COCAINE ABUSE IN THE RURAL ENVIRONMENT

这项前瞻性纵向发展研究的目标是 确定产前使用快克对医疗和 婴儿前3年的神经发育结果 生活，在农村，卫生部门人口使用裂纹， 廉价，高度上瘾，强效可卡因，没有其他非法 毒品这一人群的产前快克滥用更令人感兴趣，因为 它对公共援助计划的潜在长期影响。具体 目的包括：（1）评价单独和联合对 吸毒儿童，母婴健康状况，婴儿 神经行为状态和气质，母亲因素， 辐射环境;（2）剂量反应效应的测定 产前使用快克，与其他婴儿、产妇和孕妇分开 风险因素，医学/神经系统状态和行为/发育 结果;（3）确定可卡因代谢物与 婴儿尿标本对早期神经行为结果的影响 与后遗症的关系。 这项研究将提供以前从未报道过的有关人口的新数据 关于：（1）接受公共保健但无法随时获得 戒毒;（2）几乎完全使用快克作为其 选择可卡因的形式，不使用其他非法药物;（3）农村， 南方人口。初步研究估计，在3000个国家中， 我们医院每年出生的婴儿都有裂纹暴露。150名母亲承认使用 并招募150名匹配的对照以回答研究假设。 将在首次产前访视时对母体尿液进行药物筛查， 在每个妊娠期和随访访视时采集的心理社会/药物史。在 将记录分娩、胎儿和新生儿并发症， 完成报告库存。婴儿措施将包括尿液药物 屏幕、颅骨超声、哭声记录、医疗/神经系统，以及 发展评价。在1、12和24个月时， 特点和居住环境将在家中进行评估 探访在6、18和36个月时，医学/神经学、语言、发育 并进行行为评估所有患者将被称为 needed.使用交易分析，我们将测试假设：（1） 产前使用快克，以剂量依赖的方式，将与更多的 胎儿/新生儿并发症，家庭功能障碍，母亲贫困 发育不良的儿童和（2）裂缝最多的儿童 暴露，最多的医疗并发症，最差的早期神经行为 结果，和最困难的气质谁拥有的母亲与最 社会心理问题，最不适当的能力，和最 功能失调的家庭最有可能表现出较低的适应性， 行为和不太理想的发展结果。 这项研究的独特之处包括获得了一个农村人口的裂缝 使用者;收集广泛的产前药物史的能力;使用 最新技术发展和进步评估措施;使用 裂纹使用对 发展成果;和剂量反应的影响，裂纹使用短， 长期发展成果。

The goal of this prospective, longitudinal developmental study is to determine the effects of prenatal crack use on the medical and neurodevelopmental outcomes of infants throughout the first 3 years of life, in a rural, health department population which uses crack, the inexpensive, highly-addictive, potent form of cocaine, and no other illicit drugs. Prenatal crack abuse in this population is of added interest because of its potential long-term impact on public assistance programs. Specific aims include: (1) evaluation of the separate and combined effects on the developing child of crack use, maternal and neonatal heath status, infant neurobehavioral status and temperament, maternal factors, and the caregiving environment; (2) determination of dose response effects of prenatal crack use, separate from other infant, maternal and caregiving risk factors, on medical/neurologic status and behavioral/developmental outcome; (3) determination of the relationship of cocaine metabolites in infant urine specimens to early neurobehavioral outcome and their relationship to sequelae. This study will provide new data about populations never before reported on: (1) women receiving public heath care who do not have ready access to drug rehabilitation; (2) women who use crack almost exclusively as their chosen form of cocaine and use no other illegal drugs; (3) a rural, Southern population. Pilot studies estimate at least 8% of the 3,000 births/year at our hospital are crack exposed. 150 mothers admitting use and 150 matched controls will be enrolled to answer research hypotheses. Maternal urine will be drug-screened at the first prenatal visit and psychosocial/drug histories taken at each trimester and followup visit. At delivery, fetal and neonatal complications will be recorded and parent report inventories completed. Infant measures will include urine drug screen, cranial ultrasound, cry recordings, medical/neurologic, and developmental evaluations. At 1, 12, and 24 months, maternal characteristics and the caregiving environment will be assessed during home visits. At 6, 18, and 36 months medical/neurologic, language, developmental and behavioral assessments will be made. All patients will be referred as needed. Using transactional analyses, we will test the hypotheses that: (1) Prenatal crack use, in a dose-dependent fashion, will be related to more fetal/neonatal complications, family dysfunction, poorer maternal caregiving, and poorer development and (2) children with the most crack exposure, the most medical complications, poorest early neurobehavioral outcome, and the most difficult temperament who have mothers with the most psychosocial problems, least adequate caregiving abilities, and the most dysfunctional families are the most likely to demonstrate less adaptive behavior and less optimal developmental outcome. The uniqueness of this study includes access to a rural population of crack users; the ability to collect extensive prenatal drug histories; use of state of the art developmental and caregiving assessment measures; use of transactional analysis for the evaluation of the effects of crack use on developmental outcome; and dose response effects of crack use on short and long-term developmental outcome.