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Aram J, Slopen N, Cosgrove C, Arria A, Liu H, Dallal CM. Self-Reported Disability Type and Risk of Alcohol-Induced Death - A Longitudinal Study Using Nationally Representative Data. Subst Use Misuse 2024:1-8. [PMID: 38635979 DOI: 10.1080/10826084.2024.2340993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
BACKGROUND Disability is associated with alcohol misuse and drug overdose death, however, its association with alcohol-induced death remains understudied. OBJECTIVE To quantify the risk of alcohol-induced death among adults with different types of disabilities in a nationally representative longitudinal sample of US adults. METHODS Persons with disabilities were identified among participants ages 18 or older in the Mortality Disparities in American Communities (MDAC) study (n = 3,324,000). Baseline data were collected in 2008 and mortality outcomes were ascertained through 2019 using the National Death Index. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were estimated for the association between disability type and alcohol-induced death, controlling for demographic and socioeconomic covariates. RESULTS During a maximum of 12 years of follow-up, 4000 alcohol-induced deaths occurred in the study population. In descending order, the following disability types displayed the greatest risk of alcohol-induced death (compared to adults without disability): complex activity limitation (aHR = 1.7; 95% CI = 1.3-2.3), vision limitation (aHR = 1.6; 95% CI = 1.2-2.0), mobility limitation (aHR = 1.4; 95% CI = 1.3-1.7), ≥2 limitations (aHR = 1.4; 95% CI = 1.3-1.6), cognitive limitation (aHR = 1.2; 95% CI = 1.0-1.4), and hearing limitation (aHR = 1.0; 95% CI = 0.9-1.3). CONCLUSIONS The risk of alcohol-induced death varies considerably by disability type. Efforts to prevent alcohol-induced deaths should be tailored to meet the needs of the highest-risk groups, including adults with complex activity (i.e., activities of daily living - "ALDs"), vision, mobility, and ≥2 limitations. Early diagnosis and treatment of alcohol use disorder within these populations, and improved access to educational and occupational opportunities, should be considered as prevention strategies for alcohol-induced deaths.
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Affiliation(s)
- Jonathan Aram
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, USA
| | - Natalie Slopen
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, USA
| | - Candace Cosgrove
- Mortality Research Group, Center for Economic Studies, U.S. Census Bureau, USA
| | - Amelia Arria
- Department of Behavioral and Community Health, University of Maryland School of Public Health, USA
| | - Hongjie Liu
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, USA
| | - Cher M Dallal
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, USA
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Aram J, Dallal CM, Cosgrove C, Arria A, Liu H, Slopen N. The risk of drug overdose death among adults with select types of disabilities in the United States - A longitudinal study using nationally representative data. Prev Med 2024; 178:107799. [PMID: 38070712 DOI: 10.1016/j.ypmed.2023.107799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/03/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Disability is associated with increased risk of drug overdose mortality, but previous studies use coarse and inconsistent methods to identify adults with disabilities. This investigation makes use of the U.S. Department of Health and Human Services disability questions to estimate the risk of drug overdose death among U.S. adults using seven established disability categories. METHODS The longitudinal Mortality Disparities in American Communities study was used to determine disability status among a nationally representative sample of adults age ≥18 in 2008 (n = 3,324,000). Through linkage to the National Death Index, drug overdose deaths were identified through 2019. Adults in mutually-exclusive disability categories (hearing, vision, cognitive, mobility, complex activity, ≥2 limitations) were compared to adults with no reported disabilities using adjusted hazard ratios (aHRs) and controlling for demographic and socioeconomic covariates. RESULTS The risk of drug overdose death varied considerably by disability type, as adults in some disability categories displayed only marginally significant risk, while adults in other disability categories displayed substantially elevated risk. Compared to non-disabled adults, the risk of drug overdose death was highest among adults with ≥2 limitations (aHR = 3.0, 95% CI = 2.8-3.3), cognitive limitation (aHR = 2.6, 95% CI = 2.3-2.9), mobility limitation (aHR = 2.6, 95% CI = 2.3-2.9), complex activity limitation (aHR = 2.3, 95% CI = 1.8-2.9), hearing limitation (aHR = 1.6, 95% CI = 1.3-1.9), and vision limitation (aHR = 1.3, 95% CI = 1.0-1.7). CONCLUSIONS The examination of specific disability categories revealed unique associations that were not apparent in previous research. These findings can be used to focus overdose prevention efforts on the populations at greatest risk for drug-related mortality.
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Affiliation(s)
- Jonathan Aram
- Department of Epidemiology & Biostatistics, University of Maryland School of Public Health, USA.
| | - Cher M Dallal
- Department of Epidemiology & Biostatistics, University of Maryland School of Public Health, USA.
| | | | - Amelia Arria
- Department of Behavioral & Community Health, University of Maryland School of Public Health, USA.
| | - Hongjie Liu
- Department of Epidemiology & Biostatistics, University of Maryland School of Public Health, USA.
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Eze N, Smith LM, LaGasse LL, Derauf C, Newman E, Arria A, Huestis MA, Della Grotta SA, Dansereau LM, Neal C, Lester BM. School-Aged Outcomes following Prenatal Methamphetamine Exposure: 7.5-Year Follow-Up from the Infant Development, Environment, and Lifestyle Study. J Pediatr 2016; 170:34-8.e1. [PMID: 26781836 PMCID: PMC4769906 DOI: 10.1016/j.jpeds.2015.11.070] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 10/28/2015] [Accepted: 11/24/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess the relationship between prenatal methamphetamine exposure (PME) and behavior problems at age 7.5 years and the extent to which early adversity mediated this relationship. STUDY DESIGN The multicenter, longitudinal Infant Development, Environment, and Lifestyle study enrolled 412 mother-infant pairs at 4 sites. Methamphetamine-exposed participants (n = 204) were identified by self-report and/or gas chromatography/mass spectrometry confirmation of amphetamine and metabolites in infant meconium. Matched participants (n = 208) denied methamphetamine use and had a negative meconium screen. At the 7.5-year follow-up, 290 children with complete Child Behavior Checklist data and an early adversity index score were available for analysis (n = 146 exposed). RESULTS PME was significantly associated with an increased early adversity index score (P < .001) and with increased externalizing, rule-breaking behavior, and aggressive behavior (P < .05). Early adversity was also associated with higher externalizing behavior scores. Early adversity significantly mediated the relationship between PME and behavioral problems. After adjusting the mediation model for sex, prenatal tobacco, alcohol, and marijuana exposures, and study site, the association of PME with early adversity remained significant. CONCLUSIONS Though PME is associated with behavioral problems, early adversity may be a strong determinant of behavioral outcome for children exposed to methamphetamine in utero. Early adversity significantly mediated the relationship between PME and behavioral problems.
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Affiliation(s)
- Nwando Eze
- Department of Pediatrics, David Geffen School of Medicine at University of California, Los Angeles (UCLA) and Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Lynne M Smith
- Department of Pediatrics, David Geffen School of Medicine at University of California, Los Angeles (UCLA) and Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA.
| | - Linda L LaGasse
- Pediatrics Division, Brown Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, RI
| | - Chris Derauf
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI
| | - Elana Newman
- Department of Psychology, The University of Tulsa, Tulsa, OK
| | - Amelia Arria
- Center for Substance Abuse Research, University of Maryland, College Park, MD
| | - Marilyn A Huestis
- Section on Chemistry and Drug Metabolism, National Institute on Drug Abuse, Bethesda, MD
| | - Sheri A Della Grotta
- Pediatrics Division, Brown Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, RI
| | - Lynne M Dansereau
- Pediatrics Division, Brown Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, RI
| | - Charles Neal
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI
| | - Barry M Lester
- Pediatrics Division, Brown Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, RI
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Smith LM, Diaz S, LaGasse LL, Wouldes T, Derauf C, Newman E, Arria A, Huestis MA, Haning W, Strauss A, Della Grotta S, Dansereau LM, Neal C, Lester BM. Developmental and behavioral consequences of prenatal methamphetamine exposure: A review of the Infant Development, Environment, and Lifestyle (IDEAL) study. Neurotoxicol Teratol 2015. [PMID: 26212684 DOI: 10.1016/j.ntt.2015.07.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This study reviews the findings from the Infant Development, Environment, and Lifestyle (IDEAL) study, a multisite, longitudinal, prospective study designed to determine maternal outcome and child growth and developmental findings following prenatal methamphetamine exposure from birth up to age 7.5 years. These findings are presented in the context of the home environment and caregiver characteristics to determine how the drug and the environment interact to affect the outcome of these children. No neonatal abstinence syndrome requiring pharmacologic intervention was observed but heavy drug exposure was associated with increased stress responses in the neonatal period. Poorer inhibitory control was also observed in heavy methamphetamine exposed children placing them at high risk for impaired executive function. Independent of methamphetamine exposure, children with more responsive home environments to developmental and emotional needs demonstrated lower risks for internalizing and externalizing behavior.
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Affiliation(s)
- Lynne M Smith
- Department of Pediatrics, Los Angeles Biomedical Institute at Harbor-UCLA Medical Center and David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Sabrina Diaz
- Department of Pediatrics, Los Angeles Biomedical Institute at Harbor-UCLA Medical Center and David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Linda L LaGasse
- Pediatrics Division, Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, RI, USA
| | - Trecia Wouldes
- Department of Psychological Medicine, University of Auckland, New Zealand
| | - Chris Derauf
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Elana Newman
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Amelia Arria
- Family Science Department, Center on Young Adult Health and Development, University of Maryland School of Public Health, College Park, MD, USA
| | - Marilyn A Huestis
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA
| | - William Haning
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Arthur Strauss
- Miller Children's Hospital Long Beach (MCHLB), Long Beach, CA, USA
| | - Sheri Della Grotta
- Pediatrics Division, Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, RI, USA
| | - Lynne M Dansereau
- Pediatrics Division, Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, RI, USA
| | - Charles Neal
- Department of Psychological Medicine, University of Auckland, New Zealand
| | - Barry M Lester
- Pediatrics Division, Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, RI, USA
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Kirby KC, Versek B, Kerwin ME, Meyers K, Benishek LA, Bresani E, Washio Y, Arria A, Meyers RJ. Developing Community Reinforcement and Family Training (CRAFT) for Parents of Treatment-Resistant Adolescents. J Child Adolesc Subst Abuse 2015; 24:155-165. [PMID: 25883523 PMCID: PMC4394369 DOI: 10.1080/1067828x.2013.777379] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We describe a project focused on training parents to facilitate their treatment-resistant adolescent's treatment entry and to manage their child after entry into community-based treatment. Controlled studies show that Community Reinforcement and Family Training (CRAFT) is a unilateral treatment that fosters treatment entry of adults; however, there are no controlled trials for parents with a substance-abusing child. We examined the behavioral parent training literature to guide us in tailoring CRAFT for parents of adolescents. We discuss adaptations to CRAFT, outcomes and experiences gained from a brief pilot of the revised CRAFT program, and the future directions of this work.
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Affiliation(s)
- Kimberly C. Kirby
- Treatment Research Institute
- University of Pennsylvania School of Medicine
| | | | | | | | - Lois A. Benishek
- Treatment Research Institute
- University of Pennsylvania School of Medicine
| | | | | | - Amelia Arria
- Treatment Research Institute
- University of Maryland
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Kiblawi ZN, Smith LM, Diaz SD, LaGasse LL, Derauf C, Newman E, Shah R, Arria A, Huestis M, Haning W, Strauss A, DellaGrotta S, Dansereau LM, Neal C, Lester B. Prenatal methamphetamine exposure and neonatal and infant neurobehavioral outcome: results from the IDEAL study. Subst Abus 2015; 35:68-73. [PMID: 24588296 DOI: 10.1080/08897077.2013.814614] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Methamphetamine (MA) use among pregnant women is an increasing problem in the United States. How MA use during pregnancy affects neonatal and infant neurobehavior is unknown. METHODS The Infant Development, Environment, and Lifestyle (IDEAL) study screened 34,833 subjects at 4 clinical centers. Of the subjects, 17,961 were eligible and 3705 were consented, among which 412 were enrolled for longitudinal follow-up. Exposed subjects were identified by self-report and/or gas chromatography/mass spectroscopy (GC/MS) confirmation of amphetamine and metabolites in meconium. Comparison subjects were matched (race, birth weight, maternal education, insurance), denied amphetamine use, and had a negative meconium screen. Both groups included prenatal alcohol, tobacco, and marijuana use, but excluded use of opiates, lysergic acid diethylamide, or phencyclidine. The Neonatal Intensive Care Unit (NICU) Network Neurobehavioral Scale (NNNS) was administered within the first 5 days of life and again at 1 month to 380 enrollees (185 exposed, 195 comparison). Analysis of variance (ANOVA) tested exposure effects on NNNS summary scores at birth and 1 month. General linear model (GLM) repeated-measures analysis assessed the effect of MA exposure over time on the NNNS scores with and without covariates. RESULTS By 1 month of age, both groups demonstrated higher quality of movement (P = .029), less lethargy (P = .001), and fewer asymmetric reflexes (P = .012), with no significant differences in NNNS scores between the exposed and comparison groups. Over the first month of life, arousal increased in exposed infants but decreased in comparison infants (P = .031) and total stress was decreased in exposed infants, with no change in comparison infants (P = .026). CONCLUSIONS Improvement in total stress and arousal were observed in MA-exposed newborns by 1 month of age relative to the newborn period.
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Affiliation(s)
- Zeina N Kiblawi
- a LA Biomed Institute at Harbor-UCLA Medical Center and David Geffen School of Medicine , Los Angeles , California , USA
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Cacciola JS, Meyers K, Bates SE, Rosenwasser B, Arria A, McLellan AT. Assessing Adolescent Substance Abuse Programs with Updated Quality Indicators: The Development of a Consumer Guide for Adolescent Treatment. J Child Adolesc Subst Abuse 2015; 24:142-154. [PMID: 26417196 PMCID: PMC4583134 DOI: 10.1080/1067828x.2013.777378] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
When adolescent substance abuse requires treatment, few parents know which treatment features are important and which treatment programs are effective. There are few resources to help them select appropriate care. We describe early work on an evaluation method and comparative treatment guide for parents based upon the premise that the quality of a program and its potential effectiveness is a function of the number and frequency of evidence-based treatment practices (EBPs) delivered. Thus, we describe the development of and measurement approach for a set of EBPs toward the goal of developing a Consumer Guide to Adolescent Substance Abuse Treatment.
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Affiliation(s)
- John S. Cacciola
- Treatment Research Institute
- University of Pennsylvania School of Medicine
| | | | | | | | - Amelia Arria
- Treatment Research Institute
- University of Maryland
| | - A. Thomas McLellan
- Treatment Research Institute
- University of Pennsylvania School of Medicine
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Diaz SD, Smith LM, LaGasse LL, Derauf C, Newman E, Shah R, Arria A, Huestis MA, Grotta SD, Dansereau LM, Neal C, Lester BM. Effects of prenatal methamphetamine exposure on behavioral and cognitive findings at 7.5 years of age. J Pediatr 2014; 164:1333-8. [PMID: 24630350 PMCID: PMC4035384 DOI: 10.1016/j.jpeds.2014.01.053] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Revised: 11/15/2013] [Accepted: 01/27/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To examine child behavioral and cognitive outcomes after prenatal exposure to methamphetamine. STUDY DESIGN We enrolled 412 mother-infant pairs (204 methamphetamine-exposed and 208 unexposed matched comparisons) in the Infant Development, Environment, and Lifestyle study. The 151 children exposed to methamphetamine and 147 comparisons who attended the 7.5-year visit were included. Exposure was determined by maternal self-report and/or positive meconium toxicology. Maternal interviews assessed behavioral and cognitive outcomes using the Conners' Parent Rating Scale-Revised: Short Form. RESULTS After adjusting for covariates, children exposed to methamphetamine had significantly higher cognitive problems subscale scores than comparisons and were 2.8 times more likely to have cognitive problems scores that were above average on the Conners' Parent Rating Scale-Revised: Short Form. No association between prenatal methamphetamine exposure and behavioral problems, measured by the oppositional, hyperactivity, and attention-deficit/hyperactivity disorder index subscales, were found. CONCLUSIONS Prenatal methamphetamine exposure was associated with increased cognitive problems, which may affect academic achievement and lead to increased negative behavioral outcomes.
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Affiliation(s)
- Sabrina D. Diaz
- LABiomed Institute at Harbor-UCLA Medical Center and David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Lynne M. Smith
- LABiomed Institute at Harbor-UCLA Medical Center and David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Linda L. LaGasse
- Brown Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, RI, USA
| | | | - Elana Newman
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Rizwan Shah
- Blank Hospital Regional Child Protection Center - Iowa Health, Des Moines, IA, USA
| | - Amelia Arria
- Center on Young Adult Health and Development, University of Maryland, School of Public Health, College Park, MD, USA
| | - Marilyn A. Huestis
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA
| | - Sheri Della Grotta
- Brown Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, RI, USA
| | - Lynne M. Dansereau
- Brown Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, RI, USA
| | - Charles Neal
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Barry M. Lester
- Brown Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, RI, USA
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Twomey J, LaGasse L, Derauf C, Newman E, Shah R, Smith L, Arria A, Huestis M, DellaGrotta S, Roberts M, Dansereau L, Neal C, Lester B. Prenatal methamphetamine exposure, home environment, and primary caregiver risk factors predict child behavioral problems at 5 years. Am J Orthopsychiatry 2013; 83:64-72. [PMID: 23330624 PMCID: PMC3721329 DOI: 10.1111/ajop.12007] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study investigated the prospective association between prenatal methamphetamine (MA) exposure and child behavioral problems at 5 years while also examining the home environment at 30 months and several primary caregiver (PC) risk factors. Participants were 97 MA-exposed and 117 comparison children and their PCs enrolled in the Infant Development, Environment and Lifestyle Study. Hypotheses were that child behaviors would be adversely impacted by (a) prenatal MA exposure, (b) home environments that provided less developmental stimulation and emotional responsiveness to the child, and (c) the presence of PC psychological symptoms and other risk factors. Prenatal MA exposure was associated with child externalizing behavioral problems at 5 years. Home environments that were more conducive to meeting children's developmental and emotional needs were associated with fewer internalizing and externalizing behavioral problems. Independent of prenatal MA exposure, PC parenting stress and psychological symptoms were associated with increased child behavioral problems. Findings suggest prenatal MA exposure may contribute to externalizing behavioral problems in early childhood and the importance of considering possible vulnerabilities related to prenatal MA exposure in the context of the child's caregiving environment.
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Affiliation(s)
- Jean Twomey
- Warren Alpert Medical School at Brown University, USA.
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Abar B, LaGasse LL, Derauf C, Newman E, Shah R, Smith LM, Arria A, Huestis M, Della Grotta S, Dansereau LM, Neal C, Lester BM. Examining the relationships between prenatal methamphetamine exposure, early adversity, and child neurobehavioral disinhibition. Psychol Addict Behav 2012; 27:662-73. [PMID: 23067308 DOI: 10.1037/a0030157] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Methamphetamine use is a growing problem among pregnant women in the United States. Many negative consequences of methamphetamine use have been documented for the users, but little research has examined the long-term association between prenatal methamphetamine exposure (PME) and childhood outcomes. The current study examined the extent to which PME was predictive of childhood neurobehavioral disinhibition (ND), as well as the extent to which early adversity mediated this relationship. A sample of 320 mother-infant dyads (162 PME) was followed from birth through 6.5 years of age. ND was conceptualized as a two factor model consisting of deficits in (a) behavioral and emotional control, and (b) executive function. PME was associated with behavioral and emotional control at 5 years, which was associated with executive function deficits at 6.5 years. Early adversity (birth through year 3) significantly mediated the relationship between PME and ND. Associations with previous research and implications for prevention are discussed.
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Affiliation(s)
- Beau Abar
- Center for the Study of Children at Risk, Brown University Warren Alpert Medical School
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Smith LM, Paz MS, LaGasse LL, Derauf C, Newman E, Shah R, Arria A, Huestis MA, Haning W, Strauss A, Grotta SD, Dansereau LM, Neal C, Lester BM. Maternal depression and prenatal exposure to methamphetamine: neurodevelopmental findings from the infant development, environment, and lifestyle (ideal) study. Depress Anxiety 2012; 29:515-22. [PMID: 22555777 PMCID: PMC3717341 DOI: 10.1002/da.21956] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 02/07/2012] [Accepted: 03/25/2012] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Maternal depression is associated with a higher incidence of behavioral problems in infants, but the effects of maternal depression as early as 1 month are not well characterized. The objective of this study is to determine the neurobehavioral effects of maternal depression on infants exposed and not exposed to methamphetamine (MA) using the NICU Network Neurobehavioral Scale (NNNS). METHODS Four hundred twelve mother-infant pairs were enrolled (MA = 204) and only biological mothers with custody of their child were included in the current analysis. At the 1-month visit (n = 126 MA-exposed; n = 193 MA-unexposed), the Beck Depression Inventory-II (BDI-II) was administered, and the NNNS was administered to the infant. Exposure was identified by self-report and/or gas chromatography/mass spectroscopy confirmation of amphetamine and metabolites in newborn meconium. Unexposed subjects were matched, denied amphetamine use, and had negative meconium screens. General Linear Models tested the effects of maternal depression and prenatal MA exposure on NNNS, with significance accepted at P < .05. RESULTS The MA group had an increased incidence of depression-positive diagnosis and increased depression scores on the BDI-II. After adjusting for covariates, MA exposure was associated with increased arousal and handling scores, and a decreased ability to self-regulate. Maternal depression was associated with higher autonomic stress and poorer quality of movement. No additional differences were observed in infants whose mothers were both depressed and used MA during pregnancy. CONCLUSIONS Maternal depression is associated with neurodevelopmental patterns of increased stress and decreased quality of movement, suggesting maternal depression influences neurodevelopment in infants as young as 1 month.
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Affiliation(s)
- Lynne M. Smith
- Department of Pediatrics, LABioMed Institute at Harbor-UCLA Medical Center and David Geffen School of Medicine at UCLA, Los Angeles, California,Correspondence to: Lynne M. Smith, Department of Pediatrics, Harbor-UCLA Medical Center, 1124 West Carson Street, RB-1, Torrance, CA 90502.
| | - Monica S. Paz
- Department of Pediatrics, LABioMed Institute at Harbor-UCLA Medical Center and David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Linda L. LaGasse
- Pediatrics Division, Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, Rhode Island
| | - Chris Derauf
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Elana Newman
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Rizwan Shah
- Blank Hospital Regional Child Protection Center—Iowa Health, Des Moines, Iowa
| | - Amelia Arria
- Family Science Department, Center on Young Adult Health and Development, University of Maryland School of Public Health, College Park, Maryland
| | - Marilyn A. Huestis
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland
| | - William Haning
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Arthur Strauss
- Miller Children’s Hospital Long Beach (MCHLB), Long Beach, California
| | - Sheri Della Grotta
- Pediatrics Division, Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, Rhode Island
| | - Lynne M. Dansereau
- Pediatrics Division, Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, Rhode Island
| | - Charles Neal
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Barry M. Lester
- Pediatrics Division, Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, Rhode Island
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Shah R, Diaz SD, Arria A, LaGasse LL, Derauf C, Newman E, Smith LM, Huestis MA, Haning W, Strauss A, Grotta SD, Dansereau LM, Roberts MB, Neal C, Lester BM. Prenatal methamphetamine exposure and short-term maternal and infant medical outcomes. Am J Perinatol 2012; 29:391-400. [PMID: 22399214 PMCID: PMC3717348 DOI: 10.1055/s-0032-1304818] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Examine maternal and infant medical outcomes of prenatal exposure to methamphetamine (MA). STUDY DESIGN Four hundred and twelve mother-infant pairs (204 MA-exposed and 208 unexposed matched comparisons) were enrolled in the Infant Development, Environment and Lifestyle (IDEAL) study. Exposure was determined by maternal self-report during this pregnancy and/or positive meconium toxicology. Maternal interviews assessed prenatal drug use, pregnancy course, and sociodemographic information. Medical chart reviews provided medical history, obstetric complications, infant outcomes, and discharge placement. RESULTS MA-using mothers were more likely to be poor, to have a psychiatric disorder/emotional illness and less prenatal care, and to be less likely to breast-feed their infant than comparison mothers. After adjusting for covariates, MA-exposed infants were more likely to exhibit poor suck, to have smaller head circumferences and length, to require neonatal intensive care unit (NICU) admission, and to be referred to child protective services (CPS). Several outcomes previously reported from studies that lacked adequate control groups or adjustment for covariates were not significantly different in this study. CONCLUSION Prenatal MA exposure is associated with maternal psychiatric disorder/emotional illness, poor suck, NICU admission, and CPS involvement, and MA-exposed infants were less likely to be breast-fed; however, the absence of many serious complications, such as fetal distress, chronic hypertension, preeclampsia, placenta previa, abruptio placentae, and cardiac defects, suggests confounding variables influenced prior studies.
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Affiliation(s)
- Rizwan Shah
- Blank Hospital Regional Child Protection Center, Iowa Health, Des Moines, Iowa
| | - Sabrina D. Diaz
- LABiomed Institute at Harbor-UCLA Medical Center and David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Amelia Arria
- Center on Young Adult Health and Development, University of Maryland, School of Public Health, College Park, Maryland
| | - Linda L. LaGasse
- Brown Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, Rhode Island
| | - Chris Derauf
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Elana Newman
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Lynne M. Smith
- LABiomed Institute at Harbor-UCLA Medical Center and David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Marilyn A. Huestis
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland
| | - William Haning
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Arthur Strauss
- Miller Children’s Hospital at Long Beach Memorial Medical Center, Long Beach, California
| | - Sheri Della Grotta
- Brown Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, Rhode Island
| | - Lynne M. Dansereau
- Brown Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, Rhode Island
| | - Mary B. Roberts
- Brown Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, Rhode Island
| | - Charles Neal
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Barry M. Lester
- Brown Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, Rhode Island
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LaGasse LL, Derauf C, Smith LM, Newman E, Shah R, Neal C, Arria A, Huestis MA, DellaGrotta S, Lin H, Dansereau LM, Lester BM. Prenatal methamphetamine exposure and childhood behavior problems at 3 and 5 years of age. Pediatrics 2012; 129:681-8. [PMID: 22430455 PMCID: PMC3313637 DOI: 10.1542/peds.2011-2209] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We evaluated behavior problems in children who were prenatally exposed to methamphetamine (MA) at ages 3 and 5 years. METHODS The Infant Development, Environment, and Lifestyle study, a prospective, longitudinal study of prenatal MA exposure and child outcome, enrolled subjects postpartum in Los Angeles, California; Honolulu, Hawaii; Des Moines, Iowa; and Tulsa, Oklahoma. Prenatal exposure was determined by maternal self-report and/or meconium results. Exposed and comparison groups were matched on race, birth weight, public health insurance, and education. Mothers in the comparison group denied use and had a negative meconium screen for amphetamines. Prenatal exposures to tobacco, alcohol, or marijuana occurred in both groups. At ages 3 and 5 years, 330 children (166 exposed and 164 comparison) were assessed for behavior problems by using the caregiver report on the Child Behavior Checklist. General linear mixed models were used to determine the effects of prenatal MA exposure, including heavy exposure (≥3 days per week), age, and the interaction of exposure and age on behavior problems with adjustment for other drugs of abuse and environmental risk factors. RESULTS MA exposure was associated with increased emotional reactivity and anxious/depressed problems at both ages and externalizing and attention-deficit/hyperactivity disorder problems by age 5 years. Heavy exposure was related to attention problems and withdrawn behavior at both ages. There were no effects of MA on the internalizing or total behavior problems scales. CONCLUSIONS This first report of behavior problems in patients as young as 3 years associated with MA exposure identifies an important public health problem. Continued follow-up can inform the development of preventive intervention programs.
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Affiliation(s)
- Linda L. LaGasse
- Brown Center for the Study of Children at Risk, Warren Alpert Medical School at Brown University and Women & Infants Hospital, Providence, Rhode Island
| | - Chris Derauf
- Department of Pediatrics, University of Hawaii, Honolulu, Hawaii
| | - Lynne M. Smith
- Department of Pediatrics, Los Angeles Biomedical Research Institute at Harbor–UCLA Medical Center and David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Elana Newman
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Rizwan Shah
- Blank Children’s Hospital Regional Child Protection Center, Iowa Health, Des Moines, Iowa
| | - Charles Neal
- Department of Pediatrics, University of Hawaii, Honolulu, Hawaii
| | - Amelia Arria
- Family Science Department, Center on Young Adult Health and Development, University of Maryland School of Public Health, College Park, Maryland; and
| | - Marilyn A. Huestis
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland
| | - Sheri DellaGrotta
- Brown Center for the Study of Children at Risk, Warren Alpert Medical School at Brown University and Women & Infants Hospital, Providence, Rhode Island
| | - Hai Lin
- Brown Center for the Study of Children at Risk, Warren Alpert Medical School at Brown University and Women & Infants Hospital, Providence, Rhode Island
| | - Lynne M. Dansereau
- Brown Center for the Study of Children at Risk, Warren Alpert Medical School at Brown University and Women & Infants Hospital, Providence, Rhode Island
| | - Barry M. Lester
- Brown Center for the Study of Children at Risk, Warren Alpert Medical School at Brown University and Women & Infants Hospital, Providence, Rhode Island
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Zabaneh R, Smith LM, LaGasse LL, Derauf C, Newman E, Shah R, Arria A, Huestis M, Haning W, Strauss A, Grotta SD, Dansereau LM, Lin H, Neal C, Lester BM. The effects of prenatal methamphetamine exposure on childhood growth patterns from birth to 3 years of age. Am J Perinatol 2012; 29:203-10. [PMID: 21818727 PMCID: PMC3717349 DOI: 10.1055/s-0031-1285094] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
We examined the effects of prenatal methamphetamine (MA) exposure on growth parameters from birth to age 3 years. The 412 subjects included (n = 204 exposed) were enrolled at birth in the Infant Development, Environment and Lifestyle study, a longitudinal study assessing the effects of prenatal MA exposure on childhood outcomes. Individual models were used to examine the effects of prenatal MA exposure on weight, head circumference, height, and weight-for-length growth trajectories. After adjusting for covariates, height trajectory was lower in the exposed versus the comparison children (p = 0.021) over the first 3 years of life. Both groups increased height on average by 2.27 cm per month by age 3 years. In term subjects, MA exposure was also associated with a lower height trajectory (p = 0.034), with both the exposed and comparison groups gaining 2.25 cm per month by age 3 years. There was no difference in weight, head circumference, or weight-for-length growth trajectories between the comparison and the exposed groups. Children exposed prenatally to MA have a modest decrease in height growth trajectory during the first 3 years of life with no observed difference in weight, head circumference, or weight-for-length trajectories.
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Affiliation(s)
- Rachel Zabaneh
- Los Angeles Biomedical Institute at Harbor–UCLA Medical Center and David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Lynne M. Smith
- Los Angeles Biomedical Institute at Harbor–UCLA Medical Center and David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Linda L. LaGasse
- Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, Rhode Island
| | - Chris Derauf
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Elana Newman
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Rizwan Shah
- Blank Hospital Regional Child Protection Center–Iowa Health, Des Moines, Iowa
| | - Amelia Arria
- Center for Substance Abuse Research (CESAR), University of Maryland, College Park, Maryland
| | - Marilyn Huestis
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland
| | - William Haning
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Arthur Strauss
- Long Beach Memorial Medical Center, Long Beach, California
| | - Sheri Della Grotta
- Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, Rhode Island
| | - Lynne M. Dansereau
- Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, Rhode Island
| | - Hai Lin
- Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, Rhode Island
| | - Charles Neal
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Barry M. Lester
- Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, Rhode Island
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Unger A, Jagsch R, Jones H, Arria A, Leitich H, Rohrmeister K, Aschauer C, Winklbaur B, Bäwert A, Fischer G. Randomized controlled trials in pregnancy: scientific and ethical aspects. Exposure to different opioid medications during pregnancy in an intra-individual comparison. Addiction 2011; 106:1355-62. [PMID: 21438938 PMCID: PMC3107876 DOI: 10.1111/j.1360-0443.2011.03440.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chronic medical conditions such as opioid dependence require evidence-based treatment recommendations. However, pregnant women are under-represented in clinical trials. We describe the first within-subject comparison of maternal and neonatal outcomes for methadone- versus buprenorphine-exposed pregnancies. Although methadone is the established treatment of pregnant opioid-dependent women, recent investigations have shown a trend for a milder neonatal abstinence syndrome (NAS) under buprenorphine. However, it is not only the choice of maintenance medication that determines the occurrence of NAS; other factors such as maternal metabolism, illicit substance abuse and nicotine consumption also influence its severity and duration and represent confounding factors in the assessment of randomized clinical trials. CASE SERIES DESCRIPTION: Three women who were part of the European cohort of a randomized, double-blind multi-center trial with a contingency management tool [the Maternal Opioid Treatment: Human Experimental Research (MOTHER) study], each had two consecutive pregnancies and were maintained on either methadone or buprenorphine for their first and then the respective opposite, still-blinded medication for their second pregnancy. Birth measurements, the total neonatal abstinence score, the total amounts of medication used to treat NAS and the days of NAS treatment duration were assessed. RESULTS Both medications were effective and safe in reducing illicit opioid relapse and avoiding preterm labor. Methadone maintenance yielded to a significantly higher neonatal birth weight. Data patterns suggest that buprenorphine exposure was associated with lower neonatal abstinence syndrome (NAS) scores. Findings from this unique case series are consistent with earlier reports using between-group analyses. CONCLUSIONS Buprenorphine has the potential to become an established treatment alternative to methadone for pregnant opioid-dependent women. Under special consideration of ethical boundaries, psychopharmacological treatment during pregnancy must be addressed as an integral part of clinical research projects in order to optimize treatment for women and neonates.
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Affiliation(s)
- Annemarie Unger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | | | - Hendree Jones
- Departments of Psychiatry and Behavioural Sciencesand Obstetrics and Gynaecology, Johns Hopkins University School of Medicine, Baltimore, MD 21224 USA
| | - Amelia Arria
- Center for Young Adult Health and Development, University of Maryland, College Park, College Park, MD 20742 USA
| | - Harald Leitich
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Austria
| | | | - Constantin Aschauer
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | | | - Andjela Bäwert
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Gabriele Fischer
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
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16
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Smith LM, LaGasse LL, Derauf C, Newman E, Shah R, Haning W, Arria A, Huestis M, Strauss A, Della Grotta S, Dansereau LM, Lin H, Lester BM. Motor and cognitive outcomes through three years of age in children exposed to prenatal methamphetamine. Neurotoxicol Teratol 2011; 33:176-84. [PMID: 21256431 DOI: 10.1016/j.ntt.2010.10.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 08/13/2010] [Accepted: 10/15/2010] [Indexed: 11/17/2022]
Abstract
BACKGROUND Methamphetamine (MA) use among pregnant women is an increasing problem in the United States. The impact of prenatal MA exposure on development in childhood is unknown. OBJECTIVE To examine the effects of prenatal MA exposure on motor and cognitive development in children at 1, 2, and 3 years of age. DESIGN/METHODS IDEAL enrolled 412 mother-infant pairs at four sites (Tulsa OK, Des Moines IA, Los Angeles CA, and Honolulu HI). MA subjects (n=204) were identified by self report or GC/MS confirmation of amphetamine and metabolites in infant meconium. Comparison subjects (n=208) were matched (race, birth weight, maternal education, and type of insurance), denied amphetamine use, and had a negative meconium screen. Both groups included prenatal alcohol, tobacco and marijuana use, but excluded use of opiates, lysergic acid diethylamide, phencyclidine or cocaine only. The Peabody Developmental Motor Scales (PDMS-2) were administered to the infants at the 1 and 3 year visits. This analysis includes a subsample (n=350) of the IDEAL study with completed 1 and/or 3 year visits (n=330 and 281, respectively). At each annual visit we also conducted the Bayley Scales of Infant Development (BSID-II) as a general evaluation of mental and motor development. The BSID-II analysis includes a subsample (n=356) of the IDEAL study with completed 1, 2, and/or 3 year visits (n=331, 288, and 278 respectively). GLM analysis conducted on the PDMS-2 and BSID-II examined the effects of MA exposure and heavy MA exposure (≥3 days of use/week), with and without covariates. Longitudinal analyses were used to examine the effects of MA exposure on changes in motor and cognitive performance over time. RESULTS Heavy MA exposure was associated with significantly lower grasping scores than some and no use at 1 year (P=0.018). In longitudinal analysis, lower grasping scores associated with any MA exposure and heavy exposure persisted to 3 years. There were no effects of MA exposure, including heavy exposure, on the Bayley Mental Development Index (MDI) or Psychomotor Development Index (PDI) at any or across age. CONCLUSIONS There were no differences in cognition as assessed by the BSID-II between the groups. There was a subtle MA exposure effect on fine motor performance at 1 year with the poorest performance observed in the most heavily exposed children. By 3 years, no differences in fine motor performance were observed. These findings suggest MA exposure has modest motor effects at 1 year that are mostly resolved by 3 years.
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Affiliation(s)
- Lynne M Smith
- Los Angeles Biomedical Institute at Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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Winters KC, Arria A. Adolescent Brain Development and Drugs. Prev Res 2011; 18:21-24. [PMID: 22822298 PMCID: PMC3399589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
New scientific discoveries have put a much different perspective on our understanding of adolescent behavior. Research now suggests that the human brain is still maturing during the adolescent years. The developing brain may help explain why adolescents sometimes make decisions that are risky and can lead to safety or health concerns, including unique vulnerabilities to drug abuse. This new science can be useful in revising prevention strategies to be more effective.
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Affiliation(s)
- Ken C. Winters
- Department of Psychiatry, University of Minnesota Medical School
- Treatment Research Institute
| | - Amelia Arria
- University of Maryland, School of School of Public Health
- Treatment Research Institute
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Heil SH, Jones HE, Arria A, Kaltenbach K, Coyle M, Fischer G, Stine S, Selby P, Martin PR. Unintended pregnancy in opioid-abusing women. J Subst Abuse Treat 2010; 40:199-202. [PMID: 21036512 DOI: 10.1016/j.jsat.2010.08.011] [Citation(s) in RCA: 189] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Accepted: 08/25/2010] [Indexed: 11/26/2022]
Abstract
The aim of this study was to estimate the prevalence of unintended pregnancy and its three subtypes (mistimed, unwanted, and ambivalent) among opioid-abusing women. In the general population, 31%-47% of pregnancies are unintended; data on unintended pregnancy in opioid- and other drug-abusing women are lacking. Pregnant opioid-abusing women (N = 946) screened for possible enrollment in a multisite randomized controlled trial comparing opioid maintenance medications completed a standardized interview assessing sociodemographic characteristics, current and past drug use, and pregnancy intention. Almost 9 of every 10 pregnancies were unintended (86%), with comparable percentages mistimed (34%), unwanted (27%), and ambivalent (26%). Irrespective of pregnancy intention, more than 90% of the total sample had a history of drug abuse treatment, averaging more than three treatment episodes. Interventions are sorely needed to address the extremely high rate of unintended pregnancy among opioid-abusing women. Drug treatment programs are likely to be an important setting for such interventions.
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Affiliation(s)
- Sarah H Heil
- Department of Psychiatry and Psychology, University of Vermont, Burlington, VT 05401, USA.
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Nguyen D, Smith LM, LaGasse LL, Derauf C, Grant P, Shah R, Arria A, Huestis MA, Haning W, Strauss A, Grotta SD, Liu J, Lester BM. Intrauterine growth of infants exposed to prenatal methamphetamine: results from the infant development, environment, and lifestyle study. J Pediatr 2010; 157:337-9. [PMID: 20570284 PMCID: PMC3018351 DOI: 10.1016/j.jpeds.2010.04.024] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Revised: 03/17/2010] [Accepted: 04/13/2010] [Indexed: 11/30/2022]
Abstract
Previous studies suggest that prenatal methamphetamine exposure inhibits fetal growth. We examined neonatal growth effects of prenatal methamphetamine exposure in a prospective cohort study. After adjusting for covariates, exposed neonates had a higher incidence of being small for gestational age than unexposed neonates.
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Affiliation(s)
- Diana Nguyen
- Los Angeles Biomedical Institute at Harbor-UCLA Medical Center and David Geffen School of Medicine at UCLA
| | - Lynne M. Smith
- Los Angeles Biomedical Institute at Harbor-UCLA Medical Center and David Geffen School of Medicine at UCLA
| | - Linda L. LaGasse
- Brown Medical School, Women and Infant's Hospital, University of Hawaii
| | - Chris Derauf
- John A. Burns School of Medicine, University of Hawaii
| | | | - Rizwan Shah
- Blank Children's Hospital-Iowa Health, Des Moines
| | | | - Marilyn A. Huestis
- National Institute on Drug Abuse, Intramural Research Program, Chemistry and Drug Metabolism
| | | | | | | | - Jing Liu
- Brown Medical School, Women and Infant's Hospital, University of Hawaii
| | - Barry M. Lester
- Brown Medical School, Women and Infant's Hospital, University of Hawaii
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Gray TR, Kelly T, LaGasse LL, Smith LM, Derauf C, Grant P, Shah R, Arria A, Haning W, Della Grotta S, Strauss A, Lester BM, Huestis MA. New meconium biomarkers of prenatal methamphetamine exposure increase identification of affected neonates. Clin Chem 2010; 56:856-60. [PMID: 20185623 DOI: 10.1373/clinchem.2009.139055] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Prenatal methamphetamine (MAMP) exposure is poorly reflected in neonatal meconium. Often, maternal self-reported MAMP use is not corroborated by positive results in amphetamines immunoassays of meconium, and even if initial test results are positive, they frequently are not confirmed for MAMP or amphetamine (AMP) by chromatographic analysis. The presence of the MAMP metabolites p-hydroxymethamphetamine (pOHMAMP), p-hydroxyamphetamine (pOHAMP), and norephedrine (NOREPH) in meconium may improve the identification of MAMP- and AMP-exposed neonates. METHODS Immunoassay-positive and -negative meconium samples were subjected to liquid chromatography- tandem mass spectrometric reanalysis for these recently identified metabolites. RESULTS pOHAMP and NOREPH were detected only when MAMP and/or AMP were present and thus do not appear to be promising biomarkers of prenatal MAMP exposure. pOHMAMP, in contrast, identified 6 additional neonates whose mothers reported MAMP exposure, yet had a meconium sample screened as negative; pOHMAMP was more likely to be present if maternal MAMP use continued into the third trimester. Although the pOHMAMP results for meconium samples corroborated the maternal self-reports, the confirmation rate for positive meconium screening results did not improve with the inclusion of these new biomarkers. CONCLUSIONS pOHMAMP identified additional MAMP- exposed neonates; therefore, MAMP, AMP, and pOHMAMP should be included in meconium chromatographic analyses. Maximizing the identification of MAMP-exposed children requires improvement in immunoassay screening tests to reduce false-negative and false-positive results. Additional research will help clarify which AMP-related compounds, if any, contribute to unconfirmed positive results in screening tests. Furthermore, nonamphetamine compounds endogenous to the complex meconium matrix also may cross-react, making chromatographic confirmation of screening results essential.
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Affiliation(s)
- Teresa R Gray
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, NIH, Baltimore, MD, USA
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Paz MS, Smith LM, LaGasse LL, Derauf C, Grant P, Shah R, Arria A, Huestis M, Haning W, Strauss A, Della Grotta S, Liu J, Lester BM. Maternal depression and neurobehavior in newborns prenatally exposed to methamphetamine. Neurotoxicol Teratol 2008; 31:177-82. [PMID: 19059478 DOI: 10.1016/j.ntt.2008.11.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2008] [Revised: 11/12/2008] [Accepted: 11/24/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND The effects of maternal depression on neonatal neurodevelopment in MA exposed neonates have not been well characterized. OBJECTIVE To determine the neurobehavioral effects of maternal depressive symptoms on neonates exposed and not exposed to methamphetamine (MA) using the NICU Network Neurobehavioral Scale (NNNS). DESIGN The purpose of the IDEAL study is to determine the effects of prenatal MA exposure on child outcome. IDEAL screened 13,808 subjects, 1632 were eligible and consented and 176 mothers were enrolled. Only biological mothers with custody of their child at the one-month visit (n=50 MA; n=86 comparison) had the Addiction Severity Index (ASI) administered. The NNNS was administered to the neonate by an examiner blinded to MA exposure within the first five days of life. General Linear Models tested the effects of maternal depression and prenatal MA exposure on NNNS outcomes, with and without covariates. Significance was accepted at p<.05. RESULTS After adjusting for covariates, regardless of exposure status, maternal depressive symptoms were associated with lower handling and arousal scores, elevated physiological stress scores and an increased incidence of hypotonicity. When adjusting for covariates, MA exposure was associated with lower arousal and higher lethargy scores. CONCLUSIONS Maternal depressive symptoms are associated with neurodevelopmental patterns of decreased arousal and increased stress. Prenatal MA exposure combined with maternal depression was not associated with any additional neonatal neurodevelopmental differences.
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Affiliation(s)
- Monica S Paz
- Los Angeles Biomedical Institute at Harbor-UCLA Medical Center and David Geffen School of Medicine at UCLA, USA
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Derauf C, LaGasse LL, Smith LM, Grant P, Shah R, Arria A, Huestis M, Haning W, Strauss A, Della Grotta S, Liu J, Lester BM. Demographic and psychosocial characteristics of mothers using methamphetamine during pregnancy: preliminary results of the infant development, environment, and lifestyle study (IDEAL). Am J Drug Alcohol Abuse 2007; 33:281-9. [PMID: 17497551 PMCID: PMC2737408 DOI: 10.1080/00952990601175029] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study describes the psychological characteristics and caretaking environments of 131 women enrolled in the first longitudinal study of prenatal methamphetamine (MA) exposure and child development. Prenatal MA use was associated with lower maternal perceptions on quality of life, greater likelihood of substance use among family and friends, increased risk for ongoing legal difficulties, and a markedly increased likelihood of developing a substance abuse disorder. Our preliminary findings suggest that MA using women are more likely to have multiple, intertwined psychosocial risks that may result in maladaptive parenting and caregiving. These factors may impact the developmental outcomes of affected children.
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Affiliation(s)
- Chris Derauf
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96826, USA.
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Smith LM, LaGasse LL, Derauf C, Grant P, Shah R, Arria A, Huestis M, Haning W, Strauss A, Della Grotta S, Liu J, Lester BM. The infant development, environment, and lifestyle study: effects of prenatal methamphetamine exposure, polydrug exposure, and poverty on intrauterine growth. Pediatrics 2006; 118:1149-56. [PMID: 16951010 DOI: 10.1542/peds.2005-2564] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Methamphetamine use among pregnant women is an increasing problem in the United States. Effects of methamphetamine use during pregnancy on fetal growth have not been reported in large, prospective studies. We examined the neonatal growth effects of prenatal methamphetamine exposure in the multicenter, longitudinal Infant Development, Environment and Lifestyle study. DESIGN/METHOD The Infant Development, Environment and Lifestyle study screened 13808 subjects at 4 clinical centers: 1618 were eligible and consented, among which 84 were methamphetamine exposed, and 1534 were unexposed. Those who were methamphetamine exposed were identified by self-report and/or gas chromatography-mass spectrometry confirmation of amphetamine and metabolites in infant meconium. Those who were unexposed denied amphetamine use and had a negative meconium screen. Both groups included prenatal alcohol, tobacco, or marijuana use, but excluded use of opiates, LSD, PCP or cocaine only. Neonatal parameters included birth weight and gestational age in weeks. One-way analysis of variance and linear-regression analyses were conducted on birth weight by exposure. The relationship of methamphetamine exposure and the incidence of small for gestational age was analyzed using multivariate logistic-regression analyses. RESULTS The methamphetamine exposed group was 3.5 times more likely to be small for gestational age than the unexposed group. Mothers who used tobacco during pregnancy were nearly 2 times more likely to have small-for-gestational-age infants. In addition, less maternal weight gain during pregnancy was more likely to result in a small-for-gestational-age infant. Birthweight in the methamphetamine exposed group was lower than the unexposed group. CONCLUSIONS These findings suggest that prenatal methamphetamine use is associated with fetal growth restriction after adjusting for covariates. Continued follow-up will determine if these infants are at increased risk for growth abnormalities in the future.
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Affiliation(s)
- Lynne M Smith
- Department of Pediatrics, David Geffen School of Medicine at UCLA and Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90502.
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Paz MS, Smith LM, LaGasse LL, Derauf C, Grant P, Shah R, Arria A, Huestis M, Haning W, Strauss A, Grotta DS, Fallone M, Liu J, Lester BM. 73 MATERNAL DEPRESSION AND PRENATAL EXPOSURE TO METHAMPHETAMINE: PRELIMINARY NEONATAL NEURODEVELOPMENTAL FINDINGS FROM THE INFANT DEVELOPMENT, ENVIRONMENT, AND LIFESTYLE (IDEAL) STUDY. J Investig Med 2006. [DOI: 10.2310/6650.2005.x0004.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Fuller CM, Vlahov D, Ompad DC, Shah N, Arria A, Strathdee SA. High-risk behaviors associated with transition from illicit non-injection to injection drug use among adolescent and young adult drug users: a case-control study. Drug Alcohol Depend 2002; 66:189-98. [PMID: 11906806 DOI: 10.1016/s0376-8716(01)00200-9] [Citation(s) in RCA: 125] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The goal of our study was to elucidate characteristics of persons likely to transition into injection drug use so that an identifiable group with high-risk for blood-borne infection may be targeted for interventions. METHODS An age-matched case-control analysis was performed from a cohort study in Baltimore, 1997-1999, of street-recruited non-injection and injection drug users (IDUs), aged 15-30. Cases were IDUs injecting < or = 2 years and controls were age-matched persons who used non-injection heroin, cocaine or crack. At baseline, all were interviewed about prior year-by-year behaviors; analysis using conditional logistic regression was based on information for the year prior to injection onset for the case and the same calendar time for the controls as well as recent behaviors for both groups. RESULTS Of 270 participants, most were African American (78%), female (61%), and HIV seroprevalence was 7% at baseline. IDUs were significantly more likely than controls to be non-African American (adjusted odds ratio (AOR)=0.09) and report high school dropout (AOR=2.32), early sex-trading (AOR=2.72), and recent violence victimization (AOR=9.28). CONCLUSION Given that new injectors are at high-risk for HIV and hepatitis yet difficult to reach for prevention efforts, our data suggest some categories to use to target non-injectors who are likely to transition into injection use.
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Affiliation(s)
- Crystal M Fuller
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 622 West 168th Street, PH 18-120, New York, NY 10032, USA.
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Arria A, Borges G, Anthony JC. Fears and other suspected risk factors for carrying lethal weapons among urban youths of middle-school age. Arch Pediatr Adolesc Med 1997; 151:555-60. [PMID: 9193237 DOI: 10.1001/archpedi.1997.02170430021004] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To estimate the strength of a suspected causal association between fearfulness and carrying a lethal weapon among urban middle-school students, while holding constant other suspected risk factors. DESIGN A prospective study of an epidemiological sample assessed at baseline in 1992 and 1 year later, with relative risk estimates derived from the conditional form of the multiple logistic regression model used to hold constant alternative explanatory variables. SETTING An urban environment in the mid-Atlantic region of the United States. PARTICIPANTS An epidemiological sample of 1131 youths enrolled in public middle schools. MAIN OUTCOME MEASURES Carrying a lethal weapon for protection or defense during a 1-year observation interval after the baseline assessment of fears and other suspected risk factors. RESULTS Of the 1131 youths, 194 (17%) reported carrying a lethal weapon for protection or defense during the 1-year interval of follow-up observation after baseline; 937 youths (83%) reported that they had not carried a lethal weapon for any reason. Self-reported fears, deviant peer affiliation, and worrying were associated with risk of starting to carry a weapon. For youths with the lowest worrying scores, the lowest neighborhood danger scores, and the least affiliation with deviant peers, self-reported fears were associated with risk of starting to carry a lethal weapon (relative risk estimate, 1.68; 95% confidence interval, 1.11-2.52; P = .01), even after holding constant age, sex, and conduct problems. However, the fear of crowded or closed-in places and the fear of leaving home alone were more salient risk factors than the fear of using public transportation or the fear of open spaces. CONCLUSIONS In this study, youths with fears were at greater risk of carrying a lethal weapon for protection or defense, even when alternative explanatory variables were taken into account. Pending confirmation by other investigators, this new finding could point out a useful target for public health interventions to reduce the carrying of weapons and associated violence in urban America.
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Affiliation(s)
- A Arria
- Department of Mental Hygiene, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Md, USA
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Abstract
Compared with alcohol-abstaining normal postmenopausal women, estradiol levels are known to be statistically increased in normal postmenopausal women who consume alcoholic beverages moderately, and to be even further increased in alcoholic postmenopausal women with cirrhosis. This study was undertaken to evaluate whether or not there is a spectrum of changes in levels of sex steroids and pituitary hormones associated with alcohol abstinence, alcohol use, and alcohol-induced cirrhosis in the absence of current alcohol abuse. For levels of estradiol and testosterone, as well as for the estradiol to testosterone ratio, all three groups differed significantly from each other; for the pituitary hormones, levels in the abstainers and alcohol users were similar and statistically different from levels in the alcoholic cirrhotic women. Compared with the alcohol-abstaining women, the relationships of age and estradiol with levels of the other hormones were disturbed for 4 of 11 correlations examined among the alcohol users, and for 9 of 11 correlations evaluated among the alcoholic cirrhotic women. These findings suggest that not only are hormonal relationships markedly disrupted among alcoholic cirrhotics, but also that alcoholic beverage consumption in the range of 0.1-28 total weekly drinks results in detectable perturbations of the normal hormonal relationships expected in postmenopausal women.
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Affiliation(s)
- J S Gavaler
- Department of Medicine, School of Medicine, University of Pittsburgh, Pennsylvania
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Abstract
A taxonomy of alcohol problem involvement is proposed which encompasses categorical and dimensional approaches to classification. It is argued that contemporary nosology such as that described in DSM or ICD cannot, in principle, yield discrete categories containing homogeneous membership. Nor does current classification and diagnosis yield sufficient specific information necessary for effective treatment. These limitations are not resolvable by additional empirical research; rather, as discussed herein, a new conceptual framework and focus are required. The proposed new taxonomy comprises the first step in developing a comprehensive and clinically useful method for characterizing the alcohol consuming population.
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Affiliation(s)
- R E Tarter
- Department of Psychiatry, University of Pittsburgh Medical School, PA 15213
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Tarter RE, Switala J, Arria A, Plail J, Van Thiel D. Quality of life before and after orthotopic hepatic transplantation. Arch Intern Med 1991; 151:1521-6. [PMID: 1872657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Fifty-three nonalcoholic patients were evaluated prior to liver transplantation and again approximately 3 years after surgery using the Sickness Impact Profile and Social Behavior Adjustment Schedule. Test-retest scores reflected significant improvement across all health and psychosocial scales of the Sickness Impact Profile. On the Social Behavior Adjustment Schedule, significant improvement was observed on scales measuring disturbed behavior, social role performance, and burden. Comparisons between groups indicated that the liver transplant patients were still impaired on eight of the Sickness Impact Profile scales after transplant; however, the severity of disturbance was not considered to be clinically significant. No between-group differences were noted on the Social Behavior Adjustment Schedule. These results indicate that liver transplantation is associated with substantial improvement in life quality, although as a group, the patients undergoing this surgery do not recover to the level of functioning demonstrated by normal individuals.
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Affiliation(s)
- R E Tarter
- Department of Psychiatry, University of Pittsburgh School of Medicine, PA
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Abstract
One-hundred and twenty-nine opiate addicts on a monthly maintenance regimen were studied. Subjects with a positive family history of opium use had an earlier age of onset than the subjects without a family history of opium use. Self-reported psychosocial problems resulting from opium use were documented in only seven subjects. Individuals who began opium use after 1979, when it became illegal to use the drug, had a significantly later age of onset than subjects who began before 1979, suggesting that negative legal sanctions can delay initiation of opium consumption.
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Abstract
The impact of different types of liver diseases on life quality in transplantation candidates was assessed. For all disease types, psychosocial impairment exceeded physical impairment. Among the various disease conditions, differences on the pattern and severity of life quality disturbances were observed.
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Affiliation(s)
- R E Tarter
- Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213
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Tarter RE, Switala JA, Arria A, Plail J, Van Thiel DH. Subclinical hepatic encephalopathy. Comparison before and after orthotopic liver transplantation. Transplantation 1990. [PMID: 2219286 DOI: 10.1097/00007890-199010000-00021] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Sixty-two patients were evaluated before and after liver transplantation on a battery of neuropsychologic tests measuring hepatic encephalopathy. Compared to controls, deficits were found on tasks measuring memory and visuospatial capacity prior to transplantation. Most of these deficits were ameliorated following the surgery. It is concluded that functional psychological capacity is restored to a large extent, but not completely, following orthotopic liver transplantation.
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Affiliation(s)
- R E Tarter
- Department of Psychiatry, University of Pittsburgh, School of Medicine, Pennsylvania 15213
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Tarter RE, Switala JA, Arria A, Plail J, Van Thiel DH. Subclinical hepatic encephalopathy. Comparison before and after orthotopic liver transplantation. Transplantation 1990; 50:632-7. [PMID: 2219286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Sixty-two patients were evaluated before and after liver transplantation on a battery of neuropsychologic tests measuring hepatic encephalopathy. Compared to controls, deficits were found on tasks measuring memory and visuospatial capacity prior to transplantation. Most of these deficits were ameliorated following the surgery. It is concluded that functional psychological capacity is restored to a large extent, but not completely, following orthotopic liver transplantation.
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Affiliation(s)
- R E Tarter
- Department of Psychiatry, University of Pittsburgh, School of Medicine, Pennsylvania 15213
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