Rural Pregnant Cocaine Users: An In-Depth Sociodemographic Comparison

Article excerpt

As part of a prospective, longitudinal study of the effects of prenatal cocaine use on infant outcome, we enrolled 308 women when they first came in for prenatal care or at delivery, in the case of no prenatal care. The 154 women in the cocaine use group, identified by means of drug history and urine testing, were matched to 154 non-cocaine using controls on race, parity, socioeconomic status, and level of prenatal risk This report presents a summary of the demographic and drug-use information collected at the time of delivery and the psychosocial data measured at delivery including standardized measures of depression, locus of control, self-esteem, concepts of development, life stress, and social support. Between group comparisons revealed that cocaine users were more likely than non-users to be older, to use other drugs, to begin their drug use at an earlier age, to have more depressive symptoms, to have an external locus of control, to have lower self-esteem, to have a more simplistic understanding of child development, and to have higher positive life event impact scores.

Introduction

Prenatal cocaine use continues to be a serious problem in the United States. A survey by the National Institute on Drug Abuse (NDA) conducted during 1992 documents prevalence rates of 5.5% for use of any illicit drug during pregnancy and 1.1 % for prenatal use of cocaine. This survey included a representative sample of 2,613 women who delivered babies in 52 urban and rural hospitals out of a total of 4 million women who delivered babies in 1992 (Mathias 1995). That translates into about 45,000 cocaine-exposed infants born in this country each year.

Most of the literature available regarding prenatal cocaine use has emphasized maternal obstetrical outcome, particularly as it pertains to the fetus or newborn, or the outcome of the infant. To date, few studies have investigated how substance use affects the parent herself or her parenting ability. It has been shown that women who use drugs experience a chaotic lifestyle, including such problems as unstable housing, history of violence, and inadequate social support (McNulty 1989; Regan et al.1987).

Evidence from the alcohol literature raises concern for the long-term outcome of cocaine-using mothers. For example, alcohol using women are more likely to exhibit sleep disturbances and affective disorders (Schuckit et al. 1969; Weissman and Klerman 1977), reproductive problems and depression (Wilsnack et al. 1986), anxiety disorders (Bowen et al. 1984), and suicidal tendencies (Blume 1982; Dahlgren 1986). They are more likely to suffer from psychosocial problems such as living with a substance using partner (Dahlgren 1986), being exposed to violence (Frienze and Schafer 1984), and having low self-esteem (Beckman 1978).

Studies of prenatal cocaine users show that the women are more likely to be older, to be non-white, to be unmarried, to be of lower socioeconomic status (SES), to have less prenatal care, to gain less weight durring pregnancy, and to have an increased number of sexually transmitted diseases during pregnancy than nonusers (Behnke et al.1994; Eyler et al.1994; Coles et al.1992; Neuspiel et al. 1991; Frank et al. 1988; Gillogley et al. 1990; Ostrea et al. 1992; Matera et al. 1990; Woods et al.1993; Zuckerman, Frank, et al. 1989; Minkoffet al. 1990). Although there have been some reports of depression in perinatal cocaine users when compared with nonusers (Woods et al. 1993; Haller et al. 1993, Strickland et al. 1993; Zuckerman, Amaro, et al. 1989) there have been a limited number of reports regarding other psychosocial measures (Williams-Petersen et al. 1994; Strickland et al. 1993; Haller et al.1993; Singer et al.1995; Black et al. 1994). Thus, there exists in the literature a gap in information comparing the psychosocial functioning of perinatal cocaine users to non-users.

The purpose of this paper is to report on a variety of demographic, drug-use, and psychosocial variables for a sample of women heretofore rarely described in the scientific literature, i. …