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Exposure to traumatic events, ongoing adversity, and posttraumatic stress disorder (PTSD) are associated with altered activity of the hypothalamic-pituitary-adrenal (HPA) axis, but findings are mixed. This may be explained in part by heterogeneity in PTSD symptom profiles. The aim of this study was to investigate the complex relationships between the number of traumatic events and post-displacement stressors, individual symptoms of PTSD, and HPA-axis hormones cortisol and dehydroepiandrosterone (DHEA) in refugees. Adult (18+ years) Syrian refugees with increased levels of distress participating in a randomized controlled trial completed baseline measures to assess traumatic events (trauma checklist), post-displacement stressors (Post-Migration Living Difficulties checklist), symptoms of PTSD (PTSD Checklist for DSM-5; PCL-5), and provided a hair sample for additional stress hormone analyses. We used R-packages qgraph and bootnet to perform network analysis on the number of traumatic events and post-displacement stressors, individual symptoms of PTSD, and HPA-axis hormones cortisol and DHEA. The final network model was corrected for depression severity. 115 (53% male, M age = 36.9, SD = 12.7) of 206 participants provided a hair sample. A higher number of traumatic events was directly associated with three symptoms of the PTSD cluster arousal and reactivity, i.e., sleep disturbance, hypervigilance and physiological reactivity, and with three other PTSD symptoms, namely flashbacks, avoidance of reminders, and self-destructive behavior. A higher number of post-displacement stressors was associated with four symptoms of the PTSD cluster cognition and mood, i.e., trauma-related amnesia, negative beliefs, blaming of self/others, and detachment, as well as with intrusive thoughts, sleep disturbance, hypervigilance, and exaggerated startle response. The number of traumatic events and post-displacement stressors were not associated with cortisol or DHEA. Cortisol was positively associated with two symptoms of the PTSD cluster cognition and mood, i.e., negative beliefs and negative trauma-related emotions, and negatively associated with avoidance of reminders. DHEA was positively associated with restricted affect and with three symptoms of the PTSD symptom cluster arousal and reactivity, i.e., irritability/anger, sleep disturbance, and self-destructive behavior, and negatively associated with avoidance of thoughts. This study demonstrated that exposure to traumatic events and post-displacement stressors is not related to cortisol and DHEA, but that cortisol and DHEA are differentially related to individual symptoms of PTSD. While lower levels of both cortisol and DHEA were associated with increased avoidance, higher levels of cortisol were mostly associated with symptoms of the PTSD cluster cognition and mood and higher levels of DHEA were mostly associated with symptoms of the PTSD cluster arousal and reactivity. These findings contribute to explaining the variability of findings in the literature on HPA-axis activity in PTSD. The study was approved by the Research Ethics Review Committee at VU Medical Center, the Netherlands (Protocol ID: NL61361.029.17, 7 September 2017) and prospectively registered online (https://www.trialregister.nl/trial/6665). • This is a network analysis of PTSD symptoms, the number of traumatic events/post-displacement stressors, and hair cortisol/DHEA in refugees. • Cortisol and DHEA were differentially associated with symptoms of PTSD but not with the number of traumatic events and post-displacement stressors. • Lower levels of both cortisol and DHEA were associated with increased avoidance. • Higher levels of cortisol were mostly associated with symptoms of the PTSD symptom cluster cognition and mood. • Higher levels of DHEA were mostly associated with symptoms of the PTSD symptom cluster arousal and reactivity. [ABSTRACT FROM AUTHOR]

The Pregnancy Experience Scale – Brief version (PES-Brief) assesses the frequency and intensity of the hassles and uplifts of pregnancy. This study aimed to assess the psychometric properties of the Dutch PES-Brief— Beleving van Zwangerschap Schaal – verkorte versie ( BZS-K )—in a sample of healthy Dutch pregnant women. Participants ( n =115) completed questionnaires twice during pregnancy, within a three-week interval. Factor analyses resulted in the expected two factors, one positive and one negative. The BZS-K showed sufficient internal consistency ( α =.76 for Hassles, .83 for Uplifts) and reproducibility of subscales (Intraclass correlation coefficients ( ICC )=.72–.84). Concurrent validity with measures of pregnancy anxiety, general depression, anxiety and stress, and emotional well-being was established. We conclude that the BZS-K is a reliable, valid measure for assessment of women's perceptions of hassles and uplifts of pregnancy. [ABSTRACT FROM AUTHOR]

Summary Background It is of debate whether or not childhood anxiety disorders (AD) can be captured by one taxonomic construct. This study examined whether perceived arousal (PA), autonomic nervous system (ANS) and hypothalamic–pituitary–adrenal (HPA) axis measures can distinguish children with different primary diagnoses of clinical anxiety disorders (AD) from each other, and from a general population reference group (GP). Methods The study sample consisted of 152 AD children (comparing separation anxiety disorder, generalized anxiety disorder, social phobia and specific phobia), aged 8- to 12-years, and 200 same-aged reference children. HPA-axis functioning was measured by a diurnal cortisol profile. ANS functioning was measured by continuous measures of skin conductance level in rest and during a mental arithmetic task and high frequency heart rate variability in rest. PA was assessed by a questionnaire. Results The AD sample showed lower high frequency heart rate variability during rest, heightened anticipatory PA, higher basal and reactive skin conductance levels and lower basal HPA-axis functioning compared to the GP sample. The existence of three or more clinical disorders, i.e. a high clinical ‘load’, was associated with lower basal HPA-axis functioning, higher skin conductance level and lower posttest PA. Specific phobia could be discerned from social phobia and separation anxiety disorder on higher skin conductance level. Conclusions Our findings indicated that children with AD have specific psychophysiological characteristics, which resemble the psychophysiological characteristics of chronic stress. A high clinical ‘load’ is associated with an altered ANS and HPA-axis functioning. Overall, ANS and HPA-axis functioning relate to AD in general, accept for specific phobia. [ABSTRACT FROM AUTHOR]

Abstract: Background: Several studies have shown that early cannabis use is correlated with poor educational performance including high school drop-out. The predominant explanation for this relationship is that cannabis use causes disengagement from education. Another explanation is that the association between early cannabis use and educational attainment is not causal, but the result of overlapping risk factors that increase the likelihood of both early cannabis use and disengagement from education. These confounding factors could be of genetic and/or environmental origin. Methods: Here we use data from a large community-based sample of adult twins (N =3337) who completed a comprehensive semi-structured telephone interview. We first apply the classical twin-design to determine whether genetic and/or environmental influences underlie the relationship between early-onset cannabis use (prior to age 18) and early school leaving. Next, with a co-twin control design we investigate whether the relationship between the two variables is more likely due to direct causality or overlapping risk factors. Results: We find a significant phenotypic correlation between early-onset cannabis use and early school leaving (r =0.26), which could be explained by familial influences (of genetic and/or shared environmental origin). The pattern of odds ratios found in the co-twin control design is not consistent with direct causation, but rather suggests that the association is due to shared environmental factors influencing both variables. Conclusion: Our findings suggest that the relationship between early-onset cannabis use and school leaving is due to shared environmental risk factors influencing both the risk of early-onset cannabis use and early school leaving. [Copyright &y& Elsevier]

Abstract: Purpose: There is substantial research linking tobacco and alcohol use to subsequent cannabis use, yet the specificity of this relationship is still under debate. The aim of this study was to examine which substance use model—the gateway hypothesis, the common liability (CL) model and/or the route of administration model—best explains the relationship between early onset of tobacco and alcohol use and subsequent cannabis use initiation. Methods: We used data from 2,113 (51% female) Dutch adolescents who participated in three consecutive assessment waves (mean age: 11.09, 13.56, and 16.27 years, respectively) of the TRacking Adolescents'' Individual Lives Survey study. (Pre)adolescent cannabis, tobacco and alcohol use was assessed using the Youth Self-Report and a TRacking Adolescents'' Individual Lives Survey developed questionnaire. Results: We found that, during adolescence, early onset of tobacco use does not pose a significantly higher risk of initiating cannabis use than early onset alcohol use. Therefore, we can rule out the route of administration model. Moreover, we found that adolescents who reported early onset comorbid use of both tobacco and alcohol have a higher likelihood to initiate cannabis use than adolescents who have tried either tobacco or alcohol. The gateway hypothesis is not broad enough to explain this finding. Therefore, the CL model best predicts our findings. Conclusion: Future research on adolescent cannabis initiation should focus on testing the robustness of the CL model. Furthermore, identifying adolescents who use both tobacco and alcohol, before the age of 13, may help to curtail the onset of cannabis use. [Copyright &y& Elsevier]

Summary: Given the inconsistent associations of cortisol with posttraumatic stress disorder (PTSD), analysis of basal functioning of the hypothalamic–pituitary–adrenal (HPA) axis in subjects frequently exposed to trauma and critical incidents with a range of PTSD symptomatology, may be valuable. In an epidemiological sample of 1880 police officers and firefighters, associations of salivary cortisol with PTSD, negative life events (NLE) and exposure to a major air disaster more than 8 years earlier, was explored. Probable PTSD was unrelated to cortisol level while past (>8 years earlier) and more recently experienced NLE were associated with lower cortisol levels even after adjustment for confounders. Disaster exposure interacted significantly with PTSD symptoms on cortisol level. In the disaster-exposed subgroup, PTSD symptomclusters of intrusion and hyperarousal (in particular sleep disturbances), were associated with lower and higher cortisol levels, respectively. A final model using backward elimination strategy, retained time of saliva sampling, smoking, gender, and NLE>8 years earlier in the total sample, and additionally symptomclusters of intrusion and hyperarousal in the disaster-exposed subgroup. The final model explained 10% of the variance in cortisol. The findings are discussed in relation to literature on posttraumatic stress and basal functioning of the HPA-axis. [Copyright &y& Elsevier]

Abstract: Interest in fetal origins of adverse offspring outcomes has grown extensively in the last decade. This has resulted in many published studies focusing on exposure in utero to substances and human offspring outcomes. Exposure to maternal substance use in pregnancy is believed to be a preventable hazard, and is therefore a main issue for public health concern and policy. However, an important question in human studies remains whether prenatal substance use exposure has an aetiological role in pathways to adverse developmental and behavioural outcomes via teratological effects. Recent insights and developments in research methodology will aid the adequate and more refined testing of associations between prenatal substance use and offspring outcomes. In particular, novel approaches could assist in disentangling the exposure to substance effects from correlated risk factors. The purpose of this manuscript is therefore to provide an overview of methodological issues involved in studies that focus on the association between maternal substance use during pregnancy and offspring''s outcomes, to describe novel approaches to test these associations, and present some examples of new and well-designed studies and discuss their findings. [Copyright &y& Elsevier]

Abstract: Background: Although use of illicit drugs shows varying degree of heritability, the influence of shared and unique environmental factors predominate among adolescents. We explored factors predicting use of cannabis and other illicit drugs among Finnish adolescent twins. Methods: We used longitudinal data from the FinnTwin12–17 study with baseline at age 11–12 and follow-up at ages 14 and 17½, including 4138 individuals. The outcome was self-reported ever use of cannabis or other illicit drugs at age 17½. The potential predictors were measures reported by the twins, their parents or teachers. As individual factors we tested smoking, alcohol use, behavioral and emotional problems; as peer factors: number of smoking friends and acquaintances with drug experience; as family factors: parental substance use, socio-economic status and pre-natal exposure to nicotine. We used logistic regression models, controlling for twinship, age and sex, to compute odds ratios (OR) for each potential predictor. To adjust for within-family confounds, we conducted conditional logistic regressions among 246 twin pairs discordant for drug use. Results: 13.5% of subjects had initiated use of cannabis or other illicit drugs by age of 17½. When adjusted for within-family confounds, smoking, drinking, and aggressiveness, as well as smoking and drug use among peers predicted use of illicit drugs. In the final regression model, the significant predictors were female sex, early smoking onset, drinking to intoxication, having smoking peers and acquaintances with drug experience, father''s weekly drinking to intoxication, and aggressive behavior among boys. Smoking initiation by age of 12 was the most powerful predictor among individuals (OR=26, p <0.001) and within discordant pairs (OR=22, p <0.001). Conclusions: Early onset smoking is a powerful predictor for subsequent use of illicit drugs among Finnish adolescents, but the causal nature of this relationship needs to be clarified. [Copyright &y& Elsevier]

Abstract: Teratological investigations have demonstrated that agents that are relatively harmless to the mother may have significant negative consequences to the fetus. Among these agents, prenatal alcohol, nicotine or cannabis exposure have been related to adverse offspring outcomes. Although there is a relatively extensive body of literature that has focused upon birth and behavioral outcomes in newborns and infants after prenatal exposure to maternal smoking, drinking and, to a lesser extent, cannabis use, information on neurobehavioral and cognitive teratogenic findings beyond these early ages is still quite limited. Furthermore, most studies have focused on prenatal exposure to heavy levels of smoking, drinking or cannabis use. Few recent studies have paid attention to low or moderate levels of exposure to these substances. This review endeavors to provide an overview of such studies, and includes animal findings and potential mechanisms that may explain the mostly subtle effects found on neurobehavioral and cognitive outcomes. It is concluded that prenatal exposure to either maternal smoking, alcohol or cannabis use is related to some common neurobehavioral and cognitive outcomes, including symptoms of ADHD (inattention, impulsivity), increased externalizing behavior, decreased general cognitive functioning, and deficits in learning and memory tasks. [Copyright &y& Elsevier]

Assessment of general anxiety during pregnancy may underestimate anxiety specifically related to pregnancy. Pregnancy anxiety rather than general anxiety has been shown to predict birth outcome and neuroendocrine changes during pregnancy. Therefore, a questionnaire on pregnancy anxieties was used to test their structure, and to examine their associations with general anxiety and depression.Nulliparous pregnant women with a normal risk status (N=230) filled in a 34-item questionnaire on pregnancy-related anxiety and other questionnaires covering general anxiety and depression. These questionnaires were filled in at 15–17, 27–28, and 37–38 weeks of gestation.A three-factor model of pregnancy anxiety was found by means of confirmatory factor analysis, reflecting ‘fear of giving birth’, ‘fear of bearing a handicapped child’ and ‘concern about one''s appearance’. General anxiety and depression measures explain only a small part of the variance of these fears.Pregnancy anxiety should be regarded as a relatively distinctive syndrome. Its measurement enables researchers and clinicians to address issues of prediction, identification and risk reduction more precisely and perhaps more effectively in the future. [Copyright &y& Elsevier]

Objective: To examine, in a prospective study, whether maternal stress during pregnancy is related to infant temperament.Method: Self-report data on various aspects of prenatal stress were collected from nulliparous women in early pregnancy. Infant temperament was measured at 3 and 8 months by direct observation and by parent report.Results: Complete data were available for 170 term-born infants. Pregnancy-specific anxiety explained 3.3% of the variance of attention regulation at 3 months. Perceived stress and pregnancy anxiety taken together explained 5% of the variance of attention regulation at 8 months. Perceived stress accounted for 8.2% of the variance of difficult behavior of the 3-month-old infant. All results were adjusted for covariates.Conclusions: Increased maternal prenatal stress seems to be associated with temperamental variation of young infants and may be a risk factor for psychopathology later in life. [ABSTRACT FROM AUTHOR]

Developmental science theory and empirical research on refugee situations requires an updated approach to the study of trauma as a multi-systemic and multilevel phenomenon. We present a theoretical framework that integrates developmental science approaches to highlight critical threats to development in situations of violent displacement. Given the complexities of displacement (causes, trajectories, and living circumstances once displaced), this theoretical model highlights the utility of an approach that recognizes the person-age-context fit in which displaced individuals live their lives and how both trauma and ongoing major disruption to daily life affects outcomes. In so doing, we aim to broaden understanding for future trauma and intervention research as well as practice with those who experience potentially traumatic events and severe disruption to their social ecology at different points in the lifespan. [ABSTRACT FROM AUTHOR]

Studies in rodents and nonhuman primates indicate that maternal stress during pregnancy can influence the developing fetus, resulting in delay of motor and cognitive development and impaired adaptation to stressful situations. These effects may be mediated by the hypothalamic–pituitary–adrenal (HPA) axis. We examined whether stress during pregnancy predicted developmental outcome of human infants in a prospective design. Self-report data about daily hassles and pregnancy-specific anxiety and salivary cortisol levels were collected in nulliparous pregnant women. Dependent measures were scores on the Bayley Scales of Infant Development and on temperamental questionnaires at 3 and 8 months. Pregnancy-specific anxiety in mid pregnancy predicted lower mental and motor developmental scores at 8 months. Early morning values of cortisol in late pregnancy were negatively related to both mental and motor development at 3 months and motor development at 8 months. Pregnancy-specific anxiety explained 7% of the variance of test-affectivity and goal-directedness at 8 months. Increased maternal stress during pregnancy seems to be one of the determinants of temperamental variation and delay of development of infants and may be a risk factor for developing psychopathology later in life. [Copyright &y& Elsevier]

• Stress reduction did not explain reduction in smoking behavior in our sample of pregnant women. • Motivation to quit smoking moderated the intervention effect on the number of smoking days per week and number of cigarettes smoked on average on a weekly basis. • The dose–response effect of program use on smoking frequency, and smoking quantity suggests that the eHealth intervention consists of effective components. Prenatal smoking and stress are associated with adverse health effects for women themselves and are risk factors for adverse outcomes of the child. Effective interventions are needed to support women with smoking cessation and reducing stress. The aims were (1) to test the effectiveness of an 8-week eHealth intervention targeting stress reduction and smoking cessation; (2) to examine whether stress reduction mediated the intervention effect on smoking behavior; (3) to test motivation to quit as a moderator; and (4) to investigate a dose–response effect of program usage. Pregnant women were included if they were >18 years of age, < 28 weeks pregnant at recruitment, and currently smoking. In total, 156 consenting participants were randomly assigned to the intervention or active control condition. Study outcomes on smoking (yes/no, frequency, and quantity) were collected via online questionnaires at pre-intervention (baseline; t0), post-intervention (8 weeks after t0; t1), and follow up at two weeks (t2) and three months (t3) after birth. Smoking and stress reduced over the 8-week period in both conditions. The intervention effect on smoking was not mediated by stress reduction. Motivation to quit was found to moderate the intervention effect (smoking frequency and quantity) and a dose–response effect was found for program usage in the intervention for the reduction on smoking frequency and quantity. Program usage and motivation to quit are important for smoking reduction in pregnant women. Further research is needed to examine how the intervention could be improved to increase treatment effectiveness. [ABSTRACT FROM AUTHOR]

Abstract: Background: The present study examined the relation between two different acculturation measures (i.e., linguistic acculturation and the acculturation strategies integration, separation and marginalization) and past year cannabis use. Additionally, we studied the mediating role of affiliation with cannabis-using peers. Method: Data were utilized from i4culture, a Dutch study on immigrant adolescents and young adults aged 15–24 years. Participants belonged to the five largest immigrant populations in the Netherlands, living in or around the four major Dutch cities: Amsterdam, the Hague, Rotterdam, and Utrecht. In total, 771 adolescents and young adults (mean age 19.29, SD=2.61, 53.8% female) from Surinamese (n =210, 27.2%), Moroccan (n =209, 27.1%), Turkish (n =110, 14.3%), Antillean (n =109, 14.1%), and Asian (n =133, 17.3%) backgrounds participated. With questionnaires, past year cannabis use, acculturation strategy, linguistic acculturation, and affiliation with cannabis-using peers were assessed. Results: Using logistic regression analyses, we found no relation between acculturation strategy and past year cannabis use (OR=1.25, p =0.38 for separation vs integration and OR=0.86, p =0.50 for marginalization vs integration). Linguistic acculturation was positively related to cannabis use (OR=2.20, p <0.01). Affiliation with cannabis-using peers partly mediated this relation (OR=1.09, p <0.01). Conclusions: Non-Western immigrant youngsters who speak the host culture's language at home are more likely to use cannabis than youngsters who speak their native language at home. The former group is more likely to affiliate with cannabis-using peers, which partly explains their increased risk of cannabis use. [Copyright &y& Elsevier]

Abstract: The purpose of the present study was to investigate whether a length polymorphism in the dopamine receptor D4 gene (DRD4) was associated with approach related traits in adolescents. Data were used from TRAILS (TRacking Adolescents’ Individual Lives Survey), a population based cohort of Dutch adolescents. Sensation seeking, assessed with personality questionnaires from the participants themselves and their biological father and mother (n =1282) was not associated with DRD4 genotype. Gambling performance (n =591) and startle reactivity (n =432) were not associated with DRD4 genotype either. Explanations for the dissociation might be sought in differences in development of the limbic system and the prefrontal cortex, both with high dopamine receptor D4 densities and both involved in approach related behaviours. [Copyright &y& Elsevier]

Background: Internalizing psychiatric disorders and early childhood adversity have both been associated with altered basal cortisol secretion. The aim of the present study is to investigate if early childhood adversity modifies the relationship between anxiety and mood disorders and cortisol secretion. Methods: A sample of 429 international adoptees was followed from childhood to adulthood. In childhood, adoptive parents provided information about abuse and neglect before adoption. As adults, adoptees completed a standardized psychiatric interview to assess internalizing disorders and collected saliva samples four times a day. Analyses of covariance were performed. Results: The relationship between anxiety disorders and cortisol secretion during 1 day, as measured by the area under the curve (AUC), was dependent on the experience of severe early maltreatment (p value of interaction = .03). In adoptees with an anxiety disorder, severe maltreatment was associated with lower daily cortisol secretion compared with nonmaltreated adoptees (respective AUC means: 28.19 and 36.96; difference = −8.78; confidence interval = −14.65 to −2.90; p = .004). In adoptees without an anxiety disorder, no difference in cortisol secretion was found between persons who did or did not experience severe maltreatment early in life (respective AUC means: 34.72 and 34.20; difference = .52; confidence interval = −1.92 to 2.96; p = .67). We found no modifying effect of severe early maltreatment on the relationship between mood disorders and daily cortisol secretion. Conclusions: The experience of early adversities modifies the relationship between anxiety disorders and basal cortisol seretion in adults. To understand the relationship between anxiety disorders and cortisol secretion, early maltreatment has to be taken into account. [ABSTRACT FROM AUTHOR]

Highlights • HPA-axis changes can influence susceptibility to peripartum depression. • Common genetic variants in HPA-axis genes were investigated. • HSD11B2 SNPs associated with PPD and S ERPINA6 SNPs with de novo PPD. • SNPs in these genes also associated with HPA-axis hormone levels. Abstract Individual differences in the response of the stress system to hormonal changes during pregnancy and the postpartum period render some women susceptible to developing depression. The present study sought to investigate peripartum depression and stress hormones in relation to stress-related genotypes. The Edinburgh Postnatal Depression Scale was used to assess peripartum depressive symptoms in a sample of 1629 women, followed from pregnancy week seventeen to six months postpartum. Genotypes of ninety-four haplotype-tag single nucleotide polymorphisms (SNPs) in sixteen genes of the hypothalamus-pituitary-adrenal axis pathway were analyzed and data on psychosocial and demographic factors was collected. In sub-studies, salivary cortisol awakening response in gestational week 35–39, salivary evening cortisol levels in gestational week 36 and postpartum week 6, and blood cortisol and cortisone levels in gestational week 35–39 were analyzed. SNP-set kernel association tests were performed at the gene-level, considering psychosocial and demographic factors, followed by post-hoc analyses of SNPs of significant genes. Statistically significant findings at the 0.05 p -level included SNPs in the hydroxysteroid 11-beta dehydrogenase 1 (HSD11B1) gene in relation to self-rated depression scores in postpartum week six among all participants, and serpin family A member 6 (SERPINA6) gene at the same time-point among women with de novo onset of postpartum depression. SNPs in these genes also associated with stress hormone levels during pregnancy. The present study adds knowledge to the neurobiological basis of peripartum depression by systematically assessing SNPs in stress-regulatory genes and stress-hormone levels in a population-based sample of women. [ABSTRACT FROM AUTHOR]

Introduction Higher prevalence rates of cannabis abuse/dependence and abuse/dependence criteria in 18–24 year old versus older cannabis users and in males versus females might reflect true differences in the prevalence of these disorders across age and gender or, alternatively, they could arise from age- and gender-related measurement bias. To understand differences in endorsement across important subgroups, we examined the influence of age and gender simultaneously on the likelihood of endorsement of the various abuse/dependence criteria. Method The sample consisted of 1603 adult past year cannabis users participating in the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), a U.S. population study (39.6% aged 18–24; 62.1% male). Past year DSM-IV cannabis abuse/dependence criteria and withdrawal were assessed with the AUDADIS-IV. A restricted factor analysis with latent moderated structures was used to detect measurement bias. Results Although cannabis abuse and dependence diagnoses and various individual abuse/dependence criteria showed different prevalence rates across younger and older male and female cannabis users, none of the items showed uniform or non-uniform measurement bias with respect to age or gender. Conclusion The results indicate that, although prevalence rates of cannabis abuse/dependence criteria differ across age and gender, past year abuse/dependence criteria function similarly across these groups. It can thus be concluded that the criteria are applicable to younger and older, as well as male and female, adult cannabis users. [ABSTRACT FROM AUTHOR]

Background The present study examined (1) the association between changes in perceived parental control and support from age 13 to 15 and early onset of cannabis use (before age 16), and (2) whether personality modifies the association between a decline in perceived parental control and support and early onset of cannabis use. Method Objectives were studied using data (three waves covering two years) from 444 Dutch adolescents participating in the Research on Adolescent Development and Relationships (RADAR) study. Adolescents had a mean age of 13 years at baseline, and reported at each wave about perceived parental control and support. Big Five personality traits and past year cannabis use were also measured by self-report. Joint latent growth curve–discrete-time survival analyses were used to answer the research questions. Results Early onset of cannabis use was reported by 19.4% of the sample. Overall, a decline in perceived parental control or support from age 13 to age 15 was unrelated to the risk of early onset of cannabis use. In adolescents with low levels of emotional stability and extraversion, a stronger decline in perceived parental control was associated with an increased risk of early cannabis use. Conclusions Experiencing a decline in parental control from age 13 to 15 is associated with early onset of cannabis use in adolescents characterized by low emotional stability and low extraversion. [ABSTRACT FROM AUTHOR]

Summary: Background: Children of parents with a substance use disorder (CPSUDs) are at increased risk for the development of substance use disorders later in life, and therefore may manifest vulnerability markers for these disorders at a higher level than children from the general population. Our aim was to examine hypothalamic-pituitary-adrenal (HPA) axis activity as a potential vulnerability marker in CPSUDs as compared to healthy controls. We further examined whether having experienced more adverse life events (ALEs) accounted for differences in cortisol levels between CPSUDs and controls. Methods: 83 CPSUDs were matched to 83 controls on the basis of age, sex and socioeconomic status. Salivary cortisol was assessed at four time points during a normal day and at six time points during a psychosocial stress procedure, during which perceived stress was also measured. We implemented piecewise multilevel growth curve modeling to examine group differences in diurnal and stress-evoked cortisol levels. Results: Diurnal cortisol levels of CPSUDs did not differ from those of controls. Only stress-evoked cortisol levels at onset of the experiment were explained by group status, such that CPSUDs exhibited lower cortisol levels at onset of the stress procedure. CPSUDs reported experiencing significantly more ALEs, yet number of ALEs was not related to cortisol levels. CPSUDs furthermore reported less perceived stress than controls at onset of the procedure. Conclusions: HPA axis dysregulation may be a vulnerability marker for substance use disorders, as CPSUDs show blunted activation in anticipation of stress. These blunted cortisol levels were not the result of having experienced more stressful experiences during their lifetimes, thus might reflect an inborn vulnerability to substance use disorders. [Copyright &y& Elsevier]

Abstract: Background: Few studies have investigated physiological stress (re)activity in relation to substance use, especially in adolescents. Using substances is one way to stimulate physiological arousal, therefore inherent hypo-arousal may be associated with substance use in adolescents. The purpose of this study was to examine the relation of autonomic nervous system (ANS) activity with alcohol and tobacco use in adolescents. Methods: ANS activity and perceived stress during a social stress procedure were examined in relation to substance use. 275 Dutch adolescents from a general population study provided complete data. Heart rate was recorded continuously during a pre-task rest period, a stressful task period and a post-task recovery period. Alcohol and tobacco use were self-reported. Results: Adolescents who consumed a medium and high number of alcoholic drinks per week (more than two) exhibited lower heart rates during the entire stress procedure as compared to those who consumed a low number of alcoholic drinks. Adolescents who smoked every day portrayed blunted heart rate reactivity to stress as compared to adolescents who smoked less frequently or not at all. Perceived stress was not related to alcohol or tobacco use. Conclusions: Overall lower heart rate in adolescents who drank more and blunted heart rate reactivity to stress in those who used tobacco every day may indicate inherent hypo-arousal of the ANS system in those vulnerable to use substances more often. These adolescents may actively seek out substances in order to achieve a more normalized state of arousal. [Copyright &y& Elsevier]

Abstract: Endophenotypes are intermediate phenotypes on the putative causal pathway from genotype to phenotype and can aid in discovering the genetic etiology of a disorder. There are currently very few suitable endophenotypes available for substance use disorders (SUD). The amplitude of the P300 event-related brain potential is a possible candidate. The present study determined whether the P300 amplitude fulfils two fundamental criteria for an endophenotype: (1) an association with the disorder (disease marker), and (2) presence in unaffected biological relatives of those who have the disorder (vulnerability marker). For this purpose, two separate meta-analyses were performed. Meta-analysis 1 investigated the P300 amplitude in relation to SUD in 39 studies and Meta-analysis 2 investigated P300 amplitude in relation to a family history (FH+) of SUD in 35 studies. The findings indicate that a reduced P300 amplitude is significantly associated with SUD (d =0.51) and, though to a lesser extent, with a FH+ of SUD (d =0.28). As a disease maker, the association between reduced P300 amplitude and SUD is significantly larger for participants that were exclusively recruited from treatment facilities (d =0.67) than by other methods (i.e., community samples and family studies; d =0.45 and 0.32, respectively), and larger for abstinent SUD patients (d =0.71) than for current substance users (d =0.37). Furthermore, in contrast to FH+ males, a P300 amplitude reduction seems not to be present in FH+ females (d =−0.07). Taken together, these results suggest that P300 amplitude reduction can be both a useful disease and vulnerability marker and is a promising neurobiological endophenotype for SUD, though only in males. Implications and future directions are discussed. [Copyright &y& Elsevier]

Abstract: Background: The development of the fetal endocannabinoid receptor system may be vulnerable to maternal cannabis use during pregnancy and may produce long-term consequences in children. In this study, we aimed to determine the relationship between gestational cannabis use and childhood attention problems and aggressive behavior. Methods: Using a large general population birth cohort, we examined the associations between parental prenatal cannabis and tobacco use and childhood behavior problems at 18 months measured using the Child Behavior Checklist in N =4077 children. Substance use was measured in early pregnancy. Results: Linear regression analyses demonstrated that gestational exposure to cannabis is associated with behavioral problems in early childhood but only in girls and only in the area of increased aggressive behavior (B =2.02; 95% CI: 0.30–3.73; p =0.02) and attention problems (B =1.04; 95% CI: 0.46–1.62; p <0.001). Furthermore, this study showed that long-term (but not short term) tobacco exposure was associated with behavioral problems in girls (B =1.16; 95% CI: 0.20–2.12; p =0.02). There was no association between cannabis use of the father and child behavior problems. Conclusions: Our results suggest that intrauterine exposure to cannabis is associated with an increased risk for aggressive behavior and attention problems as early as 18 months of age in girls, but not boys. Further research is needed to explore the association between prenatal cannabis exposure and child behavior at later ages. Our data support educating future mothers about the risk to their babies should they smoke cannabis during pregnancy. [Copyright &y& Elsevier]

Summary: Background: Anxiety and depression might be two different valid constructs that often co-occur, or they could be different manifestations of the same underlying vulnerability. A theoretical framework to address this question is the tripartite model, by Clark and Watson, which hypothesizes that physiological hyperarousal (PH) is specific for anxiety. Knowledge about the relationship between PH, psychophysiological measures, perceived arousal, and anxiety would increase our understanding of the validity of the PH construct in this model. Our objective was to assess whether (a) hypothalamic–pituitary–adrenocortical (HPA) axis functioning, and (b) perceived arousal before, during and after stress can differentiate anxious from depressive children. Methods: In a general population sample of 225 children aged 8–12 years, self-reported anxiety and depressive symptoms were assessed using the Multidimensional Anxiety Scale for Children (MASC) and the Children''s Depression Inventory (CDI). Perceived arousal was assessed using a self-report questionnaire before, during and after a stress task. Basal and reactive HPA-axis functioning were used as indices for psychophysiological arousal. Results: Our data showed that the relation between perceived arousal and anxiety problems is stronger than the relation with depressive problems. Reactive HPA-axis functioning is reduced in children with depressive problems. Conclusions: Some evidence was found in support of the tripartite model. Our findings indicate that perceived arousal to a challenge might be a useful tool to assess the PH component of the tripartite model. Reactive HPA-axis functioning might be able to differentiate between anxiety and depressive problems in children in a general population sample, but effect sizes are small and replication is needed. [Copyright &y& Elsevier]

Abstract: Background: Cannabis is commonly used among pregnant women. It is unclear whether cannabis exposure causes hemodynamic modifications in the fetus, like tobacco does. Aims: This study aims to ascertain fetal blood redistribution due to intrauterine cannabis exposure. Methods: This study was embedded in the Generation R Focus Study, a population-based cohort of parents and children followed from pregnancy onwards. In late pregnancy, fetal hemodynamics was assessed with ultrasound measurements in cannabis-exposed and non-exposed fetuses. Pregnant women reported about substance use during pregnancy. A distinction was made between continued cannabis use (n =9), cannabis use only in early pregnancy (n =14), continued tobacco use (n =85), tobacco use only in early pregnancy (n =92), and no tobacco or cannabis use during pregnancy (n =85). Results: Continued cannabis use was associated with an increased pulsatility and resistance index of the uterine artery, while discontinued cannabis use was associated with a decreased pulsatility, and resistance index, as compared to controls. Additionally, continued cannabis exposure resulted in a significantly higher uterine pulsatility index and uterine resistance index compared to tobacco exposure. Continued cannabis use was found to be associated with a smaller aortic diameter, as well. No association between intrauterine cannabis exposure and the fetal cerebral vascular system was found. Conclusions: Our findings suggest that intrauterine cannabis exposure was associated with changes in hemodynamic programming of the vascular system of the fetus in late pregnancy mainly due to tobacco exposure, but intrauterine cannabis exposure did demonstrate a specific effect on the uterine blood flow. [Copyright &y& Elsevier]

The article discusses a study to examine externalizing behavior problems and cigarette smoking as predictors of subsequent cannabis use. It involves an analysis which focused on externalizing behavior problems, self-reported smoking, and cannabis use among adolescents in the Netherlands. Furthermore, it shows that although externalizing behavior problem is a starting point for substance use trajectories, early smoking is more important in the prediction of later cannabis initiation.

The article presents a study which investigates the effect of intrauterine cannabis exposure of pregnant women on fetal growth. In this study, 7,452 mothers who provided information on substance use and fetal growth were examined while fetal growth in the early, mid and late pregnancy was determined through ultrasound measures. It concludes that several adverse fetal growth trajectories can be associated with cannabis use even if pregnant women used it for only a short period of time.

Abstract: Background: While temperamental characteristics have been related to the onset of cannabis use, it is not clear at what point(s) along the trajectory from early onset of tobacco use (EOT) to early onset of cannabis use (EOC) these characteristics exert their impact. This study examined if (1) temperamental characteristics predispose to EOT that on its turn predisposes to EOC, and (2) temperament moderates the importance of EOT on the progression to EOC. Methods: Data from 1848 (83%) participants in the TRacking Adolescents’ Individual Lives Survey (TRAILS), a prospective population study of Dutch adolescents, were analyzed. We used parent-reports on the Early Adolescent Temperament Questionnaire to assess the dimensions of high-intensity pleasure, frustration, effortful control, shyness and fearfulness at age 10–12. EOT and EOC were defined as use at least once before the ages of 12 and 13 years, respectively, assessed by means of self-reports. We performed mediation and moderation analyses in Mplus. Results: High levels of high-intensity pleasure predisposed to entrance in the trajectory from EOT to EOC. Once tobacco use had been initiated at early age, low levels of shyness and high levels of high-intensity pleasure increased the risk of progression to EOC. Conclusions: Besides a common liability for EOT and EOC based on temperament, the risk of transition from tobacco to cannabis use is modified by temperamental characteristics. Differences in interplay with other risk factors may explain the impact of temperament on distinct points along the substance use trajectory. [Copyright &y& Elsevier]

Abstract: Aims: To ascertain demographic, emotional and social determinants of cannabis use in early pregnancy. Design: This study was embedded in the Generation R study, a multiethnic population-based cohort of parents and their children, followed from pregnancy to childhood. Setting: Rotterdam, The Netherlands. Participants: Mothers enrolled in pregnancy who answered questions about their own and their partners substance use before and during pregnancy (n =7610). Measurements: Using self-report questionnaires, information was collected on maternal demographics, psychopathology, delinquency, childhood trauma, social stress, family functioning, and parental alcohol, tobacco and substance use. Multinomial logistic regression analysis was used, with non-using women as reference. Findings: 246 (3.2%) women used cannabis before pregnancy and 220 (2.9%) women used cannabis both before and during pregnancy. The strongest determinant for maternal cannabis use during pregnancy was cannabis use by the biological father of the child (OR=38.56; 95%CI=26.14–58.88). Maternal cannabis use during pregnancy was also independently associated with being single (OR=4.25; 95%CI=2.33–7.75) or having a partner without being married (OR=2.75; 95%CI=1.56–4.85), childhood trauma (OR=1.39; 95%CI=1.22–1.57) and delinquency (OR=3.37; 95%CI=1.90–5.98), but not with maternal age, ethnicity, psychopathology, family functioning and perceived stress. Being religious was protective (Islam: OR=0.25; 95%CI=0.09–0.65) for maternal cannabis use during pregnancy. Additionally, lower educational level determined continued cannabis use in ever-users (OR=3.22; 95%CI=1.54–6.74). Conclusions: Our results showed that multiple demographic, emotional and social characteristics were associated with maternal cannabis use. These characteristics should be considered when investigating offspring exposed to cannabis in utero, as they may play an important role in mother–child interaction and child development. [Copyright &y& Elsevier]

Abstract: Persistent cigarette smoking is associated with significant morbidity and mortality. Correlates of difficulty quitting smoking include psychopathology, such as major depressive disorder, and problems with other substances, such as alcoholism. In addition, socio-demographic risk (e.g. poverty) and protective (e.g. living in a region with stringent tobacco laws) influences can modify risk for persistent cigarette smoking. Using data on 17,919 individuals with a lifetime history of smoking 100 or more cigarettes, from a nationally representative U.S. sample, we examine the constellation of risk and protective factors that correlate with smoking cessation (defined as remaining smoke-free in the past 12 months) across four cohorts: young (18–31 years), intermediate-aged (32–43 years), middle-aged (44–60 years) and older (61–99 years) adults. Using survival analyses, we demonstrate that in addition to a history of DSM-IV nicotine dependence, which is negatively associated with smoking cessation, living below the poverty line is also associated with persistent smoking across all age cohorts. Residents over the age of 31 years living on the U.S. West Coast are less likely to be persistent smokers as well. Major depressive disorder is associated with persistent smoking, but interestingly, only in middle-aged and older adults. Alcoholism and a family history of substance use problems are both correlated with persistent smoking but only in older adults. Here, we find evidence for psychopathology that may hinder successful quit attempts during the developmental period when a majority of quit attempts are made (early to mid-40''s). However, our analyses also highlight the important benefits of effective tobacco legislation on the U.S. West Coast and urge policy makers to actively consider addressing issues surrounding tobacco taxation and the impact of poverty on tobacco use, in addition to the risks posed by co-occurring psychiatric problems and other substance use disorders. [Copyright &y& Elsevier]

Abstract: The aim of this study was to test for sex differences in the role of physical and relational victimization in anxiety and depression development through a randomized prevention trial. 448 seven-year-old boys and girls were randomly assigned to the Good Behavior Game intervention, a two-year universal classroom based intervention aimed at reducing disruptive behavior problems and creating a safe and predictable classroom environment, or to a control condition. Assessments of self-reported physical and relational victimization at age 10 years, and self-reported major depressive disorder, generalized anxiety, social anxiety, and panic/agoraphobia symptoms at age 13 years were available. Reductions in anxiety/depression were mediated by reduced rates of relational victimization in girls, whereas reductions in physical victimization accounted for the reduced anxiety/depression scores among boys. The results support sex-specific pathways of victimization leading to anxiety and depression. [Copyright &y& Elsevier]

Abstract: Confirmatory factor analyses were done to assess the dimensionality of the stress response in a sample of police officers and fire fighters (n =1168) involved in the 1992 air disaster in Amsterdam. The confirmatory factor analyses were applied to the responses on two psychometrically different instruments, i.e., the Self-Rating Inventory for Posttraumatic Stress Disorder (SRIP) and the Impact of Event Scale (IES). The previously found distinction between (active) avoidance and numbing in samples highly affected by posttraumatic stress disorder appears to be applicable to the stress response of a less affected sample. For the SRIP, a five-factor structure (i.e., intrusion, avoidance, hyperarousal, emotional numbing and sleep disturbance) appeared to fit slightly better than the four-factor structures from previous findings. For the IES, our results replicated findings of a four-dimensional structure (i.e., intrusion, avoidance, numbing and sleep disturbance) underlying the posttraumatic stress response. The factors of the best-fitting structure of both instruments proved reliable. Due to the psychometric properties of the two instruments, the relationship between similar factors in both instruments was only low to moderate. Compared with the IES, factors of the SRIP were, however, less discriminative from other symptoms of psychopathology. Replication in different traumatized or community samples is recommended. [Copyright &y& Elsevier]