期刊
PEDIATRICS
卷 130, 期 6, 页码 E1479-E1488出版社
AMER ACAD PEDIATRICS
DOI: 10.1542/peds.2011-3306
关键词
behavior problems; cumulative risks; prenatal cocaine exposure; protective factors
类别
资金
- National Institutes of Health through the National Institute on Drug Abuse
- Eunice Kennedy Shriver National Institute of Child Health and Human Development [U10 HD42638, U10 DA024128, GCRC M01 RR16587, U10 HD21397, U10 HD21385, U10 HD27904, N01 HD23159, U10 HD36790]
- National Institute of Mental Health
- Administration on Children, Youth, and Families
- Center for Substance Abuse and Treatment, US Department of Health and Human Services
- National Institutes of Health (NIH)
- Brown University
- Brown University Warren Alpert Medical School Women & Infants Hospital of Rhode Island [U10 HD27904, N01 HD23159]
- Eunice Kennedy Shriver National Institute of Child Health and Human Development
- National Institute on Drug Abuse
- RTI International [U10 HD36790]
- University of Miami Holtz Children's Hospital [GCRC M01 RR16587, U10 HD21397]
- MSN
- ARNP
- MSW
- University of Tennessee [U10 HD42638, U10 DA024128]
- Wayne State University Hutzel Women's Hospital and Children's Hospital of Michigan [U10 HD21385]
BACKGROUND: We determined the role of risk and protective factors on the trajectories of behavior problems associated with high prenatal cocaine exposure (PCE)/polydrug exposure. METHODS: The Maternal Lifestyle Study enrolled 1388 children with or without PCE, assessed through age 15 years. Because most women using cocaine during pregnancy also used other substances, we analyzed for the effects of 4 categories of prenatal drug exposure: high PCE/other drugs (OD), some PCE/OD, OD/no PCE, and no PCE/no OD. Risks and protective factors at individual, family, and community levels that may be associated with behavior outcomes were entered stepwise into latent growth curve models, then replaced by cumulative risk and protective indexes, and finally by a combination of levels of risk and protective indexes. Main outcome measures were the trajectories of externalizing, internalizing, total behavior, and attention problems scores from the Child Behavior Checklist (parent). RESULTS: A total of 1022 (73.6%) children had known outcomes. High PCE/OD significantly predicted externalizing, total, and attention problems when considering the balance between risk and protective indexes. Some PCE/OD predicted externalizing and attention problems. OD/no PCE also predicted behavior outcomes except for internalizing behavior. High level of protective factors was associated with declining trajectories of problem behavior scores over time, independent of drug exposure and risk index scores. CONCLUSIONS: High PCE/OD is a significant risk for behavior problems in adolescence; protective factors may attenuate its detrimental effects. Clinical practice and public health policies should consider enhancing protective factors while minimizing risks to improve outcomes of drug-exposed children. Pediatrics 2012;130:e1479-e1488
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