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2001
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1022 al. et B. MAUGHAN
based studies of criminality in adult males suggest that (1) Gestational age, birthweight, and maternal age: recorded
prenatal smoking maybe especially associated with more at the birth sweep.
severe, persistent offending. In a large Danish cohort, (2) Maternal smoking: a number of questions on cigarette
prenatalsmoking was morestrongly associatedwith smoking were included at the birth sweep. These were
combined to produce a five-category indicator of the
persistent than with adolescence-limited criminality extent of any smokingin pregnancy: (a)never smoked;
(Brennan,Grekin, & Mednick, 1999). InaFinnish (b) smoked previously, but stopped smoking in preg-
cohort, maternal smoking in pregnancy was associated nancy; (c) smoked 1 4 cigarettes a dayin pregnancy; (d)
withviolentoffending upto age 28, butnot with smoked 5-14 cigarettes a day in pregnancy:(e) smoked
nonviolent crimes (Rasanen et al., 1999). 15 or morecigarettes a dayin pregnancy. Self-reports of
Our first aim in the present study was to explore this subsequent maternal smoking were also available from
issue further, testing associations between prenatal smok- the 5, 10, and 16 year contacts.
ing and age at onset of behaviour problems in a large- (3) Maternal drinking in pregnancy: reports were collected
scale childhood sample. We hypothesized that if preg- retrospectively, attheage 10 sweep. Motherswho
nancy smoking is indeed directly implicated in risk for reported drinking on two or more days per week were
contrasted with all others.
serious or persistent conduct problems, this should be (4) Social andfamily background: extensive data on family
moreevidentinchildhoodthaninadolescent-onset and social background werecollected throughinter-
difficulties. The 1970 British birth cohort study (BCS70, views with parentsat each study contact. Measures used
Butler & Golding, 1986) offered the opportunity to test in the present analyses include: (a) parental education
this out. BCS70 has tracked a national sample of children (no academic or vocational qualifications vs. any); (b)a
from birth; mothers were questioned about smoking in composite social adversity index combining measures of
pregnancy shortly
after
the
childs
birth,
and the family social class, housing tenure, overcrowding, and
childrens behaviour was subsequently assessed in both availability of carsand telephones: families in the lowest
childhood and adolescence. The sample is large enough quintile of the range on this index were contrasted with
to test the postulatedspecificity of effects to boys, and the all others; (c) family structure (two biological parents
vs. all other types) at each study contact: (d) instability
data-set includesmeasures of other childoutcomes in family structure (i.e., changes in parentfigures) across
known tobe associated with prenatal smoking; indicators three age-ranges: (i) birth-age 5 ; (ii) age 5-age 10; (iii)
of hyperactivity and depressive symptoms (allowing for age 10-age 16; (e) ordinal position of the study child
tests of the specificity of any associations to antisocial (middle child vs. all other positions) at age 10; and (f)
behaviours); and measures of a wide range of potential major family disruption, resultinginthe study child
environmentalconfounds.Ina recent review of the being placed in Local Authority care before age 16.
consequences of prenatalexposure to nicotine, Ernst, (5) Maternal depressed mood: mothers completed the Mal-
Moolchan, and Robinson (2001) stressed the likelihood aise Inventory(Rutteret al., 1970), a24-item self-
of both environmental andgenetic confounds of prenatal completionmeasure of affective symptomatology, at
smoking, and the difficulties these raise in interpreting eachchildhoodstudy sweep. TheMalaiseInventory
shows good psychometric properties, and high scores
much current evidence from human studies. Oursecond (of 6 or more) have been shown to provide an index of
aimwas toexaminethe effects of theenvironmental risk for case-level depression (Rodgers,Power,
confounds assessedinBCS70in moredetail.Inpar- Collishaw,Pickles, & Maughan, 1999). Binaryindi-
ticular, we set out to assess how far any associations cators of high/low scores at this cut-pointwere used in
between prenatalsmokingand childrensbehaviour the analyses.
problems were robust to theextensiverangeofsocial ( 6 ) Abilityandattainnzents: thechildrencompletedthe
backgroundmeasuresrecorded inBCS70, andinde- EnglishPictureVocabularyTest (EPVT; Brimer &
pendent of reports of later maternal smoking, after the Dunn, 1962) at age 5, and a shortened version of the
childs birth. If prenatal smoking retained associations Edinburgh Reading Testdevised specially for the study
with behaviour problems after controls for these various (GodfreyThomsonUnitforEducationalResearch,
1977) at age 10.
confounds, the presumption of a direct causal influence
(7) Conduct problems and hyperactivity at uges 5 and 10
on developmentalprocesses associated with vulnerability years: parentscompleted the Rutter A2 behaviour rating
to antisocial behaviour would clearly be strengthened. scales (Rutter, Tizard,& Whitmore, 1970) at each of the
S and 10 yearcontacts.0-2ratings (no problem,
somewhat, and definite) are made on3 1 items reflecting
Methods emotional and behavioural difficulties. The scales have
been widely used in studies of childrensemotional and
Samples behaviouralproblems,andshowgoodpsychometric
BCS70 is a prospective studyof all children born in England, properties(Elander & Rutter, 1996). Factoranalyses
Scotland, and Wales in the first week of April 1970 (Butler & identified two main factors of interest for the present
Golding, 1986). Survivors a t l month ( N = 16,151) were study:conductproblems(loading on lying,stealing,
followed up atages 5, 10, and 16 years. Response rates (one or bullying,fighting,destructiveness, and disobedience)
more follow-up questionnaires completed)were 8 1 % at age 5, and hyperactivity (loading on restlessness, fidgetiness,
92% at age 10, and 71 YOat age 16. In addition to the usual and lack of concentration). Scores on these items were
factors affecting attrition inlarge-scale longitudinal surveys, the summed to create subscales, and subscale scores at or
lower response rateat age16 was influencedby industrial action above the 90th percentile were used to identify children
by teachers, which affected tracing via schools. with high levels of problems at ages S and 10 years.
(8) Conduct problems at age 16 years: parents also com-
pleted modified Rutter A(2) scales at the age 16 sweep.
Measures Inaddition,theadolescent self-completionquestion-
nairesincludedavarietyofindicatorsofconduct
Data were collected from medical examinations and parental problems.Itemsfromboth ofthesesourceswere
interviews, and from cognitive tests and questionnaires com- combined usinga n O Rrule (i.e., the item was treatedas
pleted by the study children. The following measures were used present if reported eitherby parent or adolescent) to rate
in the analyses: the presence of seven conduct problems (stealing with-
PREGNANCY
SMOKING
CHILD
CONDUCT
ANDPROBLEMS 1023
Table 1
Correlates of' Maternal Cigarette Smoking in Pregnancy
Number of cigarettes smoked per day in pregnancy
Table 2
Maternal Smoking in Pregnancy and Selected Child Outcomes
Numbers of cigarettes smoked per day in pregnancy
B F test with 4, 5670 &(birthweight); 4, S424 df'(EPVT); 4, 5070 @(Edinburgh reading test).
* Significantly different from never smoked at p < .OS.
smoking on risk for childhood-onset conduct problems. problems at age 16 bycomparison with 21.5 YOof sons of
Compared withmotherswhohad never smoked,the nonsmokers. Contrasts for girls were if anything more
adjustedoddsofchildhood-onsetconductproblems striking: 29.2 % persistence amongdaughters of the
among children whose mothers smoked 5-14 cigarettes a heaviest smokers,13.2 YO amongdaughters of non-
day in pregnancy was 1.48 (95 YOC1 = 1.18-1.85, p = smokers. Other predictors of persistence were male sex,
.OOl). For children of the heaviest smoking mothers (15 young maternal age, and family instability between ages
or more cigarettes per day) the adjusted odds ratio was 10 and 16 years;for girls only, persistence was also
1.53 (95 Yo C1 = 1.17-2.00, JJ .002).1 associated with family change in middle childhood (ages
Heavy smoking in pregnancy was also associated with 5-10 years). Once again, prenatal smoking continued to
persistence of conductproblemsfromchildhood to show significant associationswithpersistentconduct
adolescence. Thirtypercent of boyswithchildhood- problems in alogistic regression model takingthese other
onsetproblemswhosemotherssmoked 15 or more factors into account. Compared with mothers who had
cigarettes perday in pregnancy showed persistentconduct never smoked, the adjusted odds of persisting conduct
PREGNANCY SMOKING A N D CHILD CONDUCT PROBLEMS I025
Childhood (ages 5 10 years) Adolescent (age 16 years) Figwe 3. Childhood-onset conduct problems, maternal
Age at onset of conduct probfems
smoking in pregnancy, and subsequent maternal smoking.
..__.
.............................................................................................................
;4 0Nonsmoker Stopped in pregnancy l + per day i year study contacts-the period over which childhood-
onset conduct problems had been assessed. Controlling
i 5+ per day 15+ per day
for all other significant predictors, this index, treatedas a
scale, was significantly associated with increased risk for
Figure 1. Conduct problems and maternal smoking in childhood conduct problems (adjustedOR = l . 17, 95 %
pregnancy: boys.
C1 = 1.04-1.32,~ = -011 ) ; with this indicator included in
themodel, effects of smoking in pregnancy became
nonsignificant ( p = ,238). Exploring contrasts between
25 l categories of the postnatal smoking index, it was clear
that these effects were primarily associated with persistent
smoking. Risks for children of mothers who smoked at
only one of the 5 or 10 year sweeps werenot significantly
elevated by contrast with those who reported ne postnatal
smoking (adjusted OR = 1.20, 9 5 % C1 = 0.88-1.62);
for children of persistent smokers, however, risks were
significantly increased (adjusted OR = 1.37, 95% C1 =
1.07-1.74).
Thesefindingssuggestedthatmotherssubsequent
smoking was associatedwith some additional effects,
over and above those apparentfor smoking in pregnancy.
Childhood (ages 5-10 years) Adolescent (age 16 years)
To explore this further, we plotted rates of childhood-
onsetconductproblems for children in each of the
Age at onset of conduct problems pregnancy smoking categories, subdivided according to
the mothers reports of subsequent smoking. Figure 3
i Nonsmoker Stopped in pregnancy I+ per day I illustrates the results, contrasting rates for children of
mothers who reportedsmoking at boththe 5 and 10
i 5+ per day 15+ per day contacts(persistentsmokers) with those forchildren
...................................................................................................................... whose mothersreportedsmoking at neitherpostnatal
Figure 2. Conduct problems and maternal smoking in contact, oratonly one. Two featuresare especially
pregnancy: girls. striking. First, children whose mothers had not smoked
in pregnancy but who did report smoking at both later
study contactsseemed at someincreased risk ofchildhood
problemsamongchildren of mothers in theheaviest conduct problems; tests confirmed that this was indeed
pregnancysmokingcategory was 1.69 (95 YO C1 = the case (OR = 1.43, 95 Yo C1 = 0.95-2.14, p = 48).
1.08-2.63, p = .021). Second, at the opposite endof the spectrum,effects were
more marked, and significantly higher ( p = .03 on a one-
S~bseguenrMaternal Smoking tailed test).Outcomes for childrenofmothers who
smoked most heavily in pregnancy (15or more cigarettes
Theseanalysessuggestedthatassociationsbetween per day) variedmarkedlydepending on themothers
prenatal smoking and both early onset and persistent subsequentsmokinghistory. Where motherssmoked
childhood conduct problems could notbe accounted for persistently, rates of childhood conduct problems were
by the strong overlaps between maternal smoking and a the highest in the sample as a whole (31.5 %); if women
range of social, family, and maternal characteristics. The who smoked heavily in pregnancy subsequently gave up
final stage in the analyses was designedto explore how far smoking for a t least some period, problem levels were
these effects were specific toprenaralsmoking. To do this, little elevated above those of the children of nonsmokers
we repeated the logistic regressionanalysespredicting (14.2 % vs. 14.3 % among complete nonsmokers). Given
childhood-onset conduct probIems, but included as an the strong continuity in maternal smoking across study
additional predictor a 3-point cumulative indexof post- contacts (see Table l), the numbersin this last group were
natal smoking, reflecting on how many occasions (none, inevitably relatively small: only 15.2% of mothers who
one, or two) mothers reported smoking at the 5 and 10 smoked heavily in pregnancy (100/657) did not report
1026 B. MAUGHAN et a1
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American Journal ojPsychiatry, 1.56, 857-862. Manuscript accepted 4 June 2001
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