Maternal cocaine/polydrug use during pregnancy continues to be a significant public health problem in the United States, especially in poor, urban areas. Although hundreds of thousands of infants born in the cocaine epidemic of the 1980's are now children of school age, we have little definitive knowledge of the long-term effects of fetal cocaine exposure. Maternal use of cocaine is also associated with numerous other risk conditions which can negatively affect child outcomes, such as increased risk for child abuse/neglect, greater maternal psychological distress, altered parenting behavior, and violence exposure. In addition to documenting a range of child outcomes at school age, the proposed study aims to assess environmental and maternal psychological factors, which may increase or reduce risk in cocaine-exposed children. The proposed study will be a continuation of a longitudinal, prospective investigation (NIDA 07957) of the medical, environmental, and developmental correlates of fetal cocaine exposure, with the cohort previously seen from birth-2 years, and at 4 and 6 years. 377 children (195 cocaine-exposed; 182 non-exposed) followed from birth and their mothers/caregivers will be seen at 9, 10, 11, and 12 years of age, and given standardized assessments of growth, cognitive, emotional-behavioral, language, and neuropsychological outcomes. Cocaine exposure was determined by biologic (urine/meconium) and self-report measures, with all children drawn from the same race/social class population, and matched for very low birth weight status. At birth, demographic, medical, and prenatal substance abuse exposure were noted from chart review, clinical interview, and meconium analysis. Standardized questionnaires assessing maternal psychological status, coping style, social supports, intellectual ability, and exposure to violence, which were previously assessed, will be updated. Maternal psychopathology associated with drug use will be described, using standardized interviews to yield DSM-IV diagnoses. Environmental risks, including abuse/neglect, growth failure, out of home placement, and characteristics of the home environment, have been documented throughout. Data will be evaluated descriptively, through MANOVAS/MANCOVAS or mixed model analyses, and hierarchical multiple regression and structural equation models to describe the functioning of cocaine-exposed children at school age, and the relative impact of cocaine and other drug exposures on (NB) child outcomes, maternal psychological functioning, and environmental risk. Data sets from the prior longitudinal studies will be merged with the current data to assess change over time and predictive models of child risk, using linear mixed models or structural equation models. The proposed research will provide information about long-term child developmental sequelae of fetal cocaine exposure, maternal psychological status, parenting behaviors, and environmental factors which can guide the design of effective maternal drug treatment and child intervention programs.
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