Prenatal & Environmental Tobacco Smoke (ETS) Exposure: Effects on Child Regulati

描述（由申请人提供）：这是一项多方法纵向研究的竞争性更新，该研究使用行为和生物学指标以及香烟暴露和非暴露儿童的社会能力预测因子来研究反应性和调节的发展轨迹。吸烟的比率仍然很高，特别是在年轻、低收入的妇女中，我们对吸烟儿童中报告的调节障碍的发育途径的理解有限。最初的应用侧重于婴幼儿在2、9、16和24个月时的反应性和调节能力。为了保持样本和获得母亲关于儿童自我调节的报告，我们在项目第4年的第36个月开始了一个简短的评估。在这次更新中，我们的目标是完成36个月的评估，并在进入幼儿园时启动和完成评估。本申请的具体目的是：1)检查香烟暴露对学龄前/学龄儿童肾上腺皮质、自主神经和行为反应性和调节、自我调节和社会能力的直接影响；2)研究香烟暴露与这些儿童结局之间的关系是否通过婴儿期的反应性/调节调节；3)检查这些关联是否可能被婴儿围产期风险、母亲风险（精神病理、养育）或累积环境风险所调节。最后的样本包括251对在怀孕前三个月招募的母婴（吸烟组168对，不吸烟组83对）。产前暴露是通过自我报告（3次产前访谈）、产妇口服液（3次产前访谈）和胎粪测定（分娩时）来确定的。对婴儿结局数据的分析表明，产前暴露对婴儿2月龄时睡眠中的自主神经调节和9月龄时情绪唤醒任务中的自主神经调节有显著影响。暴露于香烟的婴儿在9个月时具有较低的皮质醇基线，以及高行为反应性和低频率调节行为。产前暴露与16和24个月时较低的行为能力有关，环境暴露与较高的行为问题有关。当前提案的数据分析将建立在这些婴儿/幼儿结果的基础上，重点关注从24个月到幼儿园的自我调节的发展轨迹，婴儿期的反应性和调节作为幼儿园显著结果的中介，以及吸烟儿童结果异质性的原因。本研究解决了文献中的一些空白，包括对多层次自我调节的研究，与卷烟暴露相关的长期发育途径，以及对这些途径的关键介质和调节因子的考虑。了解发育轨迹将为预防/干预工作的时机提供信息。了解预测结果或可能增加风险或促进复原力的中介过程将为干预措施的内容提供信息。

DESCRIPTION (provided by applicant): This is a competing renewal of a multi-method longitudinal study of developmental trajectories of reactivity and regulation using behavioral and biological indices and predictors of social competence among cigarette exposed and non-exposed children. The rates of cigarette smoking continue to be quite high, particularly among younger, lower-income women, and our understanding of developmental pathways to regulatory disturbances reported among cigarette exposed children is limited. The original application focused on reactivity and regulation of infants and toddlers at 2, 9, 16, and 24 months. In order to maintain the sample and obtain maternal reports of children's self-regulation, we initiated a brief assessment at 36 months in Year 4 of the project. In the current renewal, we aim to complete the 36 month assessments, and initiate and complete assessments upon entry into kindergarten. The specific aims of this application are to 1) examine direct effects of cigarette exposure on adrenocortical, autonomic, and behavioral reactivity and regulation, self-regulation, and social competence in the preschool/school age period; 2) to examine if the relationship between cigarette exposure and these child outcomes are mediated by reactivity/regulation in infancy; and 3) to examine if these associations may be moderated by infant perinatal risks, maternal risks (psychopathology, parenting), or cumulative environmental risk. The final sample consists of 251 mother-infant dyads (168 in the smoking group and 83 in the non-smoking group) recruited in the first trimester of pregnancy. Prenatal exposure was ascertained by a combination of self-report (from 3 prenatal interviews), maternal oral fluid (at 3 prenatal interviews), and meconium assays (at delivery). Analyses of infant outcome data indicate significant effects of prenatal exposure on infant autonomic regulation during sleep at 2 months, and during affect arousing tasks at 9 months of infant age. Cigarette exposed infants had lower baseline cortisol, and a profile of high behavioral reactivity and low frequency regulatory behavior at 9 months. Prenatal exposure was associated with lower behavioral competence at 16 and 24 months and environmental exposure was associated with higher behavior problems. Data analyses for the current proposal will build on these infant/toddler outcomes by focusing on developmental trajectories of self-regulation from 24 month to kindergarten, on reactivity and regulation in infancy as mediators of salient outcomes at kindergarten, and reasons for heterogeneity in outcomes among cigarette exposed children. This study addresses several gaps in the literature including examination of multiple levels of self-regulation, long-term developmental pathways associated with cigarette exposure, and consideration of key mediators and moderators of these pathways. Understanding developmental trajectories will inform the timing of prevention/intervention efforts. Understanding mediating processes that predict outcomes, or may act to increase risk or promote resilience will inform the content of interventions. PUBLIC HEALTH RELEVANCE: The impact of maternal smoking is a significant public health concern because of the likely negative consequences on child development that involve a cascade of negative developmental events that compromise children's self-regulatory capacity, setting the stage for problem behavior and poor social competence. We know surprisingly little about the psychobiological mechanisms that account for this cascade of negative outcomes and the risk and protective factors that might exacerbate or buffer them. Understanding these developmental processes is crucial for the development of effective preventive interventions targeting children of cigarette smoking mothers.