The Role of Cognitive Stimulation in the Home and Maternal Responses to Low Grades in Low-Income African American Adolescents' Academic Achievement.

Parental involvement in education has generally been shown to foster adolescent academic achievement, yet little is known about whether two important forms of parental involvement-how parents respond to academic underachievement and how parents provide cognitive stimulation in the home-are related to academic achievement for African American adolescents. This study uses two waves of data to evaluate whether these forms of parental involvement are related to future academic achievement for low-income African American adolescents and whether there are gender differences in these associations. African American mothers and adolescents (N = 226; 48% girls) were interviewed when adolescents were ages 14 and 16. Mothers of girls reported higher mean levels of punitive responses to grades than mothers of boys, but child gender did not moderate associations between parental involvement and academic achievement. Cognitive stimulation in the home was related to changes in academic achievement from 14 to 16 years of age, controlling for age 14 academic achievement. This study provides evidence that nonpunitive responses to inadequate grades and cognitive stimulation at home are linked to academic achievement among African American adolescents.

Maternal Age and Trajectories of Risky Alcohol Use: A Prospective Study.

BACKGROUND: No prospective study of maternal alcohol use has focused on age at transition to motherhood as a predictor of trajectories of risky drinking. The goal of this study was to examine the impact of maternal age at first birth on trajectories of alcohol use beyond recommended levels over a 17-year span. METHODS: Pregnant women (N = 456) were recruited at an urban prenatal clinic. The women (13 to 42 years old; 64% African American, 36% White) were interviewed about alcohol use during pregnancy and at 6, 10, 14, and 16 years postpartum. Growth mixture modeling (GMM) was used to identify trajectories of risky drinking. Maternal age at first birth was then regressed onto trajectory class membership. RESULTS: The GMM on maternal alcohol use identified 3 groups of mothers as a function of alcohol use before, during, and after the pregnancy. The majority of mothers (66%) were identified as having low-risk trajectories of alcohol use over the 17-year span. However, 2 groups were in the higher-risk categories, with 23% identified as being in a long-term high-risk trajectory, and 11% in a short-term high-risk trajectory group. Maternal age at first birth predicted membership in a high-risk group: Younger mothers were more likely to be classified into a long-term high-risk alcohol use group. CONCLUSIONS: Younger mothers were more likely to engage in risky drinking early in pregnancy, continuing 6 to 14 years postpartum. These results can help physicians target mothers who are likely to exceed current NIAAA guidelines of abstinence during pregnancy, and no more than 7 drinks per week in the postpartum.

Prenatal and Postnatal Maternal Trajectories of Cigarette Use Predict Adolescent Cigarette Use.

INTRODUCTION: The goal of this study was to identify maternal patterns of prenatal and postnatal cigarette smoking associated with adolescent smoking. We hypothesized that maternal use at multiple time points, especially at later assessments when the offspring were adolescents, would predict offspring use. METHODS: Pregnant women (N = 456: ages 13-42) were recruited from a prenatal clinic and interviewed during pregnancy and at delivery, providing data on cigarette use (any/none) for the first and third trimesters. Mothers were re-assessed at 6, 10, 14, and 16 years postpartum. Offspring reported cigarette use at age 16. Covariates included maternal race, age, education, family income, child age, parenting behavior, and other maternal and child substance use. RESULTS: A growth mixture model revealed five patterns of tobacco use: infrequent/nonuse (39%), postpartum quitters (5%), later quitters (7%), increasing likelihood of being smokers (17%), and chronic users (32%). Offspring of postpartum quitters and the increasing likelihood of being smokers groups were more likely to use cigarettes, compared to adolescents of mothers from the infrequent/nonuse group, controlling for significant covariates. CONCLUSIONS: This is the first study to examine trajectories of maternal cigarette use from pregnancy to 16 years postpartum, linking prenatal and postnatal patterns of maternal use to use in adolescent offspring. Our findings highlight the risk associated with prenatal exposure, because mothers who used during pregnancy but quit by 6 years postpartum still had offspring who were 3.5 times more likely to smoke than non/infrequent users. IMPLICATIONS: This is the first study to examine trajectories of maternal cigarette use from the prenatal period to 16 years postpartum, and to link prenatal and postnatal patterns of use to use in adolescent offspring. We identified two long-term patterns of maternal cigarette use that were associated with offspring smoking at age 16, including one where offspring were exposed prenatally, but much less likely to be exposed to maternal cigarette use postpartum. Our findings highlight the risk associated with prenatal exposures for cigarette use in offspring, even if mothers quit in the postpartum.

Adverse Environmental Exposures During Gestation and Childhood: Predictors of Adolescent Drinking.

Adverse conditions, including exposures to drugs and other environmental influences during early development, may affect behaviors later in life. This study examined the role of environmental influences from the gestation and childhood on adolescent drinking behavior. 917 mother/offspring dyads were followed prospectively from pregnancy to a 16-year follow-up assessment. Interim assessments occurred at delivery, 6, 10, and 14 years. Prenatal exposures to alcohol, tobacco, and marijuana were measured during gestation. Data were collected at each phase on childhood environment, including parenting practices, quality of the home environment, maternal depression and hostility, and lifetime exposure to child maltreatment and community violence. Alcohol outcomes were offspring age of drinking initiation and level of drinking at age 16 years. Cox Proportional Hazards ratios were used to model offspring age of drinking initiation. Logistic regression analyses were used to evaluate significant predictors of drinking level. Childhood environment, including less parental strictness, greater exposure to violence and childhood maltreatment, significantly predicted earlier age of alcohol initiation. Level of drinking among the adolescent offspring was significantly predicted by prenatal exposure to alcohol, less parental strictness, and exposures to maltreatment and violence during childhood. Whites and offspring with older mothers were more likely to initiate alcohol use early and drink at higher levels. Early and heavier alcohol use was associated with early exposures to adversity such as prenatal alcohol exposure, and child exposures to maltreatment and violence. These results highlight the importance of environmental adversity and less effective parenting practices on the development of adolescent drinking behavior.

Family Resources as Protective Factors for Low-Income Youth Exposed to Community Violence.

Exposure to community violence is a risk factor for internalizing and externalizing problems; however, resources within the family can decrease the likelihood that adolescents will experience internalizing and externalizing problems as a result of such exposure. This study investigates the potential moderating effects of kinship support (i.e., emotional and tangible support from extended family) and parental involvement on the relation between exposure to community violence (i.e., witnessing violence and violent victimization) and socioemotional adjustment (i.e., internalizing and externalizing problems) in low-income adolescents. The sample included 312 (50 % female; 71 % African American and 29 % White) low-income youth who participated in a longitudinal investigation when adolescents were age 14 (M age = 14.49 years) and again when they were 16 (M age = 16.49 years). Exposure to community violence at age 14 was related to more internalizing and externalizing problems at age 16. High levels of kinship support and parental involvement appeared to function as protective factors, weakening the association between exposure to violence and externalizing problems. Contrary to prediction, none of the hypothesized protective factors moderated the association between exposure to violence and internalizing problems. The results from this study suggest that both kinship support and parental involvement help buffer adolescents from externalizing problems that are associated with exposure to community violence.

Maternal patterns of marijuana use and early sexual behavior in offspring of teenage mothers.

Teenage mothers use marijuana more frequently than older mothers, and marijuana use may predict HIV risk behavior in offspring. Our goals were to (1) describe trajectories of marijuana use in teenage mothers and (2) determine if these trajectories were associated with early sexual behavior in their offspring. Pregnant adolescents (12-18 years) were recruited at a prenatal clinic and interviewed during pregnancy, at delivery, and during follow-up visits when offspring were 6, 10, 14 and 16 years old. At 16 years, 332 women (71 % Black, 29 % White) and their offspring were assessed. Mothers were asked about their marijuana use at each time point. Offspring reported on their sexual behavior at age 14. Trajectory analyses using growth mixture models revealed four maternal patterns of marijuana use: no use, only at the 6 year follow-up, quit by the 16 year follow-up, and used across most of the time points. The children of chronic users were more likely to have early sex. The maternal marijuana trajectory group variable remained a statistically significant predictor in multivariate models controlling for race, gender, socioeconomic status, child pubertal timing, child externalizing behavior problems, and child marijuana use. These findings suggest that a minority of teenage mothers continue to use marijuana over time. Chronic maternal marijuana use across a decade was associated with early sex in offspring (oral or vaginal sex by age 14). Early sexual behavior places these children at significantly higher risk of teenage pregnancy and HIV risk behaviors.

Economic hardship and adolescent problem drinking: family processes as mediating influences.

Alcohol is the most commonly used substance among adolescents in the United States, and adolescent drinking is associated with various health risk behaviors. Given the prevalence and consequences of adolescent drinking, understanding family factors that contribute to adolescent drinking is an important area for research. This study used three waves of data to evaluate a family stress model in which economic hardship is indirectly related to adolescent problem drinking through maternal psychological distress, parenting behaviors, and adolescent externalizing behaviors. Respondents included 300 mothers (71 % Black, 29 % White) and adolescents (51 % male) who were interviewed when adolescents were ages 10, 14, and 16. Structural equation modeling was used to test the hypothesized model and findings supported our hypothesized model. Economic hardship was positively related to maternal psychological distress. Maternal psychological distress was negatively associated with supportive parenting, which in turn was negatively associated with externalizing problems. Externalizing problems were positively associated with problem drinking. In support of our hypothesis regarding indirect effects, economic hardship was indirectly related to problem drinking through maternal psychological distress, parenting behaviors, and adolescent externalizing problems. The findings from this study highlight the role of family processes in adolescent problem drinking.

Prenatal cigarette smoke exposure and early initiation of multiple substance use.

INTRODUCTION: Earlier studies have shown a relation between prenatal cigarette smoke exposure (PCSE) and offspring initiation of tobacco use. No prior study has examined the association between PCSE and early initiation of multiple substances (EIMS) including marijuana and alcohol in addition to tobacco. We investigated the association between PCSE and multiple substance use during adolescence. METHODS: Pregnant women attending an urban prenatal clinic were selected to participate in the prospective longitudinal study based on their substance use. This study is based on the 16-year follow-up phase and consists of 579 mother-offspring dyads. The women were of lower socioeconomic status, 54% were Black, and 53% reported smoking cigarettes. 52% of the offspring were female. EIMS is a measure of the number of substances initiated prior to age 16 by the adolescents; it ranged from 0 (no initiation, N = 166) to 3 (all, N = 162). RESULTS: Adolescents exposed to tobacco during first trimester of gestation were 1.4 times more likely to initiate multiple substances by age 16 than the nonexposed group. PCSE was a significant predictor of EIMS after controlling for other prenatal exposures, home environment, and demographic characteristics, using ordinal polytomous logistic regression. Other risk factors of EIMS were maternal and adolescent depression, less strict and less involved parenting, offspring attention problems, and lack of participation in a youth club. CONCLUSIONS: There is a significant relation between PCSE and adolescent's EIMS.

Long-term effects of prenatal cigarette smoke exposure on behavior dysregulation among 14-year-old offspring of teenage mothers.

In this prospective study, we examined the long-term effects of prenatal cigarette smoke exposure (PCSE) on behavioral dysregulation (BD) in the offspring of adolescent mothers. The adolescent mothers (mean age = 16; range = 12-18; 70% African American) were interviewed about their tobacco use during pregnancy. Offspring were followed to age 14 years (n = 318). Indices of BD outcomes included aggression, rule breaking, externalizing, social problems, attention, distractibility and activity. Multiple measures and multiple informants were used for each construct. Regression analyses were conducted to test if PCSE predicted the BD outcomes, adjusting for demographic and maternal psychological characteristics, and for prenatal exposure to other substances. Independent effects of PCSE were found. Exposed offspring had more aggressive, social, and externalizing problems on both the maternal report and the adolescent self-report measures. They were more active, had more attention problems and greater difficulty with distraction and task orientation. Most PCSE effects were found from first trimester exposure and from exposure to as few as 10 cigarettes per day. These results are consistent with previous findings in this cohort when offspring were 6 and 10 years old, demonstrating that the effects of prenatal cigarette smoke exposure can be identified early and persist into adolescence.

Pubertal timing and early sexual intercourse in the offspring of teenage mothers.

Early puberty is associated with stressful family environments, early sexual intercourse, and teenage pregnancy. We examined pubertal timing and sexual debut among the 14-year-old offspring of teenage mothers. Mothers (71% Black, 29% White) were recruited as pregnant teenagers (12-18 years old). Data were collected during pregnancy and when offspring were 6, 10 and 14 years old (n = 318). Adolescents (50% male) compared the timing of their pubertal maturation to same-sex peers. There was a significant 3-way interaction effect of race, sex, and pubertal timing on sexual debut (n = 305). This effect remained significant in a model controlling for maternal age at first intercourse, substance use, exposure to trauma, authoritative parenting, and peer sexual activity (n = 255). Early maturation was associated with early sex in daughters, and may be one pathway for the inter-generational transfer of risk for teenage pregnancy among daughters of teenage mothers.

Prenatal exposure to tobacco and cannabis, early cannabis initiation, and daily dual use of combustible cigarettes and cannabis during young adulthood.

INTRODUCTION: Daily combustible cigarette use is common among cannabis users, and dual use of cigarettes and cannabis is associated with detrimental outcomes. This study addresses gaps in the literature by examining data from the prenatal and adolescent phases of a prospective, longitudinal study to predict adult daily dual use. METHODS: Young adult offspring (M age = 22.8 years, 53% female) from a prenatal cohort reported on combustible cigarette and cannabis use (N = 500, 58% Black, 42% White). Pathways to daily dual use were modeled using variables from the gestational and adolescent phases of the study including prenatal tobacco, alcohol, and cannabis exposures; ages at initiation of cigarettes and cannabis; and adolescent learning/memory, impulsivity, and behavior problems. RESULTS: Prenatal cannabis and tobacco use were not directly linked to adult daily dual use of cannabis and tobacco. However, structural equation modeling revealed three significant indirect pathways from prenatal cigarette and cannabis exposures to adult daily dual use of cigarettes and cannabis via early cigarette initiation, early cannabis initiation, and adolescent behavior problems. CONCLUSIONS: This study identified pathways from prenatal cannabis and tobacco exposure to adult daily dual use, in addition to clarifying adolescent outcomes that may be part of the pathways. In a climate of growing acceptance of cannabis use and increasing legalization of recreational use, these findings serve as a warning that early exposure to cannabis may have an important role in shaping long-term dual use of tobacco and cannabis.

Validity of recall of tobacco use in two prospective cohorts.

This project studied the convergent validity of current recall of tobacco-related health behaviors, compared with prospective self-report collected earlier at two sites. Cohorts were from the Oregon Research Institute at Eugene (N = 346, collected 19.5 years earlier) and the University of Pittsburgh, Pennsylvania (N = 294, collected 3.9 years earlier). Current recall was examined through computer-assisted interviews with the Lifetime Tobacco Use Questionnaire from 2005 through 2008. Convergent validity estimates demonstrated variability. Validity estimates of some tobacco use measures were significant for Oregon subjects (age at first cigarette, number of cigarettes/day, quit attempts yes/no and number of attempts, and abstinence symptoms at quitting; all P < 0.03). Validity estimates of Pittsburgh subjects' self-reports of tobacco use and abstinence symptoms were significant (P < 0.001) for all tobacco use and abstinence symptoms and for responses to initial use of tobacco. These findings support the utility of collecting recalled self-report information for reconstructing salient lifetime health behaviors and underscore the need for careful interpretation.

Developmental consequences of prenatal tobacco exposure.

PURPOSE OF REVIEW: This paper reviews results from published, in press, and conference proceedings from 2007 and 2008 that link in-utero tobacco exposure to neurodevelopmental outcomes in exposed offspring. RECENT FINDINGS: Prenatal tobacco exposure (PTE) affected speech processing, levels of irritability and hypertonicity, attention levels, ability to self-regulate, need to be handled, and response to novelty preference in infants. In early childhood, PTE effects were mostly behavioral outcomes including activity and inattention and externalizing behaviors, including conduct disorder and antisocial behavior. In adolescents, PTE predicted increased attention deficit hyperactivity disorder, modulation of the cerebral cortex and white matter structure, and nicotine addiction. Several studies found moderating effects with PTE and genetic susceptibilities including dopamine transporter, serotonergic synaptic function, and monomine oxidase pathways. Other studies suggested that environmental and genetic factors might be more important than the direct teratological effects of PTE. SUMMARY: The majority of studies reviewed were prospective and tobacco exposure was quantified biologically. Most demonstrated a direct association between PTE and neurodevelopmental outcomes. More work is needed to examine multifactorial influences. Effects of PTE on the offspring appear to be moderated by genetic variability, neurobehavioral disinhibition, and sex.

Body size and intelligence in 6-year-olds: are offspring of teenage mothers at risk?

OBJECTIVES: Children born to teenage mothers are at risk for more physical and cognitive problems than those born to adult mothers. Our objective was to examine differences in size and intelligence between two cohorts of offspring born to adolescent (n = 357) and adult mothers (n = 668) who attended the same prenatal clinic. METHODS: Two prospective study cohorts assessed children from gestation through age 6 years. The adult cohort was studied in the mid-1980's and the teen cohort was evaluated in the mid-1990's. Both samples were of low socio-economic status. The same study design and measures allowed us to adjust for the covariates of size and IQ. RESULTS: Offspring of adolescent mothers had a significantly smaller mean head circumference (5 mm) (HC) and higher body mass index (BMI) than offspring of adult mothers. Offspring of adolescent mothers scored significantly lower than the offspring of adult mothers on the Stanford-Binet (SBIS) composite score (4 points), and the quantitative (6.2 points), verbal reasoning (4.8 points), and short-term memory (3.9 points) area scores. Additional predictors of child IQ were maternal IQ, home environment, race, and number of siblings. When child HC was entered into our final regression model for the SBIS, maternal age and HC significantly predicted the composite score, the verbal reasoning, and short-term memory area scores. A 1 cm decrease in HC predicted a 1 point decrease in the SBIS composite score. CONCLUSIONS: Compared to offspring of adult women, children of adolescent mothers have lower mean scores on cognitive measures, smaller head circumference, and higher BMI. These differences were significant after adjusting for differences between the two groups. Adolescent mothers and their children would benefit from interventions such as parenting support, education about nutritional needs, and advice on enriching the environments of their children.

Prenatal alcohol exposure and offspring alcohol use and misuse at 22 years of age: A prospective longitudinal study.

Studies have shown that prenatal alcohol exposure (PAE) is related to drinking problems during adulthood, but the level of prenatal exposure associated with young adults' quantity and frequency of alcohol use and drinking problems has not yet been established. The relation between PAE and offspring levels of alcohol use and alcohol abuse/dependency was examined in 608 22-year-olds. Mothers were recruited in early pregnancy and maternal alcohol use data were collected for each trimester of pregnancy. The offspring were assessed at multiple phases from birth to young adulthood. The average daily volume of drinking was calculated based on a self-report questionnaire developed by the Maternal Health Practices and Child Development Project and alcohol abuse/dependence was assessed using the Diagnostic Interview Schedule-IV. Exposure to one or more drinks/day during the first trimester of pregnancy was significantly related to increased levels of drinking at 22 years of age, controlling for other predictors of alcohol use. PAE was also related to two or more symptoms of Alcohol Use Disorder, but not to a full diagnosis of young adult alcohol abuse/dependence. These results indicate that individuals exposed to as little as one drink per day during gestation are at risk of higher levels of drinking and more problems with alcohol by age 22.

Trajectories of pre- and postnatal co-use of cannabis and tobacco predict co-use and drug use disorders in adult offspring.

Co-use of cannabis and tobacco is increasingly common among women and is associated with tobacco and cannabis dependence and poorer cessation outcomes. However, no study has examined maternal patterns of co-use over time, or the impact of maternal co-use on co-use and drug problems in adult offspring. Pregnant women (M age = 23, range = 18-42; 52% African American, 48% White) were asked about substance use during each trimester of pregnancy, and at 8 and 18 months, 3, 6, 10, 14, 16, and 22 years postpartum. We examined patterns of any maternal cigarette and cannabis use during pregnancy and the postpartum years. As young adults (M age = 22.8 years, range = 21-26), 603 offspring completed the Diagnostic Interview Schedule (DIS). Growth mixture modeling (GMM) was used to identify four maternal trajectories through 16 years postpartum: (1) no co-use (66%), (2) decreasing co-use (16%), (3) postpartum-only co-use (11%), and (4) chronic co-use (7%). Offspring whose mothers were in the decreasing co-use group (co-users primarily during prenatal and preschool periods) were more likely to be co-users than the offspring of non-co-users. Offspring whose mothers were chronic co-users of cigarettes and cannabis were more than twice as likely to have a drug use disorder than young adults whose mothers were not co-users. The results of this study highlight the heterogeneity in maternal co-use of tobacco and cannabis over time, with some women quitting during pregnancy but resuming co-use in the postpartum, and other women co-using during pregnancy but desisting co-use over time. Maternal trajectories of co-use were associated with inter-generational transfer of risk for substance use and dependence in adult offspring.

Prenatal exposures to tobacco and cannabis: Associations with adult electronic cigarette use.

INTRODUCTION: Prenatal exposures to tobacco and cannabis are associated with combustible cigarette use. This study evaluated pathways from these prenatal exposures to adult electronic cigarette use. We tested whether there were indirect effects of these prenatal exposures via childhood behavior dysregulation, early tobacco use, and adolescent tobacco dependence. METHODS: Telephone interviews were conducted with 427 adult offspring (22-33 years old) from 3 prenatal cohorts with trimester-specific data on exposures to tobacco, alcohol, and cannabis. The offspring were 59% Black and 41% White (61% female). Prenatal exposures included quantity/frequency of tobacco, alcohol, and cannabis use by mothers during the first trimester. Using logistic regression and structural equation modeling, we examined the effects of gestational exposures on adult electronic cigarette use via early cigarette use (prior to age 14), controlling for covariates of combustible and electronic cigarette use. RESULTS: There were no effects of childhood behavioral dysregulation on electronic cigarette use. However, there was a significant indirect effect of prenatal exposures to tobacco and cannabis on electronic cigarette use via early adolescent combustible cigarette use and adolescent risk for tobacco dependence. CONCLUSIONS: One implication of these findings is that the inter-generational risk for tobacco use conferred via gestational exposures to tobacco and cannabis generalizes to novel products such as electronic cigarettes. These results have implications for public health, as more women use cannabis and co-use cigarettes and cannabis during pregnancy.

Marijuana use and sexually transmitted infections in young women who were teenage mothers.

PURPOSE: Teenage pregnancy and marijuana use are associated with higher risk of contracting sexually transmitted infections (STIs). In this study, we examined the role of early and current marijuana use as it related to STI risk in a sample of young women who were pregnant teenagers, using a variety of statistical models. METHODS: We recruited 279 pregnant adolescents, ages 12-18, from an urban prenatal clinic as part of a study that was developed to evaluate the long-term effects of prenatal substance exposure. Six years later, they were asked about their substance use and sexual history. The association of early and late marijuana use to lifetime sexual partners and STIs was examined, and then structural equation modeling (SEM) was used to illustrate the associations among marijuana use, number of sexual partners, and STIs. RESULTS: Bivariate analyses revealed a dose-response effect of early and current marijuana use on STIs in young adulthood. Early and current marijuana use also predicted a higher number of lifetime sexual partners. However, the effect of early marijuana use on STIs was mediated by lifetime number of sexual partners in the SEM, whereas African-American race, more externalizing problems, and a greater number of sexual partners were directly related to more STIs. CONCLUSIONS: Adolescent pregnancy, early marijuana use, mental health problems, and African-American race were significant risk factors for STIs in young adult women who had become mothers during adolescence. Pregnant teenage girls should be screened for early drug use and mental health problems, because they may benefit the most from the implementation of STI screening and skill-based prevention programs.

Childhood neurobehavior disinhibition amplifies the risk of substance use disorder: interaction of parental history and prenatal alcohol exposure.

OBJECTIVE: This investigation examined the influence of parental substance use disorder (SUD) and mother's alcohol consumption during pregnancy on neurobehavior disinhibition (ND) measured in 10- to 12-year-old children. The extent to which ND predicted SUD outcome 7 to 9 years later was also determined. METHODS: SUD was documented in each parent and as the outcome variable in their 19-year-old sons. Average daily alcohol consumption during the mother's pregnancy was recorded using a structured interview. ND was assessed using indicators of behavior undercontrol, affect modulation and executive cognitive functions. RESULTS: Paternal SUD and the interaction between maternal SUD and alcohol consumption during pregnancy predicted child's ND score. ND at 10 to 12 years of age was a significant predictor of SUD at age 19. CONCLUSIONS: The disinhibitory disturbance associated with risk of SUD has both transmissible and teratogenic causes. The ramifications of this finding for pediatric practice are discussed.