Home Environmental Risk Research Articles

Development of the home environment risk rating scale and investigation of the psychometric properties in the elderly and adult individuals.

To reduce home accidents, which is one of the critical public health problems, it is necessary to evaluate the home environment first. The aim of this study was to develop the Home Environment Risk Rating Scale (HERRS) and examine its psychometric properties in elderly and adult individuals. This study was conducted on 220 elderly and adult individuals (63.68±10.31 years old, 68.2% female, 31.8% male) living in their homes. The participants completed the Sociodemographic Information Form, Home Environment Conditions Evaluation Form for Falls, and Home and Environment Risk Rating Scale. In addition, psychometric measurement results for horizontal and vertical measurements were analyzed by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) methods. It was found that the Kaiser-Mayer-Olkin (KMO) value for horizontal and vertical measurements were 0.613 and 0.704, respectively. Results of EFA for horizontal and vertical measurements revealed that five factors together explain 72.033% and three factors together explain 68.368% of the total variance, respectively. The result of CFA for horizontal and vertical measurements demonstrate that the 5-sub-dimension horizontal scale structure and the 3-sub-dimension vertical measurement structure generally fit acceptable in this scale. Cronbach's alpha was satisfactory in all of the measurements (0.73 and 0.80 respectively); the ICCs were good/excellent in all of the measurements (0.99 and 0.90, respectively). The results show that HERRS has the potential to examine the risks of the home environment adequately for the home structure of Turkish society in detail and is a valid and reliable test that health professionals can use. The online version contains supplementary material available at 10.1007/s10389-023-01885-6.

Rural Settlement Development in Western China: Risk, Vulnerability, and Resilience

Rural development is an essential link in the social governance system, and it is the key to market rural development and enhancing farmers’ living conditions. It is a critical starting point for changing the agricultural landscape and improving agricultural social governance capability. It is also the proper means of encouraging the balanced growth of urban and rural society, as well as traditional wealth. Farmers no longer have to worry about “short of food and clothing,” but “housing challenges” pose a threat to the soundness, harmony, and growth of rural areas, social hazards are increasing, and rural areas in distant western areas continue to create risk and vulnerability of living setting. Most previous studies have focused on economic and regulatory elements; however, this study focuses on the composition of home environment risk factors, as well as the influence of fabric vulnerability, trust vulnerability, and emotional vulnerability produced by risks. To successfully resist residential surroundings threats, improving the effectiveness of risk response and boosting farmers’ resilience are all critical strategies to reduce susceptibility. This study, which employs in-depth interview methodology, explains how the growth of a gorgeous new country must enhance and ensure the safety of farmers’ living surroundings to prevent risk impact, as well as how the country’s resilience should be improved. The findings indicate that, in the technique of rural government, the preservation of living environments is not only one of the primary desires of farmers, but, furthermore, the key to increasing farmers’ flexibility to combat hazards, and also the lone way to come through property rural development. In accordance with the specific situation, the associated countermeasures, square measure, imply: to begin, the highest body’s role placement is treated to weaken the fabric, this weakness caused by the unclear role positioning. Second, we should always encourage excellent communication among subjects about the concept of trust in order to reduce the vulnerability of trust produced by insufficient policy coverage and differences in policy interpretation and knowledge. Third, we should always perceive and satisfy the emotional needs of farmers’ families in order to reduce the emotional vulnerability caused by policies and procedures that neglect their true feelings.

Risk factors of in-home unintentional injuries among 0-6-year-old children in Changsha city of China: a cross-sectional survey based on Bronfenbrenner’s ecological system theory

BackgroundIn-home unintentional injuries (IUIs) seriously threatened children’s safety. Three factors, including risky behaviors, parental supervision, and home environmental risks, have been identified as major causes for IUIs. Studies considering the interrelations between the three were limited and no relative studies has been carried out among Chinese children. The purpose of this study is to fully explore the influences of behavioral, supervisory and environmental risk factors on IUIs and their associations among Chinese children on the bases of our self-developed scales.MethodsThrough stratified cluster sampling, a cross-sectional survey was conducted with 798 parents of children aged 0 ~ 6 years in Changsha, China. Social demographics and IUIs history in the past year were collected by self-administered questionnaires. Three IUI-related scales, which had been developed and validated by our team, aimed to measure risks from children behavior, parental supervision and in-home environment. Structural equation models were constructed to analyze the relationship of these factors and their influences on IUIs using SPSS 26.0 and AMOS 22.0.ResultsSeven hundred ninety-eight parents were surveyed in total, and 33.58% of them reported with IUIs history of their children. X2/df, goodness-of-fit index (GFI), adjusted goodness-of-fit index (AGFI) and the root-mean-square error of approximation (RMSEA) for the model of the whole children were 4.832, 0.879, 0.856 and 0.069 respectively, indicating an acceptable level of model fit. Direct influences were discovered between risky behaviors and children’s IUIs. Home environmental risks indirectly exerted impacts on IUIs by the mediating effect of risky behaviors, while the significant effect of parental supervision only existed in children aged 4-6 and girls.ConclusionsRisky behaviors played a mediating role in IUIs among children. Supervision and environmental risks affected IUIs indirectly by the exposure to risky behaviors. Parental supervision may not be able to offset the risks posed by the environmental and behavioral factors, so effective IUIs prevention strategies should focus on behavioral and environmental interventions, with appropriate supervision strategies based on the age and sex characteristics of the child.

Development of Numeracy and Literacy Skills in Early Childhood—A Longitudinal Study on the Roles of Home Environment and Familial Risk for Reading and Math Difficulties

This study examines the direct and indirect effects of home numeracy and literacy environment, and parental factors (parental reading and math difficulties, and parental education) on the development of several early numeracy and literacy skills. The 265 participating Finnish children were assessed four times between ages 2.5 and 6.5. Children’s skills in counting objects, number production, number sequence knowledge, number symbol knowledge, number naming, vocabulary, print knowledge, and letter knowledge were assessed individually. Parents (N = 202) reported on their education level, learning difficulties in math and reading (familial risk, FR), and home learning environment separately for numeracy (HNE) and literacy (HLE) while their children were 2.5 years old and again while they were 5.5 years old. The results revealed both within-domain and cross-domain associations. Parents’ mathematical difficulties (MD) and reading difficulties (RD) and home numeracy environment predicted children’s numeracy and literacy skill development within and across domains. An evocative effect was found as well; children’s skills in counting, number sequence knowledge, number symbol identification, and letter knowledge negatively predicted later home numeracy and literacy activities. There were no significant indirect effects from parents’ RD, MD, or educational level on children’s skills via HLE or HNE. Our study highlights that parental RD and MD, parental education, and the home learning environment form a complex pattern of associations with children’s numeracy and literacy skills starting already in toddlerhood.

An Exploratory Qualitative Study With Older Malaysian Stroke Survivors, Caregivers, and Healthcare Practitioners About Falls and Rehabilitation for Falls After Stroke.

Background: Studies on rehabilitation for falls after a stroke remain limited despite its impact being profound. This scenario justifies a deeper understanding of why falls in stroke rehabilitation received less attention. Current investigations on the perception of falls and stroke also proved inadequate. Therefore, this study aims to explore the perceptions and experiences of older Malaysian stroke survivors, spousal caregivers, and healthcare practitioners on falls in stroke rehabilitation.Method: A qualitative study of three focus groups with 18 individuals from one community-based stroke rehabilitation center was conducted. The discussions were audio-recorded, video-recorded, transcribed, summarized, and analyzed using thematic analysis.Results: Three themes emerged from the analysis: (i) perceived factors and consequences of falls after stroke, (ii) physical-based interventions predominate in rehabilitation for falls after stroke, and (iii) the role of home hazards in fall prevention is taken for granted. Although, awareness of falls is high, they are regarded as a peripheral issue in stroke. Rehabilitation interventions such as improved functionality are believed to be adequate and can indirectly prevent falls. Other interventions for fall prevention such as home hazards management are relatively less known.Conclusion: There is a need for more attention regarding home environment risk assessment and intervention among healthcare professionals, and more education for clients and caregivers is required. Although, other stroke interventions may also benefit stroke survivors, falls prevention should be a central component in stroke rehabilitation. As this study focused on a specific population, the findings should be validated with larger populations, and in diverse settings.

113 An Online Platform for the Home Falls and Accidents Screening Tool (Home Fast)

Abstract The Home Falls and Accidents Screening Tool (HOME FAST) is a well validated and researched tool designed to identify risk of falls in home environments for older people. The reach of the tool is limited by its availability only in paper-based form. This paper will outline the process involved in making the HOME FAST available online for health professionals, older people and their carers, and its utility in providing links to recommendations to modify home hazards, referring on to appropriate health professionals, generating reports, and communicating results with general practitioners. An online platform is being designed for both the health professional and self-report versions of the HOME FAST which will be available for use on smartphones, tablets and computers. The program will indicate high, moderate and low falls risk. The platform will be tested by groups of health professionals, and older people throughout NSW. Once approved the online platform will be made generally available and demographic data will be collected about the person the HOME FAST is used with and common hazards they face. Older people have been recruited through NSW council community groups and senior’s expos to trial the online HOME FAST and provide feedback through surveys, interviews and focus groups. Health professionals are being recruited through professional networks. We anticipate collection of useful data about the home environmental risks present in the homes of older people as well as the uptake and adoption of the online HOME FAST and its potential to be used routinely in health professional practice. Findings will inform primary falls prevention in the community, how older people view the advice that is given through the on-line resources and how the home environment can be implicated in falls risk for older people living in the community.

Home environmental and lifestyle factors associated with asthma, rhinitis and wheeze in children in Beijing, China

BackgroundThe prevalence of asthma and allergic diseases has increased rapidly in urban China since 2000. There has been limited study of associations between home environmental and lifestyle factors with asthma and symptoms of allergic disease in China. MethodsIn a cross-sectional analysis of 2214 children in Beijing, we applied a two-step hybrid Least Absolute Shrinkage and Selection Operator (LASSO) algorithm to identify environmental and lifestyle-related factors associated with asthma, rhinitis and wheeze from a wide range of candidates. We used group LASSO to select variables, using cross-validation as the criterion. Effect estimates were then calculated using adaptive LASSO. Model performance was assessed using Area Under the Curve (AUC) values. ResultsWe found a number of environmental and lifestyle-related factors significantly associated with asthma, rhinitis or wheeze, which changed the probability of asthma, rhinitis or wheeze from −5.76% (95%CI: −7.74%, −3.79%) to 27.4% (95%CI: 16.6%, 38.3%). The three factors associated with the largest change in probability of asthma were short birth length, carpeted floor and paternal allergy; for rhinitis they were maternal smoking during pregnancy, paternal allergy and living close to industrial area; and for wheeze they were carpeted floor, short birth length and maternal allergy. Other home environmental risk factors identified were living close to a highway, industrial area or river, sharing bedroom, cooking with gas, furry pets, cockroaches, incense, printer/photocopier, TV, damp, and window condensation in winter. Lifestyle-related risk factors were child caretakers other than parents, and age<3 for the day-care. Other risk factors included use of antibiotics, and mother’s occupation. Major protective factors for wheeze were living in a rural/suburban region, air conditioner use, and mother’s occupation in healthcare. ConclusionsOur findings suggest that changes in lifestyle and indoor environments associated with the urbanization and industrialization of China are associated with asthma, rhinitis, and wheeze in children.

The effect of educational intervention by nurses on home environmental risk factors for falls

Aim: The purpose of this study was to assess the incidence of environmental safety hazards in the homes of people aged 65 years and above, and to evaluate the effect of an educational intervention by nurses on the incidence of home environmental risk factors for falls, and on the perception of the safety of the home environment. Design: The study was a non-randomized single-arm pre-post intervention study. Methods: The sample consisted of 106 elderly patients living in their homes in the Czech Republic. The intervention involved individual education about home hazards, including the provision of a free educational leaflet and emergency call sticker, and advice regarding home environment modification and safety devices. Results: A statistically significant difference was found in the number of risk factors before and after the intervention (p &lt; 0.001). After the intervention the elderly subjects perceived their home environment as being less safe than they had before. Conclusion: This study demonstrates that home environmental risk factors for falls can be reduced by a well-prepared educational intervention.

A Smart Home Environment to Support Risk Monitoring for the Elderly Living Independently

Elderly people prefer to live independently despite being vulnerable to age-related challenges. Constant monitoring is required in cases where the elderly are living alone. The home environment can be a dangerous environment for the elderly due to adverse events that can occur at any time. The potential risks for the elderly living independently can be categorised as injury in the home, home environmental risks, and inactivity due to unconsciousness.&#x0D; &#x0D; The aim of this paper is to discuss the development of a low-cost Smart Home Environment (SHE) that can support risk and safety monitoring for the elderly living independently. An unobtrusive and low cost SHE prototype that uses a Raspberry Pi 3 model B, a Microsoft Kinect Sensor and an Aeotec 4-in-1 Multisensor was designed and implemented. An experimental evaluation was conducted to determine the accuracy with which the prototype SHE detected abnormal events. The results show that the prototype has a mean accuracy, sensitivity and specificity of 94%, 96.92% and 88.93% respectively. The sensitivity shows that the chance of the prototype missing a risk situation is 3.08%, and the specificity shows that the chance of incorrectly classifying a non-risk situation is 11.07%.

Düşme Öyküsü Olan Yaşlıların Ev Ortamlarının ve Düşme Risklerinin İncelenmesi

Amaç: En az bir düşme öyküsü olan 65 yaş ve üzerindeki yaşlı bireylerde meydana gelen düşmelerde sosyodemografik özelliklerin ve ev ortamı özelliklerinin düşme riskine etkisini ortaya koymaktır. Gereç ve Yöntemler: Çalışmada en az bir düşme öyküsü olan, 65 yaş ve üzerinde 561 yaşlı birey kendi ev ortamında değerlendirmeye alındı. Veriler sosyodemografik veri formu ve İtaki Düşme Riski Ölçeği kullanılarak toplandı. İtaki Düşme Ölçeği; düşmelere neden olabilecek 11 minör, 8 majör olmak üzere toplam 19 risk faktörünü değerlendirmektedir. Verilerin analizi

Chemical and mineral composition of fly ashes from home furnaces, and health and environmental risk related to their presence in the environment

The study presents the results of an analysis of fly ashes produced from burning of solid fuels mixed with municipal waste and assesses the environmental and health risk associated with infiltration of the selected metals to the environment. The phase composition suggests that the material is extremely mixed and diverse. Low-temperature components were mixed with substances formed in high temperatures. The variable composition of waste from different home furnaces with high content of the amorphous phase (which dissolves in water more easily than its crystalline equivalents) may be harmful to the environment and for the people. The dominant elements were silicates and aluminosilicates, such as: quartz, feldspar and plagioclase (albite). Clay minerals (kaolinite and mullite), carbonates (calcite), oxides/oxidehydroxides of iron and sulfate minerals (gypsum and anhydrite) were also abundant. The particles' major constituents were Si, Al, Ca and Fe oxides (85.5%), while S, Mg, Na, K and Ti oxides accounted for 12.6% of the total content. The risk assessment code suggested: Low Risk for As, Co, Cr, Ni, Medium Risk for Cd, Cu and Pb, and High Risk for Zn. Hazard Index (HI) calculated for non-cancerogenic substances for children was 2.35E+00. The total Risk index for children was 4.88E-05. As for adults, HI was 2.42E-01 for women, and 2.89E-01 for men, while the Risk index value was 6.85E-05 for women, and 8.48E-05 for men. The value HI > 1 points to the risk of adverse health impact on children exposed to fly ashes.

Hope, the Household Environment, and Sexual Risk Behaviors Among Young Women in Rural South Africa (HPTN 068).

We assessed the psychological trait of hope as an explanatory mediator in the relationship between the home environment and sexual risk behaviors among 2533 young women in rural South Africa. Hope mediated the relationship between average household age and sexual debut (mediated effect=-0.003, p<0.05), and between household consumption and sexual debut (mediated effect=-0.019, p<0.05). Both higher average household age (β=0.01; 95% CI 0.00, 0.01) and greater household consumption (β=0.05; 95% CI 0.02, 0.08) were marginally associated with higher hope. In turn, greater hope was associated with lower odds of sexual debut (aOR=0.62; 95% CI 0.52, 0.74). These results provide important preliminary evidence of the role of the home environment in shaping protective psychological assets and healthy sexual behaviors. Continued exploration of the relationship between hope and the home environment may help to explain why young women in this context have a disproportionate risk for HIV.

Home environmental and behavioral risk indices for reading achievement

The goal of this study was to identify home environmental and temperament/behavior variables that best predict standardized reading comprehension scores among school-aged children. Data from 269 children aged 9–16 (M=12.08; SD=1.62) were used in discriminant function analyses to create the Home and Behavior indices. Family income was controlled in each index. The final Home and Behavior models each classified around 75% of cases correctly (reading comprehension at grade level vs. not). Each index was then used to predict other outcomes related to reading. Results showed that Home and/or Behavior accounted for 4–7% of the variance in reading fluency and spelling and 20–35% of the variance in parent-rated problems in math, social anxiety, and other dimensions. These metrics show promise as environmental and temperament/behavior risk scores that could be used to predict and potentially screen for further assessment of reading related problems.

Preferred and Actual Location of Death: What Factors Enable a Preferred Home Death?

Fulfillment of patient preferences for location of dying is of continued end-of-life care interest. Of those voicing a preference, most prefer home. However the majority of deaths occur in an institutional setting. The study objective was to report on the congruence between the last preferred and actual location of death among adult Nova Scotians who died from chronic disease, and to identify individual, illness-related, and environmental factors associated with achieving a preferred home death. The study employed a population-based mortality follow-back telephone survey interview. Subjects were eligible death certificate identified informants (next-of-kin) of adults (aged 18+) (n = 1316) who died of advanced chronic diseases in the Canadian province of Nova Scotia between June 2009 and May 2011 who were knowledgeable about the decedent's care over the last month of life. Congruence was assessed as to whether or not the decedent died in their preferred death location. Among decedents preferring a home death, individual, illness-related, and environmental risk factor multivariable analyses were used to identify predictors of home death achievement. Among all who voiced a preference (n = 606), 52% died in their preferred location (kappa: 0.29). Factors contributing independently to achievement of a preferred home death were emotional needs being met, nursing and family physician home visits, palliative care program involvement, and being at home for the majority of the last month. This study identifies elements of primary and integrated care that address the gap between preferred and actual place of care.

Home environment in relation to allergic rhinitis among preschool children in Beijing, China: A cross-sectional study

The prevalence of allergic rhinitis (AR) among children has increased markedly in Beijing during the last two decades. The purpose of this study was to estimate the prevalence of AR and to identify indoor risk factors for AR among preschool children. A cross-sectional questionnaire survey was conducted in Beijing, 2011. Parents of 5388 3–6 years old children (65% response rate) from randomly selected kindergartens in Beijing participated in this study. A Chi-square test and multiple logistic regressions were used to identify risk factors. Our survey found that the prevalences of “AR symptoms ever,” “AR symptoms current” (AR symptoms in the last 12 months) and “doctor-diagnosed AR” are 49.5%, 45.6% and 7.8%, respectively. Confounding factors for “AR symptoms” and/or “doctor-diagnosed AR” are gender, age, family allergic history, breastfeeding and current environmental tobacco smoke (ETS). New furniture, condensation on window pane and cockroaches are risk factors for both “AR symptoms ever” and “AR symptoms current”. Risk factors for “AR symptoms ever” include the use of humidifier and incense. A risk factor for “AR symptoms current” is mosquitoes/flies. Risk factors for “doctor-diagnosed AR” include living close to a main road or highway, visible mold spots and current pet keeping. A protective factor against doctor-diagnosed AR is opening the child's bedroom window in winter (aOR 0.66, 95% CI 0.48, 0.92). We found that the greater the number of home environmental risk factors, the higher risk of AR. A number of home environmental factors are associated with AR among preschool children.

Improving Asthma Care in the Hospital: an Overview of Treatments and Quality Improvement Interventions for Children Hospitalized for Status Asthmaticus

Asthma is one of the leading causes of pediatric hospitalization in the USA. This review summarizes evidence-based practices for inpatient pediatric asthma treatment, including routine care, care escalation, and discharge care, along with established and emerging inpatient quality improvement approaches. Intermittent inhaled beta agonists, systemic steroids, and, for patients with low oxygen saturation, supplemental oxygen remain the cornerstones of routine inpatient asthma care. Compared to nebulization, metered-dose inhaler delivery of intermittent beta agonist therapy is more effective and underused. Oral prednisone produces similar clinical outcomes and is more cost-effective when compared with intravenous methylprednisolone. Standardized respiratory assessment scores should supplement clinical judgment in evaluating response to therapy. There are no studies that demonstrate the effectiveness of routine adjuvant anticholinergic therapy outside of the emergency room, though it may be effective in a subset of inpatients. Evidence for inpatient care escalation is limited. With respect to discharge care, simple provision of asthma care plans does not appear to reduce readmissions, though individually tailored asthma care plans remain a standard of discharge care, along with systemic steroids, beta agonists, and, when indicated, inhaled corticosteroids. To avoid medication access barriers for high-risk patients, clinicians can ensure that discharge medications are in-hand before the patient leaves the hospital. A number of quality improvement strategies have shown promise in the inpatient setting. Clinical pathways reduce length of stay and costs associated with care without an associated increase in readmissions. Inpatient family education programs can be effective but should incorporate multiple strategies, including individualized management strategies and post-discharge follow-up. Inpatient care also serves as a useful opportunity to assess home environmental risk and to refer high-risk families to outpatient and community resources.

Connecting At-Risk Inpatient Asthmatics to a Community-Based Program to Reduce Home Environmental Risks: Care System Redesign Using Quality Improvement Methods

Connecting patients admitted with asthma to community-based services could improve care and more efficiently allocate resources. We sought to develop and evaluate an intervention to mitigate in-home environmental hazards (eg, pests, mold) for such children. This was a controlled, quality improvement study on the inpatient units of an urban, academic children's hospital. Clinicians and public health officials co-developed processes to identify children with in-home risks and refer them for assessment and remediation. Processes assessed were the rate at which those identified as eligible were offered referrals, those referred received inspections, and primary care physicians (PCPs) were notified of risks and referrals. Consecutively occurring and seasonally matched intervention (n = 30) and historical control (n = 38) subcohorts were compared with respect to postdischarge mitigating actions (eg, discussions with landlords, PCPs), remaining risks, and morbidity (symptom-free days in previous 2 weeks and Child Asthma Control Test scores). In the first year, the percentage of eligible children offered referrals increased to a sustained rate of ∼90%; ∼65% of referrals led to in-home inspections (n = 50); and hazards were abated in 30 homes. PCP notification increased from 50% to ∼80%. After discharge, referred parents were more likely to discuss concerns with landlords, the health department, attorneys, and PCPs than patients admitted preimplementation (all P < .05). Referred households were more likely to report reduced presence of ≥2 exposures (P < .05). No differences in asthma morbidity were observed. We integrated environmental hazard mitigation into inpatient care. Community-engaged care delivery that reduces risks for poor asthma outcomes can be initiated within the hospital.

Residential characteristics and household risk factors and respiratory diseases in Chinese women: The Seven Northeast Cities (SNEC) Study

BackgroundFew studies have assessed the impact of residential home characteristics and home environmental risk factors on respiratory diseases in Chinese women. Therefore, this study sought to determine the association between residential home features, domestic pets, home renovation and other indoor environmental risk factors with respiratory health outcomes of Chinese women. MethodsThis cross-sectional study included a study sample of 30,780 Chinese women aged 23 to 49 from 25 districts of seven cities in Liaoning Province, Northeast China. Information on respiratory health, residential characteristics, and indoor air pollution sources was obtained by a standard questionnaire from the American Thoracic Society. Multivariable logistic regression was used to estimate prevalence odds ratios (POR) and 95% confidence interval (95%CI). ResultsThe odds of respiratory diseases were higher for those who lived near the main road, or near ambient air pollution sources. Pet-keeping was associated with increased odds of chronic bronchitis (POR=1.40; 95%CI: 1.09–1.81) and doctor-diagnosed asthma (POR=2.07; 95%CI: 1.18–3.64). Additionally, humidifier use was associated with increased odds of chronic bronchitis (POR=1.44; 95%CI: 1.07–1.94). Home renovation in recent 2years was associated with increased likelihood of allergic rhinitis (POR=1.39; 95%CI 1.17–1.64). ConclusionHome renovation and residential home environmental risk factors were associated with an increased likelihood of respiratory morbidity among Chinese women.

Prenatal methamphetamine exposure, home environment, and primary caregiver risk factors predict child behavioral problems at 5 years.

This study investigated the prospective association between prenatal methamphetamine (MA) exposure and child behavioral problems at 5 years while also examining the home environment at 30 months and several primary caregiver (PC) risk factors. Participants were 97 MA-exposed and 117 comparison children and their PCs enrolled in the Infant Development, Environment and Lifestyle Study. Hypotheses were that child behaviors would be adversely impacted by (a) prenatal MA exposure, (b) home environments that provided less developmental stimulation and emotional responsiveness to the child, and (c) the presence of PC psychological symptoms and other risk factors. Prenatal MA exposure was associated with child externalizing behavioral problems at 5 years. Home environments that were more conducive to meeting children's developmental and emotional needs were associated with fewer internalizing and externalizing behavioral problems. Independent of prenatal MA exposure, PC parenting stress and psychological symptoms were associated with increased child behavioral problems. Findings suggest prenatal MA exposure may contribute to externalizing behavioral problems in early childhood and the importance of considering possible vulnerabilities related to prenatal MA exposure in the context of the child's caregiving environment.

Prenatal Cocaine Exposure: Drug and Environmental Effects at 9 Years

To assess school-age cognitive and achievement outcomes in children with prenatal cocaine exposure, controlling for confounding drug and environmental factors. At age 9 years, 371 children (192 cocaine exposure [CE]; 179 non-cocaine exposure [NCE]) were assessed for IQ and school achievement in a longitudinal, prospective study from birth. An extensive number of confounding variables were controlled, including quality of caregiving environment, polydrug exposure, blood lead level, iron-deficiency anemia (IDA), and foster/adoptive care. Prenatal cocaine exposure predicted poorer perceptual reasoning IQ, with a linear relationship of the concentration of the cocaine metabolite benzoylecgonine to the degree of impairment. Effects were mediated through birth head circumference, indicating a relationship with fetal brain growth. Negative effects of alcohol, lead, and marijuana exposure and positive effects of the home environment were additive. The CE children in foster/adoptive care had better home environments and lower lead levels. School achievement was not affected. Persistent teratologic effects of CE on specific cognitive functions and additive effects of alcohol, lead, and marijuana exposure; IDA; and the home environment were identified. Documenting environmental factors in behavioral teratology studies is important, because in this sample, CE was associated with better home environment and lower environmental risk in a substantial number of children.