Publications by authors named "Amanda L Elmore"

5 Publications

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Prescription opioid use among women of reproductive age in the United States: NHANES, 2003-2018.

Prev Med 2021 Dec 13;153:106846. Epub 2021 Oct 13.

University of South Carolina, Arnold School of Public Health, Department of Epidemiology and Biostatistics, Columbia, SC, United States.

Women are prescribed opioids more often than men. Prescription opioid use among women of reproductive age is a public health concern because opioid use during pregnancy is associated with decreased prenatal care and increased risk of adverse perinatal and maternal outcomes. Recent prevalence estimates and correlates of prescription opioid use and long-term use among women of reproductive age are limited. Using the 2003-2018 National Health and Nutrition Examination Survey (NHANES), we estimated the national prevalence, trend, and correlates of prescription opioid use, long-term use (≥ 90 days of use), and use of medications for opioid use disorder (MOUD) among women aged 15-44 (n = 13,558). Prescription opioid use within the last 30 days and prescription duration were collected through interviews and identified using prescription codes. Trend analysis was conducted using the National Cancer Institute Joinpoint Trend Analysis Software. The prevalence of prescription opioid use significantly decreased from 5.2% in 2003-2004 to 3.0% in 2017-2018 (p < .05). MOUD use increased significantly from 0.1% in 2005-2006 to 0.4% in 2011-2012. Long-term opioid use did not significantly change over time. Correlates of prescription opioid use and long-term use included ages 35-44, non-Hispanic White, public insurance, and women with poor or fair health status. As policy makers and clinicians strive to reduce the negative impacts of the opioid epidemic, they should consider the demographic groups most likely to use prescription opioids long-term. Additionally, reductions in opioid prescribing should be balanced with increased availability of nonopioid therapies and monitoring for opioid use disorder.
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http://dx.doi.org/10.1016/j.ypmed.2021.106846DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8595805PMC
December 2021

Diagnosis Codes and Case Definitions for Neonatal Abstinence Syndrome.

Pediatrics 2020 09;146(3)

Birth Defects Surveillance Program and.

Background And Objectives: The increase in neonatal abstinence syndrome (NAS) has underscored the need for NAS surveillance programs, but many rely on passive surveillance using unverified diagnosis codes. Few studies have evaluated the validity of these codes, and no study has assessed the recently proposed Council of State and Territorial Epidemiologists (CSTE) case definition. The Florida Birth Defects Registry investigated the accuracy of codes related to NAS (P96.1 and P04.49) and assessed the sensitivity of the CSTE case definition.

Methods: We identified a sample of infants born during 2016 coded with P96.1 and/or P04.49. Record review was completed for 128 cases coded with P96.1, 68 with P04.49, and 7 with both codes. Lacking consensus regarding a gold standard definition of NAS, we used clinical data to classify each case using the Florida and CSTE definitions. The code-specific accuracy was measured by using the positive predictive value (PPV). The clinical characteristics indicative of NAS were compared for case classification based on both definitions.

Results: By using the Florida definition, the overall PPV was 68% but varied by code: 95.3% for P96.1 and 13.2% for P04.49. The overall (47.8%) and code-specific PPVs were lower by using the CSTE definition. Comparison of clinical characteristics demonstrated that 60.7% of cases classified as no NAS by using the CSTE definition had robust clinical signs of NAS. In our sample, the CSTE case definition underestimated NAS prevalence.

Conclusions: Only the P96.1 code displayed high accuracy. Discordance in NAS case definitions and surveillance methodologies may result in erroneous comparisons and conclusions that negatively impact NAS-related surveillance and research.
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http://dx.doi.org/10.1542/peds.2020-0567DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7461215PMC
September 2020

The Interaction of Adverse Childhood Experiences and Resiliency on the Outcome of Depression Among Children and Youth, 8-17 year olds.

Child Abuse Negl 2020 09 6;107:104616. Epub 2020 Jul 6.

Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA.

Background: Adverse childhood experiences (ACEs) are common among children. Little is known on how resilience factors and positive childhood experiences (PCEs) may moderate the relationship between ACEs and childhood depression.

Objective: Our study fills this gap by providing recent, nationally representative estimates of ACE and PCE exposure for ages 8-17 and examines the associations between ACE exposure and PCEs on the outcome of depression.

Participants And Setting: Data were drawn from the nationally representative 2016-2017 National Survey of Children's Health (NSCH) and included a total sample of 40,302 children and adolescents.

Methods: Chi square analysis and multivariate logistic regressions were performed to assess associations of depression with 9 ACE and 6 PCE exposures. Additive and multiplicative interactions were examined between ACE exposure and PCEs (resiliency measures) on depression. Survey sampling weights and SAS survey procedures were used.

Results: Our study found that 4% of children had current depression and those with an ACE count greater than four had increased odds (aOR: 2.29; CI: 1.74-3.02). Multivariate regressions demonstrated associations between depression and low resiliency as well as significant interactions between ACE exposure and three PCEs. Children who were exposed to greater than four ACEs and did not exhibit resilience had 8.75 higher odds of depression (CI: 5.23-14.65) compared to those with less than four ACEs and some resilience.

Conclusions: These findings illustrate the need for the promotion of PCEs and the building of resiliency for combatting depression and reducing the impact of trauma in children and adolescents.
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http://dx.doi.org/10.1016/j.chiabu.2020.104616DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7494539PMC
September 2020

The Association of Adverse Childhood Experiences With Anxiety and Depression for Children and Youth, 8 to 17 Years of Age.

Acad Pediatr 2020 07 22;20(5):600-608. Epub 2020 Feb 22.

Rural and Minority Health Research Center (E Crouch), Arnold School of Public Health, University of South Carolina, Columbia, SC.

Objective: To determine the prevalence of anxiety and depression and examine their association with adverse childhood experiences (ACEs) among children and adolescents ages 8 to 17 years old.

Methods: Using data from the 2016-2017 National Survey of Children's Health, we conducted a cross-sectional study design with a total sample of 39,929. Our exposure and outcome variables included caregiver report of 9 ACE exposures and current anxiety or current depression. Survey sampling weights and SAS survey procedures were implemented to produce nationally representative results.

Results: Our study found that 9% of children had current anxiety while 4% had current depression. Multivariate analysis concluded that all ACE measures were associated with significantly higher odds of both anxiety and depression. Children exposed to 4 or more ACEs had higher odds of anxiety (adjusted odds ratio [aOR] = 1.7; 95% confidence interval [CI], 1.4-2.1) and depression (aOR = 2.2; 95% CI, 1.7-2.9) than children with exposure to fewer than four ACEs. Assessment of the outcomes of anxiety and depression separately showed differential impacts of ACE exposures as associations were stronger with depression for almost all ACE categories.

Conclusions: Our study demonstrates a differential association between ACEs and anxiety and depression. This highlights the importance of assessing the impact of ACEs on internalizing behaviors separately. These findings are significant for pediatric providers as diagnosis and treatment for mental health disorders are vital components of pediatric care and further support the American Academy of Pediatrics' recommendation to screen for ACEs.
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http://dx.doi.org/10.1016/j.acap.2020.02.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7340577PMC
July 2020

Population-Based Surveillance for Birth Defects Potentially Related to Zika Virus Infection - 22 States and Territories, January 2016-June 2017.

MMWR Morb Mortal Wkly Rep 2020 Jan 24;69(3):67-71. Epub 2020 Jan 24.

Zika virus infection during pregnancy can cause congenital brain and eye abnormalities and is associated with neurodevelopmental abnormalities (1-3). In areas of the United States that experienced local Zika virus transmission, the prevalence of birth defects potentially related to Zika virus infection during pregnancy increased in the second half of 2016 compared with the first half (4). To update the previous report, CDC analyzed population-based surveillance data from 22 states and territories to estimate the prevalence of birth defects potentially related to Zika virus infection, regardless of laboratory evidence of or exposure to Zika virus, among pregnancies completed during January 1, 2016-June 30, 2017. Jurisdictions were categorized as those 1) with widespread local transmission of Zika virus; 2) with limited local transmission of Zika virus; and 3) without local transmission of Zika virus. Among 2,004,630 live births, 3,359 infants and fetuses with birth defects potentially related to Zika virus infection during pregnancy were identified (1.7 per 1,000 live births, 95% confidence interval [CI] = 1.6-1.7). In areas with widespread local Zika virus transmission, the prevalence of birth defects potentially related to Zika virus infection during pregnancy was significantly higher during the quarters comprising July 2016-March 2017 (July-September 2016 = 3.0; October-December 2016 = 4.0; and January-March 2017 = 5.6 per 1,000 live births) compared with the reference period (January-March 2016) (1.3 per 1,000). These findings suggest a fourfold increase (prevalence ratio [PR] = 4.1, 95% CI = 2.1-8.4) in birth defects potentially related to Zika virus in widespread local transmission areas during January-March 2017 compared with that during January-March 2016, with the highest prevalence (7.0 per 1,000 live births) in February 2017. Population-based birth defects surveillance is critical for identifying infants and fetuses with birth defects potentially related to Zika virus regardless of whether Zika virus testing was conducted, especially given the high prevalence of asymptomatic disease. These data can be used to inform follow-up care and services as well as strengthen surveillance.
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http://dx.doi.org/10.15585/mmwr.mm6903a3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7367037PMC
January 2020
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