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Aims of the Study: This study assesses whether, and the extent to which, the positive association between the two conditions reflects a causal link from major depression to higher BMI and obesity.

Methods: Individual-level data from three nationally-representative studies are utilized: (i) National Comorbidity Survey-Replication (N=3,229); (ii) National Longitudinal Survey of Youth-1979 (N=21,365); and (iii) Behavioral Risk Factor Surveillance System (N=2,858,973). Dependent variables include body mass index (BMI) and a dichotomous indicator for overweight or obese. We measure diagnosed major depression based on DSM-IV criteria and the CES Depression scale. While contemporaneous effects are considered, the study primarily focuses on the effects of past and lifetime depression to bypass reverse causality and further assess the role of non-random selection on unobservable factors. The effects of past and lifetime depression on obesity are estimated based on: (i) models that control for an extensive set of typically-unobserved factors, including parental history, family background, parental investments, risk-taking, and use of anti-depressants and other prescription medications; (ii) constrained selection models; and (iii) models controlling for family fixed effects.

Results: There are expectedly no significant or substantial effects of current depression on BMI or overweight/obesity, given that BMI is a stock that changes relatively slowly over time. Results also do not support a causal interpretation among males. However, among females, estimates indicate that past or lifetime diagnosis of major depression raises the probability of being overweight or obese by about seven percentage points. Results also suggest that this effect appears to plausibly operate through shifts in food consumption and physical activity.

AIMS OF STUDY: This study investigate the relationship between prenatal substance use and subsequent children's behavior problems in early childhood (4-6.5 years) and in later childhood (8-10.5 years). The datasets used are the Children of the National Longitudinal Survey (CNLSY), linked with the National Longitudinal Survey of Youth (NLSY79).

METHODS: Prenatal substance use is measured by binary indicators of smoking during pregnancy and alcohol-use during pregnancy. The outcome of interest is the age and gender specific standardized Behavior Problem Index (BPI) scale that is constructed using 32 mother-reported items on the child's behavior, as well as six sub-scales of problem behavior. Initially OLS regressions are estimated to verify the positive association between prenatal substance use and higher-levels of behavior problems. Thereafter, maternal fixed effects, maternal household fixed effects, propensity score matching, and propensity score inclusive regressions are all employed to obtain estimates of the effects of prenatal smoking and alcohol-use after reducing bias from unobserved confounding factors.

RESULTS: Initial OLS results find very strong associations between prenatal smoking and alcohol-use and higher levels of behavioral problems among both younger and older children. Howeve r, when we use fixed-effects, propensity-score matching and propensity-score inclusive regressions, prenatal alcohol use continues to be significant related with increases in behavior problems, but prenatal smoking by and large ceases to have any significant effects. DISCUSSION: While prenatal smoking has many deleterious outcomes for children, mostly related to low birthweight, it appears that the association between prenatal smoking and behavioral problems among children is largely driven by other confounding factors. On the other hand, results of this study suggest that prenatal alcohol-use may have true physiological/biological effects on the fetus that eventually exacerbate behavior problems. However, it should be noted that none of the methods used can account for all potential confounding factors -- especially time-variant ones -- hence, there may still remain some estimation bias. It should also be noted that the study suffers from certain shortcomings -- namely, behavioral problems as well as prenatal substance-use are all based on mother-reported data, and thus there are concerns about the accuracy of these measures. Hence, there remains scope for further research into this topic using alternate datasets. IMPLICATIONS FOR POLICY: The 1999 United States Surgeon General's Report stated that almost one in five children and adolescents in the U.S. exhibit signs of mental and behavioral disorder. This study suggests that policies aimed at reducing alcohol-use among pregnant women might contribute to reducing the prevalence of such disorders. However, while reducing cigarette use among pregnant women has numerous other health benefits for their children, it may not help reduce the incidence of behavior problems.