The number of referrals to Orange County's social services agency for infants who were exposed to substances during pregnancy increased by more than 55% from 2014 to 2023.

That's according to a report the county's Social Services Agency released this month looking at familial health and the health of children across the county.

The "Conditions of Children" report also found significant increases in youth mental health struggles and a spike in the cost of childcare over recent years in the county. The report is meant to inform county decisions on how to better support families and children in the area.

Orange County saw 212 referrals last year to its Social Services Agency for infants exposed to substances in their first week of life, according to the new report -- up from 136 referrals in 2014.

Substances include alcohol and cannabis.

That's a notable increase, said Kristina Uban, an associate professor at UC Irvine who studies infant exposure to substances and serves on Orange County's Family Wellness Plan committee, which assists pregnant people with histories of substance use.

She partly attributed the rise to the increased potency of drugs and alcohol over the past decade. She also said it was likely a result of efforts by Orange County organizations to train medical professionals on substance use during pregnancy.

She also called the data just the "tip of the iceberg," noting that many pregnancies where the fetus is exposed to tobacco, drugs or alcohol don't get reported in part due to stigma. Exposure during pregnancy can lead to adverse health conditions.

"If we can resource people and close the gap in inequities, especially that we see in Orange County, that's going to always make us better able to handle the inevitable exposures that will enter pregnancy," Uban said.

Multiple experts linked health outcomes in the county to economic stability. The report found that nearly 15% of Orange County children were living in poverty -- a higher number than the U.S. Census Bureau's estimate of around 11%.

"Our families are really still struggling because of the high cost of living in Orange County," said Dr. Sara Marchese, the medical director of Orange County's Social Services Agency. " Which creates challenges around many things, particularly housing as well as access to child care."

The study found that over the past 10 years or so, the cost of licensed childcare centers for infants in Orange County increased from $270 a week to $380 a week.

A recent report by First 5 California found that 48% of parents in California, primarily women, find it difficult to afford childcare.

The report also found that students in Orange County were more likely to experience feelings of hopelessness and depression in recent years.

From 2021 to 2023, 36% of high school juniors and 30% of 7th and 9th graders in OC experienced "depressed related feelings" in the previous year. Those rates are lower than state averages, but up compared to the period from 2013 to 2015.

Among lesbian, gay and bisexual youth, those numbers are worse. 62% of those 11th graders and 59% of 9th graders and 7th graders reported having feelings of depression.

"Unfortunately, these findings are not surprising and are very much in line with what we are seeing," said Peg Corley, the executive director at LGBTQ Center OC, in an email.

These numbers align with several recent reports about a mental health crisis among American youth. USC professor of education Morgan Polikoff pointed to social media and the lingering effects of the COVID-19 pandemic as two potential reasons for this spike.

" Kids' mental health is also connected to the other things that we are most concerned about in schools right now," Polikoff said. "Academic achievement has also declined post-COVID, and chronic absenteeism is way up."

The report also found significant progress, including a drop in the number of young children who were without health insurance and an increase in child immunizations.

" Most of the indicators in the report are actually heading in the right direction ... But then, this one about student mental health is something that clearly is not trending in the right direction. So that's something that we need to tackle," Polikoff said. "And it's not just an Orange County problem, it's an everywhere problem."