Lauren S Wakschlag

Northwestern University, Evanston, Illinois, United States

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Publications (76)262.35 Total impact

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    ABSTRACT: Impairment in learning from punishment ("punishment insensitivity") is an established feature of severe antisocial behavior in adults and youth but it has not been well studied as a developmental phenomenon. In early childhood, differentiating a normal: abnormal spectrum of punishment insensitivity is key for distinguishing normative misbehavior from atypical manifestations. This study employed a novel measure, the Multidimensional Assessment Profile of Disruptive Behavior (MAP-DB), to examine the distribution, dimensionality, and external validity of punishment insensitivity in a large, demographically diverse community sample of preschoolers (3-5 years) recruited from pediatric clinics (N = 1,855). Caregivers completed surveys from which a seven-item Punishment Insensitivity scale was derived. Findings indicated that Punishment Insensitivity behaviors are relatively common in young children, with at least 50 % of preschoolers exhibiting them sometimes. Item response theory analyses revealed a Punishment Insensitivity spectrum. Items varied along a severity continuum: most items needed to occur "Often" in order to be severe and behaviors that were qualitatively atypical or intense were more severe. Although there were item-level differences across sociodemographic groups, these were small. Construct, convergent, and divergent validity were demonstrated via association to low concern for others and noncompliance, motivational regulation, and a disruptive family context. Incremental clinical utility was demonstrated in relation to impairment. Early childhood punishment insensitivity varies along a severity continuum and is atypical when it predominates. Implications for understanding the phenomenology of emergent disruptive behavior are discussed.
    Journal of Abnormal Child Psychology 11/2014; · 3.09 Impact Factor
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    ABSTRACT: Neuroscience Letters j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / n e u l e t Short communication Preliminary evidence for the interaction of the oxytocin receptor gene (oxtr) and face processing in differentiating prenatal smoking patterns h i g h l i g h t s • Prenatal smoking patterns may reflect differences in maternal empathic capacity. • Relation between face processing and prenatal smoking depended on genetic context. • Enhancing empathy may improve prenatal smoking cessation for selected individuals. • Oxytocin functioning may be a biological substrate in prenatal smoking behavior. a b s t r a c t Prenatal smoking cessation has been described as an empathic action "for the baby," but this has not been empirically demonstrated. We capitalized on a genetically-characterized extant dataset with out-standing measurement of prenatal smoking patterns and maternal face processing data (as an indicator of empathy) to test this hypothesis, and explore how empathy and smoking patterns may be moderated by a genetic substrate of empathy, the oxytocin receptor gene (OXTR). Participants were 143Caucasian women from the East Boston family study with repeated prospective reports of smoking level, adjusted based on repeated cotinine bioassays. Salivary DNA and face processing (Diagnostic Analysis of Nonverbal Accuracy-2) were assessed 14 years later at an adolescent follow-up of offspring. Two-thirds of partici-pants reported smoking prior to pregnancy recognition. Of these, 21% quit during pregnancy; 56% reduced smoking, and 22% smoked persistently at the same level. A significant interaction between face process-ing and OXTR variants previously associated with increased sensitivity to social context, rs53576GG and rs2254298A, was found = −.181; p = .015); greater ability to identify distress in others was associated with lower levels of smoking during pregnancy for rs53576(GG)/rs2254298(A) individuals (p = .013), but not for other genotypes (p = .892). Testing this "empathy hypothesis of prenatal smoking cessation" in larger studies designed to examine this question can elucidate whether interventions to enhance empathy can improve prenatal smoking cessation rates.
    Neuroscience Letters 11/2014; 584(584):259-264. · 2.03 Impact Factor
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    ABSTRACT: Dimensional approaches are gaining scientific traction. However, their potential for elucidating developmental aspects of psychopathology has not been fully realized. The goal of this article is to apply a multidimensional, developmental framework to model the normal-abnormal spectrum of preschool disruptive behavior. The Multidimensional Assessment of Preschool Disruptive Behavior (MAP-DB), a novel measure, was used to model dimensional severity across developmental parameters theorized to distinguish the normative misbehavior of early childhood from clinically salient disruptive behavior. The 4 MAP-DB dimensions are Temper Loss, Noncompliance, Aggression, and Low Concern for Others. Parents of a diverse sample of 1,488 preschoolers completed the MAP-DB. Multidimensional item response theory (IRT) was used for dimensional modeling. The 4-dimensional, developmentally informed model demonstrated excellent fit. Its factor loadings did not differ across demographic subgroups. All dimensions provided good coverage of the abnormal end of the severity continuum, but only Temper Loss and Noncompliance provided good coverage of milder, normatively occurring behaviors. The developmental expectability and quality of behaviors distinguished normative from atypical behaviors. The point at which frequency of behaviors was atypical varied based on dimensional location for Temper Loss, Noncompliance, and Aggression. The MAP-DB provides an innovative method for operationalizing developmentally specified, dimensional phenotypes in early childhood. Establishing the validity of these dimensional phenotypes in relation to clinical outcomes, neurocognitive substrates, and etiologic pathways will be a crucial test of their clinical utility.
    Journal of the American Academy of Child and Adolescent Psychiatry 01/2014; 53(1):82-96.e3. · 6.97 Impact Factor
  • Development and Psychopathology 01/2014; · 4.40 Impact Factor
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    ABSTRACT: Externalizing behaviors (encompassing antisocial, impulsive, and substance use behaviors) are pervasive and impairing across a multitude of settings and developmental contexts. These behaviors, though often investigated separately, are highly comorbid. Prenatal tobacco exposure in interaction with various genetic influences has predicted later externalizing behavior, and recent evidence supports investigating sex differences in these patterns. In the current study, we extend this work by (a) examining two functional genetic markers in the dopamine system: the transporter gene (DAT1) and the dopamine receptor D4 gene (DRD4) in interaction with prenatal tobacco exposure to predict a latent composite of externalizing behavior and (b) testing whether these patterns differ by sex of youth in a community sample of adolescents (n=176). The relatively small sample is partially offset by high quality, multi-method prospective measurement. We assessed prenatal tobacco exposure using prospective repeated cotinine-corrected reports and externalizing behaviors were assessed utilizing multiple measures across three waves. The interaction between DAT1 (but not DRD4) and prenatal tobacco exposure was statistically significant in boys, and patterns appeared to differ by sex. Risk for externalizing behaviors for exposed boys increased linearly as a function of the 10r DAT1 allele. For exposed girls, there was a trend such that DAT1heterozygotes had a marginally higher risk than homozygotes. This pattern was not explained by passive gene-environment correlation. Elucidating sex-specific pathways through which early adverse exposures and genetic susceptibilities contribute to externalizing behavior can inform early targeted prevention efforts for those children at highest risk.
    Neurotoxicology and Teratology 09/2013; · 3.18 Impact Factor
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    ABSTRACT: Youth and adults with psychopathic traits display disrupted reinforcement learning. Advances in measurement now enable examination of this association in preschoolers. The current study examines relations between reinforcement learning in preschoolers and parent ratings of reduced responsiveness to socialization, conceptualized as a developmental vulnerability to psychopathic traits. One hundred and fifty-seven preschoolers (mean age 4.7 ± 0.8 years) participated in a substudy that was embedded within a larger project. Children completed the 'Stars-in-Jars' task, which involved learning to select rewarded jars and avoid punished jars. Maternal report of responsiveness to socialization was assessed with the Punishment Insensitivity and Low Concern for Others scales of the Multidimensional Assessment of Preschool Disruptive Behavior (MAP-DB). Punishment Insensitivity, but not Low Concern for Others, was significantly associated with reinforcement learning in multivariate models that accounted for age and sex. Specifically, higher Punishment Insensitivity was associated with significantly lower overall performance and more errors on punished trials ('passive avoidance'). Impairments in reinforcement learning manifest in preschoolers who are high in maternal ratings of Punishment Insensitivity. If replicated, these findings may help to pinpoint the neurodevelopmental antecedents of psychopathic tendencies and suggest novel intervention targets beginning in early childhood.
    Journal of Child Psychology and Psychiatry 08/2013; · 5.42 Impact Factor
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    ABSTRACT: INTRODUCTION: Maternal smoking during pregnancy (MSP) is a known risk factor for regular smoking in young adulthood and may pose a risk independently of mother's lifetime smoking. The processes through which MSP exerts this influence are unknown but may occur through greater smoking quantity and frequency following initiation early in adolescence or increased sensitivity to nicotine dependence (ND) at low levels of smoking. METHODS: This study used path analysis to investigate adolescent smoking quantity, smoking frequency, and ND as potential simultaneous mediating pathways through which MSP and mother's lifetime smoking (whether she has ever smoked) increase the risk of smoking in young adulthood among experimenters (at baseline, <100 cigarettes/lifetime) and current smokers (>100 cigarettes/lifetime). RESULTS: For experimenters, MSP was directly associated with more frequent young adult smoking and was not mediated by adolescent smoking behavior or ND. Independently of MSP, the effect of mother's lifetime smoking was fully mediated through frequent smoking and was heightened ND during adolescence. Controlling for MSP eliminated a previously observed direct association between mother's lifetime smoking and future smoking among experimenters. For current smokers, only prior smoking behavior was associated with future smoking frequency. CONCLUSIONS: These results seem to rule out sensitivity to ND and increased smoking behavior as contributing pathways of MSP. Further, the impact of MSP on young adult smoking extends beyond that of having an ever-smoking mother. Future work should test other possible mediators; for example, MSP-related epigenetic changes or gene variants influencing the brain's nicotine response.
    Nicotine & Tobacco Research 06/2013; · 2.48 Impact Factor
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    ABSTRACT: The present investigation compared parenting practices in a sample of preschoolers whose mothers reported smoking during pregnancy versus those who did not. A sample of n = 216, 3.0- to 5.11-year-old children, participants in an ongoing longitudinal study, was separated into those reportedly exposed to smoking in utero and those who were not. Parenting practices were compared between the two groups, using T-tests and exact logistic regressions. Multiple linear regressions and multivariate logistic regressions were used to examine the association between smoking status and parenting, controlling for variables also known to be associated with parenting practices. Current study findings suggest that smoking during pregnancy is associated with harsh parenting practices. Study results highlight the possible role of parenting in disruptive outcomes well-known in toddlers exposed to nicotine in utero and have implications for targeting early interventions in these populations.
    Journal of Clinical Medicine Research 04/2013; 5(2):84-91.
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    ABSTRACT: This longitudinal study examined how observations of parental general communication style and control with their adolescents predicted changes in negative affect over time for adolescent smokers and nonsmokers. Participants were 9th- and 10th-grade adolescents (N = 111; 56.8% female) who had all experimented with cigarettes and were thus at risk for continued smoking and escalation; 36% of these adolescents (n = 40) had smoked in the past month at baseline and were considered smokers in the present analyses. Adolescents participated separately with mothers and fathers in observed parent-adolescent problem-solving discussions to assess parenting at baseline. Adolescent negative affect was assessed at baseline, 6 months, and 24 months via ecological momentary assessment. Among both smoking and nonsmoking adolescents, escalating negative affect significantly increased risk for future smoking. Higher quality maternal and paternal communication predicted a decline in negative affect over 1.5 years for adolescent smokers but was not related to negative affect for nonsmokers. Controlling maternal, but not paternal, parenting predicted escalation in negative affect for all adolescents. Findings suggest that reducing negative affect among experimenting youth can reduce risk for smoking escalation. Therefore, family-based prevention efforts for adolescent smoking escalation might consider parental general communication style and control as intervention targets. However, adolescent smoking status and parent gender may moderate these effects.
    Journal of Clinical Child & Adolescent Psychology 11/2012; · 1.92 Impact Factor
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    ABSTRACT: The present study examined smoking-specific and general parenting predictors of in vivo observed patterns of parent-adolescent discussion concerning adolescents' cigarette smoking experiences and associations between these observed patterns and 24-month longitudinal trajectories of teen cigarette smoking behavior (nonsmokers, current experimenters, escalators). Parental solicitation, adolescent disclosure, and adolescent information management were coded from direct observations of 528 video-recorded parent-adolescent discussions about cigarette smoking with 344 teens (M age = 15.62 years) with a history of smoking experimentation (321 interactions with mothers, 207 interactions with fathers). Adolescent initiation of discussions concerning their own smoking behavior (21% of interactions) was predicted by lower levels of maternal observed disapproval of cigarette smoking and fewer teen-reported communication problems with mothers. Maternal initiation in discussions (35% of interactions) was associated with higher levels of family rules about illicit substance use. Three categories of adolescent information management (full disclosure, active secrecy, incomplete strategies) were coded by matching adolescents' confidential self-reported smoking status with their observed spontaneous disclosures and responses to parental solicitations. Fully disclosing teens reported higher quality communication with their mothers (more open, less problematic). Teens engaged in active secrecy with their mothers when families had high levels of parental rules about illicit substance use and when mothers expressed lower levels of expectancies that their teen would smoke in the future. Adolescents were more likely to escalate their smoking over 2 years if their parents initiated the discussion of adolescent smoking behavior (solicited) and if adolescents engaged in active secrecy. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
    Developmental Psychology 11/2012; · 3.21 Impact Factor
  • 59th Meeting of American Academy of Child and Adolescent Psychiatry; 10/2012
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    ABSTRACT: Background:  Temper modulation problems are both a hallmark of early childhood and a common mental health concern. Thus, characterizing specific behavioral manifestations of temper loss along a dimension from normative misbehaviors to clinically significant problems is an important step toward identifying clinical thresholds. Methods:  Parent-reported patterns of temper loss were delineated in a diverse community sample of preschoolers (n = 1,490). A developmentally sensitive questionnaire, the Multidimensional Assessment of Preschool Disruptive Behavior (MAP-DB), was used to assess temper loss in terms of tantrum features and anger regulation. Specific aims were: (a) document the normative distribution of temper loss in preschoolers from normative misbehaviors to clinically concerning temper loss behaviors, and test for sociodemographic differences; (b) use Item Response Theory (IRT) to model a Temper Loss dimension; and (c) examine associations of temper loss and concurrent emotional and behavioral problems. Results:  Across sociodemographic subgroups, a unidimensional Temper Loss model fit the data well. Nearly all (83.7%) preschoolers had tantrums sometimes but only 8.6% had daily tantrums. Normative misbehaviors occurred more frequently than clinically concerning temper loss behaviors. Milder behaviors tended to reflect frustration in expectable contexts, whereas clinically concerning problem indicators were unpredictable, prolonged, and/or destructive. In multivariate models, Temper Loss was associated with emotional and behavioral problems. Conclusions:  Parent reports on a developmentally informed questionnaire, administered to a large and diverse sample, distinguished normative and problematic manifestations of preschool temper loss. A developmental, dimensional approach shows promise for elucidating the boundaries between normative early childhood temper loss and emergent psychopathology.
    Journal of Child Psychology and Psychiatry 08/2012; 53(11):1099-108. · 5.42 Impact Factor
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    ABSTRACT: There is increasing emphasis on dimensional conceptualizations of psychopathology, but empirical evidence of their utility is just emerging. In particular, although a range of multidimensional models have been proposed, the relative fit of competing models has rarely been tested. Furthermore, developmental considerations have received scant attention. In this study, we tested a developmentally based, four-dimensional model of disruptive behavior theorized to represent the defining features of disruptive behavior at preschool age: Temper Loss, Noncompliance, Aggression, and Low Concern for Others. Model testing was conducted in two independent samples of preschoolers: Clinically Enriched Sample (n = 336) and Epidemiologic Sample (n = 532). The tau-equivalent confirmatory factor analyses were used to test the fit of the Developmental Model relative to three leading competing models (DSM opositional defiant disorder (ODD)/conduct disorder (CD) Model, "Callous" Model, and an "Irritable/Headstrong/Hurtful" Model). Reliability of the four dimensions was also tested. Validity of the dimensions was tested by predicting multi-informant, multi-method ratings of disruptive behavior and impairment, and incremental utility relative to DSM symptoms. In both samples, the Developmental Model demonstrated a superior fit compared with the competing models within the full sample, and across key demographic subgroups. Validity was also demonstrated, including incremental utility relative to DSM-IV disruptive behavior symptoms. Critical next steps for achieving scientific consensus about the optimal dimensional model of disruptive behavior and its clinical application are discussed.
    Journal of the American Academy of Child and Adolescent Psychiatry 06/2012; 51(6):593-604.e4. · 6.97 Impact Factor
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    ABSTRACT: This study illustrates the application of a latent modeling approach to genotype-phenotype relationships and gene × environment interactions, using a novel, multidimensional model of adult female problem behavior, including maternal prenatal smoking. The gene of interest is the monoamine oxidase A (MAOA) gene which has been well studied in relation to antisocial behavior. Participants were adult women (N = 192) who were sampled from a prospective pregnancy cohort of non-Hispanic, white individuals recruited from a neighborhood health clinic. Structural equation modeling was used to model a female problem behavior phenotype, which included conduct problems, substance use, impulsive-sensation seeking, interpersonal aggression, and prenatal smoking. All of the female problem behavior dimensions clustered together strongly, with the exception of prenatal smoking. A main effect of MAOA genotype and a MAOA × physical maltreatment interaction were detected with the Conduct Problems factor. Our phenotypic model showed that prenatal smoking is not simply a marker of other maternal problem behaviors. The risk variant in the MAOA main effect and interaction analyses was the high activity MAOA genotype, which is discrepant from consensus findings in male samples. This result contributes to an emerging literature on sex-specific interaction effects for MAOA.
    Archives of Women s Mental Health 05/2012; 15(4):269-82. · 2.01 Impact Factor
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    ABSTRACT: Sex differences in disruptive behavior and sensitivity to social context are documented, but the intersection between them is rarely examined empirically. This report focuses on sex differences in observed disruptive behavior across interactional contexts and diagnostic status. Preschoolers (n = 327) were classified as nondisruptive (51%), clinically at risk (26%), and disruptive (23%) using parent and teacher reports on developmentally validated measures of disruptive behavior and impairment. Observed disruptive behavior was measured with the Disruptive Behavior Diagnostic Observation Schedule, a developmentally sensitive observational paradigm characterizing variation in preschoolers' disruptive behavior across two interactional contexts (parent and examiner). Repeated measures analyses of variance revealed a three-way interaction of child sex by diagnostic status by interactional context (F = 9.81, p < .001). Disruptive boys were the only subgroup whose behavior was not sensitive to interactional context: They displayed comparable levels of disruptive behavior with parents and examiners. In contrast, disruptive girls demonstrated the strongest context effect of any group. Specifically, with the examiner, disruptive girls' behavior was comparable to nondisruptive boys (though still more elevated than nondisruptive girls). However, in interactions with their mothers, disruptive girls displayed the highest rates of disruptive behavior of any subgroup in any context, although the difference between disruptive boys and disruptive girls in this context was not statistically significant. Findings suggest the importance of sex-specific conceptualizations of disruptive behavior in young children that take patterns across social contexts into account.
    Journal of Clinical Child & Adolescent Psychology 04/2012; 41(4):499-507. · 1.92 Impact Factor
  • Marisha L. Humphries, Kate Keenan, Lauren S. Wakschlag
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    ABSTRACT: Children's social and emotional competence abilities have been linked to successful social interactions and academic performance. This study examined the teacher and observer ratings of social and emotional competence for 89 young (3- to 5-year-old), African American children from economically stressed urban environments. There was a specific interest in understanding the convergence and divergence of the raters on these competence behaviors within the classroom. This study also examined the association among children's competence abilities and their overall functioning at school. There were significant associations between teacher and observer reports of children's competence. Children who were observed to be socially and emotionally competent were rated by their teachers as functioning well in school. However, there were differences among teacher and observer reports in terms of the specific behaviors that represented social and emotional competence. These findings provide support for the use of multi-method, multi-informant measures to assess competence among African American children. © 2012 Wiley Periodicals, Inc.
    Psychology in the Schools 04/2012; 49(4). · 0.72 Impact Factor
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    ABSTRACT: This paper examines the selection and use of multiple methods and informants for the assessment of disruptive behavior syndromes and attention deficit/hyperactivity disorder, providing a critical discussion of (a) the bidirectional linkages between theoretical models of childhood psychopathology and current assessment techniques; and (b) current knowledge concerning the utility of different methods and informants for key clinical goals. There is growing recognition that children's behavior varies meaningfully across situations, and evidence indicates that these differences, in combination with informants' unique perspectives, are at least partly responsible for inter-rater discrepancies in reports of symptomatology. Such data suggest that we should embrace this contextual variability as clinically meaningful information, moving away from models of psychopathology as generalized traits that manifest uniformly across situations and settings, and toward theoretical conceptualizations that explicitly incorporate contextual features, such as considering clinical syndromes identified by different informants to be discrete phenomena. We highlight different approaches to measurement that embrace contextual variability in children's behavior and describe how the use of such tools and techniques may yield significant gains clinically (e.g., for treatment planning and monitoring). The continued development of a variety of feasible, contextually sensitive methods for assessing children's behavior will allow us to determine further the validity of incorporating contextual features into models of developmental psychopathology and nosological frameworks.
    Journal of Child Psychology and Psychiatry 02/2012; 53(5):558-74. · 5.42 Impact Factor
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    ABSTRACT: The effects of tobacco exposure are typically examined by comparing groups based on a cut-score of self-reported number of cigarettes or bioassays collected in cross-sectional studies. This study introduces a new fuzzy clustering method that facilitates detection of subtle exposure effects by objectively deriving subgroups from modeling multidimensional exposure measures. We test the new method on a known exposure effect (fetal growth) and report on the graded exposure effect detected in a pregnancy cohort. A total of 978 pregnant women were enrolled from 1986 to 1992 in the Maternal Infant Smoking Study of East Boston (MISSEB). Four kinds of exposure data were used to generate exposure groups: self-reported smoking, cotinine levels, nicotine levels, and nicotine dependence scores. Subgroups were identified via a comprehensive validation procedure. The results from MISSEB (number of exposure clusters, exposure effects on birth weight, body length, and head circumference) were compared with those obtained in a separate cohort. Using our new method in MISSEB, the same number of clusters was generated as previously, and graded exposure effects were again detected. Neonates with heavier exposure weighed less at birth relative to nonexposed neonates, with no difference between lighter-exposed and nonexposed neonates. The same graded prenatal exposure effect emerges for known exposure-related outcomes across 2 different studies, about 2 decades apart. Our new method characterizes the degree of prenatal exposure, with the potential to help detect subtler effects on developmental outcomes, such as deficits in growth or development, neonatal temperament and behavior, and psychological functioning.
    Nicotine & Tobacco Research 01/2012; 14(9):1115-20. · 2.48 Impact Factor
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    ABSTRACT: Research has shown that self-reports of smoking during pregnancy may underestimate true prevalence. However, little is known about which populations have higher rates of underreporting. Availability of more accurate measures of smoking during pregnancy could greatly enhance the usefulness of existing studies on the effects of maternal smoking offspring, especially in those populations where underreporting may lead to underestimation of the impact of smoking during pregnancy. In this paper, we develop a statistical Monte Carlo model to estimate patterns of underreporting of smoking during pregnancy, and apply it to analyze the smoking self-report data from birth certificates in the state of Massachusetts. Our results illustrate non-uniform patterns of underreporting of smoking during pregnancy among different populations. Estimates of likely underreporting of smoking during pregnancy were highest among mothers who were college-educated, married, aged 30 years or older, employed full-time, and planning to breastfeed. The model's findings are validated and compared to an existing underreporting adjustment approach in the Maternal and Infant Smoking Study of East Boston (MISSEB). The validation results show that when biological assays are not available, the Monte Carlo method proposed can provide a more accurate estimate of the smoking status during pregnancy than self-reports alone. Such methods hold promise for providing a better assessment of the impact of smoking during pregnancy.
    PLoS ONE 01/2012; 7(4):e34853. · 3.53 Impact Factor
  • American Academy of Child and Adolescent Psychiatry/Canadian Academy of Child and Adolescent Psychiatry Joint Annual Meeting; 10/2011

Publication Stats

2k Citations
262.35 Total Impact Points

Institutions

  • 2011–2013
    • Northwestern University
      • • Department of Medical Social Sciences
      • • Feinberg School of Medicine
      Evanston, Illinois, United States
    • Columbia University
      New York City, New York, United States
    • West Virginia University
      Morgantown, West Virginia, United States
  • 2012
    • Massachusetts General Hospital
      • Psychiatric and Neurodevelopment Genetics Unit
      Boston, MA, United States
    • McGill University
      • Department of Psychology
      Montréal, Quebec, Canada
    • University of Massachusetts Boston
      • Department of Psychology
      Boston, MA, United States
  • 2010–2012
    • University of Massachusetts Medical School
      • Department of Quantitative Health Sciences
      Worcester, MA, United States
  • 1999–2012
    • University of Illinois at Chicago
      • • Institute for Health Research and Policy
      • • Department of Psychiatry (Chicago)
      • • School of Public Health
      Chicago, IL, United States
  • 2009
    • CUNY Graduate Center
      New York City, New York, United States
  • 2008–2009
    • The University of York
      • Department of Health Sciences
      York, ENG, United Kingdom
  • 1991–2009
    • University of Chicago
      • Department of Health Studies
      Chicago, IL, United States