Prenatal cocaine exposure and self-reported behavioral adjustments from ages 12 to 21: environmental pathways.

BACKGROUND: In a birth-cohort study, we followed offspring with prenatal cocaine exposure (PCE) to investigate longitudinal associations of PCE with self-reported behavioral adjustment from early adolescence to emerging adulthood (EA). Environmental pathways (family functioning, non-kinship care, maltreatment) were specified as potential mediators of PCE. METHODS: Participants were 372 (190 PCE; 47% male), primarily Black, low socioeconomic status, enrolled at birth. Internalizing and externalizing behaviors were assessed using Youth Self-Report at ages 12 and 15 and Adult Self-Report at age 21. Extended random-intercept cross-lagged panel modeling was used to account for potential bidirectional relationships between internalizing and externalizing behaviors over time, examining potential mediators. RESULTS: Adjusting for covariates, significant indirect effects were found for each mediator at different ages. For family functioning, these were both internalizing (ß = 0.83, p = 0.04) and externalizing behaviors (ß = 1.58, p = 0.02) at age 12 and externalizing behaviors at age 15 (ß = 0.51, p = 0.03); for non-kinship care, externalizing behaviors at ages 12 (ß = 0.63, p = 0.02) and 15 (ß = 0.20, p = 0.03); and for maltreatment, both internalizing and externalizing behaviors at ages 15 (ß = 0.64, p = 0.02 for internalizing; ß = 0.50, p = 0.03 for externalizing) and 21 (ß = 1.39, p = 0.01 for internalizing; ß = 1.11, p = 0.01 for externalizing). Direct associations of PCE with internalizing and externalizing behaviors were not observed, nor cross-lagged relationships between internalizing and externalizing behaviors. CONCLUSIONS: Negative associations of PCE with behavioral adjustment persist into EA via environmental pathways, specifying intervention points to disrupt adverse pathways toward healthy development.

Motion Robust MR Fingerprinting Scan to Image Neonates With Prenatal Opioid Exposure.

PURPOSE: To explore whether MR fingerprinting (MRF) scans provide motion-robust and quantitative brain tissue measurements for non-sedated infants with prenatal opioid exposure (POE). STUDY TYPE: Prospective. POPULATION: 13 infants with POE (3 male; 12 newborns (age 7-65 days) and 1 infant aged 9-months). FIELD STRENGTH/SEQUENCE: 3T, 3D T1-weighted MPRAGE, 3D T2-weighted TSE and MRF sequences. ASSESSMENT: The image quality of MRF and MRI was assessed in a fully crossed, multiple-reader, multiple-case study. Sixteen image quality features in three types-image artifacts, structure and myelination visualization-were ranked by four neuroradiologists (8, 7, 5, and 8 years of experience respectively), using a 3-point scale. MRF T1 and T2 values in 8 white matter brain regions were compared between babies younger than 1 month and babies between 1 and 2 months. STATISTICAL TESTS: Generalized estimating equations model to test the significance of differences of regional T1 and T2 values of babies under 1 month and those older. MRI and MRF image quality was assessed using Gwet's second order auto-correlation coefficient (AC2) with confidence levels. The Cochran-Mantel-Haenszel test was used to assess the difference in proportions between MRF and MRI for all features and stratified by the type of features. A P value <0.05 was considered statistically significant. RESULTS: The MRF of two infants were excluded in T1 and T2 value analysis due to severe motion artifact but were included in the image quality assessment. In infants under 1 month of age (N = 6), the T1 and T2 values were significantly higher compared to those between 1 and 2 months of age (N = 4). MRF images showed significantly higher image quality ratings in all three feature types compared to MRI images. CONCLUSIONS: MR Fingerprinting scans have potential to be a motion-robust and efficient method for nonsedated infants. LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY STAGE: 1.

Preschool blood lead levels, language competency, and substance use in adolescence.

BACKGROUND: Elevated lead levels in children are a persistent public health problem, particularly in urban areas in the United States, yet few prospective studies have examined the association of childhood lead levels with substance use in adolescence. OBJECTIVES: To determine the association of early lead levels with adolescent substance use and whether childhood IQ, language skills, and externalizing (aggressive and disruptive) behavior mediate the association, controlling for confounding biological and environmental factors. METHODS: The participants (N = 265) were a subsample of a prospective birth cohort study on the developmental effects of prenatal cocaine exposure in the Midwest United States. Blood lead levels (BLL) were assessed at age 4, IQ at age 11, language skills and externalizing behavior at age 12, and substance (alcohol, tobacco, marijuana) use and substance use-related problems at age 15. Biologic assays (hair, urine, bloodspots), along with self-report, were utilized to determine adolescent substance use. Path analyses were conducted to examine the direct and indirect associations of BLL with adolescent substance use. RESULTS: The children's mean BLL at 4 years of age was 7.07 (SD = 4.12) µg/dL. Approximately 31% of adolescents used tobacco or marijuana, 40% used alcohol, and 23% reported experiencing substance use-related problems at age 15.7 (SD = 0.28). Elevated BLL was related to a higher likelihood of substance use. Childhood language skills fully mediated the relationship of BLL with substance use-related problems. IQ was related to neither substance use nor substance use-related problems. DISCUSSION: Elevated BLL in preschool years is a risk factor for adolescent substance use and related problems. Early screening and intervention for language impairment may reduce substance use-related problems.

Substance use and individual assets in urban adolescents: Subgroups and correlates in emerging adulthood.

INTRODUCTION: To investigate patterns of divergence in adolescent adjustment, this study examined the co-occurring patterns of adolescents' individual assets (e.g., school engagement, values) and substance use, and whether the co-occurring patterns were associated with later functioning in emerging adulthood. METHODS: Participants were 358 (54% females), predominantly African American, urban adolescents, recruited at birth for a prospective study on the effects of prenatal substance exposure in the Midwest United States. Individual assets, using the Developmental Assets Profile, substance use (alcohol, tobacco, marijuana), via biologic assays and self-report, and substance use-related problems were assessed at age 15 years. High-school completion, substance use disorder, mental health symptoms, and legal problems were assessed at age 21 years. RESULTS: Latent class analysis identified five classes as follows: high assets with low substance use (C1, 10.2%); moderate assets with low substance use (C2, 28.7%); low assets with low substance use (C3, 32%); moderate assets with high substance use (C4, 9.4%); and low assets with high substance use (C5, 19.2%). Despite similar levels of assets, adolescents in C5 reported more life adversities (suboptimal caregiving environment, daily hassles, non-birth parents' care) than those in C3. C4 and C5 reported more substance use disorder at age 21 years than the three low substance use classes; adolescents in C5 were less likely to complete high school than those in C2. More females in C5 reported greater mental health symptoms than those in C1 and C3, and criminal justice involvement than those in C1. CONCLUSIONS: The current findings underscore the significance of substance use in adolescence in disrupting healthy transition to adulthood, especially among females in the context of low individual assets.

Profiles of individual assets and mental health symptoms in at-risk early adolescents.

INTRODUCTION: Few studies investigated the combined patterns of individual assets (e.g., social competence, positive identity) and mental health symptoms (MHS) in adolescents. This study examined the patterns of early adolescents' individual assets and MHS and whether identified patterns were associated with later adolescents' outcomes. METHODS: Participants were 352 (164 boys, 188 girls) adolescents who were primarily African-American and from low socioeconomic status families, participating in a prospective study of the effects of prenatal cocaine exposure from birth in the Midwest United States. Individual assets, using the Developmental Assets Profile, and MHS, using the Youth Self-Report, were assessed at age 12. Substance use, via self-report and biologic assays, early (before age 15) sexual behaviors, and behavioral adjustment were assessed at age 15. RESULTS: Latent profile analysis indicated four distinctive profiles: low assets with elevated MHS (P1, n = 54, 15.3%); adequate assets with thought and social problems (P2, n = 84, 23.9%); low assets without MHS (P3, n = 101, 28.7%); and high assets without MHS (P4, n = 113, 32.1%). Children in the profile with high assets without MHS (P4) were more likely to have a higher IQ and to be in a more optimal environment (higher parental monitoring and less family conflict) than those in other profiles. Although profiles with MHS were associated with adolescent risk behaviors, this relationship was more pronounced for girls than for boys. CONCLUSIONS: Girls in the low assets with elevated MHS (P1) should be a primary concern for preventive intervention. Our study demonstrates the heterogeneity of individual patterns of adaptation and maladaptation.

Individual assets and problem behaviors in at-risk adolescents: A longitudinal cross-lagged analysis.

Autoregressive cross-lagged structural equation modeling was conducted to examine longitudinal relationships between individual assets (social competence, positive values and identity) and problem behaviors in 373 adolescents (174 boys, 199 girls) who participated in a prospective study on the effects of prenatal cocaine exposure from birth. More behavioral problems at age 12 were related to fewer individual assets at age 15, while greater individual assets were related to more behavioral problems, with a non-significant yet nuanced (p = .076) gender difference. More problem behaviors were associated with decreased individual assets in girls, yet greater individual assets were associated with more problem behaviors in boys. Efforts to promote individual assets may not lower the risk of engaging in problem behaviors especially among boys. Continued studies into adulthood will uncover how individual assets and problem behaviors in childhood and adolescence may affect social and vocational adjustment in this high risk population.

Association of fatty acid ethyl esters in meconium and cognitive development during childhood and adolescence.

OBJECTIVE: To examine associations between amounts of fatty acid ethyl esters (FAEEs) in meconium and cognitive development in school-aged children exposed to alcohol and drugs in utero. STUDY DESIGN: A secondary analysis of a prospective cohort of children, primarily African American and of low socioeconomic status, that was recruited at birth. FAEEs were quantified with gas chromatography via a flame ionization detector. Meconium was analyzed for FAEEs in 216 newborns; 191 of these infants were assessed for IQ at ages 9, 11, and 15 years with the Wechsler Intelligence Scales for Children-Fourth Edition. RESULTS: Longitudinal mixed model analyses indicated that, after we controlled for maternal and child covariates, greater concentrations of FAEEs (ethyl myristate, ethyl oleate, ethyl linoleate, and ethyl linolenate) were associated with lower Wechsler Intelligence Scales for Children-Fourth Edition Verbal Comprehension Index, Working Memory Index, and Full-Scale IQ scores. Associations of FAEEs with Verbal Comprehension Index, Working Memory Index, and Full-Scale IQ did not vary over time. No associations of FAEEs with Perceptual Reasoning and Processing Speed Indices were found. CONCLUSION: Elevated levels of FAEEs in meconium are potential markers for identifying newborns at risk for poor cognitive development related to prenatal alcohol exposure.

Prenatal cocaine exposure and child outcomes: a conference report based on a prospective study from Cleveland.

OBJECTIVE: The study aims to describe developmental outcomes from a longitudinal prospective cohort (Cleveland study) of prenatally cocaine-exposed (CE) infants. METHODS: Two hundred eighteen CE and 197 nonexposed infants were enrolled at birth and followed through mid-adolescence. Birth CE status was determined by interview and biologic measures. Multiple demographic, drug, and environmental correlates were controlled. Standardized, normative, reliable measures of fetal growth, intelligence quotient (IQ), behavior, executive function, and language were given at each age and risk for substance misuse assessed in adolescence. A subset of children received volumetric magnetic resonance imaging (MRI) at 7 years and functional MRI at 14 years. The effect of CE was determined through multiple regression analyses controlling for confounders. RESULTS: Cocaine exposed had significant negative effects on fetal growth, attention, executive function, language, and behavior, while overall IQ was not affected. CE had significant negative effects on perceptual reasoning IQ and visual-motor skills and predicted lower volume of corpus callosum and decreased gray matter in the occipital and parietal lobes. CE children had higher risk for substance misuse. Confounding risk factors had additive effects on developmental outcomes. CONCLUSIONS: Prenatal exposure to cocaine was related to poorer perceptual organization IQ, visual-spatial information processing, attention, language, executive function, and behavior regulation through early adolescence.

Developmental outcomes of 3,4-methylenedioxymethamphetamine (ecstasy)-exposed infants in the UK.

OBJECTIVE: This paper aims to review findings from a longitudinal study of prenatal methylenedioxymethamphetamine (MDMA, "ecstasy") on infant development. METHODS: In a prospective, longitudinal cohort design, we followed 28 MDMA-exposed and 68 non-MDMA-exposed infants from birth to 2 years of age. Women recruited voluntarily into a study of recreational drug use during pregnancy were interviewed to obtain type, frequency, and amount of recreational drug use. Their children were followed for a 2-year period after birth. A large number of drug and environmental covariates were controlled. Infants were seen at 1, 4, 12, 18, and 24 months using standardized normative tests of mental and motor development. RESULTS: There were no differences between MDMA-exposed and non-MDMA-exposed infants at birth except that MDMA-exposed infants were more likely to be male. Motor delays were evident in MDMA infants at each age and amount of MDMA exposure predicted motor deficits at 12 months in a dose-dependent fashion. CONCLUSIONS: Prenatal MDMA exposure is related to fine and gross motor delays in the first 2 years of life. Follow-up studies are needed to determine long-term effects.

MDMA and heightened cortisol: a neurohormonal perspective on the pregnancy outcomes of mothers used 'Ecstasy' during pregnancy.

OBJECTIVE: The illicit recreational drug 3,4-methylenedioxymethamphetamine (MDMA) or Ecstasy has strong neurohormonal effects. When taken by recreational users at dance clubs and raves, it can generate an 800% increase in the stress hormone cortisol, whereas drug-free users show chronically raised levels of cortisol. The aim here is to critically debate this neurohormonal influence for the children of pregnant MDMA-using mothers. METHODS: High levels of cortisol are known to be damaging for neuropsychobiological well-being in adult humans. MDMA can damage foetal development in laboratory animals, and the prospective Drugs and Infancy Study was established to monitor the effects of MDMA taken recreationally by pregnant women. RESULTS: The Drugs and Infancy Study revealed that young mothers, who took MDMA during the first trimester of pregnancy, gave birth to babies with significant gross psychomotor retardation. These mothers would have experienced high levels of cortisol due to Ecstasy/MDMA use, and since cortisol can cross the placenta, this is likely to have also occurred in the foetus. CONCLUSIONS: In terms of causation, the developmental problems may reflect a combination of neurotransmitter and neurohormonal effects on the hypothalamic-pituitary-adrenal axis, with serotonergic activity being influenced by the high levels of cortisol.

Externalizing behavior and substance use related problems at 15 years in prenatally cocaine exposed adolescents.

The effect of prenatal cocaine exposure (PCE) on externalizing behavior and substance use related problems at 15 years of age was examined. Participants consisted of 358 adolescents (183 PCE, 175 non-cocaine exposed (NCE)), primarily African-American and of low socioeconomic status, prospectively enrolled in a longitudinal study from birth. Regression analyses indicated that the amount of PCE was associated with higher externalizing behavioral problems (ß = .15, p = .02). Adolescents with PCE were also 2.8 times (95% CI = 1.38-5.56) more likely to have substance use related problems than their NCE counterparts. No differences between PCE adolescents in non-kinship adoptive/foster care (n = 44) and PCE adolescents in maternal/relative care (n = 139) were found in externalizing behavior or in the likelihood of substance use related problems. Findings demonstrate teratologic effects of PCE persisting into adolescence. PCE is a reliable marker for the potential development of problem behaviors in adolescence, including substance use related problems.

Comparison of 12-year-old children with prenatal exposure to cocaine and non-exposed controls on caregiver ratings of executive function.

Differences in caregiver reported executive function in 12-year-old children who were prenatally exposed to cocaine (PCE) compared to children who were not prenatally exposed to cocaine (NCE) were assessed. One hundred and sixty-nine PCE and 169 NCE, primarily African-American, low socioeconomic status children participated in a prospective longitudinal study. The Behavior Rating Inventory of Executive Function (BRIEF) Parent Form was administered. Two broadband BRIEF scores (Behavioral Regulation Index (BRI) and Metacognition Index (MI)) and a summary Global Executive Composite (GEC) were computed. Multiple and logistic regression analyses were used to assess the effects of amount of PCE on executive function, controlling for covariates including caregiver (rater) psychological distress, child's gender and other prenatal drug exposure variables. After adjustment for covariates, amount of PCE was associated with the GEC and two MI subscales, Plan/Organize and Monitor, with heavier exposure associated with more problems of executive function. An amount of PCE by gender interaction revealed amount of PCE effects in other remaining subscales of the MI (Initiate, Working Memory, and Organization of Materials) only among girls. Head circumference did not mediate the effects of cocaine on outcomes. Higher current caregiver psychological distress levels were independently associated with poorer ratings on the executive function scales. Assessment and targeted interventions to improve metacognitive processes are recommended for girls who were prenatally exposed to cocaine.

Infant Behaviors, Prenatal Cocaine Exposure, and Adult Intelligence.

Importance: Linking prenatal drug exposures to both infant behavior and adult cognitive outcomes may improve early interventions. Objective: To assess whether neonatal physical, neurobehavioral, and infant cognitive measures mediate the association between prenatal cocaine exposure (PCE) and adult perceptual reasoning IQ. Design, Setting, and Participants: This study used data from a longitudinal, prospective birth cohort study with follow-up from 1994 to 2018 until offspring were 21 years post partum. A total of 384 (196 PCE and 188 not exposed to cocaine [NCE]) infants and mothers were screened for cocaine or polydrug use. Structural equation modeling was performed from June to November 2023. Exposures: Prenatal exposures to cocaine, alcohol, marijuana, and tobacco assessed through urine and meconium analyses and maternal self-report. Main Outcomes and Measures: Head circumference, neurobehavioral assessment, Bayley Scales of Infant Development, Fagan Test of Infant Intelligence score, Wechsler Perceptual Reasoning IQ, Home Observation for Measurement of the Environment (HOME) score, and blood lead level. Results: Among the 384 mothers in the study, the mean (SD) age at delivery was 27.7 (5.3) years (range, 18-41 years), 375 of 383 received public assistance (97.9%) and 336 were unmarried (87.5%). Birth head circumference (standardized estimate for specific path association, -0.05, SE = 0.02; P = .02) and 1-year Bayley Mental Development Index (MDI) (standardized estimate for total of the specific path association, -0.05, SE = 0.02; P = .03) mediated the association of PCE with Wechsler Perceptual Reasoning IQ, controlling for HOME score and other substance exposures. Abnormal results on the neurobehavioral assessment were associated with birth head circumference (ß = -0.20, SE = 0.08; P = .01). Bayley Psychomotor Index (ß = 0.39, SE = 0.05; P < .001) and Fagan Test of Infant Intelligence score (ß = 0.16, SE = 0.06; P = .01) at 6.5 months correlated with MDI at 12 months. Conclusions and Relevance: In this cohort study, a negative association of PCE with adult perceptual reasoning IQ was mediated by early physical and behavioral differences, after controlling for other drug and environmental factors. Development of infant behavioral assessments to identify sequelae of prenatal teratogens early in life may improve long-term outcomes and public health awareness.

Prenatal cocaine exposure and substance use disorder in emerging adulthood at age 21.

BACKGROUND: Prenatal cocaine exposure (PCE) has been associated with child and adolescent externalizing behaviors and early substance use, yet few studies investigated its association with substance use disorder (SUD) in emerging adults. The present study examined the association of PCE with SUD in emerging adulthood, and whether childhood externalizing behaviors and adolescent substance use mediated the relationship. METHODS: Participants were 367 (187 PCE; 53% female) adults at age 21, primarily urban African American who were recruited at birth. PCE and exposure to alcohol, tobacco, and marijuana were determined using biologic assays for drug metabolites and/or maternal self-report at birth. Offspring externalizing problems were assessed using the Youth Self-Report at age 12, substance use and substance use-related problems via biologic assays and/or self-report at age 15, and SUD determined using DSM-5 diagnostic criteria at age 21. RESULTS: About 32.3% of the emerging adults were determined to have marijuana use disorder, 30.3% tobacco use disorder, and 15.5% alcohol use disorder. PCE was related to greater externalizing behaviors at age 12 (ß = 0.12, p = .042), which in turn was related to SUD (ß = 0.22, p = .008). PCE was also related to substance use, mainly marijuana, at age 15 (ß = 0.22, p = .011), which was related to SUD (ß = 0.51, p < .001). Total indirect effects including these two pathways were significant (ß = 0.19, p = .002). CONCLUSIONS: PCE may increase risk for SUD in emerging adulthood through childhood externalizing behaviors and adolescent substance use.

Cognitive and functional outcomes at age 21 after prenatal cocaine/polydrug exposure and foster/adoptive care.

OBJECTIVE: Prenatal cocaine exposure (PCE) has been linked to specific cognitive deficits and behavioral outcomes through early adolescence but there is little information on adult outcomes nor on the relationship of environmental interventions, such as foster/adoptive care, to outcomes. METHODS: At 21 years, data were available on 325 young adults, [163 PCE and 162 non-exposed (NCE)], primarily African-American, with low SES, who were followed from birth in a prospective longitudinal cohort study. Participants were administered the Wechsler Abbreviated Scale of Intelligence (WASI-II) and surveyed regarding high school completion, problematic substance use, and incarceration/probation history. In the PCE group, 32 remained in non-kinship foster/adoptive care (PCE/FA) from early in life (< 4 years) to 17 years. Group differences were examined through t-tests, MANOVA/ MANCOVA with post-hoc analyses, comparing outcomes and environmental correlates of young adults with PCE vs. NCE, as well as outcomes of PCE young adults in non-kinship foster/adoptive care (PCE/ FA) vs. PCE in birth/kinship care and NCE young adults. RESULTS: At 21 years, young adults with PCE had lower mean Full Scale (83.7 ± 10.4 vs. 87.3 ± 12.5, p < .01) and Perceptual Reasoning IQs (87.3 ± 11.5 vs. 91.4 ± 13.9, (p < .02), lower high school completion rates (75% vs. 86%, p < .02), and were marginally more likely to have been on probation than NCE young adults, but did not differ in Verbal IQ, self-report of problematic substance use or incarceration. Young adults with PCE in F/A had similar lower IQ scores but had better verbal skills and high school graduation rates that did not differ from NCE young adults (80.6 vs 86.2%, p > .05). They had higher drug exposure at birth and more experiences of maltreatment (p's < 0.05) but their home environment quality was better and lead levels lower (p's < 0.05) than those of young adults with PCE in birth/kinship care. CONCLUSIONS: Young adults with PCE had lower Perceptual Reasoning and Full-Scale IQ scores, independent of caregiving placement, compared to non-exposed young adults. Young adults with PCE placed in non-kinship foster/adoptive care had lower lead levels, more stimulating home environments, better vocabulary skills and were more likely to graduate from high school than those in birth/kinship care,but were not different in their self-report of problematic substance use, or experiences of incarceration or probation. Our data suggest that some cognitive deficits observed in young adults with PCE may be biologically based, but that some functional outcomes can be modified through environmental interventions. Our data also reflect the complexity of disentangling the effects of teratologic exposures on long term outcomes across a variety of domains and the need for studies of children in the foster care system.

Motion robust MR fingerprinting scan to image neonates with prenatal opioid exposure.

BACKGROUND: A noninvasive and sensitive imaging tool is needed to assess the fast-evolving baby brain. However, using MRI to study non-sedated babies faces roadblocks, including high scan failure rates due to subjects motion and the lack of quantitative measures for assessing potential developmental delays. This feasibility study explores whether MR Fingerprinting scans can provide motion-robust and quantitative brain tissue measurements for non-sedated infants with prenatal opioid exposure, presenting a viable alternative to clinical MR scans. ASSESSMENT: MRF image quality was compared to pediatric MRI scans using a fully crossed, multiple reader multiple case study. The quantitative T1 and T2 values were used to assess brain tissue changes between babies younger than one month and babies between one and two months. STATISTICAL TESTS: Generalized estimating equations (GEE) model was performed to test the significant difference of the T1 and T2 values from eight white matter regions of babies under one month and those are older. MRI and MRF image quality were assessed using Gwets second order auto-correlation coefficient (AC2) with its confidence levels. We used the Cochran-Mantel-Haenszel test to assess the difference in proportions between MRF and MRI for all features and stratified by the type of features. RESULTS: In infants under one month of age, the T1 and T2 values are significantly higher (p<0.005) compared to those between one and two months. A multiple-reader and multiple-case study showed superior image quality ratings in anatomical features from the MRF images than the MRI images. CONCLUSIONS: This study suggested that the MR Fingerprinting scans offer a motion-robust and efficient method for non-sedated infants, delivering superior image quality than clinical MRI scans and additionally providing quantitative measures to assess brain development.

Self-reported mental health outcomes in prenatally cocaine exposed adolescents at 17 years of age.

OBJECTIVE: Adverse developmental effects of prenatal cocaine exposure (PCE) are hypothesized to extend into late adolescence, yet few studies have investigated the association between PCE and late adolescent mental health outcomes. We examined the associations between PCE and self-reported mental health symptoms at age 17, controlling for biologic and environmental confounders. We further explored the potential moderating role of sex and the mediating role of earlier drug use by age 15 in the associations. METHOD: 327 (162 PCE; 165 non-cocaine exposed, NCE) urban adolescents, primarily African Americans, of low socioeconomic status, were prospectively recruited at birth for a longitudinal study and participated in the current study. We administered the Computerized Diagnostic Interview Schedule for Children-IV to assess their mental health symptoms at age 17. Alcohol, tobacco, and marijuana use by age 15 were assessed using biologic samples and self-reports. Confounders included other prenatal drug exposures, caregiving environment, and childhood maltreatment. RESULTS: Although no overall associations between PCE and mental health outcomes were observed, multivariate logistic regression models indicate girls with PCE were 3.60 times (95% CI = 1.45-8.96, p = .006) more likely to have symptoms of oppositional defiance disorder than girls with NCE. This relationship was partially mediated by marijuana use by age 15. CONCLUSION: Continued studies into emerging adulthood will further elucidate the long-term mental health outcomes associated with PCE.

Association of fatty acid ethyl esters in meconium with behavior during childhood.

OBJECTIVE: To examine associations between amounts of fatty acid ethyl esters (FAEEs) in meconium and behavior in school aged children exposed to alcohol and drugs in utero. METHODS: A secondary analysis of a prospective cohort of cocaine, polydrug exposed children, primarily African-American, low socioeconomic status, recruited at birth into a longitudinal study. FAEEs were quantified with gas chromatography via a flame ionization detector. Meconium was analyzed for FAEEs for 216 newborns of whom 194 were assessed with the Child Behavior Checklist (CBCL) at ages 4, 6, 9, 10, 11, and 12. Generalized estimating equation analyses were used to assess the relationship of quantity of FAEEs to outcomes, controlling for maternal psychological distress. RESULTS: Higher concentrations of FAEEs (ethyl myristate, ethyl palmitate, ethyl oleate, ethyl linoleate, and ethyl linolenate) were associated with caregiver reported aggressive and/or delinquent behavior at ages 10 and 12. After control for caregiver psychological distress, and age, significant (p < 0.05) FAEE by age interactions were found for ethyl myristate for aggression and for ethyl oleate, ethyl linoleate and ethyl linolenate for delinquency. Thus, higher concentrations of FAEE were related to more caregiver reported aggressive and delinquent behaviors of clinical significance at ages 10 and 12. CONCLUSION: Higher concentrations of FAEEs in meconium are potential markers for children at risk for aggressive and delinquent behaviors related to the effects of prenatal alcohol exposure.

Fatty acid ethyl esters in meconium and substance use in adolescence.

Prenatal alcohol exposure (PAE) continues to be a serious public health problem, yet no reliable clinical tools are available for assessing levels of drinking during pregnancy. Fatty acid ethyl esters (FAEEs), the nonoxidative metabolites of ethanol measured in meconium, are potential biomarkers to quantify the level of PAE. The association between the concentrations of FAEEs from meconium and adolescent substance use and related problems was examined in a prospective birth-cohort of adolescents exposed to alcohol and drugs in utero. FAEEs were quantified with gas chromatography via a flame ionization detector. Meconium was analyzed for FAEEs in 216 newborns; 183 of them (81 boys, 102 girls) were assessed at age 15 for alcohol, tobacco, and marijuana use using biologic assays and self-report. Substance use problems were assessed using the Problem Oriented Screening Instrument for Teenagers. Findings from multivariable logistic regression analyses indicated that, after controlling for other prenatal drug exposure and covariates, higher concentrations of FAEEs (ethyl myristate, ethyl palmitate, ethyl oleate, ethyl linoleate, ethyl linolenate, and ethyl arachidonate) were related to a greater likelihood of marijuana use and experiencing substance use problems, but not tobacco or alcohol use, at age 15. Elevated levels of FAEEs in meconium may be promising markers for PAE, identifying newborns at risk for early substance use and developing substance use problems.