Maternal cocaine use and the caregiving environment during early childhood.
Eiden, Rina DasView Profile; Peterson, MelissaView Profile; Coleman, Tamaira. Psychology of Addictive Behaviors13.4 (Dec

Abstract
The purpose of this study was to examine the quality of the caregiving environment for young children of polydrug cocaine-using mothers. Three aspects of the caregiving environment were examined: physical and social settings for development, maternal psychosocial functioning, and child rearing customs and attitudes. It was hypothesized that maternal cocaine use would be associated with more negative caregiving environments. Results indicated that cocaine-using mothers were more likely to have symptoms of posttraumatic stress disorder, experience or witness community violence, and use negative discipline and that their children were more likely to remain in foster care for longer periods of time, experience more changes in primary caregivers, and be visited by male caregivers less often. The implications of these findings for child adjustment and directions for future research are discussed. (PsycINFO Database Record (c) 2013 APA, all rights reserved)(journal abstract)

The purpose of present study was to examine the quality of the caregiving environment among polydrug cocaine-using mothers who were at high risk also because of poverty and minority group status. Given that a majority of cocaine-using women identified through urine screens (with choice of whom to screen influenced by subjective factors) at the time of delivery are African American or Hispanic women living in poverty (Myers, Britt, Lodder, & Kendall, 1992), the influence of these factors assumes special importance for this population. Three aspects of the caregiving environment defined as the child's developmental niche were included: the physical and social settings, maternal psychosocial functioning, and child rearing customs and attitudes. We hypothesized that these three aspects of the caregiving environment would be more negative among cocaine-using mothers compared with control group mothers.
 
Method
 
Participants
Participants were 94 mothers (90 African American, 4 Hispanic) with at least one child 5 years of age or younger (age ranged from 2 months to 69 months, M = 33 months, SD = 19.11 months). Forty of the children were boys, and 54 were girls. Mothers ranged in age from 19 to 45 years (M = 31 years, SD = 7.14). Participants were recruited in one of five ways: word of mouth (n = 34) or advertisements in newspapers (n = 18), at homeless shelters or the YWCA (n = 10), at substance abuse treatment centers (n = 19), or at substance abuse prevention centers located in public housing areas of the city (n = 13). At the time they were recruited, only a small proportion of mothers were living with a male partner (n = 4) or the child's biological father (n = 16). The majority of the children (n = 86) were in the care of their mother, whereas the remainder were in the care of a relative (n = 8). Children in care of a relative were visited by their mother at least weekly.
Mothers were eligible for the study if they had at least one child at or below the age of 5 years, were above 18 years of age, were of minority group status, and were living below the poverty limit (as calculated from the Federal Poverty Guidelines, 1995, based on income and number of dependents). Mothers were recruited into the cocaine-using group if they acknowledged using cocaine during pregnancy or during the postnatal period (n = 41) and if cocaine was their primary substance of choice. Mothers were recruited into the control group if they did not acknowledge using cocaine during pregnancy or during the postnatal period (n = 53). Most of the mothers in the cocaine-using group also used other substances such as alcohol and marijuana. Some mothers in the control group also used alcohol and marijuana. Modal annual family income was $5,400, and 87% of the mothers were on Aid to Families With Dependent Children. About 80% of the mothers had a high school degree or equivalent, 15% had 1 year of vocational education, and the remaining 5% had an associate degree or 2 years of higher education. Only 17% of the mothers were employed. All mothers were paid for participating.
 
Procedure
All the advertisements and flyers described the project as a study of the impact of neighborhoods and families on parents and children. Mothers who were interested in participating were asked to call the Research Institute on Addictions for more information. All interested mothers were screened over the telephone with regard to eligibility criteria. Eligible mothers were recruited into the study and were scheduled to come in for an interview at the Institute. After the initial maternal interview was completed for each group of 6–8 mothers, a focus group interview was scheduled. Only the data from the initial maternal interview are reported in this article.

Discussion
The results indicate that maternal cocaine use is associated with a more negative caregiving environment. As expected, this was generally true for all three aspects of the caregiving environment: the physical and social settings, psychosocial functioning, and customs of child rearing. Mothers who used cocaine were more likely to experience or witness community violence, and their children were more likely to remain in foster care for longer periods of time, to experience more changes in primary caregivers, and to be visited by male caregivers less often, compared with non-cocaine-using mothers. These results are quite consistent with previous studies on the caregiving environment of cocaine-exposed children (e.g., Hawley et al., 1995), which also reported lower levels of father contact and a higher rate of foster care placement among children of cocaine-using mothers. These aspects of the caregiving environment are likely to have significant influences on child adjustment and need to be considered in future studies focusing on children of cocaine-using mothers.
Maternal cocaine use was associated also with higher levels of PTSD symptoms. However, this group difference became nonsignificant after controlling for alcohol consumption. Similarly, the significant association between alcohol consumption during pregnancy and PTSD symptoms did not exist after controlling for cocaine use. Thus, the group difference on PTSD symptoms seems to be a function of both cocaine and heavy alcohol use. There is ample evidence in the literature suggesting strong associations between trauma and both alcohol abuse and cocaine use (see Epstein, Saunders, Kilpatrick, & Resnick, 1998; Stewart, 1996). The current results lend further support to this association. Moreover, the results suggest that maternal exposure to violence partially mediates the association between cocaine use and PTSD, that is, one pathway to higher PTSD symptoms among cocaine-using mothers is through the association between substance use and violence exposure. Studies examining child adjustment as a function of maternal cocaine or alcohol use need to consider the potential impact of maternal PTSD symptoms and violence exposure on parenting and child outcomes.
Finally, there was an indication that maternal cocaine use may be associated with more problematic maternal discipline tactics like ignoring misbehavior or yelling at their children. Use of such disciplinary techniques are likely to have significant effects on child behavior problems. This may be especially problematic if mothers alternate between ignoring their child's behavior and yelling. Apart from differences in parenting behavior, these results may also be attributed to the likelihood of more problematic child behaviors in this sample or to differences in parental values about use of punishment. Studies designed to examine child contributions as well as maternal contributions to maternal discipline are needed to examine these associations more closely.
These results may have significant implications for children of cocaine-using mothers. Several studies on risk and resilience in high-risk samples have indicated that lack of a consistent caregiver is one of the major risk factors for later outcomes (e.g., Werner, 1986). Further, increased maternal exposure to community violence, maternal PTSD, and problematic parenting behaviors all have the potential for increasing risk for negative outcomes among children of cocaine-using mothers.
There are several limitations to this study. First, although the inclusion of heavy drinking women in the control group may have obscured significant group differences, when all analyses were repeated after dropping 14 heavy drinking women from the control group, no significant changes were obtained. Second, the overlap between cocaine and alcohol use may be problematic, although in reality, most cocaine-using women also use other substances such as alcohol and marijuana. This limitation was addressed by repeating all analyses after controlling for frequency of pre- and postnatal alcohol use. With the exception of maternal PTSD symptoms, these analyses yielded results similar to those obtained without controlling for alcohol consumption. Third, the ages of the children were quite variable (e.g., 2 to 69 months). Given the extent of developmental changes in the first 5 years of life, important age-specific caregiving deficits might have been obscured. However, when we repeated the analyses, excluding the children below 12 months of age for maternal discipline, the results remained identical. Fourth, the measurement of psychosocial functioning is somewhat narrow in this study. Other aspects of maternal functioning such as antisocial behavior, sensation seeking, and anxiety would have added considerably to the picture of maternal psychosocial functioning. Finally, as noted earlier, all the measures in the study were obtained through maternal report. The use of self-report data to define substance use is always subject to problems of accuracy. Thus, there is always the risk that some mothers in the control group used cocaine and other illicit substances. However, in spite of this drawback, group differences were noted in general for all three aspects of the caregiving environment investigated in this study. Further, the use of observational measures for some aspects of the caregiving environment like maternal discipline would have minimized the problem of method bias.
The generalizability of the results are limited to African American or Hispanic substance-using women living below the poverty limit. It is likely that the nature of the caregiving environment is quite different for nonminority substance-using women who are not living in poverty. Generalizability is also limited because of lack of information about refusal rates. Mothers responded to flyers about the study and to presentations by research staff about the study.
In spite of these drawbacks, this is one of the few studies that provides descriptive information on the quality of the caregiving environment as a function of maternal substance use. The results suggest that maternal cocaine use is associated with significant problems in the caregiving environment, placing children of cocaine-using mothers at increased risk not only because of the potential teratological effects of cocaine and alcohol but also because of the negative caregiving environments associated with maternal cocaine use. The implications of these environmental and caregiving problems among children of cocaine-using mothers have not been studied well. In fact, little is known about the potential developmental consequences of these aspects of the caregiving environment for children of cocaine-using mothers or about potential interactive effects of maternal cocaine use and the caregiving environment. Future studies incorporating measures of developmental outcomes are needed to understand how these aspects of the caregiving environments mediate or moderate child adjustment among children of cocaine-using mothers.

Citation:

Eiden, R. D., Peterson, M., & Coleman, T. (1999). Maternal cocaine use and the caregiving environment during early childhood. Psychology of Addictive Behaviors, 13(4), 293-302. doi:http://dx.doi.org/10.1037/0893-164X.13.4.293