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

项目摘要/摘要 美国阿片类药物危机的负担沉重地落在了儿童身上，他们是越来越脆弱的人群 在子宫或儿童时期通过父母使用阿片类药物暴露于阿片类药物(POU)。宫内暴露POU可能导致 对经历新生儿阿片类药物戒断综合征的新生儿来说，而儿童时期接触POU可能会导致 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 制度化，或寄养安置。生命历程理论认为，早期生活中的逆境，尤其是在 子宫和儿童早期，可能会导致终生身心健康、物质使用、行为和 社会经济问题。这份K01指导研究科学家发展奖申请书提出了一个 培训和研究计划，将支持Angélica Meinhofer博士走上独立的道路，重点是 在阐明早期接触POU(在子宫中直到8岁)对精神健康障碍的影响时， 儿童早期和中期的慢性病、传染病、伤害和医疗保健利用情况。这个 培训计划补充了Meinhofer博士在阿片类药物使用障碍、卫生经济学和政策方面的先前专业知识 通过以下方面的培训进行评价：(1)从生命过程的角度看儿童健康；(2)行为健康系统和 儿童和家庭服务，(3)流行病学和生物统计方法，(4)复杂数据 管理和链接算法。迈因霍费尔博士将通过一项 结合正式的课程、研讨会和实践经验，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·杜尼芬博士。从医疗补助中提取 分析提取(MAX)与其他数据集链接，并结合基于人口的纵向研究 设计采用差异法和倾向评分法，迈因霍费尔博士将使用知识和 通过这些培训活动获得的技能，以实现以下目标：(1)评估协会 宫内阿片类药物暴露与身心健康和早期医疗保健利用之间的关系 儿童时期；(2)估计早年接触父母药物过量死亡率之间的关系 童年与儿童早期和中期的身心健康、损伤和医疗保健利用； 和(3)估计接触父母阿片类药物使用障碍药物治疗之间的联系 儿童早期和中期的身心健康、损伤和医疗保健利用 童年。了解早期接触POU如何影响后代的一生结局 提供了坚实的基础，在此基础上，临床医生和政策制定者可以设计出更主动、 协调一致、以家庭为中心、总体上更加有效的议程。拟议的K01奖将为Dr。 Meinhofer拥有成为R01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 受父母药物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.