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Prenatal Substance Exposure and Reporting of Child Maltreatment by Race and Ethnicity
Emily Putnam-Hornstein1, John J Prindle2, John M Leventhal3
1Department of Children, Youth, and Families, School of Social Work, University of Southern California, Los Angeles, California; and ehornste@usc.edu.
Insights
This study found no evidence that race influences child protective services (CPS) reports for substance-exposed infants. Clinicians did not report Black and Hispanic infants at higher rates than white infants for prenatal substance exposure.
Area of Science:
- Pediatrics
- Public Health
- Neonatal Care
Background:
- Substance exposure in newborns is linked to child protective services (CPS) reports.
- Limited data exists on racial disparities in reporting substance-exposed infants.
Purpose of the Study:
- To examine racial differences in diagnosed substance exposure and subsequent maltreatment reports for infants.
- To determine if Black and Hispanic substance-exposed infants are reported to CPS at different rates than white infants.
Main Methods:
- Utilized linked birth, hospital discharge, and CPS records for a California birth cohort.
- Identified substance exposure using diagnostic codes and maltreatment reports from CPS records.
- Calculated prevalence of infant exposure by race/ethnicity and substance type, using multivariable models to estimate racial differences in reporting.
Main Results:
- 1.6% of 474,071 infants had substance exposure diagnoses, varying significantly by race (highest in Black infants, lowest in Hispanic infants).
- Cannabis and amphetamine were common substances for White and Hispanic infants; cannabis and cocaine for Black infants.
- After adjusting for covariates, Black and Hispanic substance-exposed infants were reported to CPS at lower or comparable rates to White infants.
Conclusions:
- No evidence suggests racial disparities in infant CPS reports stem from variable responses to prenatal substance exposure.
- Further research is needed to address potential racial/ethnic disparities in substance screening at birth.
Background:
Substance exposure is thought to contribute to reports of suspected maltreatment made to child protective services (CPS) at or shortly after birth. There are limited data, however, on whether clinicians are more likely to report black and Hispanic substance-exposed infants compared with white infants.
Methods:
We examined racial differences in diagnosed substance exposure and subsequent maltreatment reports by using linked birth, hospital discharge, and CPS records. Diagnostic codes were used to document substance exposure; CPS records provided information on maltreatment reports. Prevalence of infant exposure was calculated by race or ethnicity, substance type, and sociodemographic covariates. We estimated racial differences in maltreatment reporting among substance-exposed infants using multivariable models.
Results:
In a 2006 population-based California birth cohort of 474 071 black, Hispanic, and white infants, substance exposure diagnoses were identified for 1.6% of infants (n = 7428). Exposure varied significantly across racial groups (P < .001), with the highest prevalence observed among black infants (4.1%) and the lowest among Hispanic infants (1.0%). Among white and Hispanic infants, the most frequently observed substances were amphetamine and cannabis; for black infants, cannabis was the most common, followed by cocaine. After adjusting for sociodemographic and pregnancy factors, we found that substance-exposed black and Hispanic infants were reported at significantly lower or statistically comparable rates to substance-exposed white infants.
Conclusions:
Although we were unable to address potential racial and ethnic disparities in screening for substances at birth, we found no evidence that racial disparities in infant CPS reports arise from variable responses to prenatal substance exposure.
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