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Nadler E, Jacobus J, Rabin RA. Prenatal Cannabis and Tobacco Co-Exposure and Its Association with Behavioural Outcomes in Middle Childhood: Co-exposition prénatale au cannabis et au tabac et son association avec les résultats comportementaux au cours de l'enfance intermédiaire. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024:7067437241271696. [PMID: 39140868 DOI: 10.1177/07067437241271696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
OBJECTIVES Cannabis legalization has triggered an increase in prenatal cannabis use. Given that tobacco is commonly co-used with cannabis, determining outcomes associated with prenatal cannabis and tobacco co-exposure is crucial. While literature exists regarding the individual effects of prenatal cannabis and tobacco exposure on childhood behaviour, there is a gap regarding their combined use, which may have interactive effects. Therefore, we investigated whether prenatal cannabis and tobacco co-exposure was associated with greater externalizing and internalizing problems in middle childhood compared to prenatal exposure to either substance alone or no exposure. METHODS Baseline data from the Adolescent Brain Cognitive Development (ABCD) Study (collected in children ages 9-11) were used to explore differences in externalizing and internalizing scores derived from the Childhood Behavior Checklist across four groups: children with prenatal cannabis and tobacco co-exposure (CT, n = 290), children with prenatal cannabis-only exposure (CAN, n = 225), children with prenatal tobacco-only exposure (TOB, n = 966), and unexposed children (CTL, n = 8,311). We also examined if the daily quantity of tobacco exposure modulated the effect of cannabis exposure on outcomes. RESULTS Adjusting for covariates, a 2 × 2 ANCOVA revealed significant main effects for prenatal cannabis (p = 0.03) and tobacco exposure (p < 0.001), and a significant interaction effect on externalizing scores (p = 0.032); no significant main effects or interactions were found for internalizing scores. However, interactions between daily quantity of cannabis and tobacco exposure significantly predicted both externalizing and internalizing scores (p < 0.01). CONCLUSIONS These findings indicate that co-exposure is associated with greater externalizing problems than exposure to either substance alone, which did not differ from each other. Further, greater tobacco exposure may amplify the negative effect of cannabis exposure on both externalizing and internalizing behaviours in children. These findings underscore the need for interventions that target cannabis and tobacco co-use in pregnant women to circumvent their adverse impact on middle childhood behaviour.
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Affiliation(s)
| | - Joanna Jacobus
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Rachel A Rabin
- Department of Psychiatry, McGill University and The Douglas Mental Health University Institute, Montreal, Canada
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Min MO, Albert JM, Minnes S, Kim JY, Kim SK, Singer LT. Prenatal cocaine exposure and self-reported behavioral adjustments from ages 12 to 21: environmental pathways. Psychol Med 2024; 54:721-731. [PMID: 37614188 DOI: 10.1017/s0033291723002404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
BACKGROUND In a birth-cohort study, we followed offspring with prenatal cocaine exposure (PCE) to investigate longitudinal associations of PCE with self-reported behavioral adjustment from early adolescence to emerging adulthood (EA). Environmental pathways (family functioning, non-kinship care, maltreatment) were specified as potential mediators of PCE. METHODS Participants were 372 (190 PCE; 47% male), primarily Black, low socioeconomic status, enrolled at birth. Internalizing and externalizing behaviors were assessed using Youth Self-Report at ages 12 and 15 and Adult Self-Report at age 21. Extended random-intercept cross-lagged panel modeling was used to account for potential bidirectional relationships between internalizing and externalizing behaviors over time, examining potential mediators. RESULTS Adjusting for covariates, significant indirect effects were found for each mediator at different ages. For family functioning, these were both internalizing (β = 0.83, p = 0.04) and externalizing behaviors (β = 1.58, p = 0.02) at age 12 and externalizing behaviors at age 15 (β = 0.51, p = 0.03); for non-kinship care, externalizing behaviors at ages 12 (β = 0.63, p = 0.02) and 15 (β = 0.20, p = 0.03); and for maltreatment, both internalizing and externalizing behaviors at ages 15 (β = 0.64, p = 0.02 for internalizing; β = 0.50, p = 0.03 for externalizing) and 21 (β = 1.39, p = 0.01 for internalizing; β = 1.11, p = 0.01 for externalizing). Direct associations of PCE with internalizing and externalizing behaviors were not observed, nor cross-lagged relationships between internalizing and externalizing behaviors. CONCLUSIONS Negative associations of PCE with behavioral adjustment persist into EA via environmental pathways, specifying intervention points to disrupt adverse pathways toward healthy development.
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Affiliation(s)
- Meeyoung O Min
- College of Social Work, University of Utah, Salt Lake City, Utah, USA
| | - Jeffrey M Albert
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sonia Minnes
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - June-Yung Kim
- Department of Social Work, College of Nursing and Professional Disciplines, University of North Dakota, Grand Forks North Dakota, USA
| | - Sun-Kyung Kim
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Lynn T Singer
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
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Olsavsky AK, Chirico I, Ali D, Christensen H, Boggs B, Svete L, Ketcham K, Hutchison K, Zeanah C, Tottenham N, Riggs P, Epperson CN. Maternal Childhood Maltreatment, Internal Working Models, and Perinatal Substance Use: Is There a Role for Hyperkatifeia? A Systematic Review. Subst Abuse 2023; 17:11782218231186371. [PMID: 37476500 PMCID: PMC10354827 DOI: 10.1177/11782218231186371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 06/16/2023] [Indexed: 07/22/2023]
Abstract
The parent-infant relationship is critical for socioemotional development and is adversely impacted by perinatal substance use. This systematic review posits that the mechanisms underlying these risks to mother-infant relationships center on 3 primary processes: (1) mothers' childhood maltreatment experiences; (2) attachment styles and consequent internal working models of interpersonal relationships; and (3) perinatal substance use. Further, the review considers the role of hyperkatifeia, or hypersensitivity to negative affect which occurs when people with substance use disorders are not using substances, and which drives the negative reinforcement in addiction. The authors performed a systematic review of articles (published 2000-2022) related to these constructs and their impact on mother-infant relationships and offspring outcomes, including original clinical research articles addressing relationships between these constructs, and excluding case studies, reviews, non-human animal studies, intervention studies, studies with fewer than 30% female-sex participants, clinical guidelines, studies limited to obstetric outcomes, mechanistic/biological studies, and studies with methodological issues precluding interpretation. Overall 1844 articles were screened, 377 were selected for full text review, and data were extracted from 157 articles. Results revealed strong relationships between mothers' childhood maltreatment experiences, less optimal internal working models, and increased risk for perinatal substance use, and importantly, all of these predictors interacted with hyperkatifeia and exerted a marked impact on mother-infant relationships with less data available on offspring outcomes. These data strongly support the need for future studies addressing the additive impact of maternal childhood maltreatment experiences, suboptimal internal working models, and perinatal substance use, with hyperkatifeia as a potential moderator, and their interacting effects on mother-infant socioemotional outcomes.
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Affiliation(s)
- Aviva K. Olsavsky
- University of Colorado School of Medicine, Aurora, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
| | - Isabella Chirico
- SUNY Downstate Health Sciences University College of Medicine, Brooklyn, NY, USA
| | - Diab Ali
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Hannah Christensen
- University of Colorado School of Medicine, Aurora, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
| | - Brianna Boggs
- University of Colorado School of Medicine, Aurora, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
| | - Lillian Svete
- University of Colorado School of Medicine, Aurora, CO, USA
- University of Kentucky College of Medicine, Louisville, KY, USA
| | | | - Kent Hutchison
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Charles Zeanah
- Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Paula Riggs
- University of Colorado School of Medicine, Aurora, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
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Hofheimer JA, McGrath M, Musci R, Wu G, Polk S, Blackwell CK, Stroustrup A, Annett RD, Aschner J, Carter BS, Check J, Conradt E, Croen LA, Dunlop AL, Elliott AJ, Law A, Leve LD, Neiderhiser JM, O’Shea TM, Salisbury AL, Sathyanarayana S, Singh R, Smith LM, Aguiar A, Angal J, Carliner H, McEvoy C, Ondersma SJ, Lester B. Assessment of Psychosocial and Neonatal Risk Factors for Trajectories of Behavioral Dysregulation Among Young Children From 18 to 72 Months of Age. JAMA Netw Open 2023; 6:e2310059. [PMID: 37099294 PMCID: PMC10134008 DOI: 10.1001/jamanetworkopen.2023.10059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/10/2023] [Indexed: 04/27/2023] Open
Abstract
Importance Emotional and behavioral dysregulation during early childhood are associated with severe psychiatric, behavioral, and cognitive disorders through adulthood. Identifying the earliest antecedents of persisting emotional and behavioral dysregulation can inform risk detection practices and targeted interventions to promote adaptive developmental trajectories among at-risk children. Objective To characterize children's emotional and behavioral regulation trajectories and examine risk factors associated with persisting dysregulation across early childhood. Design, Setting, and Participants This cohort study examined data from 20 United States cohorts participating in Environmental influences on Child Health Outcomes, which included 3934 mother-child pairs (singleton births) from 1990 to 2019. Statistical analysis was performed from January to August 2022. Exposures Standardized self-reports and medical data ascertained maternal, child, and environmental characteristics, including prenatal substance exposures, preterm birth, and multiple psychosocial adversities. Main Outcomes and Measures Child Behavior Checklist caregiver reports at 18 to 72 months of age, with Dysregulation Profile (CBCL-DP = sum of anxiety/depression, attention, and aggression). Results The sample included 3934 mother-child pairs studied at 18 to 72 months. Among the mothers, 718 (18.7%) were Hispanic, 275 (7.2%) were non-Hispanic Asian, 1220 (31.8%) were non-Hispanic Black, 1412 (36.9%) were non-Hispanic White; 3501 (89.7%) were at least 21 years of age at delivery. Among the children, 2093 (53.2%) were male, 1178 of 2143 with Psychosocial Adversity Index [PAI] data (55.0%) experienced multiple psychosocial adversities, 1148 (29.2%) were exposed prenatally to at least 1 psychoactive substance, and 3066 (80.2%) were term-born (≥37 weeks' gestation). Growth mixture modeling characterized a 3-class CBCL-DP trajectory model: high and increasing (2.3% [n = 89]), borderline and stable (12.3% [n = 479]), and low and decreasing (85.6% [n = 3366]). Children in high and borderline dysregulation trajectories had more prevalent maternal psychological challenges (29.4%-50.0%). Multinomial logistic regression analyses indicated that children born preterm were more likely to be in the high dysregulation trajectory (adjusted odds ratio [aOR], 2.76; 95% CI, 2.08-3.65; P < .001) or borderline dysregulation trajectory (aOR, 1.36; 95% CI, 1.06-1.76; P = .02) vs low dysregulation trajectory. High vs low dysregulation trajectories were less prevalent for girls compared with boys (aOR, 0.60; 95% CI, 0.36-1.01; P = .05) and children with lower PAI (aOR, 1.94; 95% CI, 1.51-2.49; P < .001). Combined increases in PAI and prenatal substance exposures were associated with increased odds of high vs borderline dysregulation (aOR, 1.28; 95% CI, 1.08-1.53; P = .006) and decreased odds of low vs high dysregulation (aOR, 0.77; 95% CI, 0.64-0.92; P = .005). Conclusions and Relevance In this cohort study of behavioral dysregulation trajectories, associations were found with early risk factors. These findings may inform screening and diagnostic practices for addressing observed precursors of persisting dysregulation as they emerge among at-risk children.
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Affiliation(s)
- Julie A. Hofheimer
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill
- Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill
| | - Monica McGrath
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Rashelle Musci
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Guojing Wu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sarah Polk
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Courtney K. Blackwell
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Annemarie Stroustrup
- Division of Neonatology, Department of Pediatrics, Cohen Children’s Medical Center at Northwell Health, New Hyde Park, New York
| | - Robert D. Annett
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque
| | - Judy Aschner
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
- Hackensack Meridian School of Medicine, Nutley, New Jersey
| | - Brian S. Carter
- Department of Pediatrics, University of Missouri-Kansas City, Children’s Mercy Kansas City, Kansas City
| | - Jennifer Check
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Elisabeth Conradt
- Department of Psychiatry, Duke University School of Medicine, Durham, North Carolina
| | - Lisa A. Croen
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Anne L. Dunlop
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Amy J. Elliott
- Avera Research Institute, Sioux Falls, South Dakota
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls
| | - Andrew Law
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Leslie D. Leve
- Prevention Science Institute, University of Oregon, Eugene
| | | | - T. Michael O’Shea
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill
| | | | - Sheela Sathyanarayana
- Department of Pediatrics, University of Washington, Seattle Children’s Research Institute, Seattle
| | - Rachana Singh
- Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts
| | - Lynne M. Smith
- Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, California
| | - Andréa Aguiar
- Department of Comparative Biosciences, University of Illinois at Urbana-Champaign, Urbana-Champaign
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana-Champaign
| | - Jyoti Angal
- Avera Research Institute, Sioux Falls, South Dakota
| | - Hannah Carliner
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Cindy McEvoy
- Department of Pediatrics, Oregon Health & Science University, Doernbecher Children’s Hospital, Portland
| | - Steven J. Ondersma
- Division of Public Health, Michigan State University, East Lansing
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing
| | - Barry Lester
- Brown Center for the Study of Children at Risk, Women & Infants Hospital, Brown University Alpert School of Medicine, Providence
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Min MO, Minnes S, Kim SK, Kim JY, Singer LT. Prenatal cocaine exposure and substance use disorder in emerging adulthood at age 21. Drug Alcohol Depend 2023; 242:109736. [PMID: 36516550 PMCID: PMC9772296 DOI: 10.1016/j.drugalcdep.2022.109736] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Prenatal cocaine exposure (PCE) has been associated with child and adolescent externalizing behaviors and early substance use, yet few studies investigated its association with substance use disorder (SUD) in emerging adults. The present study examined the association of PCE with SUD in emerging adulthood, and whether childhood externalizing behaviors and adolescent substance use mediated the relationship. METHODS Participants were 367 (187 PCE; 53% female) adults at age 21, primarily urban African American who were recruited at birth. PCE and exposure to alcohol, tobacco, and marijuana were determined using biologic assays for drug metabolites and/or maternal self-report at birth. Offspring externalizing problems were assessed using the Youth Self-Report at age 12, substance use and substance use-related problems via biologic assays and/or self-report at age 15, and SUD determined using DSM-5 diagnostic criteria at age 21. RESULTS About 32.3% of the emerging adults were determined to have marijuana use disorder, 30.3% tobacco use disorder, and 15.5% alcohol use disorder. PCE was related to greater externalizing behaviors at age 12 (β = 0.12, p = .042), which in turn was related to SUD (β = 0.22, p = .008). PCE was also related to substance use, mainly marijuana, at age 15 (β = 0.22, p = .011), which was related to SUD (β = 0.51, p < .001). Total indirect effects including these two pathways were significant (β = 0.19, p = .002). CONCLUSIONS PCE may increase risk for SUD in emerging adulthood through childhood externalizing behaviors and adolescent substance use.
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Affiliation(s)
| | - Sonia Minnes
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, USA
| | - Sun-Kyung Kim
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, USA
| | - June-Yung Kim
- Department of Social Work, College of Nursing and Professional Disciplines, University of North Dakota, USA
| | - Lynn T Singer
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, USA
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Marceau K, Horvath G, Loviska AM, Knopik VS. Developmental Cascades from Polygenic and Prenatal Substance Use to Adolescent Substance Use: Leveraging Severity and Directionality of Externalizing and Internalizing Problems to Understand Pubertal and Harsh Discipline-Related Risk. Behav Genet 2021; 51:559-579. [PMID: 34241754 PMCID: PMC8628579 DOI: 10.1007/s10519-021-10068-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/26/2021] [Indexed: 12/13/2022]
Abstract
The current study leveraged the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort (n = 4504 White boys, n = 4287 White girls assessed from the prenatal period through 18.5 years of age) to test a developmental cascade from genetic and prenatal substance use through pubertal timing and parenting to the severity of (regardless of type) and directionality (i.e., differentiation) of externalizing and internalizing problems to adolescent substance use. Limited associations of early pubertal timing with substance use outcomes were only observable via symptom directionality, differently for girls and boys. For boys, more severe exposure to prenatal substance use influenced adolescent substance use progression via differentiation towards relatively more pure externalizing problems, but in girls the associations were largely direct. Severity and especially directionality (i.e., differentiation towards relatively more pure externalizing problems) were key intermediaries in developmental cascades from parental harsh discipline with substance use progressions for girls and boys.
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Affiliation(s)
- Kristine Marceau
- Purdue University, 225 Hanley Hall, 1202 W. State Street, West Lafayette, IN, 47906, USA.
| | | | - Amy M Loviska
- Purdue University, 225 Hanley Hall, 1202 W. State Street, West Lafayette, IN, 47906, USA
| | - Valerie S Knopik
- Purdue University, 225 Hanley Hall, 1202 W. State Street, West Lafayette, IN, 47906, USA
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