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Background: Most studies of the effects of prenatal alcohol exposure (PAE) on cognitive function have assumed that the dose-response curve is linear. However, data from a few animal and human studies suggest that there may be an inflection point in the dose-response curve above which PAE effects are markedly stronger and that there may be differences associated with pattern of exposure, assessed in terms of alcohol dose per drinking occasion and drinking frequency. Methods: We performed second-order confirmatory factor analysis on data obtained at school age, adolescence, and early adulthood from 2227 participants in six US longitudinal cohorts to derive a composite measure of cognitive function. Regression models were constructed to examine effects of PAE on cognitive function, adjusted for propensity scores. Analyses based on a single predictor (absolute alcohol (AA)/day) were compared with analyses based on two predictors (dose/occasion and drinking frequency), using (1) linear models and (2) nonparametric general additive models (GAM) that allow for both linear and nonlinear effects. Results: The single-predictor GAM model showed virtually no nonlinearity in the effect of AA/day on cognitive function. However, the two-predictor GAM model revealed differential effects of maternal drinking pattern. Among offspring of infrequent drinkers, PAE effects on cognitive function were markedly stronger in those whose mothers drank more than ~3 drinks/occasion, and the effect of dose/occasion was strongest among the very frequent drinkers. Frequency of drinking did not appear to alter the PAE effect on cognitive function among participants born to mothers who limited their drinking to ~1 drink/occasion or less. Conclusions: These findings suggest that linear models based on total AA/day are appropriate for assessing whether PAE affects a given cognitive outcome. However, examination of alcohol dose/occasion and drinking frequency is needed to fully characterize the impact of different levels of alcohol intake on cognitive impairment. [ABSTRACT FROM AUTHOR]

Alcohol use across pregnancy causes growth and other abnormalities in the offspring. Confirmation of pregnancy leads some women to discontinue alcohol use and other women to continue use. The study discussed in this article assessed alcohol use at the first and third trimesters and at delivery for 393 pregnant African American women in an urban area. At the first trimester, 118 women were moderate to heavy drinkers (one or more drinks per day), compared with 38 women who were at delivery. Socioenvironmental and psychological differences were identified for both women who reduced consumption and women who continued. An understanding of continued drinkers' vulnerability to factors that influence their drinking behaviors demands the development of appropriate, early, and effective intervention strategies. Social welfare implications are discussed. [ABSTRACT FROM AUTHOR]

Investigates the impact of prenatal cocaine exposure while controlling for other factors that influence infant outcome. Detailed information about the use of cocaine, crack, alcohol, tobacco, marijuana and other drugs during each trimester of pregnancy; Results suggesting the absence of any significant effect of prenatal cocaine use in infant growth and morphology.

This paper discusses efforts to retain resistant subjects (N = 88) in a prospective research project which investigates the effects of prenatal substance use on pregnancy and infant outcome. Resistant subjects were women for whom we had valid addresses and/or phone numbers. They did not refuse to participate but were reluctant to schedule appointments and/or keep scheduled appointments. The persistent resistance we encountered led us to develop procedures which established and maintained rapport with resistant respondents and facilitated access to the 18-month assessment. No significant differences were found between the resistant participants and nonresistant subjects on six sociodemographic factors and on substance use. [ABSTRACT FROM AUTHOR]

Abstract: This study characterized the extent and patterns of self-reported drug use among aging adults with and without HIV, assessed differences in patterns by HIV status, and examined pattern correlates. Data derived from 6351 HIV-infected and uninfected adults enrolled in an eight-site matched cohort, the Veterans Aging Cohort Study (VACS). Using clinical variables from electronic medical records and socio-demographics, drug use consequences, and frequency of drug use from baseline surveys, we performed latent class analyses (LCA) stratified by HIV status and adjusted for clinical and socio-demographic covariates. Participants were, on average, age 50 (range 22–86), primarily male (95%) and African-American (64%). Five distinct patterns emerged: non-users, past primarily marijuana users, past multidrug users, current high consequence multidrug users, and current low consequence primarily marijuana users. HIV status strongly influenced class membership. Non-users were most prevalent among HIV uninfected (36.4%) and current high consequence multidrug users (25.5%) were most prevalent among HIV-infected. While problems of obesity marked those not currently using drugs, current users experienced higher prevalences of medical or mental health disorders. Multimorbidity was highest among past and current multidrug users. HIV-infected participants were more likely than HIV-uninfected participants to be current low consequence primarily marijuana users. In this sample, active drug use and abuse were common. HIV-infected and uninfected Veterans differed on extent and patterns of drug use and on important characteristics within identified classes. Findings have the potential to inform screening and intervention efforts in aging drug users with and without HIV. [Copyright &y& Elsevier]

We prospectively examined the relationship between prenatal tobacco exposure (PTE) and child behavior in a birth cohort of 357 offspring of teenage mothers. PTE was defined as any exposure across pregnancy and, in separate analyses, exposure within each trimester. Outcomes included measures of behavior problems, activity, and attention. On average, the children were 6.4 years of age, 48% were females, and 69% were Black. Data on maternal tobacco and other substance use were collected prenatally and postnatally: 46% of the mothers smoked in the first trimester and 58% smoked 6 years later. Child urinary cotinine measured exposure to environmental tobacco smoke (ETS). Stepwise multiple regressions were run. PTE predicted significantly increased offspring activity; impulsivity; and aggression, externalizing, and total behavior problems in step 1. PTE remained a significant predictor of increased activity when maternal psychological characteristics, home environment, and ETS were added. The results were similar when PTE was examined by trimesters, although later pregnancy tobacco exposure predicted the most behavioral outcomes. In the final model, PTE (all three trimesters) and PTE (second trimester) were significant predictors of increased activity and attention problems, respectively. Other predictors of child behavior included maternal anxiety, depression, hostility, and home environment. ETS was not a significant predictor of child behavior when PTE was considered. Smoking during pregnancy among adolescents is a significant predictor of increased activity and attention problems in their offspring after controlling for covariates in the prenatal and current environments. Smoking cessation interventions are recommended for this population to avoid the effects of PTE on the offspring of pregnant adolescents. This is particularly important because these mothers will likely become pregnant again and many will increase their level of tobacco use as they mature.

Aim: To evaluate the effects of prenatal marijuana exposure (PME) on the age of onset and frequency of marijuana use while controlling for identified confounds of early marijuana use among 14-year-olds., Design: In this longitudinal cohort study, women were recruited in their fourth prenatal month. Women and children were followed throughout pregnancy and at multiple time-points into adolescence., Setting and Participants: Recruitment was from a hospital-based prenatal clinic. The women ranged in age from 18 to 42, half were African American and half Caucasian, and most were of lower socio-economic status. The women were generally light to moderate substance users during pregnancy and subsequently. At 14 years, 580 of the 763 offspring-mother pairs (76%) were assessed. A total of 563 pairs (74%) was included in this analysis., Measurements: Socio-demographic, environmental, psychological, behavioral, biological and developmental factors were assessed. Outcomes were age of onset and frequency of marijuana use at age 14. PME predicted age of onset and frequency of marijuana use among the 14-year-old offspring. This finding was significant after controlling for other variables including the child's current alcohol and tobacco use, pubertal stage, sexual activity, delinquency, peer drug use, family history of drug abuse and characteristics of the home environment including parental depression, current drug use and strictness/supervision., Conclusions: Prenatal exposure to marijuana, in addition to other factors, is a significant predictor of marijuana use at age 14.

Objective: To identify factors that predict or are correlated with symptoms of depression and anxiety in 10-year-olds., Method: Women and their offspring were followed from the fourth prenatal month through 10 years. There were 636 mother-child pairs at 10 years, a follow-up rate of 83% of the birth cohort. Cognitive, psychological, sociodemographic, and environmental factors were measured at each phase. High depression and anxiety were defined as having a number of symptoms >1 SD above the mean for each measure. These measures were combined to represent high depression and/or anxiety (D/A) at 10 years of age., Results: Predictors from the prenatal period of D/A at 10 years were more maternal depression symptoms, African American race, less social support, greater household density, and prenatal marijuana exposure. From 18 months through 6 years, lower child IQ, child injuries at age 3, and attention problems predicted symptoms of D/A at age 10. Across all study phases, lower child IQ, household density during pregnancy, attention problems, early childhood injuries, and prenatal marijuana exposure predicted D/A. Maternal psychological and sociodemographic factors were not significant in the final model., Conclusions: Factors from gestation and early childhood predict high symptom levels of depression and anxiety at age 10. When gestational exposure, early environmental factors, and child characteristics were considered, maternal depression and socioeconomic status were not significantly associated with early onset D/A. Marijuana exposure during gestation marginally predicted depression/anxiety at age 10.