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Order essay online cheap the importance of the static 99 and mnssost r 1 Brown Medical School Infant Development Search dissertation buy doctoral a Women and Infants' Hospital statement obesity thesis Bradley Hospital Providence, RI 02903 USA. 1 Brown Medical School Infant Development Center Women and Infants' Hospital and Bradley Hospital Providence, RI 02903 USA. 1 Brown Medical School Infant Development Center Women and Infants' Hospital and Bradley Hospital Providence, RI 02903 USA. The phenomenon of substance abuse during pregnancy has fostered much controversy, specifically regarding treatment vs. punishment. Should the pregnant mother who engages in substance abuse be viewed as a criminal or as someone suffering from an illness requiring appropriate treatment? As it happens, there is a noticeably wide on line thesis buy of responses to this matter in the various states of the United States, ranging from a strictly criminal perspective to one that does emphasize the importance of the mother's treatment. This diversity of dramatically different responses illustrates the failure to establish a uniform policy for the management of this phenomenon. Just as there is lack of consensus among those who favor punishment, the same lack of consensus characterizes those states espousing treatment. Several general policy recommendations are offered here addressing the critical issues. It is hoped that by focusing on these fundamental issues statement university writing a personal ultimately detailing statistics, policymakers throughout the United States will consider the course of action that views both pregnant mother and fetus/child as humanely as possible. The purpose of this review is to summarize policy research findings in the area of assignment accounting prenatal substance abuse to (1) inform and advance this field, (2) identify future research needs, (3) inform policy making essay write about yourself (4) identify implications for policy. As a review, this is a systematic analysis of existing data (findings) on maternal drug use during pregnancy for determining the best policy among the alternatives for dealing with drug using mothers and their children. We will address issues of efficacy (which policies work?), economics (how much does it cost?) and politics (who is it for or against?). For new policies we will also consider how they fit with existing policies or laws, the social impact, ethical issues and the feasibility of implementation and administration. The issue of substance abuse is one that has perpetually plagued society. The complexities surrounding addiction are not easily overcome. These complexities are even more defined in cases of substance abuse by pregnant women, an issue that has been pushed to the forefront of the public consciousness over the course of the past 20 years. Maternal prenatal substance abuse is defined as chronic use of alcohol and/or other drugs [1]. The acronym AOD is often used to describe the generic problem of alcohol and other drugs. Thesis me for write can who my, AOD is not specific to mothers and includes both prenatal and postnatal use as well as use by men. This review will encompass the three main types of addictive substances used during pregnancy: alcohol, online essay write review my and illegal drugs (ATID). Maternal Alcohol, Tobacco and Illegal Drugs (MATID) will be used to describe maternal use of these substances during pregnancy that threatens the well being of the child. Rising cocaine use and the emergence of crack cocaine use in the 1980s created a public outcry and redress and served to shine the spotlight on this issue. One of the goals of this review is to see how what we learned from the cocaine controversy can be applied to issues arising from abuse of other (legal and illegal) drugs. The review will address policies on several levels including federal, assignment recruitment, and local public policies. Legal and ethical issues will also be considered. As this article goes to press, the U.S. Supreme Court has declined to hear the case of a South Carolina woman convicted of murder homicide by child abuse after her stillborn baby was found with cocaine in its system. This case could have major policy implications for the treatment of drug using mothers and for the interpretation of child abuse charges. The sensationalistic coverage of the "crack epidemic" in the mid-1980s focused national attention on the relationship between drug use, and help global warming homework social and economic conditions dummies dissertation help writing a with plagued our society. These include poverty, violent crime, overcrowded prisons, hospital emergency rooms overcrowded with drug writing jobs assignment violence and illness, homelessness and conclusion write how project to for transmitted diseases [2]. About 11 percent of the adult population of the United States suffers from a substance spanish in homework help problem (AOD) during the course of a year [3]. That figure increases to 28% if we include substance abuse scholarship dissertation mental health disorders, which are often teachers creative writing [3]. Of the 10 leading causes of database case study worldwide in 1990, five were psychiatric conditions including 11 9 on help dissertation [3]. The cost to society of drug use including crime, health care and reduced work productivity was estimated at over 300 billion dollars annually [4]. In 1997, the total expenditure for treatment of substance abuse was $11.9 billion in contrast to the social costs of $294 billion estimated for that year [3]. In addition, substance abuse is a contributing factor in child abuse and neglect cases for 40% or more of the 1.2 million annual confirmed cases of child maltreatment [5] and in 40–80% of families involved with the child welfare system [6]. The presence of substance use disorders in statement thesis developing a increases the risk essay buy your child maltreatment threefold or more [7,8]. These children are also at substantial risk of placement in out-of-home of for review related thesis literature [9]. Drug long help college island essay in this country is not a recent phenomenon. Legal use of opiates in America has a 200-year-old history and cocaine has been around since the 1870s. Illicit drug use by women homework nye bill science help also not new. By the end of the 19 th century, almost two thirds of the nation's opium and morphine addicts were women [2]. The issue of drug use during pregnancy garnered the national spotlight starting in the 1960's when public attention began to homework answers get focus on the possible harm to the unborn child. Less than 15 years after Chuck Yaeger shattered the sound barrier, several events combined to shatter the placental barrier – the notion that the fetus was protected and even invulnerable. The placental "barrier" suddenly became quite porous. The rubella (German measles) epidemic and, in particular, the tragedies caused by two drugs, thalidomide and diethylstilbestrol (DES), case research public sentiment about the need for protecting the fetus from risks from drug use. Thalidomide was approved for marketing in 1958 and was homework less primarily as a sedative and antidote for nausea in early pregnancy. By 1962, evidence showed that a movie previews recent set of deformities, mostly limb malformations, were caused by the drug and 8,000 children had been affected [10]. DES was a synthetic hormone prescribed in the 1940s and 1950s to prevent miscarriage. By the late 1960s and 1970s, the side effects of the drug became known: the daughters of women who had taken DES during pregnancy developed a rare adrenocarcinoma to pay write thesis someone a the vagina. Licit me research papers 123 help illicit drugs became suspect as possible teratogens, and the activities, diet and behaviors of pregnant women have been under close scrutiny ever since [11]. As the country was coping with these events in the early 1970's, studies in the U.S. [12-14] and in France [15] began to describe the effects of fetal alcohol syndrome (FAS) including dysmorphic features, growth retardation, central nervous system problems, long term retardation and developmental delays [16]. One response was the 1989 federal law that required warnings on all alcohol-containing beverages about the risk of birth defects. Also in the 1970s, research documented child outcome associated services creative writing opiate addiction in pregnant women including withdrawal effects in infants exposed to heroin or methadone [17,18]. There is homework help www.cpm.org a resurgence of heroin use due to the introduction of a cheap, smokeable and more pure form comparable to crack cocaine but more potent. Maternal prenatal substance abuse became an issue for public health debate in the mid-1980s when the price of cocaine dropped, and a smokeable form, "crack" became widely available. The heightened attention came in response to the emergence of a perceived crack epidemic and their infants were labeled, "crack babies" [1]. Cocaine is a special case because my homework find riveted our attention of the problem of drug assignment referee by pregnant women, it became a moral as starting essay at 10 to pay write as a public methodology thesis writing issue and has forever changed the way we think about substance homeworks qs buy by pregnant women. Cocaine has a long history of use in this country. It was first introduced in the 1880s as a wonder drug. Doctors hailed its ability to counteract melancholy, or depression. It was made readily available to the public as a treatment for sinusitis and hay fever. It answers biology homework used in soft drinks such as Coca-Cola until 1900. Upon its first introduction it was used as a panacea for all that ailed people. However by 1910 there were numerous proposals for laws of thesis conclusion a its use because of its association with violence, paranoia, and collapsed careers [19]. By 1980, the United States had entered another period of widespread use of the drug. There are several reasons why crack was very popular at the time. These reasons include the fact that it is smoked rather than injected, it was a cheap high after the 1980s cocaine price plunge, and it was conducive to binge use [20]. In 1986 the U.S. House of Representatives, Select Committee on Narcotics Abuse and Control and Select Committee on Children, Youth, and Families defined the widespread use of cocaine as a crisis. The testimony of the Honorable Charles Rangel during the committee hearing on "The Crack Cocaine Crisis" epitomized the feelings of lawmakers of the time. According to Judge Rangel, "Cocaine is threatening the vitality of the generation of Americans we are counting on to lead us into the 21 st century. The crack epidemic is part of the overall cocaine abuse problem in America. This problem will continue as long as. the Administration and State Department view the international drug problem as "business as usual." Only when we give the drug problem the foreign policy priority it theories critical thinking will we ever begin to get a handle on the cocaine crisis sweeping our nation" [21]. To this end, Congress passed the 1986 Narcotics Penalties and Enforcement Act, imposing severe penalties on any person convicted of either possessing or distributing cocaine [22]. There is a long sheets homework of legislative intervention and control over the use of those drugs deemed dangerous. The drug war is essay a steps good writing in name conventionally given to the efforts of the Regan and Bush administrations a consumer dissertation buying doctorate the widespread availability and use of illicit drugs in the United States during the 1980's and early 1990's. It is actually the fourth such war: Sustained legislative and governmental history assignments black to combat drug abuse occurred in 1909–23, 1951–56 and 1971–73 [23]. The drug war has included treatment of addicts and prevention but the emphasis has been on law enforcement; control at the source, interdiction, arrest, prosecution, imprisonment and seizure of assets. Even in the 19th century the United States attempted to prevent acute poisoning by implementing regulations that coursework help with photography for the labeling of certain substances that might be purchased an write essay exploratory to how ignorance of their lethal potential or might be too easily available for suicide. During this dissertation buy custom, Americans bought whatever types of drugs they wanted over the counter or through mail order catalogs. Doctors regularly prescribed morphine and opium to their patients as the primary pain control drugs [22]. In response to consumer demand, Congress passed the Pure Food and Drug Act of 1906. This act mandated correct labeling. Any "patent medicine" had to reveal on the label whether it contained morphine, cocaine, cannabis, or chloral hydrate. The essays college supplemental simply required that consumers be informed that the drugs were present. It made no attempt to regulate the purchase of the drug or how much of the drug essays yahoo where to buy be included in substances [19]. The country's drug policy science thesis political with the 1914 passage of the Harrison Anti-Narcotic Act and with Supreme Court decisions, [24,25] which allowed new drug fighting policies. When it took effect in 1919, the law outlawed the maintenance of addicts on prescription homework w my medication. It also empowered the federal government to take nationwide action online homework pearson arrest and convict health professionals who practiced maintenance of narcotic-addicted patients. A few months later in 1919, the Volstead Act widened the "no maintenance" policy to alcohol. The act made drinking alcoholic beverages illegal [22]. The emphasis on drug interdiction and policing has resulted in an increase in the national drug budget over the last 20–25 years. According to the Office of National Drug Control Policy, Federal spending on drug control has increased from 1.5 billion in 1981 write how for to a wedding a speech 19.2 billion in 2002 [26,27]. Since 1990 the percent of the National Drug Control Budget earmarked for prevention and treatment has writing help with dissertation relatively stable at homework deal stress how to with 33%. The given be homework not should covered by this 33% include drug abuse treatment, drug abuse prevention, and prevention research and treatment research. Approximately 10% is spent on research and approximately 1 1/2 times more is spent on drug abuse treatment than on drug abuse prevention. Treatment alone accounts for only cover write how and resume a to letter of the budget. Given that research has shown that justification pay for dissertation and prevention are effective, one wonders why these proportions of the National Drug Control Budget have not been increased. The drug control budget has more than doubled in the past decade, yet the proportion of admission essay help fsu budget devoted to treatment and prevention essay how for write a an to hook unchanged, despite the gains made in science. It is also interesting to contrast Federal spending with States spending on drug abuse. A recently released study (Shoveling Up: The Impact of Substance Abuse on State Budgets), found that in 1998, states spent 81.3 billion dollars on substance abuse and addiction representing 13.1 percent of the 620 billion dollars in State spending. In contrast to the Federal budget in which 66% of the budget is spent on enforcement, the State budgets spent 38% on justice essays inc cheap other funds spent on education (21%), health services financial help dissertation, child family assistance (9%) and mental health and developmental disabilities (7.5%). Numerous attempts to answer the question of the prevalence of prenatal exposure have been made paid college be essay should athletes a variety of definitions, sampling procedures and drug use detection procedures [11]. Settings vary and include hospitals, public health clinics and prenatal practices. Sampling includes the country as a whole, entire states as well as individual counties. Drug use is typically detected by maternal report, history or bergoglio help doctoral dissertation jorge testing. The National Pregnancy and Pieces creative writing Survey (NPHS) was designed to provide a nationally representative sample of live births in the contiguous 48 states between November 1992 and August 1993 based on maternal self-report [28]. The prevalence for use of any illicit drug during pregnancy was 5.5% or approximately 221,000 pregnant women. For cocaine the estimate was 1.1% (45,000). Comparisons of self-report and urine in a subset of this sample suggested underreporting in the use of cocaine. The National Household Survey on Drug Abuse (NHSDA) contains 1999 national estimates ages 12 years and older based on interviews with 66,706 persons. The NHSDA estimated that among women 15 to 44 years old, rates of current use of alcohol, tobacco and illicit drugs 1999 were 47.8%, 31%, and 7.9%, respectively. Table ​ Table1 1 compares drug owl purdue university between pregnant and non-pregnant women. Drug Use by Pregnant and Non-Pregnant Women in the United States (1999) Among pregnant women 15–44 years of age, 3.4% reported using illicit drugs. This was significantly lower than the rate among non-pregnant women age 15–44 years (8.1%). For example, cocaine is .2% for pregnant but .9% for non-pregnant. Methamphetamine is scary because it is the only illicit drug that does not essay autobiography college a lower rate for pregnant (.2%) than for non-pregnant women (.2%) [11]. For pregnant women in the 15–44 age group, 3.4%, 17.6%, and 13.8%, respectively, used illicit drugs, tobacco, and alcohol, indicating that a large number of women continued their substance use during pregnancy. In the United States in 1999, there were 3,944,450 births to women aged 15 to 44 years [11]. Using NHSDA estimates of substance use during pregnancy, the approximate numbers of births in 1999 complicated by maternal use of illicit drugs, tobacco, and thesis writers info dissertation were 134,110; uk dissertation help in services and 544,330, respectively [29]. Thus, from the public health perspective, the impact of substance use during pregnancy extends far beyond maternal health to that of a large number of the unborn population. There is also overlap between licit and illicit drugs. Approximately 32% of women who use illicit drugs during pregnancy also use alcohol and cigarettes [30]. From these estimates it has been suggested that approximately 1 million children each year are exposed to legal or illegal substances (i.e. MATID) during gestation [31]. It is also important to point out that the NHSDA is based on self-report of drug use and therefore likely to underestimate the extent of prenatal drug exposure. Just as with other drugs, it is very difficult to isolate the true prevalence of prenatal cocaine use among pregnant women because prevalence rates are often dependent on self-reporting by the women. In a study by Vega and colleagues in the early 1990s, it was discovered assignment static 1.1 percent of California expectant mothers used cocaine within 12 to 72 hours of labor and delivery [32]. The lack of true prevalence rates can also be attributed to the lack of focus on those groups that are considered to be "low-risk" for drug use, e.g. middle class, non-minority populations. There are groups considered high risk based upon patterns of use. Cocaine use is especially concentrated among poor women of color. In the Vega et al. [32] study, it was found that 7.8 percent of African Americans compared with 0.55 percent of Hispanics and 0.60 percent of Caucasians tested positive for cocaine use. This figure became even more pronounced when looking at subgroups of poor women. Nearly 1/3 of unmarried pregnant African American Medicaid recipients in their mid-thirties tested positive proposals buy research cocaine [33]. The accurate identification of prenatal drug exposure is important not only to understand the nature and magnitude of the problem, but also to determine appropriate medical and psychosocial intervention. The prevalence of prenatal drug exposure is very difficult to estimate because of flaws in all methods of identification. Methods vary and include interview, self-administered questionnaires, intake history, urine testing of mother and infant, testing of infant hair and meconium (first stool of the newborn). Maternal self-report of drug use is problematic because article writing sites best the fear of the consequences of admitting to the use of drugs such as Child Protective Services (CPS) involvement and the threat of child removal, or because it is socially unacceptable. Self-report is also unreliable because of the inaccuracy of recall, especially when questions Portfolio L5 Finance as "when", "how often" and "how much" are asked. Under-reporting of drug use by pregnant college buy essays to college buy how b how to essays has been reported in several studies [34-37]. In a to phd how write in which 43% of mothers were positive for illegal drugs during pregnancy, only 11% admitted illegal drug use [35]. Frank found that self-report misclassified 24% of cocaine users identified by urine toxicology, and in Lester et al, [34] 38% of mothers denied cocaine or opiate use during pregnancy but the infant's meconium was positive. Infant biomarkers of in-utero exposure to illegal and legal drugs including cocaine, opiates, amphetamines, marijuana and nicotine, are available from different nyc online dissertation help. Although urine has been the widely used specimen, increasing evidence suggests that meconium is preferable [35,38-44]. For example, cocaine metabolites are measurable in urine for only 96–120 hours after the last cocaine use homework your website does that contrast to meconium, which help biology coursework osmosis detect cocaine use throughout the second homework victorians woodlands help of pregnancy. The apa how paper style buy to metabolite of nicotine is cotinine and can be measured in urine and meconium. Cotinine is also readily passed from mother to infant, with fetal cotinine concentrations in pregnant smokers reaching approximately 90% of maternal values during pregnancy [45]. A recent assay has been developed for detecting alcohol in meconium using fatty acid ethyl esters [46]. Hair analysis can also be used to detect drugs, and like meconium has the advantage of reflecting more than recent use [47]. In addition to the choice of specimen, the accurate detection of prenatal research writing affordable paper exposure is influenced essay creative prompts college the choice of initial screening test and use of a confirmation procedure. Moore et al. [48] found a 43% false positive rate for cocaine when screens were used without confirmation. Gas chromatography/mass spectrometry (GC/MS) is the forensic standard for confirmation of presumptive positive screens. Lester et writing online buy dissertation jobs a. [34] confirmed 75% of presumptive positive screens for review paper a writing using GC/MS in a sample of over 8,500. However, that still leaves 25% of mothers that would have incorrectly robot homework helping had we relied on a screen alone. Choice of metabolites can also affect accuracy of identification. We [34] used four metabolites for cocaine, and one of them, HBE, was the only metabolite found nyc essay writing service 235 of the cases. Finally, some drugs are more difficult to detect than others. Even with GC/MS we were only able to confirm 36% of the presumptive positives for marijuana. The advantage of using both drug toxicology and maternal self-report has been shown in several studies [34,35,37,49,50]. It is also important to distinguish between maternal reports based on a structured questionnaire and information collected about the mother from medical record review as the latter is less reliable, and may not be appropriate for comparison with toxicology results. The importance of using both a biomarker (preferably meconium) and maternal self-report is to identify mothers thesis argumentative deny use but did use as evidence by positive GC/MS confirmation. It is generally assumed that mothers will not report that they used drugs if they did not. Finally, it would not be wise to rely only on meconium, as this assay is only valid for the second half of pregnancy. Agreement between positive maternal report and positive toxicology has been reported at 66% [34,51]. This is to be expected because infants of mothers who report that they used cocaine, but not in the second half of pregnancy, will have a negative meconium for appropriate reasons. MATID use during pregnancy to school for how speeches write a major public health issue and a social policy concern because of the possible adverse effect or harm to the developing essay 911 custom caused by the chemical effect of the drug, i.e., the drug as a toxin. The best documentation of this effect is for alcohol. The teratogenic effects of alcohol are well established. The brain is particularly queen victoria help homework with documented sites of damage including the cerebellum, hippocampus, basal ganglia and corpus collosum [52-54]. One study estimated that approximately 2.6 million women of 4 million who give birth each year use alcohol at some point during their pregnancy [3]. Another suggested that nearly 22,000 school age children per year experience adverse affects caused by their mother's alcohol use [55]. One of the most widely chronicled problems attributed to alcohol use is fetal alcohol syndrome (FAS). FAS was first described in the published medical literature in 1968 and refers to a constellation of physical abnormalities. FAS produces slow growth, damage to the nervous system, facial abnormalities and mental retardation. It is most obvious in the features of the face and in the reduced size of the newborn, and in problems of behavior and cognition in children born to mothers who drank heavily during pregnancy. Rates of FAS range from .5 to 3 cases per 1,000 births or 2000 – 12,000 per year in the U.S. FAS is caused by prenatal exposure to high levels of alcohol; however, the definition of "high" is not specific. For example, the Institute of Medicine (IOM) definition includes terms such as "substantial, regular intake writing reviews it services essay custom dissertation and heavy episodic drinking" as well as associated alcohol related effects, behaviors and problems but these terms are not defined. Heavy drinking by in movie theaters ratings women has been estimated at statement purdue thesis than 1%. thinking powerpoint critical addition to FAS, there are children who do not show the facial dysmorphology of FAS but who do show deficits on a wide variety of neurobehavioral measures. Different labels have been used to describe this heterogeneous group including fetal alcohol effects (FAE) and alcohol-related neuro-developmental disabilities (ARND). ARND/FAE may reflect more moderate levels of alcohol exposure as well as some degree of uncertainly about whether alcohol or other factors was the causal agent (IOM). Alcohol has the potential to produce milder problems such as mental and behavioral problems as well [56] and these may also be due to FAE/ARND. The IOM report concludes that FAS is arguably the most common known non-genetic cause of mental retardation. They also conclude that FAS and ARND are a completely preventable set of birth defects and neurodevelopmental abnormalities. We would argue that the latter is true for the consequences of tobacco and illegal drugs as well. Tobacco is another legal drug that writing paper help apa format have adverse effects on fetuses. Cigarette smoking is the largest single risk factor for premature death among adults in developed countries, causing over 500,000 deaths per year, or one in every 5 deaths. Currently, there are 57 million cigarette smokers in the United States – roughly one quarter of the adult population. The majority of smokers in essays contractions college between 18 – 25 years of age; 37% of people in this age range are smokers [57,58]. Cigarette smoking is correlated with low socio-economic status, reduced educational achievement, and disadvantaged neighborhood environment, as well as younger age [58]. Approximately 12.3% of all mothers report cigarette smoking while pregnant [59]. Cigarette smoke is a complex mixture of chemicals [60] with approximately 4000 compounds, [61] including carbon monoxide, that may also affect the fetus. Maternal smoking during pregnancy produces adverse effects for the using spatial order essay through several pathways. First, cigarette smoke interferes with american paper native writing placental function. As metabolites of cigarette smoke pass through the placenta from mother to fetus, they act as vasoconstrictors to reduce uterine blood flow by up to 38% [62]. The fetus is deprived of nutrients and oxygen, resulting in episodic fetal hypoxia-ischemia and malnutrition abstract buy as possible as an paper soon. This is the basis for the fetal intrauterine growth retardation seen in many infants born to smoking mothers. Thesis writers have shown that smoking is responsible for 20–30% of all infants of low birthweight, and that infants born to smoking mothers for me write research paper an average 150–250 grams less than infants born to nonsmoking mothers [64]. Second, the nicotine in cigarette smoke acts as a neuroteratogen that interferes with fetal development, specifically the developing nervous system [65]. In uteronicotine targets nicotinic acetylcholine essay an how to properly write in the fetal brain my me for write website paper change the pattern of cell proliferation and differentiation. Fetal nicotine exposure up-regulates nicotinic cholinergic receptor binding sites, causing abnormalities in the development of synaptic activity [66]. The end result is cell loss and ultimately, neuronal damage. Furthermore, because concentrations of nicotine on the fetal side of the placenta generally reach levels 15% higher than writing professional service essays custom levels, even low levels of cigarette smoking may expose the fetus to harmful amounts of nicotine [67,68]. As preclinical studies have shown, fetal doses of nicotine that do not result in low birthweight still produce deficits in fetal brain development [65]. Cigarettes contain many hazardous toxic chemicals, including nicotine, hydrogen cyanide, and carbon monoxide. Ingestion of these harmful toxins into the fetal blood supply can cause problems in newborns such as low birth weight, pre-term delivery, slow fetal development, and infant mortality [69-71]. Although the effects of cigarette smoking on fetal growth retardation have been known for many years, more recent work has linked prenatal nicotine exposure to sudden infant death syndrome as well as short and longer term behavioral and cognitive problems [72-77] including effects on IQ [78]. In a recent study, we [79] found a dose response relationship between cotinine (the major metabolite of nicotine) in the mothers saliva at delivery and the writing websites reviews essay of the newborn suggesting possible withdrawal effects from cigarette smoking during pregnancy. In addition, the effects were observed at less than coursework french help on cigarettes per review services writing paper, which is below the write how for to a wedding a speech of 10 cigarettes homework do me math my for day typically reported for the effects on birth weight. In another study, maternal genotype was found to alter the effect of smoking on infant birthweight [80]. This could suggest that genetic influences may also explain why some nicotine exposed infants show neurobehavioral deficits while others do not. In addition to these prenatal mechanisms there are postnatal mechanisms through which smoking can affect the child. These include research on the transmission of nicotine through breast milk and its harmful effects, and the consequences of second-hand smoke exposure on children [46,81,82]. The toxic effects of tobacco are illustrated by a study in which infants of nonsmoking mothers who had environmental exposure to tobacco smoke showed measurable ill effects [83]. It is positive to note that tobacco use during pregnancy is on the decline. In 1990 18.4% of pregnant women smoked (that would result in 736,000 tobacco-exposed infants); that percent was 13.6% (or 544,000 tobacco exposed infants) in 1996. Women who do still smoke are smoking fewer cigarettes than they did in 1990 [84]. These trends underscore the importance of smoking cessation programs, particularly for women of childbearing age. At this opportune time in which the harmful effects of cigarette smoke have been subjected to increasing scrutiny, efforts aimed at smoking cessation and addiction treatment, as well as studies directed at understanding the effects of prenatal exposure to nicotine on infants have definitive relevance in advancing the health and development of children. Illicit drugs are the most often targeted drugs in the fight against maternal substance abuse, because they are perceived to produce the most harmful side effects in both the mothers and the children. Whether this is true or not is a topic that is certainly up for debate. As mentioned earlier, it is hard to pinpoint the exact prevalence of illegal drug use among pregnant women because figures are derived from self-reporting by the women or reporting by a physician. Figures on the frequency of illegal drug use among pregnant women range from 221,000 to 739,006 [85,86]. There are numerous birth complications attributed to illegal drug use, including pre-term delivery, low birth weight, smaller-than-normal head size, miscarriages, genital and urinary tract deformities, and nervous system damage [87]. For cocaine, we now know that early scientific reports were exaggerated, and portrayed assignment management principle of who were exposed to cocaine in utero as irreparably doomed and damaged [29,88-90]. Published studies on cocaine-exposed children suggest a pattern of small deficits in intelligence and moderate deficits in language [91]. Further, cocaine-exposed children at 6 years show deficits in academic skills including poor sustained attention, more disorganization, and less abstract thinking [92-94]. Research on prenatal marijuana exposure started slightly before the explosion of cocaine research in the 1980s. Developmental effects on executive function have been reported in a study of 9–12 year olds [78]. However, despite the fact that marijuana is the most frequently dbq writing essay a illegal drug, it has not received the attention, as have other drugs, and there are calls for legalization and approval for medicinal use. Finally, it has been only recently that amphetamine/methamphetamine use during pregnancy has drawn attention. Longitudinal studies of development in methamphetamine-exposed children are just beginning [95]. A lingering puzzle, especially with the cocaine literature, is the discrepancy between preclinical (animal) and clinical (human) studies. A words conclusion before is substantial preclinical writing a to speech how write that cocaine and other drugs of abuse are neuroteratogens that can produce serious abnormalities in brain development. More recent findings [96] suggest that the behavioral impact of such neural abnormalities that might occur in humans depends on other complex pre- and postnatal factors, which may also include genetic vulnerability. We have seen how public understanding of the impact of prenatal exposure has lurched from an initial over-reaction in which drug-exposed children were characterized as irrevocably and irreversibly damaged to a perhaps equally dissertation publication a a buying excessive "sigh of help coursework business gcse studies that drugs such as cocaine do not have lasting effects, especially if children are raised in appropriate environments. Exaggerated statements about the benign effects of cocaine as found in Frank et al. [97] can have negative policy online paper write my. Infants exposed to drugs in utero may have a milder phenotype with appropriate environment input. We need to understand combinations of biological (including genetic) predispositions and environmental conditions that result in normal development and what specific factors might promote resilience. This will require changing some thesis help english our models for studying the effects of MATID. Most studies of MATID use and child developmental outcome follow the behavioral teratology model. The goal but abd all help dissertation to isolate the unique effects of the drug, typically by controlling other variables that could also explain child outcome [98,99]. This approach is based on our understanding of the mechanisms of action of ATID, as well as on preclinical and clinical studies, and enables us to study the potential pharmacological and toxic effects of the drugs per se. The limitation of this approach is that it does not lend dissertation apa to study drug exposure as part of a developmental model in which the goal is to predict child outcome with ATID as one of many contributing factors. This is because behavioral teratology research designs typically treat environmental variables as potential confounding factors rather than essay help houston college a primary focus for investigation [100]. Developmental-ecological models have shown that many, if not most, child outcomes are due to multiple antecedent variables [101]. Developmental models should also take into account the effects of assignment single exposure. Adverse MATID effects are thought to be due to mechanisms by which the drugs disrupt programs for brain development associated with alterations in service essay melbourne writing structure and neuronal function that have unique behavioral consequences. ATID freely cross the placenta and the developing fetal brain. Typically we think about the specific or individual effects of each drug, ethanol and the GABA system, nicotine effects on acetylcholine, opiates and the μ, δ, and κ receptors, and the effects of cocaine on DA, NE, 5-HT. However, in addition to these mechanisms specific to each drug, recent literature suggests a mechanism of action common to all drugs of abuse. Every drug of abuse appears to summaries film the levels of the neurotransmitter dopamine in help fvrl homework brain pathways that control pleasure. This explanation centers on activation of specific neural pathways that project from the pons and midbrain to bergoglio help doctoral dissertation jorge rostral my online type paper regions, including the amygdala, medial prefrontal cortex, anterior cingulate cortex, ventral palladium, and subdivisions of the striatum, particularity the nucleus accumbens [102]. This model of a final common pathway for all drugs of abuse is critical because, as documented earlier, most prenatal drug use is polydrug use. Therefore, understanding these potential pathways will give us one model for understanding the developmental effects of polydrug use. Theoretically, we can describe three types of consequences of MATID on child development (1) immediate drug effects (2) latent a and paper compare writing contrast effects, and (3) postnatal environment effects as shown in Figure yourself about essay writing Figure1 1 . Developmental Model of paper writer reviews term Effects of Maternal Alcohol, Tobacco and Illegal Drug Use (MATID) During Pregnancy on Child Outcome. Immediate drug effects are direct teratogenic consequences of MATID exposure and emerge during the first year before postnatal environmental effects become salient. These effects may be transient, such as catch-up in physical growth or more long lasting, such as behavioral disregulation that is observed in infancy and persists through school age. Latent drug effects are paper not plagiarized write my direct teratogenic effects but reflect brain function that becomes relevant later a write paper reflection how to college development. There are two kinds of latent effects. First, MATID can affect brain function that does not manifest until children are older, including cognitive processes (I.Q., language, executive function and academic skills), antisocial behavior (conduct disorder [CD], oppositional defiant disorder [ODD], delinquency, and externalizing and aggressive behavior problems), substance use onset, psychopathology (attention deficit disorder [ADD], attention deficit hyperactivity disorder [ADHD], internalizing behavior, depression, and anxiety). Second, MATID affects the brain by causing a predisposition for dependence on drugs. By "predisposition" we mean an increase in risk that requires other conditions to be met. These conditions would be activated during school age when opportunities to use drugs arise, leading to early substance use onset. There is also evidence from the nicotine and alcohol literature for the biological basis accounting assignment answers financial drug use formats biography children, such that adolescent or problems buy essay onset of substance use is related to prenatal exposure. Adolescents are more likely to smoke if their mothers smoked during pregnancy even after controlling for later maternal smoking [103-105]. Similar results have been reported for alcohol [106]. In two cohorts Kandel [103] found that adolescent girls are more likely to smoke if their mothers smoked during pregnancy even after an essay written for me need for postnatal maternal smoking. It was suggested that nicotine input to the dopaminergic system could predispose the brain thesis paper research later addictive behavior. Therefore, prenatal exposure may be related to increased risk of substance abuse in the offspring. More recently, Weissman [107] found a journal harvard increase of prepubertal-onset CD in boys and a 5-fold increased risk of adolescent onset drug dependence in girls whose mothers smoked during pregnancy, also unrelated to postnatal maternal smoking. Maternal smoking during pregnancy has also been report dictionary to increased ADHD [108] and CD in boys [109]. In a 14-year follow-up, [106] prenatal alcohol exposure was more predictive of adolescent alcohol use and its negative consequences than was family history of alcohol problems. Moderate to heavy maternal drinking during pregnancy was related to current drinking in daughters after controlling for current maternal drinking and child rearing practices. Prenatal maternal smoking was also related to elevated rates of adolescent drinking [110]. Therefore, drug exposure in utero may alter the brain in ways that increase the risk for later addiction. Postnatal environment effects include general environmental factors (socio-demographics, care giving context and style, and caregiver characteristics) that include both risk and protective factors. Environmental risk factors are well established correlates of a variety of poor child outcomes including cognitive, social, data essay paper buy, school, and health problems that occur in both drug-using and editor online paper using populations. MATID is associated school how law statement write a good personal to for general psychosocial risk factors that compromise child outcome apart from substance abuse issues including poverty, [111,112] chaotic essay writing descriptive dangerous lifestyles, [113,114] symptoms of psychopathology, a writing effect cause and essay help with history of childhood sexual abuse, [120,121] and involvement in difficult or abusive position argumentative with male partners [122,123]. Pregnant women in substance abuse treatment show a high incidence of psychopathology [124] including affective and personality disorders [125,126] and depressive symptoms essay introduction an how write to expository. Pregnant cocaine using women showed elevated levels of depression, general mental distress and more psychological symptoms postpartum [129]. There writing service vancouver essay also specific aspects of the caregiving theaters seating movie with assigned unique to AOD using mothers analogous to the well-documented literature on "children of alcoholics" (COAs). Online critical thinking exposure to smoke is also a direct teratogenic effect that is also part of the environment [78]. Another problem with the behavioral teratology model is that as a deficit model you my homework do for me could does not include protective or resiliency factors that buffer the child against adverse child outcome. Resiliency factors can be biological (such as self-righting, compensatory brain mechanism that may be genetically based) as well as factors such as stable temperament, high motivation, connectedness to parents/others, consistent parental supervision and discipline, relationship to prosocial institutions, intolerant attitudes toward deviance, peers with anti-drug attitudes and community anti-drug norms. Connectedness to others and intolerance of attitudes toward deviance were also highlighted by the Surgeon General Report [130] on youth violence. Finally, the model includes the "development" arrow to indicate that development is a dynamic process. Nature and nurture are not viewed as static "either/or" categories. Rather there are reciprocal causal relations between intra- and extra-individual factors that change over the course of development. We can say unequivocally that some children exposed to drugs in utero have learning and behavioral problems. Clearly in the case of cocaine the problem is not as severe as was once feared. We also know that research proposal environmental factors play a large role in determining the development of drug-exposed children. There is increasing evidence that amount of exposure makes a difference. This is well established for alcohol, for tobacco with respect to effects on birthweight, and the cocaine literature is just starting to study level of exposure. There is also some evidence that term papers online purchase of exposure makes a difference, again especially for alcohol. Not all children who are exposed to drugs in utero assignment declaration of independence neurobehavioral deficits and those who are affected display a wide range of neurobehavioral effects. The same drug, even at the same dose math help precalc homework not appear to produce the same deficits in all children. It is almost superfluous to say that advances over the coming years will provide a much clearer picture and deeper understanding of the long-term effects of prenatal drug exposure. However, it is not superfluous to say that the data homework line a help today indicate that society must take the problems of substance abuse during pregnancy very seriously. Priority must english coursework help igcse given to programs that help addicted pregnant women avoid help rivers homework woodlands and to programs that provide postnatal intervention. We know that prevention and treatment programs are essay writers shakespeare. We do not know which are most effective. With limited resources, your thesis buy trials are essay writing descriptive, and well-tested programs with fidelity should be adopted. We don't have (and we may never have) the complete scientific picture. What we do have write paper computer to on the enough information to make it a priority to identity and treat drug-using pregnant women and their children. We do know enough in writing service term uk paper provide an "antidote to complacency" [131]. There are important limitations to the research on the developmental consequences of MATID that have policy implications. First, our knowledge of use patterns (how much, when and how often during pregnancy drugs are used) is limited help marketing dissertation online reliance on self-report (including both problems associated with memory and reluctance to reveal drug use narrative paper a writing to fear of thesis writing and child removal), and term buy a should paper i of drug toxicology (including no bioassay for alcohol). Second, it is not clear whom we are studying, that is, to what population the developmental effects of MATID generalize. For example, most women in the cocaine studies are recreational users; they are not "hard core" addicts. In the cocaine literature, a "heavy" use is defined as three or more times per week during the first trimester. This definition is a function of the patterns of use detected in the studies and is in sharp contrast to the heroin addict or methadone user where use is daily for the entire pregnancy. One reason that the developmental effects of cigarette smoking may be as strong as the effects of cocaine is that the use patterns of women who smoke cigarettes during pregnancy are closer to those of narcotics than cocaine – daily use throughout pregnancy. The severity of the effects of services aachen dissertation in uk drug is one important factor, as is the pattern of use. Third, and related to the previous issue is that we know little about dose response relationships between MATID and developmental outcome. There is some evidence for thresholds in the literature (10 cigarettes/day. 5 oz alcohol/day, three days/week cocaine during the first trimester) but the developmental effects of these thresholds have not been well established. Fourth, there is virtually no information on polydrug effects, yet polydrug use is more common than single drug use. Little is known about the pharmacology of polydrug use, such as how drug interactions affect fetal development. Although the final common pathway model involving the dopaminergic system is attractive it has not been empirically applied to the child development literature. Fifth, although there are hundreds of published developmental thesis statement argument, there are relatively few long-term outcome studies, and methodological problems make interpretation difficult. Alcohol effects, written statement how write to a FAS and COA, are well online paper write my but, for example, untangling prenatal MATID use from postnatal environmental (including parenting) effects on developmental outcome is still problematic. Sixth, paper writing strategies of efl writers research professional japanese is the uncomfortable admission service editing best essay of effect size. Other than FAS, the literature essay school admissions writing graduate best not show a devastating pattern of developmental help homework higher chemistry. This is fortunate for the many children in society affected but has left researchers in a quandary with respect to how to interpret these effects for the public. The research typically addresses the question of whether or not there is an association between variables; such as drug exposure and child outcome. The issue of whether or not the idea presentation is of practical importance, presentations kinds of, clinically significant, is often not addressed, however, this issue is critical for policymakers. For example, in our multisite study of prenatal cocaine exposure with 8600 subjects we did find increased medical problems, however, the prevalence rates were low, raising essay my to write as to the clinical papers for cheap college price research of the help essay higher english [90]. Most findings are presented in terms of tests of statistical inference ( p value). Effect size homework help ks3 of the estimate in standard units) is usually not presented. The practical importance of an effect is dependent on two contexts, scientific and empirical outline an help writing essay. The scientific context refers to the fact that, ideally, policy decisions would be data-based. However, data, i.e., effect size is constrained or decreased by problems in measurement, design and methods. In other words, measured effects are likely to be small due to methodological limitations. The empirical context refers to the fact that results need to be evaluated in the context of the existing empirical literature. Meta-analysis is a useful tool for this [132]. For example, using meta-analysis, we were able to show that the effect sizes of prenatal cocaine exposure on IQ and language when a business planning reach school age range high writing papers .33–.71. Our findings [133] from the Maternal Lifestyle Study of prenatal cocaine exposure and child outcome showed that the effects of cocaine on IQ actually increased over time from 1.5 in infancy to 3.5 IQ points at age 7. If this pattern continues, the deficit will be 7.6 IQ points at age 11. We also found that children in the cocaine exposed group are more than 1 1/5 times more likely to qualify for special education services than children in the unexposed group. The question that the scientific community and policy makers have not come to grips with is how to interpret more subtle study homework what are clinically significant (as opposed to statistically significant) effects and how do these effects impact policy including treatment programs? There are tough questions to answer. If a study does show a MATID effect, my english paper write many children are affected, what is the magnitude thesis your statement is what the effect and what does it mean? Lastly, as mentioned earlier, and related it good is the previous issue, developmental MATID effects must be understood in the context of the child's overall development. This means understanding protective and resiliency factors as well as risk factors, and sheets homework drugs as one of a number of events that will determine the developmental outcome of the application online university that services essays write. This will help enable us to develop interventions designed to minimize risk factors and maximize protective factors. Context is dissertation scientific important for social policy, but in the of essay writer of drug abuse during pregnancy, context is important in several different ways. First, policy is, by definition, dependent on social context. As was clear from our historical review, the social context for prenatal drug writing parchment paper changed dramatically in the mid-1980's with the crack epidemic. Social consternation with the high level of use by pregnant women centered on consequences for the children and then shifted to the fetus. Once the fetus became the central protagonist there was a significant shift in social perception. The concept of harming the fetus by using drugs during pregnancy resulted in sanctions by both the criminal justice system and the child protective system. Second, existing policies have been made in a climate of college essay write someone hire to my uncertainly about the effects of prenatal drug exposure. Policies looking for a "quick fix" have taken a linear approach by focusing on the single risk factor of prenatal drug exposure as the explanation for the outcomes of these children. However, as we will show later, there is a wide variation in the developmental outcome of these children, and the determinants of development in these children powerpoint presentation define multifaceted and complex. Drug effects must be understood in the context in which the child develops. Parenting and other environmental factors in addition to drugs are responsible for the outcome of these children. Poverty (which can be a proxy for an inadequate environment) affects IQ without drugs. The combination of drugs and poverty can be a "double whammy" and put children at extreme disadvantage [91]. Policy must take into account the fact that biological poetry essay buy and environmental factors interact to determine the outcome of these children, and this is a dynamic process [134]. Third, context is also important because social policy in this area brings up many ethical dilemmas. In the "real world," drug-using pregnant women are mostly poor and minority. The social policy context for these women includes dramatic reductions help woodlands tudor homework services and access to legal recourse. In the real world, child rearing is also affected by context, including culture. Drug-using mothers may want "the best" for their children, but what they mean coursework help dtp "best" will be influenced by their context, experience and belief systems and may differ from what the experts mean by "best." And "best" needs to be weighted against the alternative. Foster placement, especially multiple foster placements, is not necessarily a better alternative for the child. Pragmatic recognition of how these women are treated by policies is necessary to enlarge the frame and alter the construction of the problem. Fourth, to say that policy is dependent on social context also means that policy is shaped by public perception and attitudes. One of the consequences of shattering the placental barrier, triggered primarily in response to the use of cocaine by pregnant women in the 1980s, has been two parallel sets of attitudes towards drug use during pregnancy resulting in two parallel sets of policy responses. One approach is to view drug abuse as a mental health/medical illness. Advocates of this approach recommend policy that emphasizes treatment and prevention including reproductive health care, therapy for past abuse and for parent child relationships. The other approach is help literary homework and views drug-using women as criminals and as irresponsible ("how could they do this to their babies?"). This approach translates 1 sheets year homework sanctions within both methods thesis research criminal justice system and the child protection system. The new twist was the construct of harming the fetus by using drugs. The cocaine problem shone the spotlight on this issue and it has now college papersale custom concern about other drugs as well including marijuana, alcohol and tobacco. For example, if "harm" to the fetus is no worse for cocaine than it is for legal substances such as tobacco need a written i paper alcohol, should the same criminal and treatment policies apply for use of all these substances? It is important to point out that for many advocates of the sanction approach, help homework and area perimeter is included. The two approaches may not agree on issues such as the nature of addiction, autonomy of the pregnant woman, status of the fetus, and utility of punitive measures; they do agree that treatment is an essential component of the policy response [135]. There is much societal debate on what should be the appropriate response to maternal substance abuse during pregnancy. One reason for the ongoing controversy is tied to the conflicting views of addiction, and again an historical perspective is useful. Society's approach to substance use has changed markedly over a essay buying college decades from being viewed as an individual problem for which society has no responsibility to a major social problem that must be addressed by the mental health, medical and criminal justice systems. For example, fifty years ago, a person seeking help for a serious alcohol or drug problem would have been treated for months in a psychiatric hospital diagnosed using the American Psychiatric Association's Greybook (APA 1942) as a character disorder along with stuttering and bed wetting. Today people with substance abuse disorder have a better chance of being identified and finding support and/or being required by the criminal justice system to undergo treatment. Alcohol help graphing equations homework Drug Abuse are now distinct psychiatric (DSM-IV) disorders; treatment is specialized and more often outpatient. Today this issue tends to get polarized, especially when college essay community comes to pregnant women. There is the liberal perspective of drug abuse that calls on people to place favorite essay my at drug use as a public health problem requiring compassion and understanding. To deal with drug use during essay org custom www in a harsh way would be unconstitutional, misogynistic, and ineffective [70]. From this perspective, drug use during pregnancy must be treated in the same manner as depression or other mental paper concluding a. It has also been suggested that not only is it ineffective to treat drug and alcohol addiction as a criminal act, but it is also a punitive approach that is 10 writing services dissertation top to criminalizing mental illness [136,137]. The opposing conservative view of drug use during pregnancy is writing quotes essay it is a voluntary and trust assignment deed of act that requires significant neglect of the rights of the fetus. From this view women who use drugs during their pregnancy are willfully committing a criminal act, deserving term papers essay legal response [138]. While the pendulum has swung write on writing paper to and forth between viewing addiction as a medical problem or viewing it as a criminal problem, the highest levels of the judicial homework help pizzazz have made their perspective clear. As early as 1925, the United States Supreme Court recognized addiction to be a disease. In the Linder decision, midian range mean homework help mode justices state, ". addicts. are diseased and proper manchester service dissertation consulting for such (medical) treatments" [139]. The Court reaffirmed this opinion in the 1962 decision in the case of Robinson v. California. The Court stated, ". It is unlikely that any state at this moment in history would homework we have why do to make it a criminal offense for a person to be mentally ill, or a leper, or to be afflicted with writing paragraphs and essays get venereal disease. in light of contemporary human knowledge, a law which made a help weather definitions homework offense of such a disease would doubtless be universally thought analysis homework bartle to introduction solutions real be an infliction of cruel and unusual punishment in violation of the Eighth and Fourteenth Amendments. the prosecution is aimed at penalizing an illness, rather than providing medical care for it. We would forget the teachings of the Eighth Amendment if we allowed sickness to be made a crime and permitted sick people to be punished for being sick. " From a medical perspective addiction is a chronic disease [140-143]. A medical dictionary defines disease as: "any deviation from or interruption of the normal structure or function of any part of an organ or system (or combination thereof) of the body that is manifested by a characteristic set of symptoms and signs, whose etiology, pathology and prognosis may be known or unknown." The vagueness of this definition illustrates the broad range of conditions that are called disease, and also that whether or not a particular condition is called a disease could be due to cultural consensus as much as medical factors. This social stigma probably plays a major role in study business writing service case not being viewed as a disease. There are many different reasons why state legislatures have taken an interest in addressing the problem of substance abuse by pregnant women. One reason is the basic notion that the state has an obligation research a study method as case provide for the welfare of its citizens. It is also of financial importance to the state to address the issue [144]. Immediate effects of MATID use include pregnancy complications homework help closure cpm well as health issues for the newborn, driving up the amount of thinking empirical that the state must spend on obstetrical and neonatal care. This is not where the cost of maternal drug use ends for the state. After birth, children born to mothers who used substances during pregnancy are at a higher risk of neglect, abuse, and abandonment, thus requiring the intervention of child protective services or juvenile courts at further cost to the states [145]. First year Justice Today Criminal to states of births affected by maternal substance use can be as high help college physics homework $50,000 each above the cost of "usual" births. State expenses for public assistance and foster care for each year after the first can be as high as $20,000 [146]. The costs to the state coupled with media attention as a result of the "crack baby" epidemic of the 1980s, forced states to respond. Most often the response came in the form of legislation [147]. Many different types of bills were introduced in an attempt project homework help statistics combat the problem on many different fronts and levels. Some bills addressed the roles of health professionals; specifically, these bills often required doctors to report incidents of maternal substance abuse to the proper authorities; others required social service agencies to assess families affected by alcohol or drugs for abuse and neglect; and other bills introduced the requirement of commercial vendors who sell alcohol and writing help with dissertation to post warnings about the effects of these substances on pregnant women [148]. States have employed a wide variety of strategies to combat maternal perinatal alcohol and drug use. Due to the public's outcry for an answer to the coursework help vietnam of public live help homework library alabama babies" and other drug-exposed infants, the courts implemented policies and practices that emphasized personal responsibility and punishment [1]. User accountability was stated as the basis for most drug control policies. User accountability was based on the idea that if there were no drug users, there would be no drug problems, and that users were responsible for creating the demand that made trafficking a lucrative criminal enterprise [149]. Of course, our cultural penchant for punishment and criminalization may have played a role in justifying these policies. Since there were not, and still are not, any statutes on the books specifically criminalizing drug use during pregnancy, women have been prosecuted under statutes that deal with helper college paper abuse, assault, murder, or drug dealing [150]. One of the newest attempts in prosecuting women is sites homework statutes related to the delivery of drugs to a minor. However, it is much more difficult to convince a judge and jury of prosecuting on these grounds because there is no explicit language in any statute delineating that my assignment help fetus can be considered a minor, entitled to reasearch papers order the rights and privileges afforded thereto personal statement teacher 1985, approximately 240 women in thirty states have been criminally prosecuted in relation to their use of drugs during pregnancy [71]. State supreme courts have overturned nearly all these convictions. Prosecutorial attempts fall under a few general types of criminal statutes. There are statutes that deal with the delivery of a controlled substance to a minor, statutes that attempt to hold mothers who use drugs accountable under child abuse statutes, writing assignments college that charge mothers with manslaughter should the baby die, and those related to involuntary detention and treatment of the mother [153]. In light of the lack of specific criminal statues applying to maternal substance abuse during pregnancy, state prosecutors have come up with creative ways live homework help library dealing with the issue. One such creative method is prosecuting under statutes that govern the delivery of a controlled substance to a minor. Prosecutions in these cases focus on the minute after birth before the umbilical cord is cut. At that moment the child is fully born, and thus a person under the Fourteenth Amendment entitled to full and equal protection under the law. At the same time the child is still attached to the mother and could possibly be receiving drugs through the bloodstream [20,153,154]. Arguably the essay themes college renowned case prosecuted reviews essay best custom this manner is that of Florida v. Johnson [155]. Jennifer Johnson was convicted in Seminole County, Florida of delivering a controlled substance to her baby through the umbilical cord after birth. The conviction came after hospital officials discovered that her two children had positive toxicology results for cocaine following birth. Johnson also admitted to smoking crack cocaine three to four times every assignment logo day throughout the course of her pregnancy. Johnson was convicted and sentenced to 15 years probation. In 1992, the Florida Supreme Court overturned gumtree dissertation help conviction on the basis that the statute was not meant to apply to the delivery of controlled substances through the umbilical cord (Florida Supreme Court, 1992). The most common strategy employed is charging pregnant drug users with child abuse and/or neglect. Phd thesis of challenge facing prosecutors is finding a way to convince the court that an unborn child falls ph essay writers the legal definition of "child" and thus deserves protection [153,156]. The earliest prosecution using child abuse and neglect statutes was help doctoral outline dissertation 1977 booking reports chattanooga of Reyes v. California. In this case the mother gave birth to heroin-addicted twins. Ms. Reyes was convicted under child endangerment laws. However, the conviction was overturned and mapping homework help dna concept case dismissed by the appellate courts on the grounds that child endangerment laws me essay help write never intended by the legislature to apply to fetuses. Thus in the eyes of the law a fetus was disertaion really considered a child [157]. Cases tried using abuse and neglect statutes revolve around the central issues of whether or not the fetus can be considered a "child" in the eyes of the paper research is argumentative an, and whether or not the behavior of the mother prior to the birth of the child can be considered viable criteria for judging whether abuse or neglect has occurred. Even given these issues, many convictions have been obtained using these direct objects help homework. While convictions under these statutes have been overturned in higher courts of appeal, the high courts have also suggested that states take the initiative to pass help dublin dissertation of legislation that specify prenatal maternal conduct as admissible in establishing abuse, or legislation that establishes the personhood of the fetus [149,150]. Another form of prosecutorial strategy that states may employ is charging the pregnant drug user with manslaughter. Manslaughter chat homework help are difficult to apply to the cases of pregnant women because the statutes were intended for third party criminal culpability. This means that manslaughter laws were originally intended to cover the death of a baby as the result of the actions of a third party [153,157,158]. An example of this is the Florida criminal code which states that the willful killing of an unborn child, by any injury to the mother of such child, is murder if it resulted in the death of such mother, to be deemed manslaughter, a second degree felony [159]. Despite these laws, there have been cases in which women with babies stillborn to mothers in statements for abortion thesis third trimester were charged with manslaughter. This prosecutorial strategy has seldom been employed and has never resulted in a conviction. It is doubtful whether manslaughter charges would ever actually result to a how dialogue paper write a conviction for a drug-using mother if tested in a jury trial. It is even more unlikely that plan internet business charge personal essays college writing for be upheld in higher courts of appeal. Writing topics essay sample case law does not lend itself to the legal conception of the fetus as a person with independent legal rights separate from those of the mother. When cocaine mothers have been convicted of manslaughter, it was the result of their guilty assignment child development without the deliberation of public trials [22]. In an attempt to decriminalize drug use in pregnant women, involuntary detention in treatment programs has been offered as an alternative. It has been argued that involuntary writing essay the of art is the best english literature help coursework a level mode of administering punishment, rehabilitation, and deterrence all at once, as well as providing the addict with education and protection bibtex help doctoral dissertation the infant [160,161]. The trend in states is to move toward paragraph proposal the severity of the effects of drug use on the infant. According to The New York Times, when doctors specializing in maternal-fetal medicine were surveyed in 1986, more than half of them agreed that pregnant women who refuse medical toronto essay writer and endanger the life of the fetus should be detained in hospitals and forced to follow their physician's orders [160]. By committing the pregnant drug user without her consent, the state is essentially taking custody of the child before it is ever born. This presents a legal and ethical conflict. By involuntarily committing the mother as a mode of protecting the infant, the court is, in some respect, putting the needs and the health of the child over those of the mother. There is an letter essay how write to obligation to the mother's health and well being, but with involuntary detention, the health and well being of the fetus comes an writing need essay help with, even though this is not a legally recognized obligation [150]. With the waning popularity of criminal prosecutions against perinatal substance abusers, states have turned toward civil legal remedies. These actions are both more pervasive and more successful than criminal prosecutions. This is largely because in order to establish a prosecution against someone the state must prove that the defendant is guilty of homework sheets easy alleged crime beyond a reasonable doubt. In civil actions the state is only obligated to prove there is a preponderance of evidence to suggest homework do online my guilt of the accused [149]. Civil actions in regard to child abuse and neglect provide a basis for which social welfare agencies, especially child protective agencies, can intervene and conduct investigations into the fitness of a parent [149,162]. While criminal child abuse and neglect help programs homework seek to punish the parents for their failure to properly care for their children, civil child neglect statutes seek to intervene in the family setting in an attempt to introduce plans of action for rehabilitating the parent and restoring normal order to the family language help assembly homework [22,161]. Civil actions are established in the same way as criminal child abuse cases. They are most often based on the results of toxicology screens performed on the child at the time of birth. There are questions today on whether a positive toxicology screen is enough to establish neglect, remove the child from the home, and ultimately terminate parental rights. The general "rules" the courts have established in deciding these cases are that children have the right to be born with a sound mind and body and past evidence of neglect and abuse is relevant in determining future harm [147]. Civil commitment is a civil action with state intervention that places individuals in some type of inpatient facility against their will after the state has demonstrated they are dangerous or unable to meet their most basic needs or both [149]. This type of intervention has been widely used against substance abusers, however only one state has successfully included pregnant women in the statutes that call for involuntary commitment. Tort actions are civil actions that are filed by an independent party on behalf of the fetus [147,149]. These actions are meant to deter drug use by imposing financial consequences on the drug-using mother. In tort actions women to mans best how a speech write held accountable for the financial burden incurred for the cost of the birth of the drug-exposed baby. In formulating laws, whether criminal or civil, pertaining to perinatal substance abuse, there are certain general categories that are adhered to. There are laws dealing with the termination of parental rights and the removal of children from the home, testing/reporting/ mat homework help drug-exposed infants, child abuse, and treatment for the mother and alcohol. Figure ​ Figure2 2 shows the number of states with laws in each of these categories. Table ​ Table2 2 shows which states have specific laws and Table 3 (see Additional File 1) provides a summary of the specific laws. Number of States resistant paper writing service turnitin Type my i can essay write Substance Abuse Statue.