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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: Ghertner, Robin; Groves, Lincoln
    Reference Type: Report
    Year: 2018

    This study examines relationships between indicators of economic opportunity and the prevalence of prescription opioids and substance use in the United States. Overall, areas with lower economic opportunity are disproportionately affected by the opioid crisis. However, the extent of that relationship varies regionally.

    (1) The prevalence of drug overdose deaths and opioid prescriptions has risen unevenly across the county, with rural areas more heavily affected. Specific geographic areas, such as Appalachia, parts of the West and the Midwest, and New England, have seen higher prevalence than other areas.

    (2) Poverty, unemployment rates, and the employment-to-population ratio are highly correlated with the prevalence of prescription opioids and with substance use measures. On average, counties with worse economic prospects are more likely to have higher rates of opioid prescriptions, opioid-related hospitalizations, and drug overdose deaths.

    (3) Some high-poverty regions of the country were relatively isolated from the opioid epidemic, as shown by our...

    This study examines relationships between indicators of economic opportunity and the prevalence of prescription opioids and substance use in the United States. Overall, areas with lower economic opportunity are disproportionately affected by the opioid crisis. However, the extent of that relationship varies regionally.

    (1) The prevalence of drug overdose deaths and opioid prescriptions has risen unevenly across the county, with rural areas more heavily affected. Specific geographic areas, such as Appalachia, parts of the West and the Midwest, and New England, have seen higher prevalence than other areas.

    (2) Poverty, unemployment rates, and the employment-to-population ratio are highly correlated with the prevalence of prescription opioids and with substance use measures. On average, counties with worse economic prospects are more likely to have higher rates of opioid prescriptions, opioid-related hospitalizations, and drug overdose deaths.

    (3) Some high-poverty regions of the country were relatively isolated from the opioid epidemic, as shown by our substance use measures, as of 2016. (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: Ghertner, Robin; Baldwin, Melinda; Crouse, Gilbert; Radel, Laura; Waters, Annette
    Reference Type: Report
    Year: 2018

    This research brief describes how select indicators associated with substance use prevalence relate to the changing trend in child welfare caseloads. It is part of a series describing findings of a mixed methods study undertaken to better understand how parental substance use relates to child welfare caseloads, which began rising in 2012 following years of sustained declines. (Author abstract)

    This research brief describes how select indicators associated with substance use prevalence relate to the changing trend in child welfare caseloads. It is part of a series describing findings of a mixed methods study undertaken to better understand how parental substance use relates to child welfare caseloads, which began rising in 2012 following years of sustained declines. (Author abstract)

  • Individual Author: Institute for Research on Poverty
    Reference Type: Report
    Year: 2018

    The U.S. Centers for Disease Control and Prevention officially declared an opioid epidemic in 2011, and the problem has continued to grow; President Trump declared it a public health emergency in October 2017. Between 2000 and 2015, more than half a million people died from opioid overdose, half of which were from prescription (as opposed to illicit) drugs. In 2016, opioid overdose killed 91 Americans every day, more than 64,000 people by year’s end—almost double the deaths in 2015. Deaths from fentanyl, a synthetic opioid that is similar to morphine but 50 to 100 times more powerful, rose 540 percent in three years. In addition to rising overdose deaths among opioid users, the number of babies born with symptoms of opiate withdrawal due to maternal opioid use during pregnancy also continues to climb. Although substance abuse and addiction are complex social problems experienced by people from all walks of life, several studies suggest that opioid abuse and socioeconomic disadvantage are often intertwined. This brief draws the contours of the crisis, explores associations of low...

    The U.S. Centers for Disease Control and Prevention officially declared an opioid epidemic in 2011, and the problem has continued to grow; President Trump declared it a public health emergency in October 2017. Between 2000 and 2015, more than half a million people died from opioid overdose, half of which were from prescription (as opposed to illicit) drugs. In 2016, opioid overdose killed 91 Americans every day, more than 64,000 people by year’s end—almost double the deaths in 2015. Deaths from fentanyl, a synthetic opioid that is similar to morphine but 50 to 100 times more powerful, rose 540 percent in three years. In addition to rising overdose deaths among opioid users, the number of babies born with symptoms of opiate withdrawal due to maternal opioid use during pregnancy also continues to climb. Although substance abuse and addiction are complex social problems experienced by people from all walks of life, several studies suggest that opioid abuse and socioeconomic disadvantage are often intertwined. This brief draws the contours of the crisis, explores associations of low education and income with opioid misuse, and identifies some research gaps. (Author abstract)

     

  • Individual Author: Singh, Gopal K. ; Kogan, Michael D. ; Slifkin, Rebecca T.
    Reference Type: Journal Article
    Year: 2017

    Appalachia—a region that stretches from Mississippi to New York—has historically been recognized as a socially and economically disadvantaged part of the United States, and growing evidence suggests that health disparities between it and the rest of the country are widening. We compared infant mortality and life expectancy disparities in Appalachia to those outside the region during the period 1990–2013. We found that infant mortality disparities widened for both whites and blacks, with infant mortality 16 percent higher in Appalachia in 2009–13, and the region’s deficit in life expectancy increased from 0.6 years in 1990–92 to 2.4 years in 2009–13. The association between area poverty and life expectancy was stronger in Appalachia than in the rest of the United States. We found wide health disparities, including a thirteen-year gap in life expectancy among black men in high-poverty areas of Appalachia, compared to white women in low-poverty areas elsewhere. Higher mortality in Appalachia from cardiovascular diseases, lung cancer, chronic lower respiratory diseases or chronic...

    Appalachia—a region that stretches from Mississippi to New York—has historically been recognized as a socially and economically disadvantaged part of the United States, and growing evidence suggests that health disparities between it and the rest of the country are widening. We compared infant mortality and life expectancy disparities in Appalachia to those outside the region during the period 1990–2013. We found that infant mortality disparities widened for both whites and blacks, with infant mortality 16 percent higher in Appalachia in 2009–13, and the region’s deficit in life expectancy increased from 0.6 years in 1990–92 to 2.4 years in 2009–13. The association between area poverty and life expectancy was stronger in Appalachia than in the rest of the United States. We found wide health disparities, including a thirteen-year gap in life expectancy among black men in high-poverty areas of Appalachia, compared to white women in low-poverty areas elsewhere. Higher mortality in Appalachia from cardiovascular diseases, lung cancer, chronic lower respiratory diseases or chronic obstructive pulmonary disease, diabetes, nephritis or kidney diseases, suicide, unintentional injuries, and drug overdose contributed to lower life expectancy in the region, compared to the rest of the country. Widening health disparities were also due to slower mortality improvements in Appalachia. (Author abstract)

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