Inner-city African American Women Research Articles

Breast cancer diagnosis in Inner-City African American and Hispanic women: The importance of early screening

PurposeTo evaluate the diagnosis of breast cancer in inner-city African-American and Hispanic women under age 50 to support the importance of screening in this population. MethodsThis retrospective chart review included women newly diagnosed with breast cancer from 1/1/2015 to 1/1/2019 in a city hospital mainly serving minority patients. Chi-square and Fisher's exact tests were used for analysis. ResultsIn this cohort of 108 newly diagnosed African-American (63%) and Hispanic (31%) women, 60/108 (56%) presented with a site of palpable concern for diagnostic workup, and the remaining were diagnosed via asymptomatic screening. Women ages 30–49 were significantly more likely to present with a site of palpable concern when compared to women ages 50–69 (68% vs. 44%, p = 0.045). Additionally, women ages 30–49 were more likely to have triple-negative breast cancer (TNBC) than women ages 50–69 (20% vs. 10%, p = 0.222). However, women ages 30–49 were less likely to have prior mammogram than women ages 50–69 (24% vs. 46%, p = 0.062). ConclusionAfrican-American and Hispanic women ages 30–49 were more likely to present with a site of palpable concern and TNBC than those ages 50–69. However, these young minority women ages 30–49 were less likely to have prior screening mammograms when compared to those ages 50–69. Our data highlights the importance of starting screening mammography no later than age 40 in African-American and Hispanic women. In addition, these women should have risk assessment for breast cancer no later than age 30 and be screened appropriately.

Gender differences in psychosocial characteristics and diabetes self‐management among inner‐city African Americans

AimsTo characterize differences in psychosocial variables between inner‐city African American men and women with type 2 diabetes, and to test if the relationships between psychosocial variables and diabetes self‐management behaviours differ by gender.DesignSecondary analysis.MethodsWe used baseline data from participants enrolled in the Prevention through Lifestyle Intervention and Numeracy 4 Success‐Diabetes study (N = 37). Differences in psychosocial variables between genders were compared using chi‐square tests. A two‐way analysis of variance was then used to compare self‐management scores by different psychosocial characteristics and gender.ResultsThere was no statistically significant difference in psychosocial characteristics between genders. High diabetes knowledge and self‐efficacy were associated with better self‐management behaviours in African American women but not in men. In contrast, high numeracy was associated with better diabetes self‐management only in men. Low depression, high health literacy, and high social support were associated with better self‐management practices in both genders.

Evaluating the effectiveness of faith-based breast health education

Objective: In an effort to evaluate the effectiveness of faith-based health promotion programmes in educating African American women about breast cancer knowledge and risks, the local affiliate of a national breast cancer research foundation funded the Genesis Health Project (GHP) Network, a community-designed, culturally competent intervention, to develop, implement and evaluate the Breast Cancer Awareness and Education Program. This article reports on the faith-based education model used and uses evaluation data to determine whether the intervention improved awareness of breast cancer risk, methods for reducing risk, the importance of early detection and the availability of low-cost or free mammograms. Design: Pastoral health messaging and culturally appropriate strategies were used to heighten awareness of breast cancer risks and prevention, promote mammography and early detection, increase awareness of free/low-cost mammography and encourage the adoption of healthier behaviours. Setting: African American churches and collaborators targeting African American women in a mid-sized city in the northeastern USA. Method: Summative evaluations used paper and pencil pre- and post-event surveys, with measures for objectives targeted by the programme to evaluate the impact of activities. Results: Overall, participants in the Breast Cancer Awareness and Education Program showed improvements in general knowledge about breast cancer, higher breast cancer mortality among African American women, warning signs, risks and ways to mitigate risk, and the availability of low-cost or free mammograms. Conclusion: Findings confirm that faith-based health promotion programmes can be effective in helping to educate inner-city African American women about breast cancer and associated risk factors.

Breast for Success: A Community-Academic Collaboration to Increase Breastfeeding Among High-Risk Mothers in Cleveland.

Exclusive breastfeeding is the optimal method of infant feeding. However, breastfeeding rates are notable for profound health disparities, for example, among inner-city African American women. Community-academic partnership offers an opportunity to intervene. To describe a targeted breastfeeding intervention anchored on community health worker (CHW) home visits to high-risk expectant mothers in Cleveland, Ohio, and to identify specific intervention components that increase the chances (odds) of a mother breastfeeding. We used a community-based participatory research (CBPR) approach and partnered with the Cleveland Department of Public Health MomsFirst Project and Community Endeavors Foundation, Inc., to create a culturally competent breastfeeding education program that "piggy backed" onto MomsFirst programming. Intervention components assessed include those delivered by CHWs (interactive modules and opportunity to select a doula) and by a lactation counselor (pre and postpartum phone calls, post-partum home visits). The 602 women who received any intervention component and reported a feeding outcome at 1 month postpartum were a mean age of 22.2 years, 514 (85.4%) were African American, 555 (92%) were unmarried, and 311 (52.4%) had not graduated high school. In multivariate analysis, odds of any breastfeeding were increased by receipt of curricular modules (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.05-1.17, for each additional module) and by a postpartum visit (OR, 3.79; 95% CI, 2.06-6.96), and odds of exclusive breastfeeding were significantly increased by a postpartum visit (OR, 2.03; 95% CI, 1.13-3.63). Through community-academic partnership, we identified intervention components that significantly increased the odds of breastfeeding in this high-risk population and can inform future collaborations.

Breast for Success: A Community-Academic Collaboration to Increase Breastfeeding Among High-Risk Mothers in Cleveland.

Background: Exclusive breastfeeding is the optimal method of infant feeding. However, breastfeeding rates are notable for profound health disparities, for example, among inner-city African American women. Community–academic partnership offers an opportunity to intervene. Objectives: To describe a targeted breastfeeding intervention anchored on community health worker (CHW) home visits to high-risk expectant mothers in Cleveland, Ohio, and to identify specific intervention components that increase the chances (odds) of a mother breastfeeding. Methods: We used a community-based participatory research (CBPR) approach and partnered with the Cleveland Department of Public Health MomsFirst Project and Community Endeavors Foundation, Inc., to create a culturally competent breastfeeding education program that “piggy backed” onto MomsFirst programming. Intervention components assessed include those delivered by CHWs (interactive modules and opportunity to select a doula) and by a lactation counselor (pre and postpartum phone calls, post-partum home visits). Results: The 602 women who received any intervention component and reported a feeding outcome at 1 month postpartum were a mean age of 22.2 years, 514 (85.4%) were African American, 555 (92%) were unmarried, and 311 (52.4%) had not graduated high school. In multivariate analysis, odds of any breastfeeding were increased by receipt of curricular modules (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.05–1.17, for each additional module) and by a postpartum visit (OR, 3.79; 95% CI, 2.06–6.96), and odds of exclusive breastfeeding were significantly increased by a postpartum visit (OR, 2.03; 95% CI, 1.13–3.63). Conclusions: Through community–academic partnership, we identified intervention components that significantly increased the odds of breastfeeding in this high-risk population and can inform future collaborations.

Abstract A26: Tackling cervical cancer disparities through African American beauty salons: A community-based health education intervention

Abstract While traditional settings such as physician offices and community health agencies have had measurable success in delivering behavioral health interventions, they are less successful in recruiting underserved African American participants. Inner-city African American women, faced with multiple risk factors contributing to persistent health disparities, require a source of reliable health information in a setting that is easily accessible and credible to them. Salon-based health education programs are becoming increasingly popular for reaching African American females because they engage trusted members of the community (salon owners and hair stylists) in a location that represents care and reflects the tradition of sharing information through oral communication. We partnered with neighborhood hair salons to promote messages about persistent cervical cancer disparities and low rates of human papillomavirus (HPV) vaccination in the African American community. Study goals were to: (1) recruit eight beauty salons in low-income Philadelphia neighborhoods to serve as health education sites; (2) train hair stylist to be able to discuss cervical cancer disparities and HPV infection with their customers, and (3) increase knowledge and awareness about HPV, as well as intentions to vaccinate, among customers at each salon. Study inclusion criteria for customers consisted of being a young woman ages 18 to 26 or the caregiver of a young female ages 9 to 17. Stylists were trained by members of the research team to be able to briefly discuss cervical cancer and HPV with their customers during regular salon hours. Additionally, professional health educators were trained more substantially on the health topics and were placed in the salons to supplement the work of the stylists and provide a more in-depth educational experience for the customers. Survey data related to knowledge and attitudes about HPV and HPV vaccination were collected from customers immediately before and after the health education, and approximately one month later. Salon stylists and owners were interviewed post-intervention to assess their experiences with participating in the intervention. Two hundred and forty women from 10 salons were enrolled in the study. Roughly 60% of participants were caregivers while 40% were young women. Knowledge about cervical cancer and HPV infection increased significantly in both groups from baseline to endpoint and remained high at the one-month follow-up assessment. At follow-up, 68% of participants said that they had had a discussion with a friend or family member about what they learned, and 57% planned to talk to their doctor or their daughter's doctor about HPV vaccination. Sixty-two percent of caregivers reported that it was important that their daughter be vaccinated against HPV in the future. There were no significant differences between the caregivers and the young women on outcome measures of knowledge, attitudes, or intentions to vaccinate. During the post-intervention interviews with the stylists, many indicated that they enjoyed having discussions about health in the salon and that salons should continue to serve as venues of education for women in the African American community. The majority of stylists indicated that neither they, nor their customers, were aware of the magnitude of cervical cancer disparities among African American women nor the availability of the HPV vaccine as a method of protection for young women. Results of the study indicate that such community-based interventions are both feasible and effective in reaching populations not traditionally included in health education interventions. Citation Format: Amy Leader, Pamela Weddington, Ralph DiClemente, Gina Wingood, Alicia Jackson, Ivan Juzang. Tackling cervical cancer disparities through African American beauty salons: A community-based health education intervention. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A26. doi:10.1158/1538-7755.DISP13-A26

Influence of Partner Type on Condom Use

The current study examined sexual risk reduction practices of inner-city African American women. Specifically, the intersection of condom use and partner type is examined through the effectiveness of a single session, one-to-one behavioral skills and motivational enhancement HIV prevention intervention for women at risk for HIV. At pre-intervention, women with non-regular partners reported higher frequency condom use than those with regular partners. Similar results were found for women with multiple partners, in that higher rates of condom use were reported with non-regular partners compared to regular partners. Findings suggest that further investigation into the effectiveness of negotiated safety for women at risk is needed.

Inner-City African-American Women’s Adolescence as Stressful Life Events: Understanding Substance Abusing Behavior

Lula Beatty (2003:59) asks, "What makes a black woman, voluntarily take a substance into her body which alters her perceptions and feelings of well-being?" This research examines African American women's substance abuse as a response to stressful life events grounded in adolescence, drawing in part on the cognitive-transactional approach and distal stressor model to discuss the effects of stressors on mental health and substance abusing behavior. Most respondents viewed their adolescent experiences and the associated stress as tribulations or lessons to be lived through, rather than a signal of needed change in their social, cultural, and ecological life circumstances. The effect of exposure to constant stressors early in the life course coupled with proximal stressors often resulted in negative active responses to stress (i.e. substance abuse) and continued stunted emotional growth. Thus, our findings indicate that the experience of African American women as adolescents contributes to understanding substance abuse amongst this population. These findings further help develop the cognitive-transactional model, while adding to the distal stressors and life process model as a way of considering gender, race, and structural forces.

Sexually Transmitted Infection/HIV Risk Reduction Interventions in Clinical Practice Settings

African American women, particularly those who live in inner-city areas, experience disproportionately high rates of sexually transmitted infections including HIV. As there are currently no preventive vaccines for HIV and most sexually transmitted infections, prevention efforts must focus on behavioral risk reduction. Thus, culturally tailored interventions for African American women are needed to reduce their incidence of sexually transmitted infections including HIV. One place to intervene with inner-city African American women is in primary care settings. Primary care settings have the potential to reach a wide range of women, including those who may not proactively seek sexually transmitted infection/HIV prevention services. However, in order to be feasible for use in clinical settings, sexually transmitted infection/HIV risk reduction interventions must be brief and easily adapted for use with diverse clients in varied practice environments. To date, few brief sexually transmitted infection/HIV prevention interventions have been designed for use with African American women in primary care settings. Only one of these, the "Sister to Sister: Respect Yourself! Protect Yourself! Because You Are Worth It!" intervention, has demonstrated effectiveness in reducing sexual risk behaviors and sexually transmitted infection incidence. This article describes this 20-minute, one-on-one nurse-led intervention for African American women and discusses considerations for its implementation in primary care and other clinical settings.

Maternal Smoking is Associated With Decreased 5-Methyltetrahydrofolate in Cord Plasma

ABSTRACT In developed countries, smoking during pregnancy appears to be a major determinant of birth weight. In addition, it may increase the risk of congenital abnormalities. Maternal blood levels of folate are reduced in parturients who smoke. There is evidence that exposure to cigarette smoke compromises maternal folate status through altered dietary intake, and possibly through nondietary effects such as increased turnover of folate. The goal of this study was to learn whether and how maternal smoking influences plasma levels of 5-methyltetrahydrofolic acid (5-MTHFA) in umbilical cord blood from 58 pregnant African American women. Demographic features including smoking status were ascertained in structured interviews. Venous cord plasma 5-MTHFA concentrations correlated with maternal plasma 5-MTHFA concentrations, although the venous cord levels were significantly higher. After controlling for maternal plasma 5-MTHFA concentrations, cigarettes smoked by the mothers at the first prenatal visit correlated negatively with venous cord 5-MTHFA concentrations. Both of these correlations were confirmed by multivariate analysis. Prepregnancy smoking was negatively associated with venous cord 5-MTHFA, and the mean 5-MTHFA concentration in venous cord plasma was significantly lower in the 32 mothers who smoked (15.1 ng/mL) than in the 26 nonsmokers (19.0 ng/mL). Prepregnancy smoking status did not correlate significantly with maternal plasma 5-MTHFA levels. Maternal smoking significantly influenced birth weight when controlling for gender and gestational age. These findings suggest that maternal smoking may impair folate transport to the fetus, and may help to explain why folic acid fortification of foods seems to have a suboptimal effect in preventing neural tube defects in certain populations such as inner-city African American women.

Effects on Sexual Risk Behavior and STD Rate of Brief HIV/STD Prevention Interventions for African American Women in Primary Care Settings

We tested the efficacy of brief HIV/sexually transmitted disease (STD) risk-reduction interventions for African American women in primary care settings. In a randomized controlled trial, 564 African American women recruited at a Newark, NJ, inner-city women's health clinic were assigned to a 20-minute one-on-one HIV/STD behavioral skill-building intervention, 200-minute group HIV/STD behavioral skill-building intervention, 20-minute one-on-one HIV/STD information intervention, 200-minute group HIV/STD information intervention, or 200-minute health intervention control group. Primary outcomes were self-reported sexual behaviors in the previous 3 months; secondary outcome was STD incidence. At 12-month follow-up, participants in the skill-building interventions reported less unprotected sexual intercourse than did participants in the information interventions (Cohen's d [d]=0.23, P=.02), reported a greater proportion of protected sexual intercourse than did information intervention participants (d=0.21, P=.05) and control participants (d=0.24, P=.03), and were less likely to test positive for an STD than were control participants (d=0.20, P=.03). This study suggests that brief single-session, one-on-one or group skill-building interventions may reduce HIV/STD risk behaviors and STD morbidity among inner-city African American women in primary care settings.

Are alcohol problems linked with an increase in depressive symptoms in abused, inner-city African American women?

Little is known regarding the link between intimate partner violence (IPV), alcohol problems (AP), and depression in inner-city African American women. We sought to investigate whether abused inner-city African American women reporting AP endorsed more depressive symptoms compared to women reporting either AP or IPV or reporting neither. Participants for this cross-sectional study were 361 African American women seeking medical care at a large public hospital. Measurements included the Index of Spouse Abuse, Michigan Alcoholism Screening Test, and the Brief Symptom Index-Depression Subscale to assess IPV, AP, and depressive symptoms, respectively. Based on IPV and AP status, participants were assigned to one of four non-hierarchical risk groups: (i) low or no IPV, no AP; (ii) high IPV alone; (iii) AP alone; or (iv) both high IPV and AP. Additive effect of high levels of IPV and AP on outcome were assessed using logistic regression techniques. Thirty percent reported high IPV levels, and 18% had AP. Compared with participants reporting both no AP and low or no IPV, those reporting either high IPV levels or AP reported moderate to severe depressive symptoms 4 times more often (p < .001). Women reporting high IPV and AP endorsed moderate to severe depressive symptoms 8 times more often than women reporting neither (p < .001). Among inner-city, African American women, depressive symptoms are highest among those reporting both high IPV levels and AP. Health care systems serving similar communities should implement a systematic approach to identifying IPV, AP, and depression in patients.

Status of plasma folate after folic acid fortification of the food supply in pregnant African American women and the influences of diet, smoking, and alcohol consumption1–3

African American women and socioeconomically challenged women are at risk of compromised folate status and, thus, of folate-related birth defects. Data are limited on circulating folate concentrations in pregnant African American women after folic acid fortification of the food supply was implemented. The objective was to determine the influence of smoking and alcohol consumption on plasma 5-methyltetrahydrofolic acid (5-MTHFA) concentrations in pregnant African American women. Alcohol consumption, smoking exposure, and other characteristics of pregnant African American women reporting to an inner-city antenatal clinic were assessed. At 24 wk of gestation, blood samples and food-frequency intake data were collected. Plasma 5-MTHFA concentrations were determined by liquid chromatography-mass spectrometry for 116 subjects and examined in a correlational study design. Dietary folate and markers of alcohol consumption were positively associated, whereas exposure to smoke was negatively associated with plasma 5-MTHFA. More than one-half of the participants in this population failed to meet the recommended dietary allowance for dietary folate equivalents of 600 microg/d during pregnancy. Most inner-city African American women are not meeting the recommended dietary allowance for dietary folate during pregnancy, and smoking may further compromise their folate status. Programs to reduce smoking and raise awareness about the importance of folate and multivitamin supplementation during pregnancy need to target this population.

Predictors of Self-Reported Physical Symptoms in Low-Income, Inner-City African American Women: The Role of Optimism, Depressive Symptoms, and Chronic Illness

In this study we examined the association of optimism and depressive symptoms with self-reported physical symptoms in 241 low-income, inner-city African American women with or without a chronic illness (HIV). Although optimism was not a unique predictor of self-reported physical symptoms over and above depressive symptoms, optimism interacted with depressive symptoms and health status. In the community sample, but not the chronically ill sample, optimism buffered the association between depressive symptoms and self-reported physical symptoms. Clinical implications and directions for future research are discussed.

Effect of Socioeconomic Status on Exposures to Polychlorinated Biphenyls (PCBs) and Dichlorodiphenyldichloroethylene (DDE) among Pregnant African-American Women

In this study, the authors investigated the associations between socioeconomic status and exposures to polychlorinated biphenyls (PCBs) and dichlorodiphenyldichloroethylene (DDE) in a cohort of inner-city African-American pregnant women. Data for this study were derived from the Columbia Presbyterian Medical Center subcohort of the National Collaborative Perinatal Project. African-American women from whom venous blood had been collected during their third trimester of pregnancy during the time period between 1960 and 1965 were included in the current study (n = 152). Prenatal samples were assayed for PCB and DDE concentrations. The authors used linear-regression analysis to explore the association between socioeconomic indicators and PCB and DDE concentrations. Mean concentrations of the 4 most abundant congeners (i.e., PCB4) and total DDE were 3.9 microg/l and 37.2 microg/l, respectively. In adjusted analyses, income was associated significantly with an increase in serum concentrations of PCBs, whereas education was not. Neither income nor education was associated with concentrations of DDE. The authors concluded that maternal socioeconomic indicators may influence the effects of exposure to PCBs among African-American pregnant women.

Effects of Dumbbell and Elastic Band Training on Physical Function in Older Inner-City African-American Women

ABSTRACT Providing inner-city minorities with inexpensive exercise programs may be a means of reducing frailty and maintaining independent lifestyles in this population. To determine the efficacy of such a program, 22 African-American women aged 62–94 years were recruited from a senior center in the Wichita urban community. Sixteen women (age = 74.8 ± 8.8 yr) participated in exercise training (3 days per week for 4 weeks) and 6 women (age = 74.7 ± 4.5 yr) served as controls. Training consisted of chair-based exercises using elastic resistance bands (upper and lower body) and dumbbells (upper body). Elastic band training improved (p < 0.05) lower body strength (30-second chair stand, time for 5 stands) by approximately 20% and the combination of bands and dumbbell training improved upper body strength (30-second dumbbell curl) by 24%. Grip strength improved by 5%. Up-&-Go performance improved by 10% al though balance and mobility exercises were not a fundamental element of the training program. Upper and lower body flexibility did not change. Changes were not observed for any variable in the control group. This study suggests that exercising with equipment that costs only a few dollars per participant improves upper and lower body fitness in older African-American women who live in an urban setting.

BLOOD LIPID LEVELS ARE RELATED TO PHYSICAL ACTIVITY LEVELS FOR AFRICAN AMERICAN WOMEN AND CHILDREN

Coronary artery disease (CAD) results from the buildup of low-density lipoprotein cholesterol (LDL) in atherosclerotic plaques on arterial walls, and is highly correlated with obesity. African American women are at high-risk for developing CAD, and approximately 50% of African American women are overweight after age 20 and have elevated blood cholesterol levels. Exercise increases high-density lipoprotein cholesterol (HDL) and is thought to decrease LDL, but African American women exercise less than their Caucasian counterparts. PURPOSE: This descriptive study was conducted to determine the prevalence of obesity, level of physical activity (PA), and blood lipid levels for inner-city African American mothers (ages 21–50 years) and their daughters (ages 5–17 years) (n = 44 and 66, respectively). METHODS: Apparently healthy, inner-city African American women and daughters (ages 5–17 yr) volunteered and gave informed consent to participate. Technicians assisted as subjects reported 24-hr food recalls and completed physical activity questionnaires. Data were blocked by the body mass index (BMI) for normal weight (BMI < 25), overweight (BMI 25–29.99), and obesity (BMI > 30) and ANOVAs run to determine differences in blood lipids and PA between the groups. Correlations were run between variables. RESULTS: LDL decreased as PA increased for all groups except obese daughters, but only reached significance for normal weight and overweight daughters (p < 0.001). There was not a consistent relationship between HDL and PA. CONCLUSION: Results suggest that PA may correlate with LDL in African American women and girls. Additional studies are needed that implement a controlled exercise intervention program to accurately assess these effects. Supported by The Ohio Board of Regents, and The Graduate School adn the Department of Health and Sport Science, University of Dayton

Early adult characteristics and mortality among inner-city African American women.

This study examined predictors of longevity in a cohort of inner-city African American women. Data were derived from a cohort study of inner-city African American mothers whose median age in 1966 was 31 years. Analyses involved single-decrement life tables and pooled logistic regression. Giving birth for the first time before age 25 and having at least a high school education predicted longevity in this sample. Effects of later age at first delivery in terms of mortality risk were stronger after 55 years and, especially, after 70 years. The findings offer support for Geronimus's weathering hypothesis. Predictors of longevity among African Americans may be distinct from predictors for the population as a whole.

Inner-city African American women who failed to receive cancer screening following a culturally-appropriate intervention: the role of health insurance

Culturally-appropriate health promotion programs are thought to be more effective among minority groups than those designed for the population at large. We investigated factors associated with failure to obtain cervical and breast cancer screening among inner-city African American women who received a culturally-appropriate educational intervention. Women who completed the intervention, but did not obtain a Pap smear, a clinical breast examination, and/or a mammogram at follow-up were compared with those who did obtain these tests. Women with private health insurance were more likely to be screened following the intervention than those covered by Medicaid or Medicare or those who were not insured ( P<0.001). Post-intervention screening was not associated with age, education, income, employment, or marital status. The effectiveness of a culturally-appropriate intervention is likely to be reduced if women’s ability to respond is limited by inadequate insurance coverage.

The Influence of Maternal Drinking and Drug Use on the Quality of the Home Environment of School‐Aged Children

Although many studies have examined the development of children of male alcoholics, few studies have considered substance use by the female caregiver. This study evaluated the relationship between substance use by female caregivers and factors that affect the child-rearing environment. A total of 480 inner-city African-American women were recruited during pregnancy for a longitudinal study of the effects of prenatal alcohol use and substance use by caregivers on the development of their children. All women were screened for alcohol consumption at their first prenatal visit to a large urban maternity hospital. Those who averaged seven or more drinks per week (0.5 oz absolute alcohol per day) at the time of conception were invited to participate in the study, as was a 5% random sample of lighter drinkers and abstainers. At the 7.5-year follow-up assessment, the quantity and frequency of alcohol consumption and drug use, as well as several measures of the child-rearing environment, were assessed for 231 of the caregivers. Current alcohol use was uncorrelated with standard demographic factors, such as socioeconomic status, but was related to poorer family functioning, lower quality of parental intellectual stimulation, and higher levels of domestic violence. There were independent effects of illicit drug use on family environment, domestic violence, and caregiver depression. History of drinking during pregnancy, however, was not related to the current child-rearing environment. Poorer parental functioning generally was found only among the caregivers who currently drank both heavily (six or more drinks/occasion) and frequently (three or more days/week). After controlling for lifetime alcohol problems, current drinking still predicted a less cohesive and organized family environment and higher levels of domestic violence. Current heavy, frequent drinking in this relatively homogenous, economically disadvantaged sample was unrelated to demographics and seemed to have an important negative impact on the quality of the child-rearing environment, whereas drinking during pregnancy was unrelated to the current child-rearing environment.