Papers by Ruth Rose-jacobs
Archives of pediatrics & adolescent medicine, May 1, 2012
Objectives: To examine how family stressors (household food insecurity and/or caregiver depressiv... more Objectives: To examine how family stressors (household food insecurity and/or caregiver depressive symptoms) relate to child health and whether participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) attenuates stress-related child health risks.
Neurotoxicology and Teratology, 2003
The objective of this longitudinal prospective cohort study was to determine whether level of pre... more The objective of this longitudinal prospective cohort study was to determine whether level of prenatal cocaine exposure, or the interaction between level of prenatal cocaine exposure and contextual risk variables, was associated with a higher rate of infant -caregiver insecure attachment and disorganized attachment, or with alterations in infant crying or avoidant behavior, after controlling for prenatal exposure to alcohol, tobacco, and marijuana, the quality of the proximal caregiving environment, and other covariates. Subjects were 154 full-term 12month-old infants (64 unexposed, 61 with lighter cocaine exposure, 29 with heavier cocaine exposure) and their primary caregivers from low-income, urban backgrounds. Exposure status was determined in the maternity ward by biologic assay (infant meconium and/or maternal or infant urine) and maternal self-report. At the 12-month follow-up visit, infants were videotaped with their primary caregiver in Ainsworth's Strange Situation. Reliable coders masked to exposure status scored videotapes for attachment variables, amount of crying, and level of avoidance. Contrary to popular perceptions, level of prenatal cocaine exposure was not significantly related to secure/insecure attachment status, disorganized attachment status, or rated level of felt security. Foster care status also was not associated with attachment status. However, heavier prenatal cocaine exposure, in interaction with maternal contextual variables (public assistance or multiparity) was associated with alterations in infant socio-affective behavior, including a higher level of behavioral disorganization, more avoidance of the caregiver, and less crying. D
Pediatric Physical Therapy, 2001
The online version of this article, along with updated information and services, is
The online version of this article, along with updated information and services, is
Addictive Behaviors, 2019
Study designed to evaluate psychosocial complexities within this pregnant population • These wome... more Study designed to evaluate psychosocial complexities within this pregnant population • These women in substance abuse treatment report food (56%), housing (61%) hardships. • Food/housing hardships associated with depression, intimate partner vulnerability. • Psychosocial factors complicate substance abuse recovery and maternal-child health. • Substance abuse treatment should include psychosocial screening/remediation.
Journal of Studies on Alcohol and Drugs, 2019
Studies examining cross-sectional associations between age at marijuana initiation and memory def... more Studies examining cross-sectional associations between age at marijuana initiation and memory deficits yield mixed results. Because longitudinal data are sparse, controversy continues regarding whether these deficits reflect premorbid risk factors or sequelae of early marijuana initiation; here, we examine this question in a community sample followed since birth. Method: Masked examiners administered four subtests of the Wide Range Assessment of Memory and Learning (WRAML/WRAML2) from childhood until young adulthood to 119 urban, predominantly African American participants. Multivariable generalized estimated equation models measured longitudinal trajectories of learning. Participants were grouped as never users (n = 26), later initiators (≥16 years old; n = 31), and earlier initiators of marijuana use (n = 62). Results: Marijuana onset groups did not significantly differ on WRAML scaled scores or IQ in childhood, nor did they differ on WRAML scaled scores in adolescence. On most WRAML2 subtests, these groups did not significantly differ in young adulthood after taking into account sex and childhood IQ. However, on Story Memory, later initiators attained higher scaled scores in young adulthood, even after including additional covariates of anxiety, depression, postsecondary education, past-month marijuana use, and past-week high-risk drinking. They showed a significantly more positive trajectory than never users that was driven by within-group improvement after adolescence. Earlier initiators showed within-group decline in Story Memory after adolescence. Conclusions: Differences in learning following earlier initiation of marijuana use may not be solely attributable to premorbid deficits. (J.
Psychological assessment, 2018
Retrospective recall-based measures administered to adults, like the Childhood Trauma Questionnai... more Retrospective recall-based measures administered to adults, like the Childhood Trauma Questionnaire (CTQ), are commonly used to determine experiences of childhood trauma in the home. However, the CTQ has not been compared with prospective measures of childhood violence exposure, whether at home or in the community. We evaluated the relationships between young adults' responses to the CTQ and their prospective self-reports of exposure to violence in childhood and adolescence. Participants were 127 (93% African American, 47% male) urban young adults in a longitudinal birth cohort study examining effects of prenatal substance exposure and environmental factors on development. Participants completed the Violence Exposure Scale for Children-Revised (VEX-R), a 21-item self-report measure of experience of/witness to interpersonal violence, administered face to face at 9, 10, and 11 years using cartoon pictures, and via audio-computer assisted self-interview at 12, 14, and 16 years. Par...
Journal of Drug Issues, 2016
Research on the association between prenatal substance exposures and adaptive functioning among y... more Research on the association between prenatal substance exposures and adaptive functioning among young adults is limited, with inconsistent conclusions. In a prospective longitudinal study of 138 urban young adults, prenatal substance exposures were identified at birth from maternal self-report, urine screens, and/or infant meconium. At follow-up between ages 18 and 24 years, masked interviewers assessed level of adaptive functioning, a composite indicator comprising five domains: education, housing, adolescent pregnancy, arrest history, and employment. A significant negative association was found between prenatal tobacco exposure and adaptive functioning, particularly among females with heavier exposure. This association with heavier, but not lighter, prenatal tobacco exposure is consistent with a neuroteratologic explanation, but other, non-biological explanations cannot be ruled out. No statistically significant associations were observed between prenatal cocaine, marijuana, or lo...
American Journal of Preventive Medicine, 2017
Introduction: This study examined how mothers' Adverse Childhood Experiences (ACEs) relate to the... more Introduction: This study examined how mothers' Adverse Childhood Experiences (ACEs) relate to their children's developmental risk and assessed how the association is mediated through mothers' depressive symptoms and fair/poor health. Methods: Mothers of children aged between 4 months and 4 years were recruited from the emergency department of a children's hospital between March 2012 and June 2015 and interviewed about ACEs, mothers' depressive symptoms and health status, and children's developmental risk (screened via Parents' Evaluations of Developmental Status [PEDS]). Between August and November 2016 a Cochran-Armitage test assessed trend of PEDS by ACEs. Multinomial regression models examined differences in PEDS by ACEs severity. Mediation by mothers' depressive symptoms and self-rated health was also assessed. Results: Of 1,293 mothers, 56.7% reported one or more ACEs. Mothers also reported developmental risk (20.4% overall): 120 (9.2%) reported one concern and 144 (11.2%) reported two or more concerns on the PEDS. Mothers who reported household substance use, mental illness, or an incarcerated household member during childhood were more likely to report at least one child developmental concern on the PEDS. After controlling for covariates, odds of one PEDS concern were 1.86 (95% CI¼1.16, 3.00) for ACEs, one to three versus none, and 2.21 (95% CI¼1.26, 3.87) for ACEs four or more versus none. Adjusted odds of two or more concerns were 1.70 (95% CI¼1.07, 2.72) for ACEs, one to three versus none, and 1.76 (95% CI¼1.02, 3.05) for ACEs, four or more versus none. Mothers' depressive symptoms and self-rated health were potential mediators. Conclusions: Mothers' ACEs are significantly associated with their children's developmental risk. If replicated, findings suggest that addressing intergenerational trauma through focus on childhood adversity among young children's caregivers may promote child development.
Psychology of Addictive Behaviors, 2015
Understanding behavioral resilience among at-risk adolescents may guide public policy decisions a... more Understanding behavioral resilience among at-risk adolescents may guide public policy decisions and future programs. We examined factors predicting behavioral resilience following intrauterine substance exposure in a prospective longitudinal birth-cohort study of 136 early adolescents (ages 12.4-15.9 years) at risk for poor behavioral outcomes. We defined behavioral resilience as a composite measure of lack of early substance use initiation (before age 14), lack of risky sexual behavior, or lack of delinquency. Intrauterine substance exposures included in this analysis were cocaine, tobacco, alcohol, and marijuana. We recruited participants from Boston Medical Center as mother-infant dyads between 1990 and 1993. The majority of the sample was African American/Caribbean (88%) and 49% female. In bivariate analyses, none and lower intrauterine cocaine exposure level predicted resilience compared with higher cocaine exposure, but this effect was not found in an adjusted model. Instead, strict caregiver supervision (adjusted odds ratio [AOR] = 6.02, 95% confidence interval (CI) [1.90, 19.00], p = .002), lower violence exposure (AOR = 4.07, 95% CI [1.77, 9.38], p < .001), and absence of intrauterine tobacco exposure (AOR = 3.71, 95% CI [1.28, 10.74], p = .02) predicted behavioral resilience. In conclusion, caregiver supervision in early adolescence, lower violence exposure in childhood, and lack of intrauterine tobacco exposure predicted behavioral resilience among a cohort of early adolescents with significant social and environmental risk. Future interventions should work to enhance parental supervision as a way to mitigate the effects of adversity on high-risk groups of adolescents. (PsycINFO Database Record
Drug and Alcohol Dependence, 2014
Background-Linkages between intrauterine exposures to cocaine and marijuana and adolescents' prob... more Background-Linkages between intrauterine exposures to cocaine and marijuana and adolescents' problematic substance use have not been fully delineated.
Archives of Pediatrics & Adolescent Medicine, 2012
Objectives: To examine how family stressors (household food insecurity and/or caregiver depressiv... more Objectives: To examine how family stressors (household food insecurity and/or caregiver depressive symptoms) relate to child health and whether participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) attenuates stress-related child health risks.
Journal of Child and Family Studies, 2009
We evaluated the Starting Early Starting Smart (SESS) national initiative to integrate behavioral... more We evaluated the Starting Early Starting Smart (SESS) national initiative to integrate behavioral health services (parenting, mental health, and drug treatment) into the pediatric health care setting for families with young children. Data are presented from five pediatric care (PC) sites, drawing from families at risk due to demographic and behavioral health factors, with infants less than 12 months of age (n = 612). Families were randomly assigned to either the SESS program or a standard care Comparison group. We utilized longitudinal analyses to estimate differences in utilization rates for parenting, mental health, and drug treatment over 6 follow-up time points (3, 6, 9, 12, 15 and 18 months). Our findings indicate that SESS caregiver participants were 4.6 times (p \ 0.001; CI = 3.33-6.26) more likely to receive parenting services, 2.1 times (p \ 0.001; CI = 1.48-2.86) more likely to receive outpatient mental health treatment, and 1.8 times (p = 0.025; CI = 1.08-3.14) more likely to receive drug treatment than Comparison group participants. Our results demonstrate the success of the SESS program in coordinating and improving access to behavioral health services for high-risk caregivers within the pediatric health care setting and highlight the importance of continuing to focus public health policy on the behavioral health care needs of families with young children.
Drug and alcohol dependence, Jul 1, 2017
Executive functioning (EF), an umbrella construct encompassing gradual maturation of cognitive or... more Executive functioning (EF), an umbrella construct encompassing gradual maturation of cognitive organization/management processes, is important to success in multiple settings including high school. Intrauterine tobacco exposure (IUTE) correlates with negative cognitive/behavioral outcomes, but little is known about its association with adolescent EF and information from real-life contexts is sparse. We evaluated the impact of IUTE on teacher-reported observations of EF in urban high school students controlling for covariates including other intrauterine and adolescent substance exposures. A prospective low-income birth cohort (51% male; 89% African American/Caribbean) was followed through late adolescence (16-18 years old). At birth, intrauterine exposures to cocaine and other substances (52% cocaine, 52% tobacco, 26% marijuana, 26% alcohol) were identified by meconium and/or urine assays, and/or maternal self-report. High school teachers knowledgeable about the student and unaware ...
Addiction Science & Clinical Practice
Background: Little is known about opioid overdose or naloxone access among pregnant women. Object... more Background: Little is known about opioid overdose or naloxone access among pregnant women. Objectives: The objectives of this study were to determine the prevalence of non-fatal overdose, risk factors for overdose, and naloxone access among third trimester women in treatment for opioid use disorder. Methods: We collected baseline data from a case management parental-support intervention study. To explore the association of variables with past year overdose, we used Wilcoxon rank-sum test, Chi square or Fisher's exact tests. Results: Among 99 participants, 14% (95% CI 7-21%) reported past year overdose and 67% (95% CI 57-76%) had received overdose education and a naloxone kit. Younger age was the only variable associated with past year overdose. Conclusions: In this sample, past year non-fatal overdose was common, younger age was a risk factor, and most participants had received a naloxone kit. Further work is needed to understand whether younger age is a risk factor in the general population of pregnant women with opioid use disorder and to identify other potential risk factors for overdose in this population.
The authors have indicated they have no financial relationships relevant to this article to discl... more The authors have indicated they have no financial relationships relevant to this article to disclose. What's Known on This Subject MRI neuroimaging has been used to study the effect of prenatal exposure to alcohol on the human brain but comparatively little data have been gathered using these methods to study the effects of prenatal exposure to cigarettes, cocaine or marijuana. What This Study Adds This study adds MRI neuroimaging data on the lasting effect of prenatal exposures to alcohol, cigarettes, cocaine and marijuana on human brain structure in early adolescence. Moreover, it provides new information about the persisting potential effects of prenatal exposure to combinations of these substances.
Uploads
Papers by Ruth Rose-jacobs