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Book Summary: Break the Cycle of Children’s Environmental Health Disparities (or simply, Break the Cycle) is an annual collaborative interdisciplinary research and training program involving university students in academic tracks that focus on the impact of adverse social, economic, and environmental factors on children’s health, development, and education. The target populations are communities where environmental hazards are related to circumstances of social and economic disadvantage. Each student develops a project that focuses on preventing or reducing adverse environmental factors to benefit the children who live in these communities. At the end of the project, the students present their studies and findings at a national conference and write papers which are then published. This book is the result of the 12th annual Break the Cycle program. The projects cover a range of factors that operate over a period of time and have an influence on individual, community, and social perspectives. Most importantly, they inform us about children’s environmental health disparities and propose solutions to reduce health disparities in order to promote health equity for all children.

Background: In East Tennessee and Middle Appalachia, the epicenter of the opioid epidemic, approximately 15% of women give birth taking buprenorphine or methadone for opioid addiction (medical assisted therapy--MAT) or using other drugs illicitly and 5% of births are diagnosed with neonatal abstinence syndrome (NAS). A better understanding is needed of factors contributing to the severity of NAS. Objective: To identify maternal and infant characteristics associated with length of stay among newborns with neonatal abstinence syndrome. Design/Methods: Participants were 150 newborns systematically sampled from births diagnosed with NAS during the past 5 years at a single medical center. Data were obtained through abstraction of maternal prenatal records, infant delivery and infant medical charts. The abstraction included maternal and child demographic and clinical characteristics. Drug and other substance use/exposure histories were based on maternal history, and urine and cord tissue drug screening. Results: The infants’ average length of stay was 18.6 (s.d. = 11.9), 15% were low birthweight, and had an average gestational age of 38.8 (s.d. = 1.8); 62% were male; 49% were breast-fed. The mothers mean age was 27.5 (s.d. = 5.0); mean parity was 1.6 (s.d. = 1.4); 77% were unmarried; 75% had < HS education; and 89% had exposure at some time during pregnancy to other prescription (in addition to buprenorphine or methadone) or illicit opioids. In the least squares regression, which included important potential covariates such as infant sex, birth weight and gestational age, significant predictors of infant length of stay include: maternal benzodiazepine use (8.3 day longer LOS on average; p = 0.019), and infants whose mothers had a history of mental illness (3.9 day longer LOS on average, p = 0.040 ). While infants born to mothers smoking in the final 30 days of pregnancy had a 2.7 day longer LOS on average after adjustment for other significant predictors, this association was no longer significant in regression analysis (p = 0.293). Conclusion(s): Maternal use of prescription or illicit opioids leading to NAS is rooted in women’s’ life histories characterized by disadvantage, relationship instability, polysubstance use and mental illness. Efforts to reduce the incidence and severity of NAS among those on MAT during pregnancy should focus on preventing poly-substance misuse and providing supports for other maternal health needs including treating mental illness.

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