Methods: This is a secondary analysis of a prospective cohort of adolescents, primarily African-American and of low socioeconomic status, recruited at birth. Meconium was analyzed for FAEEs in 216 newborns. At age 15, 183 adolescents (81 boys, 102 girls), 85% retention, were assessed for alcohol, tobacco, and marijuana use via self-report and biologic assays (urine, hair, and blood spots). Substance use problems (e.g., experiencing mood swings, forgetfulness, accidents) were assessed via the 17-item Substance Use/Abuse scale from the Problem Oriented Screening Instrument for Teenagers. Respondents reporting ≥ 1 problem associated with substance use were coded 1 (yes). Adolescent gender, other drug exposure (cocaine, tobacco, marijuana), maternal psychological distress (α= .95) assessed at birth via the Brief Symptom Inventory, quality of the caregiving environment assessed at age 9 via The Home Observation for Measurement of the Environment, and violence exposure (α= .75) assessed at age 12, were used as covariates.
Results: About one-third of the offspring reported tobacco (34%), alcohol (39%), and marijuana (31%) use by age 15, and 22% reported experiencing substance use problems. Findings from multiple logistic regression analyses indicated that higher levels of FAEE were related to a greater likelihood of marijuana use (OR= 1.50, 95% CI= 1.05 - 2.14, p= .02) and experiencing substance use problems (OR = 2.29, 95% CI= 1.05 - 5.0, p= .04), controlling for other prenatal drug exposure and covariates. No relationship was found between FAEE and adolescent tobacco or alcohol use. Boys were more likely to report substance use problems (OR= 3.70, 95% CI= 1.61 - 8.50, p = .0003), despite no gender difference in alcohol, tobacco, or marijuana use. As we have reported previously, prenatal cocaine exposure was also independently related to a higher likelihood of marijuana use (OR= 2.33, 95% CI= 1.19 - 4.55, p= .01) and substance use problems (OR= 3.76, 95% CI= 1.63 - 8.65, p= .0003).
Conclusions & Implications: Prenatal alcohol exposure is a risk factor for developing substance use problems. Elevated levels of FAEEs are potential markers for identifying newborns at risk for early substance use and developing substance use problems. Continued follow-up with this sample will elucidate whether and how prenatal alcohol exposure may affect the chronicity or severity of substance use problems over time.