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The SSRC Library allows visitors to access materials related to self-sufficiency programs, practice and research. Visitors can view common search terms, conduct a keyword search or create a custom search using any combination of the filters at the left side of this page. To conduct a keyword search, type a term or combination of terms into the search box below, select whether you want to search the exact phrase or the words in any order, and click on the blue button to the right of the search box to view relevant results.

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  • Individual Author: Aliprantis, Dionissi; Fee, Kyle; Schweitzer, Mark E.
    Reference Type: Journal Article
    Year: 2019

    This paper studies the relationship between local opioid prescription rates and labor market outcomes. We improve the joint measurement of labor market outcomes and prescription rates in the rural areas where nearly 30 percent of the US population lives. We find that increasing the local prescription rate by 10 percent decreases the prime-age employment rate by 0.50 percentage points for men and 0.17 percentage points for women. This effect is larger for white men with less than a BA (0.70 percentage points) and largest for minority men with less than a BA (1.01 percentage points). Geography is an obstacle to giving a causal interpretation to these results, especially since they were estimated in the midst of a large recession and recovery that generated considerable cross-sectional variation in local economic performance. We show that our results are not sensitive to most approaches to controlling for places experiencing either contemporaneous labor market shocks or persistently weak labor market conditions. We also present evidence on reverse causality, finding that a short-...

    This paper studies the relationship between local opioid prescription rates and labor market outcomes. We improve the joint measurement of labor market outcomes and prescription rates in the rural areas where nearly 30 percent of the US population lives. We find that increasing the local prescription rate by 10 percent decreases the prime-age employment rate by 0.50 percentage points for men and 0.17 percentage points for women. This effect is larger for white men with less than a BA (0.70 percentage points) and largest for minority men with less than a BA (1.01 percentage points). Geography is an obstacle to giving a causal interpretation to these results, especially since they were estimated in the midst of a large recession and recovery that generated considerable cross-sectional variation in local economic performance. We show that our results are not sensitive to most approaches to controlling for places experiencing either contemporaneous labor market shocks or persistently weak labor market conditions. We also present evidence on reverse causality, finding that a short-term unemployment shock did not increase the share of people abusing prescription opioids. Our estimates imply that prescription opioids can account for 44 percent of the realized national decrease in men’s labor force participation between 2001 and 2015. (Author abstract)

  • Individual Author: Skewes, Monica C.; Blume, Arthur W.
    Reference Type: Journal Article
    Year: 2019

    Historians and scholars from various disciplines have documented the pervasive influence of racism on American society and culture, including effects on the health and well-being of American Indian (AI) people. Among the many health problems affected by racial discrimination and oppression, both historical and current, are substance use disorders. Epidemiological studies have documented greater drug and alcohol-related morbidity and mortality among AI/AN Alaska Natives compared to other ethnic groups, and culturally appropriate, effective interventions are sorely needed. We collected, as part of a larger community-based participatory research project to address substance use disparities in rural AI communities, qualitative interview data from 25 AI key informants from a frontier reservation in Montana. Using a semistructured interview guide, we asked participants to discuss their perceptions of the causes of substance use problems and barriers to recovery on the reservation. Although no questions specifically asked about discrimination, key informants identified stress from...

    Historians and scholars from various disciplines have documented the pervasive influence of racism on American society and culture, including effects on the health and well-being of American Indian (AI) people. Among the many health problems affected by racial discrimination and oppression, both historical and current, are substance use disorders. Epidemiological studies have documented greater drug and alcohol-related morbidity and mortality among AI/AN Alaska Natives compared to other ethnic groups, and culturally appropriate, effective interventions are sorely needed. We collected, as part of a larger community-based participatory research project to address substance use disparities in rural AI communities, qualitative interview data from 25 AI key informants from a frontier reservation in Montana. Using a semistructured interview guide, we asked participants to discuss their perceptions of the causes of substance use problems and barriers to recovery on the reservation. Although no questions specifically asked about discrimination, key informants identified stress from racism as an important precipitant of substance use and barrier to recovery. As one participant stated: “Oppression is the overarching umbrella for all sickness with drugs and alcohol.” Participants also identified historical trauma resulting from colonization as a manifestation of race-based stress that drives behavioral health problems. Findings suggest that interventions for AIs with substance use disorders, and possibly other chronic health problems, may be more effective if they address social determinants of health such as racial discrimination and historical trauma. (Author abstract)

  • Individual Author: Azuine, Romuladus E.; Ji, Yuelong; Chang, Hsing-Yuan; Kim, Yoona; Ji, Hongkai; DiBari, Jessica; Hong, Xiumei; Wang, Guoying; Singh, Gopal K.; Pearson, Colleen; Zuckerman, Barry; Surkan, Pamela J.; Wang, Xiaobin
    Reference Type: Journal Article
    Year: 2019
    Importance: The opioid epidemic increasingly affects pregnant women and developing fetuses, resulting in high rates of neonatal abstinence syndrome. However, longitudinal studies that prospectively observe newborns with neonatal abstinence syndrome or with maternal opioid use and examine their long-term physical and neurodevelopmental outcomes are lacking.
     
    Objective: To examine prenatal risk factors associated with maternal opioid use during pregnancy and the short-term and long-term health consequences on their children.
     
    Design, Setting, and Participants: This cohort study analyzed data from the Boston Birth Cohort, an urban, low-income, multiethnic cohort that enrolled mother-newborn pairs at birth at Boston Medical Center (Boston, Massachusetts) starting in 1998, and a subset of children were prospectively observed at Boston Medical Center pediatric primary care and subspecialty clinics from birth to age 21 years. Data analysis began in June 2018 and was completed in May 2019...
    Importance: The opioid epidemic increasingly affects pregnant women and developing fetuses, resulting in high rates of neonatal abstinence syndrome. However, longitudinal studies that prospectively observe newborns with neonatal abstinence syndrome or with maternal opioid use and examine their long-term physical and neurodevelopmental outcomes are lacking.
     
    Objective: To examine prenatal risk factors associated with maternal opioid use during pregnancy and the short-term and long-term health consequences on their children.
     
    Design, Setting, and Participants: This cohort study analyzed data from the Boston Birth Cohort, an urban, low-income, multiethnic cohort that enrolled mother-newborn pairs at birth at Boston Medical Center (Boston, Massachusetts) starting in 1998, and a subset of children were prospectively observed at Boston Medical Center pediatric primary care and subspecialty clinics from birth to age 21 years. Data analysis began in June 2018 and was completed in May 2019.
     
    Exposures: In utero opioid exposure was defined as maternal self-reported opioid use and/or clinical diagnosis of neonatal abstinence syndrome.
     
    Main Outcomes and Measures: Pregnancy outcomes, postnatal child physical health, and major neurodevelopmental disabilities, documented in maternal and child medical records.
     
    Results: This study included 8509 Boston Birth Cohort mother-newborn pairs for prenatal and perinatal analyses. Of those, 3153 children continued to receive pediatric care at Boston Medical Center and were included in assessing postnatal outcomes. Overall, 454 of the 8509 children (5.3%) in the Boston Birth Cohort had in utero opioid exposure. At birth, opioid exposure was associated with higher risks of fetal growth restriction (odds ratio [OR], 1.87; 95% CI, 1.41-2.47) and preterm birth (OR, 1.49; 95% CI, 1.19-1.86). Opioid exposure was associated with increased risks of lack of expected physiological development (OR, 1.80; 95% CI, 1.17-2.79) and conduct disorder/emotional disturbance (OR, 2.13; 95% CI, 1.20-3.77) among preschool-aged children. In school-aged children, opioid exposure was associated with a higher risk of attention-deficit/hyperactivity disorder (OR, 2.55; 95% CI, 1.42-4.57).
     
    Conclusions and Relevance: In this sample of urban, high-risk, low-income mother-child pairs, in utero opioid exposure was significantly associated with adverse short-term and long-term outcomes across developmental stages, including higher rates of physical and neurodevelopmental disorders in affected children. Efforts to prevent the opioid epidemic and mitigate its health consequences would benefit from more intergenerational research. (Author abstract)
  • Individual Author: Honein, Margaret A.; Boyle, Coleen; Redfield, Robert R.
    Reference Type: Journal Article
    Year: 2019

    The US opioid crisis is the public health emergency of our time and requires urgent public health action to monitor and protect the most vulnerable Americans. We have witnessed a startling death toll in 2017 with 70 237 drug overdose deaths in the United States, of which two-thirds involved opioids. The devastating consequences of this epidemic for mothers and infants have received less attention. Increases in opioid use and misuse in pregnancy have paralleled the increases in the general population; at delivery hospitalization, there were 4 times as many women with an opioid use disorder in 2014 compared with 1999. One of the most immediate and visible impacts of the opioid crisis on infants is the drug withdrawal in the newborn period, termed neonatal abstinence syndrome (NAS). On the basis of 2014 data, 1 newborn was diagnosed with NAS every 15 minutes in the United States, totaling about 32 000 infants annually with associated hospital costs estimated at $563 million. (author introduction)

    The US opioid crisis is the public health emergency of our time and requires urgent public health action to monitor and protect the most vulnerable Americans. We have witnessed a startling death toll in 2017 with 70 237 drug overdose deaths in the United States, of which two-thirds involved opioids. The devastating consequences of this epidemic for mothers and infants have received less attention. Increases in opioid use and misuse in pregnancy have paralleled the increases in the general population; at delivery hospitalization, there were 4 times as many women with an opioid use disorder in 2014 compared with 1999. One of the most immediate and visible impacts of the opioid crisis on infants is the drug withdrawal in the newborn period, termed neonatal abstinence syndrome (NAS). On the basis of 2014 data, 1 newborn was diagnosed with NAS every 15 minutes in the United States, totaling about 32 000 infants annually with associated hospital costs estimated at $563 million. (author introduction)

  • Individual Author: Prindle, John J.; Hammond, Ivy; Putnam-Hornstein, Emily
    Reference Type: Journal Article
    Year: 2018

    Infants have the highest rates of maltreatment reporting and entries to foster care. Prenatal substance exposure is thought to contribute to early involvement with child protective services (CPS), yet there have been limited data with which to examine this relationship or variations by substance type. Using linked birth, hospital discharge, and CPS records from California, we estimated the population prevalence of medically diagnosed substance exposure and neonatal withdrawal disorders at birth. We then explored the corresponding rates of CPS involvement during the first year of life by substance type after adjusting for sociodemographic and health factors. Among 551,232 infants born alive in 2006, 1.45% (n = 7994) were diagnosed with prenatal substance exposure at birth; 61.2% of those diagnosed were reported to CPS before age 1 and nearly one third (29.9%) were placed in foster care. Medically diagnosed prenatal substance exposure was strongly associated with an infant’s likelihood of being reported to CPS, yet significant variation in the likelihood and level of CPS...

    Infants have the highest rates of maltreatment reporting and entries to foster care. Prenatal substance exposure is thought to contribute to early involvement with child protective services (CPS), yet there have been limited data with which to examine this relationship or variations by substance type. Using linked birth, hospital discharge, and CPS records from California, we estimated the population prevalence of medically diagnosed substance exposure and neonatal withdrawal disorders at birth. We then explored the corresponding rates of CPS involvement during the first year of life by substance type after adjusting for sociodemographic and health factors. Among 551,232 infants born alive in 2006, 1.45% (n = 7994) were diagnosed with prenatal substance exposure at birth; 61.2% of those diagnosed were reported to CPS before age 1 and nearly one third (29.9%) were placed in foster care. Medically diagnosed prenatal substance exposure was strongly associated with an infant’s likelihood of being reported to CPS, yet significant variation in the likelihood and level of CPS involvement was observed by substance type. Although these data undoubtedly understate the prevalence of prenatal illicit drug and alcohol use, this study provides a population-based characterization of a common pathway to CPS involvement during infancy. Future research is needed to explicate the longer-term trajectories of infants diagnosed with prenatal substance exposure, including the role of CPS. (Author abstract)

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