Elsevier

Drug and Alcohol Dependence

Volume 176, 1 July 2017, Pages 33-43
Drug and Alcohol Dependence

Full length article
The association of prenatal cocaine exposure, externalizing behavior and adolescent substance use

https://doi.org/10.1016/j.drugalcdep.2017.01.027Get rights and content

Highlights

Abstract

Prenatal cocaine exposure (PCE) may increase adolescent substance use through alterations of neurotransmitter systems affecting fetal brain development. The relationship between PCE and substance use at 15 and 17 years was examined. Subjects (365: 186 PCE; 179 non-cocaine exposed (NCE)) supplied biologic and self-report data using the Youth Risk Behavior Surveillance System (YRBSS) and Computerized Diagnostic Interview Schedule for Children (C-DISC 4) at ages 15 and 17. The relationship between PCE and substance use was assessed using General Estimating Equation (GEE) analyses controlling for confounding factors including violence exposure and preschool lead level. Teens with PCE vs. NCE teens were 2 times more likely to use tobacco (OR = 2.1; 95% CI 1.21–3.63; p < .001) and marijuana (OR = 1.85; CI 1.18–2.91; p < .001) and have a substance use disorder at age 17 (OR = 2.51; CI 1.00–6.28; p < .05). Evaluation of PCE status by gender revealed an association between PCE and marijuana use that was more pronounced for boys than girls at 17 years. Violence exposure was also a significant predictor of alcohol (p < .001), tobacco (p < .05), and marijuana (p < .0006) use and substance abuse/dependence (p < .01). Externalizing behavior at age 12 fully mediated the effects of PCE on substance use disorder at age 17 and partially mediated effects of PCE on tobacco use, but did not mediate effects on marijuana use. The percentage of substance use reported increased between 15 and 17 years, with no differences between the PCE and NCE groups. Data suggest specialized drug use prevention measures for children with PCE may benefit this high risk group.

Section snippets

1 Introduction

Adolescent substance use is a significant concern in the United States, with 6.5% of 12th graders reporting daily marijuana use (Johnston et al., 2014), 1.0% of 12–17 year-olds reporting five or more drinks at one time at least five days during the past 30 days (Center for Behavioral Health Statistics and Quality, 2015) and 20.8% of high school students reporting binge drinking five or more drinks in a row on at least one day in the past 30 days (Kann et al., 2014). In 2014, the national rate of

Sample

The study sample consisted of 365 adolescents (186 PCE, 179 NCE) who were followed prospectively from birth and assessed for substance use at ages 15 and 17 years. The participants and their birth mother were recruited between September 1994 and June 1996 from a large urban teaching hospital in the Midwest for a longitudinal investigation of the developmental effects of prenatal cocaine exposure.

Drug toxicology screens were administered to 647 mothers and infants at delivery who were identified

Sample characteristics

Table 1 provides birth outcome and demographic characteristics of study participants by cocaine exposure status. Those with PCE had lower average gestational age, birth lengths, and head circumferences and were small for gestational age compared with non-exposed infants. Adolescents with PCE reported more externalizing behavior problems at age 12 and had lower IQ scores at age 15 than their non-exposed counterparts. Adolescents with PCE were more likely to be placed in non-kinship foster or

Overall findings and relationship to existing research

Data from this study indicate that both prenatal cocaine exposure and environmental factors are associated independently with increased incidence of teen substance use in the past 30 days and self-reported diagnosis of abuse or dependence of any substance by 17 years of age after control for covariates. Specifically, at ages 15 and 17, youth with PCE reported greater tobacco and marijuana use over the past 30 days. Past 30 day use likely indicates more regular use patterns. Interestingly, the

Contributors

Dr. Meeyoung Min performed the statistical analyses, and drafted the manuscript. Dr. Sonia Minnes conceptualized the paper, designed the study and interpreted the data. Dr. Adelaide Lang coordinated the study, performed the measurements, and proofread the manuscript. Ms. Miaoping Wu participated in the interpretation of data. Ms. June-Yung Kim assisted in the literature review, drafting, and proofing the manuscript. Ms. Meredith Francis assisted in the literature review, drafting, and proofing

Role of funding source

This research was supported by the National Institute on Drug Abuse (NIDA)R01 07957. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Drug Abuse or the National Institutes of Health. This publication was also made possible by the Clinical and Translational Science Collaborative of Cleveland, UL1TR000439 from the National Center for Advancing Translational Sciences (NCATS) component of the National

Conflict of interest

No conflict declared

Acknowledgements

Contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. The authors would like to thank all of our families who participated in our research for 17 years. We would also like to thank Miaoping Wu, MS, Laurie Ellison, LISW, and Paul Weishampel, M.A. for research assistance, and Terri Lotz-Ganley for manuscript preparation and editorial assistance.

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      These may include prenatal exposure to other substances such as alcohol (Larkby et al., 2011; Min et al., 2021b; Singer et al., 2021), tobacco (Maughan et al., 2004; Min et al., 2021a), and marijuana (Goldschmidt et al., 2000); maternal/caregiving factors, such as caregiver’s ongoing substance use (Elkington et al., 2011) and psychological distress (Min et al., 2018), the quality of home environment (Singer et al., 2008), and parental monitoring (Trucco, 2020); and environmental factors, such as exposure to violence (Delaney-Black et al., 2002; Kobulsky et al., 2016), sexual victimization (Cicchetti and Handley, 2019; Min et al., 2016), non-kinship adoptive/foster care placement (Linares et al., 2006; Sariaslan et al., 2022), and few ecological resources from family, school, and the community (Min et al., 2017; Tucker et al., 2013). We also assessed offspring sex and IQ as covariates given the well-documented sex differences in substance use (Becker et al., 2016; Minnes et al., 2017) and the impact of IQ on SUD (Harden et al., 2017). We hypothesized that PCE would be related to higher externalizing behaviors in childhood, which would in turn contribute to substance use and substance use related problems in adolescence, leading to SUD in emerging adulthood.

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      Elevated blood lead levels with known effects on children's behavior are prevalent among inner city children with PCE (Minnes et al., 2010). Adolescents with PCE are often exposed to suboptimal caregiving conditions, including caregivers' ongoing drug use, psychological distress (Minnes et al., 2010), with decreased receptive vocabulary skills (Minnes et al., 2014, 2017), and impoverished home environments (Min et al., 2015), all of which may be adversely related to the adolescents' mental health. Related environmental factors such as violence exposure (Gerteis et al., 2011; Lagasse et al., 2006; Richardson et al., 2016) or placement in foster or adoptive care (Barthelemy et al., 2016; Sousa et al., 2018) may also confound the associations of PCE with mental health symptoms.

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