title: Problematic substance use in urban adolescents: role of intrauterine exposures to cocaine and marijuana and post-natal environment.
abstract: BACKGROUND
  Linkages between intrauterine exposures to cocaine and marijuana and adolescents' problematic substance use have not been fully delineated.
  
  
  METHODS
  Prospective longitudinal study with assessors unaware of intrauterine exposure history followed 157 urban participants from birth until late adolescence. Level of intrauterine exposures was identified by mother's report and infant's meconium. Problematic substance use, identified by the Voice Diagnostic Interview Schedule for Children (V-DISC) or the Audio Computer Assisted Self-Interview (ACASI) and urine assay, was a composite encompassing DSM-IV indication of tolerance, abuse, and dependence on alcohol, marijuana, and tobacco and any use of cocaine, glue, or opiates.
  
  
  RESULTS
  Twenty percent (32/157) of the sample experienced problematic substance use by age 18 years, of whom the majority (22/157) acknowledged abuse, tolerance or dependence on marijuana with or without other substances. Structural equation models examining direct and indirect pathways linking a Cox survival model for early substance initiation to a logistic regression models found effects of post-natal factors including childhood exposure to violence and household substance use, early youth substance initiation, and ongoing youth violence exposure contributing to adolescent problematic substance use.
  
  
  CONCLUSIONS
  We did not identify direct relationships between intrauterine cocaine or marijuana exposure and problematic substance use, but did find potentially modifiable post-natal risk factors also noted to be associated with problematic substance use in the general population including earlier substance initiation, exposure to violence and to household substance use.
authors.affiliation: Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, 771 Albany Street, Dowling Ground, Boston, MA 02118, United States. Electronic address: dafrank@bu.edu.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Frank
authors.affiliation: Department of Community Health Sciences, Boston University School of Public Health, 4th Floor, 801 Massachusetts Avenue, Boston, MA 02118, United States.
authors.forename: Seth
authors.initials: S
authors.lastname: Kuranz
authors.affiliation: Data Coordinating Center, Boston University School of Public Health, 801 Massachusetts Avenue, 3rd Floor, Boston, MA 02118, United States.
authors.forename: Danielle
authors.initials: D
authors.lastname: Appugliese
authors.affiliation: Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, 3rd Floor, Boston, MA 02118, United States.
authors.forename: Howard
authors.initials: H
authors.lastname: Cabral
authors.affiliation: Data Coordinating Center, Boston University School of Public Health, 801 Massachusetts Avenue, 3rd Floor, Boston, MA 02118, United States.
authors.forename: Clara
authors.initials: C
authors.lastname: Chen
authors.affiliation: Department of Pediatrics, Boston Medical Center, 771 Albany Street, Dowling Ground, Boston, MA 02118, United States.
authors.forename: Denise
authors.initials: D
authors.lastname: Crooks
authors.affiliation: Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, 3rd Floor, Boston, MA 02118, United States.
authors.forename: Timothy
authors.initials: T
authors.lastname: Heeren
authors.affiliation: Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, 801 Massachusetts Avenue, 3rd Floor, Boston, MA 02118, United States.
authors.forename: Jane
authors.initials: J
authors.lastname: Liebschutz
authors.affiliation: Department of Psychiatry, Boston University School of Medicine, 771 Albany Street, Dowling 7, Boston, MA 02118, United States.
authors.forename: Mark
authors.initials: M
authors.lastname: Richardson
authors.affiliation: Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, 771 Albany Street, Dowling Ground, Boston, MA 02118, United States.
authors.forename: Ruth
authors.initials: R
authors.lastname: Rose-Jacobs
mesh_terms: D000293:Adolescent; D002188:Cannabis / Q000009:adverse effects*; D003042:Cocaine / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects; D011446:Prospective Studies; D012307:Risk Factors; D012931:Social Environment; D019966:Substance-Related Disorders / Q000209:etiology* / Q000523:psychology; D014754:Violence
chemical_list: D003042:Cocaine
keywords: Adolescence; Household substance use; Intrauterine cocaine exposure; Marijuana; Problematic substance use