Elsevier

Journal of Health Economics

Volume 20, Issue 5, September 2001, Pages 703-731
Journal of Health Economics

The impact of maternal alcohol and illicit drug use on children’s behavior problems: evidence from the children of the national longitudinal survey of youth

https://doi.org/10.1016/S0167-6296(01)00090-XGet rights and content

Abstract

This study uses Children of the National Longitudinal Survey of Youth to test for evidence of a causal relationship between maternal alcohol, marijuana, and cocaine use, and children’s behavior problems. Ordinary least squares (OLS) results provide strong evidence that substance use is associated with behavior problems. However, OLS estimation fails to account for unobserved factors that may be correlated with substance use and child behavior. To account for this problem, mother–child and family fixed-effects models are tested. The results suggest that maternal illicit drug use is positively associated with children’s behavior problems, while alcohol use has a less consistent impact.

Introduction

In 1996, approximately one out of 10 American children lived in a household where at least one parent met clinical standards for alcohol and/or illicit drug dependence. Larger numbers of children in 1996 lived in households where one or more parents reported any illicit drug use (Huang et al., 1996). Previous researchers, mostly from the fields of psychology and psychiatry, have noted that parental substance abuse is associated with mental health problems in children, but it is unclear whether or not the relationship is causal. The observed positive correlation may be causal if illegal drug or alcohol consumption directly impacts parenting ability and the amount of time parents spend with children, which in turn adversely affect children’s mental health. However, the observed relationship also may be due to unobserved factors that determine both parental substance use and children’s mental health outcomes, such as parental psychiatric disorder, personality, or environment.

The objective of this study is to use a large, national sample of mothers and children to test for evidence of a causal relationship between maternal alcohol, marijuana and cocaine use, and children’s early mental health problems, as measured by an index of behavior problems. Behavior problems during childhood are associated with psychiatric disorders, mental health services use, and delinquency later on in childhood and in adolescence (Gortmaker et al., 1990, Wacschlag et al., 1997). This study is based on the hypothesis that some forms of maternal substance use will interfere with the production of children’s mental health by decreasing the quality of parenting inputs, or by reducing the amount of time mothers invest in producing children’s mental health.

Empirically, establishing a causal relationship between maternal substance use and children’s behavior problems is not straightforward. If unobserved factors exist that are correlated with both maternal substance use and children’s outcomes, an observed positive association may not be causal. For example, if a mother suffers from chronic depression, this psychiatric disorder may lead both to maternal substance use and to children’s behavior problems.

If the relationship between maternal substance use and children’s outcomes can be explained by unobservable factors, programs and policies that reduce maternal substance use will not be effective in improving children’s behavior problems. Alternatively, if maternal substance use is causally linked to children’s outcomes, children will benefit from programs and policies that reduce maternal substance use. This study uses three empirical methods to address this issue: (1) an instrumental variables (IV) method, which uses alcohol and illicit drug prices and policies as identifying instruments; (2) family fixed-effects models, which control for unobserved heterogeneity at the level of the mother’s family of birth; and (3) mother–child fixed-effects models, which control for unobserved heterogeneity at the level of the mother–child pair.

The ordinary least squares (OLS) results of this study suggest that after controlling for a range of socioeconomic and demographic factors, maternal alcohol use, marijuana use and cocaine use are all strong predictors of children’s behavior problems. However, when maternal depression and cigarette use measures are included in the OLS models, alcohol use is no longer a statistically significant predictor of children’s behavior problems. Illicit drug use remains statistically significant. Mother–child and family fixed-effects models are generally consistent with the main OLS findings. The results from IV estimation show no consistent relationship between maternal substance use and children’s behavior problems. The identifying instruments, however, performed very poorly in the first stage, casting doubt on the validity of the IV results. Overall, then, this analysis provides some evidence that the observed association between maternal substance use and children’s behavior problems may be causal.

Section snippets

Previous literature

Researchers have identified a number of physiological, environmental, and genetic pathways that link maternal substance use to children’s behavioral outcomes. First, maternal substance use during pregnancy may affect adversely a developing child’s future behavioral outcomes through teratogenic processes. Second, maternal substance use may disrupt the home environment or affect parenting in a way that leads to children’s behavior problems. Finally, mothers and children may share an unobserved

Theoretical motivation

Theoretically, this study is motivated by the household production and health production frameworks developed by Becker (1965) and Grossman (1972). In our framework, a mother maximizes utility which is a function of the child’s stock of mental health capital and the mother’s stock of relaxation or euphoria capital. Euphoria is produced with a mind-altering substance such as alcohol, marijuana or cocaine, as well as with a time input. The child’s mental health is produced through good parenting

Empirical estimation

The child mental health production function is represented empirically by Eq. (1):BPIijt01Ajt2Xit3Xjt4ui5ujijt,and is specific to the ith child of mother j at time t. The output of the production function is measured by the standardized percentile score calculated from the BPI. The variable Ajt represents maternal alcohol and illicit substance use measures. The vectors Xi and Xj include observed, child specific factors and mother-specific factors, respectively, that may impact the

Estimation strategies

This analysis uses three approaches to estimate the coefficient on maternal substance use in Eq. (1). All three methods are intended to adjust for the potential correlation of maternal substance use (Ajt) with uj in the disturbance term. The first method accounts for as much of the unobserved uj as possible in the empirical specification by controlling for observed characteristics of the mother. The second method, IV, purges the maternal substance use measures of their correlation with uj. The

The CoNLSY data

The data used in this study come from the Children of the National Longitudinal Survey of Youth (CoNLSY). The National Longitudinal Survey of Youth (NLSY79) is an annual, national survey that was initiated in 1979 with a sample of 12,686 young people who at that time were aged 14–21. NLSY79 respondents provided extensive information on labor market participation, education, fertility, substance use, attitudes and family background. Beginning in 1986, children of female NLSY79 respondents were

Regression results

Initially, the models are estimated using OLS to establish baseline estimates of the effects of maternal substance use on children’s behavior problems. Although the OLS method ignores the potential endogeneity of maternal substance use, it offers the advantage of being robust to many specification errors. The baseline OLS results are displayed in the first columns of Tables 4 and 5. Next, in an effort to further control for unobserved factors that might affect both maternal substance use and

Summary and conclusions

This study provides some evidence that maternal substance use may be linked causally to children’s behavior problems. Although TSLS results are problematic due to the poor performance of the identifying instruments, OLS models, family fixed-effects models, and mother–child fixed-effects models all suggest that maternal marijuana and cocaine use are associated with increases in 4–15-year-old children’s BPI scores. Maternal alcohol use, as measured by the number of days the mother used alcohol in

Acknowledgements

We would like to express our gratitude to Michael Grossman, Robert Kaestner, Chris Swann, Sherry Glied, David Cutler, Jon Gruber, and two anonymous referees for very helpful comments and insights.

References (60)

  • C Stanger et al.

    Behavioral and emotional problems among children of cocaine and opiate dependent parents

    Journal of the American Academy of Child and Adolescent Psychiatry

    (1999)
  • M Barrera et al.

    Parent-adolescent conflict in the context of parental support: families with alcoholic and nonalcoholic fathers

    Journal of Family Psychology

    (1998)
  • N Baydar et al.

    Effects of maternal employment and child-care arrangements on preschoolers’ cognitive and behavioral outcomes: evidence from the Children of the National Longitudinal Survey of Youth

    Developmental Psychology

    (1991)
  • G Becker

    A theory of the allocation of time

    Economic Journal

    (1965)
  • E Becona et al.

    Anxiety, affect, depression and cigarette consumption

    Personality and Individual Differences

    (1999)
  • M Behnke et al.

    The consequences of prenatal substance use for the developing fetus, newborn and young child

    The International Journal of Addictions

    (1993)
  • J Belsky et al.

    Early and extensive maternal employment and young children’s socioemotional development: Children of the National Longitudinal Survey of Youth

    Journal of Marriage and the Family

    (1991)
  • K.A Bollen et al.

    Binary outcomes and endogenous explanatory variables: Tests and solutions with an application to the demand for contraceptive use in Tunisia

    Demography

    (1995)
  • J Bound et al.

    Problems with instrumental variables estimation when the correlation between the instruments and the endogenous explanatory variables is weak

    Journal of the American Statistical Association

    (1995)
  • N Breslau et al.

    Major depression and stages of smoking: A longitudinal investigation

    Archives of General Psychiatry

    (1998)
  • C Brown et al.

    The association between depressive symptoms and cigarette smoking in an urban primary care sample

    International Journal of Psychiatry in Medicine

    (2000)
  • Campbell, S.B., 1990. Behavior Problems in Preschool Children: Clinical and Developmental Issues. Guilford Press, New...
  • S.B Campbell et al.

    Follow-up of hard-to-manage preschoolers: adjustment at age 9 and predictors of continuing symptoms

    Journal of Child Psychology and Psychiatry

    (1990)
  • L Chassin et al.

    Relation of parental alcoholism to early adolescent substance use: a test of three mediating mechanisms

    Journal of Abnormal Psychology

    (1993)
  • W.S Choi et al.

    Cigarette smoking predicts development of depressive symptoms among US adolescents

    Annals of Behavioral Medicine

    (1997)
  • P Cornely et al.

    Prevalence of behavior problems in 3-year-old children living near Three Mile Island: a comparative analysis

    Journal of Child Psychology and Psychiatry and Allied Disciplines

    (1986)
  • S Crockenberg et al.

    Autonomy as competence in 2-year-old: maternal correlates of child defiance, compliance, and self-assertion

    Developmental Psychology

    (1990)
  • F Earls

    Prevalence of behavior problems in 3-year-old children: A cross-national replication

    Archives of General Psychiatry

    (1980)
  • M Fendrich et al.

    Inconsistencies in lifetime cocaine and marijuana use reports: impact on prevalence and incidence

    Addiction

    (1995)
  • M Fendrich et al.

    Diminished lifetime substance use over time: an inquiry into differential underreporting

    Public Opinion Quarterly

    (1994)
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