Characteristics of persistent smoking among pregnant teenagers followed to young adulthood

Use of E-Cigarettes and Cigarettes During Late Pregnancy Among Adolescents

Importance

Pregnant adolescents sometimes use cigarettes; however, little is known about e-cigarette use among pregnant adolescents, a population with increased health vulnerability.

Objective

To examine yearly trends, sociodemographic and pregnancy-related determinants, and the association with small-for-gestational-age (SGA) birth of e-cigarette and/or cigarette use during late pregnancy among adolescents.

Design, Setting, and Participants

This cohort study used existing data from the 2016-2021 Pregnancy Risk Assessment Monitoring System on 10 428 US adolescents aged 10 to 19 years who had a singleton birth with complete data on e-cigarette or cigarette use and SGA birth.

Exposure

Adolescents reported e-cigarette and cigarette use during the last 3 months of pregnancy.

Main Outcomes and Measures

SGA birth (birth weight below the 10th percentile for the same sex and gestational duration) was determined from birth certificates. Multivariable logistic regression was used to compare the odds of SGA birth across pregnant adolescents who exclusively used e-cigarettes, exclusively used cigarettes, used e-cigarettes and cigarettes, or did not use either.

Results

Of the 10 428 pregnant adolescents, 72.7% were aged 18 or 19 years; 58.9% self-identified as White and 23.3% as Black; and 69.8% were non-Hispanic. The weighted prevalence of exclusive e-cigarette use during late pregnancy increased from 0.8% in 2016 to 4.1% in 2021, while the prevalence of exclusive cigarette use decreased from 9.2% in 2017 to 3.2% in 2021. The prevalence of dual use fluctuated, ranging from 0.6% to 1.6%. White pregnant adolescents were more likely than those who self-identified as another race and ethnicity to use e-cigarettes (2.7% vs 1.0% for American Indian or Alaska Native adolescents, 0.8% for Asian or other race adolescents, 0.6% for Black adolescents, and 0.7% for multiracial adolescents). Compared with those who did not use either product, adolescents who exclusively used e-cigarettes (16.8% vs 12.9%; confounder-adjusted odds ratio [AOR], 1.68 [95% CI, 0.89-3.18]) or who used cigarettes and e-cigarettes (17.6% vs 12.9%; AOR, 1.68 [95% CI, 0.79-3.53]) had no statistically significant difference in risk of SGA birth. However, adolescents who exclusively used cigarettes had a more than 2-fold higher risk of SGA birth (24.6% vs 12.9%; AOR, 2.51 [95% CI, 1.79-3.52]).

Conclusions and Relevance

This cohort study suggests that pregnant adolescents increasingly used e-cigarettes, with the highest use among White adolescents. Results from this analysis found that, unlike cigarette use, e-cigarette use during late pregnancy was not statistically significantly associated with an increased risk of SGA birth among adolescents. Due to the uncertainty of this nonsignificant association, future research could benefit from a larger sample size.

Determination of Tobacco Specific Hemoglobin Adducts in Smoking Mothers and New Born Babies by Mass Spectrometry

Biological markers for assessment of exposure to a variety of environmental carcinogens has been widely applied in both basic as well as clinical research. Exposure to tobacco smoke presents an ideal environment with which to develop, characterize, and refine biological markers, especially of those carcinogens found in tobacco. In the present study, a sensitive gas chromatography/mass spectrometry (GC/MS) method was developed to measure nitrosamine- hemoglobin adducts (HPB-Hb (4-Hydroxy-3-pyridinyl-1-butanone) at trace levels in red blood cells of both African-American and Caucasian smoking and nonsmoking mothers and their infants. Gas chromatographic and mass spectrometric methods with chemical ionization (CI) of methane reagent gas in both positive and negative ion mode as well as electron ionization (EI) were studied to determine differences in sensitivity of detection among the various ionization methods. Detection limits using both positive and negative chemical ionization modes were found to be 30 femtomoles of HPB, whereas detection using electron impact modes yielded a detection limit of 80 femtomoles of HBP. Comparative derivatization of HPB was performed using O-bis(Trimethylsilyl)-trifluoroacetamide (BSTFA) and 2, 3, 4, 5, 6-Pentafluorobenzoylchloride (PFBC). Both Negative CI and Positive CI modes of analysis were compared to the more widely accepted EI modes of mass spectrometric analysis.

The Enduring Impact of Parents' Monitoring, Warmth, Expectancies, and Alcohol Use on Their Children's Future Binge Drinking and Arrests: a Longitudinal Analysis

Binge drinking is associated with many health and financial costs and is linked to risks of legal consequences. As alcohol use typically is initiated during adolescence, the current study assessed the relationship between parental behaviors and strategies in forecasting adolescents' likelihood of binge drinking and later arrest. Restricted data from waves I-IV of the National Longitudinal Study of Adolescent Health were used to assess hypotheses. A weighted path analytic model (N = 9421) provided a multifaceted picture of variables linked to later antisocial behavior. Low parental monitoring, low parental warmth, parent alcohol use, and parent expectancies regarding their children's alcohol use were associated with higher incidence of adolescent binge drinking. In turn, low monitoring, low warmth, parent alcohol use, parent expectancies, and underage consumption were associated with binge drinking in early adulthood. Binge drinking during both adolescence and young adulthood were predictive of respondents' likelihood of arrest 8-14 years later. Findings demonstrated the substantial, enduring effects of parental behaviors on child alcohol-related actions and have implications for parent-targeted interventions designed to reduce excessive alcohol consumption. They suggest campaigns focus on parenting strategies that involve setting effective and strict alcohol-related rules and guidelines, while maintaining a warm and supportive family environment.

Maternal Age and Trajectories of Risky Alcohol Use: A Prospective Study

BACKGROUND

No prospective study of maternal alcohol use has focused on age at transition to motherhood as a predictor of trajectories of risky drinking. The goal of this study was to examine the impact of maternal age at first birth on trajectories of alcohol use beyond recommended levels over a 17-year span.

METHODS

Pregnant women (N = 456) were recruited at an urban prenatal clinic. The women (13 to 42 years old; 64% African American, 36% White) were interviewed about alcohol use during pregnancy and at 6, 10, 14, and 16 years postpartum. Growth mixture modeling (GMM) was used to identify trajectories of risky drinking. Maternal age at first birth was then regressed onto trajectory class membership.

RESULTS

The GMM on maternal alcohol use identified 3 groups of mothers as a function of alcohol use before, during, and after the pregnancy. The majority of mothers (66%) were identified as having low-risk trajectories of alcohol use over the 17-year span. However, 2 groups were in the higher-risk categories, with 23% identified as being in a long-term high-risk trajectory, and 11% in a short-term high-risk trajectory group. Maternal age at first birth predicted membership in a high-risk group: Younger mothers were more likely to be classified into a long-term high-risk alcohol use group.

CONCLUSIONS

Younger mothers were more likely to engage in risky drinking early in pregnancy, continuing 6 to 14 years postpartum. These results can help physicians target mothers who are likely to exceed current NIAAA guidelines of abstinence during pregnancy, and no more than 7 drinks per week in the postpartum.

Applying Multilevel Modeling to Understand Individual and Cross-Cultural Variations in Attitudes Toward Homosexual People Across 28 European Countries

Individual and cross-cultural factors associated with attitudes toward homosexual people were examined in this study. Using cross-sectional data from the sixth biennial European Social Survey, which represents 36,959 individuals nested within 28 European countries, successive nested models were tested using multilevel modeling (MLM). Results found that attitudes varied cross-culturally as a function of people’s country of residence—this clustering effect was controlled for in all subsequent models. Individual-level predictors (Level 1) of male gender, older age, less education, being an immigrant to one’s residing country, conservative political affiliation, high religiosity, perceptions that politics in one’s country were unfair, low openness to change values, low self-transcendence values, high conservation values, and high self-enhancement values were significantly linked with anti-homosexuality attitudes. At the country level (Level 2), a high emphasis on social conservatism and fewer civil rights for homosexuals was connected with more unfavorable attitudes. Findings indicate main effects of predictors at both levels; however, country-level variables tended to yield stronger coefficients than individual-level factors, highlighting the contributions of macro- and microfactors in simultaneously shaping attitudes toward homosexuality. Beyond these effects, interactions of country- and individual-level variables show political affiliation, religiosity, self-enhancement values as stronger predictors in liberal countries, but openness to change values, younger age, and higher education as stronger predictors in conservative countries. Implications are discussed for understanding the wide continuum of views toward homosexuality across people and countries.

Alcohol attitudes, motives, norms, and personality traits longitudinally classify nondrinkers, moderate drinkers, and binge drinkers using discriminant function analysis

INTRODUCTION

Binge drinking is commonly defined in the literature as consuming at least 5 drinks for males and 4 drinks for females. These quantities correspond to approximately a blood alcohol concentration of 0.08%, the level of intoxication making it illegal to drive in the United States.

METHODS

The study scrutinized the longitudinal classification of three drinker types using male (n=155) and female (n=351) college students. Measures of personality (sensation seeking, extraversion, agreeableness, conscientiousness, neuroticism, and openness), alcohol attitudes, alcohol motivations (social, coping, enhancement, and conformity), and alcohol social norms (typical students, friends, closest friends, and parents) were administered at Time 1. Drinker type (nondrinkers, moderate drinkers, or binge drinkers) was assessed one month later.

RESULTS

Discriminant function analyses revealed that the set of measures statistically distinguished among the three drinker types. The first function was significant and yielded high loadings for attitudes, social motives, enhancement motives, coping motives, closest friend norms, and friend norms for both genders. Model classification accuracy was 73% for the male and 67% female samples. Multivariate analysis of variance (MANOVA) compared mean differences in a 2 (gender: males or females)×3 (drinker type: nondrinkers, moderate drinkers, or binge drinkers) design. Measures systematically differing across all pairwise comparisons of the three drinker types, starting from the strongest effect (eta-squared), were as follows: alcohol attitudes, social motives, enhancement motives, closest friend norms, friend norms, coping motives, sensation seeking, and extraversion.

CONCLUSIONS

Attitude, motivation, and norm variables tended to be more important than personality in distinguishing drinker types. Considering the malleability of attitudes and belief motivations, the risk variables of alcohol attitudes, social motives, and enhancement motives identified in this research warrant consideration in prevention and campaign efforts targeting problematic drinking.

Adolescent Alcohol Use: Protective and Predictive Parent, Peer, and Self-Related Factors

Adolescent alcohol use has been linked with a multitude of problems and a trajectory predictive of problematic use in adulthood. Thus, targeting factors that enhance early prevention efforts is vital. The current study highlights variables that mitigate or predict alcohol use and heavy episodic drinking. Using Monitoring the Future (MTF) data, multiple path analytic models revealed links between parental involvement and alcohol abstinence and initiation. Parental involvement predicted enhanced self-esteem and less self-derogation and was negatively associated with peer alcohol norms for each MTF grade sampled, with stronger associations for 8th and 10th graders than 12th graders. For younger groups, self-esteem predicted increased perceptions of alcohol risk and reduced drinking. Self-derogation was associated with peers' pro-alcohol norms, which was linked to lower risk perceptions, lower personal disapproval of use, and increased drinking. Peer influence had a stronger association with consumption for 8th and 10th graders, whereas 12th graders' drinking was related to personal factors of alcohol risk perception and disapproval. In all grades, general alcohol use had a strong connection to heavy episodic drinking within the past 2 weeks. Across-grade variations in association of parent, peer, and personal factors suggest the desirability of tailored interventions focused on specific factors for each grade level, with the overall goal of attenuating adolescent alcohol use.

Tobacco exposure and maternal psychopathology: Impact on toddler problem behavior

Prenatal exposure to tobacco has consistently predicted later problem behavior for children. However, little is known about developmental mechanisms underlying this association. We examined a conceptual model for the association between prenatal tobacco exposure and child problem behavior in toddlerhood via indirect paths through fetal growth, maternal depression, and maternal aggressive disposition in early infancy and via maternal warmth and sensitivity and infant negative affect in later infancy. The sample consisted of 258 mother-child dyads recruited during pregnancy and assessed periodically at 2, 9, and 16months of child age. Pathways via maternal depression and infant negative affect to toddler problem behavior were significant. Further, combined tobacco and marijuana exposure during pregnancy and reduced fetal growth also demonstrated important associations with infant negative affect and subsequent problem behavior. These results highlight the importance of considering the role of maternal negative affect and poor fetal growth as risk factors in the context of prenatal exposure.

Maternal patterns of marijuana use and early sexual behavior in offspring of teenage mothers

Teenage mothers use marijuana more frequently than older mothers, and marijuana use may predict HIV risk behavior in offspring. Our goals were to (1) describe trajectories of marijuana use in teenage mothers and (2) determine if these trajectories were associated with early sexual behavior in their offspring. Pregnant adolescents (12-18 years) were recruited at a prenatal clinic and interviewed during pregnancy, at delivery, and during follow-up visits when offspring were 6, 10, 14 and 16 years old. At 16 years, 332 women (71 % Black, 29 % White) and their offspring were assessed. Mothers were asked about their marijuana use at each time point. Offspring reported on their sexual behavior at age 14. Trajectory analyses using growth mixture models revealed four maternal patterns of marijuana use: no use, only at the 6 year follow-up, quit by the 16 year follow-up, and used across most of the time points. The children of chronic users were more likely to have early sex. The maternal marijuana trajectory group variable remained a statistically significant predictor in multivariate models controlling for race, gender, socioeconomic status, child pubertal timing, child externalizing behavior problems, and child marijuana use. These findings suggest that a minority of teenage mothers continue to use marijuana over time. Chronic maternal marijuana use across a decade was associated with early sex in offspring (oral or vaginal sex by age 14). Early sexual behavior places these children at significantly higher risk of teenage pregnancy and HIV risk behaviors.

Nonmedical use of prescription stimulants in college students: Attitudes, intentions, and vested interest

INTRODUCTION

Research on vested interest theory (VIT) indicates that the importance and hedonic relevance of attitudes moderates the link between attitudes and attitude-congruent behavior. Though largely untested in prevention research, this relationship may prove crucial in determining the success or failure of prevention efforts. The current study was designed to determine if subjectively perceived vested interest maximized the association between attitudes and intentions regarding the nonmedical use of prescription stimulants (NUPS).

METHODS

A cross-sectional survey was conducted with college student respondents (N=162) using Amazon's MTurk. Participant age ranged from 19 to 49years old. A subsample analysis (n=129) was also conducted with younger respondents, as the typical college student is usually under the age of 30.

RESULTS

Four-step hierarchical regression analysis indicated that both attitudes and perceived vested interest were significantly associated with NUPS behavioral intentions (p<.001). Further, vested interest moderated the relationship between stimulant-related attitudes and usage intentions (p<.001). Attitudes were significantly associated with intentions of moderately and highly vested respondents (p<.001), but not those of participants expressing low levels of perceived vested interest.

CONCLUSIONS

Findings support the proposition that vested interest may be a useful target for attenuating NUPS. Rather than attempting to weaken positive attitudes toward NUPS, campaigns may prove more successful if designed to convince receivers that NUPS is not in their best interest.

Variations in parental monitoring and predictions of adolescent prescription opioid and stimulant misuse

OBJECTIVE

This study examined relations between adolescents' family structures, social ties, and drug-related attitudes, and their misuse of prescription opioids and stimulants. Different relationships were anticipated for the substances based on prior research highlighting varying motivations for their use.

METHOD

Based on an earlier model of adolescent substance misuse, two path analytic models were tested using data from 12 to 17 year olds in the 2012 U.S. National Survey on Drug Use and Health (NSDUH: N=17,399).

RESULTS

Female respondents reported higher levels of parental warmth, as did youth from wealthier families. Greater parental monitoring was reported by adolescents from wealthier and intact families. Parental monitoring and warmth predicted adolescents' social ties and individual differences associated with drug use, and both variables predicted prescription opioid and stimulant misuse. Contrary to previous research, for adolescents aged 12 to 14, high levels of parental monitoring, while positively associated with attitudes and social ties, also predicted higher rates of prescription stimulant misuse when combined with low levels of parental warmth. Results were cross-validated with data from the 2011 NSDUH.

CONCLUSIONS

Analyses highlighted the importance of understanding and differentiating the underlying factors associated with adolescent prescription stimulant and opioid misuse, and the role of parental behaviors in prevention.

Long-term consequences of perinatal and adolescent cannabinoid exposure on neural and psychological processes

Marihuana is the most widely consumed illicit drug, even among adolescents and pregnant women. Given the critical developmental processes that occur in the adolescent and fetal nervous system, marihuana consumption during these stages may have permanent consequences on several brain functions in later adult life. Here, we review what is currently known about the long-term consequences of perinatal and adolescent cannabinoid exposure. The most consistent findings point to long-term impairments in cognitive function that are associated with structural alterations and disturbed synaptic plasticity. In addition, several neurochemical modifications are also evident after prenatal or adolescent cannabinoid exposure, especially in the endocannabinoid, glutamatergic, dopaminergic and opioidergic systems. Important sexual dimorphisms are also evident in terms of the long-lasting effects of cannabinoid consumption during pregnancy and adolescence, and cannabinoids possibly have a protective effect in adolescents who have suffered traumatic life challenges, such as maternal separation or intense stress. Finally, we suggest some future research directions that may encourage further advances in this exciting field.

Maternal drinking and risky sexual behavior in offspring

Teenage mothers are more likely to use drugs, and their children are more likely to use substances and become pregnant during adolescence. Teenage mothers' substance use may play a role in the intergenerational risk for adolescent pregnancy. Pregnant adolescents (12-18 years) were seen during pregnancy and postnatal years 6, 10, 14, and 16 (n = 332). Teenage mothers reported on substance use and family characteristics. The offspring reported substance use (starting at age 10) and sexual behavior (ages 14 and 16). Prenatal alcohol exposure was associated with offspring (a) having a risky first sex partner and (b) multiple sex partners in the past year. Heavy maternal drinking during childhood was associated with offspring reports of a risky first sex partner and early teenage pregnancy. Findings from this unique birth cohort have implications for alcohol prevention efforts with girls during and after a teenage pregnancy and interventions to prevent risky sex in high-risk youth.

Changes in smoking patterns during pregnancy

This study examined trajectories of smoking during pregnancy among low-income smokers and differences on demographics, psychopathology, and smoking outcome expectancies among women with different smoking trajectories. The sample consisted of 215 urban pregnant smokers living in the United States. Results indicated four trajectories of smoking and significant changes over time within each trajectory. Persistent smokers had the highest demographic and mental health risks, reported higher craving compared to light smokers, and were more likely to endorse smoking to reduce negative affect, for state enhancement motives. Implications for intervention are discussed. The study was funded by the National Institute on Drug Abuse.

Substance Use among Adolescent Mothers: A Review

Maternal substance abuse is a critical problem, and adolescent mothers appear to be at high risk for such behaviors. We review studies on postpartum adolescent substance use to explore the extent of this problem and avenues for new research. Authors screened 1,300 studies, identifying 12 articles on substance use among postpartum adolescent mothers for this review. Adolescent mothers reported greater substance use before pregnancy compared to other adolescent females. Although some adolescents continued substance use during pregnancy, most stopped using only to resume within six months after birth. Comparisons of use to national samples of nulliparous adolescent females showed a higher prevalence of substance use in this population. Substances used often varied by race/ethnicity, with white mothers more likely to smoke cigarettes and use marijuana, and Black mothers more likely than whites to drink and use drugs. Of all identified studies, only one focused on Hispanics. Beliefs about drug use grew less negative as girls transitioned from pregnancy to parenthood. As they transitioned to adulthood, substance use remained prevalent and stable. Psychological distress and low self-esteem appeared to influence continued use. Friends' cigarette smoking predicted early initiation of and persistent smoking, while increased education predicted quitting. Early initiation of substances often predicted problem behaviors. Adolescent mothers are a vulnerable population, implicating use of problem behavior theory or the self-medication hypothesis in future research. Multiple avenues for new studies are needed to help identify effective treatment and intervention for this understudied population.

Anger, hostility, and aggression as predictors of persistent smoking during pregnancy

OBJECTIVE

We examined the role of anger, hostility, and aggression, in addition to depression and stress, in predicting persistent smoking during pregnancy in a low-income sample.

METHOD

The sample consisted of 270 pregnant women (189 smokers, 81 nonsmokers) recruited into a prospective study of prenatal cigarette exposure in the first trimester. Persistent pregnancy smoking was defined as self-reporting daily smoking in at least two trimesters, a positive salivary cotinine level in at least two trimesters, or infant meconium positive for nicotine and/ or its metabolites.

RESULTS

Persistent smokers reported higher prenatal stress and negative affect symptoms (depression, anger, hostility, aggression) than nonpersistent smokers or nonsmokers. However, in the context of model testing, maternal anger, hostility, and aggression each accounted for unique variance in persistent smoking, whereas symptoms of depression and stress did not.

CONCLUSIONS

To date, interventions for pregnant low-income smokers have been largely ineffective. The current results suggest that anger management interventions may be particularly effective for low-income persistent pregnant smokers and may be more likely to prevent relapse than depression-focused interventions.

Understanding early-onset drug and alcohol outcomes among youth: the role of family structure, social factors, and interpersonal perceptions of use

Research on adolescents focuses increasingly on features of the family in predicting and preventing illicit substance use. Multivariate analyses of data from the National Survey of Parents and Youth (N=4173) revealed numerous significant differences on risk variables associated with family structure on adolescent drug-related perceptions and substance use. Youth from dual-parent households were least likely to use drugs and were monitored more closely than single-parent youth (p<0.001). A path analytic model estimated to illuminate linkages among theoretically implicated variables revealed that family income and child's gender (p<0.001), along with family structure (p<0.05), affected parental monitoring, but not parental warmth. Monitoring and warmth, in turn, predicted adolescents' social and interpersonal perceptions of drug use (p<0.001), and both variables anticipated adolescents' actual drug use one year later (p<0.001). Results reconfirm the importance of parental monitoring and warmth and demonstrate the link between these variables, adolescents' social and intrapersonal beliefs, and their use of illicit substances.

Risk factors for young adult substance use among women who were teenage mothers

Teenage mothers may not "mature out" of substance use during young adulthood, and this non-normative trajectory of use may contribute to negative outcomes for teenage mothers and their offspring. Pregnant teenagers (age range=12-18 years; 68% Black) were recruited from a prenatal clinic and interviewed about their substance use, and subsequently re-interviewed six and ten years later (n=292). Consistent with the literature, early tobacco and marijuana use were risk factors for young adult use. Other substance use, peer adolescent use and mental health indicators were more important than race and socioeconomic status (SES) in determining which teenage mothers would use tobacco, engage in binge drinking, and use marijuana as young adults. However, race and SES were significant predictors of quitting tobacco use and marijuana use by the 10-year follow-up. Depression was associated with both persistent tobacco use and marijuana use in teenage mothers. These results illustrate the long-term consequences of teenage childbearing and identify modifiable risk factors for later health risks that should be addressed among younger mothers.

Smoking during teenage pregnancies: effects on behavioral problems in offspring

We prospectively examined the relationship between prenatal tobacco exposure (PTE) and child behavior in a birth cohort of 357 offspring of teenage mothers. PTE was defined as any exposure across pregnancy and, in separate analyses, exposure within each trimester. Outcomes included measures of behavior problems, activity, and attention. On average, the children were 6.4 years of age, 48% were females, and 69% were Black. Data on maternal tobacco and other substance use were collected prenatally and postnatally: 46% of the mothers smoked in the first trimester and 58% smoked 6 years later. Child urinary cotinine measured exposure to environmental tobacco smoke (ETS). Stepwise multiple regressions were run. PTE predicted significantly increased offspring activity; impulsivity; and aggression, externalizing, and total behavior problems in step 1. PTE remained a significant predictor of increased activity when maternal psychological characteristics, home environment, and ETS were added. The results were similar when PTE was examined by trimesters, although later pregnancy tobacco exposure predicted the most behavioral outcomes. In the final model, PTE (all three trimesters) and PTE (second trimester) were significant predictors of increased activity and attention problems, respectively. Other predictors of child behavior included maternal anxiety, depression, hostility, and home environment. ETS was not a significant predictor of child behavior when PTE was considered. Smoking during pregnancy among adolescents is a significant predictor of increased activity and attention problems in their offspring after controlling for covariates in the prenatal and current environments. Smoking cessation interventions are recommended for this population to avoid the effects of PTE on the offspring of pregnant adolescents. This is particularly important because these mothers will likely become pregnant again and many will increase their level of tobacco use as they mature.