Protective Factors Can Mitigate Behavior Problems After Prenatal Cocaine and Other Drug Exposures

Department of Pediatrics, College of Medicine, University of Kentucky, Lexington, Kentucky
PEDIATRICS (Impact Factor: 5.47). 11/2012; 130(6). DOI: 10.1542/peds.2011-3306
Source: PubMed


We determined the role of risk and protective factors on the trajectories of behavior problems associated with high prenatal cocaine exposure (PCE)/polydrug exposure.

The Maternal Lifestyle Study enrolled 1388 children with or without PCE, assessed through age 15 years. Because most women using cocaine during pregnancy also used other substances, we analyzed for the effects of 4 categories of prenatal drug exposure: high PCE/other drugs (OD), some PCE/OD, OD/no PCE, and no PCE/no OD. Risks and protective factors at individual, family, and community levels that may be associated with behavior outcomes were entered stepwise into latent growth curve models, then replaced by cumulative risk and protective indexes, and finally by a combination of levels of risk and protective indexes. Main outcome measures were the trajectories of externalizing, internalizing, total behavior, and attention problems scores from the Child Behavior Checklist (parent).

A total of 1022 (73.6%) children had known outcomes. High PCE/OD significantly predicted externalizing, total, and attention problems when considering the balance between risk and protective indexes. Some PCE/OD predicted externalizing and attention problems. OD/no PCE also predicted behavior outcomes except for internalizing behavior. High level of protective factors was associated with declining trajectories of problem behavior scores over time, independent of drug exposure and risk index scores.

High PCE/OD is a significant risk for behavior problems in adolescence; protective factors may attenuate its detrimental effects. Clinical practice and public health policies should consider enhancing protective factors while minimizing risks to improve outcomes of drug-exposed children.

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    • "Many of these correlates of age of sexual initiation have also been documented in youth with prenatal cocaine exposure (PCE). For example, PCE is associated with increased child behavior problems (Ackerman et al., 2010; Bada et al., 2012; Bennett et al., 2013; Delaney-Black et al., 2004; McLaughlin et al., 2011; Minnes et al., 2010; Richardson et al., 2011; Whitaker et al., 2011). Children with PCE are often raised in less than optimal environments that are also linked to poor behavioral outcomes (Bradley and Corwyn, 2002; McLeod et al., 2007). "
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    ABSTRACT: Prenatal cocaine exposure (PCE) has been linked to child behavior problems and risky behavior during adolescence such as early substance use. Behavior problems and early substance use are associated with earlier initiation of sexual behavior. The goal of this study was to examine the direct and indirect effects of PCE on sexual initiation in a longitudinal birth cohort, about half of whom were exposed to cocaine in utero. Women were interviewed twice prenatally, at delivery, and 1, 3, 7, 10, 15, and 21 years postpartum. Offspring (52% female, 54% African American) were assessed at delivery and at each follow-up phase with age-appropriate assessments. At age 21, 225 offspring reported on their substance use and sexual behavior. First trimester cocaine exposure was a significant predictor of earlier age of first intercourse in a survival analysis, after controlling for race, sociodemographic characteristics, caregiver pre- and postnatal substance use, parental supervision, and child's pubertal timing. However, the association between PCE and age of first sexual intercourse was mediated by adolescent marijuana and alcohol use prior to age 15. Most of the effect of PCE on age of sexual initiation occurred between the ages of 13-18, when rates of initiation were approximately 10% higher among exposed offspring. This effect was mediated by early adolescent substance use. These results have implications for identification of the exposed offspring at greatest risk of HIV risk behaviors and early, unplanned pregnancy. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
    Drug and Alcohol Dependence 12/2014; 145:194-200. DOI:10.1016/j.drugalcdep.2014.10.011 · 3.42 Impact Factor
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    • "Environmental factors associated with prenatal drug use, such as poor quality of the home environment, caregiver ongoing substance use and psychological distress, violence exposure (Bada et al., 2007, 2011; Frank et al., 2011), non-kinship adoptive/foster care placement (Linares et al., 2006), negative attachment to caregiver (Warner et al., 2011) and low levels of parental monitoring (Bohnert, Anthony, & Breslau, 2012; Laird, Criss, Pettit, Dodge, & Bates, 2008) may heighten the drug exposed child's vulnerability to maladaptive behavioral development and obscure the long-term effects of PCE. In contrast, positive environmental factors may be protective or compensate for earlier biologic risk factors (Bada et al., 2012; Singer, 2004, 2008). "
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