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Published on: August 25, 2014
Adolescent Overdose Mortality and Child Protection System Involvement: Evidence from a California Birth Cohort,
Lindsey Palmer1, Tenesha Littleton1, Andrea Lane Eastman1
1Lindsey Palmer is with the College of Social Work, University of Utah, Salt Lake City. Tenesha Littleton is with the School of Social Work, University of Alabama, Tuscaloosa. Andrea Lane Eastman is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA. Emily Putnam-Hornstein is with the School of Social Work, University of North Carolina at Chapel Hill.
Abstract:
Objectives. To examine overdose mortality across 4 levels of child protection system (CPS) involvement during childhood. Methods. Using integrated vital birth, death, and CPS records of California births (2000-2005) followed through 2024 (n = 3 208 771), we identified 747 adolescent overdose decedents and matched each to 4 comparison adolescents (n = 2988). We categorized CPS exposure as no contact, referral, substantiated referral, or foster care. Using conditional Poisson regression, we estimated overdose prevalence by CPS involvement level. Results. Overall, 69.9% of decedents had at least 1 CPS referral, compared with 34.6% of matched comparison adolescents. Any CPS history was associated with a 5-fold higher rate of overdose death (incidence rate ratio = 5.36; 95% confidence interval = 4.41, 6.51), with elevated rates observed across all levels of CPS involvement. Conclusions. CPS history was highly prevalent among adolescents who died from overdose, and regardless of level, may function as a meaningful marker of overdose vulnerability. Public Health Implications. Improved coordination between CPS and Medicaid-funded behavioral health services may facilitate earlier intervention for this high-risk population. (Am J Public Health. Published online ahead of print September 24, 2026:e1-e4. https://doi.org/10.2105/AJPH.2026.308762).
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