-diagnosed asthma, and doctor-diagnosed atopic eczema was 22.1%, 18.6%, 4.3%, and 9.0%, respectively. Maternal smoking during pregnancy was not related to the risk of wheeze, whereas postnatal maternal smoking in the same room as the child increased the risk of wheeze. No significant association was observed between perinatal tobacco smoke exposure and the development of asthma and atopic eczema. Conclusions. Our findings suggest that postnatal maternal smoking might be associated with an increased risk of wheeze in Japanese infants.

Tarter RE; Kirisci L; Reynolds M; Mezzich A. Neurobehavior disinhibition in childhood predicts suicide potential and substance use disorder by young adulthood. Drug and Alcohol Dependence 76(Supplement): S45-S52, 2004. (47 refs.)

The objectives of this study were to (a) determine whether two factors that are established components of the risk for substance use disorder (SUD) also impact on the risk for suicide; and (2) evaluate whether SUD manifest by early adulthood predicts suicide propensity. Neurobehavior disinhibition assessed in 227 boys at ages 10-12 and 16 and parental history of SUD were prospectively evaluated to determine their association with the risk for SUD and suicide propensity between ages 16 and 19. The results indicated that neurobehavior disinhibition at age 16 predicts suicide propensity between ages 16 and 19 (p =.04). A trend was observed (p =.08) for SUD manifest between ages 16 and 19 to predict suicide propensity during the same period. Maternal SUD is directly associated with son's SUD risk but not suicide propensity. Paternal SUD predicts son's neurobehavior disinhibition that, in turn, predisposes to SUD. A direct relation between paternal SUD and son's suicide propensity was not observed. These findings suggest that neurobehavior disinhibition, a component of the liability of SUD, is also associated with suicide risk. These results are discussed within a neurobehavioral framework in which prefrontal cortex dysfunction is hypothesized to underlie the risk for these two outcomes.

Thyrian JR; Hannover W; Roske K; Rumpf HJ; John U; Hapke U. Postpartum return to smoking: Identifying different groups to tailor interventions. Addictive Behaviors 31(10): 1785-1796, 2006. (42 refs.)

Objective: (a) To describe a population-based sample of women postpartum who smoked before pregnancy on grounds of the perceived advantages and disadvantages of nonsmoking and the self-efficacy not to smoke. (b) To identify grouping characteristics that can differentiate among those women. This could lead to the development of intervention strategies that are of different efficacy depending on the cluster the woman is member of. Sample: A population-based sample of 317 women who had smoked at the beginning of pregnancy and who were smoke-free at the time of giving birth. Data: Data about the acquisition stages of change to restart smoking, the perceived advantages of nonsmoking and the self-efficacy to remain smoke free on grounds of the Transtheoretical Model of Behavior Change was assessed. Smoking status was assessed 12 months later. Statistical analysis: A cluster analysis was used to identify different groups; a logistic regression was calculated to assure the external validity of the clusters identified. Results: The acquisition stages of change do not fit the situation of nonsmoking women postpartum in Germany, but four different clusters of ex-smoking women postpartum were identified on grounds of the other TTM-constructs. These are: the protected, the high risk, the premature and the ambivalent group. The clusters are associated with relapse after 12 months, none of the other variables controlled for was statistically significant. Conclusions: The TTM contributes to a better understanding of nonsmoking women postpartum. Further studies have to replicate the clusters found and have to find whether interventions tailored to these clusters are more effective in preventing relapse than other interventions.

van de Venne J; Bradford K; Martin C; Cox M; Omar HA. Depression, sensation seeking, and maternal smoking as predictors of adolescent cigarette smoking. TheScientificWorldJOURNAL 6: 643-652, 2006. (45 refs.)

The purpose of this study was to examine maternal and adolescent depression, maternal and teen sensation seeking, and maternal smoking, and their associations with adolescent smoking. Data were collected from a sample of 47 male and 66 female adolescents (ages 11-18 years) and their mothers from three different health clinics. The findings indicated that maternal sensation seeking was linked indirectly with adolescent smoking through teen sensation seeking, both of which were significantly associated with teen smoking (beta = 0.29, p < 0.001 and beta = 0.32, p < 0.001, respectively). Teen depression was associated positively with teen smoking (beta = 0.24, p < 0.01) when controlling for sensation seeking behaviors. Maternal smoking was also directly linked to adolescent smoking (beta = 0.20, p < 0.05). These findings underscore a potentially important role of sensation seeking in the origins of adolescent smoking, and clarify pathways of influence with regard to maternal attitudes and behaviors in subsequent teenage nicotine use.

Wakschlag LS; Metzger A; Darfler A; Ho J; Mermelstein R; Rathouz PJ. The Family Talk About Smoking (FTAS) Paradigm: New directions for assessing parent-teen communications about smoking. Nicotine & Tobacco Research 13(2): 103-112, 2011. (29 refs.)

Smoking experimentation represents transient risk taking for some youth, whereas for others, it is the onset of a chronic smoking trajectory. However, distinguishing these groups during the experimentation phase has proved challenging. We theorized that variations in parent and teen discourse about smoking might be informative for characterizing this heterogeneity. However, standardized methods for direct assessments of these family processes have been lacking. We examined the predictive utility of directly observed facets of smoking-specific communication for predicting persistence of teen smoking experimentation using a novel method, the Family Talk About Smoking (FTAS) paradigm. The FTAS was tested in a sample of 344 teens with a history of smoking experimentation during interactions with their mothers and fathers. Level of disapproval, smoking expectancies, elaboration of consequences, and quality of personal disclosure were coded during videotaped parent-teen discussions about smoking. Patterns of observed smoking-specific communication varied by teen and parent smoking status. Predictive validity of the FTAS for teen persistent experimentation was demonstrated, net effects of reported smoking-specific socialization, general quality of communication, and parental smoking status. Teen smoking expectancies, disclosure, and disapproval predicted teen persistent experimentation with some differences based on whether interactions were with mothers or fathers. Prediction of persistent experimentation by observed maternal disclosure and elaboration of consequences was moderated by maternal smoking status. Direct observations show promise for generating detailed characterization of individual differences in patterns of family communication about smoking. Implications for targeted prevention and future research are discussed.

Wang IJ; Hsieh WS; Wu KY; Guo YL; Hwang YH; Jee SH et al. Effect of gestational smoke exposure on atopic dermatitis in the offspring. Pediatric Allergy and Immunology 19(7): 580-586, 2008. (31 refs.)

The adverse impact of smoking on respiratory diseases and birth outcomes in children is well-known. However, the influence of smoke exposure including environmental tobacco smoke (ETS) and maternal smoking during pregnancy on atopic dermatitis (AD) is not clear. The purpose of this study was to evaluate the effect of gestational smoke exposure on the development of AD in the offspring on the basis of the maternal and cord blood cotinine. We recruited 261 mother and newborn pairs in 2004. Cord blood and information on perinatal factors of children were gathered at birth. At 2 yr of age, information about development of AD and environmental exposures were collected. We compared AD with non-AD children for the concentration of cotinine in cord and maternal blood measured by high performance liquid chromatography-mass spectrometry. Multiple logistic regressions were performed to estimate the relationship of cotinine levels and AD. About 150 mother and child pairs completed the follow-up study and specimen collection with 38 (25.3%) children developing AD. Two (1.3%) out of 150 mothers smoked during pregnancy, while 38 (25.3%) mothers reported having ETS exposure. Cotinine levels in cord blood and maternal blood were highly correlated (r = 0.71, p < 0.001). The risk of AD was found to increase with maternal and cord blood cotinine levels in a dose-response manner (p for trend = 0.01). Children exposed to high levels (> 75th percentile) had a significantly increased risk of AD. Smoke exposure during pregnancy might increase the risk of AD in children. Avoidance of prenatal smoke exposure may be warranted for early prevention.

Wells K; Shafran R. Obstacles to employment among mothers of children in foster care. Child Welfare 84(1): 67-96, 2005. (57 refs.)

This article reports on a study of obstacles to employment among mothers with children in foster care. The study relies on standardized measures, has a cross-sectional design, and includes a sample of 158 mothers. The analysis shows a high prevalence of obstacles; identifies three co-occurring obstacles, each involving substance abuse, that are related to a low probability of employment (p <= .05); and reveals that employment and access to transportation are related to higher income relative to mothers' needs (p <= .05).

Whitaker RC; Orzol SA; Kahn RS. The co-occurrence of smoking and a major depressive episode among mothers 15 months after delivery. Preventive Medicine 45(6): 476-480, 2007. (43 refs.)

Objective. To examine the association between maternal smoking 15 months after delivery and the occurrence of a major depressive episode in the prior 12 months. Methods. Data were obtained from the Fragile Families and Child Wellbeing Study, a birth cohort study. In 20 U.S. cities, 4898 mothers were surveyed at delivery in the years 1998 to 2000. In a survey 15 months later, 4353 (89%) of the mothers reported their smoking behavior and symptoms of a major depressive episode during the prior 12 months. Results. At the follow-up survey, 26.6% of mothers reported that they were current smokers and 13.6% reported that they had symptoms of a major depressive episode during the prior 12 months. After adjusting for sociodemographic characteristics, the prevalence (95% confidence interval) of a major depressive episode was higher among smokers than nonsmokers: 17.7% (15.7%, 19.8%) vs. 12.1% (10.9%, 13.3%). Smoking was also more common among mothers with a major depressive episode than in those without one: 34.0% (30.6%, 37.4%) vs. 25.5% (24.1%, 26.8%). Conclusion. Smoking and depression often co-occur among mothers with infants. This suggests that these conditions should not be diagnosed or treated in isolation from each other and that the care of mothers and children should be integrated.

Yilmaz G; Karacan C; Yoney A; Yilmaz T. Brief intervention on maternal smoking: A randomized controlled trial. Child Care Health and Development 32(1): 73-79, 2006. (15 refs.)

Objectives: To determine if mothers receiving a smoking cessation intervention emphasizing health risks of environmental tobacco smoke (ETS) for their children have a higher quit rate than mothers who received routine smoking cessation advice, which focused on their own health, or a control group of mothers. Setting: Tertiary referral centre. Methods Randomized control trial. A total of 363 mothers were randomly assigned to a smoking cessation intervention either aimed at their children's health (n = 111) or their own health (n = 131), or to a control group receiving no smoking cessation advice (n = 121). Results Provision to mothers of both groups of health risks of tobacco smoke resulted in significantly higher rate of cessation of smoking and smoking location change than those of the control group, with child intervention group having significantly higher rate of cessation of smoking and smoking location change than those of the maternal intervention group (P < 0.05). Post-intervention knowledge scores differed significantly for all groups; however, child intervention group was the only significantly better group than the others (P < 0.05). According to the multivariate analysis results, intervention grouping and presence of smoking friends were independent factors determining smoking cessation (P < 0.05). Intervention grouping, post-intervention knowledge, presence of other household members who smoked and family income were independent factors determining smoking location change (P < 0.05). Family income, intervention grouping and presence of smoking friends were significant independent factors influencing post-intervention knowledge (P < 0.05). Conclusion: Discussion during short paediatric visits on effects of smoking on child's or maternal health may result in a significant smoking cessation, smoking location change rate or knowledge change. Those who cannot give up smoking usually change their location of smoking. Provision of information on effects of smoking on child's health, rather than maternal, may result in more significant changes in behaviour or knowledge. Maternal education on smoking should include information on effects of smoking on both child's and maternal health, but should be especially focused on child's health.

Zakarian JM; Hovell MF; Sandweiss RD; Hofstetter CR; Matt GE; Bernert JT et al. Behavioral counseling for reducing children's ETS exposure: Implementation in community clinics. Nicotine & Tobacco Research 6(6): 1061-1074, 2004. (51 refs.)

The present randomized controlled trial tested the effectiveness of a behavioral counseling program for reducing children's exposure to environmental tobacco smoke (ETS). Counseling was delivered by clinic staff as part of well-child health care services in a community clinic setting. A total of 150 mothers with children aged 4 years or younger were recruited. Parent-reported and children's urinary cotinine measures of ETS exposure were obtained at baseline. 3 months, 6 months (post-test), and 12 months (follow-up). Saliva samples were obtained from mothers who reported quitting smoking, for objective verification by thiocyanate analysis. After baseline, mothers were randomly assigned to a measures-only control condition or an intervention consisting of seven behavioral counseling sessions over 6 months. Counseling included behavioral contracting, self-monitoring, problem solving, and positive reinforcement. Results indicated acceptable test-retest reliability and validity of measures. Parent-reported measures indicated that, in both groups, children's exposure to their mothers' tobacco smoke in the home and to all tobacco smoke declined steeply from baseline to 6 months post-test, and remained essentially level during follow-up. Mothers' smoking rates followed the same pattern. Children's urinary cotinine concentrations did not show significant change over time in either group. Findings on the fidelity of treatment implementation suggest that the structure and funding of the community clinic health care system and associated staff turnover and training issues resulted in participants receiving a less efficacious intervention than in our past efficacy trials. Implications for future effectiveness trials are discussed.

Zammit S; Thomas K; Thompson A; Horwood J; Menezes P; Gunnell D et al. Maternal tobacco, cannabis and alcohol use during pregnancy and risk of adolescent psychotic symptoms in offspring. British Journal of Psychiatry 195(4): 294-300, 2009. (52 refs.)

Background: Adverse effects of maternal substance use during pregnancy on fetal development may increase risk of psychopathology. Aims To examine whether maternal use of tobacco, cannabis or alcohol during pregnancy increases risk of offspring psychotic symptoms. Method A longitudinal study of 6356 adolescents, age 12, who completed a semi-structured interview for psychotic symptoms in the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort. Results Frequency of maternal tobacco use during pregnancy was associated with increased risk of suspected or definite psychotic symptoms (adjusted odds ratio 1.20, 95% CI 1.05-1.37, P=0.007). Maternal alcohol use showed a non-linear association with psychotic symptoms, with this effect almost exclusively in the offspring of women drinking >21 units weekly. Maternal cannabis use was not associated with psychotic Symptoms. Results for paternal smoking during pregnancy and maternal smoking post-pregnancy lend some support for a causal effect of tobacco exposure in utero on development of psychotic experiences. Conclusions: These findings indicate that risk factors for development of non-clinical psychotic experiences may operate during early development. Future studies of how in utero exposure to tobacco affects cerebral development and function may lead to increased understanding of the pathogenesis of psychotic phenomena.