Search

Background: The existing epidemiological evidence on the link between maternal depression and the risk of attention deficit and hyperactivity disorder (ADHD) symptoms in children lacks consistency. This systematic review and meta-analysis aimed to comprehensively synthesise the existing evidence on the relationship between maternal depression during the antenatal and postnatal periods and the risk of ADHD symptoms in offspring., Methods: We systematically searched PubMed, Medline, Embase, Scopus, CINAHL, and PsychINFO to identify relevant articles. Random-effects meta-analysis models were employed to estimate the pooled odds ratio (OR) along with 95 % confidence intervals (CI). Statistical heterogeneity was assessed using Cochrane's Q-test and I2-test. Subgroup analysis was conducted to explore potential sources of variation within the included studies. Publication bias was assessed using a funnel plot and Egger's test for regression asymmetry., Results: Twenty-one observational studies, comprising 796,157 mother-offspring pairs, were included in the final analysis. Our meta-analysis found a 67 % (OR = 1.67, 95 % CI = 1.35-2.00) and a 53 % (OR = 1.53, 95 % CI = 1.27-1.78) increased risk of ADHD symptoms in the offspring of mothers experiencing antenatal and postnatal depression, respectively., Conclusion: Our systematic review and meta-analysis identified an elevated risk of ADHD symptoms in the offspring of mothers who experienced both antenatal and postnatal depression. These findings underscore the importance of early screening and targeted intervention programs for at-risk children and adolescents., Competing Interests: Declaration of Competing Interest The authors collectively confirm that they do not have any conflicting interests to disclose., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: This study addresses a critical knowledge gap by exploring the intricate relationship between low birth weight (LBW) and the heightened risk of suboptimal academic achievement during adolescence through a comprehensive retrospective cohort design., Methods: In this registry-based cohort study, meticulously linked health and curriculum-based test data for individuals born in New South Wales (NSW), Australia, between 2003 and 2005 were employed. Birth weight data were carefully sourced from the NSW perinatal data collection (PDC). The educational performance of offspring was thoroughly evaluated using the National Assessment Program for Literacy and Numeracy (NAPLAN) during grade 9, approximately at 14 years of age., Results: After rigorous adjustments for potential confounders, findings revealed a compelling narrative: LBW adolescents demonstrated an elevated susceptibility to not meeting national minimum standards across all domains, encompassing spelling [OR, 1.59 (95%CI 1.48-1.69)], writing [OR, 1.51 (95%CI 1.41-1.61)], reading [OR, 1.38 (95%CI 1.29-1.48)], and numeracy [OR, 1.52 (95%CI 1.40-1.63)]. Notably, LBW boys exhibited a more pronounced inclination towards diminished academic performance compared to their female counterparts., Conclusions: This comprehensive retrospective cohort study, based on linked data, unequivocally establishes LBW as significantly associated with an increased vulnerability to substandard educational achievement during adolescence. Particularly robust effects were observed in females across all outcomes. Aimed at investigating whether LBW serves as a predictive factor for later academic difficulties, this study underscores the imperative for the adoption and fortification of preventative and early intervention strategies to curtail the prevalence of LBW-associated academic underachievement in later adolescence., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024. Published by Elsevier B.V.)

Background: Early childhood developmental vulnerability has been closely related to the predictors of relatively good health, social and educational outcomes later in adulthood. However, the impacts of prenatal tobacco exposure on childhood developmental vulnerability have been rarely examined. Further, a few of the studies that have investigated maternal prenatal tobacco smoking and child developmental vulnerability have reported mixed results and there are currently no published estimates derived from causal epidemiological methods., Methods: We conducted a retrospective population-based cohort study on the association between maternal prenatal tobacco smoking and developmental vulnerability in children born in Western Australia (WA). De-identified individual-level maternal, infant and birth records were obtained from the Midwives Notification System (MNS), a statutory record of all births in WA. WA register for Developmental Anomalies (WARDA) were also obtained from the WA Data Linkage. Records on early childhood developmental vulnerability at the median age of 5 years were obtained from the Australian Early Development Census (AEDC). We used a doubly robust estimator to estimate the causal effects., Results: Complete data were available for 64,558 mothers-children's pairs. Approximately 16% of children were exposed to maternal prenatal tobacco smoking. Children exposed to maternal prenatal tobacco smoking were more likely to be classified as developmentally vulnerable/at-risk on the physical health and wellbeing (RR = 1.40, 95%CI:1.36-1.45), social competence (RR = 1.42, 95%CI: 1.38-1.47), emotional maturity (RR = 1.34, 95%CI:1.30-1.39), language and cognitive skills (RR = 1.50, 95%CI:1.45-1.54), and communication skills and general knowledge (RR = 1.37, 95%CI:1.33-1.42) domains., Conclusion: Maternal prenatal exposure to tobacco may influence early childhood developmental vulnerability. Early intervention to quit tobacco smoking before becoming pregnant could potentially reduce later childhood developmental vulnerability on multiple domains., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Prenatal alcohol exposure has been found to be associated with adverse physical and mental health outcomes in postnatal life, but the evidence is equivocal as to whether such exposure increases the risk of subsequent alcohol use in the offspring. We systematically reviewed the literature on the association between prenatal alcohol exposure and subsequent alcohol use in the offspring., Methods: Relevant primary studies were identified via systematic search of PubMed/Medline, SCOPUS, EMBASE and Psych-INFO databases. Articles were also retrieved by reviewing reference lists of the identified studies. Literature searches did not have language and date limits but were restricted to human studies. The revised Newcastle-Ottawa Scale was used to evaluate the methodological quality of the studies included in this review. The protocol of this study was prospectively registered in the PROSPERO., Results: Twelve observational studies, published between 1998 and 2020, were included in the final review. Eight studies (66.7%) reported an increased risk of alcohol use or increased level of alcohol drinking, two studies (16.7%) reported an increased risk of alcohol use disorder and one study (8.3%) reported an increased odds of alcohol sipping in offspring exposed to maternal prenatal alcohol use compared to non-exposed. However, one study (8.3%) reported insufficient statistical evidence for an association between prenatal alcohol exposure and offspring subsequent alcohol use. However, it should be noted that the large amount of variability across studies included in this review may limit more conclusive inference., Conclusion: The findings of this review suggest a positive link between prenatal alcohol exposure and offspring's subsequent alcohol use. However, further mechanistic studies that allow stronger causal inference are warranted to further elucidate specific causal pathways., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: There is some compelling, though not comprehensive, epidemiological evidence which suggests an association between prenatal tobacco exposure and tobacco smoking/dependence in offspring. We conducted a systematic review and meta-analysis to identify the magnitude and consistency of associations reported between prenatal tobacco exposure and subsequent tobacco smoking/dependence in offspring., Methods: Using the PRISMA guideline, we systematically searched PubMed, SCOPUS, EMBASE and Psych-INFO to identify relevant studies. The methodological quality of all identified studies was checked by the Newcastle-Ottawa Scale. Inverse variance weighted random effects meta-analysis was used to estimate pooled risk ratio (RR) and 95 % confidence intervals (CI). We stratified outcomes by tobacco smoking initiation, lifetime tobacco smoking, current tobacco smoking and tobacco dependence. We further performed subgroup and leave-one-out sensitivity analyses. The protocol of this review was registered in the PROSPERO., Results: Twenty-six cohort and one case-control study were included in the final meta-analysis. We found elevated pooled risks of tobacco smoking initiation [RR = 2.08, (95 % CI: 1.18-3.68)], ever tobacco smoking [RR = 1.21, (95 % CI: 1.05-1.38)], current tobacco smoking [RR = 1.70, (95 % CI: 1.48-1.95)] and tobacco dependence [RR = 1.50, (95 % CI: 1.31-1.73)] in offspring exposed to maternal prenatal tobacco use compared to non-exposed. We also noted higher risk estimate of current tobacco smoking in offspring exposed to heavy prenatal tobacco smoking [RR = 1.68, (95 % CI: 1.26-2.23)] when compared to prenatal exposure to lighter tobacco use [RR = 1.39, (95 % CI: 1.09-1.78)]. There was no association observed between paternal smoking during pregnancy and tobacco smoking in offspring., Conclusion: Offspring exposed to maternal prenatal tobacco smoking are at an increased risk of tobacco smoking/dependence, indicating that tobacco smoking cessation during gestation may be imperative to reduce these risks in offspring., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Antenatal depression has been associated with poor perinatal outcomes such as preterm birth and low birth weight. Universal screening of perinatal depression has been recommended to improve maternal and pregnancy outcomes., Hypothesis and Aim: We hypothesise that screening for antenatal depressive symptoms may reduce the risk of preterm birth and low birth weight. To assess the hypothesis, we explore the association between antenatal depression screening using the Edinburgh Postnatal Depression Scale and neonatal outcomes., Methods: A retrospective analysis of state-wide population-based health administrative data. Inclusion criteria were pregnant women who gave birth to a singleton in Queensland in the second half of 2015 (29,543 women). Logistic regression analyses were run in 27,817 women with information in all variables. Main outcomes were preterm birth (<37 weeks of gestation) and low birth weight (<2500 grs)., Results: Women who did not complete the screening had increased odds of preterm birth (AOR, 1.56; 95% CI, 1.39-1.74; p < 0.001) and low birth weight (AOR, 1.48; 95% CI, 1.30-1.68; p < 0.001) before and after adjustments for relevant confounders when compared to women who completed the screening. Sensitivity analyses performed in women with spontaneous labour and in women without a diagnosis of depression showed similar results., Conclusion(s): We found an association between screening for depressive symptoms during pregnancy and better neonatal outcomes. However, this result does not necessarily infer causality. Any association may represent a previously unknown benefit to screening, which could support the case for universal antenatal depression screening., (Copyright © 2020 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Objectives: A major challenge for hospitals and clinicians is the early identification of neonates at risk of developing adverse conditions. We develop a model based on routinely collected administrative data, which accurately predicts two common disorders among early term and preterm (<39 weeks) neonates prior to discharge., Study Design: The data included all inpatient live births born prior to 39 weeks (n = 154,755) occurring in the Australian state of Queensland between January 2009 and December 2015. Predictor variables included all maternal data captured in administrative records from the beginning of gestation up to, and including, the delivery, as well as neonatal data recorded at the delivery. Gradient boosted trees were used to predict neonatal respiratory distress syndrome and hypoglycaemia prior to discharge, with model performance benchmarked against a logistic regression models., Results: The gradient boosted trees model achieved very high discrimination for respiratory distress syndrome [AUC = 0.923, 95% CI (0.917, 0.928)] and good discrimination for hypoglycaemia [AUC = 0.832, 95% CI (0.827, 0.837)] in the validation data, as well as outperforming the logistic regression models., Conclusion: Our study suggests that routinely collected health data have the potential to play an important role in assisting clinicians to identify neonates at risk of developing selected disorders shortly after birth. Despite achieving high levels of discrimination, many issues remain before such models can be implemented in practice, which we discuss in relation to our findings., (Copyright © 2020. Published by Elsevier Inc.)

Purpose: This study examined the effect of hypertensive disorders during pregnancy on trajectories of emotional and behavioral problems in offspring., Methods: We used data from the Avon Longitudinal Study of Parents and Children, a prospective birth cohort study in Avon, United Kingdom. A group-based trajectory modeling was used to identify the distinct trajectories of emotional and behavioral problems in children at four time points: at age 3.5, 6.75, 9, and 11 years. Multinomial logistic regression analyses were used to examine the association between hypertensive disorders during pregnancy and trajectories of emotional and behavioral problems., Results: We identified four trajectories of offspring emotional and behavioral problems: normal (42.6%), borderline decreasing (40.6%), borderline stable (10.0%), and persistently elevated (6.8%). We found that children exposed to maternal pre-eclampsia were more likely to be in the persistently elevated symptom trajectory (OR = 2.72; 95% CI: 1.10-6.74) than in the normal trajectory group. We found no associations between maternal gestational hypertension and trajectories of offspring emotional and behavioral problems., Conclusions: Maternal pre-eclampsia, but not gestational hypertension was associated with persistently elevated trajectory of offspring emotional and behavioral problems. Our findings highlight that the antenatal environment is important for children's behavioral and emotional development., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Epidemiological evidence suggests offspring exposed to prenatal alcohol are at increased risk of alcohol use disorders in adulthood. The evidence on the risk of developing harmful alcohol use in adolescence is less clear., Methods: We used data from the Raine Study, a multi-generational birth cohort study, to examine the association between prenatal alcohol exposure and the risk of harmful alcohol use in offspring at the age of 17 years. Log binomial regression was used to estimate the relative risks (RRs) of harmful alcohol use in offspring exposed to maternal alcohol use in the first (early) and third (late) trimesters of pregnancy. Maternal pre-pregnancy alcohol use was used as a negative control for intrauterine exposure for comparison., Results: Complete data were available for 1200 mother-offspring pairs. After adjustment for potential confounders, we found increased RRs of harmful alcohol use in offspring born to mothers who consumed four or more standard drinks of alcohol per week during the first trimester [RR 1.45(95% CI: 1.08-1.93)], third trimester [RR 1.34 (95% CI: 1.04-1.72)] and during both trimesters of pregnancy [RR 1.86 (95% CI: 1.16-2.96)]. Maternal pre-pregnancy alcohol use was not associated with an increased risk of harmful alcohol use in offspring [RR 1.15 (95% CI: 0.89-1.48)]., Conclusion: Observed associations for maternal prenatal alcohol exposure but not maternal pre-pregnancy alcohol use suggests a biological mechanism for intrauterine alcohol exposure on the risk of harmful alcohol use in the offspring., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Aims: People who inject drugs frequently experience discrimination. However, little is known about how discrimination experienced in different social domains is linked to health and wellbeing., Design: We used data collected in 2016 from the Illicit Drug Reporting System (IDRS), an Australian survey of people who inject drugs. We used a modified version of the Discrimination Scale (DISC-12) to assess discriminatory behaviours in diverse social domains, including public institutions, neighbours, family and friends. We used the Kessler-10 scale, the Personal Wellbeing Index and specific items from the IDRS questionnaire to assess participants' health and wellbeing., Findings: Sixty three percent of participants who responded to the discrimination module included in the IDRS 2016 (N = 796) reported ever having experienced discrimination due to their injecting drug use and 53% reported having experienced discrimination in the past month. Discrimination in all social domains analysed was linked with poor health and wellbeing, except for housing. Self-reported mental health problems and poorer general health were most frequently associated with discrimination. Participants who experienced discrimination from friends were three times more likely to report mental health problems (AOR=3.0, CI 95 =1.5-6.0)., Conclusions: There are significant associations between the domains in which discrimination takes place and the health and wellbeing of people who inject drugs. Our findings highlighted the importance of assessing the social domains of discrimination in relation to mental health. Further research needs to assess not just whether a group or individual is discriminated against, but rather how they are likely to perceive this discrimination and how this experience can affect their life as a whole., (Copyright © 2019. Published by Elsevier B.V.)

Background: Discrimination can be a daily issue in the lives of people who inject drugs (PWID). However, the extent to which discrimination is related to the health of PWID remains unclear., Methods: Data focusing on discrimination against PWID and potential health correlates were collected as part of the 2013 Illicit Drug Reporting System, a national survey with 887 PWID recruited in all Australian states and territories. Experience of discrimination, its setting, perceived reason and outcome, were self-reported by participants. The Kessler-10 scale and the mental component score of the Short Form 12-Item Health Survey were used to measure mental health. Physical health was assessed using the physical component score of the Short Form 12-Item Health Survey, specifically questions assessing injecting related problems and risk behaviour. Poisson and multinomial regression analyses were performed. Models were adjusted for socio-demographic and drug-related covariates., Findings: PWID reported experiencing discrimination in pharmacies, hospitals, government services and doctors/prescribers. The most commonly reported instances of discrimination were being refused service and experiencing abuse and/or violence. Experience of discrimination was associated with mental and physical health indicators. PWID who experienced discrimination were more likely to report high or very high mental distress (ARRR = 2.4, CI 95  = 1.5-3.6) and mental health problems (ARRR = 1.4, CI 95  = 1.2-1.7). The mental functioning (ARRR = 1.3, CI 95  = 1.1-1.4) and physical functioning (ARRR = 1.1, CI 95  = 1.1-1.4) of PWID, who experienced discrimination, were also more likely to be below Australian population mean scores., Conclusion: Self-reported experience of discrimination was associated with poor mental and physical health amongst PWID., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Previous research has shown that people who inject drugs (PWID) experience discrimination on a regular basis. This study explores the relationships between discrimination against PWID and health and wellbeing., Methods: Data on discrimination against PWID and their health and wellbeing were drawn from the Illicit Drug Reporting System collected in Australia in 2016. The Personal Wellbeing Index was used to measure wellbeing, and the Kessler-10 scale was used to measure psychological distress. Experience of overdose, injecting related illnesses, diseases, and risky injecting behaviour were also assessed. We fitted multivariate logistic regression models adjusted for socio-demographic, imprisonment history, and drug-related factors., Results: Of the 796 participants included in the study, the majority who reported experiencing discrimination were male (65%), heterosexual (89%), and unemployed (89%). Thirty percent of the sample (n = 238) reported they had never experienced discrimination because of their injecting drug use. Seventeen percent of participants had not experienced discrimination in the twelve months prior to the interview, 24% experienced discrimination monthly, 16% experienced discrimination weekly, and 13% experienced discrimination daily or more. Frequent discrimination was associated with increased odds of overdosing, injecting related illnesses and diseases, mental health issues, and poor wellbeing. Among those who reported experiencing discrimination, females and those who identified as Indigenous were found to have poorer health and wellbeing outcomes., Conclusions: Our findings highlighted that frequent discrimination may lead to worse health and wellbeing among PWID. If our findings are supported by other research, policies aimed at reducing discrimination against PWID may be warranted or improved., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objective: Existing evidence of predictors of repeated teenage pregnancy has not been assessed rigorously. This systematic review provides a comprehensive evaluation of protective and risk factors that are associated with repeated teenage pregnancy through a metaanalytical consensus., Data Sources: We used PubMed, EMBASE, CINAHL, ProQuest, PsychINFO, ScienceDirect, Scopus, and Web of Science databases from 1997-2015 and the reference list of other relevant research papers and related reviews., Study Eligibility Criteria: Eligibility criteria included (1) epidemiologic studies that analyzed factors associated with repeated pregnancy or birth among adolescents <20 years of age who were nulliparous or experienced at least 1 pregnancy, and (2) experimental studies with an observational component that was adjusted for the intervention., Study Appraisal and Synthesis Methods: We performed narrative synthesis of study characteristics, participant characteristics, study results, and quality assessment. We also conducted random-effects and quality-effects metaanalyses with meta-regression to obtain pooled odds ratios of identified factors and to determine sources of between-study heterogeneity., Results: Twenty-six eligible epidemiologic studies, most from the United States (n=24), showed >47 factors with no evidence of publication bias for each metaanalysis. Use of contraception (pooled odds ratio, 0.60; 95% confidence interval, 0.35-1.02), particularly long-acting reversible contraceptives (pooled odds ratio, 0.19; 95% confidence interval, 0.08-0.45), considerably reduced repeated teenage pregnancy risk. Among studies about contraception, the number of follow-up visits (adjusted coefficient, 0.72; P=.102) and country of study (unadjusted coefficient, 2.57; permuted P=.071) explained between-study heterogeneity. Education-related factors, which included higher level of education (pooled odds ratio, 0.74; 95% confidence interval, 0.60-0.91) and school continuation (pooled odds ratio, 0.53; 95% confidence interval, 0.33-0.84), were found to be protective. Conversely, depression (pooled odds ratio, 1.46; 95% confidence interval, 1.14-1.87), history of abortion (pooled odds ratio, 1.66; 95% confidence interval, 1.08-2.54), and relationship factors, such as partner support, increased the repeated teenage pregnancy risk., Conclusion: Contraceptive use, educational factors, depression, and a history of abortion are the highly influential predictors of repeated teenage pregnancy. However, there is a lack of epidemiologic studies in low- and middle-income countries to measure the extent and characteristics of repeated teenage pregnancy across more varied settings., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Intervention by community health workers (CHWs) is believed to prevent repeated childbearing among teenagers. This review investigated the effectiveness of CHWs in reducing repeated pregnancies and births among adolescents aged <20 years, 2 years after the delivery of their first child. Through electronic database and hand searching, experimental and/or observational studies were screened with their results undergoing systematic review and meta-analyses. Subgroup analyses were performed to further assess how study characteristics affected the pooled estimates and heterogeneity. A total of 11 eligible articles, from January 1980 to May 2015, were included. Seven studies evaluated repeated births and eight measured repeated pregnancies. Studies showed relevant disparities in terms of selected methodological aspects and program characteristics. Although most studies (n = 9) were either of "strong" or of "moderate" quality, only two of five finding a significant reduction exhibited a high level of quality as the other three failed to adjust results for confounders. Random effects modeling revealed an overall 30% decrease in repeated adolescent births (odds ratio = .70, confidence interval = .49-.99) among CHW-visited areas relative to nonvisited sites. On the other hand, no significant association was detected in terms of repeated pregnancies (odds ratio = .96, confidence interval = .70-1.28)., (Copyright © 2016 The Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To examine the rates and patterns of tobacco and e-cigarette use amongst two samples of illicit drug users in Australia., Method: Data were obtained from the 2015 Illicit Drug Reporting System (IDRS) and the 2015 Ecstasy and Related Drugs Reporting System (EDRS). These studies comprised cross-sectional samples of 888 people who inject drugs (PWID) and 763 regular psychostimulant users (RPU)., Results: Tobacco was consumed by the majority of both samples, however, use in the 6 months preceding interview was significantly higher amongst PWID (92.2%) than RPU (82.4% [OR 2.53 95% CI 1.86-3.44]). Inversely, PWID were less likely to have a history of e-cigarette use: 31.5% of PWID reported lifetime use of e-cigarettes (vs. 57.0% of RPU [OR 0.35 95% CI 0.28-0.42]) and 18.1% reported use in the 6 months preceding interview (vs. 33.7% of RPU [OR 0.44 95% CI 0.35-0.55]). PWID were more than three times as likely than RPU to report using e-cigarettes as a smoking cessation tool (OR 3.09 95% CI 2.03-4.71), but were less likely to use e-liquids that contained nicotine (OR 0.52 95% CI 0.32-0.83). Higher levels of poly drug use, daily tobacco use, recent use of synthetic cannabinoids and employment status were found to be significantly associated with e-cigarette use., Conclusion: The use of e-cigarettes was relatively common amongst Australian samples of PWID and RPU. Whilst the majority of PWID reported using e-cigarettes as a smoking cessation tool, it appears that RPU are using them for experimental or recreational purposes., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Background: This study investigates whether the type, nature or amount of polysubstance use can explain the increased risk of non-fatal overdose among people who inject drugs with severe psychological distress., Methods: Data came from three years (2011-2013) of the Illicit Drug Reporting System (IDRS), an annual sentinel sample of injecting drug users across Australia (n=2673). Structural Equation Modelling (SEM) was used on 14 drug types to construct five latent factors, each representing a type of polysubstance use. Tests of measurement invariance were carried out to determine if polysubstance use profiles differed between those with and without severe psychological distress. Next, we regressed non-fatal overdose on the polysubstance use factors with differences in the relationships tested between groups., Findings: Among those with severe psychological distress a polysubstance use profile characterised by heroin, oxycodone, crystal methamphetamine and cocaine use was associated with greater risk of non-fatal overdose. Among those without severe psychological distress, two polysubstance use profiles, largely characterised by opioid substitution therapies and prescription drugs, were protective against non-fatal overdose., Conclusion: The types of polysubstance use profiles did not differ between people who inject drugs with and without severe psychological distress. However, the nature of use of one particular polysubstance profile placed the former group at a strongly increased risk of non-fatal overdose, while the nature of polysubstance use involving opioid substitution therapies was protective only among the latter group. The findings identify polysubstance use profiles of importance to drug-related harms among individuals with psychological problems., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Background: Substance and mental health disorders convey significant health burdens and impair interpersonal relationships. We tested associations between comorbid substance and mental health disorders and different forms of intimate partner violence (IPV) experienced by young adults., Method: Mothers (n = 6703) were recruited during pregnancy to the longitudinal Mater-University of Queensland Study of Pregnancy. Mother/offspring dyads were followed up from birth to 21 years. Offspring with complete psychiatric data at 21 years who reported having had an intimate partnership were included (n = 1781). Participants' experiences of psychological, physical and severe combined IPV were assessed at 21 years using a summarised form of the Composite Abuse Scale. We used the Composite International Diagnostic Interview to obtain lifetime diagnoses of mental health and substance disorders. Multivariable logistic regression models of each IPV form were adjusted for individual, family and neighbourhood factors during adolescence, and for other forms of IPV., Results: We have shown specific links between different forms of IPV experienced and individual substance and mental health disorders. Mental health disorders were related to all three forms of IPV, while alcohol disorders were linked to psychological IPV (ORAUD = 1.86; 1.21-2.86) and illicit substance disorders to physical IPV (ORSUD = 2.07; 1.25-3.43). The co-occurrence of related disorders was strongly linked to psychological and physical IPV., Conclusions: Intimate partner violence was experienced by both men and women. Substance and mental health disorders were associated with specific forms of IPV victimisation, suggesting that screening IPV clients and mental health/substance disorder patients for the converse problems may be important for intervention planning., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Objective: To examine the association between self-reported lifetime diagnosis of mental disorder and health-related outcomes in prisoners during the first six months after release., Methods: We interviewed 1,324 adult prisoners in Queensland, Australia, within six weeks of expected release and one, three and six months post-release. Outcomes of interest included health service access, housing, employment, substance use and criminal activity. We used multivariate logistic regression to investigate the association between self-reported, lifetime diagnosis of mental disorder and these health-related outcomes post-release, adjusting for pre-existing disadvantage., Results: 43.4% of participants reported a lifetime diagnosis of mental disorder. This group had increased crude odds of poor outcomes across all evaluated domains. After adjusting for pre-existing disadvantage, significantly increased odds of poor outcomes persisted in the substance use, mental health, crime and health service access domains., Conclusions: People with a history of mental disorder experience particularly poor outcomes following release from prison that are not fully explained by pre-existing disadvantage., Implications: Evidence-based transitional programs for prisoners with a history of mental disorder should be provided at a level commensurate with need., (© 2014 Public Health Association of Australia.)

Background: Alcohol and mental health disorders are highly prevalent in the general population, with co-occurrence recognised as a major public health issue. Socio-economic factors are frequently associated with both disorders but their temporal association is unclear. This paper examines the association between prenatal socio-economic disadvantage and comorbid alcohol and mental health disorders at young adulthood., Methods: An unselected cohort of women was enrolled during early pregnancy in the large longitudinal Mater-University of Queensland Study of Pregnancy (MUSP), at the Mater Misericordiae Public Hospital in Brisbane, Australia. The mothers and their offspring were followed over a 21 year period. Offspring from the MUSP birth cohort who provided full psychiatric information at age 21 and whose mothers provided socioeconomic information at baseline were included (n=2399). Participants were grouped into no-disorder, mental health disorder only, alcohol disorder only or comorbid alcohol and mental health disorders according to DSM-IV diagnoses at age 21 as assessed by the Composite International Diagnostic Interview. We used multivariate logistic regression analysis to compare associations of disorder group with single measures of prenatal socio-economic disadvantage including family income, parental education and employment, and then created a cumulative scale of socioeconomic disadvantage., Results: Greater socio-economic disadvantage was more strongly associated with comorbidity (OR 3.36; CI95 1.37, 8.24) than with single disorders. This relationship was not fully accounted for by maternal mental health, smoking and drinking during pregnancy., Conclusion: Multiple domains of socio-economic disadvantage in early life are associated with comorbid alcohol and mental health disorders., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Objective: Strategies such as reminders are frequently used to maximize baseline recruitment and for this reason are collectively termed "usual practice." The objective of this study was to investigate substitution sampling as an alternative recruitment strategy., Study Design and Settings: Data are from the Living with Diabetes Study, which is a prospective cohort study providing a comprehensive examination of health care utilization. Baseline information was collected for 3,197 of 11,470 eligible individuals between November 2008 and October 2009. Follow-up occurred 12 months after recruitment, with outcome of interest being emergency department attendance. Biases resulting from the two recruitment programs were investigated through the comparison of adjusted logistic regression coefficients and absolute relative biases (ARBs)., Results: Corresponding estimates resulting from both programs were similar except for age (75+ years). This effect was significant (β: -0.59; 95% confidence interval [CI]: -1.04, -0.13) under substitution sampling, but not under "usual practice" (β: -0.36; 95% CI: -0.78, 0.07). Analysis using the ARB metric reinforced similarity, with the Wilcoxon signed-rank test failing to detect significant difference between programs (median difference: -1.01; 95% CI: -5.88, 2.02)., Conclusion: Substitution sampling deserves consideration as a recruitment option alongside "usual practice," as concerns about additional bias may be unwarranted., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Backgrounds: Parental drinking, harsh parental discipline and adolescent antisocial behaviour have been independently implicated in adolescent alcohol use. Robust prospective studies are required to examine developmental relationships between these factors and their effect on trajectories of alcohol use across adolescence., Methods: Data were ascertained at three consecutive adolescent waves (13.5, 15.5 and 17.5 years) from the Australian Temperament Project, a 15-wave (30 year) general population birth cohort in Victoria, Australia. Adolescent alcohol trajectories, adjusted for time-varying measures of parenting and antisocial behaviour, were regressed on time-stable measures of parental alcohol use. The full case analysis comprised 751 individuals with complete data., Results: Two distinct alcohol trajectories were identified across the three adolescent waves after adjusting for time-varying factors: a higher and lower drinking group. Both trajectories increased linearly over the study period. Antisocial behaviour was positively associated with both trajectories while harsh parental discipline was positively associated with alcohol use in the lower-use group only. Increased maternal and paternal drinking at 13.5 years placed teenagers at a greater risk of being included in the high-risk trajectory., Conclusion: Parental drinking was the strongest predictor of different drinking trajectories in adolescence. This finding underscores the importance of comprehensive public heath approaches that target both parental and adolescent drinking attitudes and behaviour.

Background: This study aimed to assess the predictive validity of the Alcohol Use Disorders Identification Test (AUDIT) among adult prisoners with respect to hazardous drinking following release, and identify predictors of post-release hazardous drinking among prisoners screening positive for risk of alcohol-related harm on the AUDIT., Methods: Data came from a survey-based longitudinal study of 1325 sentenced adult prisoners in Queensland, Australia. Baseline interviews were conducted pre-release with follow-up at 3 and 6 months post-release. We calculated sensitivity, specificity and area under the receiver operating characteristic (AUROC) to quantify the predictive validity of the AUDIT administered at baseline with respect to post-release hazardous drinking. Other potential predictors of hazardous drinking were measured by self-report and their association with the outcome was examined using logistic regression., Results: At a cut-point of 8 or above, sensitivity of the AUDIT with respect to hazardous drinking at 3-month follow-up was 81.0% (95%CI: 77.9-84.6%) and specificity was 65.6% (95%CI: 60.6-70.3%). The AUROC was 0.78 (95%CI: 0.75-0.81), indicating moderate accuracy. Among those scoring 8 or above, high expectations to drink post-release (AOR: 2.49; 95%CI: 1.57-3.94) and past amphetamine-type stimulant (ATS) use (AOR: 1.64; 95%CI: 1.06-2.56) were significantly associated with hazardous drinking at 3 months post-release. Results were similar at 6 months., Conclusions: Among adult prisoners in our sample, pre-release AUDIT scores predicted hazardous drinking six months after release with acceptable accuracy, sensitivity and specificity. Among prisoners screening positive on the AUDIT, expectations of post-release drinking and ATS use are potential targets for intervention to reduce future hazardous drinking., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

We tested if the risk of suicidal ideation in individuals with PTSD symptoms was dependent on comorbid sleep disturbance. Our cross-sectional sample included 2465 participants with complete data from the 21 year follow-up of the Mater University Study of Pregnancy (MUSP), a birth cohort study of young Australians. Using structural equation modelling with indirect pathways we found that 12 month PTSD symptoms did not directly predict suicidal ideation at 21 when adjusting for major depression symptoms, polyvictimization and gender. However, PTSD symptoms had an indirect effect on suicidal ideation via past-month sleep disturbance. Our results suggest that increased suicidal ideation in those with PTSD may result from the fact that PTSD sufferers often exhibit other comorbid psychiatric conditions which are themselves known to predict suicidal behaviours. Sleep disturbance may be targeted in those who experience PTSD to help prevent suicidal ideation., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Background: Limited evidence suggests that younger people who inject drugs (PWID) engage in high-risk injecting behaviours. This study aims to better understand the relationships between age and risky injecting behaviours., Methods: Data were taken from 11 years of a repeat cross-sectional study of sentinel samples of regular PWID (The Australian Illicit Drug Reporting System, 2001-2011). Multivariable Poisson regression was used to explore the relationship between age and four outcomes of interest: last drug injection occurred in public, receptive needle sharing (past month), experiencing injecting-related problems (e.g. abscess, dirty hit; past month), and non-fatal heroin overdose (past six months)., Results: Data from 6795 first-time study participants were analysed (median age: 33 years, interquartile range [IQR]: 27-40; median duration of injecting: 13 years [IQR: 7-20]). After adjusting for factors including duration of injecting, each five year increase in age was associated with significant reductions in public injecting (adjusted incidence rate ratio [AIRR]: 0.90, 95% confidence interval [CI]: 0.88-0.92), needle sharing (AIRR: 0.84, 95% CI: 0.79-0.89) and injecting-related problems (AIRR: 0.96, 95% CI: 0.95-0.97). Among those who had injected heroin in the six months preceding interview, each five year increase in age was associated with an average 10% reduction in the risk of heroin overdose (AIRR: 0.90, 95% CI: 0.85-0.96)., Conclusions: Older PWID report significantly lower levels of high-risk injecting practices than younger PWID. Although they make up a small proportion of the current PWID population, younger PWID remain an important group for prevention and harm reduction., (Copyright © 2013. Published by Elsevier Ireland Ltd.)

Background: Health outcomes after release from prison are typically poor with elevated rates of morbidity and mortality widely documented. Under-utilisation of health services contributes to these outcomes, but interventions to increase health service utilisation in ex-prisoners are in their infancy and few have been rigorously evaluated., Methods: Single-blinded randomised controlled trial of a service brokerage intervention (the 'Passports study') for N = 1325 adult ex-prisoners in Queensland, Australia. Participants in the intervention group received a personalised booklet summarising their health status and identifying appropriate community health services; trained workers made weekly telephone contact in the first 4 weeks post-release to identify health needs and facilitate health service utilisation. Participants in the control arm received usual care. Baseline data were collected within 6 weeks of expected release from custody with follow-up telephone interviews 1, 3 and 6 months post-release. Participant identities were linked with federal health service utilisation records, a national death register and corrective services records, two years post-release. The primary outcome was self-reported health service utilisation in the first 6 months post-release., Results: Between 2008 and 2010 1976 prisoners were screened for eligibility, 1665 met eligibility criteria and 1325 were recruited; 665 were randomised to the intervention and 660 to the control condition. Participants were broadly representative of adults being released from prison in Queensland except that women were intentionally oversampled (21% vs. 11%)., Conclusions: Outcomes from this large RCT will provide the first robust evidence of the effect of service brokerage on health service utilisation and health outcomes for ex-prisoners., (© 2013.)

Objectives: Longitudinal studies are a major tool for public health research, but their value can be undermined by attrition. Identification of factors associated with attrition through modeling depends on the efficient use of data and is conditional on modeling assumptions being met. The primary aim of this study was to compare the performance of four models in analyzing attrition risk., Study Design and Setting: Data from participants who were lost to follow-up from The Nambour Skin Cancer Study between 1992 and 2000 were analyzed using logistic and survival models, for all-cause and nondeath attritions., Results: During follow-up, 321 (19.8%) of 1,621 participants were lost to follow-up; 70 (4.3%) because of death and 251 (15.5%) for other reasons. Using survival models showed skin cancer diagnosis to be associated with increased all-cause attrition (hazard ratio: 2.3; 95% confidence interval [95% CI]: 1.5, 3.4) and nondeath attrition (subhazard ratio: 1.9; 95% CI: 1.0, 3.3). Using logistic regression resulted in inverse associations being observed for both all-cause attrition (odds ratio [OR]: 0.7; 95% CI: 0.5, 1.1) and nondeath attrition (OR: 0.5; 95% CI: 0.3, 1.0)., Conclusion: These results demonstrate the relative inadequacy of a logistic as opposed to a survival approach when analyzing attrition risk in the presence of time-varying covariates and multiple timepoints., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objectives: Minimizing attrition is a key objective in longitudinal research, with possible consequences being additional bias and reduced generalizability. Identifying determinants of attrition is essential in determining attrition prevention strategies. The objective of this study was to investigate a number of these determinants, with an emphasis on contactability., Study Design and Setting: Data were taken from the Passports project, a randomized controlled trial of an intervention to provide postrelease support to ex-prisoners in Queensland, Australia. Measures of contactability included intervention intensity, baseline collaterals, and follow-up telephone calls, with attrition at follow-up being the outcome event. Multivariable modeling was used to assess the independent effects of these measures on attrition., Results: Attrition was found to be more likely among those who were not contacted between the release and follow-up (adjusted odds ratio [AOR]: 2.93; 95% confidence interval [CI]: 1.87, 4.60), did not provide collaterals (AOR: 2.58; 95% CI: 1.68, 3.97), and received more than four telephone calls (AOR: 2.42; 95% CI: 1.61, 3.63). Evidence of dose-response relationships between attrition and the measures of collaterals and telephone calls was also seen to exist., Conclusion: These findings have implications for sample size maintenance, especially those involving hard-to-reach populations. Subject to cost constraints and possible diminishing returns, researchers should endeavor to implement a study protocol that facilitates continued contact during follow-up., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objective: To assess the cost-effectiveness of sample size maintenance programs in a prospective cohort., Study Design and Setting: The Living with Diabetes Study in Queensland, Australia is a longitudinal survey providing a comprehensive examination of health care utilization and disease progression among people with diabetes. Data from this study were used to compare the cost-effectiveness of a program incorporating substitution sampling with two alternative programs: "no follow-up" and "usual practice.", Results: A program involving substitution sampling was shown to be the most effective with an additional 3,556 complete responses (compared with a "no follow-up" program) and an additional 2,099 complete responses (compared with "usual practice"). An incremental analysis through a Monte Carlo simulation found substitution sampling to be the most cost-effective option for maintaining sample size with an incremental cost-effective ratio of $54.87 (95% uncertainty interval $52.68-$57.25) compared with $87.58 ($77.89-$100.09) for "usual practice.", Conclusions: Based on the available data, a program involving substitution sampling is economically justified and should be considered in any approach with the aim of maintaining sample size. There is, however, a continuing need to evaluate the effectiveness of this option on other outcome measures, such as bias., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: The past decade has seen the development of an array of emerging psychoactive substances (EPS), however, there is minimal information on the extent of their use outside Europe. This study aimed to determine the extent of use of EPS from stimulant (such as mephedrone) and psychedelic classes (such as 5-methoxy-dimethyltryptamine [5-MeO-DMT]) among an Australian sample of regular ecstasy users (REU). Further, to determine if consumers of these drugs represent a distinct subgroup of REU., Methods: Australian national cross-sectional surveys of 693 regular (at least monthly) ecstasy users conducted during 2010., Results: More than one quarter (28%) of REU had used an EPS in the past six months, most commonly from the stimulant class (20%, typically mephedrone, 17%) rather than the psychedelic class (13%). Demographics and risk behaviours of REU that used stimulant EPS were largely no different from non-EPS consuming REU. Those using psychedelic EPS were distinct, initiating ecstasy use earlier, more frequently using multiple substances (cannabis, inhalants, GHB, ketamine) and more commonly experiencing legal, psychological and social problems., Conclusions: Psychedelic EPS use appears largely restricted to a distinct subset of REU with high-level non-injecting polydrug use, but use appears generally limited. The demographic similarity of stimulant EPS consumers with 'mainstream' REU, in conjunction with positive responses to the psychoactive effects of these drugs and declining ecstasy purity, suggests strong potential for stimulant EPS to expand further into ecstasy markets. Such drugs may have a greater public health impact than ecstasy, and merit careful monitoring into the future., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Recent evidence has linked birth weight to later behaviour/mental disorders, yet studies have hitherto neglected to investigate the relationship between birth weight and adult anxiety disorders. Prospectively collected data from 2210 mother/offspring pairs of the Mater University Study of Pregnancy (MUSP) birth cohort was used to test for associations between birth weight z-score and four major groupings of DSM-IV anxiety disorders. Birth weight z-score was linearly and inversely associated with lifetime diagnosis of post-traumatic stress disorders at 21 years, with those falling within the smallest birth weight quintile group at almost two-fold increased odds (OR=1.96, 95% CI: 1.10, 3.52) of being diagnosed with the disorder compared to those falling within the largest group. The association remained when subsequent analysis restricted the sample to those exposed to trauma. This is the first study in which birth weight has been found to be associated with post-traumatic stress disorders in adults., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: Studies of the effects of maternal smoking during pregnancy have reported inconsistent findings in relation to measures of offspring cognitive functioning. Few studies, however, have examined learning outcomes in adolescents, as opposed to IQ., Aim: To examine the association between maternal smoking during pregnancy and academic performance among adolescent offspring., Study Design: Population-based birth cohort study., Subjects: 7223 mothers and children were enrolled in the Mater-University of Queensland Study of Pregnancy in Brisbane (Australia) from 1981 to 1984. Analyses were restricted to the 4294 mothers and children for whom all information was reported at 14-year follow-up., Outcome Measures: Reports of academic performance of 14-year-old offspring in English, Science and Mathematics with different patterns of maternal smoking (never smoked, smoked before and/or after pregnancy but not during pregnancy, or smoked during pregnancy)., Results: Low academic achievement was more common only in those whose mothers had smoked during pregnancy. Effect sizes were, however, small. The adjusted mean difference in total learning score for smoking before and/or after pregnancy but not during pregnancy, and for smoking during pregnancy were -0.18 (-0.58, 0.22) and -0.40 (-0.69, -0.12). Similarly, the adjusted odds ratios were 0.9 (0. 65, 1.24) and 1.35 (1.07, 1.70)., Conclusion: Maternal smoking during pregnancy is a preventable prenatal risk factor associated with small decrements in offspring academic performance that continue into adolescence.

Objective: To investigate whether maternal smoking during pregnancy predicts offspring nicotine disorder (dependence or withdrawal) at 21 years., Method: Participants comprised a prospective birth cohort involving 7,223 singleton children whose mothers were enrolled between 1981 and 1983 at the first antenatal visit to the Mater Mothers' Hospital, Brisbane, Queensland. The present sub-cohort consisted of 2,571 youth who completed the Composite International Diagnostic Interview-computerised version (CIDI-Auto) that assesses nicotine dependence and withdrawal according to DSM-IV diagnostic criteria at the 21-year follow-up., Results: 12.8% of offspring met criteria for nicotine dependence and 8.5% met criteria for withdrawal. 16.6% met criteria for either dependence or withdrawal. Smoking during pregnancy resulted in offspring being more likely to have dependence or withdrawal at 21 years than offspring of mothers who never smoked (age adjusted odds ratio 1.53 (95% CI: 1.19-1.96)., Conclusions: Findings emphasise the long-term adverse effects of maternal smoking during pregnancy, including nicotine dependence in young adult offspring., Implications: Public health approaches should strengthen arguments for mothers to cease smoking during pregnancy in view of the long-term health implications for offspring, and reinforce measures to help smokers among pregnant women and women of childbearing age to stop.

Objective: To assess the value of drinking guidelines applied in adolescence for predicting alcohol-related outcomes in young adulthood., Methods: We conducted an eight-wave, population-based cohort study of 696 males and 824 females in Victoria between 1992 and 2003. Adolescent drinking was assessed at five survey waves, in six month intervals, from mean age 15.4-17.4 years. We created three measures of adolescent alcohol use using categories from NHMRC drinking guidelines: risky/high-risk drinking in the short and long term (2001), and high-risk drinking (2007). Each measure was defined according to the number of waves at which drinking was reported at or above the designated level during adolescence: non-drinkers, zero waves (low-risk drinkers), one wave, and 2+ waves. Alcohol use disorders and alcohol-related sexual behaviours were assessed at mean age 24.1 years., Results: Fourteen per cent of males and 17% of females were non-drinkers during adolescence. Using each NHMRC drinking guideline, the prevalence of each outcome for men increased with the number of waves at which drinking was reported above the low-risk level (p-values <0.007). The association was less clear for women. The prevalence of each outcome was lower among the nondrinkers compared to the low-risk drinkers for both men and women., Conclusions and Implications: These findings support the emphasis in the NHMRC guidelines on abstaining from alcohol during the adolescent years. Any drinking, even at the low-risk level, may not be appropriate in adolescence. However, refinements that could better capture the risk of adolescent drinking in women would be useful.

Background: It is unclear whether fetal alcohol exposure contributes to alcohol use in adolescence. In this study, we examine the association between maternal alcohol use in pregnancy and adolescents' drinking patterns at age 14., Methods: The association of maternal alcohol exposure with early drinking was examined in 4363 adolescents taking part to the Mater University Study of Pregnancy (MUSP) and its outcomes, a population based birth cohort study commenced in Brisbane (Australia) in 1981. Mothers and children were followed up at birth, 5 and 14 years after the initial interview. Maternal alcohol use was assessed before and during pregnancy and at the 5 years follow-up. Adolescents' alcohol use was assessed at child age 14., Results: In multivariable analysis those born of mothers who consumed 3+ glasses during pregnancy were at increased risk to report drinking 3+ glasses compared with those whose mothers reported no drinking or drinking up to 2 glasses. Comparisons controlling for drinking before pregnancy and at age 5 found the averaged odds ratio of maternal drinking in pregnancy on risk of reporting alcohol consumption of 3 and more glasses at age 14 was 2.74 (CI 1.70, 4.22)., Conclusion: Our study suggests that they maybe a biological origin of early drinking. Further studies are needed to better disentangle the nature of the association and the role of other possible confounding factors.

Aims: To investigate pathways to ecstasy use disorders from pre-birth to early adulthood with particular attention to the relationship between early depressive and anxiety symptoms and later ecstasy use disorders., Design: Prospective, longitudinal, population-based study started in Brisbane, South East Queensland (Australia) in 1981. Participants were 2143 young adults, followed up from pre-birth to young adulthood., Measurements: Ecstasy use disorders were assessed with the composite international diagnostic interview (CIDI-Auto). Maternal socio-economic position and mental health status were assessed at baseline (antenatal visit); maternal substance use was measured at the 5-year follow-up, adolescents' behaviour at the 5- and 14-year follow-up and tobacco and alcohol use were assessed at the 14-year follow-up., Findings: Eight syndrome scales of childhood behaviour were examined. After adjustment for important confounders, delinquent and aggressive behaviour in early adolescence remained significantly associated with ecstasy use disorders in early adulthood. The associations became statistically non-significant when adolescent tobacco and alcohol use were included in the model [OR=1.50 (95%CI=0.75, 3.01) for delinquency and OR=1.69 (95%CI=0.92, 3.12) for aggression]. Formal mediation tests were statistically significant (p=0.001 for delinquent behaviour and p=0.05 for aggressive behaviour)., Conclusions: Our findings suggest a pathway from early deviant behaviour to ecstasy use disorders, possibly mediated through licit drug experimentation in early adolescence.

Objective: To examine whether age of first use or frequency of use of cannabis is associated with anxiety and depression (AD) in young adults, independent of known potential confounders, including the use of other illicit drugs., Method: A cohort of 3,239 Australian young adults was followed from birth to the age of 21 when data on AD were obtained from sample members along with information on their use of cannabis at 21 years. Potential confounding factors were prospectively measured when the child was born and at 14 years., Results: After controlling for confounding factors, those who started using cannabis before age 15 years and used it frequently at 21 years were more likely to report symptoms of AD in early adulthood (odds ratio 3.4; 95% CI 1.9-6.1). This association was of similar magnitude for those who had only used cannabis and those who reported having used cannabis and other illicit drugs., Conclusion: The relationship between early-onset and frequent use of cannabis and symptoms of AD is independent of individual and family backgrounds. Frequent cannabis use is associated with increased AD in young adults independently of whether the person also uses other illicit drugs.