BACKGROUND: As the coronavirus disease pandemic spread across the United States and protective measures to mitigate its impact were enacted, parents and children experienced widespread disruptions in daily life. Our objective with this national survey was to determine how the pandemic and mitigation efforts affected the physical and emotional well-being of parents and children in the United States through early June 2020. METHODS: In June 2020, we conducted a national survey of parents with children age ,18 to measure changes in health status, insurance status, food security, use of public food assistance resources, child care, and use of health care services since the pandemic began. RESULTS: Since March 2020, 27% of parents reported worsening mental health for themselves, and 14% reported worsening behavioral health for their children. The proportion of families with moderate or severe food insecurity increased from 6% before March 2020 to 8% after, employer-sponsored insurance coverage of children decreased from 63% to 60%, and 24% of parents reported a loss of regular child care. Worsening mental health for parents occurred alongside worsening behavioral health for children in nearly 1 in 10 families, among whom 48% reported loss of regular child care, 16% reported change in insurance status, and 11% reported worsening food security. CONCLUSIONS: The coronavirus disease pandemic has had a substantial tandem impact on parents and children in the United States. As policy makers consider additional measures to mitigate the health and economic effects of the pandemic, they should consider the unique needs of families with children. WHAT'S KNOWN ON THIS SUBJECT: The coronavirus disease 2019 (COVID-19) pandemic and protective measures associated with it created widespread disruptions in daily life of US parents and children. Families with children disproportionately live in poverty, potentially increasing their risk to COVID-19-related economic distress and difficulties sustaining basic needs. WHAT THIS STUDY ADDS: COVID-19 has had a substantial impact on the well-being of parents and children. As policy makers consider additional measures to mitigate the health and economic effects of the pandemic, they should consider the unique needs of families with children.

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Background: Medications for opioid use disorder (MOUD) improve outcomes for pregnant women and infants. Our primary aim was to examine disparities in maternal MOUD receipt by family sociodemographic characteristics. Methods: This retrospective cohort study included mother-infant dyads with Medicaid-covered deliveries in Tennessee from 2009 to 2016. First, we examined family sociodemographic characteristicsincluding race/ethnicity, rurality, mother's primary language and education level, and whether paternity was recorded in birth recordsand newborn outcomes by type of maternal opioid use. Second, among pregnant women with OUD, we used logistic regression to measure disparities in receipt of MOUD by family sociodemographic characteristics including interactions between characteristics. Results: Our cohort from Medicaidcovered deliveries consisted of 314,965 mother-infant dyads, and 4.2 percent were exposed to opioids through maternal use. Among dyads with maternal OUD, MOUD receipt was associated with lower rates of preterm and very preterm birth. Logistic regression adjusted for family sociodemographic characteristics showed that pregnant women with OUD in rural versus urban areas (aOR: 0.66; 95% CI: 0.60-0.72) and who were aged !35 years versus 25 years (aOR: 0.75; 95% CI: 0.64-0.89) were less likely to have received MOUD. Families in which the mother's primary language was English (aOR: 2.47; 95% CI: 1.24-4.91) and paternity was recorded on the birth certificate (aOR: 1.30; 95% CI: 1.19-1.42) were more likely to have received MOUD. Regardless of high school degree attainment, non-Hispanic Black versus non-Hispanic White race was associated with lower likelihood of MOUD receipt. Hispanic race was associated with lower likelihood of MOUD receipt among women without a high school degree. Conclusions: Among a large cohort of pregnant women, we found disparities in receipt of MOUD among non-Hispanic Black, Hispanic, and rural pregnant women. As policymakers consider strategies to improve access to MOUD, they should consider targeted approaches to address these disparities.

Sexual minority individuals (eg, lesbian, gay, bisexual, and queer people) experience high rates of bullying and violence, a predictor of worse mental health, 1 but little research has examined adverse childhood experiences (ACEs) occurring before age 18 years among sexual minority individuals. This study uses a large, multistate probability sample to (1) characterize population-level prevalence of ACEs by sexual orientation and (2) estimate the association between level of ACE exposure and mental distress in adulthood by sexual orientation.Methods | This cross-sectional study uses a probability-based sample from the 2019 Behavioral Risk Factor Surveillance System (BRFSS) among states implementing both the optional sexual orientation and the ACE modules. The exposure variable was sexual minority identity. Methodology for BRFSS ACE modules has been published elsewhere. 2 No research has found that ACEs cause sexual minority identity; rather, it is hypothesized that perpetrators target socially vulnerable youth (eg, individuals with low income or a disability), including sexual minority individuals. 3 Outcomes included weighted prevalence and odds of ACEs and frequent mental distress 4 (≥14 bad mental health days in the past month) and the number of bad mental health days in the past month, stratified by ACE exposure level. Self-identified race and ethnicity were used to assess demographic differences in subsamples. This study was deemed exempt from review by the Vanderbilt University institutional review board because BRFSS data are publicly available. Statistical analysis was conducted via Stata version 17.0. Logistic regression was used to estimate unadjusted and adjusted odds ratios (ORs), controlling for sex, age, and race and ethnicity.