Intergenerational effects of America's opioid crisis: Parental drug use and offspring health

项目总结/摘要 美国阿片类药物危机的负担沉重地落在儿童身上，这是一个越来越脆弱的群体。 在子宫内或童年时期通过父母使用阿片类药物（POU）暴露于阿片类药物。子宫内POU暴露可能导致 新生儿经历新生儿阿片类药物戒断综合征，而儿童期POU暴露可能导致 对于因父母吸毒过量死亡而遭受虐待和家庭分离的儿童，父母 机构化或寄养安置。生命历程理论假定，早期生活的逆境，特别是在 子宫和幼儿期，可能导致终身的身心健康，物质使用，行为， 社会经济问题。这份K 01指导研究科学家发展奖申请提出了 培训和研究计划，将支持博士安吉利卡Meinhofer走向独立的道路上，重点 阐明生命早期（8岁以下子宫内）接触POU对精神健康障碍的影响， 慢性病、传染病、伤害和儿童早期和中期的医疗保健利用。的 培训计划补充了Meinhofer博士先前在阿片类药物使用障碍，卫生经济学和政策方面的专业知识 通过培训进行评估（1）从生命过程的角度看待儿童健康，（2）行为健康系统， 儿童和家庭服务，（3）流行病学和生物统计学方法，以及（4）复杂的数据 管理和链接算法。Meinhofer博士将通过以下方式实现拟议的培训目标： 正式的课程，研讨会和实践经验相结合，以及博士的指导。 布鲁斯沙克曼，包玉华博士，凯瑟琳凯斯博士和雷切尔杜尼丰博士。从医疗补助中提取 Analytic eXtract（MAX）与其他数据集相关联，并结合了纵向、基于人群的研究 设计与差异中的差异和倾向评分方法，博士Meinhofer将使用的知识和 通过这些培训活动获得的技能，以实现以下目标：（1）估计协会 子宫内暴露于阿片类药物与身心健康之间的关系，以及早期 （2）估计早期暴露于父母药物过量死亡率之间的关联， 儿童期与身心健康、伤害和儿童早期和中期的保健利用; 和（3）估计暴露于父母阿片类药物使用障碍药物治疗之间的关联， 儿童早期和身心健康，伤害，以及早期和中期的医疗保健利用 童年.了解生命早期暴露于POU如何影响后代的生命过程 为临床医生和政策制定者提供了一个坚实的基础， 协调一致、以家庭为中心、总体上更有效的议程。建议的K 01奖将提供博士。 Meinhofer拥有成为R 01资助的独立公司所需的资源，培训和指导 领导多学科研究计划的调查员，为改善人民福祉的政策提供信息 受父母物质使用影响的儿童和家庭。

PROJECT SUMMARY/ABSTRACT The burden of America's opioid crisis has heavily fallen on children, a vulnerable population increasingly exposed to opioids in utero or childhood through parental opioid use (POU). POU exposure in utero may lead to a newborn experiencing neonatal opioid withdrawal syndrome, while POU exposure in childhood may lead to a child experiencing maltreatment and family separation due to parental drug overdose mortality, parental institutionalization, or foster care placement. Life course theory postulates that early life adversity, especially in utero and early childhood, may lead to lifelong physical and mental health, substance use, behavioral, and socioeconomic problems. This K01 Mentored Research Scientist Development Award application proposes a training and research plan that will support Dr. Angélica Meinhofer on a path towards independence, focused on elucidating the impact of exposure to POU in early life (in utero up to age 8) on mental health disorders, chronic conditions, infectious diseases, injuries, and healthcare utilization in early and middle childhood. The training plan supplements Dr. Meinhofer's prior expertise in opioid use disorders, health economics, and policy evaluation with training in (1) child health with a life course perspective, (2) behavioral health systems and services for children and families, (3) epidemiology and biostatistics methods, and (4) complex data management and linkage algorithms. Dr. Meinhofer will achieve the proposed training objectives with a combination of formal coursework, workshops, and hands-on experience, as well as the mentorship of Dr. Bruce Schackman, Dr. Yuhua Bao, Dr. Katherine Keyes, and Dr. Rachel Dunifon. Drawing from the Medicaid Analytic eXtract (MAX) linked with other datasets and combining a longitudinal, population-based study design with difference-in-differences and propensity score methods, Dr. Meinhofer will use the knowledge and skills acquired through these training activities to achieve the following aims: (1) Estimate the association between exposure to opioids in utero and physical and mental health, and healthcare utilization in early childhood; (2) Estimate the association between exposure to parental drug overdose mortality in early childhood and physical and mental health, injuries, and healthcare utilization in early and middle childhood; and (3) Estimate the association between exposure to parental opioid use disorders medication treatment in early childhood and physical and mental health, injuries, and healthcare utilization in early and middle childhood. Understanding how early life exposure to POU may affect offspring outcomes over the life course provides a strong foundation upon which clinicians and policymakers can design a more proactive, coordinated, family-centered, and overall more effective agenda. The proposed K01 Award will provide Dr. Meinhofer with the resources, training, and mentoring needed to become an R01-funded independent investigator leading a multidisciplinary research program to inform policies for improving the wellbeing of children and families affected by parental substance use.