Timing of poverty in childhood and adolescent health: Evidence from the US and UK

Childhood poverty is associated with poorer adolescent health and health behaviours, but the importance of the timing of poverty remains unclear. There may be critical or sensitive periods in early life or early adolescence, or poverty may have cumulative effects throughout childhood. Understanding when poverty is most important can support efficient timing of interventions to raise family income or buffer against the effects of low income, but answers may vary across social contexts. The US and the UK are a useful comparison with similar liberal approaches to cash transfers, but very different approaches to healthcare provision. Utilising data from large population studies in the US (n = 9408; born 1979–1996) and UK (n = 1204; born 1991–1997), this study employs a structured life course approach to compare competing hypotheses about the importance of the timing or pattern of childhood exposure to poverty in predicting adolescent health limitations, symptoms of psychiatric distress, and smoking at age 16 (age 15/16 in US). Household income histories identified experience of poverty (measured as <60% of the national median equivalised income for a given year) in early life (ages 0–5), mid-childhood (ages 6–10) and early adolescence (ages 11–15). The Bayesian Information Criterion (BIC) compared fit across models with variables representing different life course patterns of exposure to poverty. Adolescent distress was not associated with poverty in either country. In both countries, however, variables representing cumulative or persistent experiences of poverty exhibited optimal fit of all poverty exposure variables in predicting adolescent smoking and health limitations. There was also evidence of an early life sensitive period for smoking in the US. Poverty was more persistent in the US, but associations between poverty and outcomes were consistent across countries. Although poverty can have cumulative effects on health and behaviour, early interventions may offer the best long-term protection

Substance Use-Associated Infant Maltreatment Report Rates in the Context of Complex Prenatal Substance Use Policy Environments

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

Adverse childhood experiences and substance use across diverse neighborhoods

Adverse childhood experiences (e.g., abuse, substance abuse or mental illness in the household, incarceration of a family member) have gained prominence in the medical and epidemiological literature in recent years due in part to the implications these experiences have for later adult health. One pathway by which adverse childhood experiences influence later health is through the development of problematic health behaviors that serve as coping mechanisms, such as drinking alcohol and smoking. Individuals typically initiate these behaviors in one form or another during adolescence, a time of experimentation and increased autonomy. Accordingly, the first aim of this study analyzes the extent to which adverse childhood experiences are linked with later substance use during adolescence and the transition to adulthood. In addition to the household environment, neighborhood context may also play a role in adolescents’ substance use behaviors. Protective resources in youth’s neighborhood, such as collective efficacy, might buffer the effects of growing up in a troubled household, although other neighborhood environments may contribute to youth’s substance use. The second aim of this study explores how the neighborhood social context moderates the association between adverse childhood experiences and later substance use. Lastly, as substance use shows systematic age-related patterns, the third aim of this study tests if the foregoing relationships vary by age. This study uses the Project on Human Development in Chicago Neighborhoods data to estimate multi-level models predicting three health behaviors during adolescence: drinking, cigarette smoking, and drug use. Results showed consistent associations between adverse childhood experiences and the amount of cigarettes smoked and the likelihood of illicit drug use, although not the amount of days drunk in the past year. Second, neighborhood interaction effects operated unexpectedly so that some neighborhood resources increased substance use among youth with adverse childhood experiences. Third, adverse childhood experiences and neighborhood resources were the most salient for substance use at the older ages. This examination of how childhood experiences relates to substance use behaviors in adolescence provides additional insight into the family and neighborhood contexts of adolescent substance use as well as how adverse childhood experiences matter across the life course.Sociolog

Parental substance use and foster care entrance : trends, geographic variation, and predictors of reunification

Parental substance use is a major risk factor for a child’s entrance into foster care and, in the context of the opioid epidemic, has contributed to an increasing proportion of foster care entrances. However, parental substance use exists on a spectrum of severity and risk to a child’s safety and well-being. Whether or not a child with substance-using parent(s) is removed to foster care and returns to their parents’ home following foster care depends on the extent to which professionals, caseworkers, judges, and other authorities perceive parental substance use as maltreatment and whether it can be reconciled with a child’s safety and wellbeing. Decision-making in the child welfare system largely depends on the personal judgments of caseworkers, judges, and other child welfare workers, which are in turn influenced by external factors varying over time and place. Regarding time, the primary narrative regarding substance abuse has shifted dramatically from one emphasizing criminality and the need for punishment during the 1980s crack cocaine epidemic to one emphasizing public health and the need for treatment during the current opioid crisis. How this new narrative is reflected in child welfare decision-making, however, has not been adequately explored. Regarding place, the policies, availability of services, and more general sociodemographic and health environment of counties and states are known factors in child welfare decision-making, but have yet to be applied specifically to cases involving parental substance use. This dissertation links data from the Adoption and Foster Care Analysis and Reporting System with various county- and state-level data sources to address these gaps in the literature. The first study shows how sociodemographic variation in substance use-associated foster care entry rates over time reveal changes in where and for whom the child welfare system allocates resources. The second study demonstrates how county-level policy, health, and sociodemographic characteristics explain geographic variation in these rates. In the third study, I show how Medicaid expansion and program generosity interact in nuanced ways to predict reunification among children removed from the home due to parental substance use. All three studies illustrate the ongoing connections between the opioid epidemic and child welfare.Sociolog

Initial development of the Stress Monitoring and Response Tool (SMART): A holistic measure of stress following trauma

In the immediate aftermath of trauma exposure, individuals may experience an acute stress reaction (ASR). ASRs may be transient but for individuals operating in high-stakes occupations, these reactions can potentially endanger themselves and those around them. Thus, a better understanding of ASRs could facilitate development of early interventions that help prevent longer-term sequelae. Although existing measures (e.g., PCL-5, CAPS-5) target symptoms that occur in the weeks following trauma, they do not encompass the range of ASR symptoms identified in emerging research. Using data from a large-scale study conducted across emergency departments in the United States, we employed confirmatory factor analysis to identify survey items that sensitively assess ASR symptoms during the peri- and post-trauma phases. These analyses identified 23 core items that are appropriate for administration both immediately following trauma exposure and at later timepoints, as well as 11 supplementary items that can be added to the core items for assessment at later timepoints. Collectively, these items constitute the Stress Monitoring and Response Tool (SMART). Both the SMART Core Scale and the combined SMART Core Scale with Supplemental Items demonstrate good convergent and concurrent validity with several other measures of mental health, physical health, somatic symptoms, pain, and functioning. In addition, the SMART scale remains moderately-to-strongly correlated with multiple measures of symptoms and functional impairment at three months post-trauma. Consequently, the SMART can be used to assess individuals in clinical settings, predict trajectories of recovery, and inform tailoring of interventions across time. Future studies should be conducted to assess the potential utility of the SMART as a decision aid in high-intensity occupational contexts

Peer and Community Influences on Adolescent Substance Use in the Context of Adverse Childhood Experiences

Both adverse childhood experiences (ACEs) and peer influences consistently predict early tobacco, alcohol, and illicit drug use. However, less research considers how peer and community influences contribute to or modify the association between ACEs and early substance use. This study addresses these gaps in the literature by analyzing multilevel, longitudinal data from the Project on Human Development in Chicago Neighborhoods (PHDCN; N = 1,912). Unstructured socializing and peer substance use largely explained the association between ACEs and drinking, smoking cigarettes, and illicit drug use in the past month. A history of ACEs magnified the association between peer substance use and the number of cigarettes smoked. Collective efficacy also shaped the associations between peer influences, ACEs, and substance use, but in different ways depending on the substance use outcome analyzed. </jats:p

Supplemental Material - Substance Use-Associated Infant Maltreatment Report Rates in the Context of Complex Prenatal Substance Use Policy Environments

Supplemental Material for Substance Use-Associated Infant Maltreatment Report Rates in the Context of Complex Prenatal Substance Use Policy Environments by Haley Stritzel in Child Maltreatment</p

A cross-national comparison of the linkages between family structure histories and early adolescent substance use

No abstract available