title: Are community level prescription opioid overdoses associated with child harm? A spatial analysis of California zip codes, 2001-2011.
abstract: Non-medical prescription opioid use is increasing globally within high-income countries, particularly the United States. However, little is known about whether it is associated with negative outcomes for children. In this study, we use prescription opioid overdose as a proxy measure for non-medical prescription opioid use and ask the following: Do California communities with greater rates of non-medical prescription opioid use also have higher rates of child maltreatment and unintentional child injury?
  
  
  
  We used longitudinal population data to examine ecological associations between hospital discharges involving overdose of prescription opioids and those for child maltreatment or child injury in California zip codes between 2001 and 2011 (n=18,517 zip-code year units) using Bayesian space-time misalignment models.
  
  
  
  The percentage of hospital discharges involving prescription opioid overdose was positively associated with the number of hospital discharges for child maltreatment (relative rate=1.089, 95% credible interval (1.004, 1.165)) and child injury (relative rate=1.055, 95% credible interval (1.012, 1.096)) over the ten-year period, controlling for other substance use and environmental factors.
  
  
  
  Increases in community level prescription opioid overdoses between 2001 and 2011 are associated with a 2.06% increase in child maltreatment discharges and a 1.27% increase in discharges for child injury. Communities with higher rates of non-medical prescription opioid use may experience greater levels of child harms.
authors: Division of Social Work, California State University, Sacramento 600 J Street, Sacramento, CA 95812, United States; Pacific Institute for Research and Evaluation, Prevention Research Center, 180 Grand Avenue, Oakland, CA 94612, United States. Electronic address: wolf@csus.edu.
authors: Jennifer Price
authors: JP
authors: Wolf
authors: Pacific Institute for Research and Evaluation, Prevention Research Center, 180 Grand Avenue, Oakland, CA 94612, United States.
authors: William R
authors: WR
authors: Ponicki
authors: School of Social Welfare, University of Kansas, 1545 Lilac Ln., Lawrence, KS 66045, United States.
authors: Nancy J
authors: NJ
authors: Kepple
authors: Pacific Institute for Research and Evaluation, Prevention Research Center, 180 Grand Avenue, Oakland, CA 94612, United States.
authors: Andrew
authors: A
authors: Gaidus
mesh_terms: D000293:Adolescent; D001499:Bayes Theorem; D002140:California; D002648:Child; D002649:Child Abuse / Q000706:statistics & numerical data*; D002675:Child, Preschool; D062787:Drug Overdose / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D009294:Narcotics / Q000506:poisoning*; D010351:Patient Discharge / Q000706:statistics & numerical data; D055553:Prescription Drugs / Q000506:poisoning*; D013223:Statistics as Topic; D014947:Wounds and Injuries / Q000453:epidemiology*
chemical_list: D009294:Narcotics; D055553:Prescription Drugs
keywords: Child maltreatment; Prescription opioid overdose; Spatial analysis; Unintentional injury