Article Abstract

Article Abstract

Online ISSN: 1099-176X Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 10, Issue 4, 2007. Pages: 189-206
Published Online: 18 Dec 2007

Maternal Prenatal Substance Use and Behavior Problems among Children in the U.S.

Bisakha Sen,¹* Shailender Swaminathan²

¹Associate Professor, Department of Healthcare Organization & Policy, University of Alabama at Birmingham, Birmingham, AL, USA
²Research Fellow, Center for Gerontology & Healthcare Research, BrownUniversity, Providence, RI, USA

* Correspondence to: Bisakha Sen, Associate Professor, Dept of Healthcare Organization & Policy U. Alabama at Birmingham, RPHB 330, 1665 University Blvd, Birmingham, AL 35294, USA.
Tel.: +1-205-975 8960
Fax: +1-205-934 3347
E-mail: BSen@ms.soph.uab.edu

Source of Funding: This research was supported by an intramural grant from the ListerHillCenter, UAB.

Abstract

Prenatal exposure to smoking and alcohol-use is found to be correlated with various adverse consequences for children, including behavior problems. However, it is not clear whether this relationship is an artifact of underlying confounding factors that impact both the mother’s decision to smoke/drink during pregnancy and subsequent child behavior. We investigate the relationship between prenatal substance use and children’s behavior problems using data from the Children of the National Longitudinal Survey (CNLSY). Specifically, we investigate whether prenatal cigarette use and alcohol-use affect children’s behavior problems when they are 4-6 years old, and when they are 8-10 years old. Fixed-effects regression and propensity score methods are used to minimize bias from confounding factors. Our results suggest that the relationship between prenatal smoking and behavior problems are driven by underlying confounding factors, but prenatal alcohol-use may indeed cause behavior problems in children, though there may still be some bias in the results.

Background: Prenatal exposure to smoking and alcohol consumption is associated with various adverse physical health consequences for children. Numerous studies find that prenatal substance use is associated with low birthweight, as well as subsequent developmental and cognitive problems. A growing body of literature has also begun to show associations between prenatal exposure to smoking or/and alcohol and behavior problems among children. However, it is not clear whether these latter associations arise from underlying confounding factors that can impact both the mother's decision to smoke or drink during pregnancy and subsequent child behavior.

Aims of Study: This study investigate the relationship between prenatal substance use and subsequent children's behavior problems in early childhood (4-6.5 years) and in later childhood (8-10.5 years). The datasets used are the Children of the National Longitudinal Survey (CNLSY), linked with the National Longitudinal Survey of Youth (NLSY79).

Methods: Prenatal substance use is measured by binary indicators of smoking during pregnancy and alcohol-use during pregnancy. The outcome of interest is the age and gender specific standardized Behavior Problem Index (BPI) scale that is constructed using 32 mother-reported items on the child's behavior, as well as six sub-scales of problem behavior. Initially OLS regressions are estimated to verify the positive association between prenatal substance use and higher-levels of behavior problems. Thereafter, maternal fixed effects, maternal household fixed effects, propensity score matching, and propensity score inclusive regressions are all employed to obtain estimates of the effects of prenatal smoking and alcohol-use after reducing bias from unobserved confounding factors.

Results: Initial OLS results find very strong associations between prenatal smoking and alcohol-use and higher levels of behavioral problems among both younger and older children. However, when we use fixed-effects, propensity-score matching and propensity-score inclusive regressions, prenatal alcohol use continues to be significant related with increases in behavior problems, but prenatal smoking by and large ceases to have any significant effects.

Discussion: While prenatal smoking has many deleterious outcomes for children, mostly related to low birthweight, it appears that the association between prenatal smoking and behavioral problems among children is largely driven by other confounding factors. On the other hand, results of this study suggest that prenatal alcohol-use may have true physiological/biological effects on the fetus that eventually exacerbate behavior problems. However, it should be noted that none of the methods used can account for all potential confounding factors -- especially time-variant ones -- hence, there may still remain some estimation bias. It should also be noted that the study suffers from certain shortcomings -- namely, behavioral problems as well as prenatal substance-use are all based on mother-reported data, and thus there are concerns about the accuracy of these measures. Hence, there remains scope for further research into this topic using alternate datasets.

Implications for Policy: The 1999 United States Surgeon General's Report stated that almost one in five children and adolescents in the U.S. exhibit signs of mental and behavioral disorder. This study suggests that policies aimed at reducing alcohol-use among pregnant women might contribute to reducing the prevalence of such disorders. However, while reducing cigarette use among pregnant women has numerous other health benefits for their children, it may not help reduce the incidence of behavior problems.

Received 16 August 2006; accepted 15 October 2007