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Bruzelius E, Underhill K, Askari MS, Kajeepeta S, Bates L, Prins SJ, Jarlenski M, Martins SS. Punitive legal responses to prenatal drug use in the United States: A survey of state policies and systematic review of their public health impacts. Int J Drug Policy 2024; 126:104380. [PMID: 38484529 PMCID: PMC11056296 DOI: 10.1016/j.drugpo.2024.104380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/05/2024] [Accepted: 02/28/2024] [Indexed: 04/01/2024]
Abstract
BACKGROUND Punitive legal responses to prenatal drug use may be associated with unintended adverse health consequences. However, in a rapidly shifting policy climate, current information has not been summarized. We conducted a survey of U.S. state policies that utilize criminal or civil legal system penalties to address prenatal drug use. We then systematically identified empirical studies evaluating these policies and summarized their potential public health impacts. METHODS Using existing databases and original statutory research, we surveyed current U.S. state-level prenatal drug use policies authorizing explicit criminalization, involuntary commitment, civil child abuse substantiation, and parental rights termination. Next, we systematically identified quantitative associations between these policies and health outcomes, restricting to U.S.-based peer-reviewed research, published January 2000-December 2022. Results described study characteristics and synthesized the evidence on health-related harms and benefits associated with punitive policies. Validity threats were described narratively. RESULTS By 2022, two states had adopted policies explicitly authorizing criminal prosecution, and five states allowed pregnancy-specific and drug use-related involuntary civil commitment. Prenatal drug use was grounds for substantiating civil child abuse and terminating parental rights in 22 and five states, respectively. Of the 16 review-identified articles, most evaluated associations between punitive policies generally (k = 12), or civil child abuse policies specifically (k = 2), and multiple outcomes, including drug treatment utilization (k = 6), maltreatment reporting and foster care entry (k = 5), neonatal drug withdrawal syndrome (NDWS, k = 4) and other pregnancy and birth-related outcomes (k = 3). Most included studies reported null associations or suggested increases in adverse outcome following punitive policy adoption. CONCLUSIONS Nearly half of U.S. states have adopted policies that respond to prenatal drug use with legal system penalties. While additional research is needed to clarify whether such approaches engender overt health harms, current evidence indicates that punitive policies are not associated with public health benefits, and therefore constitute ineffective policy.
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Affiliation(s)
- Emilie Bruzelius
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722W. 168th St. New York, NY 10032, USA.
| | - Kristen Underhill
- Cornell University Law School, 306 Myron Taylor Hall Ithaca, NY 14853-4901, USA
| | - Melanie S Askari
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722W. 168th St. New York, NY 10032, USA
| | - Sandhya Kajeepeta
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722W. 168th St. New York, NY 10032, USA
| | - Lisa Bates
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722W. 168th St. New York, NY 10032, USA
| | - Seth J Prins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722W. 168th St. New York, NY 10032, USA
| | - Marian Jarlenski
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, A619 130 De Soto Street, Pittsburgh, PA 15261, USA
| | - Silvia S Martins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722W. 168th St. New York, NY 10032, USA
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Marceau K, Loviska AM, Horvath G, Knopik VS. Interactions Between Genetic, Prenatal Substance Use, Puberty, and Parenting are Less Important for Understanding Adolescents' Internalizing, Externalizing, and Substance Use than Developmental Cascades in Multifactorial Models. Behav Genet 2024; 54:181-195. [PMID: 37840057 DOI: 10.1007/s10519-023-10164-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 10/03/2023] [Indexed: 10/17/2023]
Abstract
This study tested interactions among puberty-related genetic risk, prenatal substance use, harsh discipline, and pubertal timing for the severity and directionality (i.e., differentiation) of externalizing and internalizing problems and adolescent substance use. This is a companion paper to Marceau et al. (2021) which examined the same influences in developmental cascade models. Data were from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort (n = 4504 White boys, n = 4287 White girls assessed from the prenatal period through 18.5 years). We hypothesized generally that later predictors would strengthen the influence of puberty-related genetic risk, prenatal substance use exposure, and pubertal risk on psychopathology and substance use (two-way interactions), and that later predictors would strengthen the interactions of earlier influences on psychopathology and substance use (three-way interactions). Interactions were sparse. Although all fourteen interactions showed that later influences can exacerbate or trigger the effects of earlier ones, they often were not in the expected direction. The most robust moderator was parental discipline, and differing and synergistic effects of biological and socially-relevant aspects of puberty were found. In all, the influences examined here operate more robustly in developmental cascades than in interaction with each other for the development of psychopathology and transitions to substance use.
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Affiliation(s)
- Kristine Marceau
- Purdue University, 225 Hanley Hall, 1202 Mitch Daniels Blvd, West Lafayette, IN, 47907, USA.
| | - Amy M Loviska
- Purdue University, 225 Hanley Hall, 1202 Mitch Daniels Blvd, West Lafayette, IN, 47907, USA
| | - Gregor Horvath
- Department of Biostatistics, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Valerie S Knopik
- Purdue University, 225 Hanley Hall, 1202 Mitch Daniels Blvd, West Lafayette, IN, 47907, USA
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Durrance CP, Atkins DN. Estimating the incidence of substance exposed newborns with child welfare system involvement. Child Abuse Negl 2024; 149:106629. [PMID: 38232502 DOI: 10.1016/j.chiabu.2023.106629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 12/04/2023] [Accepted: 12/31/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Prenatal substance use can have negative health consequences for both mother and child and may also increase the likelihood of child welfare involvement. The rate of newborns with substance exposure has increased dramatically. As of 2016, federal law requires notification of all infants to child welfare agencies so that a plan of safe care can be developed and referrals to services can be offered. OBJECTIVE Child welfare agencies have not historically collected consistent, systematic data identifying substance exposed newborns. We utilized a unique strategy to identify substance exposed newborns with child welfare involvement. PARTICIPANTS & SETTING We used data from the National Child Abuse & Detection System (NCANDS) which captures N = 3,189,034 unique child protective services investigations for children under the age of 1 between 2004 and 2017. METHODS We calculated the incidence of substance exposed newborns investigated by child welfare agencies and compared with other administrative data on prenatal substance exposure. We also analyzed this rate by infant demographic characteristics (race/ethnicity, sex, rurality). RESULTS Between 2004 and 2017, approximately 13 % of infants reported to child protective services were likely reported because of substance exposure at birth, and the rate of substance exposed newborns with child welfare involvement increased from 3.79 to 12.90 per 1000 births, an increase of 240 %, over this period. CONCLUSIONS Understanding the extent of the substance use crisis for child welfare involvement is important for policymakers to support children and families.
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Affiliation(s)
- Christine Piette Durrance
- La Follette School of Public Affairs, Institute for Research on Poverty, University of Wisconsin, Madison, United States of America.
| | - Danielle N Atkins
- Askew School of Public Administration, Florida State University, United States of America.
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Green VR, Kennedy-Hendricks A, Saloner B, Bandara S. Substance use and treatment characteristics among pregnant and non-pregnant females, 2015-2019. Drug Alcohol Depend 2024; 254:111041. [PMID: 38043227 DOI: 10.1016/j.drugalcdep.2023.111041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/08/2023] [Accepted: 11/21/2023] [Indexed: 12/05/2023]
Abstract
INTRODUCTION In the United States (US), pregnant females who use substances face increased morbidity and mortality risks compared to non-pregnant females. This study provides a national snapshot of substance use and treatment characteristics among US reproductive-aged females, including those who are pregnant. METHODS Our sample included females aged 15-44 years (n=97,830) from the 2015-2019 National Survey on Drug Use and Health (NSDUH) data. We calculated weighted percentages of past-month alcohol or drug use and past-year substance use disorder (SUD), stratified by pregnancy status. We also calculated weighted percentages of past-year treatment setting and payer. Pearson chi-square tests were conducted to determine if percentages were statistically significantly different. RESULTS Compared to non-pregnant females, pregnant females had lower prevalence of past-month illicit drug use excluding cannabis (1.6% vs. 4.3%, p<0.01), cannabis use (5.3% vs. 12.5%, p<0.01), binge drinking (4.5% vs. 29.3%, p<0.01) and past-year SUD (7.1 vs. 8.8%, p<0.01). Less than 13% of females with SUD received treatment regardless of pregnancy status, but treatment use was higher among pregnant females compared to non-pregnant females (12.8% vs. 10.5%). However, there were no statistically significant differences in past-year treatment use, setting, or treatment payer. DISCUSSION The prevalence of substance use and SUD was lower among pregnant females compared to non-pregnant females in 2015-2019. Low uptake of substance use treatment suggests that barriers exist to treatment-seeking among reproductive-aged women. Further exploration of stigma, payment, and access to treatment, and how they differ by pregnancy status, is needed.
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Affiliation(s)
- Victoria R Green
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Alene Kennedy-Hendricks
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Brendan Saloner
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Sachini Bandara
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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Reddy J, Palmer L, Putnam-Hornstein E. Three-Year Custody Outcomes Among Infants Investigated by Child Protection Systems for Prenatal Substance Exposure in California. Matern Child Health J 2023; 27:94-103. [PMID: 37256517 PMCID: PMC10692263 DOI: 10.1007/s10995-023-03690-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Infants affected by prenatal alcohol and drug use are more likely to be removed from parental custody than those in the general population, although it is unclear whether their custody outcomes differ from infants investigated by child protection systems (CPS) for other reasons. This analysis seeks to compare trajectories of involvement and custody outcomes among infants investigated by CPS with and without documentation of prenatal substance exposure (PSE). METHOD We used vital birth records linked to administrative CPS records to examine the timing of system involvement and 3-year custodial outcomes among investigated infants with and without identified PSE. We defined PSE according to documentation on the state's standardized hotline screening form, which CPS completes upon referral for alleged maltreatment. We estimated the likelihood a child was in nonparental custody at age 3 by specifying multivariable generalized linear models, adjusted for covariates available in the birth record. RESULTS In our sample of 22,855 infants investigated by CPS in 2017 in California, more than 26% had documentation of PSE. These infants experienced an accelerated timeline of system penetration and were 2.2 times as likely to be in nonparental placement at age 3. DISCUSSION PSE confers an independent risk of custody interruption among infants investigated by CPS. The younger age of these infants, complexity of parental substance use, and potential misalignment of administrative permanency timelines with parental recovery all suggest the need for increased research, policy, and programmatic interventions to serve this vulnerable population.
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Affiliation(s)
- Julia Reddy
- Gillings School of Global Public Health, University of North Carolina, 412 Rosenau Hall, Chapel Hill, NC, 27599, USA.
| | - Lindsey Palmer
- The Pennsylvania State University, 133 Health and Human Development Building, University Park, PA, 16802, USA
| | - Emily Putnam-Hornstein
- School of Social Work, University of North Carolina at Chapel Hill, Tate-Turner-Kuralt Building, 325 Pittsboro St, Chapel Hill, NC, 27599-3550, USA
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Sharp N, Fuchs J, Drake A. An Implementation Evaluation of the Comprehensive Addiction Recovery Act (CARA) Policy in New Mexico. Matern Child Health J 2023; 27:113-121. [PMID: 37851151 PMCID: PMC10691990 DOI: 10.1007/s10995-023-03787-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE The purpose of this field report is to describe an evaluation of the fidelity with which the comprehensive addiction and recovery act (CARA) policy has been implemented in New Mexico. DESCRIPTION The CARA program in New Mexico focuses on providing nonpunitive supportive care for pregnant people affected by substance use and on coordinating services for parents, caregivers, and family members of newborns affected by substance exposure. The evaluation used information from program reports, a family follow-up survey, the plan of safe care database, and a data linkage between CARA participant records with Medicaid claims data. RESULTS Follow-up survey data substantiated the program reports. Both sources showed that families were not engaged consistently in developing or receiving information about plans of safe care. The survey answers also indicated that the time-period immediately after the delivery of a baby is not the best time to communicate the contents of the plan of safe care to families. Additionally, the survey found that respondents believed that medical staff judged them for using substances during pregnancy. The Medicaid data linkage showed that 40.3% of families of infants exposed to substances in-utero did not receive a plan of safe care. Program reports revealed that limited resources existed for implementing CARA. CONCLUSION Program funding, limited system capacity, lack of systematic screening for prenatal substance use, regional differences in access to care, and provider biases toward pregnant people using substances affected health-care workers' ability to identify at-risk families and develop plans of safe care. To support CARA implementation, healthcare systems must implement universal prenatal substance use screening, increase the level of anti-bias training pertaining to substance use, increase hospital supports, and improve data management systems.
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Affiliation(s)
- Nicholas Sharp
- New Mexico Department of Health, 2040 S. Pacheco, Santa Fe, NM, USA.
| | - Jessi Fuchs
- New Mexico Department of Health, 2040 S. Pacheco, Santa Fe, NM, USA
| | - Amy Drake
- New Mexico Department of Health, 2040 S. Pacheco, Santa Fe, NM, USA
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Avalos LA, Oberman N, Alexeeff SE, Croen LA, Adams SR, Davignon M, Young-Wolff KC. Association between maternal prenatal cannabis use and missed child preventive care visits in an integrated health care delivery system in Northern California. Prev Med 2023; 175:107716. [PMID: 37775081 PMCID: PMC10849893 DOI: 10.1016/j.ypmed.2023.107716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/08/2023] [Accepted: 09/26/2023] [Indexed: 10/01/2023]
Abstract
The periodicity of well-child visits recommended by the American Academy of Pediatrics emphasizes the importance of continuity of care in health management. Exposure to cannabis in utero has been associated with adverse development, and adherence to well-child visits is critical for earlier detection and intervention. To assess whether maternal prenatal cannabis use was associated with missed well-child visits in the first three years after birth we conducted a longitudinal cohort study in Kaiser Permanente Northern California of pregnant individuals and their children born between January 1, 2011 and December 31, 2018. Maternal prenatal cannabis use was defined as any self-reported cannabis use since becoming pregnant and/or a positive urine toxicology test for cannabis during pregnancy. Well-child visits were defined as an encounter for a well-child visit or physical exam and categorized into seven time periods from birth to 36 months. Modified Poisson regression models were conducted. Of the 168,589 eligible pregnancies, 3.4% screened positive for maternal prenatal cannabis use. Compared to no use, maternal prenatal cannabis use was associated with more missed well-child visits at every time period; (missed 12-month visit: adjusted relative risk (aRR): 1.43, 95%CI: 1.32-1.54; missed 3-year visit: aRR: 1.15, 95%CI: 1.11-1.20). Maternal prenatal cannabis use was also associated with missing two or more well-child visits through 36 months of age (35.8% among cannabis users vs. 23.0% among non-users, Χ2p < .001). Educating pregnant individuals who use cannabis on the importance of well-child visits may benefit children's health and development.
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Affiliation(s)
- Lyndsay A Avalos
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America.
| | - Nina Oberman
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Stacey E Alexeeff
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Lisa A Croen
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Sara R Adams
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Meghan Davignon
- The Permanente Medical Group, Oakland, CA, United States of America
| | - Kelly C Young-Wolff
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, United States of America
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Shorey-Kendrick LE, Roberts VHJ, D'Mello RJ, Sullivan EL, Murphy SK, Mccarty OJT, Schust DJ, Hedges JC, Mitchell AJ, Terrobias JJD, Easley CA, Spindel ER, Lo JO. Prenatal delta-9-tetrahydrocannabinol exposure is associated with changes in rhesus macaque DNA methylation enriched for autism genes. Clin Epigenetics 2023; 15:104. [PMID: 37415206 PMCID: PMC10324248 DOI: 10.1186/s13148-023-01519-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/12/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND With the growing availability of cannabis and the popularization of additional routes of cannabis use beyond smoking, including edibles, the prevalence of cannabis use in pregnancy is rapidly increasing. However, the potential effects of prenatal cannabis use on fetal developmental programming remain unknown. RESULTS We designed this study to determine whether the use of edible cannabis during pregnancy is deleterious to the fetal and placental epigenome. Pregnant rhesus macaques consumed a daily edible containing either delta-9-tetrahydrocannabinol (THC) (2.5 mg/7 kg/day) or placebo. DNA methylation was measured in 5 tissues collected at cesarean delivery (placenta, lung, cerebellum, prefrontal cortex, and right ventricle of the heart) using the Illumina MethylationEPIC platform and filtering for probes previously validated in rhesus macaque. In utero exposure to THC was associated with differential methylation at 581 CpGs, with 573 (98%) identified in placenta. Loci differentially methylated with THC were enriched for candidate autism spectrum disorder (ASD) genes from the Simons Foundation Autism Research Initiative (SFARI) database in all tissues. The placenta demonstrated greatest SFARI gene enrichment, including genes differentially methylated in placentas from a prospective ASD study. CONCLUSIONS Overall, our findings reveal that prenatal THC exposure alters placental and fetal DNA methylation at genes involved in neurobehavioral development that may influence longer-term offspring outcomes. The data from this study add to the limited existing literature to help guide patient counseling and public health polices focused on prenatal cannabis use in the future.
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Affiliation(s)
- Lyndsey E Shorey-Kendrick
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, 97006, USA.
| | - Victoria H J Roberts
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, 97006, USA
| | - Rahul J D'Mello
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Oregon Health and Science University, Portland, OR, 97239, USA
| | - Elinor L Sullivan
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, 97006, USA
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, 97239, USA
- Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, 97239, USA
| | - Susan K Murphy
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, 27701, USA
| | - Owen J T Mccarty
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR, 97239, USA
| | - Danny J Schust
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, 27701, USA
| | - Jason C Hedges
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, 97006, USA
- Department of Urology, Oregon Health and Science University, Portland, OR, 97239, USA
| | - A J Mitchell
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, 97006, USA
| | - Jose Juanito D Terrobias
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, 97006, USA
| | - Charles A Easley
- Department of Environmental Health Science, University of Georgia College of Public Health, Athens, GA, 30602, USA
| | - Eliot R Spindel
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, 97006, USA
| | - Jamie O Lo
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, 97006, USA
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Oregon Health and Science University, Portland, OR, 97239, USA
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Wine O, McNeil D, Kromm SK, Foss K, Caine V, Clarke D, Day N, Johnson DW, Rittenbach K, Wood S, Hicks M. The Alberta Neonatal Abstinence Syndrome Mother-Baby Care ImprovEmeNT (NASCENT) program: protocol for a stepped wedge cluster randomized trial of a hospital-level Neonatal Abstinence Syndrome rooming-in intervention. BMC Health Serv Res 2023; 23:448. [PMID: 37149626 PMCID: PMC10164330 DOI: 10.1186/s12913-023-09440-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/24/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Neonatal Abstinence Syndrome (NAS), a problem common in newborns exposed to substances in-utero, is an emerging health concern. In traditional models of care, infants with NAS are routinely separated from their mothers and admitted to the Neonatal Intensive Care Unit (NICU) with long, expensive length of stay (LOS). Research shows a rooming-in approach (keeping mothers and infants together in hospital) with referral support is a safe and effective model of care in managing NAS. The model's key components are facilitating 24-h care by mothers on post-partum or pediatric units with support for breastfeeding, transition home, and access to Opioid Dependency Programs (ODP). This study will implement the rooming-in approach at eight hospitals across one Canadian Province; support practice and culture shift; identify and test the essential elements for effective implementation; and assess the implementation's impact/outcomes. METHODS A stepped wedge cluster randomized trial will be used to evaluate the implementation of an evidence-based rooming-in approach in the postpartum period for infants born to mothers who report opioid use during pregnancy. Baseline data will be collected and compared to post-implementation data. Six-month assessment of maternal and child health and an economic evaluation of cost savings will be conducted. Additionally, barriers and facilitators of the rooming-in model of care within the unique context of each site and across sites will be explored pre-, during, and post-implementation using theory-informed surveys, interviews, and focus groups with care teams and parents. A formative evaluation will examine the complex contextual factors and conditions that influence readiness and sustainability and inform the design of tailored interventions to facilitate capacity building for effective implementation. DISCUSSION The primary expected outcome is reduced NICU LOS. Secondary expected outcomes include decreased rates of pharmacological management of NAS and child apprehension, increased maternal ODP participation, and improved 6-month outcomes for mothers and infants. Moreover, the NASCENT program will generate the detailed, multi-site evidence needed to accelerate the uptake, scale, and spread of this evidence-based intervention throughout Alberta, leading to more appropriate and effective care and use of healthcare resources. TRIAL REGISTRATION ClinicalTrials.gov, NCT0522662. Registered February 4th, 2022.
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Affiliation(s)
- Osnat Wine
- Department of Pediatrics, Division of Neonatal-Perinatal Care, College of Health Sciences, Faculty of Medicine & Dentistry, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Ave., Edmonton, AB, T6G 1C9, Canada
- Maternal Newborn Child & Youth Strategic Clinical Network, Alberta Health Services, Calgary, Canada
| | - Deborah McNeil
- Maternal Newborn Child & Youth Strategic Clinical Network, Alberta Health Services, Calgary, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Seija K Kromm
- Maternal Newborn Child & Youth Strategic Clinical Network, Alberta Health Services, Calgary, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Karen Foss
- Stollery, Edmonton, Alberta Health Services, Edmonton, AB, Canada
| | - Vera Caine
- University of Victoria, Victoria, BC, Canada
| | - Denise Clarke
- Stollery, Edmonton, Alberta Health Services, Edmonton, AB, Canada
| | | | - David W Johnson
- Departments of Pediatrics, Emergency Medicine and Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Stephen Wood
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Matt Hicks
- Department of Pediatrics, Division of Neonatal-Perinatal Care, College of Health Sciences, Faculty of Medicine & Dentistry, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Ave., Edmonton, AB, T6G 1C9, Canada.
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Hemady CL, Speyer LG, Murray AL, Brown RH, Meinck F, Fry D, Do H, Sikander S, Madrid B, Fernando A, Walker S, Dunne M, Foley S, Hughes C, Osafo J, Baban A, Taut D, Ward CL, Van Thang V, Fearon P, Tomlinson M, Valdebenito S, Eisner M. Patterns of adverse childhood experiences and associations with prenatal substance use and poor infant outcomes in a multi-country cohort of mothers: a latent class analysis. BMC Pregnancy Childbirth 2022; 22:505. [PMID: 35733125 PMCID: PMC9215006 DOI: 10.1186/s12884-022-04839-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This paper enumerates and characterizes latent classes of adverse childhood experiences and investigates how they relate to prenatal substance use (i.e., smoking, alcohol, and other drugs) and poor infant outcomes (i.e., infant prematurity and low birthweight) across eight low- and middle-income countries (LMICs). METHODS A total of 1189 mother-infant dyads from the Evidence for Better Lives Study cohort were recruited. Latent class analysis using the Bolck, Croon, and Hagenaars (BCH) 3-step method with auxiliary multilevel logistic regressions was performed. RESULTS Three high-risk classes and one low-risk class emerged: (1) highly maltreated (7%, n = 89), (2) emotionally and physically abused with intra-familial violence exposure (13%, n = 152), (3), emotionally abused (40%, n = 474), and (4) low household dysfunction and abuse (40%, n = 474). Pairwise comparisons between classes indicate higher probabilities of prenatal drug use in the highly maltreated and emotionally abused classes compared with the low household dysfunction and abuse class. Additionally, the emotionally and physically abused with intra-familial violence exposure class had higher probability of low birthweight than the three remaining classes. CONCLUSION Our results highlight the multifaceted nature of ACEs and underline the potential importance of exposure to childhood adversities on behaviors and outcomes in the perinatal period. This can inform the design of antenatal support to better address these challenges.
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Affiliation(s)
- Chad Lance Hemady
- Social Work Department, University of Edinburgh, Edinburgh, UK. .,School of Social and Political Science, 15a George Square, Edinburgh, EH8 9LD, UK.
| | | | | | | | - Franziska Meinck
- Social Work Department, University of Edinburgh, Edinburgh, UK.,Faculty of Humanities, North-West University, Potchefstroom, South Africa
| | - Deborah Fry
- Moray House School of Education and Sport, University of Edinburgh, Edinburgh, UK
| | - Huyen Do
- Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Siham Sikander
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK.,Global Institute of Human Development, Shifa Tameer-E-Millat University, Islamabad, Pakistan
| | - Bernadette Madrid
- Child Protection Unit, University of the Philippines, Manila, Philippines
| | - Asvini Fernando
- Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka
| | - Susan Walker
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Michael Dunne
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Australia
| | - Sarah Foley
- Moray House School of Education and Sport, University of Edinburgh, Edinburgh, UK
| | - Claire Hughes
- Centre for Family Research, University of Cambridge, Cambridge, UK
| | - Joseph Osafo
- Department of Psychology, University of Ghana, Accra, Ghana
| | - Adriana Baban
- Department of Psychology, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Diana Taut
- Department of Psychology, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Catherine L Ward
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Vo Van Thang
- Institute for Community Health Research, Hue University, Hue, Vietnam
| | - Pasco Fearon
- Division of Psychology & Language Sciences, University College London, London, UK
| | - Mark Tomlinson
- Department of Global Health, Institute of Life Course Health Research, Stellenbosch University, Cape Town, South Africa.,School of Nursing and Midwifery, Queens University, Belfast, UK
| | - Sara Valdebenito
- Institute of Criminology, University of Cambridge, Cambridge, UK
| | - Manuel Eisner
- Institute of Criminology, University of Cambridge, Cambridge, UK.,Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
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11
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Woodruff K, Scott KA, Roberts SCM. Pregnant people's experiences discussing their cannabis use with prenatal care providers in a state with legalized cannabis. Drug Alcohol Depend 2021; 227:108998. [PMID: 34482037 DOI: 10.1016/j.drugalcdep.2021.108998] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/20/2021] [Accepted: 08/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND As cannabis legalization spreads, so do concerns about potential harms from use during pregnancy. Legalization may facilitate improved patient-provider interactions about cannabis use. Yet little is known about pregnant people's discussions of cannabis use with healthcare providers in an environment where recreational cannabis is legal. METHODS In May-August 2019, we conducted semi-structured in-depth interviews with 33 pregnant or postpartum people in California who used cannabis during pregnancy, and explored their discussions with healthcare providers about their cannabis use. We audio-recorded and transcribed interviews, and conducted thematic analysis using inductive and deductive methods. RESULTS Participants were diverse by age, race/ethnicity, and socio-economic position. Most reported daily cannabis use, both before and during pregnancy. Most participants did not disclose their cannabis use to their prenatal care providers, due to fears of being reported to child protective services (CPS), or fears of provider judgment. Participants reported that few providers initiated any discussions about cannabis use in pregnancy with them; some participants interpreted this omission as tacit endorsement of cannabis use in pregnancy. When participants and providers did discuss cannabis use in pregnancy, participants heard a wide range of sometimes-conflicting health messages, as well as some legal threats. CONCLUSIONS This study documents notable deficits in patient-provider interactions about cannabis. Pregnant patients' fears of being reported to CPS and separated from their children for cannabis use persist despite cannabis legalization. Providers' role as potential reporters to CPS appears to pose a significant barrier to comprehensive, compassionate counseling and education on cannabis use in pregnancy.
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Affiliation(s)
- Katie Woodruff
- University of California, San Francisco, Dept. of Obstetrics, Gynecology, & Reproductive Sciences, 1330 Broadway, Suite 1100, Oakland, CA 94612, United States(1).
| | - Karen A Scott
- University of California, San Francisco, Dept. of Obstetrics, Gynecology, & Reproductive Sciences, 1330 Broadway, Suite 1100, Oakland, CA 94612, United States(1).
| | - Sarah C M Roberts
- University of California, San Francisco, Dept. of Obstetrics, Gynecology, & Reproductive Sciences, 1330 Broadway, Suite 1100, Oakland, CA 94612, United States(1).
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12
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Marceau K, Horvath G, Loviska AM, Knopik VS. Developmental Cascades from Polygenic and Prenatal Substance Use to Adolescent Substance Use: Leveraging Severity and Directionality of Externalizing and Internalizing Problems to Understand Pubertal and Harsh Discipline-Related Risk. Behav Genet 2021; 51:559-579. [PMID: 34241754 PMCID: PMC8628579 DOI: 10.1007/s10519-021-10068-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/26/2021] [Indexed: 12/13/2022]
Abstract
The current study leveraged the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort (n = 4504 White boys, n = 4287 White girls assessed from the prenatal period through 18.5 years of age) to test a developmental cascade from genetic and prenatal substance use through pubertal timing and parenting to the severity of (regardless of type) and directionality (i.e., differentiation) of externalizing and internalizing problems to adolescent substance use. Limited associations of early pubertal timing with substance use outcomes were only observable via symptom directionality, differently for girls and boys. For boys, more severe exposure to prenatal substance use influenced adolescent substance use progression via differentiation towards relatively more pure externalizing problems, but in girls the associations were largely direct. Severity and especially directionality (i.e., differentiation towards relatively more pure externalizing problems) were key intermediaries in developmental cascades from parental harsh discipline with substance use progressions for girls and boys.
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Affiliation(s)
- Kristine Marceau
- Purdue University, 225 Hanley Hall, 1202 W. State Street, West Lafayette, IN, 47906, USA.
| | | | - Amy M Loviska
- Purdue University, 225 Hanley Hall, 1202 W. State Street, West Lafayette, IN, 47906, USA
| | - Valerie S Knopik
- Purdue University, 225 Hanley Hall, 1202 W. State Street, West Lafayette, IN, 47906, USA
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13
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Young-Wolff KC, Tucker LY, Armstrong MA, Conway A, Weisner C, Goler N. Correlates of Pregnant Women's Participation in a Substance Use Assessment and Counseling Intervention Integrated into Prenatal Care. Matern Child Health J 2020; 24:423-431. [PMID: 32056081 DOI: 10.1007/s10995-020-02897-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Screening and referral for substance use are essential components of prenatal care. However, little is known about barriers to participation in substance use interventions that are integrated within prenatal care. METHODS Our study examines demographic and clinical correlates of participation in an initial assessment and counseling intervention integrated into prenatal care in a large healthcare system. The sample comprised Kaiser Permanente Northern California pregnant women with a live birth in 2014 or 2015 who screened positive for prenatal substance use via a self-reported questionnaire and/or urine toxicology test given as part of standard prenatal care (at ~ 8 weeks gestation). RESULTS Of the 11,843 women who screened positive for prenatal substance use (median age = 30 years; 42% white; 38% screened positive for alcohol only, 20% for cannabis only, 5% nicotine only, 17% other drugs only, and 19% ≥ 2 substance categories), 9836 (83%) completed the initial substance use assessment and counseling intervention. Results from multivariable logistic regression analyses indicated that younger age, lower income, single marital status, and a positive urine toxicology test predicted higher odds of participation, while other/unknown race/ethnicity, greater parity, receiving the screening later in pregnancy, and screening positive for alcohol only or other drugs only predicted lower odds of participation (all Ps < .05). DISCUSSION Findings suggest that integrated substance use interventions can successfully reach vulnerable populations of pregnant women (e.g., younger, lower income, racial/ethnic minorities). Future research should address whether differences in participation are due to patient (e.g., type of substance used, perceived stigma) or provider factors (e.g., working harder to engage traditionally underserved patients).
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Affiliation(s)
- Kelly C Young-Wolff
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA. .,Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | - Lue-Yen Tucker
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Mary Anne Armstrong
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Amy Conway
- Early Start Program, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Constance Weisner
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.,Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Nancy Goler
- Regional Offices, Kaiser Permanente Northern California, Oakland, CA, USA
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14
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Chang G, Ondersma SJ, Blake-Lamb T, Gilstad-Hayden K, Orav EJ, Yonkers KA. Identification of substance use disorders among pregnant women: A comparison of screeners. Drug Alcohol Depend 2019; 205:107651. [PMID: 31683243 DOI: 10.1016/j.drugalcdep.2019.107651] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 09/11/2019] [Accepted: 09/12/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of this study is to evaluate five self-report, non-proprietary questionnaires in the identification of substance use disorders [including alcohol, cannabis, opioids, and stimulants] among pregnant women. PROCEDURES A total of 1220 pregnant women completed the NIDA Quick Screen, CRAFFT, Substance Use Risk Profile-Pregnancy (SURP-P), Wayne Indirect Drug Use Questionnaire (WIDUS), and the 5 Ps, as well as the MINI diagnostic interview for substance use disorders, which served as the reference standard. Measures of merit calculated for each screener included sensitivity, specificity, accuracy, and area under the receiver operating curve (AUROC). MAIN FINDINGS The participants were socioeconomically diverse, with a mean age of 29 years. Over 15% met diagnostic criteria for a substance use disorder. AUROCS for identifying any substance use disorder (including alcohol) ranged from a high of 0.75 for the CRAFFT (95% CI = 0.72-79) and 0.74 for the SURP-P (95% CI = 0.71-.78) to a low of 0.62 for the NIDA Quick Screen (95% CI = 0.59-.65). Overall accuracy of most tested measures was higher for identification of alcohol use disorders than for other substance use disorders (e.g., AUROCs for the CRAFFT and SURP-P for identifying alcohol use disorders were 0.78 and 0.77, respectively). PRINCIPAL CONCLUSIONS The CRAFFT and SURP-P showed modest ability to identify substance use disorders among pregnant women. Future research is needed to develop an ideal questionnaire set in the complicated societal context which includes increasing rates of use and potential sanction.
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Affiliation(s)
- Grace Chang
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, United States; VA Boston Healthcare System, Boston, MA, 02301, United States.
| | - Steven J Ondersma
- Merrill Palmer Skillman Institute and Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, 48202, United States
| | - Tiffany Blake-Lamb
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, 02114, United States; Department of Obstetrics and Gynecology, Harvard Medical School, Boston, MA, 02115, United States
| | - Kate Gilstad-Hayden
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06520, United States
| | - E John Orav
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115, United States; Department of Medicine (Biostatistics), Harvard Medical School, Boston, MA, 02115, United States
| | - Kimberly A Yonkers
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06520, United States; Division of Chronic Disease, Yale University School of Epidemiology and Public Health, New Haven, CT, 06520, United States; Department of Obstetrics, Gynecology and Reproductive Medicine, Yale University School of Medicine, New Haven, CT, 06520, United States
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