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Meinhofer A, Chandra N, Byanova D, Keyes KM. Foster Care and Health in Medicaid-Enrolled Children Experiencing Parental Opioid Use Disorder. JAMA Netw Open 2024; 7:e2410432. [PMID: 38717771 PMCID: PMC11079692 DOI: 10.1001/jamanetworkopen.2024.10432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/08/2024] [Indexed: 05/12/2024] Open
Abstract
Importance The burden of the US opioid crisis has fallen heavily on children, a vulnerable population increasingly exposed to parental opioid use disorder (POUD) in utero or during childhood. A paucity of studies have investigated foster care involvement among those experiencing parental opioid use during childhood and the associated health and health care outcomes. Objective To examine the health and health care outcomes of children experiencing POUD with and without foster care involvement. Design, Setting, and Participants This population-based cohort study used nationwide Medicaid claims data from January 1, 2014, to December 31, 2020. Participants included Medicaid-enrolled children experiencing parental opioid use-related disorder during ages 4 to 18 years. Data were analyzed between January 2023 and February 2024. Exposure Person-years with (exposed) and without (nonexposed) foster care involvement, identified using Medicaid eligibility, procedure, and diagnostic codes. Main Outcomes and Measures The main outcomes included physical and mental health conditions, developmental disorders, substance use, and health care utilization. The Pearson χ2 test, the t test, and linear regression were used to compare outcomes in person-years with (exposed) and without (nonexposed) foster care involvement. An event study design was used to examine health care utilization patterns before and after foster care involvement. Results In a longitudinal sample of 8 939 666 person-years from 1 985 180 Medicaid-enrolled children, 49% of children were females and 51% were males. Their mean (SD) age was 10 (4.2) years. The prevalence of foster care involvement was 3% (276 456 person-years), increasing from 1.5% in 2014 to 4.7% in 2020. Compared with those without foster care involvement (8 663 210 person-years), foster care involvement was associated with a higher prevalence of developmental delays (12% vs 7%), depression (10% vs 4%), trauma and stress (35% vs 7%), and substance use-related disorders (4% vs 1%; P < .001 for all). Foster children had higher rates of health care utilization across a wide array of preventive services, including well-child visits (64% vs 44%) and immunizations (41% vs 31%; P < .001 for all). Health care utilization increased sharply in the first year entering foster care but decreased as children exited care. Conclusions and Relevance In this cohort study of Medicaid-enrolled children experiencing parental opioid use-related disorder, foster care involvement increased significantly between 2014 and 2020. Involvement was associated with increased rates of adverse health outcomes and health care utilization. These findings underscore the importance of policies that support children and families affected by opioid use disorder, as well as the systems that serve them.
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Affiliation(s)
- Angélica Meinhofer
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Nisha Chandra
- Medical College, Weill Cornell Medicine, New York, New York
| | | | - Katherine M. Keyes
- Department of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, New York
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Powell D. Growth in Suicide Rates Among Children During the Illicit Opioid Crisis. Demography 2023; 60:1843-1875. [PMID: 38009202 DOI: 10.1215/00703370-11077660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Abstract
This article documents child suicide rates from 1980 to 2020 in the United States using the National Vital Statistics System Multiple Cause of Death database. After generally declining for decades, suicide rates among children aged 10-17 accelerated from 2011 to 2018 in an unprecedented rise in both duration and magnitude. I consider the role of the illicit opioid crisis in driving this mental health crisis. In August 2010, an abuse-deterrent version of OxyContin was introduced and the original formulation was removed from the market, leading to a shift to illicit opioids and stimulating growth in illicit opioid markets. Areas more exposed to reformulation-as measured by pre-reformulation rates of OxyContin misuse in the National Survey on Drug Use and Health-were more affected by the transition to illicit opioids and experienced sharper growth in child suicide rates. The evidence suggests that children's illicit opioid use did not increase, implying that the illicit opioid crisis engendered higher suicide propensities by increasing suicidal risk factors for children, such as increasing rates of child neglect and altering household living arrangements. In complementary analyses, I document how living conditions declined for children during this time period.
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Stritzel H. Substance Use-Associated Infant Maltreatment Report Rates in the Context of Complex Prenatal Substance Use Policy Environments. CHILD MALTREATMENT 2023:10775595231213404. [PMID: 37955183 DOI: 10.1177/10775595231213404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
State responses to substance use during pregnancy have included policies designed to increase access to substance use treatment as well as punish such substance use. Prior research has found that punitive policies are associated with increased rates of child maltreatment reporting, but it is unclear if the presence of punitive-promoting policies also moderate the association between access-promoting polices and maltreatment reports. Using data from the National Child Abuse and Neglect Data System and state-level fixed effects models, this study investigates how interactions between access-promoting and punitive prenatal substance use policies are associated with rates of substance use-associated maltreatment reports among infants. In states with punitive policies, access-promoting policies were associated with smaller decreases in these reports than in states without punitive policies. In some cases, access-promoting policies were associated with greater increases in these reports when punitive policies were also present than when only one type of policy was adopted. Interactions between prenatal substance use policies may result in unintended and counterproductive consequences for maternal and child health and the child welfare system.
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Affiliation(s)
- Haley Stritzel
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Grant C, Radley J, Philip G, Lacey R, Blackburn R, Powell C, Woodman J. Parental health in the context of public family care proceedings: A scoping review of evidence and interventions. CHILD ABUSE & NEGLECT 2023; 140:106160. [PMID: 37023580 DOI: 10.1016/j.chiabu.2023.106160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/16/2023] [Accepted: 03/24/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Child protective services (CPS), or their equivalent, have statutory power to remove children from birth parents in instances of child abuse, neglect, or concerns around parenting capacity via public family care proceedings. Parents who have children subject to proceedings, 'birth parents', often have complex health and social care needs. OBJECTIVE We aimed to review what is known about the health needs of birth parents and the interventions implemented to support these health needs. METHODS We searched PubMed, Scopus, and grey literature using a systematic strategy of key concepts "health", "care proceedings", and "parents". We included all publications in English that reported parental health in the context of care proceedings from the 1st of January 2000 to the 1st of March 2021. RESULTS Included studies (n = 61) reported on maternal health (57 %) or the health of both parents (40 %), with only one study reporting on fathers alone. We conceptually categorised parental health need (n = 41) into i) mental health, ii) physical health, iii) substance misuse, iv) developmental disorders, and v) reproductive health. Health inequities and poor access to services were described across all categories, with longstanding issues often pre-dating proceedings or the child's birth. All interventions supporting parental health (n = 20) were targeted at mothers, with some supporting fathers (n = 8), formally or informally. We grouped similar interventions into three types: alternative family courts, wrap-around services, and specialist advocacy/peer support. CONCLUSIONS Parents who have children subject to care proceedings have complex health needs that pre-date CPS concerns. The studies included in our review strongly suggest that health issues are exacerbated by child removal, triggering deteriorations in mental health, poor antenatal health for subsequent pregnancies, and avoidable mortality. Findings highlight the need for targeted and timely intervention for parents to improve whole-family outcomes. There are models that have been designed, implemented, and tested using relationship-based, trauma-informed, multidisciplinary, family-focused, and long-term approaches.
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Affiliation(s)
- Claire Grant
- Department of Epidemiology and Public Health, University College London, UK.
| | - Jessica Radley
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
| | - Georgia Philip
- Centre for Research on Children & Families, University of East Anglia, Norwich, UK
| | - Rebecca Lacey
- Department of Epidemiology and Public Health, University College London, UK
| | - Ruth Blackburn
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Claire Powell
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Jenny Woodman
- Thomas Coram Research Unit, Social Research Institute, University College London, UK
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5
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Buckles K, Evans WN, Lieber EMJ. The drug crisis and the living arrangements of children. JOURNAL OF HEALTH ECONOMICS 2023; 87:102723. [PMID: 36638640 DOI: 10.1016/j.jhealeco.2022.102723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 11/16/2022] [Accepted: 12/30/2022] [Indexed: 06/17/2023]
Abstract
We examine the impact of the US drug crisis on children's living arrangements. Because factors that lead to drug use could also alter family structure, we instrument for the intensity of the drug crisis with cross-state exposure to marketing of the prescription opioid at the epicenter of the crisis. We find that the crisis increased the likelihood that a child lives away from a parent or in a household headed by a grandparent. Our results suggest that if drug use had remained at 1996 levels, 1.5 million fewer children aged 0-16 would have lived away from a parent in 2015.
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Affiliation(s)
- Kasey Buckles
- University of Notre Dame, NBER, and IZA, United States
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6
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Ali MM, Ghertner R. Is buprenorphine treatment availability associated with decreases in substantiated cases of child maltreatment? J Subst Abuse Treat 2022; 139:108780. [DOI: 10.1016/j.jsat.2022.108780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/04/2022] [Accepted: 03/30/2022] [Indexed: 11/17/2022]
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Bruzelius E, Levy NS, Okuda M, Suglia SF, Martins SS. Prescription Drug Monitoring and Child Maltreatment in the United States, 2004-2018. J Pediatr 2022; 241:196-202. [PMID: 34678247 DOI: 10.1016/j.jpeds.2021.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/13/2021] [Accepted: 10/15/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To test whether a policy approach aimed at decreasing prescription drug misuse, specifically, state monitoring of controlled substance prescriptions-prescription drug monitoring programs (PDMPs)-were associated with changes in Child Protective Services-reported maltreatment prevalence. STUDY DESIGN Using a difference-in-differences design and maltreatment data (2004-2018) from 50 states and the District of Columbia, we compared the prevalence of total maltreatment incidents and total victims, in states with and without PDMPs, before and after implementation. Exploratory analyses further examined models disaggregated by maltreatment type (neglect, physical abuse, sexual abuse, psychological abuse) and among different racial/ethnic groups. Quasi-Poisson models included state-level covariates, state- and year-fixed effects, and cluster-robust standard errors. RESULTS Difference-in-differences models identified greater relative reductions in PDMP states relative to controls (total prevalence ratio, 0.87; 95% CI, 0.80, 0.940; victimization prevalence ratio, 0.92; 95% CI, 0.85-0.98) over the observation period. Decreases seemed to be driven by changes in neglect (prevalence ratio, 0.87; 95% CI, 0.80-0.93) and physical abuse (prevalence ratio, 0.78; 95% CI, 0.71-0.87) incidents, and may have been especially salient for American Indian/Alaskan Native children (prevalence ratio, 0.78; 95% CI, 0.65-0.94). CONCLUSIONS We found evidence supporting an association between prescription drug monitoring and reduced maltreatment prevalence at the state level. Policies aimed at restricting the prescribing and dispensing of controlled substances may have indirect implications for child welfare.
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Affiliation(s)
| | - Natalie S Levy
- Department of Epidemiology, Columbia University, New York, NY
| | - Mayumi Okuda
- Department of Psychiatry, Columbia University, New York, NY
| | - Shakira F Suglia
- Department of Epidemiology, Rollings School of Public Health, Emory University, Atlanta, GA
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Loch SF, Stein BD, Ghertner R, McNeer E, Dupont WD, Smart R, Patrick SW. Neonatal Opioid Withdrawal Syndrome Is Associated With Infant Foster Care Entry At The County Level. Health Aff (Millwood) 2021; 40:1776-1783. [PMID: 34644183 DOI: 10.1377/hlthaff.2021.00460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Although the number of infants diagnosed with neonatal opioid withdrawal syndrome (NOWS) and the number of infants entering foster care have increased substantially in the US since 2009, analyses exploring their relationship are lacking. Using data from 580 US counties in eight US states from the period 2009-17, we examined the association of county rates of NOWS and county-level characteristics with infant foster care entries. In adjusted analyses, every one diagnosis of NOWS per ten births was associated with a 41 percent higher rate of infant foster care entry, and rural county residence was associated with a 19 percent higher rate of infant foster entry. A higher employment rate was associated with lower rates of infant foster care entry both overall and in urban counties when we stratified by rurality. These findings suggest that policy makers could use information about county characteristics to better target funding to support opioid-affected families at risk for foster care involvement.
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Affiliation(s)
- Sarah F Loch
- Sarah F. Loch is a director of research operations at the Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, in Nashville, Tennessee
| | - Bradley D Stein
- Bradley D. Stein is a senior physician policy researcher in the Department of Behavioral and Policy Sciences, RAND Corporation, and director of the RAND-USC Schaeffer Opioid Policy, Tools, and Information Center of Research Excellence, in Pittsburgh, Pennsylvania
| | - Robin Ghertner
- Robin Ghertner is the director of the Division of Data and Technical Analysis, Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services, in Washington, D.C
| | - Elizabeth McNeer
- Elizabeth McNeer is a senior biostatistician in the Department of Biostatistics and the Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center
| | - William D Dupont
- William D. Dupont is a professor of biostatistics and preventive medicine in the Department of Biostatistics and the Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center
| | - Rosanna Smart
- Rosanna Smart is an economist at the RAND Corporation in Santa Monica, California
| | - Stephen W Patrick
- Stephen W. Patrick is an associate professor of pediatrics and health policy, a practicing neonatologist in the Division of Neonatology, and director of the Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, and an adjunct physician policy researcher at the RAND Corporation
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Day E, Tach L, Fuzzell L, Mathios E, Kallaher A. The Consequences of Postnatal Parental Opioid Misuse on Child Well-Being: a Scoping Review. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2021. [DOI: 10.1080/1067828x.2021.1971130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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10
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Rebbe R, Bishop AS, Ahn J, Mienko JA. Opioid overdose events and child maltreatment indicators: Differential county-level associations. CHILDREN AND YOUTH SERVICES REVIEW 2020; 119:105671. [PMID: 33384462 PMCID: PMC7771646 DOI: 10.1016/j.childyouth.2020.105671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Rebecca Rebbe
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 1150 South Olive Street, Suite 1400, Los Angeles CA USA 90015
| | - Asia S. Bishop
- School of Social Work, University of Washington, 4101 15 Ave NE Seattle WA USA, 98105
| | - Jooree Ahn
- Center for Social Sector Analytics & Technology, School of Social Work, University of Washington, 4101 15 Ave NE Seattle WA USA, 98105
| | - Joseph A. Mienko
- Center for Social Sector Analytics & Technology, School of Social Work, University of Washington, 4101 15 Ave NE Seattle WA USA, 98105
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Meinhofer A, Onuoha E, Angleró-Díaz Y, Keyes KM. Parental drug use and racial and ethnic disproportionality in the U.S. foster care system. CHILDREN AND YOUTH SERVICES REVIEW 2020; 118:105336. [PMID: 32863501 PMCID: PMC7455003 DOI: 10.1016/j.childyouth.2020.105336] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND AND AIMS Following nearly a decade of entry declines, foster care entries in the United States began to rise steadily since 2012, largely because of dramatic increases in home removals involving parental drug use (PDU). America's ongoing opioid crisis and recent changes in drug policies have been associated with the growth in PDU entries. The extent to which these and other recent factors have affected historical racial/ethnic differences in the foster care system is unknown. We explored the prevalence of racial/ethnic disproportionality and disparity in PDU entries and described children characteristics across racial/ethnic populations. DESIGN Secondary data analysis of the universe of foster care entries in 2008-2017, obtained from the Adoption and Foster Care Analysis and Reporting System. SETTING Children ages 0-17 entering foster care in the United States. CASES A total of 2,489,423 foster care entries, 29% (N=714,085) designated as involving PDU. MEASUREMENTS The rate of PDU entries was measured as the number of foster care entries involving PDU per 1,000 children ages 0-17 in the general population, by racial/ethnic group. Disproportionality in PDU entries was measured as the proportion of a racial/ethnic group among PDU entries over their proportion among the general population. FINDINGS From 2008-2017, the rate of PDU entries increased 71% in the general population and across all racial/ethnic groups. Native American children displayed the highest level and fastest growth in PDU entry rates (139%; 1.74 in 2008 to 4.15 in 2017), followed by non-Hispanic White children (112%; 0.70 in 2008 to 1.49 in 2017). Native American children also displayed the highest level of disproportionality in foster care entries, with a representation in PDU entries and other entries about 3.23 and 2.56 times their representation in the general population. CONCLUSIONS Foster care entries involving PDU increased considerably across all racial/ethnic populations. Growth in PDU entries was greatest among Native American children, exacerbating existing disproportionalities in the foster care system for this vulnerable population.
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Affiliation(s)
- Angélica Meinhofer
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Erica Onuoha
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Yohanis Angleró-Díaz
- Department of Psychiatry, Boston Children’s Hospital and Harvard Medical School, Boston, MA
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12
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De Avila C, Andrews B, Buckman C, Tumin D, Ledoux M. Documentation of drug abuse in the family or household of children admitted to the hospital for non-accidental trauma. CHILD ABUSE & NEGLECT 2020; 109:104696. [PMID: 32877790 DOI: 10.1016/j.chiabu.2020.104696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/07/2020] [Accepted: 08/14/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Drug abuse in the family is known to increase the risk of child abuse, but its impact on outcomes of hospitalizations for non-accidental trauma (NAT) has not been characterized. OBJECTIVE We aimed to identify how frequently drug abuse in the household was documented among children with known or suspected NAT, and to correlate drug abuse in the family with hospitalization outcomes. PARTICIPANTS AND SETTING At our tertiary care hospital, we retrospectively queried hospital admissions of children ages 0-17 who had a Child Abuse and Neglect consultation ordered during an inpatient stay. METHODS Case manager documentation and consult notes from the inpatient response team were used to determine suspected or confirmed presence of household substance abuse. RESULTS We identified 185 children meeting inclusion criteria (59 % <1 year; 34 % 1-5 years; 7% 6-14 years of age). Drug abuse in the family was documented in 44 cases (24 %). Among 178 children surviving to discharge, drug abuse was associated with lower likelihood of discharge home (50 % vs. 70 % among children with no documented drug abuse, p = 0.018). After discharge, we found no statistically significant differences in rehospitalizations or emergency department visits according to documentation of drug abuse in the family. CONCLUSION Our study addresses the role of family drug abuse in outcomes of hospitalizations for NAT. Significantly, half of cases with suspected or known drug abuse had no prior CPS involvement, and drug abuse was associated with discharge outcomes after controlling for prior CPS involvement.
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Affiliation(s)
- Camila De Avila
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, United States
| | - Brooke Andrews
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, United States
| | - Cierra Buckman
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, United States.
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, United States
| | - Matthew Ledoux
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, United States
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Cotti CD, Gordanier JM, Ozturk OD. The relationship of opioid prescriptions and the educational performance of children. Soc Sci Med 2020; 265:113406. [PMID: 33070016 DOI: 10.1016/j.socscimed.2020.113406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/26/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
One of the more salient aspects of the opioid crisis in America has been the disparate impact it has had on communities. This paper considers the possibility that opioid abuse might have negative spillovers onto student performance in schools within the communities most affected. We use administrative data on individual children's test scores (grades 3 through 8) in South Carolina from the 2005-06 to 2016-17 academic years. These data are then linked to county-level changes in opioid prescriptions rates. Findings show that an increase in the opioid prescription rate in a county is associated with a statistically significant reduction in white student test scores, but no such decline was found among non-white students. This relationship is robust to controls for changing county-level economic conditions, time-varying controls for student-level poverty, county characteristics, and county time trends. Among white students, the association is strongest among rural students in households that are not receiving SNAP or TANF benefits. Given the importance of educational attainment, this reduction in test scores associated with high rates of opioid prescriptions may indicate that there will be long-lasting spillover effects of the opioid crisis.
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Affiliation(s)
- Chad D Cotti
- University of Wisconsin -Oshkosh College of Business, 800 Algoma Blvd, Oshkosh, WI, 54901, USA.
| | - John M Gordanier
- University of South Carolina, Darla Moore School of Business Economics Department, 1014 Greene Street, Columbia, SC, 29208, USA.
| | - Orgul D Ozturk
- University of South Carolina, Darla Moore School of Business Economics Department, 1014 Greene Street, Columbia, SC, 29208, USA.
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Smart R, Kase CA, Taylor EA, Lumsden S, Smith SR, Stein BD. Strengths and weaknesses of existing data sources to support research to address the opioids crisis. Prev Med Rep 2020; 17:101015. [PMID: 31993300 PMCID: PMC6971390 DOI: 10.1016/j.pmedr.2019.101015] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 10/22/2019] [Accepted: 11/02/2019] [Indexed: 12/18/2022] Open
Abstract
Better opioid prescribing practices, promoting effective opioid use disorder treatment, improving naloxone access, and enhancing public health surveillance are strategies central to reducing opioid-related morbidity and mortality. Successfully advancing and evaluating these strategies requires leveraging and linking existing secondary data sources. We conducted a scoping study in Fall 2017 at RAND, including a literature search (updated in December 2018) complemented by semi-structured interviews with policymakers and researchers, to identify data sources and linking strategies commonly used in opioid studies, describe data source strengths and limitations, and highlight opportunities to use data to address high-priority public health research questions. We identified 306 articles, published between 2005 and 2018, that conducted secondary analyses of existing data to examine one or more public health strategies. Multiple secondary data sources, available at national, state, and local levels, support such research, with substantial breadth in data availability, data contents, and the data's ability to support multi-level analyses over time. Interviewees identified opportunities to expand existing capabilities through systematic enhancements, including greater support to states for creating and facilitating data use, as well as key data challenges, such as data availability lags and difficulties matching individual-level data over time or across datasets. Multiple secondary data sources exist that can be used to examine the impact of public health approaches to addressing the opioid crisis. Greater data access, improved usability for research purposes, and data element standardization can enhance their value, as can improved data availability timeliness and better data comparability across jurisdictions.
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Affiliation(s)
| | | | | | - Susan Lumsden
- Office of Health Policy, Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, United States
| | - Scott R. Smith
- Office of Health Policy, Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, United States
| | - Bradley D. Stein
- RAND Corporation, Pittsburgh, PA, United States
- University of Pittsburgh School of Medicine, Pittsburgh PA, United States
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15
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Meinhofer A, Angleró-Díaz Y. Trends in Foster Care Entry Among Children Removed From Their Homes Because of Parental Drug Use, 2000 to 2017. JAMA Pediatr 2019; 173:881-883. [PMID: 31305925 PMCID: PMC6632152 DOI: 10.1001/jamapediatrics.2019.1738] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study describes trends in the number and percentage of children who entered the US foster care system between 2000 and 2017 because of parental drug use, compared with all other causes.
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Affiliation(s)
- Angélica Meinhofer
- Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, New York
| | - Yohanis Angleró-Díaz
- Department of Psychiatry, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
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