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

• DOI: http://doi.org/10.1177/00027162221144172
• Published date: 01 September 2022
• Date: 01 September 2022

ANNALS, AAPSS, 703, September 2022 139

DOI: 10.1177/00027162221144172

The Opioid

Crisis and Child

Maltreatment

Across Counties

and Time in the

United States,

2007–2017

By

ALEXANDER CHAPMAN

1144172ANN THE ANNALS OF THE AMERICAN ACADEMYTHE OPIOID CRISIS AND CHILD MALTREATMENT

research-article2022

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

mobility

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: alexander.chapman@psu.edu

140 THE ANNALS OF THE AMERICAN ACADEMY

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

Institute.