title: Protective factors can mitigate behavior problems after prenatal cocaine and other drug exposures.
abstract: 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.
authors.affiliation: Department of Pediatrics, College of Medicine, University of Kentucky, Lexington, KY 40536, USA. hbada2@uky.edu
authors.forename: Henrietta S
authors.initials: HS
authors.lastname: Bada
authors.forename: Carla M
authors.initials: CM
authors.lastname: Bann
authors.forename: Toni M
authors.initials: TM
authors.lastname: Whitaker
authors.forename: Charles R
authors.initials: CR
authors.lastname: Bauer
authors.forename: Seetha
authors.initials: S
authors.lastname: Shankaran
authors.forename: Linda
authors.initials: L
authors.lastname: Lagasse
authors.forename: Barry M
authors.initials: BM
authors.lastname: Lester
authors.forename: Jane
authors.initials: J
authors.lastname: Hammond
authors.forename: Rosemary
authors.initials: R
authors.lastname: Higgins
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000139:chemically induced / Q000517:prevention & control / Q000523:psychology; D016022:Case-Control Studies; D057189:Checklist; D002648:Child; D002649:Child Abuse / Q000517:prevention & control / Q000523:psychology; D002653:Child Behavior Disorders / Q000139:chemically induced* / Q000517:prevention & control* / Q000523:psychology; D002675:Child, Preschool; D003042:Cocaine / Q000633:toxicity*; D015331:Cohort Studies; D018765:Dopamine Uptake Inhibitors / Q000633:toxicity*; D005260:Female; D006801:Humans; D013287:Illicit Drugs / Q000633:toxicity*; D007223:Infant; D007231:Infant, Newborn; D007389:Internal-External Control; D008019:Life Style; D008137:Longitudinal Studies; D008297:Male; D009294:Narcotics / Q000633:toxicity*; D009769:Object Attachment; D016487:Parenting / Q000523:psychology; D010552:Personality Assessment; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects; D055500:Resilience, Psychological; D012307:Risk Factors; D012737:Sex Factors; D012931:Social Environment; D013223:Statistics as Topic; D015813:Substance Abuse Detection; D014481:United States
chemical_list: D018765:Dopamine Uptake Inhibitors; D013287:Illicit Drugs; D009294:Narcotics; D003042:Cocaine