Birth outcomes associated with cannabis use before and during pregnancy.

INTRODUCTION: This study aimed to examine the association between cannabis use before and during pregnancy and birth outcomes. RESULTS: Overall, 26.3% of women reported previous use of cannabis and 2.6% reported current use. Multivariate analysis, controlling for potential confounders, including tobacco smoking, alcohol consumption, and use of other illicit drugs, showed that cannabis use in pregnancy was associated with low birth weight (odds ratio (OR) = 1.7; 95% confidence interval (CI): 1.3-2.2), preterm labor (OR = 1.5; 95% CI: 1.1-1.9), small for gestational age (OR = 2.2; 95% CI: 1.8-2.7), and admission to the neonatal intensive care unit (OR = 2.0; 95% CI: 1.7-2.4). DISCUSSION: The results of this study show that the use of cannabis in pregnancy is associated with increased risk of adverse birth outcomes. Prevention programs that address cannabis use during pregnancy are needed. METHODS: Data were from women birthing at the Mater Mothers' Hospital in Brisbane, Australia, over a 7-y period (2000-2006). Women were interviewed in the initial antenatal visit about their use of cannabis and other substances. Records for 24,874 women who provided information about cannabis use, and for whom birth outcomes data were available, were included in the analysis.

The impact of an after-school physical activity program on health-related fitness of mother/daughter pairs: CASPIAN study.

OBJECTIVE: To examine the effectiveness of parental support and involvement in a low-cost intervention for the improvement of health-related fitness of high school girls through an after-school physical activity (PA) program. METHODS: This multi-site study was conducted in 2006-2007 in 7 provinces in Iran. The study population comprised of two groups of children. The first group consisted of 206 children who were randomly selected from female students (7th-10th grade) and their mothers (n=204). Another 60 children (without their mothers) were randomly selected as the control group. Overall, during 12 weeks, 24 sessions of after-school aerobic exercise were held. Health-related fitness data were collected pre- and post-intervention. RESULTS: The findings are based on 470 participants. The after-school PA significantly improved body mass index, resting heart rate, cardiorespiratory fitness, flexibility and muscle strength and endurance in children in both groups, and in mothers. Improvement in the physiological measures of the children in the mother/daughter group was significantly better than the control group. CONCLUSION: The findings suggest that after-school PA may provide an effective model for improving the health-related fitness of high school girls and their mothers. Our data show that family support, including mother's participation, contributes to enhanced health-related achievements in adolescent girls.

Association between smoking and respiratory function before and after menopause.

There is a lack of evidence about whether menopausal status influences the effect of smoking on lung function. This study examined the association between smoking and menopausal status and lung function independent of each other. Data were from a cohort of women attending the 21-year follow-up of the Mater University of Queensland Study of Pregnancy. The study was based on 2020 women who provided data on respiratory function, smoking, and menopausal status. A Spirobank G spirometer system was used to measure forced vital capacity (FVC), forced expiratory volume in first second (FEV(1)), and forced expiratory flow between 25 and 75% of forced vital capacity (FEF(25-75)). Smoking and menopausal status were assessed by self-report. Respiratory function was associated with cigarette smoking, menopausal status, and hormone replacement therapy. Regardless of smoking status, postmenopausal women had poorer lung function when compared with premenopausal women. In multivariate analysis, cigarette smoking was associated with lower FVC, FEV(1), and FEF(25-75), with the magnitude of effect being stronger for women who were postmenopausal. The data suggest that the impact of smoking intensifies after menopause. It seems plausible that effective quit-smoking programs, particularly after menopause, may lead to better lung function and reduced morbidity and mortality in women.

Depression following marital problems: different impacts on mothers and their children? A 21-year prospective study.

PURPOSE: With increased rates of marital breakdown it is important to identify the long-term mental health outcomes of marital problems and marital change for mothers and their children. Of particular interest is the possibility that mothers may benefit from leaving a relationship, but their children may not. This study examines the effects of marital quality and marital change on symptoms of depression in mothers and their children over 21 years. METHOD: Data (3,512 mothers and 3,334 children) were from Mater-University of Queensland Study of Pregnancy (MUSP), a population-based birth cohort study, which commenced in Brisbane, Australia, in 1981. Mothers and children were followed up at birth, 6 months and 5, 14 and 21 years after the initial interview. Marital status and marital quality were assessed at 5 and 14 years. Symptoms of depression were assessed in mothers and children at the 21-year follow-up. RESULTS: A poor-quality marital relationship at the 14-year follow-up was associated with increased symptoms of depression in both mothers (+3.3 symptoms) and children (+1.1 symptoms) 7 years later. Symptoms of depression in the mother improved if she changed to unpartnered status (-1.31 symptoms); however, children experienced an increase in depression (+1.30 symptoms). There was a substantial increase in mothers' depression (+3.9 symptoms) associated with a poor reconstructed relationship but no change for children (0.68). CONCLUSION: Marital transitions may improve symptoms of depression in the mothers but not in their children. Clinical decisions for families living in some difficult marital relationships need to take into account the association between maternal and child mental health particularly evidence from clinical samples that remission of depression in the mother improves outcomes for the child.

Family poverty over the early life course and recurrent adolescent and young adult anxiety and depression: a longitudinal study.

OBJECTIVES: We determined whether exposure to family poverty over a child's early life course predicts adolescent and young adult anxiety and depression. METHODS: We used a birth cohort study of a sample of women in Brisbane, Australia, who were recruited in early pregnancy and whose children were followed up on at ages 14 and 21 years. Some 2609 mothers and adolescents provided usable data at the 14- and 21-year follow-ups. RESULTS: After adjustment for poverty at other phases, poverty at the 14-year follow-up was the strongest predictor of adolescent and young adult anxiety and depression. The more frequently the child was exposed to poverty, the greater was the risk of that individual being anxious and depressed at both the 14- and 21-year follow-ups. CONCLUSIONS: Family poverty predicts higher rates of adolescent and young adult anxiety and depression. Increased frequency of child exposure to poverty is a consistent predictor of adolescent and young adult anxiety and depression. Repeated experiences of poverty over a child's early life course are associated with increased levels of poor mental health.

Association of psychiatric disorders, asthma and lung function in early adulthood.

OBJECTIVE: To examine the association between psychiatric disorders, asthma, and lung function in young adults. STUDY DESIGN: Data were from the Mater-University of Queensland Study of Pregnancy (MUSP). The study was based on 2443 young adults (1193 male and 1250 female) for whom data were available on psychiatric disorders, asthma, and respiratory function. Life time and last 12 months' generalized anxiety, panic, posttraumatic stress disorder (PTSD), and depressive disorders were assessed using a computerised version of the Composite International Diagnostic Interview (CIDI-Auto). A Spirobank G spirometer system was used to measure forced vital capacity (FVC), forced expiratory volume in one second (FEV(1)), and forced expiratory flow between 25% and 75% of forced vital capacity (FEF(25-75%)). RESULTS: Participants with mental health disorders were more likely to have experienced asthma before or to use asthma medication at 21 years. However, for both males and females, life time and last 12 months' experience of generalized anxiety, panic, PTSD, and depressive disorders were not statistically significantly associated with FVC, FEV(1), and FEF(25-75%), except a modest association with major depressive disorders for males. CONCLUSION: There is an association between mental health and asthma, but the relationship between mental health and lung function appeared to be confounded by the respondent's gender. More narrowly based prospective studies are required to determine the causal pathway between mental disorders and asthma.

Comparative study of skin sebum and elasticity level in patients with sulfur mustard-induced dermatitis and healthy controls.

BACKGROUND: Sulfur mustard (SM) - a chemical agent - has both acute and chronic effects on skin. Xerosis, which is deemed to be due to the damage of hydrolipidic barrier of the skin, is the most common complaint of veterans exposed to the chemical. This study was designed to evaluate skin sebum and elasticity in veterans with a history of SM contact. METHODS: Three hundred and ten subjects were enrolled in this study and were divided into four groups: SM-exposed patients with current skin lesions (n=87); SM-exposed patients without skin lesions (n=71); patients with dermatitis (n=78); and normal controls (n=74). The skin sebum and elasticity were measured in four areas (forehead, suprasternal, palm and back of the hands) using a Sebumeter and a Reviscometer. RESULTS: Skin sebum was higher in participants who presented with dermatitis and had history of contact with SM than others; the difference was only statistically significant on the forehead. There was no significant difference in the skin elasticity between the four groups. CONCLUSION: While SM may increase skin sebum in long term, there is no evidence that it has a substantial effect on skin elasticity.

Cannabis use and obesity and young adults.

BACKGROUND: There is shortage of evidence about the relationship between use of cannabis and obesity. OBJECTIVES: This study aimed to examine the association between cannabis use and overweight/obesity in young adults. METHODS: Data were from a 21-year follow-up of mothers and their children recruited into the Mater-University of Queensland Study of Pregnancy (MUSP), a longitudinal pre-birth cohort. The study is based on 2566 young adults (1264 males and 1302 females) who had data available on cannabis use and age of initiation to use of cannabis and BMI at the 21-year follow-up (MUSP children). Those who did not provide data on cannabis use and BMI were excluded from the analysis. RESULTS: Frequency of cannabis use and body mass index (BMI) was assessed at the 21-year follow-up. Potential confounders were prospectively measured between the child's birth and the 21-year follow-up. Some 50.9% of young adults reported use of cannabis in the last month or year and 34.1% had BMI ≤ 25. Multivariate analysis showed that those who had used cannabis were less likely to be categorised in the BMI ≥ 25 group with the least prevalence of overweight/obesity being observed in every day cannabis users (odds ratio = .2; 95% confidence interval [CI]:.1-.4). CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: The existing data suggest lower prevalence of overweight and obesity among young adult cannabis users. Further research is needed to examine the mechanism of this association.

Drinking water fluoridation in South East Queensland: a cost-effectiveness evaluation.

OBJECTIVE: The aim of this study is to examine cost-effectiveness of fluoridation of drinking water supplies for Brisbane and South East Queensland. The benefits conveyed are expressed in reduced costs of dental treatment and years of life with dental caries as a disability. METHODS: The analysis utilises a developed life table modelling initial cohort of 36,322 newborns, which when applied to the target population equals to 181,925 persons in the age group 2-100 years, 338,617 persons in the age group 7-100 years and 390,524 persons in the age group 12-100 years respectively. The analysis was conducted using a real discount rate of 3%. Sensitivity analyses investigated the effects of varying the parameters such as: discount rate, costs of dental treatment and costs of fluoridation plant. Uncertainty analysis was also conducted on costs and the measure of ratio of decayed, missing, filled teeth surfaces in deciduous dentition between the cities of Brisbane (non-fluoridated) and Townsville (fluoridated). RESULTS: If fluoridation was implemented there would be a total saving of $10,437.43 (95% CI 6,406.50- 14,035.35) disability-adjusted life years (DALYs) and AU$ 665,686,529 (95% CI -$973,573,625- $381,322,176). This result is both desirable and dominant as more DALYs are saved along with significant cost savings. CONCLUSION: Fluoridation remains still a very cost-effective measure for reducing dental decay.

The impact of episodic and chronic poverty on child cognitive development.

OBJECTIVE: To determine whether changes in family poverty between pregnancy, early childhood, and adolescence predict child cognitive development at 14 years of age. STUDY DESIGN: We conducted a population-based prospective birth cohort study of 7223 mothers who gave birth to a live singleton baby, observed to 14 years of age. Family income was measured on 4 occasions from pregnancy to the 14-year follow-up. Child cognitive development was measured at the 14-year follow-up using the Raven's Standard Progressive Matrices and Wide Range Achievement Test. RESULTS: Poverty experienced at any stage of the child's development is associated with reduced cognitive outcomes. Exposure to poverty for a longer duration (birth to 14 years) is more detrimental to cognitive outcomes than experiencing poverty at only 1 period. For each additional exposure to poverty, the Raven's Standard Progressive Matrices scores declined by 2.19 units and the Wide Range Achievement Test scores declined by 1.74 units. CONCLUSION: Children experiencing family poverty at any developmental stage in their early life course have reduced levels of cognitive development, with the frequency that poverty is experienced predicting the extent of reduced cognitive scores.

Childhood sexual abuse and cannabis use in early adulthood: findings from an Australian birth cohort study.

Childhood sexual abuse (CSA) is associated with a wide range of health problems later in life. The impact of CSA on young adults' use of cannabis remains under-studied. We examined the extent to which exposure to CSA was associated with increased rates of use of cannabis in early adulthood in a birth cohort of 3,285 Australian children followed-up to the age of 21 years, when retrospective reports of CSA were obtained from sample participants along with information on their use of cannabis at 21 years. Young adult men and women who reported experiencing CSA had significantly higher rates of frequent use of cannabis in early adulthood, defined as use of cannabis at least "every few days." In multivariate analyses, men who reported a history of CSA had an odds ratio (OR) of 2.1 (95% CI = 1.1-3.9) for frequent use of cannabis at the age of 21 years. For women, there was an OR of 3.9 (95% CI = 2.4-6.3). Family and individual factors measured earlier in the study did not confound these associations. The findings suggest that children experiencing CSA have a substantially greater risk of use of cannabis and, in particular, its frequent use in early adulthood. Further research is required to explore factors that explain the pathway linking CSA and use of cannabis in early adulthood.

Efficacy of combined levothyroxine and liothyronine as compared with levothyroxine monotherapy in primary hypothyroidism: a randomized controlled trial.

OBJECTIVES: To examine the efficacy of combination therapy with levothyroxine and liothyronine in improvement of general health, psychological problems, and metabolic status in primary hypothyroidism. METHODS: Seventy-one patients diagnosed with primary hypothyroidism were randomly allocated into two study groups: the first group received usual dose of levothyroxine and the second group received combination of levothyroxine and liothyronine for at least 4 months. The main outcomes were psychosocial problems (Goldberg's General Health Questionnaire, GHQ-28), bodyweight, heart rate, blood pressure, and serum lipid levels. RESULTS: In both groups serum thyroid-stimulating hormone levels remained unchanged compared with baseline. Psychosocial scores, body weight, heart rate, blood pressure, and lipid profile in the two groups remained constant. The only exception was a small but significant reduction in anxiety/insomnia in combined treatment group as compared with monotherapy. CONCLUSIONS: The data do not support the hypothesis that combined therapy improves the well-being and general health of patients.

Multiple risk factor model predicting cannabis use and use disorders: a longitudinal study.

BACKGROUND: Identification of factors associated with the initiation and continuation of cannabis use is important for any preventive work. OBJECTIVES: This study aimed to examine the early life course predictors of cannabis use and the development of cannabis use disorder in early adulthood. METHODS: Data from Mater Hospital and University of Queensland Study of Pregnancy (MUSP), a population-based prospective birth cohort study. Participants were a cohort of 2,493 young adults who completed the life-time version of the Composite International Diagnostic Interview-computerized version (CIDI-Auto) at the 21-year follow-up, and for whom data were available from previous follow-ups. Ever use and age at first use of cannabis was assessed via self-report, and cannabis use disorder was measured based on Diagnostic and Statistical Manual version IV (DSM-IV) diagnostic criteria. Life course predictors were obtained between the child's birth and the 14-year follow-up. RESULTS: Of 2,493 young adults, 51.4% reported having ever used cannabis, and 21.1% of young adults were classified as having ever had a cannabis use disorder. Child's gender, changes in maternal marital status, maternal smoking, child school performance, childhood sexual abuse, early adolescence smoking and alcohol consumption, and adolescent aggression/delinquency were strongly associated with young adult cannabis use and use disorder. Exposure to multiple risk factors was associated with greater risk of outcomes. CONCLUSIONS: There are a number of strong predictors of cannabis use identified in this study. They suggest that the social context within which children are reared has a major influence on cannabis use and use disorders.

Screening in early childhood for risk of later mental health problems: a longitudinal study.

Depression in childhood or adolescence is associated with increased rates of depression in adulthood. Does this justify efforts to detect (and treat) those with symptoms of depression in early childhood or adolescence? The aim of this study was to determine how well symptoms of anxiety/depression (A-D) in early childhood and adolescence predict adult mental health. The study sample is taken from a population-based prospective birth cohort study. Of the 8556 mothers initially approached to participate 8458 agreed, of whom 7223 mothers gave birth to a live singleton baby. Children were screened using modified Child Behaviour Checklist (CBCL) scales for internalizing and total problems (T-P) at age 5 and the CBCL and Youth Self Report (YSR) A-D subscale and T-P scale at age 14. At age 21, a sub-sample of 2563 young adults in this cohort were administered the CIDI-Auto. Results indicated that screening at age 5 would detect few later cases of significant mental ill-health. Using a cut-point of 20% for internalizing at child age 5 years the CBCL had sensitivities of only 25% and 18% for major depression and anxiety disorders at 21 years, respectively. At age 14, the YSR generally performed a little better than the CBCL as a screening instrument, but neither performed at a satisfactory level. Of the children who were categorised as having YSR A-D at 14 years 30% and 37% met DSM-IV criteria for major depression and anxiety disorders, respectively, at age 21. Our findings challenge an existing movement encouraging the detection and treatment of those with symptoms of mental illness in early childhood.

Pathways to ecstasy use in young adults: anxiety, depression or behavioural deviance?

AIMS: To investigate pathways to ecstasy use disorders from pre-birth to early adulthood with particular attention to the relationship between early depressive and anxiety symptoms and later ecstasy use disorders. DESIGN: Prospective, longitudinal, population-based study started in Brisbane, South East Queensland (Australia) in 1981. Participants were 2143 young adults, followed up from pre-birth to young adulthood. MEASUREMENTS: Ecstasy use disorders were assessed with the composite international diagnostic interview (CIDI-Auto). Maternal socio-economic position and mental health status were assessed at baseline (antenatal visit); maternal substance use was measured at the 5-year follow-up, adolescents' behaviour at the 5- and 14-year follow-up and tobacco and alcohol use were assessed at the 14-year follow-up. FINDINGS: Eight syndrome scales of childhood behaviour were examined. After adjustment for important confounders, delinquent and aggressive behaviour in early adolescence remained significantly associated with ecstasy use disorders in early adulthood. The associations became statistically non-significant when adolescent tobacco and alcohol use were included in the model [OR=1.50 (95%CI=0.75, 3.01) for delinquency and OR=1.69 (95%CI=0.92, 3.12) for aggression]. Formal mediation tests were statistically significant (p=0.001 for delinquent behaviour and p=0.05 for aggressive behaviour). CONCLUSIONS: Our findings suggest a pathway from early deviant behaviour to ecstasy use disorders, possibly mediated through licit drug experimentation in early adolescence.

Early childhood predictors of early substance use and substance use disorders: prospective study.

OBJECTIVES: The purpose of the present study was to examine the longitudinal association between early childhood factors and early initiation of use of substances and substance use disorders in a large prospective study. METHOD: Data were from the Mater Hospital University of Queensland Study of Pregnancy, a prospective birth cohort study in Brisbane, Australia. Use of nicotine, alcohol and cannabis and age of initiation of such use were reported at the 21 year follow up. DSM-IV diagnosis of nicotine, alcohol and cannabis use disorders was assessed at 21 years using a computerized version of the Composite International Diagnostic Interview (CIDI-Auto). Early childhood factors were measured between mother's pregnancy and child age 5 years. RESULTS: Of the 3647 respondents with complete data, 15.4% had started to smoke cigarettes before 15 years. Another 17.4% and 12.2% reported having started to consume alcohol or use cannabis in early adolescence, respectively. Some 16.2%, 27.8% and 21.9% had ever had nicotine, alcohol or cannabis abuse or dependence (disorder) by 21 years, respectively. In multivariate models early initiation of use of substances, and substance use disorders were associated with disrupted families or drug-using parents, childhood problem behaviours, and poor parental monitoring and supervision in childhood. CONCLUSIONS: There are four independent factors in early or middle childhood that predict early initiation of use of substances and subsequent substance use disorders by early adulthood. There is a need to consider whether what is known about the risk factors that predict young age of substance use, and substance use disorders, may be incorporated into treatment and/or prevention initiatives.

Child and adolescent externalizing behavior and cannabis use disorders in early adulthood: an Australian prospective birth cohort study.

This study examined the association between age of onset and persistence of externalizing behavior and young adults' cannabis use disorders (CUDs). Data were from a 21 year follow-up of a birth cohort study in Brisbane, Australia. The present cohort consisted of 2225 young adults who had data available about CUDs at 21 years and externalizing behavior at 5 and 14 years. Young adults' CUDs were assessed using the CIDI-Auto. Child and adolescent externalizing behavior were assessed at the 5- and 14-year phases of the study. After controlling for confounding variables, children who had externalizing behavior at both 5 and 14 years (child-onset-persistent) (COP) had a substantial increase in risk of CUD at age 21 years (Odds ratio (OR)=2.5; 95% CI: 1.5, 4.2). This association was similar for those who had 'adolescent onset' (AO) externalizing behavior. However, there was no association between 'childhood limited' (CL) externalizing behavior and CUD. Externalizing behavior in adolescence is a strong predictor of subsequent CUD. Smoking and drinking at 14 years partially mediated the link between externalizing behavior and CUD.

Cannabis and anxiety and depression in young adults: a large prospective study.

OBJECTIVE: To examine whether age of first use or frequency of use of cannabis is associated with anxiety and depression (AD) in young adults, independent of known potential confounders, including the use of other illicit drugs. METHOD: A cohort of 3,239 Australian young adults was followed from birth to the age of 21 when data on AD were obtained from sample members along with information on their use of cannabis at 21 years. Potential confounding factors were prospectively measured when the child was born and at 14 years. RESULTS: After controlling for confounding factors, those who started using cannabis before age 15 years and used it frequently at 21 years were more likely to report symptoms of AD in early adulthood (odds ratio 3.4; 95% CI 1.9-6.1). This association was of similar magnitude for those who had only used cannabis and those who reported having used cannabis and other illicit drugs. CONCLUSION: The relationship between early-onset and frequent use of cannabis and symptoms of AD is independent of individual and family backgrounds. Frequent cannabis use is associated with increased AD in young adults independently of whether the person also uses other illicit drugs.

Does childhood sexual abuse have an effect on young adults' nicotine disorder (dependence or withdrawal)? Evidence from a birth cohort study.

AIMS: To examine whether there is evidence of an independent association between childhood sexual abuse (CSA) and nicotine disorder in youth and to explore the mechanisms underlying this association in a prospective cohort study. DESIGN: Birth cohort study followed-up to 21 years. SETTING: One of two major obstetric hospitals in Brisbane, Australia. PARTICIPANTS: The Mater-University of Queensland Study of Pregnancy involves a prospective birth cohort from a population-based sample involving 7223 singletons whose mothers were enrolled between 1981 and 1984 at the first antenatal visit. The present cohort consisted of a subgroup of 2571 youth who completed the life-time version of the Composite International Diagnostic Interview--computerized version (CIDI-Auto) at the 21-year follow-up. MEASUREMENTS: Nicotine disorder was measured based on Diagnostic and Statistical Manual version IV (DSM-IV) diagnostic criteria and measures of CSA, including retrospective self-reports of rape, were obtained at 21 years. Results Of 2571 young adults, 16.6% met the criteria for either dependence (12.8%) or withdrawal (8.5%). Non-penetrative sexual abuse was reported by 15.5% of respondents and 8.0% reported penetrative sexual abuse. For any types of sexual abuse including non-penetrative, penetrative and self-reported rape before age 16 years, young adults had significantly higher rates of nicotine disorder than young adults who did not experience CSA. This relationship was independent and appeared direct after adjustment for a range of potential confounding and mediating factors. CONCLUSIONS: This study shows that CSA is associated with young adult nicotine disorder. The results extend the public health significance of findings in this area and highlight the importance of not only intensifying public health efforts to address substance use problems among those who have experienced CSA, but of early intervention, so that emerging risky behaviours may be targeted in the earliest stages.

Changes in maternal marital status are associated with young adults' cannabis use: evidence from a 21-year follow-up of a birth cohort.

BACKGROUND: Relatively little is known about why almost half of young adults in Australia have used cannabis. Because the upwards trend in use of cannabis has been coincident with an increase in marital breakdown, this study examines the relationship between marital status, marital changes, and the onset of cannabis use. METHODS: Data are from the Mater-University Study of Pregnancy (MUSP), a 21-year prospective study in Brisbane, Australia. The present study is based on the 3008 mothers and their children for whom there were complete follow-up data at 21 years. Outcomes were self-reported cannabis use at age 21 and early onset (before age 15) cannabis use as judged from a retrospective report obtained at 21 years. Analyses were conducted using multivariate binomial and multinomial logistic regression. RESULTS: Change in maternal marital status when the child was aged between 5 and 14 years was significantly associated with increased risk of cannabis use [odds ratio (OR) = 1.7; 95% confidence interval (95% CI) 1.4-2.0 for one or two marital changes and OR = 2.3; 95% CI 1.5-3.4 for three or more marital changes], after adjustment for a range of potential confounders. CONCLUSION: Experience of changes in maternal marital status in mid- to late-childhood is a significant predictor of subsequent and early use of cannabis by the child. This holds true even after allowing for certain possible causes and consequences of marital breakdown.