Year: 2026
Type: article
Abstract: Maternal tobacco smoking during pregnancy (MSDP) is associated with an increased risk of child externalizing problems. It remains unclear whether these associations are externalizing-specific, or better explained by comorbidity between externalizing and internalizing domains, or vary by age and sex. To address comorbidity and differentiation between domains, we leveraged the severity-directional model of psychopathology. Severity reflects the overall level of psychopathology symptoms across both domains (high levels of severity can only be reached by having symptoms of both types simultaneously), whereas directionality captures the balance/differentiation of internalizing vs. externalizing symptoms regardless of number of total symptoms. Participants included 16,335 children aged 1-19 years old (47.78% female, 58.17% White, 75.46% non-Hispanic) from 55 U.S.-based cohorts within the Environmental Influences on Child Health Outcomes (ECHO) consortium. MSDP predicted differentiation toward externalizing problems in 2-year age bins 1-2 through 7-8 and 13-14 years; remaining (non-significant) age bins had similar magnitudes. MSDP predicted higher symptom severity in all age bins. Findings likely reflect a combination of MSDP associations with comorbid symptom severity and specificity toward externalizing problems, with little evidence of age or sex differences. Additional analyses explored e-cigarette use, other prenatal substance use, and postnatal smoke exposure; associations were sparse and unsystematic.
Source: Development and Psychopathology
Authors: Kristine Marceau, Andrew Law, Karen J. Derefinko, Olivia C. Robertson, Sara S. Nozadi, Lijun Li, Chang Liu, Leslie D. Leve, Jody M. Ganiban, Nicole Bush, Cathi Propper, Briana Moore, Amy J. Elliott, Catrina A. Calub, Theresa M. Bastain, Donghai Liang, Julie B. Schweitzer, Ban Al-Sahab, Rebecca J. Schmidt, Heather E. Volk, Jenae M. Neiderhiser
Institutions: Purdue University West Lafayette, Johns Hopkins University, University of Tennessee Health Science Center, Baylor College of Medicine, University of New Mexico Health Sciences Center, Pennsylvania State University, Washington State University, University of Oregon, George Washington University, University of California, San Francisco, University of North Carolina at Chapel Hill, Colorado School of Public Health, University of South Dakota, Avera Health, Washington University in St. Louis, Emory University, University of California, Davis, Michigan State University
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,550
Funder: National Institutes of Health
OpenAlex ID: W7149982304