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社交能力预测因子，对吸烟和非吸烟儿童的反应和调节发展轨迹进行研究。吸烟率仍然相当高，特别是在年轻、低收入女性中，我们对吸烟儿童中报告的调节障碍的发育途径的了解有限。最初的应用侧重于婴儿和幼儿在2、9、16和24个月时的反应性和调节。为了保存样本和获得儿童自我调节的母亲报告，我们在项目第四年的36个月时启动了一项简短的评估。在这次续期中，我们的目标是完成36个月的评估，并在进入幼稚园时启动和完成评估。这项应用的具体目的是：1)检测香烟暴露对学龄前/学龄期肾上腺皮质、自主神经和行为反应及调节、自我调节和社交能力的直接影响；2)检测吸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/调节来调节；3)研究这些关联是否可能受到婴儿围产期风险、母亲风险(精神病理学、育儿)或累积环境风险的调节。最终样本包括在怀孕前三个月招募的251名母婴二人组(吸烟组168人，不吸烟组83人)。产前暴露通过自我报告(3次产前访谈)、母体口水(3次产前访谈)和胎粪分析(分娩时)相结合来确定。对婴儿结局数据的分析表明，产前暴露对婴儿2个月的睡眠期间和9个月大的婴儿情感唤醒任务期间的自主神经调节有显著影响。吸烟的婴儿在9个月时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的特征。产前暴露与16个月和24个月时行为能力低下有关，环境暴露与更高的行为问题有关。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，作为幼儿园显著结果的中介的婴儿期的反应性和调节，以及接触香烟的儿童结果不同的原因。这项研究解决了文献中的几个空白，包括对多个水平的自我调节、与香烟暴露相关的长期发育途径的检查，以及对这些途径的关键调节因子和调节因子的考虑。了解发展轨迹将为预防/干预工作的时机提供信息。了解预测结果的调解过程，或可能采取行动增加风险或促进复原力，将为干预措施的内容提供信息。 与公共卫生相关：母亲吸烟的影响是一个重大的公共卫生问题，因为它可能对儿童发展产生负面影响，包括一连串损害儿童自我调节能力的负面发育事件，为问题行为和社交能力低下铺平道路。令人惊讶的是，我们对造成这一系列负面后果的心理生物学机制以及可能加剧或缓冲它们的风险和保护因素知之甚少。了解这些发育过程对于制定针对吸烟母亲的儿童的有效预防干预措施至关重要。

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.