Prenatal cocaine exposure has been associated with behavior problems at school age. However, the correspondence between use of cocaine and alcohol during pregnancy is often high, making appropriate allocation of variance and control for other exposures and their interactions difficult. Additionally, gender-specific effects are not typically reported. The purpose of the current study was to determine the degree to which gender-specific effects of prenatal cocaine exposure on teacher-reported child externalizing behavior problems were evident when evaluated in relation to prenatal alcohol exposure. Subjects were singleton infants of mothers who were prospectively evaluated during pregnancy. At age seven, 499 children (214 exposed prenatally to cocaine) were evaluated in our laboratory and teacher reports were solicited. Analyses stratified by gender and prenatal alcohol exposure status, and controlled for significant pre- and postnatal confounders, revealed that among boys with prenatal alcohol exposure, those with persistent cocaine exposure throughout pregnancy had significantly higher levels of Delinquent Behavior compared to boys with no cocaine exposure. Boys with any prenatal cocaine exposure were twice as likely as unexposed boys to have clinically significant Externalizing Behavior scores. However, no association was found between prenatal cocaine exposure and scores on Externalizing Behavior and specific syndromes for boys with no prenatal alcohol exposure. Among girls with no prenatal alcohol exposure, those with persistent cocaine exposure had significantly higher levels of Externalizing Behaviors and Aggressive Behaviors compared to girls with no prenatal cocaine exposure after control for confounding, and were almost five times as likely to have clinically significant Externalizing Behavior scores. However, for girls with prenatal alcohol exposure, no association between prenatal cocaine exposure and scores on Externalizing Behavior and specific syndromes was found after control for confounding. The current findings support gender- and alcohol-moderated effects of prenatal cocaine exposure on school-age teacher-reported child behavior problems. These findings are similar to what we have reported for independent parent-reported behavioral evaluation.

Indiana University-Purdue University Indianapolis (IUPUI) / Introduction: Externalizing disorders such as attention deficit hyperactivity disorder (ADHD), conduct disorder (CD), and oppositional defiant disorder (ODD) have a high prevalence rate in both children of alcoholics and in those with prenatal alcohol exposure (PAE). These disorders are also predictors of alcohol dependence (alcdep), heritable, and share an underlying genetic liability with alcdep. Furthermore, a mother who drinks while pregnant is likely to be alcohol dependent (AD), and vice-versa. This study incorporated these factors into one model, including as well as a measure of broad genetic risk for ADHD and alcdep to test for the contributions of these effects simultaneously. An independent sample was used to confirm the results for PAE and broad genetic risk. The hypothesis is that PAE will increase the risk to ADHD but not to CD or ODD. Methods: Each of these factors was evaluated independently to test if that effect on its own, significantly contributed to each disorder. Another model included several demographic covariates, to determine which of these environmental effects also contributed to the disorder. The final model for each disorder included environmental effects along with the primary effects of interest. Results: PAE resulted in increased risk for the inattentive (INATT) sub-type of ADHD and conduct disorder (CD) in the discovery sample and for the hyperactive-impulsive (HYPIMP), INATT and CD in the replication sample. PAE and the PAE*maternal alcohol dependence interaction increased the risk for ADHD and INATT. A broad genetic risk for ADHD was associated with all disorders except HYPIMP in the replication sample. Conclusion: This study further supports the trending evidence of a unique etiology of ADHD in those with PAE, and more specifically, that INATT and HYPIMP are affected according to two different mechanisms of action, independent of a genetic contribution due to either ADHD or alcohol dependence, both of which also were associated with a risk for INATT. The contribution of PAE to INATT and CD were the only consistent results across all definitions of alcohol exposure and in both datasets, indicating that PAE is a veritable risk for INATT and CD.

Thesis (Ph. D.)--University of California, San Diego, and San Diego State University, 2009. / Title from first page of PDF file (viewed May 8, 2009). Available via ProQuest Digital Dissertations. Vita. Includes bibliographical references (p. 67-79).

Thesis (M Social Work)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Fetal alcohol syndrome (FAS) is a condition which occurs when women drink alcohol during pregnancy. The use of alcohol during pregnancy has permanent and serious consquences which manifests in developmental delays and causes harmful effects to the central nervous system. FAS is seen as completely preventable and irreversable which lasts into adulthood. The prevalence rate of FAS in the Western Cape is the highest in the world. FAS is not just a health problem but also a social welfare problem, since the care for adolescents with FAS brings about exceptional demands for the carer. For this reason it became vital to explore the educational roles of the carers of adolescents with FAS. This research study firstly describes the characteristics of FAS within the physical, cognitive and social development of the adolescents with FAS. Secondly, the study describes and explores the educational roles of the carers of adolescents with FAS. The study combines both quantitative and qualitative research. The exploratory and descriptive research designs were used and a purposive sampling method was used. The participants were interviewed individually with the help of a semi-structured questionnaire. The findings of the empirical investigation show that the carers of FAS adolescents according to their perceptions and experiences know what is expected of them within their respective educational roles and they do make an effort to fulfil this role to the best of their ability. Further findings show that due to aspects like poverty and illiteracy of the participants, the carers need the support of the social worker in order for them to fulfil their educational roles. Recommendations resulting from the empirical investigation indicated that social workers need to support the carers of adolescents with FAS in parenting programmes which is simple and practical for the carers to understand and to implement. Further recommendations focus on awareness programmes and actions where the carers also take part in educating the community in terms of FAS. Through these actions the carers of adolescents with FAS can build a support system for themselves whithin the community. Therefore the community can be utilized by the carers of adolescents with FAS as a valuable resource in the fulfilment of their educational roles. / AFRIKAANSE OPSOMMING: Fetale-alkoholsindroom (FAS) is ‘n toestand wat veroorsaak word wanneer vroue alkohol drink tydens swangerskap. Alkoholgebruik tydens swangerskap het blywende en ernstige nagevolge wat manifesteer in ontwikkelingsagterstande en skade in die senuweestelsel. FAS word dus beskou as heeltemal voorkombaar, maar is onomkeerbaar en duur voort tot in volwassenheid. Die voorkomsyfer van FAS is wêreldwyd die hoogste in veral die Wes-Kaap. FAS is nie net ‘n gesondheidsprobleem nie, maar ook ‘n maatskaplike probleem aangesien die versorging van adolessente met FAS besondere eise aan versorgers stel. Om hierdie rede is dit noodsaaklik om die opvoedingsrolle waaroor versorgers van FAS-adolessente moet oor beskik te ondersoek. Hierdie navorsingstudie beskryf eerstens die kenmerke van FAS binne die fisiese-, kognitiewe- en sosiale ontwikkeling van die adolessent met FAS. Tweedens beskryf studie die opvoedingsrolle waaroor versorgers van FAS-adolessente moet oor beskik. Die studie kombineer beide kwalitatiewe en kwantitatiewe navorsing. Die verkennende en beskrywende navorsingsontwerp is gebruik en daar is ‘n doelbewuste steekproef gedoen. Individuele onderhoude is met die deelnemers gevoer met behulp van gestruktureerde vraelyste. Die bevindinge van die empiriese ondersoek toon dat die versorgers van FAS-adolessente volgens hulle persepsie en belewenisse, weet wat van hulle verwag word in die verskillende opvoedingsrolle en dat hulle wel pogings aanwend om hierdie rolle te probeer vervul. Verdere bevindings toon dat as gevolg van aspekte soos armoede en ongeletterdheid van die deelnemers die maatskaplike werker ondersteuning sal moet bied aan die versorgers van FAS-adolessente in die vervulling van hul opvoedingsrolle. Aanbevelings vanuit die empiriese ondersoek dui daarop dat die versorgers van FASadolessente deur veral die maatskaplike werker ondersteun moet word deur ouerleidingsprogramme wat eenvoudig en prakties aangebied behoort te word sodat die versorgers die inhoud maklik kan verstaan en kan toepas. Verdere aanbevelings fokus op bewusmakingsprogramme en -aksies waarin die versorgers ‘n rol kan speel om sodoende die gemeenskap ook op te voed ten opsigte van FAS. Hierdeur kan die versorgers van FASadolessente vir hulleself ‘n ondersteuningsnet binne die gemeenskap bou en die gemeenskap as ‘n waardevolle hulpbron benut in die vervulling van hul opvoedingsrolle.

Thesis (M Social Work)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Non-biological caregivers often take children into their care when their own biological caregivers have failed to provide them with a safe and loving home. These children are often also affected with Fetal Alcohol Spectrum Disorders (FASD). Learning of a child’s disability can be a big shock to non-biological caregivers especially if it is misunderstood, available professional help is scarce and intervention resources are not readily available. These non-biological caregivers are often not prepared for the financial, emotional and physical investment that is required to fully support the children and their development. This can cause various emotional reactions and implications that are challenging for the caregivers. It is critical to recognise parenting experiences and challenges as a means of developing and promoting intervention strategies and support that will respond to the needs of the children with FASD and their non-biological caregivers especially from a South African perspective. There is a need for social workers to take on responsibility for addressing FASD as they have the professional capacity to help families living with FASD to develop and maintain stable and nurturing households. One way in which this can be achieved is through the initiation and facilitation of support groups. The goal of the study was to gain an understanding on the experiences of non-biological caregivers of children with FASD and of the utilisation of support groups to help them cope better. The researcher made use of a combination of an exploratory and descriptive research design. By using both a quantitative and qualitative approach in a complimentary manner, the researcher was able to gain an in depth insight into the lives of the non-biological caregivers and how they experience this disability and support groups that are utilised as a means of helping them cope. Permission to conduct the study was granted by the committee for Human Research at the University of Stellenbosch. The literature study firstly investigated the implication of FASD on affected children. Secondly, the extents to which non-biological caregivers are affected by the consequences of this disability were discussed. After this the utilisation of support groups as a method of supporting non-biological caregivers, with the emphasis on a mutual-aid and educational approach as theoretical underpinning was described. The empirical study was completed with 16 participants through face-to-face, semi-structured interviews. An interview schedule based on the findings of the literature study was utilised. The criteria for inclusion were that participants had to have attended at least 5 support group sessions and had to be a non-biological caregiver of FASD children who had attended the support groups specifically related to this disorder. The results of this study mostly confirmed the findings from the literature study which showed that support groups play a vital role in providing necessary support to non-biological caregivers who are often unprepared for the realities of caring for a FASD child. Recommendations are aimed at the social work profession in South Africa who need to align itself in providing necessary support to non-biological caregivers through the use of support groups and various other methods of service rendering. Suggestions for future research are also made in line with how non-biological caregivers can be supported in their unique caregiver responsibilities. / AFRIKAANSE OPSOMMING: Nie-biologiese versorgers neem dikwels kinders in hul sorg wanneer kinders se biologiese ouers versuim om vir hulle ‘n veilige en liefdevolle huis en omgewing te skep. Hierdie kinders kan ook ly aan of geaffekteer word deur Fetale Alkohol Spektrum Versteuring (FASV). Dit kan ‘n groot skok wees wanneer versorgers uitvind dat die kind geaffekteer is daardeur, veral as hierdie versteuring misverstaan word. Professionele hulp is skaars, en intervensies en hulpbronne is nie vryelik beskikbaar nie. Versorgers is dikwels nie voorbereid op die finansiële, emosionele en fisiese eise wat nodig is om ten volle die kind se ontwikkeling te ondersteun nie. Dit kan dit lei tot verskillende emosionele reaksies met verskeie gevolge wat opsigself ook verskeie uitdagings vir die nie- biologiese versorgers veroorsaak. Dit is van kritieke belang om die ervarings en uitdagings van ouerskap te verken in die bevordering en ontwikkeling van intervensiestrategieë ter ondersteuning van die behoeftes van die kinders met FASV en hul versorgers, veral vanuit ‘n Suid-Afrikaanse perspektief. Daar word vereis van maatskaplike werkers om verantwoordelikheid te neem vir die aanspreek van FASV, aangesien hulle die professionele kapasiteit het om families wat geaffekteer is te help, en om hulle by te staan sodat ‘n stabiele en koesterende huishouding ontwikkel en volgehou kan word. Een manier waarop dit bereik kan word, is deur die vestiging en fasilitering van ondersteuningsgroepe. Die doel van hierdie studie was om ‘n begrip te ontwikkel oor die ervarings van nie-biologiese versorgers van kinders met FASV se benutting van ondersteuningsgroepe. Die navorser het gebruik gemaak van ‘n kombinasie van ‘n verkennende en beskrywende navorsing. Deur die gebruik van beide ʼn kwantitatiewe en kwalitatiewe benadering, is die navorser in staat gestel om ‘n indiepte insig in die lewens van die versorgers te bekom, en ondersoek in te stel oor hul ervarings van die versteuring/gestremdheid deur ondersteuningsgroepe wat as intervensie aangewend is. Toestemming om die studie te doen is deur die Etiese Komitee vir Menslike Navorsing aan die Universiteit van Stellenbosch bekom. Eerstens is die literatuurstudie voltooi waarin die navorser ondersoek ingestel het oor die implikasies van FASV op geaffekteerde kinders. Tweedens is daar bespreek hoe nie-biologiese versorgers geraak word deur die gevolge van hierdie versteuring/gestremdheid. Daarna is ondersteuningsgroepe as ‘n metode van ondersteuning aan versorgers ondersoek, en klem is gelê op ‘n wedersydse hulpbenadering en ‘n opvoedkundige benadering as teoretiese grondslag. Die empiriese studie is voltooi met 16 deelnemers deur middel van individuele, een-tot-een, semi-gestruktureerde onderhoude. ‘n Onderhoudskedule, wat gebaseer is op die bevindinge van die literatuurstudie, is gebruik. Die kriteria vir deelname aan die studie en groep het ingesluit dat deelnemers ten minste vyf sessies van ‘n ondersteuningsgroep moes bywoon en ook ‘n pleegouer wees van ‘n FASV kind. Die resultate van hierdie studie het meestal die bevindinge uit die literatuurstudie bevestig en het getoon dat ondersteuningsgroepe ‘n belangrike rol speel in ondersteuning aan nie-biologiese versorgers, wat dikwels onvoorbereid is op die werklike problematiek van die versorging van ‘n kind met FASV. Aanbevelings word gerig aan die maatskaplikewerk-professie in Suid-Afrika, ten einde ondersteuningsgroepe en ander metodes van dienslewering te bied, ter ondersteuning aan die versorgers van FASV kinders. Voorstelle vir verdere navorsing word ook gemaak sodat daar ‘n ondersteuningsnetwerk opgebou kan word vir die versorgers van ‘n FASV kind ten einde aan hulle unieke versorgingsbehoeftes te voorsien.

Abstract: Background: Fetal Alcohol Syndrome (FAS), located on the severe end of a spectrum of disorders known as Fetal Alcohol Spectrum Disorders (FASDs), is one of the most detrimental, and publicized, teratogenic outcome of alcohol consumption during pregnancy within the United States. During pregnancy, alcohol that is consumed by the mother passes through the placenta and transfers to the baby via the umbilical cord. The same prenatal transference of alcohol that leads to FAS and FASDs might also be contributing to an increased likelihood of hypertension in youth. Additionally, factors such as stress influenced by familial instability, an increased likelihood of developing congenital and conotruncal heart defects, and a reduction in nephron count might be leading to an increased likelihood of hypertension in FAS-affected youth. The purpose of this study is to examine the relationship between prenatal exposure to alcohol, manifested through FAS, and hypertension in children, adolescents, and young adults. Methods: A case-control study design was incorporated to analyze the association between FAS status and hypertensions status; cases (n=165) were collected from a FAS clinical database in Atlanta, Georgia. Controls (n=177) were taken from the National Health and Nutrition Examination Survey (NHANES). Chi-square analyses were used to examine the extent to which FAS status, sex, race/ethnicity, medication use, and obesity status each relate to hypertension status. A logistic regression was performed analyzing the relationship between FAS status (y/n: independent) and hypertension status (y/n: dependent) whilst controlling for sex, race/ethnicity, medication use, and obesity status. Results: The univariate relationships between FAS status and hypertension status (OR=4.491, p<.001) as well as medication use and hypertension status (OR= 2.951, p=.002) proved to be statistically significant (p<.05). Through the regression, FAS status significantly predicted hypertension status (β = 1.646, OR = 5.184, p< .001) after accounting for sex, race/ethnicity, medication use, and obesity status. Those with a race/ethnicity categorized as either Non-Hispanic African American (β =1.259, OR = 3.523, p = .049) or Hispanic (β = 1.192, OR = 3.294, p = .061) were significantly more likely to have hypertensions than those categorized as non-Hispanic Caucasian. Conclusion: The major findings of this study suggest a significant relationship between FAS and hypertension in youth. Race/ethnicity also proved important in predicting hypertensive blood pressure readings independent of FAS diagnosis. The most obvious biological mechanism catalyzing the relationship between FAS and hypertension is prenatal alcohol exposure. Because prenatal alcohol exposure is the primary definitional and diagnostic factor of FAS, associative connectivity may exist independently between prenatal alcohol exposure and blood pressure at various levels of severity along an alcohol exposure dose-response spectrum. Further research is needed to isolate and measure the effect that prenatal alcohol exposure has on blood pressure independently of FAS as well as to assess the extent to which the risk for hypertension in alcohol-affected individuals increases with age and through the life course.

In this thesis I evaluate the impact of an experiment with free sales of strong beer in two Swedish counties that took place in the 1960s. I do this by studying adult earnings of persons in utero during the experiment. My data includes date and place of birth and allows me to evaluate the impact of the experiment using a difference-in differences methodology, comparing earnings across cohorts and counties. Since the availability of alcohol increased most heavily for persons under the age of 21, and male fetuses are less physiologically robust than female fetuses, I choose to study persons born by mothers younger than 21 separately and also estimate the impact of the experiment separately for men and women. I find that persons born by mothers under the age of 21 during the experiment have lower average earnings than persons born before the experiment, and that the impact is larger on men. My results indicate that the experiment has led to adverse effects on adult earnings, probably caused by the prenatal alcohol exposure’s negative impact on fetal development. This means that alcohol consumption have long-term consequences that represent large costs to society. Since these costs are generally disregarded when evaluating the cost of alcohol consumption, society’s cost of alcohol is probably higher than usually estimated.

Health at birth is considered an important indicator of health outcomes in adulthood. It is also shown to have a strong association with future educational attainment and labor market outcomes. I examine the effects of behavioral and environmental factors on infant health. The factors I focus on include alcohol consumption during pregnancy, extreme weather events associated with climate change, and pollution that may result from unconventional oil and natural gas development. In Chapter II, I examine the effects of point-of-sale alcohol warning signage that alcohol retailers are required to post in some states on alcohol use during pregnancy and on birth outcomes. I find that point-of-sale warning signs discourage alcohol consumption among pregnant women and are associated with a decrease in the odds of newborns having very low birth weight or being very pre-term. The findings of this research inform decision makers about a potentially effective mechanism through which alcohol consumption among pregnant women can be reduced. They also suggest causal evidence for the link between prenatal alcohol exposure and inferior health at birth. Chapter III documents that exposure to heat waves during pregnancy is associated with increased likelihood of the mother experiencing an adverse health condition during pregnancy and the newborn having an abnormal condition at birth. The results provide an assessment of the magnitude and timing of the effects of extreme heat events associated with climate change on infant health which is potentially helpful in enhancing the effectiveness of adaptation efforts. Finally, Chapter IV provides an empirical investigation of the link between unconventional oil and natural gas development and infant health. The results indicate that unconventional drilling activity is associated with a small, but statistically significant, decline in birth outcomes, especially for those living in rural areas. Given that it is estimated that the rapid expansion in unconventional oil and gas extraction will continue for at least a few more decades, the results of this study may contribute to the discussions related to initiation or tightening of regulations and monitoring efforts to control pollution. This dissertation includes previously unpublished co-authored material.

Thesis (Ph. D.)--University of Washington, 2006. / Vita. Includes bibliographical references (leaves 193-204).

In 1996, the Institute of Medicine made an initial step towards addressing the confusion and controversy regarding the diagnosis of fetal alcohol syndrome (FAS) by proposing a classification scheme and calling for research to evaluate its validity and clinical utility. Previous research evaluated memory, executive functions, and behaviour problems in FAS. Prior to the present study, however, there had not been an empirical evaluation of the existence of a spectrum of diagnostic subgroups or an evaluation of subgroup functioning on neuropsychological components of attention during the pre-teen and adolescent years. Part 1 of this study used categorical data regarding diagnostic domains to determine if an a priori spectrum of four subgroups could be identified. This spectrum included FAS and three fetal alcohol effect (FAE) subgroups, which were defined using teratogenic theory, previous research findings, and logic. The sample consisted of 112 children with a confirmed history of excessive prenatal alcohol exposure. Part 2 evaluated the continuity and comparability of the CNS dysfunction subgroups exhibited by assessing neuropsychological components of attention using models by Mirsky and Conners. The sample consisted of 30 children and subgroups were matched on age, sex, and living situation. Results identified 3 of the 4 potential subgroups. All subgroups exhibited a clinically significant attention deficit. After adjusting for IQ, the FAS and FAE subgroups had comparable levels of functioning on all components of attention with one exception. On the sustain component, the FAE subgroups had more difficulties than the FAS subgroup in maintaining a consistent response-speed in response to changes in the length of time between targets. This study provides empirical and theoretical support for the validity and clinical utility of a spectrum of fetal alcohol subgroups consistent with the IOM's classification. It furthers a theoretical understanding of the dose-response effects of alcohol as a teratogenic agent. It suggests that attention regulation functions are especially vulnerable to the damage caused by prenatal alcohol exposure. The findings emphasize the importance of obtaining a history of prenatal alcohol exposure in individuals presenting with neuropsychological difficulties, and developing treatment programs for pregnant women with an alcohol addiction.