Adolescent initiation of licit and illicit substance use: Impact of intrauterine exposures and post-natal exposure to violence

Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, 725 Massachusetts Avenue, Mezzanine SW, Boston, MA 02118, USA.
Neurotoxicology and Teratology (Impact Factor: 2.76). 01/2011; 33(1):100-9. DOI: 10.1016/
Source: PubMed


Whether intrauterine exposures to alcohol, tobacco, marijuana, or cocaine predispose offspring to substance use in adolescence has not been established. We followed a sample of 149 primarily African American/African Caribbean, urban adolescents, recruited at term birth, until age 16 to investigate intrauterine cocaine exposure (IUCE). We found that in Kaplan-Meier analyses higher levels of IUCE were associated with a greater likelihood of initiation of any substance (licit or illicit), as well as marijuana and alcohol specifically. Adolescent initiation of other illicit drugs and cigarettes were analyzed only in the "any" summary variable since they were used too infrequently to analyze as individual outcomes. In Cox proportional hazard models controlling for intrauterine exposure to alcohol, tobacco, and marijuana and demographic and post-natal covariates, those who experienced heavier IUCE had a greater likelihood of initiation of any substance, and those with lighter intrauterine marijuana exposure had a greater likelihood of initiation of any substance as well as of marijuana specifically. Time-dependent higher levels of exposure to violence between ages of 8 and 16 were also robustly associated with initiation of any licit or illicit substance, and of marijuana, and alcohol particularly.

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Available from: Ruth Rose-Jacobs, Mar 19, 2014
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    • "Although there is a well-known association between child's substance use and timing of first sexual intercourse, no studies to date have examined the direct and indirect effects of PCE on the full range of age at initiation of sexual behavior. Children with PCE are vulnerable to early sexual intercourse and associated reproductive health outcomes (such as STIs/HIV and unintended pregnancy) because of the strong association of PCE with early substance use (Delaney-Black et al., 2011; Frank et al., 2011; Minnes et al., 2014; Richardson et al., 2013b) and other risk factors (Ackerman et al., 2010; Buckingham-Howes et al., 2013; Richardson et al., 2011). Thus, exposed individuals may enter the period of adolescence " primed " for earlier substance use and sexual intercourse, and are more likely to engage in these behaviors at a less optimal time than unexposed individuals. "
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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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    • "Close parental supervision in adolescence did not alter these relationships. There are, however, some differences between our findings in the current analyses and results reported in our earlier work (Frank et al., 2011), which only followed participants until age 16. In both analyses we found that lighter IUME was associated with earlier marijuana use. "
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    ABSTRACT: Background: Linkages between intrauterine exposures to cocaine and marijuana and adolescents' problematic substance use have not been fully delineated. Methods: Prospective longitudinal study with assessors unaware of intrauterine exposure history followed 157 urban participants from birth until late adolescence. Level of intrauterine exposures was identified by mother's report and infant's meconium. Problematic substance use, identified by the Voice Diagnostic Interview Schedule for Children (V-DISC) or the Audio Computer Assisted Self-Interview (ACASI) and urine assay, was a composite encompassing DSM-IV indication of tolerance, abuse, and dependence on alcohol, marijuana, and tobacco and any use of cocaine, glue, or opiates. Results: Twenty percent (32/157) of the sample experienced problematic substance use by age 18 years, of whom the majority (22/157) acknowledged abuse, tolerance or dependence on marijuana with or without other substances. Structural equation models examining direct and indirect pathways linking a Cox survival model for early substance initiation to a logistic regression models found effects of post-natal factors including childhood exposure to violence and household substance use, early youth substance initiation, and ongoing youth violence exposure contributing to adolescent problematic substance use. Conclusion: We did not identify direct relationships between intrauterine cocaine or marijuana exposure and problematic substance use, but did find potentially modifiable post-natal risk factors also noted to be associated with problematic substance use in the general population including earlier substance initiation, exposure to violence and to household substance use.
    Drug and Alcohol Dependence 06/2014; 142. DOI:10.1016/j.drugalcdep.2014.06.014 · 3.42 Impact Factor
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    • "To our knowledge, this is one of the first prospective documentations of PCE-related effects on externalizing behaviors during adolescence. Our study is also in line with two prospective studies (Delaney-Black et al., 2011; Frank et al., 2011) indicating a greater risk of early substance use among PCE adolescents. PCE adolescents reported more substance related problems than their NCE counterparts, extending previous studies by demonstrating the extent of impairment in daily functioning for PCE adolescents via increased vulnerability to substance use. "
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    ABSTRACT: The effect of prenatal cocaine exposure (PCE) on externalizing behavior and substance use related problems at 15 years of age was examined. Participants consisted of 358 adolescents (183 PCE, 175 non-cocaine exposed (NCE)), primarily African–American and of low socioeconomic status, prospectively enrolled in a longitudinal study from birth. Regression analyses indicated that the amount of PCE was associated with higher externalizing behavioral problems (β = .15, p = .02). Adolescents with PCE were also 2.8 times (95% CI = 1.38–5.56) more likely to have substance use related problems than their NCE counterparts. No differences between PCE adolescents in non-kinship adoptive/foster care (n = 44) and PCE adolescents in maternal/relative care (n = 139) were found in externalizing behavior or in the likelihood of substance use related problems. Findings demonstrate teratologic effects of PCE persisting into adolescence. PCE is a reliable marker for the potential development of problem behaviors in adolescence, including substance use related problems.
    Journal of Adolescence 04/2014; 37(3):269–279. DOI:10.1016/j.adolescence.2014.01.004 · 2.05 Impact Factor
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