Author ORCID Identifier

Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation




Pharmaceutical Sciences

First Advisor

Dr. Jeffery Talbert

Second Advisor

Dr. Chris Delcher


Rates of neonatal abstinence syndrome have been rising over the past several years, alongside rising rates of opioid use disorder, propelled by the continuing Opioid Epidemic ravaging the country. Children born withdrawing from opioids they were exposed to in utero have known health complications through the first year of life that have been studied in the current literature. Less is known, however, about the outcomes these children face in childhood. As many of these children are progressing to childhood, there is an urgent need for healthcare system to prepare to handle the health needs of these children; outcomes related to child development for these children have not been well-established within the literature.

Using data procured from the Kentucky Medicaid Management Information System, a study population consisting of all Kentucky children born on Kentucky Medicaid between 2014 and 2019 was created. This data was linked to select information available on the child’s birth certificate from the Office of Vital Statistics, including indicators of prenatal health and certain maternal health characteristics. This study population formed the base population for the studies conducted within this chapter and provided a homogenous group under a common set of healthcare policies administered by one public insurance organization in one southern state.

Chapter 1 introduces the scope of the problem in Kentucky, as well as establishing some background into the condition. In Chapter 2, a literature synthesis was conducted in which outcomes in Medicaid populations were assessed and gaps in the literature were determined. Chapter 3 provides overarching methodology for the dissertation as well as basic demographic information for the entire study population.

Chapter 4 provided an assessment of socioemotional developmental factors for children, which, in the context of this work, was defined as family characteristics and structure. Specifically, a mother’s enrollment on Medicaid, the enrollment of siblings on Medicaid, evidence of siblings with prenatal exposure to opioids, foster care involvement, and whether a child was located at the same household as the mother were assessed. A cross-sectional logistic regression analysis was designed to establish the odds of a child with prenatal opioid exposure being in a different household than the mother, as well as a discussion of the factors that contribute to a child being located at a different address than the mother and the implications of that displacement.

In Chapter 5, physical health, here defined as gastrointestinal conditions and respiratory conditions, were explored through a data exploration that led to a descriptive study to establish evidence of whether such an association existed. Asthma created a signal indicating that such an association may exist for children prenatally exposed to opioids in utero. The population was subset to children born in 2016 through 2019 and a logistic regression analysis was again conducted to ascertain whether there was evidence of such an association existing that could be explored in later analyses.

Also in Chapter 5, cognitive development outcomes were assessed, here defined as the diagnosis of a mental health condition identified in two previous works on the subject. After assessing the prevalence of the conditions in the population of children born in 2014 and 2015, the population was subset again to only include children born in 2014 and with one continuous year of enrollment in the database. Again, a logistic regression analysis was conducted to ascertain the odds of a child with prenatal opioid exposure being diagnosed with a mental health condition identified in two previous works.

Finally, in Chapter 6, a longitudinal data analysis was conducted to establish whether the expenditures accrued by children with prenatal opioid exposure differed from that of their peers over time. A linear mixed model with an exponential power decay covariance structure, restricted maximum likelihood estimators, and model-based standard errors was utilized in the analysis.

Chapter 7 provides overall conclusions and policy recommendations for the Medicaid system based on the findings of the dissertation.

Digital Object Identifier (DOI)