Offspring of women with severe alcohol use disorder (AUD) are at risk for a host of negative outcomes yet data on such high-risk families are sparse. A group of women with typically severe AUD are those with recurrent drunk-driving convictions (rDUI), who come to administrative attention and thus as mothers would be an appropriate group to target for intervention with their children. The proposed study will characterize risk- mechanisms and risk-exposures in these extremely high-risk familes to inform harm-reduction efforts for children and mothers. This will be done by combining analyses of administrative data (birth records, driver?s license records including drunk driving, and residential history information, state social services data, supplemented with census socioeconomic indicators and other neighborhood variables ) (Aims 1a,1b) with collection of pilot self-report data from subsamples of rDUI mothers and matched non-DUI mothers and their 15 year old offspring to obtain data on course of AUD and comorbidity in the mothers, and offspring outcomes, including early risk- taking behaviors and adverse childhood events (Aims 2a,2b).
Aims are 1a. To use drivers? license administrative data to identify rDUI and nonDUI mothers, and to test for differences in sociodemographic and reproductive characteristics overall; 1b to use propensity score analysis to identify matched controls for rDUI mothers and to contrast rDUI and matched controls on reproductive outcomes, neighborhood characteristics, state social services data. 2a: In pilot interview data collection, to sample 40 rDUI and 40 propensity-score matched control mothers and their 15 year-old offspring for assessment in order to characterize the course of maternal alcohol involvement, AUD (persistence, remission (abstinent and non- abstinent ), escalation, treatment) and other factors not available in administrative data (relationship instability; own and partner?s illicit drug use and problems; psychiatric disorders including ASPD; health; own trauma and assaultive history; socioeconomic measures; social network) all of which contribute to offspring adverse environments; 2b In pilot web-based assessment with 80 offspring of the rDUI and matched control mothers, to characterize outcomes of early alcohol, tobacco and illicit drug use, and early sex, childhood trauma, and parental separation. Data from this study will be used to inform and design an R01 to study in rDUI mothers and matched control mothers and their adolescent offspring the effect of maternal DUI/AUD on offspring outcomes, environmental adversities experienced by their offspring, and the potential modifying influence of maternal AUD course (treatment, remission/persistence) and social factors on offspring adverse outcomes. Ultimately this would provide the basis for informing a program of harm reduction intervention with these families.
This exploratory research is guided by the hypothesis that severe maternal alcohol use disorder (AUD), as reflected in women with recurrent drunk driving citations (rDUI), is a potent risk-factor for preventable child adverse environmental exposures and associated child adverse behavioral and emotional outcomes, and therefore would be a high priority group for family-focused intervention efforts to reduce risks of alcohol-related harm. We will use administrative data (birth, driving records) to identify mothers with rDUIs, match them via propensity score to mothers without DUIs, and compare outcomes in mothers and children (e.g. reproductive, living in high risk areas, child mortality, child maltreatment reports). Pilot self-report data from rDUI and matched control mothers (sampled from risk strata) and from their adolescent offspring will provide information on maternal AUD course, comorbidity, and offspring early-onset risk behaviors and other adverse outcomes. These data will help establish feasibility and prioritize environmental domains and risk-mechanisms for a larger-scale future study to guide targeted intervention efforts focused on both offspring and mothers.
