Men's and women's patterns of substance use around pregnancy

COVID-19 pandemic-related trauma symptoms are associated with postpartum alcohol consumption

OBJECTIVE

The COVID-19 pandemic has led to escalations in substance use, including alcohol consumption. Of particular concern are the potential impacts during the postpartum period, a time of heightened vulnerability to stress and potential transmission of the negative sequelae of substance use to offspring. However, postpartum alcohol consumption during the COVID-19 pandemic has not been well characterized.

METHOD

Postpartum drinking habits and COVID-19-related stress were repeatedly assessed (every two weeks for 12 weeks, and at one-, six-, and 12-months postpartum) from N = 378 individuals during the COVID-19 pandemic. Average alcohol use trajectories as well as heterogeneity in trajectories were characterized. COVID-19-related trauma symptoms and coping were examined in relation to alcohol use over time.

RESULTS

Average postpartum alcohol use included an initial quadratic increase from one-to-four-months postpartum, followed by a plateau between four-to-12-months. Higher (15.08%), moderate (26.90%), and lower consumption (57.90%) subgroups were identified. Endorsement of COVID-19-related trauma symptoms and using alcohol to cope with stress predicted higher consumption.

CONCLUSIONS

Findings suggest a potential sensitive period in establishing postpartum alcohol use patterns from one-to-four-months postpartum. Findings further suggest that postpartum alcohol use is heterogenous and that individual response to major traumatic stressors, like the COVID-19 pandemic, may influence emerging patterns of postpartum alcohol use.

Retrospective Assessment of Human-Chemical Interactions in Health-Disparity Populations: A Process Evaluation of Life History Calendars

Life-history calendars (LHCs) can produce retrospective data regarding numerous events, exposures, and sequences that have occurred across participants' lifespans. In this mixed-quantitative-and-qualitative-methods study, processes of LHC administration were evaluated in two populations experiencing health disparities: foreign-born agricultural workers (n = 41) and Indigenous people who used injection drugs (IPWIDS) (n = 40). LHC administrator and participant perspectives were elicited during follow-up survey activities. In both agricultural workers and IPWIDs, over half of participants reported that the LHC made it easier to remember things about the past, and participant age was associated with cumulative experience in different domains of interest. Qualitative findings suggested that data-collector training and the development of concise interview guides are critical for improving LHC data quality. Participants described ethical themes, including utilitarian, cathartic, and reflective aspects, of LHC participation. Future iterations of the LHC may benefit from providing free-form and open-ended spaces for participants to reflect on the LHC activity following LHC administration.

Alcohol consumption trajectories over the Australian life course

BACKGROUND AND AIMS

Alcohol consumption changes markedly over the life course, with important implications for health and social development. Assessment of these patterns often relies on cross-sectional data, which cannot fully capture how individuals' drinking changes as they age. This study used data from 18 waves of a general population panel survey to measure drinking trajectories over the life course in Australia.

DESIGN AND SETTING

Longitudinal survey data from the Household, Income and Labour Dynamics in Australia (HILDA) survey between 2001 and 2018.

PARTICIPANTS

A total of 20 593 individuals ages 15 or above in two samples assessing quantity-frequency (n = 20 569, 52.0% female) and risky single occasion drinking (RSOD), respectively, (n = 17 340, 52.5% female), interviewed as part of HILDA.

MEASUREMENTS

Usual quantity of alcohol consumed per drinking occasion; frequency of drinking occasions per week; average daily consumption, calculated by combining reported usual quantity and frequency; and average reported frequency of RSOD per week.

FINDINGS

Multilevel, mixed effects models run with fractional polynomial terms found similar male and female alcohol consumption trajectories for quantity-frequency and RSOD measures. Usual quantity of alcohol consumed per drinking occasion (5.4 drinks for men, 3.8 for women) and RSOD frequency (0.56 occasions/week for men, 0.38 for women) peaked in young adulthood, whereas frequency of drinking occasions (2.5 occasions/week for men, 1.7 for women) peaked in middle age. Middle-age drinkers had the highest average daily consumption of alcohol (1.4 drinks/day for 54-year-old men, 0.6 drinks for 57-year-old women) and engaged in RSOD slightly less than young adults.

CONCLUSIONS

Alcohol consumption in Australia appears to vary substantially over the life course, with usual quantity per drinking occasion and frequency of risky single occasion drinking peaking during early adulthood and average daily consumption and frequency of consumption peaking in middle age.

Parents' management of alcohol in the context of discourses of 'competent' parenting: A qualitative analysis

How parents manage potential tensions between normative discourses of 'competent parenting' and their desires to consume alcohol has received little attention. In this article, we explore the elements that encourage or constrain parents' drinking and investigate how parents consider and manage their alcohol use in the context of multiple social roles with sometimes conflicting demands and expectations around 'competent parenting'. Our analysis draws on 30 semi-structured interviews with Australian parents, conducted as part of a broader project which aimed to explore how home drinking is integrated into everyday life. While parents' accounts of drinking alcohol highlighted effects such as embodied experiences of relaxation and facilitating shared adult moments, many participants described drinking less than they otherwise would if their children were not present. Participants discussed various social roles and routines which constrained consumption, with drinking bounded by responsibility. As such, drinking emerged as something needing to be actively negotiated, particularly in light of discourses that frame expectations of what constitutes 'competent parenting'. When considering parents' alcohol consumption in the future, we argue that it is important to destigmatise their consumption by acknowledging the importance of adults' pleasure and wellbeing, alongside children's needs for safety and modelling of safer alcohol consumption.

Self-reported alcohol consumption of pregnant women and their partners correlates both before and during pregnancy: A cohort study with 21,472 singleton pregnancies

Background

The partners’ role in determining the alcohol consumption behavior of pregnant women is not well studied. We measured alcohol use before and during pregnancy in pregnant women and their partners to evaluate the correlation in their levels of consumption.

Methods

We evaluated the self‐reported alcohol use of 14,822 women and their partners during 21,472 singleton pregnancies delivered in Kuopio University Hospital, Finland during the period 2009‒2018. The information was gathered during pregnancy and at the time of childbirth and recorded in two databases that were merged to yield a single cohort. Missing data were accounted for by multiple imputation using the predictive mean matching method.

Results

In 86% of the pregnancies, women reported alcohol use before pregnancy, whereas in 4.5% of the pregnancies women reported alcohol use during pregnancy. In contrast, no decrease was detected in their partners’ alcohol use before or during pregnancy. In 26% of the pregnancies, the woman reported stopping alcohol use only after recognizing that she was pregnant. Before pregnancy, there were strong correlations between the pregnant women and their partners in the total Alcohol Use Disorders Identification Test score (r_s = 0.69, p < 0.0001) and the self‐reported average weekly amount of alcohol consumed (r_s = 0.56, p < 0.0001). During pregnancy, there were weak correlations between the pregnant women and their partners in the frequency of drinking (r_s = 0.20, p < 0.0001) and the average weekly amount of alcohol consumed (r_s = 0.18, p < 0.0001).

Conclusions

The self‐reported alcohol consumption of pregnant women and their partners was positively correlated both before and during pregnancy, though the correlation declined substantially during pregnancy. Evaluating the alcohol consumption of both parents before pregnancy could assist in identifying women at risk of prenatal alcohol exposure. Supporting a reduction in partners' alcohol use could help to reduce pregnant women's alcohol consumption and prevent its associated harms.

Serious psychological distress and cannabis use among pregnant women in the United States: Findings from the National Survey of Drug Use and Health, 2015-2018

BACKGROUND

Cannabis use in pregnancy has been shown to be associated with a past diagnosis of mental health disorders. This study aimed to evaluate the association between serious psychological distress (SPD) and cannabis use in pregnant women in the United States.

METHODS

Using cross-sectional data from the 2015-2018 National Survey on Drug Use and Health (NSDUH), we compared likelihood of cannabis use among pregnant women who reported acute, recent or no SPD based on the Kessler K-6 Distress Scale. Weighted analyses were conducted to describe study population and differences in cannabis use patterns in women with SPD compared to those without. Multivariate logistic regression models were fit to determine whether the relationship between SPD and cannabis use differed by acute, recent or no SPD status.

RESULTS

Our final study sample consisted of 2,277,425 pregnant women. In adjusted analyses, pregnant women with any SPD (acute or recent) had 3.1 (95% confidence interval: 2.1, 4.5) times the odds of being current cannabis users compared to pregnant women without SPD. Compared to those with no SPD, pregnant women adjusted with acute SPD had 3.9 (2.5, 6.1) the adjusted odds and recent SPD had 2.4 (1.3, 4.4) times the odds of being current cannabis users. Cannabis use rates in each trimester were significantly higher in women with SPD compared to women without.

CONCLUSION

Women who report recent or acute SPD are significantly more likely to use cannabis during all trimesters of pregnancy than those who report no SPD.

Changes in alcohol consumption during pregnancy and over the transition towards parenthood

OBJECTIVE

To examine pre- to postnatal changes in drinking for women and men and assess the role of education level in these changes.

BACKGROUND

The transition towards parenthood can contribute to significant shifts in alcohol consumption for women and men. Research has generally focused on pregnancy and short-term changes following childbirth, usually for mothers only. Socio-economic variation in the impact of childbirth and return to drinking postnatally is similarly understudied.

METHOD

Longitudinal alcohol consumption data for 2470 individuals (1248 female) who were pregnant, or the partner of a pregnant woman, were obtained from a representative, Australian survey for three years prior and following birth. Piecewise regression models, including an education-x-time interaction, assessed changes in drinking quantity and frequency.

RESULTS

Female usual quantity and frequency significantly declined during pregnancy, followed by significant postnatal increases in quantity, approaching pre-pregnancy levels, with similar trends across education levels. Male usual quantity increased following childbirth, save for those men with a high-school education. Having an undergraduate degree was associated with a significant postnatal increase in drinking frequency.

CONCLUSION

Further awareness of the risks associated with male-partner drinking could provide substantial public health benefits. Successful facilitation and implementation of interventions and harm reduction strategies for harmful drinking over the pre- to postnatal period could benefit from further consideration of socioeconomic status and education level, particularly for men.

Alcohol and parenthood: An integrative analysis of the effects of transition to parenthood in three Australasian cohorts

AIMS

To determine the extent to which the transition to parenthood protects against heavy and problematic alcohol consumption in young men and women.

DESIGN

Integrated participant-level data analysis from three population-based prospective Australasian cohort studies.

SETTING

General community; participants from the Australian Temperament Study, the Christchurch Health and Development Study, and the Victorian Adolescent Health Cohort Study.

MEASUREMENTS

Recent binge drinking, alcohol abuse/dependence and number of standard drinks consumed per occasion.

FINDINGS

4015 participants (2151 females; 54%) were assessed on four occasions between ages 21 and 35. Compared to women with children aged <12 months, women who had not transitioned to parenthood were more likely to meet the criteria for alcohol abuse/dependence (fully adjusted risk ratio [RR] 3.5; 95% CI 1.5-7.9) and to report recent binge drinking (RR 3.0; 95% CI 2.1-4.3). The proportion of women meeting the criteria for alcohol abuse/dependence and/or binge drinking increased with the age of participants' youngest child, as did the mean number of standard drinks consumed on each occasion (1.8 if the youngest child was <1 year of age vs. 3.6 for 5+ years of age). Associations between parenthood and male drinking behaviour were considerably weaker.

CONCLUSIONS

For most women in their twenties and thirties, parenting a child <1 year of age was associated with reduced alcohol consumption. However, this protective effect diminished after 12 months with drinking levels close to pre-parenthood levels after five years. There was little change in male drinking with the transition to parenthood.

Substance use in pregnancy: The medical challenge

Substance use contributes significantly to the global burden of disease. Growing numbers of women use nicotine, alcohol, and illicit substances. Women are the most vulnerable to problematic substance use in their reproductive years. The first 1000 days of life, starting at conception, have been established as a critical window of time for long-term health and development. Substance use in pregnancy is associated with negative pregnancy and child health outcomes. The impact of antenatal substance use on these outcomes needs to be considered within a challenging and complex context. This review provides an overview of the current literature on the impact of substances on pregnancy and child outcomes as well as the evidence and guidelines on screening and interventions for women using substances during pregnancy.

Substance use behaviors and the timing of family formation during young adulthood

The impact of substance use on the life course of young adults can be substantial, yet few studies have examined to what extent early adult substance use behaviors are related to the timing of family formation, independent of confounding factors from adolescence. Using panel data from the Monitoring the Future study (N~20,000), the current study examined the associations between three substance use behaviors (i.e., cigarette use, binge drinking, and marijuana use) and the timing of family formation events in young adulthood. Survival analysis and propensity score weighting addressed pre-existing differences between substance users and non-users in the estimation of the timing of union formation (i.e., marriage, cohabitation) and parenthood. Results for young adult substance users showed general patterns of reduced rates of marriage and parenthood, and increased cohabitation during young adulthood. Variations were evident by substance and sex.

Experience of Pregnant Women with Problem Drinking during First Trimester of Pregnancy

PURPOSE

The purpose of this study was to explore the meaning of pregnant women's experiences with drinking alcohol during first trimester of pregnancy.

METHODS

The data were collected through in-depth interviews of 7 pregnant women who drank alcohol in the first trimester. Giorgi's phenomenological method was used for data analysis.

RESULTS

Findings included 6 main themes and 14 themes. The main themes concerning pregnancy and drinking were: 'Open attitude in drinking, History of drinking in family or spouse, Seeking information in how drinking affects pregnancy, Regret not doing planned pregnancy and not quitting drinking before pregnancy, Willing to stop drinking until the child birth, Awareness about importance of preconception care.

CONCLUSION

The results of this study provide a deeper understanding of pregnant women's experiences of drinking alcohol during the first trimester of pregnancy. These results can be used in the development of strategies to prevent drinking alcohol during first trimester and to support preconception care and prenatal care.

Changes in alcohol use following the transition to motherhood: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions

BACKGROUND

Little is known about the impact of motherhood on alcohol use beyond the acute reductions observed in pregnancy. This study characterizes changes in alcohol use for women who did and did not become mothers over three years.

METHODS

Data are from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC). Participants were female respondents aged 18-44 years who did not have children and were not pregnant at wave 1, and who reported having at least one drink in the year prior to wave 1 (n=2118). Women were classified as mothers (n=325) if they reported having a child between waves 1 and 2, and non-mothers if they did not (n=1793). At each wave, participants provided information on past-year frequency of alcohol use and heavy episodic drinking, and usual number of alcoholic beverages consumed per occasion.

RESULTS

At baseline, women who did and did not become mothers reported similar levels of alcohol use. Women who became mothers reported significant reductions in alcohol use indicators from wave 1 to wave 2 (i.e., 22 fewer drinking days, 15 fewer heavy drinking days, 1 less drink per occasion), whereas women who did not become mothers showed a modest increase in alcohol use frequency (i.e., 7 more drinking days). Motherhood remained significantly associated with reductions in alcohol use after adjusting for sociodemographic variables and baseline alcohol use.

CONCLUSIONS

The transition to motherhood is associated with marked reductions in alcohol consumption. Similar reductions were not observed for women who did not become mothers.

Planning for Long-Term Follow-Up: Strategies Learned from Longitudinal Studies

Preventive interventions are often designed and tested with the immediate program period in mind, and little thought that the intervention sample might be followed up for years or even decades beyond the initial trial. However, depending on the type of intervention and the nature of the outcomes, long-term follow-up may well be appropriate. The advantages of long-term follow-up of preventive interventions are discussed and include the capacity to examine program effects across multiple later life outcomes, the ability to examine the etiological processes involved in the development of the outcomes of interest, and the ability to provide more concrete estimates of the relative benefits and costs of an intervention. In addition, researchers have identified potential methodological risks of long-term follow-up such as inflation of type 1 error through post hoc selection of outcomes, selection bias, and problems stemming from attrition over time. The present paper presents a set of seven recommendations for the design or evaluation of studies for potential long-term follow-up organized under four areas: Intervention Logic Model, Developmental Theory and Measurement Issues; Design for Retention; Dealing with Missing Data; and Unique Considerations for Intervention Studies. These recommendations include conceptual considerations in the design of a study, pragmatic concerns in the design and implementation of the data collection for long-term follow-up, as well as criteria to be considered for the evaluation of an existing intervention for potential for long-term follow-up. Concrete examples from existing intervention studies that have been followed up over the long term are provided.

Spread of health behaviors in young couples: How relationship power shapes relational influence

INTRODUCTION

Romantic relationships provide a context in which partners can influence each other's health behaviors (e.g., weight-related behaviors, substance use). Partner influence may be especially pronounced among newly parenting adolescent and young adult couples because of the desire to maintain relationships (and therefore openness to influence), and because parenting-related challenges can pose risk for uptake of unhealthy behaviors. Two understudied factors that might affect partner influence on health behaviors include relative power within the relationship and prior levels of engagement in health behaviors.

METHODS

The current study explored longitudinal partner influence effects in a sample of newly parenting adolescent and young adult females and their male partners (Ncouples = 157) recruited from four obstetrics/gynecology clinics in Connecticut between July 2007 and February 2011. Five health behaviors in two domains were explored: weight-related behaviors (unhealthy eating, exercise) and substance use (cigarette, alcohol, and marijuana use). Relationship power and previous levels of health behaviors were examined as moderators. Variations across gender were also examined.

RESULTS

Results of dyadic analysis showed partner influences for alcohol use. Partner influence depended on relationship power for eating, alcohol, and marijuana use, and on previous behavior for cigarette use. Results also varied by gender - only female-to-male influence was found for unhealthy eating and cigarette use. Higher relationship power was protective against smoking escalation for females.

DISCUSSION

These results differ from previous research findings mainly on male-to-female influences. Such asymmetries may reflect traditional female dominance in food preparation, as well as shifts in power balances postpartum. Targeting relational power dynamics may buffer the spread and escalation of unhealthy behaviors in young parents, with implications for the health of both members of a couple as well as their children.

Prevalence and correlates of a lifetime cannabis use disorder among pregnant former tobacco smokers

BACKGROUND

Following tobacco and alcohol, cannabis is the most commonly used substance during pregnancy. Given the high prevalence of concurrent cannabis and tobacco use as well as the health consequences associated with prenatal substance use, we sought to document the relative contributions of psychosocial and psychiatric factors commonly associated with cannabis use in predicting a lifetime cannabis use disorder (CUD) among women who had quit smoking tobacco as a result of pregnancy.

METHODS

Pregnant former tobacco smokers (n=273) enrolled in a larger randomized controlled trial for postpartum tobacco relapse prevention completed semi-structured psychiatric interviews and self-reported demographic, pregnancy, health, psychosocial, and tobacco use factors during their third trimester of pregnancy.

RESULTS

In total, 14% (n=38) of women met criteria for a lifetime CUD. The strongest predictors of a lifetime CUD were a history of having multiple psychiatric disorders (OR=36.44; 95% CI=5.03-264.27; p<0.001) followed by a lifetime alcohol use disorder (OR=3.54; 95% CI=1.27-9.87; p<0.05). In addition, more frequent attempts to quit smoking tobacco (OR=1.12; 95% CI=1.01-1.25; p<0.05) and lower self-efficacy about weight management after quitting smoking tobacco (OR=0.78; 95% CI=0.62-0.97; p<0.05) also were significantly associated with a lifetime CUD.

CONCLUSIONS

Women with a history of both cannabis and tobacco dependence may represent a subset of women who need more specialized treatment during the perinatal period to improve substance use outcomes.

Unemployment and substance use problems among young adults: Does childhood low socioeconomic status exacerbate the effect?

The current study tested whether unemployment predicted young adults' heavy episodic drinking, cigarette smoking, and cannabis use after taking into account individual development in substance use. Furthermore, building on the life course perspective, this study examined whether the link between unemployment and substance use among young adults differed for those who experienced low childhood SES compared to those who did not. Data for the present study came from the Seattle Social Development Project (SSDP), a panel study examining a broad range of developmental outcomes from ages 10 to 33. A life history calendar (LHC) was administered to assess substance use and unemployment status during young adulthood. Covariates included baseline symptoms of psychopathology, baseline substance use, gender, ethnicity, and adult educational attainment. Results suggest that unemployment is associated with young adults' heavy episodic drinking and possibly cigarette use, but not cannabis use. Moreover, for all three substances, the detrimental impact of unemployment on substance use seems to be exacerbated among young adults who spent their childhood and adolescence in a lower SES household. Public health efforts that provide other viable and affordable options to cope with unemployment among young adults from low SES backgrounds are needed to address this disproportionate concentration of adverse impacts of unemployment on behavioral health.

Receiving Versus Being Denied a Pregnancy Termination and Subsequent Alcohol Use: A Longitudinal Study

AIM

Research finds women who terminate pregnancies are at risk of subsequent problematic alcohol use, but methodological and conceptual problems are common. This study examines the relationship between receiving versus being denied termination and subsequent alcohol use.

METHODS

Data are from a prospective, longitudinal study of US women seeking pregnancy terminations. Participants presented just before a facility's gestational limit and received terminations (Near Limits, n = 452) or just beyond the limit and were denied terminations (Turnaways, n = 231).

RESULTS

Groups did not differ in alcohol use before pregnancy recognition. One week after termination-seeking (Turnaways still pregnant, Near Limits not), Turnaways had lower odds of any and binge alcohol use, but did not differ on 1+ problem symptoms. Over 2.5 years, both Near Limits and Turnaways increased any and binge alcohol use, with Turnaways increasing more rapidly. The groups did not converge again on any or binge use. For Near Limits, any alcohol use surpassed the pre-pregnancy recognition level, but binge use did not. Changes in problem symptoms over time were not evident for either group.

CONCLUSION

While women who had a termination were more likely to report any and binge alcohol use than women who had a child, this difference was due to a reduction in consumption among women having the child rather than an increase in consumption among women having a termination. Thus, assertions that having a termination leads women to increase alcohol use to cope with having had a termination are not supported.

Romantic partner influences on prenatal and postnatal substance use in young couples

BACKGROUND

Alcohol, tobacco and other drug use (ATOD) among adolescent and young adult couples during prenatal and postnatal periods is a significant public health problem, and couples may mutually influence each others' ATOD behaviors.

PURPOSE

The current study investigated romantic partner influences on ATOD among adolescent and young adult couples during pregnancy and postnatal periods.

METHODS

Participants were 296 young couples in the second or third trimester of pregnancy recruited from OBGYN clinics between July 2007 and February 2011. Participants completed questionnaires at prenatal, 6 months postnatal, and 12 months postnatal periods. Dyadic data analysis was conducted to assess the stability and interdependence of male and female ATOD over time.

RESULTS

Male partner cigarette and marijuana use in the prenatal period significantly predicted female cigarette and marijuana use at 6 months postnatal (b = 0.14, P < 0.01; b = 0.11, P < 0.05, respectively). Male partner marijuana use at 6 months postnatal also significantly predicted female marijuana use at 12 months postnatal (b = 0.11, P < 0.05). Additionally, significant positive correlations were found for partner alcohol and marijuana at pre-pregnancy and 6 months postnatal, and partner cigarette use at pre-pregnancy, 6 months and 12 months postnatal.

CONCLUSIONS

Partner ATOD among young fathers, particularly during the prenatal period, may play an important role in subsequent ATOD among young mothers during postnatal periods.

Maternal patterns of postpartum alcohol consumption by age: a longitudinal analysis of adult urban mothers

The purpose of this study is to investigate a) longitudinal patterns of maternal postpartum alcohol use as well as its variation by maternal age at child birth and b) within maternal age groups, the association between other maternal characteristics and alcohol use patterns for the purposes of informed prevention design. Study sample consists of 3397 mothers from the Fragile Families and Child Wellbeing Study representing medium and large US urban areas. Maternal drinking and binge drinking were measured at child age 1, 3, and 5 years. We conducted separate longitudinal latent class analysis within each of the three pre-determined maternal age groups (ages 20-25, n = 1717; ages 26-35, n = 1367; ages 36+, n = 313). Results revealed different class structures for maternal age groups. While two classes (NB [non-binge]-drinkers and LL [low-level]-drinkers) were identified for mothers in each age group, a third class (binge drinkers) was separately distinguished for the two older age groups. Whereas binge drinking rates appear to remain stable over the 5 years postdelivery for mothers who gave birth in their early twenties, mothers ages 26 and older increasingly engaged in binge drinking over time, surpassing the binge drinking behavior of younger mothers. Depression significantly increases the odds of being a NB-drinker for the 20-25 age group and that of being a binge drinker for the 36+ age group, whereas smoking during pregnancy is associated with subsequent binge drinking only for mothers ages 20-25. Findings highlight the importance of distinguishing risk factors by maternal age groups for drinking while parenting a young child, to inform the design of intervention strategies tailored to mothers of particular ages.

Feasibility of applying the life history calendar in a population of chronic opioid users to identify patterns of drug use and addiction treatment

Uncovering patterns of drug use and treatment access is essential to improving treatment for opioid dependence. The life history calendar (LHC) could be a valuable instrument for capturing time-sensitive data on lifetime patterns of drug use and addiction treatment. This study describes the methodology applied when collecting data using the LHC in a sample of individuals with long-term opioid dependence and aims to identify specific factors that impact the feasibility of administering the LHC interview. In this study, the LHC allowed important events such as births, intimate relationships, housing, or incarcerations to become reference points for recalling details surrounding drug use and treatment access. The paper concludes that the administration of the LHC was a resource-intensive process and required special attention to interviewer training and experience with the study population. These factors should be considered and integrated into study plans by researchers using the LHC in addiction research.

Harmful alcohol use as a predictor of intimate partner violence during the transition to parenthood: interdependent and interactive effects

Harmful alcohol use is known to increase the risk of intimate partner violence (IPV), however very little is known about the role of alcohol use during the transition to parenthood. The current study was designed to examine harmful alcohol use as a dyadic and interactive time-varying risk factor for psychological and physical IPV across the transition to parenthood using a sample of 98 couples assessed prenatally and again at one and two years postpartum. Longitudinal actor-partner interdependence models demonstrated that changes in harmful alcohol use during the transition to parenthood were significantly related to changes in psychological IPV for both men and women and with physical IPV for men only, whereas harmful alcohol use was actually negatively related to variations in women's physical IPV. Partners' harmful use of alcohol during the transition to parenthood also explained additional variance in psychological IPV for men and physical IPV for women over time. Time-varying interactions between actors' and partners' harmful alcohol use were additionally predictive of greater psychological IPV for women and greater physical IPV for both men and women. Contrary to some past research, time-varying discrepancies in levels of harmful alcohol use between men and women were related to a lower risk of psychological IPV for women and physical IPV for both genders. Findings from this study indicate that harmful alcohol use by both men and women combines in a dyadic and interactive manner to place couples at risk for IPV during the transition to parenthood. Prenatal interventions may benefit from strategies to reduce the harmful use of alcohol by both men and women during the prenatal and postpartum periods.

Alcohol use before and during unwanted pregnancy

BACKGROUND

There is little information about pregnancy-related changes in alcohol use and factors contributing to changes among women with unwanted pregnancies. This study describes changes in alcohol use from before pregnancy recognition to during pregnancy and identifies important predictors of alcohol use severity among women with unwanted pregnancies.

METHODS

Data are from the Turnaway Study of 956 women seeking pregnancy termination at 30 U.S. facilities between 2008 and 2010, some of whom were denied care because they were past the gestational limit of the facility where they were recruited and were still pregnant at the baseline interview, 1 week after termination seeking. Predictors of alcohol use severity (a latent variable) were identified.

RESULTS

About 56% of the total sample reported any alcohol use the month before pregnancy recognition, with 23% reporting 6 or more drinks on an occasion. Among the total sample, 35% of those drinking before pregnancy recognition had quit and 20% had reduced 1 week after termination seeking. Among those denied terminations and still pregnant, 71% had quit and 14% had reduced. In a multivariate model predicting alcohol severity, younger age, still pregnant, 1 or more previous births, later gestation, childhood physical abuse, and marijuana and other drug use were associated with lower severity; having completed college, tobacco use, and recent physical violence were associated with higher severity.

CONCLUSIONS

The proportion of the total sample drinking before pregnancy recognition is similar to national samples of women of childbearing age, while the proportion binge drinking appears higher. Of women denied terminations, who were still pregnant, the proportion having quit is similar to other populations of pregnant women. More research is needed to examine whether pregnant women may be substituting alcohol for marijuana and other drugs. Interventions focusing on alcohol use severity during pregnancy may need to also focus on tobacco.

Family discord is associated with increased substance use for pregnant substance users

Childhood abuse and partner violence are associated with prenatal substance abuse, but the potential impact of current family discord, which reflects broader family relationships and encompasses problems less severe than violence, has had little evaluation in pregnant substance users. Using data from 196 pregnant substance users participating in a NIDA Clinical Trials Network randomized clinical trial, we examined the relationship of baseline family discord to substance use and treatment session attendance. Family discord was assessed using items from the family composite of the Addiction Severity Index. Substance use was assessed by the Substance Use Calendar and urine drug screens (UDS). Assessments were weekly for four weeks and at two- and four-month post-randomization. Women with family discord were more likely to report living with a problematic substance user, reported a higher percentage of substance use days throughout each study phase, had a greater proportion of positive UDS over the four-month study period, and attended more weeks of treatment during the first month. Specific treatment interventions targeting pregnant women with family discord may be warranted.

Receiving versus being denied an abortion and subsequent drug use

BACKGROUND

Some research finds that women receiving abortions are at increased risk of subsequent drug use and drug use disorders. This literature is rife with methodological problems, particularly inappropriate comparison groups.

METHODS

This study used data from the Turnaway Study, a prospective, longitudinal study of women who sought abortions at 30 sites across the U.S. Participants included women presenting just prior to an abortion facility's gestational age limit who received abortions (Near Limit Abortion Group, n=452), just beyond the gestational limit who were denied abortions (Turnaways, n=231), and who received first trimester abortions (First Trimester Abortion Group, n=273). This study examined the relationship between receiving versus being denied an abortion and subsequent drug use over two years. Trajectories of drug use were compared using multivariate mixed effects regression.

RESULTS

Any drug use, frequency of drug use, and marijuana use did not change over time among women in any group. There were no differential changes over time in any drug use, frequency of drug use, or marijuana use between groups. However, Turnaways who ultimately gave birth increased use of drugs other than marijuana compared to women in the Near Limit Abortion Group (p=.041), who did not increase use.

CONCLUSION

Women receiving abortions did not increase drug use over two years or have higher levels of drug use than women denied abortions. Assertions that abortion leads women to use drugs to cope with the stress of abortion are not supported.

The experiences of women who quit smoking during pregnancy and how they dealt with their spouses' continued smoking

OBJECTIVE

to explore how pregnant women in Taiwan dealt with their spouses who continued to smoke and with passive smoking during their own process of quitting and abstaining.

DESIGN

a qualitative study using an oral history approach. Data were collected via tape-recorded open-ended interviews. All interviews were transcribed verbatim. Data were analysed using narrative analysis.

SETTING

the homes of the participant women living in the district of a regional hospital of eastern Taiwan.

PARTICIPANTS

a purposive sample of 10 Taiwanese women who had quit smoking while pregnant was recruited at 1-3 months following the birth of their infants.

FINDINGS

five major themes emerged: (1) the women coping with tobacco addiction on their own, (2) creating a non-smoking section or environment at home, (3) dealing with passive smoking, (4) conflict over the wife's sensitivity to her spouse's residual tobacco smell, and (5) allowing the husband to continue smoking to avoid conflicts.

KEY CONCLUSIONS

the pregnant women were expected by their spouses to quit smoking, yet the husbands continued to smoke. Women had to struggle to quit smoking on their own. The findings from this study support the need to listen to pregnant women's stories, as this is paramount to understanding their experiences of tobacco-use reduction and cessation, and for developing gender appropriate interventions to support their efforts.

IMPLICATIONS FOR PRACTICE

health care providers should encourage and help pregnant women who are willing to quit smoking. This help could be more family-centred instead of focusing on the pregnant women alone, and therefore involve educating the spouse to support his wife.

Lifecourse socioeconomic position and alcohol use in young adulthood: results from the French TEMPO cohort study

AIMS

The aim of the study was to examine the relationship between lifetime socioeconomic position and alcohol use in young adults.

METHODS

The participants (n = 1103, age 22-35 years in 2009) were the French TEMPO cohort, offspring of employees (all French nationals) of the French national gas and electricity company (GAZEL) who were in a previous cohort study. Alcohol use was assessed by the WHO AUDIT questionnaire (none, low or intermediate alcohol use, alcohol abuse). Childhood socioeconomic position was measured using parental income documented in the GAZEL study in 1989 (low: ≤ 2592€/month vs. intermediate/high: >2592€/month). Adult socioeconomic position was measured by participants' educational level (≤ high school degree vs. >high school degree). Combining family income and educational attainment, we ascertained participants' social trajectory (stable high, upward, downward and stable low). Data were analyzed using multinomial regression analyses controlled for demographic, social, psychological and family characteristics.

RESULTS

Compared with participants with a stable high social trajectory, those with an upward, downward or low social trajectory were more likely to abstain from alcohol (compared with a stable high social trajectory, sex and age-adjusted ORs: OR = 2.22, 95% CI 1.35-3.65 for an upward social trajectory; OR = 3.20, 95% CI 1.78-5.73 for a downward social trajectory; OR = 3.27, 95% CI 1.75-6.12 for a stable low social trajectory). Additionally, participants with a downward social trajectory were disproportionately likely to abuse alcohol (sex- and age-adjusted OR: 1.48, 95% CI 0.89-2.48). In multivariate analyses, social trajectory remained associated with alcohol use.

CONCLUSION

Lifelong socioeconomic position may shape patterns of alcohol use early in life.

Changes in alcohol use and relationship satisfaction in Norwegian couples during pregnancy

Background

Numerous studies have documented a profound reduction in alcohol use among pregnant women, whereas research on expectant fathers has been scarce. The aim of this study was to measure changes in alcohol consumption from before pregnancy to 17 weeks in gestation for mothers and fathers, differentiating between parents with and without any previous children, and to measure how level and change in alcohol consumption into early pregnancy was associated with relationship satisfaction.

Methods

The data collection was conducted as part of the Norwegian Mother and Child Cohort Study (MoBa) at the Norwegian Institute of Public Health. This cohort now includes 108 000 children, 90 700 mothers and 71 500 fathers recruited from 1999 to 2008. The present study comprises 82 362 couples. Alcohol consumption was assessed using a questionnaire including items about usual drinking frequency, quantities, and number of occasions with heavy episodic drinking (HED). Relationship satisfaction was measured by five items scored on a Likert agreement scale.

Results

The findings indicate that both mothers and fathers reduce their drinking significantly during pregnancy. Reduction was apparent for all three measures of alcohol consumption. First-time fathers reduced their alcohol consumption more than experienced fathers, from initially higher levels. The gap between the fathers and their pregnant partner was greater for first-time parents compared to parents with previous children. Drinking pre-pregnancy and relationship satisfaction during pregnancy were weakly related within each partner, whereas no association across partners was observed.

Conclusions

Both expectant mothers and fathers changed their alcohol consumption patterns when expecting a child. Almost all mothers stopped drinking, whereas fathers reduced their drinking to a considerable degree. Relationship satisfaction was only slightly related to their drinking patterns. The findings may have important policy implications, mainly with regard to developing alcohol preventive strategies.

Transition to parenthood and substance use disorders: findings from a 30-year longitudinal study

BACKGROUND

This study examined the associations between the transition to parenthood and substance use disorders from ages 18 to 30 in a New Zealand birth cohort.

METHODS

Outcomes included: DSM-IV criteria for: (a) alcohol abuse/dependence (AAD) and (b) illicit substance abuse/dependence. The study also used measures transition to parenthood during the period 18-30 years; and observed covariate factors including: family socio-economic status; family functioning; childhood abuse exposure; childhood personal and behavioural characteristics; and psychosocial adjustment in adolescence. Data were analysed using repeated measures generalised estimating equation models, and conditional fixed effects regression modelling to control for confounding. Gender interactions were examined using moderated regression analyses.

RESULTS

Those who became parents had unadjusted odds of substance use disorder outcomes that were approximately 50% lower than those who had not become parents. Adjustment of the associations for both: (a) observed confounding factors and (b) non-observed fixed effects; strengthened the associations between parenthood status and substance use disorders. Custodial parents had odds of substance use disorders that were 57-78% lower than those who did not become parents after adjusting for non-observed fixed effects. Additional analyses suggested these effects were confined to custodial parents only. There was also evidence for gender×parenthood status interactions for AAD, with the effects of parenthood on AAD being stronger for females.

CONCLUSIONS

The results suggest that the transition to custodial parenthood may result in reduced risks of substance use disorder, particularly amongst female cohort members.

Review of risk and protective factors of substance use and problem use in emerging adulthood

This review examines the evidence for longitudinal predictors of substance use and abuse in emerging adulthood. Nationally representative data from the 2007 National Survey on Drug use and Health suggest that many substance use problems reach their peak prevalence during emerging adulthood (usually defined as the period from age 18 to age 26). This stage of development is characterized by rapid transitions into new social contexts that involve greater freedom and less social control than experienced during adolescence. Concurrent with this newfound independence is an increase in rates of substance use and abuse. Understanding the risk and protective factors associated with emerging adult substance use problems is an important step in developing interventions targeting those problems. While multiple reviews have examined risk and protective factors for substance use during adolescence, and many of these earlier predictors may predict emerging adult substance use, few studies have focused primarily on the emerging adult outcomes examining predictors from both adolescence and emerging adulthood. This review used the databases PubMed and PsycInfo to identify articles pertaining to longitudinal predictors of substance use problems in emerging adulthood, building from the conceptual framework presented in a review on risk and protective factors for adolescent substance abuse by Hawkins and colleagues (Hawkins, Catalano, & Miller, 1992). Predictors identified as predictors of substance use in adolescence, sometimes decreased in strength and in one case reversed direction. Unique predictors in emerging adulthood were also identified. Implications for prevention science during adolescence and emerging adulthood are discussed as well as suggestions for future research.

Pregnancy, alcohol intake, and intimate partner violence among men and women attending drinking establishments in a Cape Town, South Africa township

The highest rates of fetal alcohol syndrome worldwide can be found in South Africa. Particularly in impoverished townships in the Western Cape, pregnant women live in environments where alcohol intake during pregnancy has become normalized and interpersonal violence (IPV) is reported at high rates. For the current study we sought to examine how pregnancy, for both men and women, is related to alcohol use behaviors and IPV. We surveyed 2,120 men and women attending drinking establishments in a township located in the Western Cape of South Africa. Among women 13.3% reported being pregnant, and among men 12.0% reported their partner pregnant. For pregnant women, 61% reported attending the bar that evening to drink alcohol and 26% reported both alcohol use and currently experiencing IPV. Daily or almost daily binge drinking was reported twice as often among pregnant women than non-pregnant women (8.4% vs. 4.2%). Men with pregnant partners reported the highest rates of hitting sex partners, forcing a partner to have sex, and being forced to have sex. High rates of alcohol frequency, consumption, binge drinking, consumption and binge drinking were reported across the entire sample. In general, experiencing and perpetrating IPV were associated with alcohol use among all participants except for men with pregnant partners. Alcohol use among pregnant women attending shebeens is alarmingly high. Moreover, alcohol use appears to be an important factor in understanding the relationship between IPV and pregnancy. Intensive, targeted, and effective interventions for both men and women are urgently needed to address high rates of drinking alcohol among pregnant women who attend drinking establishments.

Men's and women's pathways to adulthood and associated substance misuse

OBJECTIVE

Social role transitions have been linked to changes in substance use and misuse during young adulthood. This study examined how commonly observed pathways to adulthood, defined by education, employment, marriage, and parenthood, were associated with alcohol, tobacco, and marijuana misuse from ages 18 to 33.

METHOD

Data came from a longitudinal panel of 412 men and 396 women recruited when they were in fifth grade in Seattle public schools in 1985. Participants were followed through age 33 in 2008, with 92% retention.

RESULTS

Young adults who had little postsecondary education and remained unmarried through age 30 generally had the highest rates of substance misuse. Those who were involved in postsecondary education and postponed family formation had the lowest rates, particularly with respect to daily smoking and nicotine dependence. Parenting during the young adult years was associated with lower rates of substance misuse for both men and women. However, taking on parenting responsibilities early, during the late teen years and early 20s (observed mostly for women), was associated with higher rates of tobacco misuse. Differences in substance misuse by pathways to adulthood were fairly constant across the young adulthood years and were already observed at age 18, suggesting that substance misuse patterns are established early.

CONCLUSIONS

Young adults may change their substance use only partially in response to new freedoms and responsibilities in young adulthood. Preventive efforts should include a focus on early initiation of substance use and educational experiences that move people into life trajectories and associated substance misuse patterns.

Prevalence and Perceived Financial Costs of Marijuana versus Tobacco use among Urban Low-Income Pregnant Women

OBJECTIVE

To examine the relative prevalence of marijuana and tobacco use among low-income post-partum women, using self-report, urine, and hair testing data; and to further explore perceptions of the substances among postpartum women by evaluating perceived risk and monetary cost of prenatal marijuana versus tobacco use.

METHODS

Data from two studies were available for a total of 100 (Study 1) and 50 (Study 2) low-income, primarily African-American post-partum women. Study 1 participants completed brief self-report measures of substance use as well as urine and hair samples; study 2 participants completed a brief opinion survey regarding the risks and monetary costs of prenatal marijuana use.

RESULTS

In Study 1, the self-reported prevalence of any tobacco or marijuana use in the past three months was 17% and 11%, respectively. However, objectively-defined marijuana use was more prevalent than self-reported tobacco use: 14% tested positive for marijuana by urinalysis, and 28% by hair analysis. Study 2 participants were more likely to believe that there is a safe level of marijuana use during pregnancy, and nearly half believed that using marijuana during pregnancy was less expensive than smoking cigarettes.

CONCLUSION

Marijuana use may be as or more prevalent than tobacco use among low-income, African-American pregnant women. These findings may in part be attributable to perceptions of roughly equivalent cost and the lack of a clear public health message regarding prenatal marijuana use, combined with growing pro-marijuana advocacy. A broader public health response to address prenatal marijuana use, along with other substances of abuse, is needed.

Opiate-addicted parents in methadone treatment: long-term recovery, health, and family relationships

Few studies follow the lives of opiate-addicted parents. The authors examined a 12-year follow-up of 144 parents in methadone treatment and their 3- to 14-year-old children. Parent mortality was high. Among survivors, drug use and treatment, incarceration, residential and family disruptions, and health problems were common. Moderate and long-term recovery were associated with consistent methadone treatment, further education, employment, and fewer relationship disruptions. Earlier depression, deviant friends, and poor coping skills predicted continued drug problems. Thus, interventions should include treatment for depression and build skills for avoiding and refusing drugs, coping with stress, and maintaining recovery-supportive friendships.

Sources and frequency of secondhand smoke exposure during pregnancy

INTRODUCTION

This study examined sources of exposure to secondhand smoke (SHS) during pregnancy and misclassification of women as having no SHS exposure if partner smoking was used as the only measure of SHS exposure. We also examined changes in SHS exposure across the three trimesters of pregnancy.

METHODS

The sample consisted of 245 pregnant women who were in a serious relationship with a partner and 106 for examination of change over time. Women's smoking status was determined by a combination of self-reports and oral fluid assays. Women's reports of partner smoking, smoking by other social network members, and frequency of exposure to SHS were obtained.

RESULTS

The most common source of SHS exposure during pregnancy was the partner (n = 245). However, reliance on the partner smoking measure alone would have misclassified a substantial number of women as having no SHS exposure during pregnancy. The importance of exposure from the general social network was also evident in the finding that among nonsmoking women with nonsmoking partners, 50% reported some level of SHS exposure in the preceding week. Contrary to expectations, there were no changes in SHS exposure across the three trimesters of pregnancy (n = 106).

CONCLUSIONS

Results highlight the need for treatment plans to target sources of exposure from other members of women's social networks in addition to partners. It may be unrealistic to expect women's cessation efforts to be successful in the face of consistent and continued SHS exposure through pregnancy.

The incidence of mental illness in early motherhood in a population-based survey

The present study examined the risk of mental disorders within the first 3 postpartum years in a nationally representative sample and the sociodemographic risk factors for mental illness in early motherhood. Women aged 18 to 55 years were asked, "Are you pregnant at this time?" at baseline. A total of 13,839 women answered, with 365 of these women reporting pregnancy. Mental disorders were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV version. After adjusting for sociodemographics, postpartum women were found to be at lower risk than non-postpartum women for having several first onset mental disorders (adjusted odds ratio range: 0.49-0.58). Postpartum women with a history of mental illness were at lower risk for the onset of any mental disorder (adjusted odds ratio: 0.60, 95% confidence interval: 0.39-0.91). No sociodemographic correlates of mental disorders were identified. Clinicians should be aware of these findings when counseling women about mental disorder risk postbirth.

Association of clinical characteristics and cessation of tobacco, alcohol, and illicit drug use during pregnancy

Pregnancy is a time of relative urgency and opportunity for the treatment of substance use disorders in women, yet little is known about modifiable factors that contribute to successful abstinence. We examined self-worth, depression, anxiety, and novelty seeking in the context of substance use cessation during pregnancy in a sample of women with a high prevalence of substance abuse. Subjects were 448 birth mothers who participated in a prospective adoption study. Discontinuation rates were: tobacco 22.2%, alcohol 64.7%, marijuana 77.2%, and other drugs, 73.7-100%. Depression, anxiety, and novelty seeking were lower among women who discontinued substance use, compared to those who did not. Self-worth was higher in women who discontinued substance use. Among 110 polysubstance users, the number of substances discontinued during pregnancy was correlated with depression, anxiety, and self-worth in the hypothesized direction. Possible clinical implications are discussed. 

Latent growth trajectories of substance use among pregnant and parenting adolescents

We examine changes among adolescent girls in substance use during pregnancy and the postpartum period. Three separate latent growth curve analyses assessed the impact of psychosocial, behavioral, and sociodemographic factors on resumption of or change in use of cigarettes, alcohol, and marijuana. The Vulnerable Populations Model for Research and Clinical Practice (Flaskerud & Winslow, 1998) provided the theoretical foundation for this study. This is a secondary analysis of data from a sample of 305 ethnic minority females (245 Latina, 60 African American), aged 13-18 years, who were pregnant at baseline and were participating in an HIV prevention study conducted in inner-city alternative schools in Los Angeles County. Data collected at 4 time points captured changes in substance use from pregnancy through the postpartum period. Baseline predictors included ethnicity/race, partner substance use, childhood abuse history, religiosity, acculturation, depressive symptoms, length of gestation at baseline, and previous substance use. Common predictors of greater resumption and/or greater level of use included greater history of use before pregnancy, partner substance use, childhood abuse, and a longer time since childbirth. African Americans were more likely to be smoking at baseline when they were still pregnant and to use marijuana postpartum; Latinas were more likely to use alcohol over the course of pregnancy and postpartum. Other variables exerted an influence on specific substances. For instance, religiosity impacted cigarette and alcohol use. Findings may assist prenatal care providers to identify and counsel pregnant adolescents at risk for perinatal substance use and to prevent resumption or initiation of substance use after childbirth.

Binge drinking among California adults: results from the 2005 California Health Interview Survey

OBJECTIVE

To calculate binge drinking rates among California adults and describe the characteristics of female and male binge drinkers.

METHOD

Analyses of 2005 California Health Interview Survey (CHIS) data.

RESULTS

At least one binge drinking episode over a 30-day period was reported by 1.4 million California women (10.7% of all adult women) and 3.2 million California men (24.7%). For both women and men, factors associated with binge drinking included being 18-44 years of age, smoking, and having mid-range psychological distress scores. There were gender differences in binge drinking risk by race/ethnicity and health status.

CONCLUSION

Binge drinking is a serious public health concern that affects millions of adult Californians [corrected].