Maternal opioid use disorder and infant mortality in Wisconsin, United States, 2010-2018.

OBJECTIVE: The difference in infant health outcomes by maternal opioid use disorder (OUD) status is understudied. We measured the association between maternal OUD during pregnancy and infant mortality and investigated whether this association differs by infant neonatal opioid withdrawal syndrome (NOWS) or maternal receipt of medication for OUD (MOUD) during pregnancy. METHODS: We sampled 204,543 Medicaid-paid births from Wisconsin, United States (2010-2018). The primary exposure was any maternal OUD during pregnancy. We also stratified this exposure on NOWS diagnosis (no OUD; OUD without NOWS; OUD with NOWS) and on maternal MOUD receipt (no OUD; OUD without MOUD; OUD with <90 consecutive days of MOUD; OUD with 90+ consecutive days of MOUD). Our outcome was infant mortality (death at age <365 days). Demographic-adjusted logistic regressions measured associations with odds ratios (OR) and 95% confidence intervals (CI). RESULTS: Maternal OUD was associated with increased odds of infant mortality (OR 1.43; 95% CI 1.02-2.02). After excluding infants who died <5 days post-birth (i.e., before the clinical presentation of NOWS), regression estimates of infant mortality did not significantly differ by NOWS diagnosis. Likewise, regression estimates did not significantly differ by maternal MOUD receipt in the full sample. CONCLUSIONS: Maternal OUD is associated with an elevated risk of infant mortality without evidence of modification by NOWS nor by maternal MOUD treatment. Future research should investigate potential mechanisms linking maternal OUD, NOWS, MOUD treatment, and infant mortality to better inform clinical intervention.

Maternal satisfaction with joint and sole child physical placement arrangements following separation in Wisconsin and Finland.

Families (and sometimes courts) make important decisions regarding child physical custody arrangements post-separation, and shared parenting arrangements are increasingly common in most developed countries. Shared arrangements may be differentially associated with parental satisfaction, and these associations may vary across countries. Using data from surveys of separated mothers in Wisconsin and Finland, the present study explores this possibility and is guided by three aims: (a) to identify child and family characteristics associated with sole and shared child placements 6 or more years after separation; (b) to estimate associations of children's post-separation placements with maternal satisfaction with placements and expense sharing; (c) to examine whether the relationship between post-separation placement and maternal satisfaction varies by mothers' earnings and the quality of parents' relationships. We find that Finnish mothers with shared placement are more satisfied with their placement than are their counterparts with sole placement, while we find the inverse is true for Wisconsin mothers. Moreover, parental satisfaction with shared placement, overall and relative to sole placement, varies greatly depending on the quality of a mother's relationship with the other parent; and differences in relationship quality in Wisconsin and Finland may help explain the difference in satisfaction with shared placement in the two locations. In both Finland and Wisconsin, we find mothers with shared placement are more satisfied with the way expenses are shared between parents than are mothers with sole placement. Associations between placement and satisfaction are robust to extensive controls for child and maternal characteristics.

Noncustodial parents, instrumental networks, and child support compliance.

Research on child support compliance has focused on the characteristics of noncustodial parents (NCPs) that are associated with compliance, finding that compliance with child support orders is primarily related to the ability to pay support as demonstrated by earnings. Yet, there is evidence linking social support networks to both earnings and noncustodial parents' relationships with children. Using a social poverty framework, we show that relatively few NCPs are completely isolated: most have at least some people in their network who can loan money, provide a place to stay, or provide a ride. We explore whether the size of these instrumental support networks is positively linked to child support compliance both directly and indirectly through earnings. We find evidence of a direct association between instrumental support network size and child support compliance, but no evidence of an indirect association via increased earnings. These findings suggest the importance for researchers and child support practitioners to consider the contextual and relational factors of the social networks in which parents are embedded, and to more thoroughly examine the process by which support from one's network can lead to child support compliance.

The Impact of Center-Based Childcare Attendance on Early Child Development: Evidence From the French Elfe Cohort.

Proponents of early childhood education and care programs cite evidence that high-quality center-based childcare has positive impacts on child development, particularly for disadvantaged children. However, much of this evidence stems from randomized evaluations of small-scale intensive programs based in the United States and other Anglo/English-speaking countries. Evidence is more mixed with respect to widespread or universal center-based childcare provision. In addition, most evidence is based on childcare experiences of 3- to 5-year-old children; less is known about the impact of center-based care in earlier childhood. The French context is particularly suited to such interrogation because the majority of French children who attend center-based care do so in high-quality, state-funded, state-regulated centers, known as crèches, and before age 3. We use data from a large, nationally representative French birth cohort, the Étude Longitudinale Français depuis l'Enfance (Elfe), and an instrumental variables strategy that leverages exogenous variation in both birth quarter and local crèche supply to estimate whether crèche attendance at age 1 has an impact on language, motor skills, and child behavior at age 2. Results indicate that crèche attendance has a positive impact on language skills, no impact on motor skills, and a negative impact on behavior. Moreover, the positive impact on language skills is particularly concentrated among disadvantaged children. This implies that facilitating increased crèche access among disadvantaged families may hold potential for decreasing early socioeconomic disparities in language development and, given the importance of early development for later-life outcomes, thereby have an impact on long-term population inequalities.

Foster care, permanency, and risk of prison entry.

Objective: (1) Examine associations of foster care exit type (e.g., reunification with birth family, adoption, guardianship/permanent relative placement, or emancipation from care) with risk of entry into state prison; (2) Examine racial disparities in those associations. Method: With data on over 10,000 Wisconsin youth who entered foster care in mid- to late-childhood, we present imprisonment rates in young adulthood by race, sex, and foster care exit type. Proportional hazards models with a robust set of covariates compared prison entry rates among the most common exit types-reunification, aging out, and guardianship/permanent relative placement. Results: Nearly 13% of the sample experienced imprisonment in young adulthood. Compared with emancipated youth, hazard of imprisonment was 1.58-1.96 times higher among reunified youth. Differences were largely unexplained by observed individual, family, or foster care characteristics. Imprisonment rates were similar for emancipated youth and youth exiting to guardianship/permanent relative placement. Hazard of imprisonment for reunified Black youth was twice that of reunified white youth, but racial differences in prison entry were statistically non-significant among emancipated youth. Conclusion: Efforts to reduce incarceration risk for all youth in foster care are needed. Reunified youth may benefit from services and supports currently provided primarily to emancipated youth.

Childhood Poverty, Adverse Childhood Experiences, and Adult Health Outcomes.

This study aimed to consider childhood poverty in relation to a count measure of adverse childhood experiences (ACEs) as a predictor of adult health outcomes and to determine whether associations are sensitive to how childhood poverty is operationalized. A sample of 10,784 adult residents was derived using data 2014-2015 Wisconsin annual Behavioral Risk Factor Survey data, derived from the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS). Adult health outcomes (health risk behaviors, general health problems, chronic health problems, and depression) were predicted using a more conservative and severe indicator of childhood poverty, and authors tested whether observed associations were attenuated by the inclusion of an ACE count variable. Findings showed that severe indicators of childhood poverty are associated with general and chronic health problems as well as adult depression. These associations are attenuated, but remain intact, when ACEs are included in regression models. Using the CDC BRFSS data for Wisconsin, the study showed that associations between childhood poverty and adult health are sensitive to the way in which childhood poverty is operationalized. The relationship between childhood poverty and other ACEs is complex and thus warrants treating the former as a distinct childhood adversity rather than an item in an ACE summary score.

Rising Household Debt and Children's Socioemotional Well-being Trajectories.

Debt is now a substantial aspect of family finances. Yet, research on how household debt is linked with child development has been limited. We use data from the National Longitudinal Survey of Youth 1979 cohort and hierarchical linear models to estimate associations of amounts and types of parental debt (home, education, auto, unsecured/uncollateralized) with child socioemotional well-being. We find that unsecured debt is associated with growth in child behavior problems, whereas this is not the case for other forms of debt. Moreover, the association of unsecured debt with child behavior problems varies by child age and socioeconomic status, with younger children and children from less-advantaged families experiencing larger associations of unsecured debt with greater behavior problems.

Prevalence and Risk Factors for Early Motherhood Among Low-Income, Maltreated, and Foster Youth.

Early childbearing is associated with a host of educational and economic disruptions for teenage girls and increased risk of adverse outcomes for their children. Low-income, maltreated, and foster youth have a higher risk of teen motherhood than the general population of youth. In this study, we assessed differences in the risk of early motherhood among these groups and investigated whether differences likely reflect selection factors versus effects of involvement with Child Protective Services (CPS) or foster care. Using a statewide linked administrative data system for Wisconsin, we employed survival analysis to estimate the hazard of early birth (child conceived prior to age 18) among females. We found that both the youth involved in CPS and youth in foster care were at significantly higher risk of early motherhood than low-income youth, and these differences were not explained by a range of sociodemographic and family composition characteristics. Moreover, our findings indicate that CPS and foster care are unlikely to be causal agents in the risk of early motherhood: among foster youth, risk was lower during foster care compared with before; among CPS-involved girls, risk was the same or lower after CPS investigation compared with before. Subsequent analysis showed that after girls exited foster care, those who were reunified with their birth families were at higher risk than those placed in adoption or guardianship. Overall, our findings suggest that whereas CPS and foster youth are high-risk populations for early motherhood, CPS involvement and foster care placement do not exacerbate, and may instead reduce, risk.

Variable Uptake of Medicaid-Covered Prenatal Care Coordination: The Relevance of Treatment Level and Service Context.

Prenatal care coordination programs direct pregnant Medicaid beneficiaries to medical, social, and educational services to improve birth outcomes. Despite the relevance of service context and treatment level to investigations of program implementation and estimates of program effect, prior investigations have not consistently attended to these factors. This study examines the reach and uptake of Wisconsin's Prenatal Care Coordination (PNCC) program among Medicaid-covered, residence occurrence live births between 2008 and 2012. Data come from the Big Data for Little Kids project, which harmonizes birth records with multiple state administrative sources. Logistic regression analyses measured the association between county- and maternal-level factors and the odds of any PNCC use and the odds of PNCC uptake (> 2 PNCC services among those assessed). Among identified Medicaid-covered births (n = 136,057), approximately 24% (n = 33,249) received any PNCC and 17% (n = 22,680) took up PNCC services. Any PNCC receipt and PNCC uptake varied substantially across counties. A higher county assessment rate was associated with a higher odds of individual PNCC assessment but negatively associated with uptake. Mothers reporting clinical risk factors such as chronic hypertension and previous preterm birth were more likely to be assessed for PNCC and, once assessed, more likely to received continued PNCC services. However, most mothers reporting clinical risk factors were not assessed for services. Estimates of care coordination's effects on birth outcomes should account for service context and the treatment level into which participants select.

Maternal Repartnering: Does Father Involvement Matter? Evidence from United Kingdom.

Maternal repartnering may have benefits for mothers and children. Yet, mothers with coresident children face more difficulty repartnering than other adults. Despite that shared physical custody and father involvement have increased over time, few studies have examined whether nonresidential father involvement and financial support are associated with subsequent maternal repartnering. Using data from the UK Millennium Cohort Study, we found a negative relationship between nonresident father involvement and subsequent maternal repartnering among mothers who were neither married nor cohabiting at childbirth. A potential explanation is that these parents may be engaged in fluid and uncertain relationships, and that the ambiguity thereof may discourage maternal repartnering. We found no association between father involvement and maternal repartnering for mothers who were cohabiting with or married to the father at the time of birth. Finally, we found no association between child support (maintenance) receipt and maternal repartnering, regardless of parental relationship status at the birth.

Family Structure Experiences and Child Socioemotional Development During the First Nine Years of Life: Examining Heterogeneity by Family Structure at Birth.

A vast amount of literature has documented negative associations between family instability and child development, with the largest associations being in the socioemotional (behavioral) domain. Yet, prior work has paid limited attention to differentiating the role of the number, types, and sequencing of family transitions that children experience, as well as to understanding potential heterogeneity in these associations by family structure at birth. We use data from the Fragile Families and Child Wellbeing Study and hierarchical linear models to examine associations of family structure states and transitions with children's socioemotional development during the first nine years of life. We pay close attention to the type and number of family structure transitions experienced and examine whether associations differ depending on family structure at birth. For children born to cohabiting or noncoresident parents, we find little evidence that subsequent family structure experiences are associated with socioemotional development. For children born to married parents, we find associations between family instability and poorer socioemotional development. However, this largely reflects the influence of parental breakup; we find little evidence that socioemotional trajectories differ for children with various family structure experiences subsequent to their parents' breakup.

Families at the Intersection of the Criminal Justice and Child Protective Services Systems.

In this article, we first describe the incidence and prevalence of incarceration and CPS involvement in the United States. Second, we outline the reasons that the same individuals and families may be at risk for involvement in both systems and review the limited existing research examining links between incarceration and CPS involvement. Third, we use unique longitudinal data from Wisconsin, spanning from 2004 to 2012, to describe intergenerational and intragenerational overlap in the two systems. Specifically, we calculate (1) the proportion of all CPS-involved children who have an incarcerated parent; (2) the proportion of incarcerated adults who have a CPS-involved child; (3) the proportion of incarcerated young men and women who were involved in the CPS system as adolescents; and (4) the proportion of CPS-involved adolescents who subsequently became incarcerated. We conclude with a discussion of potential directions for future research as well as implications for practice and policy.

Child maltreatment and children's developmental trajectories in early to middle childhood.

Associations between experiencing child maltreatment and adverse developmental outcomes are widely studied, yet conclusions regarding the extent to which effects are bidirectional, and whether they are likely causal, remain elusive. This study uses the Fragile Families and Child Wellbeing Study, a birth cohort of 4,898 children followed from birth through age 9. Hierarchical linear modeling and structural equation modeling are employed to estimate associations of maltreatment with cognitive and social-emotional well-being. Results suggest that effects of early childhood maltreatment emerge immediately, though developmental outcomes are also affected by newly occurring maltreatment over time. Additionally, findings indicate that children's early developmental scores predict their subsequent probability of experiencing maltreatment, though to a lesser extent than early maltreatment predicts subsequent developmental outcomes.

Young Adults' Roles as Partners and Parents in a Context of Family Complexity.

This article uses data from the 1979 and 1997 cohorts of the National Longitudinal Survey of Youth to estimate the proportions of young men and women who will take on a variety of partner and parent roles by age 30, as well as to describe how these estimates have changed across cohorts. It then draws from identity theory and related theoretical work to consider how the multiple family roles which young adults are likely to occupy-both over their life course and at a single point in time-may influence inter- and intra-family (unit) relationships in light of current trends in family complexity. This discussion highlights four key implications of identity theory as it relates to family complexity, and proposes several hypotheses for future empirical research to explore, such as the greater likelihood of role conflict in families with greater complexity and limited resources. Implications for public policy are also discussed.

Trends in prenatal prescription opioid use among Medicaid beneficiaries in Wisconsin, 2010-2019.

OBJECTIVE: To examine changes in prenatal opioid prescription exposure following new guidelines and policies. STUDY DESIGN: Cohort study of all (262,284) Wisconsin Medicaid-insured live births 2010-2019. Prenatal exposures were classified as analgesic, short term, and chronic (90+ days), and medications used to treat opioid use disorder (MOUD). We describe overall and stratified temporal trends and used linear probability models with interaction terms to test their significance. RESULT: We found 42,437 (16.2%) infants with prenatal exposure; most (90.5%) reflected analgesic opioids. From 2010 to 2019, overall exposure declined 12.8 percentage points (95% CI = 12.1-13.1). Reductions were observed across maternal demographic groups and in both rural and urban settings, though the extent varied. There was a small reduction in chronic analgesic exposure and a concurrent increase in MOUD. CONCLUSION: Broad and sustained declines in prenatal prescription opioid exposure occurred over the decade, with little change in the percentage of infants chronically exposed.

Prenatal opioid exposure by likelihood of exposure and risk to prenatal development: Medicaid-covered births in Wisconsin, 2010-2019.

Prenatal opioid exposure is an established public health problem, in particular among Medicaid-covered births. Yet, existing prevalence rates are plausibly underestimated. We leverage extensive linked longitudinal administrative data for all Medicaid-covered live births in Wisconsin from 2010 to 2019 to estimate a range of prevalence rates using an innovative strategy that jointly accounts for both likelihood of exposure and potential risk to prenatal development. We find that 20.8% of infants may have been prenatally exposed to opioids, with 1.7% diagnosed with neonatal abstinence syndrome and an additional 1.2% having a high combined likelihood of exposure and potential risk to prenatal development, 2.6% a moderate combined likelihood and risk, and 15.3% a low or uncertain combined likelihood and risk. We assess improvements in prevalence estimates based on our nuanced classification relative to those of prior studies. Our strategy could be broadly used to quantify the scope of the opioid crisis for pregnant populations, target interventions, and promote child health and development.

Inequality in high-cost borrowing and unemployment insurance generosity in US states during the COVID-19 pandemic.

US consumers may turn to the private market for credit when income and government benefits fall short. The most vulnerable consumers have access only to the highest-cost loans. Prior research on trade-offs of credit with government welfare support cannot distinguish between distinct forms of unsecured credit due to data limitations. Here we provide insight on credit-welfare state trade-offs vis-à-vis unemployment insurance generosity by leveraging a large sample of credit data that allow us to separate credit cards, personal loans and alternative financial services loans and to analyse heterogeneity in credit use by household income. We find that more generous state unemployment insurance benefits were associated with a lower probability of high-cost credit use during the first seven quarters of the coronavirus disease 2019 (COVID-19) pandemic. This inverse association was concentrated among consumers living in low-income households. Our results support theories that public benefits are inversely associated with the use of costly credit.

Wisconsin's Community Response Program for families that have been reported for child maltreatment.

In 2006, the Wisconsin Children's Trust Fund launched a pilot initiative called "Community Response," a program targeted to families reported for maltreatment but not served by child protective services due to insufficient child safety concerns. This article presents general information on the program, including the variation in models used by sites across the state, information on the families that were served by the program, and lessons learned from the experience that may guide practical decisions around the implementation of similar models elsewhere.

Spanking and child development during the first 5 years of life.

Using data from the Fragile Families and Child Wellbeing Study (N=3,870) and cross-lagged path analysis, the authors examined whether spanking at ages 1 and 3 is adversely associated with cognitive skills and behavior problems at ages 3 and 5. The authors found spanking at age 1 was associated with a higher level of spanking and externalizing behavior at age 3, and spanking at age 3 was associated with a higher level of internalizing and externalizing behavior at age 5. The associations between spanking at age 1 and behavioral problems at age 5 operated predominantly through ongoing spanking at age 3. The authors did not find an association between spanking at age 1 and cognitive skills at age 3 or 5.

Examining Racial Disproportionality in Child Protective Services Case Decisions.

Using a national sample of 1,461 child protective services (CPS) investigations in the United States, we examine differences between black and white families with regard to caseworker ratings of risk and harm to the child, as well as the probability that a case is substantiated for maltreatment. We employ difference-in-difference methods to identify whether gaps in outcomes for black and white families are equivalent when black and white CPS workers conduct the investigation, and Blinder-Oaxaca decomposition methods to identify the portion of the black-white difference in outcomes that is attributable to differences in case characteristics (risk factors) versus differences in associations between these characteristics and the outcomes by race (differential treatment). We find no differences in outcomes by child race after adjusting for case characteristics. At the same time, we find that relative to white caseworkers, black caseworkers are more likely to rate black children at subjectively higher risk of harm than white children and are also more likely to substantiate black families for maltreatment. The decomposition results suggest that-even after accounting for caseworker race-differences in outcomes for black and white children are primarily explained by differences in family and case circumstances rather than differential treatment. Thus, our analyses suggest that interventions addressing maltreatment-related risk factors that disproportionately affect black families may have greater utility for reducing racial disparities in CPS involvement than current emphases on cultural competence training.