Stacy Buckingham-Howes

Systematic Review of Prenatal Cocaine Exposure and Adolescent Development

BACKGROUND AND OBJECTIVE: Previous research found that prenatal cocaine exposure (PCE) may increase childrens vulnerability to behavior and cognition problems. Maturational changes in brain and social development make adolescence an ideal time to reexamine associations. The objective was to conduct a systematic review of published studies examining associations between PCE and adolescent development (behavior, cognition/school outcomes, physiologic responses, and brain morphology/functioning). METHODS: Articles were obtained from PubMed, PsycInfo, Web of Science, and CINAHL databases through July 2012 with search terms: prenatal drug, substance, or cocaine exposure; adolescence/adolescent; and in utero substance/drug exposure. Criteria for inclusion were nonexposed comparison group, human adolescents aged 11 to 19, peer-reviewed, English-language, and adolescent outcomes. RESULTS: Twenty-seven studies representing 9 cohorts met the criteria. Four outcome categories were identified: behavior, cognition/school performance, brain structure/function, and physiologic responses. Eleven examined behavior; 7 found small but significant differences favoring nonexposed adolescents, with small effect sizes. Eight examined cognition/school performance; 6 reported significantly lower scores on language and memory tasks among adolescents with PCE, with varying effect sizes varied. Eight examined brain structure/function and reported morphologic differences with few functional differences. Three examined physiologic responses with discordant findings. Most studies controlled for other prenatal exposures, caregiving environment, and violence exposure; few examined mechanisms. CONCLUSIONS: Consistent with findings among younger children, PCE increases the risk for small but significantly less favorable adolescent functioning. Although the clinical importance of differences is often unknown, the caregiving environment and violence exposure pose additional threats. Future research should investigate mechanisms linking PCE with adolescent functioning.

Trajectories of Adolescent Mother–Grandmother Psychological Conflict During Early Parenting and Children's Problem Behaviors at Age 7

This study extends the determinants of parenting model to adolescent mothers by examining how adolescent mother–grandmother psychological conflict and perceptions of infant fussiness from birth through age 2 years relate to childrens problem behaviors at age 7. Participants were 181 adolescent mother, child, and grandmother triads living in multigenerational households and recruited at delivery. Psychological conflict was characterized by two stable trajectories. In multivariate models that included maternal depression, both psychological conflict and perceptions of infant fussiness predicted externalizing behavior at age 7. Perceptions of infant fussiness, but not psychological conflict, predicted internalizing behavior at age 7.

Relations among prospective memory, cognitive abilities, and brain structure in adolescents who vary in prenatal drug exposure

This investigation examined how prospective memory (PM) relates to cognitive abilities (i.e., executive function, attention, working memory, and retrospective memory) and brain structure in adolescents who vary in prenatal drug exposure (PDE). The sample consisted of 105 (55 female and 50 male) urban, primarily African American adolescents (mean age=15.5 years) from low socioeconomic status (SES) families. Approximately 56% (n=59) were prenatally exposed to drugs (heroin and/or cocaine) and 44% (n=46) were not prenatally exposed, but the adolescents were similar in age, gender, race, and SES. Executive functioning, attentional control, working memory, retrospective memory, and overall cognitive ability were assessed by validated performance measures. Executive functioning was also measured by caregiver report. A subset of 52 adolescents completed MRI (magnetic resonance imaging) scans, which provided measures of subcortical gray matter volumes and thickness of prefrontal, parietal, and temporal cortices. Results revealed no differences in PM performance by PDE status, even after adjusting for age and IQ. Executive function, retrospective memory, cortical thickness in frontal and parietal regions, and volume of subcortical regions (i.e., putamen and hippocampus) were related to PM performance in the sample overall, even after adjusting for age, IQ, and total gray matter volume. Findings suggest that variations in PM ability during adolescence are robustly related to individual differences in cognitive abilities, in particular executive function and retrospective memory, and brain structure, but do not vary by PDE status.

Prenatal drug exposure and peer victimization in early adolescence: testing childhood anxiety/depression and aggression as possible mediators.

Objective: Children who are prenatally exposed to drugs may be at risk for emotion dysregulation, including childhood anxiety/depression and aggression, potentially increasing their risk for peer victimization. The objectives of this study were to investigate how prenatal drug exposure relates to adolescent peer victimization and the mediating effects of childhood anxiety/depression and aggression. Methods: Seventy-six prenatally drug exposed (PDE) and 38 nonexposed (NE) adolescent-caregiver dyads followed since birth and middle childhood, respectively, participated in an evaluation during adolescence. In middle childhood, caregivers reported on their childs anxiety/depression and aggression, and children reported on violence exposure. In adolescence, caregivers and adolescents responded to a parallel single-item measure of peer victimization. Analyses were conducted using multivariate linear and logistic regression models, adjusting for covariates, including violence exposure. Results: One-third (33.3%, n = 35) of the sample endorsed peer victimization: 40.8% PDE and 17.6% NE, p = .01. In middle childhood, PDE youth had more aggressive behaviors (11.92 vs 7.45, p < .01) and anxiety/depression symptoms (3.43 vs 1.76, p < .01) than NE youth. Anxious/depressed behavior during childhood mediated the association between prenatal drug exposure and adolescent peer victimization. Aggression was not a significant mediator. Conclusions: The consequences of prenatal drug exposure extend into adolescence. Prenatal drug exposure may interfere with emotion regulation, resulting in anxious/depressed behavior during childhood and significantly increasing the risk for peer victimization during adolescence, even in the presence of violence exposure. Strategies to reduce anxious/depressed behavior among children with a history of prenatal drug exposure may reduce adolescent peer victimization.

Prenatal Drug Exposure, Behavioral Problems, and Drug Experimentation Among African-American Urban Adolescents

PURPOSE To examine how prenatal drug exposure (PDE) to heroin/cocaine and behavioral problems relate to adolescent drug experimentation. METHODS The sample included African-American adolescents (mean age = 14.2 years, SD = 1.2) with PDE (n = 73) and a nonexposed community comparison (n = 61). PDE status was determined at delivery through toxicology analysis and maternal report. Internalizing/externalizing problems were assessed during adolescence with the Behavior Assessment System for Children, Second Edition. Drug experimentation was assessed by adolescent report and urine analysis. Logistic regression evaluated the likelihood of drug experimentation related to PDE and behavioral problems, adjusting for age, gender, PDE, perceived peer drug use, and caregiver drug use. Interaction terms examined gender modification. RESULTS Sixty-seven subjects (50%) used drugs: 25 (19%) used tobacco/alcohol only and 42 (31%) used marijuana/illegal drugs. Ninety-four subjects (70%) perceived peer drug use. PDE significantly increased the risk of tobacco/alcohol experimentation (odds ratio = 3.07, 95% confidence interval [CI] 1.09-8.66, p = .034) but not after covariate adjustment (adjusted odds ratio [aOR] = 1.16, 95% CI .31-4.33, p > .05). PDE was not related to the overall or marijuana/illegal drug experimentation. The likelihood of overall drug experimentation was doubled per SD increase in externalizing problems (aOR = 2.28, 95% CI 1.33-3.91, p = .003) and, among girls, 2.82 times greater (aOR = 2.82, 95% CI 1.34-5.94, p = .006) per SD increase in internalizing problems. Age and perceived peer drug use were significant covariates. CONCLUSIONS Drug experimentation was relatively common (50%), especially in the context of externalizing problems, internalizing problems (girls only), older age, and perceived peer drug use. Findings support the Problem Behavior Theory and suggest that adolescent drug prevention addresses behavioral problems and promotes prosocial peer groups.

Prenatal Drug Exposure Moderates the Association between Stress Reactivity and Cognitive Function in Adolescence

Prenatal drug exposure (PDE) can undermine subsequent health and development. In a prospective longitudinal study we examine whether PDE moderates the link between stress reactivity and cognitive functioning in adolescence. Participants were 76 prenatally drug-exposed and 61 nonexposed (NE) community comparison African American youth (50% male, mean age 14.17 years) living in an urban setting. All participants completed neuropsychological and academic achievement tests (Childrens Memory Scales, the California Verbal Learning Test - Childrens version and the Wide Range Achievement Test 4) over the course of 1 day in a laboratory setting. Two mild stressors (Balloon Analog Risk Task - Youth and Behavioral Indicator of Resilience to Distress) were administered, with saliva samples (assayed for cortisol) collected pre- and poststress task. A higher percentage in the NE group, compared to the PDE group (26% vs. 12%, χ2 = 4.70, d.f. = 1, n = 137, p = 0.03), exhibited task-related increases in salivary cortisol. PDE moderated the association between stress reactivity and 11 of 15 cognitive performance scales. In each case, the NE stress reactive group had better cognitive performance than either the NE lower cortisol reactive group or the PDE group regardless of stress reactivity status. Stress-related reactivity and regulation of the hypothalamic-pituitary-adrenal axis in adolescence may be disrupted by PDE, and the disruption may be linked to lower cognitive performance.

“Bouncing back” after the Deepwater Horizon oil spill

Purpose The psychological and behavioral consequences of the Deepwater Horizon oil spill disaster were among the most widespread, long term, and costly of all oil spill-related disasters. However, many people were resilient, and understanding the factors associated with resilience in the immediate aftermath of this disaster are needed to guide early interventions. The paper aims to discuss this issue. Design/methodology/approach In total, 133 adults from the Northeast Gulf Coast participated in a study of mental health outcomes during the oil spill and one year later. Participants completed a battery of measures that assessed their basic demographics, income status, perceived environmental risk (i.e. characteristic way people think about and interpret environmental risks), self-reported resilience (i.e. ability to “bounce back” after a disaster), and mental health status. Findings Results of univariate analyses indicated similar, elevated levels of mental health problems at both time points; however, environmental risk perception was higher one year post-spill than during the spill. In multivariate analyses, income stability, increased time, higher self-reported resilience, and lower environmental risk perception were associated with better mental health outcomes while age and gender had no association. Originality/value Oil spills are protracted disasters, and better mental health outcomes are linked to financial stability, as well as a belief in environmental restoration and one’s own capacity for resilience. Since resilience and environmental worry are potentially modifiable processes, they might be targeted in prevention and early intervention efforts in order to create more robust, prepared individuals in the face of an oil spill disaster.

BMI and disordered eating in urban, African American, adolescent girls: The mediating role of body dissatisfaction

OBJECTIVE This study examined the mediating role of body dissatisfaction between Body Mass Index (BMI) and subsequent disordered eating (e.g. dieting and restricting/purging) among early adolescent African American girls. STUDY DESIGN Participants included 701 African American girls in 6th and 7th grades in urban schools serving low-income communities, mean age 12.15 (SD = 0.72) years. Participants were assessed at baseline and approximately 6 months later. Objectively measured height and weight were used to calculate BMI z-score. Participants completed questionnaires on body size dissatisfaction and recent dieting and restricting/purging behaviors. RESULTS At baseline, 51.5% of participants were overweight/obese, and 60.4% expressed body dissatisfaction and a desire to be smaller. Path analytic analyses revealed change in body dissatisfaction significantly mediates the relation between initial BMI z-score and increases in dieting behaviors (B = 0.924, SE = 0.280, p = 0.001) but not restricting/purging behaviors (p = 0.05). CONCLUSIONS Body dissatisfaction explains some associations between excess body weight and subsequent disordered eating symptoms among early adolescent, African American girls. Body dissatisfaction, identified by screening, may be an indicator of further negative consequences, including disordered eating behaviors.

Resilience after the Deepwater Horizon oil spill

Purpose The purpose of this paper is to examine the extent to which self-reported resilience was associated with mental health outcomes four years after the Deepwater Horizon oil spill (DWHOS). Design/methodology/approach Participants included 179 men and women randomly selected from two Northeast Gulf Coast communities as part of a larger, prospective study of behavioral health post oil spill. The majority of the participants were Caucasian (70.8 percent), female (61.5 percent), had a high school education or lower (75.3 percent), and ranged in age from 18 to greater than 60 years old. Participants completed a measure of resilience (Connor-Davidson Resilience Scale, CD-RISC) 2.5 years post oil spill and measures of overall mood disturbance (Profile of Mood States), depression (Beck Depression Inventory), quality of life (World Health Organization Quality of Life-BREF Scale) 4.5 years post oil spill. Findings Based upon linear regression analyses, elevated self-reported resilience significantly predicted lower scores on mood disturbance (b=−0.63, p<0.01) and depressive symptoms (b=−0.14, p<0.05) and higher scores on psychological (b=0.08, p<0.01) and overall health quality of life (b=0.08, p<0.01). Factor analysis of the CD-RISC identified three factors (hardiness, adaptability, optimism). Each factor predicted some, but not all, of the outcomes with optimism being the least predictive of mental health. Originality/value Self-reported resilience two years after the DWHOS was a useful predictor of mental health outcome four years post-spill. Early assessment may facilitate the identification of individuals at risk of longer-term mental health problems for public health prevention or mental health intervention efforts.

Prenatal Drug Exposure and Adolescent Cortisol Reactivity: Association with Behavioral Concerns.

Objective: To examine stress reactivity in a sample of adolescents with prenatal drug exposure (PDE) by examining the consequences of PDE on stress-related adrenocortical reactivity, behavioral problems, and drug experimentation during adolescence. Methods: Participants (76 PDE, 61 non-drug exposed [NE]; 99% African-American; 50% male; mean age = 14.17 yr, SD = 1.17) provided a urine sample, completed a drug use questionnaire, and provided saliva samples (later assayed for cortisol) before and after a mild laboratory stress task. Caregivers completed the Behavior Assessment System for Children, Second Edition (BASC II) and reported their relationship to the adolescent. Results: The NE group was more likely to exhibit task-related cortisol reactivity compared to the PDE group. Overall behavior problems and drug experimentation were comparable across groups with no differences between PDE and NE groups. In unadjusted mediation analyses, cortisol reactivity mediated the association between PDE and BASC II aggression scores (95% bootstrap confidence interval [CI], 0.04–4.28), externalizing problems scores (95% bootstrap CI, 0.03–4.50), and drug experimentation (95% bootstrap CI, 0.001–0.54). The associations remain with the inclusion of gender as a covariate but not when age is included. Conclusion: Findings support and expand current research in cortisol reactivity and PDE by demonstrating that cortisol reactivity attenuates the association between PDE and behavioral problems (aggression) and drug experimentation. If replicated, PDE may have long-lasting effects on stress-sensitive physiological mechanisms associated with behavioral problems (aggression) and drug experimentation in adolescence.