The Opioid Crisis and Child Maltreatment Across Counties and Time in the United States, 2007–2017

AuthorAlexander Chapman
Published date01 September 2022
Date01 September 2022
ANNALS, AAPSS, 703, September 2022 139
DOI: 10.1177/00027162221144172
The Opioid
Crisis and Child
Across Counties
and Time in the
United States,
Rising opioid mortality coincides with reported rises in
child maltreatment since the early 2000s. I consider
mechanisms that link the opioid epidemic and child
maltreatment, focusing on social disorganization, the
geographic and temporal patterns of opioid mortality,
and community-level substance use and child maltreat-
ment. I combine data from the ACS, CDC WONDER,
and NCANDS in county-level analyses. I show a posi-
tive association between adult opioid mortality and
child maltreatment that varies over time, and the
results suggest a stronger association between opioid
mortality and child maltreatment in high-poverty coun-
ties. Counties with high levels of residential mobility
show negative associations between opioid mortality
and child maltreatment when mortality levels are low.
These findings bolster arguments that child maltreat-
ment can be decreased by reducing poverty and opioid
mortality and by increasing opportunities for residen-
tial mobility.
Keywords: opioids; child maltreatment; family; pov-
erty; social disorganization; residential
From 2007 through 2017, Child Protective
Services (CPS) agencies in the United
States oversaw more than 43 million child mal-
treatment1 reports. CPS agencies receive fed-
eral and local funding and aim to provide
services that help protect children from abuse
and neglect. CPS generates child maltreatment
reports after screening referrals of abuse and
neglect in their local county, and each report
documents a unique child maltreatment inves-
tigation (U.S. Department of Health & Human
Services 2021). The rate of child maltreatment
reporting climbed 133 percent from 24 per
100,000 children in 2002 to 32 per 100,000 in
Alexander Chapman is a PhD candidate in sociology
and demography at the Pennsylvania State University.
His interests include social networks, substance mis/
use, and population health.
Correspondence: Email:
2017; the bulk of the growth has occurred since 2010. Notwithstanding the over-
all rise in reports of child maltreatment, the number of substantiated child mal-
treatment reports has decreased since the 1990s, albeit leveling off since 2009
(Finkelhor, Saito, and Jones 2020). However, substantiation status of child mal-
treatment reports is not predictive of child behavioral outcomes like anxiety,
depression, anger, socialization, daily living skills, teen parenthood, HIV-risk
behaviors, drug use relative to reports where there is an investigation without
substantiation (Hussey etal. 2005; Kugler etal. 2019). This suggests that solely
focusing on substantiated reports would overlook the extent of children at risk of
experiencing adverse outcomes.
Meanwhile, the number of children living with an adult with an opioid2 use
disorder increased by 30 percent from 2002 to 2017 (Bullinger and Wing 2019).
Adult drug overdose deaths rose from about 9 to 23 per 100,000 between 2002
and 2017 (author calculation using CDC WONDER [Centers for Disease
Control and Prevention Wide-ranging ONline Data for Epidemiologic Research]
Multiple Cause of Death), and a larger share of children live with extended fam-
ily as a consequence of the opioid epidemic (Dolbin-MacNab and O’Connell
2021). These trends demonstrate the increasing social burden of the opioid epi-
demic in the United States and underscore the need to understand the impact of
the epidemic on children in individual households and within communities.
Individual-level research that links adult opioid use to child maltreatment
omits the role of social structure. Social structure considerations go beyond the
individual characteristics of adults or children and extend to temporal considera-
tions like the chemical composition of drugs (reformulation of OxyContin in late
2010) or community-level considerations such as poverty levels. Research estab-
lishes associations between trends in child maltreatment reports—often with a
focus on foster care—and drug overdose deaths by noting their spatial and tem-
poral co-occurrence in counties across the U.S. (e.g., Ghertner etal. 2018; Radel
et al. 2018; Bullinger and Ward 2021). Work on this relationship is limited in
multiple ways. First, it does not situate drug-related mortality and child maltreat-
ment associations in broader social theory and contexts. For example, analyses
that omit shifting economic conditions and drug supply variation obscure the role
played by underlying drivers of each trend and how those relationships may
change over time. Second, child maltreatment reports, rather than foster care
placements or substantiated child maltreatment reports, provide a wider meas-
ure to understand community-level risks to children and families. Foster care
entry is an indicator that a specific child may have had a difficult or risky home
environment at a point in time. Additionally, the share of maltreatment reports
translating into foster care services decreased about one in seven in 2001 to about
one in twelve by 2019 (U.S. Department of Health & Human Services 2003,
NOTE: I would like to thank Ashton Verdery, Sarah Font, Rachel McNealey, Megan Evans,
Thomas Siskar, and Eric Baumer for their helpful feedback on this project. This research
was supported by the Population Research Institute (PRI). PRI is supported by a grant from
the Eunice Kennedy Shriver National Institute of Child Health and Human Development
(P2CHD041025) and by the Pennsylvania State University and its Social Science Research

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