COCAINE EXPOSURE IN UTERO--ELEMENTARY SHCOOL FOLLOWUP

宫内可卡因暴露水平与小学生的神经心理、情绪和行为状态之间是否存在剂量反应关系尚不清楚。我们建议在8.5岁、9.5岁和10.5岁时继续进行纵向掩蔽评估，从出生起前瞻性地跟踪160-170名照顾者/儿童二元组中以非裔美国人为主的队列。这一队列在该领域是独一无二的，因为接触可卡因的水平以母亲访谈和婴儿胎粪分析为特征。这项研究将评估，在对潜在的混杂生物和社会变量进行统计控制后，宫内可卡因暴露水平与多个领域的结果是否存在独立关系，包括记忆、注意力和脉冲控制、复杂运动技能、语言、执行功能、认知能力和学习障碍。儿童照顾者将每年接受采访，以衡量潜在的混淆或调解环境变量，如照顾者物质使用、心理健康、社会支持以及主要和次要的生活压力。我们将监测宫内可卡因暴露水平是否与DICA-IV以及儿童、父母和教师报告症状报告措施(包括抑郁、行为问题、接触暴力和儿童物质暴露)评估的儿童精神诊断相关。这方面的混合线性回归模型是一个丰富的纵向数据集，它将能够识别历史和同时存在的生物和社会因素，这些因素与可卡因暴露水平相互作用，区分哪些儿童在小学阶段出现不良后果，哪些儿童没有表现出不良后果。这些数据可以为全国范围内照顾接触可卡因的小学生的公共政策选择提供信息。

Whether there is a dose response relationship between levels of in- utero cocaine exposure and the neuropsychological, emotional, and behavioral status of elementary school children is unresolved. We propose to continue a longitudinal masked evaluation at 8.5, 9.5, and 10.5 years of age, of a predominantly African-American cohort of 160-170 caregiver/child dyads, followed prospectively since birth. The cohort is unique in the field in that level of cocaine exposure is characterized by both maternal interview and infant meconium assays. The study will evaluate whether, after potentially confounding biologic and social variables are controlled for statistically, there are independent relationships between level of in utero cocaine exposure and outcomes in multiple domains, including memory, attention and impulse control, complex motor skills, language, executive functions, cognitive abilities, and learning disabilities. Children's caregivers will be interviewed annually to measure potentially confounding or mediating environmental variables such as caregiver substance use, mental health, social support, and major and minor life stresses. We will monitor whether level of in utero cocaine exposure correlates with children's psychiatric diagnoses as assessed by the DICA-IV and child, parent, and teacher report symptom report measures (covering depression, behavioral problems, exposure to violence, and child substance exposure). Mixed linear regression models of this is a rich longitudinal data set, which will permit the identification of historical and concurrent biologic and social factors, which, in interaction with level of cocaine exposure, differentiate children who do and do not show adverse outcomes in elementary school years. This data can inform public policy choices for care of cocaine exposed elementary school children nationwide.