Kate Beatty, Associate Professor in East Tennessee State University College of Public Health’s Department of Health Services Management and Policy, is lead author of an article in Frontiers in Public Health. The article, “The association between grandparents as caregivers and overdose mortality in Appalachia and non-Appalachia counties” discusses implications of the higher rates of grandparents as the primary caregivers observed in Appalachia compared to other parts of the nation.
Stephanie Mathis, Margaret M. Francisco, Michael Meit, and Amy Wahlquist of East Tennessee State University College of Public Health’s Center for Rural Health Research and Abby McCurry of the Bill Gatton College of Pharmacy are co-authors.
Substance use disorders (SUDs)—and opioid use disorder in particular—have become increasingly prevalent and detrimental over the past decade, including in Appalachia. The consequences of SUD can be significant not only for the person experiencing the disease, but also for their families and communities. Research has shown that the rise in drug overdose deaths and drug-related hospitalizations is positively associated with the rise in foster care cases, even after accounting for county-specific socioeconomic and demographic characteristics. Appalachia in general has experienced markedly elevated rates of both overdose deaths and foster care entries since 2012.
This study used a cross-sectional design, with percent of grandparents as caregivers and overdose mortality rates being of primary interest. County-level data were combined, and descriptive, bivariate, and multivariable statistics were applied. Multiple sociodemographic and geographic variables were included: median age of the population, percent of the population that is uninsured, percent of the population that is non-Hispanic white, teen birth rate, percent of high school dropouts, and rurality.
The researchers found the percent of grandparents as caregivers increased as the overdose mortality rate increased. For every 1% increase in the overdose mortality rate, the percent of grandparents as caregivers increased by 56% in Appalachian counties compared to 24% in non-Appalachian counties. After adjusting for sociodemographic characteristics, the interaction between overdose mortality and Appalachian vs. non-Appalachian counties was no longer significant.
Counties with higher overdose mortality rates had greater rates of grandparents as caregivers, with Appalachian counties experiencing greater rates of grandparents as caregivers than non-Appalachian counties. Sociodemographic characteristics that are often more prevalent in Appalachia may be driving the observed differences. Policies and programs are needed to support grandparents providing caregiving for children impacted by substance use disorders including reform to federal child welfare financing to support children, parents, and grandparent caregivers such as kinship navigation, substance use treatment and prevention services, mental health services and in-home supports.