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Méndez SB, Salazar-Juárez A. Prenatal and postnatal cocaine exposure enhances the anxiety- and depressive-like behaviors in rats: An ontogenetic study. Int J Dev Neurosci 2024; 84:546-557. [PMID: 39361328 DOI: 10.1002/jdn.10358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 06/01/2024] [Accepted: 06/10/2024] [Indexed: 10/05/2024] Open
Abstract
BACKGROUND Prenatal and postnatal exposure to drugs such as cocaine is a public health problem that causes deficits in brain development and function in humans and animals. One of the main effects of prenatal and postnatal cocaine exposure is increased vulnerability to developing the substance use disorder at an early age. Furthermore, the negative emotional states associated with cocaine withdrawal increase the fragility of patients to relapse into drug abuse. In this sense, prenatal and postnatal cocaine exposure enhanced the cocaine- and nicotine-induced locomotor activity and locomotor sensitization, and rats exposed prenatally to cocaine displayed an increase in anxiety- and depressive-like behaviors in adulthood (PND 60-70). OBJECTIVE Therefore, the objective of this study was to determine the effect of prenatal and postnatal cocaine exposure on anxiety- and depressive-like behaviors at different ages (30, 60, 90, and 120 days of age) in rats. METHODS The study was divided into two stages: prenatal and postnatal. In the prenatal stage, a group of pregnant female Wistar rats was administered daily from GD0 to GD21 cocaine (cocaine pre-exposure group), and another group of pregnant female rats was administered daily saline (saline pre-exposure group). In the postnatal stage, during lactation (PND0 to PND21), pregnant rats received administration of cocaine or saline, respectively. Of the litters resulting from the cocaine pre-exposed and saline pre-exposed pregnant female groups, only the male rats were used for the recording of the anxiety- and depressive-like behaviors at different postnatal ages (30, 60, 90, and 120 days), representative of adolescence, adult, adulthood, and old age. RESULTS The study found that prenatal and postnatal cocaine exposure generated age-dependent enhancement in anxiety- and depressive-like behaviors, being greater in older adult (PND 120) rats than in adolescent (PND 30) or adults (PND 60-90) rats. CONCLUSIONS This suggests that prenatal and postnatal cocaine exposure increases anxiety- and depressive-like behaviors, which may increase the vulnerability of subjects to different types of drugs in young and adult age.
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Affiliation(s)
- Susana Barbosa Méndez
- Subdirección de Investigaciones Clínicas, Laboratorio de Neurofarmacología Conductual, Microcirugía y Terapéutica Experimental, Instituto Nacional de Psiquiatría, Mexico City, Mexico
| | - Alberto Salazar-Juárez
- Subdirección de Investigaciones Clínicas, Laboratorio de Neurofarmacología Conductual, Microcirugía y Terapéutica Experimental, Instituto Nacional de Psiquiatría, Mexico City, Mexico
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Smid MC, Seliski N, Charles JE, Castro S, Humiston GE, Cash E, Allshouse A, Turner E, Carlston K, Gibson M, Gordon AJ, Cochran GT. Prevention of postpartum methamphetamine use with micronized progesterone trial (PROMPT): A pilot randomized controlled trial protocol. Contemp Clin Trials Commun 2024; 41:101359. [PMID: 39308801 PMCID: PMC11415636 DOI: 10.1016/j.conctc.2024.101359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 08/01/2024] [Accepted: 08/28/2024] [Indexed: 09/25/2024] Open
Abstract
Background While most pregnant individuals with methamphetamine use disorder (MUD) achieve abstinence, the postpartum period remains a vulnerable time for return to methamphetamine use (MU). Promising data from human and animal models, including three randomized controlled trials, suggest that micronized progesterone may prevent postpartum return to cocaine and nicotine use by reducing cravings. The primary objective of this study is to assess feasibility of enrollment and randomization of postpartum individuals with MUD to micronized progesterone to prevent return to MU. The secondary objectives are to evaluate safety, establish a preliminary estimate of efficacy, and characterize the association between allopregnanolone levels and methamphetamine cravings. Methods This is a pilot double-blind placebo randomized controlled trial. We plan to enroll 40 postpartum individuals with MUD over 24-months. Individuals, stratified by opioid use disorder (OUD), are randomized 1:1-400 mg oral micronized progesterone daily or placebo and attend weekly study sessions for 12 weeks. Feasibility is measured by achieving 80 % of enrollment goal. Safety is evaluated by side effect frequency, mental health status changes, lactation and medical complications. Efficacy is assessed by comparing proportion of participants with return to MU and time to return to MU based on self-report or urine testing between treatment and control groups. Salivary allopregnanolone levels and methamphetamine cravings are compared between the groups. Conclusion Study results will provide a first critical step towards potential intervention for prevention of return to MU among postpartum individuals. Completion of this trial will set the stage for a large-scale efficacy trial.
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Affiliation(s)
- Marcela C. Smid
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, 30 N. Mario Capecchi Drive, Floor 5 South, Salt Lake City, UT, USA
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, USA
| | - Natasha Seliski
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, USA
- Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way Suite A, Salt Lake City, UT, USA
| | - Jasmin E. Charles
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, 30 N. Mario Capecchi Drive, Floor 5 South, Salt Lake City, UT, USA
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, USA
| | - Stephanie Castro
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, USA
| | - Grace E. Humiston
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, USA
| | - Elysha Cash
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, USA
| | - Amanda Allshouse
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, 30 N. Mario Capecchi Drive, Floor 5 South, Salt Lake City, UT, USA
| | - Elizabeth Turner
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, 30 N. Mario Capecchi Drive, Floor 5 South, Salt Lake City, UT, USA
| | - Kristi Carlston
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, USA
| | - Marie Gibson
- Utah Population Database, University of Utah Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, USA
| | - Adam J. Gordon
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, USA
- Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS), Salt Lake City VA Health Care System, Salt Lake City, UT, USA
| | - Gerald T. Cochran
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, USA
- Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS), Salt Lake City VA Health Care System, Salt Lake City, UT, USA
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Bello JK, Xu KY, Salas J, Kelly J, Grucza RA. Contraceptive uptake in postpartum people with and without opioid use disorder and opioid use with co-occurring substance use. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 12:100248. [PMID: 39040479 PMCID: PMC11261297 DOI: 10.1016/j.dadr.2024.100248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/22/2024] [Accepted: 06/14/2024] [Indexed: 07/24/2024]
Abstract
Background Using contraception to delay pregnancy allows people with opioid use disorder (OUD) to choose when they are ready to continue their families. Yet, postpartum contraceptive uptake among people with OUD has not been well characterized. Methods Analyses used 73,811 pregnancy episodes among 61,221 people (2016-2021) from the St. Louis University-SSM Virtual Data Warehouse. OUD was defined from the year prior and through pregnancy. Contraceptive uptake was defined within 90-days after delivery. We used Generalized Estimating Equations-type multinomial logit models to assess association of OUD +/- co-occurring substance use disorders (SUDs) with any contraception (yes/no) and type of contraception (effective - pills, patch, ring, injection; or highly effective - long-acting reversible, LARC methods [intrauterine device, implant] and sterilization). Results The sample was 66.0 % white and average age was 27.7 years (±5.6). 32.5 % of pregnancies were followed by contraception initiation, 2.3 % had an OUD diagnosis, and 1.3 % OUD with co-occurring SUD. There was no association between OUD and postpartum contraception receipt, but OUD was associated with decreased highly effective compared to effective method initiation (aOR=0.76; 95 % CI: [0.64-0.91]). OUD plus co-occurring SUD was associated with decreased uptake across all contraception types (aOR=0.81[0.70-0.93]), specifically, highly-effective methods (aOR=0.48[0.38-0.61]). Conclusions Overall postpartum contraception uptake among people with OUD is comparable to uptake in the non-OUD population. People with OUD plus co-occurring SUDs are particularly unlikely to receive contraception. The reasons people choose contraceptive methods are complex and may differ by SUD severity. More information is needed to understand factors that impact postpartum contraception initiation.
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Affiliation(s)
- Jennifer K. Bello
- Department of Family and Community Medicine, Saint Louis University School of Medicine, SLUCare Academic Pavilion, 1008 S. Spring Ave. 3rd Floor, Saint Louis, MO 63110, USA
| | - Kevin Y. Xu
- Health and Behavior Research Center, Division of Addiction Science, Prevention and Treatment, Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Joanne Salas
- Advanced Health Data Institute, Department of Health and Outcomes Research, Saint Louis University, 3545 Lafayette Ave., St. Louis, MO 63104, USA
| | - Jeannie Kelly
- Division of Maternal-Fetal Medicine & Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine, 4901 Forest Park Ave. Suite 710, St. Louis, MO 63108, USA
| | - Richard A. Grucza
- Department of Family and Community Medicine, Saint Louis University School of Medicine, SLUCare Academic Pavilion, 1008 S. Spring Ave. 3rd Floor, Saint Louis, MO 63110, USA
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Fusco RA, Kulkarni SJ, Pless J. "He gets mad that I'm sober": Experiences of substance use coercion among postpartum women in recovery. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 164:209407. [PMID: 38782092 DOI: 10.1016/j.josat.2024.209407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/01/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE The number of women with substance use disorders (SUDs) is growing in the U.S. Many women with SUDs are of childbearing age, and studies show that women who abstain from substance use during pregnancy often relapse in the postpartum period. Given the high overlap between substance use and intimate partner violence, these women may be in relationships that make recovery more challenging. This study aimed to better understand how substance abuse coercion in intimate relationships may affect substance use and to identify and describe the presence of substance use coercion in postpartum women. METHODS The study conducted qualitative interviews with 30 women with substance use disorders who had given birth within the past six months. Researchers recruited women from a larger intervention study providing home visit support to postpartum women in substance use recovery. Thematic analysis was then identified overarching themes in the interview data. RESULTS Analysis of the impact of IPV on substance use revealed four themes: 1) sabotaging sobriety, 2) making substance use a condition of the relationship, 3) portraying her as a "bad mom," and 4) furthering social isolation. CONCLUSIONS Findings showed that women with SUDs have specific vulnerabilities that partners may exploit as a way of exerting control. Implications for practice with postpartum women who are working toward recovery are discussed.
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Affiliation(s)
- Rachel A Fusco
- University of Georgia, School of Social Work, 279 Williams St, Athens, GA 30602, United States of America.
| | - Shanti J Kulkarni
- University of North Carolina at Charlotte, School of Social Work, 9201 University City Blvd, Charlotte, NC 28262, United States of America.
| | - Jennie Pless
- University of Georgia, School of Social Work, 279 Williams St, Athens, GA 30602, United States of America.
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Dunlop CE, Scheffert AHM, Cowling A, Kohavi M, Benjamins LJ, Parish D. Perceptions of Substance Use and Sexual Risk Behaviors Among Adolescent Females Involved in Juvenile Justice. JOURNAL OF CORRECTIONAL HEALTH CARE 2024. [PMID: 39207248 DOI: 10.1089/jchc.24.01.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
CHOICES-TEEN is a bundled intervention aimed at reducing the risks of unintended pregnancy, sexually transmitted infections, and alcohol- and tobacco-exposed pregnancies for adolescent girls involved in the juvenile justice system. We examined youths' (N = 22) elicited pros and cons concerning alcohol, tobacco, condom, and contraception use to inform future iterations of CHOICES-TEEN and other prevention programming during a one-arm pilot study. Content analysis was used to identify recurring themes elicited and recorded during a decisional balance exercise with a counselor. The most recurrent pros and cons were factors that directly affected these adolescents, with more immediate consequences. The results provide insight into motivations for engaging in substance use and risky sexual behaviors for these youth, as well as barriers to change.
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Affiliation(s)
- Catherine E Dunlop
- McGovern Medical School, The University of Texas Health Science Center, Houston, Texas, USA
| | | | | | - Maya Kohavi
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | | | - Danielle Parish
- The University of Texas at Steve Hicks School of Social Work, University of Texas, Austin, Texas, USA
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Stevens MWR, Cooper M, Cusack L, Ali RL, Holmwood C, Briley AL. Screening and early intervention for substance use during pregnancy: A retrospective case note review of antenatal care records. Drug Alcohol Rev 2024. [PMID: 39138132 DOI: 10.1111/dar.13927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 07/23/2024] [Accepted: 07/24/2024] [Indexed: 08/15/2024]
Abstract
INTRODUCTION Screening for substance use during pregnancy is critical for enhancing maternal health and perinatal outcomes. However, disparities persist in screening and intervention rates within maternity services. This retrospective case note review explored contemporaneous practices around screening and interventions for substance use among pregnant women during routine antenatal care. METHODS A random sample of 100 sets of maternity records were reviewed. Eligible cases included any woman attending initial pregnancy assessments at one of two South Australian metropolitan Hospital-based antenatal clinics, from July 2019-September 2020. Screening rates for past and current alcohol, tobacco and other substance use were identified and compared with data from a subset of a nationally representative survey. Intervention details and referral pathways were also assessed. RESULTS The final sample of eligible cases (n = 93) demonstrated prioritisation of screening for current use, over past use, across all substances (p < 0.001). Screening was most likely for tobacco and least likely for e-cigarettes (p < 0.001). Significant underreporting of past use compared with the benchmark was identified for all substances (except tobacco, p = 0.224). Interventions typically involved written resources, which were usually declined by clients. DISCUSSION AND CONCLUSIONS Despite longstanding recommendations, screening and intervention practices for substance use appear inconsistent. With the recent emergence of vaping, no evidence of updated approaches to identifying e-cigarette consumption in pregnant women was found. Several opportunities for enhancing routine screening and intervention practices within antenatal clinics were identified, and will inform the development of policy directives, targeted training modules, and other resources for health professionals working in these services.
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Affiliation(s)
- Matthew W R Stevens
- School of Biomedicine (Pharmacology), The University of Adelaide, Adelaide, Australia
| | - Megan Cooper
- Caring Futures Institute Flinders University, Adelaide, Australia
| | - Lynette Cusack
- Adelaide Nursing School, The University of Adelaide, Adelaide, Australia
| | - Robert L Ali
- School of Biomedicine (Pharmacology), The University of Adelaide, Adelaide, Australia
| | - Chris Holmwood
- School of Biomedicine (Pharmacology), The University of Adelaide, Adelaide, Australia
| | - Annette L Briley
- Caring Futures Institute Flinders University, Adelaide, Australia
- Northern Adelaide Local Health Network, Lyell McEwin Hospital, Adelaide, Australia
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Jones J, Coy D, Gidron D, Hariharan S, Jones M, Patel N, Racines A, Toma S, Brown G. Using umbilical cord tissue to identify prenatal ethanol exposure and co-exposure to other commonly misused substances. J Perinatol 2024:10.1038/s41372-024-02075-2. [PMID: 39069544 DOI: 10.1038/s41372-024-02075-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 07/13/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE Substance misuse during pregnancy can result in a variety of poor pregnancy outcomes. Objective data reporting the prevalence of neonates born with ethanol metabolites (evidence of prenatal ethanol exposure) in their fluids or tissues are limited. STUDY DESIGN A secondary analysis of umbilical cord tissue specimens received for routine toxicological analysis was conducted. Prevalences of ethyl glucuronide (EtG), a long-term direct ethanol biomarker, were determined using a new laboratory tool, LDTD-MSMS. Additionally, other commonly misused substances were determined using routine procedures. RESULTS Of 12,995 specimens, 238 (1.8%) specimens contained EtG. Concentrations of EtG ranged from 5 ng/g to 6679 ng/g (median 47 ng/mg; IQR: 16 ng/g, 203 ng/g). Of those 238 EtG-positive specimens, nearly 58% (N = 138) contained additional substances or metabolites. CONCLUSION Self-report of substance use during pregnancy is under-reported. We have demonstrated co-exposure of substances with ethanol is higher than previous reports.
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Affiliation(s)
- Joseph Jones
- United States Drug Testing Laboratories, Des Plaines, IL, USA.
| | - Donna Coy
- United States Drug Testing Laboratories, Des Plaines, IL, USA
| | | | | | - Mary Jones
- United States Drug Testing Laboratories, Des Plaines, IL, USA
| | - Niranjan Patel
- United States Drug Testing Laboratories, Des Plaines, IL, USA
| | - Amy Racines
- United States Drug Testing Laboratories, Des Plaines, IL, USA
| | - Sarah Toma
- United States Drug Testing Laboratories, Des Plaines, IL, USA
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The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder. J Addict Med 2024; 18:1-56. [PMID: 38669101 PMCID: PMC11105801 DOI: 10.1097/adm.0000000000001299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
The American Society of Addiction Medicine/American Academy of Addiction Psychiatry (ASAM/AAAP) Clinical Practice Guideline on the Management of Stimulant Use Disorder provides guidance on evidence-based strategies for the treatment of stimulant use disorders (StUDs), stimulant intoxication, and stimulant withdrawal, as well as secondary and tertiary prevention of harms associated with stimulant use. The Clinical Guideline Committee (CGC) comprised experts from ASAM and AAAP representing a range of clinical settings and patient populations. The guideline was developed following modified GRADE methodology. The process included a systematic literature review as well as several targeted supplemental searches. The CGC utilized Evidence to Decision tables to review available evidence and rate the strength of each recommendation. The clinical practice guideline was revised based on external stakeholder review. Key takeaways included: Contingency management represents the current standard of care for treatment of StUDs; Pharmacotherapies may be utilized off-label to treat StUDs; Acute stimulant intoxication can result in life-threatening complications that should be addressed in an appropriate level of care; Secondary and tertiary prevention strategies should be used to reduce harms related to risky stimulant use.
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Eitel AE, Witcraft SM, McRae-Clark AL, Brady K, King C, Guille C. Exploration Into Patterns of Cannabis Use Across Pregnancy and Postpartum. J Addict Med 2024; 18:327-330. [PMID: 38258885 PMCID: PMC11150107 DOI: 10.1097/adm.0000000000001270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
OBJECTIVES Peripartum cannabis use can be harmful to pregnant individual's and children's health, yet it is the most used illicit substance during the peripartum period. Despite the ability of some people to reduce and abstain from cannabis use during pregnancy, the first year postpartum is a high-risk time for returning to cannabis. However, characterization of cannabis use patterns in the peripartum period and risk factors for return to use postpartum are not well established. The aims of this exploratory study were to describe patterns of peripartum cannabis use and identify factors associated with increased frequency of postpartum cannabis use among individuals who reported reduced use during pregnancy. METHODS An online survey identified 47 individuals who used cannabis during the peripartum period. Descriptive statistics characterized the sample and among those who reduced use during pregnancy, χ 2 determined the frequency of postpartum cannabis use per preconception reasons for use. RESULTS During preconception, 95.7% of individuals used cannabis, and of those who were presently postpartum, 65% resumed use after delivery. Anxiety and stress were the most common motivations for cannabis use throughout the peripartum period, but social motivations (ie, fun, relaxation) were the only preconception factors that increased frequency of return to cannabis use postpartum. CONCLUSIONS Our exploratory study describes the characteristics of individuals using cannabis in the peripartum period and provides insight into correlates of resumption of cannabis use postpartum. These findings may inform future work to further determine temporal associations, confounding risk factors, and intervention techniques to prevent the return to cannabis use postpartum.
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Affiliation(s)
- Anna E Eitel
- From the College of Medicine, Medical University of South Carolina, Charleston, SC (AEE); Women's Reproductive Behavioral Health Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC (SMW, CK, CG); Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC (ALMR-C, KB); and Ralph H. Johnson VA Medical Center, Charleston, SC (ALMR-C)
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Maher EJ, Stoner SA, Gerlinger J, Ferraro AC, Lepper-Pappan H. Study protocol for a randomized controlled trial of the Parent-Child Assistance Program: a case management and home visiting program for people using substances during pregnancy. Trials 2024; 25:264. [PMID: 38627843 PMCID: PMC11020811 DOI: 10.1186/s13063-024-08098-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/09/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Perinatal substance use can have significant adverse effects on maternal and child health and family stability. Few interventions are specifically designed to address this significant public health problem. The Parent-Child Assistance Program (PCAP) is a 3-year case management and home-visiting intervention that seeks to help birthing persons with at-risk substance use during pregnancy to achieve and maintain substance use disorder recovery and avoid exposing future children to substances prenatally. At-risk refers to a level of substance use that creates problems in the individuals' lives or puts them or their children at risk of harm either prenatally or postnatally. Although the program has consistently shown substantial pre- to post-intervention improvements in its participants, PCAP remains to be tested with a rigorous randomized controlled trial (RCT). This study protocol describes a randomized controlled trial that aims to examine the effectiveness of the intervention compared to services as usual in affecting primary outcomes related to substance use and family planning. Secondary outcomes will concern connection to recovery support services and family preservation. METHODS Using an intent-to-treat design, the study will recruit from two metro areas in Oklahoma and enroll 200 birthing individuals who are pregnant or up to 24 months postpartum with at-risk substance use during their current or most recent pregnancy. Participants will be randomly assigned, stratified by location, to receive either PCAP or services as usual for 3 years. Participants in the PCAP condition will meet with their case manager approximately biweekly over the course of the intervention period, in their local communities or in their own homes whenever possible. Case managers will assist with goal setting and provide practical assistance in support of participants' goals. Primary and secondary outcomes will be assessed at baseline and 12, 24, and 36 months post-baseline using the Addiction Severity Index interview and a self-administered survey. DISCUSSION Results from this trial will help to gauge the effectiveness of PCAP in improving parent and child well-being. Results will be reviewed by federal clearinghouses on home-visiting and foster care prevention to determine the strength of evidence of effectiveness with implications for federal financing of this program model at the state level. TRIAL REGISTRATION ClinicalTrials.gov NCT05534568. Registered on 6/8/2022.
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Affiliation(s)
- Erin J Maher
- Department of Sociology, University of Oklahoma, 780 Van Vleet Oval, Kaufman Hall 311, Norman, OK, 73019, USA.
| | - Susan A Stoner
- Department of Psychiatry & Behavioral Sciences, Addictions, Drug & Alcohol Institute, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA, 98195-6560, USA
| | - Julie Gerlinger
- Department of Sociology, University of Oklahoma, 780 Van Vleet Oval, Kaufman Hall 311, Norman, OK, 73019, USA
| | - A C Ferraro
- Department of Sociology, University of Oklahoma, 780 Van Vleet Oval, Kaufman Hall 311, Norman, OK, 73019, USA
| | - Heather Lepper-Pappan
- Department of Sociology, University of Oklahoma, 780 Van Vleet Oval, Kaufman Hall 311, Norman, OK, 73019, USA
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Klie KA, Nagle-Yang S, Zhao L, Fringuello ME. Integrated Care for Pregnant and Parenting People With Substance Use. Clin Obstet Gynecol 2024; 67:200-221. [PMID: 38095083 DOI: 10.1097/grf.0000000000000831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Caring for pregnant people with substance use requires knowledge about specific substances used, treatment options, and an integrated, trauma-informed care team. This chapter will discuss crucial information for clinicians regarding evidence-based practice for screening, intervention, and ongoing support for pregnant people and their families impacted by substance use.
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Affiliation(s)
| | | | - Lulu Zhao
- Departments of Obstetrics and Gynecology and Psychiatry, University Hospitals Cleveland Medical Center, Case Western Reserve School of Medicine, Cleveland, Ohio
| | - Melanie E Fringuello
- Department of Obstetrics and Gynecology, Division of Academic Specialists, University of Colorado School of Medicine, Aurora, Colorado
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Cochran G, Smid MC, Krans EE, Yu Z, Carlston K, White A, Abdulla W, Baylis J, Charron E, Okifugi A, Gordon AJ, Lundahl B, Silipigni J, Seliski N, Haaland B, Tarter R. Patient navigation for pregnant individuals with opioid use disorder: Results of a randomized multi-site pilot trial. Addiction 2024; 119:544-556. [PMID: 37859587 DOI: 10.1111/add.16364] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 09/14/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND AND AIMS Patient navigation (PN) may benefit pregnant individuals with opioid use disorder (OUD) by improving treatment adherence. We examined participant enrollment, session delivery and assessment feasibility for a PN intervention among pregnant participants and compared PN preliminary effectiveness for OUD treatment engagement with participants in usual care (UC). DESIGN This study was a pilot single-blinded multi-site randomized trial. SETTING Two academic medical centers in Pennsylvania (n = 57) and Utah (n = 45), United States participated. PARTICIPANTS One hundred and two pregnant adult participants unestablished (fewer than 6 weeks) on medication for OUD (MOUD) were randomized to PN (n = 53) or UC (n = 49). INTERVENTION PN was composed of 10 prenatal sessions (delivered after baseline but before the prenatal assessments) and four postnatal sessions (delivered before the 2- and 6-month postpartum assessments) focused upon OUD treatment and physical/mental health needs. UC involved brief case management. MEASUREMENTS Feasibility assessments included consent, session delivery and assessment rates. Mixed-effect models for intent-to-treat (ITT) and per protocol (PP, received six or more sessions) populations were estimated to compare outcomes of MOUD use, secondary outcomes of substance use disorder (SUD) treatment attendance and non-prescribed opioid use, and exploratory outcome of overdose at baseline, predelivery and 2 and 6 months postpartum. FINDINGS We consented 87% (106 of 122) of the proposed target, delivered ~60% of sessions delivered and completed ≥ 75% assessments. PN ITT and PP had better MOUD adherence, SUD treatment attendance, non-prescribed opioid use and overdose outcomes than UC. Notable changes included good evidence for greater percentage change in days for PN PP MOUD use from baseline to 2 months postpartum [PN = 28.0 versus UC = -10.9, 95% confidence interval (CI) = 9.7, 62.1] and some evidence for baseline to 6 months postpartum (PN = 45.4 versus UC = 23.4, 95% CI = -0.7, 48.2). PN PP percentage change in days for SUD treatment attendance also showed good evidence for improvements from baseline to prenatal assessment (PN = 7.4 versus UC = -21.3, 95% CI = 3.3, 53.5). PN compared to UC participants reported fewer overdoses at 2 months (PN = 11.9%/UC = 16.1%) and at 6 months postpartum (PN = 3.8%/UC = 6.2%). CONCLUSIONS Patient navigation appears to be associated with improvements in opioid use disorder treatment engagement and overdoses during pregnancy. This pilot trial shows the feasibility of the intervention and a future large-scale trial.
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Affiliation(s)
- Gerald Cochran
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Marcela C Smid
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Utah Health, Salt Lake City, UT, USA
| | - Elizabeth E Krans
- Department of Obstetrics, Gynecology and Reproductive Sciences, UPMC, Pittsburgh, PA, USA
| | - Ziji Yu
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Kristi Carlston
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ashley White
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Walitta Abdulla
- Department of Obstetrics, Gynecology and Reproductive Sciences, UPMC, Pittsburgh, PA, USA
| | - Jacob Baylis
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Elizabeth Charron
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Akiko Okifugi
- Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Adam J Gordon
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Brad Lundahl
- College of Social Work, University of Utah, Salt Lake City, UT, USA
| | - John Silipigni
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Utah Health, Salt Lake City, UT, USA
| | - Natasha Seliski
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Benjamin Haaland
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ralph Tarter
- School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
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13
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Reese SE, Glover A, Fitch S, Salyer J, Lofgren V, McCracken Iii CT. Early Insights into Implementation of Universal Screening, Brief Intervention, and Referral to Treatment for Perinatal Substance Use. Matern Child Health J 2023; 27:58-66. [PMID: 37975996 PMCID: PMC10692260 DOI: 10.1007/s10995-023-03842-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES Perinatal substance use is a growing concern across the United States. Universal screening, brief intervention, and referral to treatment (SBIRT) is one systems-level approach to addressing perinatal substance use. The objective of this study is to assess early efforts to implement SBIRT in an outpatient obstetric clinic. METHODS The research team implemented universal screening with the 5 P's screening tool. Providers then engaged patients in a brief intervention and referred to a care manager who then worked with patients via tele-health to connect patients with needed services. Feasibility was measured through the collection of aggregate data describing frequency of universal screening and referral to treatment. The implementation team met bi-weekly to reflect on implementation barriers and facilitators. RESULTS In the first year of implementation, 48.5% of patients receiving care in the clinic completed the 5 P's screener at least once during the perinatal period. Screening occurred in a little over a quarter (26.5%) of eligible visits. Of the 463 patients that completed the 5 P's at least once during the perinatal period, 195 (42%) unique patients screened positive (answered yes to at least one question). CONCLUSIONS FOR PRACTICE Early implementation efforts suggest this approach is feasible in this obstetric setting. Similar implementation studies should consider implementing universal screening for substance use and perinatal mood and anxiety disorders simultaneously; guide efforts using an implementation framework; invest resources in more intensive training and ongoing coaching for providers; and adopt strategies to track frequency and fidelity of brief intervention.
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Affiliation(s)
- Sarah E Reese
- Rural Institute for Inclusive Communities, University of Montana, Corbin Hall, Room 52, Missoula, MT, 59812, USA.
- Center for Population Health Research, University of Montana, Skaggs Building, Room 173, Missoula, MT, 59812, USA.
- School of Social Work, University of Montana, Jeanette Rankin Hall 026, 32 Campus Dr, Missoula, MT, 59812, USA.
| | - Annie Glover
- Rural Institute for Inclusive Communities, University of Montana, Corbin Hall, Room 52, Missoula, MT, 59812, USA
| | - Stephanie Fitch
- Billings Clinic, 801 North 29th Street, Billings, MT, 59101, USA
| | - Joe Salyer
- Billings Clinic, 801 North 29th Street, Billings, MT, 59101, USA
| | - Valerie Lofgren
- Billings Clinic, 801 North 29th Street, Billings, MT, 59101, USA
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14
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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] [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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15
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Bariselli S, Mateo Y, Reuveni N, Lovinger DM. Gestational ethanol exposure impairs motor skills in female mice through dysregulated striatal dopamine and acetylcholine function. Neuropsychopharmacology 2023; 48:1808-1820. [PMID: 37188849 PMCID: PMC10579353 DOI: 10.1038/s41386-023-01594-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/29/2023] [Accepted: 04/21/2023] [Indexed: 05/17/2023]
Abstract
Fetal alcohol exposure has deleterious consequences on the motor skills of patients affected by Fetal Alcohol Spectrum Disorder (FASD) and in pre-clinical models of gestational ethanol exposure (GEE). Deficits in striatal cholinergic interneurons (CINs) and dopamine function impair action learning and execution, yet the effects of GEE on acetylcholine (ACh) and striatal dopamine release remain unexplored. Here, we report that alcohol exposure during the first ten postnatal days (GEEP0-P10), which mimics ethanol consumption during the last gestational trimester in humans, induces sex-specific anatomical and motor skill deficits in female mice during adulthood. Consistent with these behavioral impairments, we observed increased stimulus evoked-dopamine levels in the dorsolateral striatum (DLS) of GEEP0-P10 female, but not male, mice. Further experiments revealed sex-specific deficits in β2-containing nicotinic ACh receptor (nAChR)-modulation of electrically evoked dopamine release. Moreover, we found a reduced decay of ACh transients and a decreased excitability of striatal CINs in DLS of GEEP0-P10 females, indicating striatal CIN dysfunctions. Finally, the administration of varenicline, a β2-containing nAChR partial agonist, and chemogenetic-mediated increase in CIN activity improved motor performance in adult GEEP0-P10 females. Altogether, these data shed new light on GEE-induced striatal deficits and establish potential pharmacological and circuit-specific interventions to ameliorate motor symptoms of FASD.
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Affiliation(s)
- Sebastiano Bariselli
- Laboratory for Integrative Neuroscience (LIN), NIH-NIAAA, 5625 Fishers Lane, Bethesda, MD, 20892, USA.
| | - Yolanda Mateo
- Laboratory for Integrative Neuroscience (LIN), NIH-NIAAA, 5625 Fishers Lane, Bethesda, MD, 20892, USA
| | - Noa Reuveni
- Laboratory for Integrative Neuroscience (LIN), NIH-NIAAA, 5625 Fishers Lane, Bethesda, MD, 20892, USA
| | - David M Lovinger
- Laboratory for Integrative Neuroscience (LIN), NIH-NIAAA, 5625 Fishers Lane, Bethesda, MD, 20892, USA
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Kock LS, Erath TG, Coleman SRM, Higgins ST, Heil SH. Contingency management interventions for abstinence from cigarette smoking in pregnancy and postpartum: A systematic review and meta-analysis. Prev Med 2023; 176:107654. [PMID: 37532032 PMCID: PMC10828115 DOI: 10.1016/j.ypmed.2023.107654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/24/2023] [Accepted: 07/29/2023] [Indexed: 08/04/2023]
Abstract
Contingency management is one of the most effective treatments for substance use disorders in not-pregnant people. The most recent quantitative review of its efficacy among pregnant and postpartum women who smoke cigarettes concluded with moderate certainty that those receiving contingent financial incentives were twice as likely to be abstinent compared with controls. We aimed to update and extend previous reviews. Five databases were systematically searched for randomized controlled trials (RCTs) published before December 2022 that assessed the effectiveness of incentives for abstinence from substance use. Data from trials of smoking abstinence were pooled using a random-effects meta-analysis model (restricted maximum likelihood). Results are reported as risk-ratios (RRs) with 95% confidence intervals (CIs). This study is registered with PROSPERO, CRD42022372291. Twelve RCTs (3136) pregnant women) were included. There was high certainty evidence that women receiving incentives were more likely to be abstinent than controls at the last antepartum assessment (12 RCTs; RR = 2.43, 95% CI 2.04-2.91, n = 2941, I2 = 0.0%) and moderate certainty evidence at the longest postpartum assessment while incentives were still available (five RCTs; RR = 2.72, 1.47-5.02, n = 659, I2 = 44.5%), and at the longest postpartum follow-up after incentives were discontinued (six RCTs; RR = 1.93, 1.08-3.46, n = 1753, I2 = 51.8%). Pregnant women receiving incentives are twice as likely to achieve smoking abstinence during pregnancy suggesting this intervention should be standard care for pregnant women who smoke. The results also demonstrate that abstinence continues into the postpartum period, including after incentives are discontinued, but more trials measuring outcomes in the postpartum period are needed to strengthen this conclusion.
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Affiliation(s)
- Loren S Kock
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, 1 South Prospect St, Burlington, VT 05401, United States.
| | - Tyler G Erath
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, 1 South Prospect St, Burlington, VT 05401, United States
| | - Sulamunn R M Coleman
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, 1 South Prospect St, Burlington, VT 05401, United States
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, 1 South Prospect St, Burlington, VT 05401, United States
| | - Sarah H Heil
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, 1 South Prospect St, Burlington, VT 05401, United States
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Johnson EE, Kruis R, Verdin R, Wells E, Ford DW, Sterba KR. Development of an Implementation Science Telehealth Toolkit to Promote Research Capacity in Evaluation of Telehealth Programs. TELEMEDICINE REPORTS 2023; 4:286-291. [PMID: 37817872 PMCID: PMC10561742 DOI: 10.1089/tmr.2023.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 10/12/2023]
Abstract
Background The field of telehealth is rapidly growing and expanding access to quality health care, although there have been varied implementation outcomes in telehealth modalities. Dissemination and implementation (D&I) research can provide a systematic approach to identifying barriers and facilitators to telehealth implementation processes and outcomes. Methods An interdisciplinary research and clinical team developed an implementation science telehealth toolkit to guide D&I evaluations of new and existing telehealth innovations. Results The toolkit includes a separate section to correspond to each step in the D&I evaluation process. Each section includes resources to guide evaluation steps, telehealth specific considerations, and case study examples based on three completed telehealth evaluations. Discussion The field of telehealth is forecasted to continue to expand, with potential to increase health care access to populations in need. This toolkit can help guide health care stakeholders to develop and carry out evaluations to improve understanding of telehealth processes and outcomes to maximize implementation and sustainability of these valuable innovations.
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Affiliation(s)
- Emily E. Johnson
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ryan Kruis
- Center for Telehealth, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Rebecca Verdin
- Center for Telehealth, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Elana Wells
- Center for Telehealth, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Dee W. Ford
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Katherine R. Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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18
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Jackson MA, Brown AL, Baker AL, Bonevski B, Haber P, Bonomo Y, Blandthorn J, Attia J, Perry N, Barker D, Gould GS, Dunlop AJ. Tobacco treatment incorporating contingency management, nicotine replacement therapy, and behavioral counseling for pregnant women who use substances: a feasibility trial. Front Psychiatry 2023; 14:1207955. [PMID: 37654991 PMCID: PMC10467262 DOI: 10.3389/fpsyt.2023.1207955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/17/2023] [Indexed: 09/02/2023] Open
Abstract
Introduction Most pregnant women with substance use problems smoke, and few will quit during their pregnancy. Tobacco treatment is often overlooked, with the focus usually placed on other substance use. Additionally, few targeted effective treatments for this group exist. To address this, the feasibility of an intensive tobacco treatment incorporating contingency management (CM) that featured non-face-to-face delivery was examined. Methods A single-arm pre-post design feasibility trial was conducted in three antenatal services that support women who use substances in metropolitan Australia. Participants were over the age of 15, had <33-week gestation, and smoked tobacco daily. They received financial incentives for daily carbon monoxide-verified smoking abstinence or reduction through an internet-based CM programme, nicotine replacement therapy (NRT) posted to women and partners or household members who smoked and telephone-delivered behavioral counseling from study enrolment to birth. Results Of the 101 referrals, 46 women (46%) consented. The mean (SD) age was 31(±6) years, and the gestation period was 22(±6) weeks. Nineteen (41%) of those enrolled were retained for 12-week postpartum. Of 46 women, 32 (70%) utilized CM; 32 (70%) used NRT for ≥2 weeks; 23 (50%) attended ≥1 counseling session; and 15 (22%) received NRT for partners/household members. Fifteen (33%) were verified abstinent from tobacco at delivery after a median (IQR) period of abstinence of 65(36-128) days. All non-smokers at birth utilized NRT and financial incentives, and 9/15 (60%) utilized counseling. Four (9%) were abstinent at 12-week postpartum. Median cigarettes smoked/day reduced from baseline to delivery (10(6-20) to 1(0-6) p =< 0.001). Women who quit smoking had more education (72% vs. 33% p =< 0.02), completed more CO samples (median (IQR) 101(59-157) vs. 2(0-20) p =< 0.001), and received more incentives (median (IQR) $909($225-$1980) vs. $34($3-$64) p =< 0.001). Intervention acceptability was rated favorably by participants (9 items rated 0-10 with scores >5 considered favorable). Discussion This study demonstrated the feasibility and acceptability of a consumer-informed, non-face-to-face intensive tobacco treatment, highlighting the potential of remotely delivered technology-based CM to reduce the health impact of tobacco smoking in high-priority populations. The intervention demonstrates scale-up potential. Future studies should extend treatment into the postpartum period, utilizing new technologies to enhance CM delivery and improve counseling provision and partner support. Clinical trial registration https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374196, ACTRN1261800056224.
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Affiliation(s)
- Melissa A. Jackson
- Hunter New England Health Local Health District, Newcastle, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Drug and Alcohol Clinical Research Improvement Network, St. Leonards, NSW, Australia
| | - Amanda L. Brown
- Hunter New England Health Local Health District, Newcastle, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Amanda L. Baker
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Billie Bonevski
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Paul Haber
- Drug and Alcohol Clinical Research Improvement Network, St. Leonards, NSW, Australia
- Edith Collins Centre, Sydney Local Health District, Camperdown, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Yvonne Bonomo
- Department of Medicine, University of Melbourne, Parkville, VIC, Australia
- Women's Alcohol and Drug Service, The Royal Women's Hospital, Parkville, VIC, Australia
| | - Julie Blandthorn
- Women's Alcohol and Drug Service, The Royal Women's Hospital, Parkville, VIC, Australia
| | - John Attia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Natasha Perry
- Hunter New England Health Local Health District, Newcastle, NSW, Australia
| | - Daniel Barker
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Gillian S. Gould
- Faculty of Health, Southern Cross University, Coffs Harbour, NSW, Australia
| | - Adrian J. Dunlop
- Hunter New England Health Local Health District, Newcastle, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Drug and Alcohol Clinical Research Improvement Network, St. Leonards, NSW, Australia
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Nillni YI, Baul TD, Paul E, Godfrey LB, Sloan DM, Valentine SE. Written exposure therapy for treatment of perinatal PTSD among women with comorbid PTSD and SUD: A pilot study examining feasibility, acceptability, and preliminary effectiveness. Gen Hosp Psychiatry 2023; 83:66-74. [PMID: 37119780 PMCID: PMC10587907 DOI: 10.1016/j.genhosppsych.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/10/2023] [Accepted: 04/21/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVE This pilot open trial examined the feasibility, acceptability, and preliminary effectiveness of Written Exposure Therapy (WET), a 5-session evidence-based intervention for posttraumatic stress disorder (PTSD) during pregnancy. Participants were pregnant women with comorbid PTSD and substance use disorder (SUD) receiving prenatal care in a high risk obstetrics-addictions clinic. METHODS A total of 18 participants with probable PTSD engaged in the intervention, and 10 completed the intervention and were included in outcome analyses. Wilcoxon's Signed-Rank analyses were used to evaluate PTSD and depression symptoms and craving at pre-intervention to post-intervention and pre-intervention to the 6-month postpartum follow-up. Engagement and retention in WET and therapist fidelity to the intervention manual were used to assess feasibility. Quantitative and qualitative measures of patient satisfaction were used to assess acceptability. RESULTS PTSD symptoms significantly decreased from pre-intervention to post-intervention (S = 26.6, p = 0.006), which sustained at the 6-month postpartum follow-up (S = 10.5, p = 0.031). Participant satisfaction at post-intervention was high. Therapists demonstrated high adherence to the intervention and excellent competence. CONCLUSIONS WET was a feasible and acceptable treatment for PTSD in this sample. Randomized clinical trial studies with a general group of pregnant women are needed to expand upon these findings and perform a full-scale test of effectiveness of this intervention.
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Affiliation(s)
- Yael I Nillni
- National Center for PTSD, Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
| | - Tithi D Baul
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA.
| | - Emilie Paul
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA; College of Liberal Arts and Sciences, St. John's University, Queens, NY, USA.
| | - Laura B Godfrey
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA.
| | - Denise M Sloan
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA; National Center for PTSD, Behavioral Science Division at VA Boston Healthcare System, Boston, MA, USA.
| | - Sarah E Valentine
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA; Department of Psychiatry, Boston Medical Center, Boston, MA, USA.
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Vicario S, Buykx P, Peacock M, Hardie I, De Freitas L, Bissell P, Meier PS. Women's alcohol consumption in the early parenting period and influences of socio-demographic and domestic circumstances: A scoping review and narrative synthesis. Drug Alcohol Rev 2023; 42:1165-1194. [PMID: 36974380 DOI: 10.1111/dar.13643] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 02/03/2023] [Accepted: 02/14/2023] [Indexed: 03/29/2023]
Abstract
ISSUES Numerous studies have explored alcohol consumption in pregnancy, but less is known about women's drinking in the early parenting period (EPP, 0-5 years after childbirth). We synthesise research related to three questions: (i) How are women's drinking patterns and trajectories associated with socio-demographic and domestic circumstances?; (ii) What theoretical approaches are used to explain changes in consumption?; (iii) What meanings have been given to mothers' drinking? APPROACH Three databases (Ovid-MEDLINE, Ovid-PsycINFO and CINAHL) were systematically searched. Citation tracking was conducted in Web of Science Citation Index and Google Scholar. Eligible papers explored mothers' alcohol consumption during the EPP, focusing on general population rather than clinical samples. Studies were critically appraised and their characteristics, methods and key findings extracted. Thematic narrative synthesis of findings was conducted. KEY FINDINGS Fourteen quantitative and six qualitative studies were identified. The (sub)samples ranged from n = 77,137 to n = 21 women. Mothers' consumption levels were associated with older age, being White and employed, not being in a partnered relationship, higher education and income. Three theoretical approaches were employed to explain these consumption differences: social role, role deprivation, social practice theories. By drinking alcohol, mothers expressed numerous aspects of their identity (e.g., autonomous women and responsible mothers). IMPLICATIONS AND CONCLUSION Alcohol-related interventions and policies should consider demographic and cultural transformations of motherhood (e.g., delayed motherhood, changes in family structures). Mothers' drinking should be contextualised carefully in relation to socio-economic circumstances and gender inequalities in unpaid labour. The focus on peer-reviewed academic papers in English language may limit the evidence.
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Affiliation(s)
- Serena Vicario
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- Centre for Health and Services Studies, Centre for Care, University of Kent, Canterbury, UK
| | - Penny Buykx
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- School of Humanities, Creative Industries and Social Science, University of Newcastle, Newcastle, Australia
| | - Marian Peacock
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- Faculty of Health Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Iain Hardie
- Department of Psychology, School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Paul Bissell
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- University of Chester, Chester, UK
| | - Petra Sylvia Meier
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Serwatka CA, Griebel-Thompson AK, Eiden RD, Kong KL. Nutrient Supplementation during the Prenatal Period in Substance-Using Mothers: A Narrative Review of the Effects on Offspring Development. Nutrients 2023; 15:2990. [PMID: 37447316 DOI: 10.3390/nu15132990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
Substance use during pregnancy increases the risk for poor developmental outcomes of the offspring, and for substance-dependent mothers, abstaining from substance use during pregnancy is often difficult. Given the addictive nature of many substances, strategies that may mitigate the harmful effects of prenatal substance exposure are important. Prenatal nutrient supplementation is an emerging intervention that may improve developmental outcomes among substance-exposed offspring. We provide a narrative review of the literature on micronutrient and fatty acid supplementation during pregnancies exposed to substance use in relation to offspring developmental outcomes. We first discuss animal models exposed to ethanol during pregnancy with supplementation of choline, zinc, vitamin E, iron, and fatty acids. We follow with human studies of both alcohol- and nicotine-exposed pregnancies with supplementation of choline and vitamin C, respectively. We identified only 26 animal studies on ethanol and 6 human studies on alcohol and nicotine that supplemented nutrients during pregnancy and reported offspring developmental outcomes. There were no studies that examined nutrient supplementation during pregnancies exposed to cannabis, illicit substances, or polysubstance use. Implementations and future directions are discussed.
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Affiliation(s)
- Catherine A Serwatka
- Baby Health Behavior Laboratory, Division of Health Services and Outcomes Research, Children's Mercy Research Institute, Children's Mercy Hospital, Kansas City, MO 64108, USA
| | - Adrianne K Griebel-Thompson
- Baby Health Behavior Laboratory, Division of Health Services and Outcomes Research, Children's Mercy Research Institute, Children's Mercy Hospital, Kansas City, MO 64108, USA
| | - Rina D Eiden
- Department of Psychology and the Social Science Research Institute, The Pennsylvania State University, University Park, PA 16801, USA
| | - Kai Ling Kong
- Baby Health Behavior Laboratory, Division of Health Services and Outcomes Research, Children's Mercy Research Institute, Children's Mercy Hospital, Kansas City, MO 64108, USA
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO 64110, USA
- Center for Children's Healthy Lifestyles and Nutrition, University of Kansas Medical Center, Kansas City, KS 66160, USA
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Swenson K. Cannabis for morning sickness: areas for intervention to decrease cannabis consumption during pregnancy. J Cannabis Res 2023; 5:22. [PMID: 37330589 DOI: 10.1186/s42238-023-00184-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 04/30/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND Cannabis use during pregnancy is increasing, with 19-22% of patients testing positive at delivery in Colorado and California. Patients report using cannabis to alleviate their nausea and vomiting, anxiety, and pain. However, preclinical and clinical data highlight harmful effects to offspring physiology and behavior following fetal cannabis exposure. This narrative review identifies potential areas for intervention to decrease cannabis consumption during pregnancy. METHODS A combination of keywords, including "cannabis", "cannabis", "weed", "pregnancy", "morning sickness", "child protective services", and "budtender" were searched in databases such as PubMed and Google Scholar, as well as in social media forums, governmental webpages, and other publicly available sources. RESULTS The literature search identified several areas for intervention to reduce cannabis use during pregnancy, including physician and pharmacist training, engagement with pregnant patients, regulation of dispensary workers, and the role of child protective services. DISCUSSION This comprehensive review identifies multiple areas for improvement to benefit pregnant patients. Recommendations are independent and can be implemented simultaneously by the identified groups. Limitations of this research includes the relatively limited availability of data focused specifically on cannabis consumption during pregnancy and the complexity of the sociopolitical field of substance use during pregnancy. CONCLUSIONS Cannabis consumption during pregnancy is increasing and causes harm to the developing fetus. To educate pregnant patients about these risks, we must address the gaps in education from multiple contact points.
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Affiliation(s)
- Karli Swenson
- Department of Pediatrics, Section of Developmental Biology, University of Colorado Anschutz Medical Campus, 12800 E 19th Avenue, RC1 North MS 8313, Aurora, CO, 80045, USA.
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Bariselli S, Reuveni N, Westcott N, Mateo Y, Lovinger DM. Postnatal ethanol exposure impairs social behavior and operant extinction in the adult female mouse offspring. Front Neurosci 2023; 17:1160185. [PMID: 37260840 PMCID: PMC10229070 DOI: 10.3389/fnins.2023.1160185] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/26/2023] [Indexed: 06/02/2023] Open
Abstract
Fetal Alcohol Spectrum Disorder (FASD) comprises a group of neurodevelopmental deficits caused by alcohol exposure during pregnancy. Clinical studies suggest that while the male progeny experiences serious neurodevelopmental defects, female patients have more severe cognitive, social, and affective symptoms. Other than sex, dose, frequency, and timing of exposure determine the neurobehavioral outcomes in young and adult progeny. In this regard, human studies indicate that some individuals relapse during late-term gestational periods. In mice, this interval corresponds to the first 10 days after birth (postnatal, P0-P10). In our model of postnatal ethanol exposure (PEEP0-P10), we tested whether adult female and male offspring show deficits in sociability, anxiety-like, reward consumption, and action-outcome associations. We report that female PEEP0-P10 offspring have mild social impairments and altered extinction of operant responding in the absence of anxiety-like traits and reward consumption defects. None of these deficits were detected in the male PEEP0-P10 offspring. Our data provide novel information on sex-specific neurobehavioral outcomes of postnatal ethanol exposure in female adult offspring.
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24
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Xu KY, Jones HE, Schiff DM, Martin CE, Kelly JC, Carter EB, Bierut LJ, Grucza RA. Initiation and Treatment Discontinuation of Medications for Opioid Use Disorder in Pregnant People Compared With Nonpregnant People. Obstet Gynecol 2023; 141:845-853. [PMID: 36897142 PMCID: PMC10201921 DOI: 10.1097/aog.0000000000005117] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/12/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVE To examine the association between pregnancy and medications for opioid use disorder (MOUD) initiation and discontinuation among reproductive-aged people receiving treatment for opioid use disorder (OUD) in the United States. METHODS We conducted a retrospective cohort study of people with gender recorded as female, aged 18-45 years, in the Merative TM MarketScan ® Commercial and Multi-State Medicaid Databases (2006-2016). Opioid use disorder and pregnancy status were identified based on inpatient or outpatient claims for established International Classification of Diseases, Ninth and Tenth Revision diagnosis and procedure codes. The main outcomes were buprenorphine and methadone initiation and discontinuation, determined by using pharmacy and outpatient procedure claims. Analyses were conducted at the treatment episode level. Adjusting for insurance status, age, and co-occurring psychiatric and substance use disorders, we used logistic regression to estimate MOUD initiation and used Cox regression to estimate MOUD discontinuation. RESULTS Our sample included 101,772 reproductive-aged people with OUD, encompassing 155,771 treatment episodes (mean age 30.8 years, 64.4% Medicaid insurance, 84.1% White), of whom 2,687 (3.2%, encompassing 3,325 episodes) were pregnant. In the pregnant group, 51.2% of treatment episodes (1,703/3,325) involved psychosocial treatment without MOUD, in comparison with 61.1% (93,156/152,446) in the nonpregnant comparator group. In adjusted analyses assessing likelihood of initiation for individual MOUD, pregnancy status was associated with an increase in buprenorphine (adjusted odds ratio [aOR] 1.57, 95% CI 1.44-1.70) and methadone initiation (aOR 2.04, 95% CI 1.82-2.27). Discontinuation rates of MOUD at 270 days were high for both buprenorphine (72.4% for nonpregnant episodes vs 59.9% for pregnant episodes) and methadone (65.7% for nonpregnant episodes vs 54.1% for pregnant episodes). Pregnancy was associated with a decreased likelihood of discontinuation at 270 days for both buprenorphine (adjusted hazard ratio [aHR] 0.71, 95% CI 0.67-0.76) and methadone (aHR 0.68, 95% CI 0.61-0.75), in comparison with nonpregnant status. CONCLUSION Although a minority of reproductive-aged people with OUD in the United States are initiated on MOUD, pregnancy is associated with a significant increase in treatment initiation and a reduced risk of medication discontinuation.
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Affiliation(s)
- Kevin Y Xu
- Health and Behavior Research Center, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Hendrée E Jones
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Davida M Schiff
- Division of General Academic Pediatrics, Mass General Hospital for Children, Boston, MA, USA
| | - Caitlin E Martin
- Department of Obstetrics and Gynecology and VCU Institute for Drug and Alcohol Studies, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Jeannie C Kelly
- Division of Maternal-Fetal Medicine and the Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Ebony B Carter
- Division of Maternal-Fetal Medicine and the Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Laura J Bierut
- Health and Behavior Research Center, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Alvin J Siteman Cancer Center, Barnes Jewish Hospital, St. Louis, MO, USA
| | - Richard A Grucza
- Health and Behavior Research Center, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Departments of Family and Community Medicine and Health and Outcomes Research, St. Louis University, St. Louis, MO, USA
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Sterba KR, Johnson EE, Douglas E, Aujla R, Boyars L, Kruis R, Verdin R, Grater R, King K, Ford D, Guille C. Implementation of a women's reproductive behavioral health telemedicine program: a qualitative study of barriers and facilitators in obstetric and pediatric clinics. BMC Pregnancy Childbirth 2023; 23:167. [PMID: 36906564 PMCID: PMC10007723 DOI: 10.1186/s12884-023-05463-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/22/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND Perinatal Mood and Anxiety Disorders and Substance Use Disorders are common and result in significant morbidities and mortality. Despite evidence-based treatment availability, multiple barriers exist to care delivery. Because telemedicine offers opportunities to overcome these barriers, the objective of this study was to characterize barriers and facilitators to implementing a mental health and substance use disorder telemedicine program in community obstetric and pediatric clinics. METHODS Interviews and site surveys were completed with practices engaged in a Women's Reproductive Behavioral Health Telemedicine program (N = 6 sites; 18 participants) at the Medical University of South Carolina and telemedicine providers involved in care delivery (N = 4). Using a structured interview guide based on implementation science principles, we assessed program implementation experiences and perceived barriers and facilitators to implementation. A template analysis approach was used to analyze qualitative data within and across groups. RESULTS The primary program facilitator was service demand driven by the lack of available maternal mental health and substance use disorder services. Strong commitment to the importance of addressing these health concerns provided a foundation for successful program implementation yet practical challenges such as staffing, space, and technology support were notable barriers. Services were supported by establishing good teamwork within the clinic and with the telemedicine team. CONCLUSION Capitalizing on clinics' commitment to care for women's needs and a high demand for mental health and substance use disorder services while also addressing resource and technology needs will facilitate telemedicine program success. Study results may have implications for potential marketing, onboarding and monitoring implementation strategies to support clinics engaging in telemedicine programs.
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Affiliation(s)
- Katherine R Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA.
| | - Emily E Johnson
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Edie Douglas
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Rubin Aujla
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Lisa Boyars
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Ryan Kruis
- Center for Telehealth, Medical University of South Carolina, Charleston, SC, USA
| | - Rebecca Verdin
- Center for Telehealth, Medical University of South Carolina, Charleston, SC, USA
| | - Rachel Grater
- Center for Telehealth, Medical University of South Carolina, Charleston, SC, USA
| | - Kathryn King
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Dee Ford
- Department of Pulmonary and Critical Care, Medical University of South Carolina, Charleston, SC, USA
| | - Constance Guille
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.,Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
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Stevenson K, Fellmeth G, Edwards S, Calvert C, Bennett P, Campbell OMR, Fuhr DC. The global burden of perinatal common mental health disorders and substance use among migrant women: a systematic review and meta-analysis. Lancet Public Health 2023; 8:e203-e216. [PMID: 36841561 DOI: 10.1016/s2468-2667(22)00342-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 02/25/2023]
Abstract
BACKGROUND There are one billion migrants globally, of whom 82 million are forced migrants. Pregnant migrants face pre-migration stressors such as conflict, transit stressors including poverty, and post-migration stressors including navigating the immigration system; these stressors can make them vulnerable to mental illness. We aimed to assess the global prevalence of and risk factors for perinatal mental health disorders or substance use among women who are migrants. METHODS In this systematic review and meta-analysis, we searched OVID MEDLINE, Embase, PsycINFO, CENTRAL, Global Health, Scopus, and Web of Science for studies published from database inception until July 8, 2022. Cohort, cross-sectional, and interventional studies with prevalence data for any mental illness in pregnancy or the postnatal period (ie, up to a year after delivery) or substance use in pregnancy were included. The primary outcome was the prevalence of perinatal common mental health disorders among women who are migrants, globally. Data for study quality and risk factors were also extracted. A random-effects meta-analysis was used to calculate pooled prevalence estimates, when appropriate. Sensitivity analyses were conducted according to study quality, sample representativeness, and method of outcome assessment. Risk factor data were synthesised narratively. This study is registered with PROSPERO, CRD42021226291. FINDINGS 18 650 studies were retrieved, of which 135 studies comprising data from 621 995 participants met the inclusion criteria. 123 (91%) of 135 studies were conducted in high-income host countries. Five (4%) of 135 studies were interventional, 40 (30%) were cohort, and 90 (66%) were cross-sectional. The most common regions of origin of participants were South America, the Middle East, and north Africa. Only 26 studies presented disaggregated data for forced migrants or economic migrants. The pooled prevalence of perinatal depressive disorders was 24·2% (range 0·5-95·5%; I2 98·8%; τ2 0·01) among all women who are migrants, 32·5% (1·5-81·6; 98·7%; 0·01) among forced migrants, and 13·7% (4·7-35·1; 91·5%; 0·01) among economic migrants (p<0·001). The pooled prevalence of perinatal anxiety disorders was 19·6% (range 1·2-53·1; I2 96·8%; τ2 0·01) among all migrants. The pooled prevalence of perinatal post-traumatic stress disorder (PTSD) among all migrant women was 8·9% (range 3·2-33·3; I2 97·4%; τ2 0·18). The pooled prevalence of perinatal PTSD among forced migrants was 17·1% (range 6·5-44·3; I2 96·6%; τ2 0·32). Key risk factors for perinatal depression were being a recently arrived immigrant (ie, approximately within the past year), having poor social support, and having a poor relationship with one's partner. INTERPRETATION One in four women who are migrants and who are pregnant or post partum experience perinatal depression, one in five perinatal anxiety, and one in 11 perinatal PTSD. The burden of perinatal mental illness appears higher among women who are forced migrants compared with women who are economic migrants. To our knowledge, we have provided the first pooled estimate of perinatal depression and PTSD among women who are forced migrants. Interpreting the prevalence estimate should be observed with caution due to the very wide range found within the included studies. Additionally, 66% of studies were cross-sectional representing low quality evidence. These findings highlight the need for community-based routine perinatal mental health screening for migrant communities, and access to interventions that are culturally sensitive, particularly for forced migrants who might experience a higher burden of disease than economic migrants. FUNDING UK National Institute for Health Research (NIHR); March of Dimes European Preterm Birth Research Centre, Imperial College; Imperial College NIHR Biomedical Research Centre; and Nuffield Department of Population Health, University of Oxford.
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Affiliation(s)
- Kerrie Stevenson
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK; Institute of Reproductive and Developmental Biology, Imperial College London, London, UK; Institute of Health Informatics, University College London, London, UK.
| | - Gracia Fellmeth
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Samuel Edwards
- School of Health Sciences, University of Liverpool, Liverpool, UK
| | - Clara Calvert
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK; Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Phillip Bennett
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - Oona M R Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Daniela C Fuhr
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK; Leibniz Institute of Prevention Research and Epidemiology, Bremen, Germany; Health Sciences, University of Bremen, Bremen, Germany
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Dauber S, Beacham A, West A, Devkota J, Barrie K, Thrul J. Ecological Momentary Assessment of Heavy Episodic Drinking in the Early Postpartum Period: A Feasibility Study. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 7:100146. [PMID: 37012980 PMCID: PMC10066518 DOI: 10.1016/j.dadr.2023.100146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/14/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023]
Abstract
Background Postpartum mothers are at heightened risk for heavy episodic drinking (HED). Research with this population is critical to developing acceptable and effective tailored interventions, but new mothers who use alcohol are often reluctant to engage in research due to stigma and fear of child removal. This study examined feasibility of recruitment and ecological momentary assessment (EMA) in early postpartum mothers with histories of HED. Methods Participants were recruited via Facebook and Reddit and completed 14 days of EMA surveys. Baseline characteristics, recruitment feasibility, and EMA feasibility and acceptability were examined. Participants attended focus groups to further inform quantitative data. Results Reddit yielded a larger proportion of eligible individuals than Facebook, and 86% of the final enroled sample was recruited via Reddit. The average compliance rate of 75% is in line with other studies of similar populations. Half the sample reported alcohol use, and 78% reported the urge to drink at least once, supporting feasibility of EMA for collecting alcohol use data. Participants reported low burden and high acceptability of the study on both quantitative and qualitative measures. Baseline low maternal self-efficacy was associated with greater EMA compliance, and first-time mothers reported lower EMA burden compared to veteran mothers. College graduates, and participants with lower drinking refusal self-efficacy and greater alcohol severity were more likely to report alcohol use on EMA. Conclusions Future studies should consider Reddit as a recruitment strategy. Findings generally support feasibility and acceptability of EMA to assess HED in postpartum mothers.
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Affiliation(s)
- Sarah Dauber
- Partnership to End Addiction, 711 Third Avenue, 5th floor, New York, NY 10017, USA
- Corresponding author.
| | - Alexa Beacham
- Partnership to End Addiction, 711 Third Avenue, 5th floor, New York, NY 10017, USA
| | - Allison West
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Janardan Devkota
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kadjatu Barrie
- Partnership to End Addiction, 711 Third Avenue, 5th floor, New York, NY 10017, USA
| | - Johannes Thrul
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
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Towobola A, Towobola B, Nair B, Makwana A. The ethics and management of cannabis use in pregnancy following decriminalisation and licensing for medical use: narrative review. BJPsych Bull 2023; 47:28-37. [PMID: 34749839 PMCID: PMC10028554 DOI: 10.1192/bjb.2021.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 09/14/2021] [Accepted: 10/08/2021] [Indexed: 02/04/2023] Open
Abstract
AIMS AND METHOD As drug policies pertaining to cannabis use become more liberalised, the prevalence of cannabis use in pregnancy could increase. However, there is limited guidance available for clinicians. This paper presents a narrative review of literature published in the past 16 years (2006-2021) to (a) address the impact of legalisation and decriminalisation on the risks, ethics and support of women who use cannabis during pregnancy and (b) develop guidance for clinicians. RESULTS Both national and international trends suggest increased use of cannabis over the past decade, while the risks of cannabis use for recreational or medicinal purposes in pregnancy remain unmitigated. CLINICAL IMPLICATIONS This review confirmed that the recommendation of cannabinoid-based products for pregnant and breast-feeding women is currently premature. More research is needed to address safety concerns. We discussed navigating ethical concerns and suggest targeted management strategies for clinicians treating pregnant women who choose to use cannabis.
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Affiliation(s)
| | | | - Bosky Nair
- Kent and Medway NHS and Social Care Partnership Trust, Maidstone, Kent, UK
| | - Arti Makwana
- Kent and Medway NHS and Social Care Partnership Trust, Maidstone, Kent, UK
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Interventions Addressing Cannabis Use During Pregnancy: A Systematic Review. J Addict Med 2023; 17:47-53. [PMID: 36731108 DOI: 10.1097/adm.0000000000001027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The prevalence of cannabis use among pregnant women is increasing in the United States and places mothers and infants at risk of multiple adverse health outcomes. Given the uncertainty expressed by providers regarding how to approach cannabis use during pregnancy and the growing need for a systematic endeavor to curb use in this population, the aim of this study is to conduct a systematic review of interventions focused on reduction in cannabis use during pregnancy. METHODS We conducted a systematic search of MEDLINE, PsycINFO, CINAHL, Web of Science, SCOPUS, and Cochrane Library to identify studies of interventions that target individuals that engaged in cannabis use during pregnancy. We included studies if they were randomized controlled trials, controlled studies, feasibility studies, pilot studies, as well as observational studies. The primary diagnostic outcome of interest is reduction in cannabis use. RESULTS We identified 9 studies for inclusion with sample sizes ranging from 15 to 658 pregnant people. Interventions involved brief counseling, cognitive behavioral therapy (CBT), motivational interviewing (MI), motivational enhancement therapy + cognitive behavioral therapy (MET-CBT), computer-delivered psychotherapy, and psychoeducation. The interventions that were effective primarily used MI, CBT, and/or MET. There was just 1 study that implemented a home intervention and one that explored computer-based psychotherapy. CONCLUSIONS The studies uncovered through this systematic review suggest that interventions involving CBT and/or MI demonstrate promise for decreasing cannabis use during pregnancy. There is a tremendous need for high-quality studies focused on this population, and the potential for remote and computer-based interventions should be explored more fully.
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Bruno AM, Blue NR, Allshouse AA, Haas DM, Shanks AL, Grobman WA, Simhan H, Reddy UM, Silver RM, Metz TD. Marijuana use, fetal growth, and uterine artery Dopplers. J Matern Fetal Neonatal Med 2022; 35:7717-7724. [PMID: 34470115 PMCID: PMC9080638 DOI: 10.1080/14767058.2021.1960973] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/16/2021] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Marijuana (MJ) use is associated with adverse effects on fetal growth. We aimed to investigate the timing of suboptimal fetal growth onset in MJ-exposed pregnancies. In addition, we aimed to explore the relationship between MJ-exposure and both abnormal uterine artery (UtA) Doppler parameters and small for gestational age (SGA). STUDY DESIGN This was a secondary analysis of a prospective multicenter cohort that enrolled nulliparous individuals delivering non-anomalous fetuses beyond 20 weeks' gestation. Marijuana exposure was ascertained by self-report or clinical urine toxicology testing. Ultrasound estimated fetal weights (EFWs) were assessed in participants at both 16w0d-21w6d and 22w0d-29w6d. EFWs and birth weight (BW) were converted to weight percentiles (wPCT). EFW and BW wPCTs were calculated using population-based standards. Additionally, a customized standard designed to be applicable to both EFWs and BWs within the same model was also used to allow for EFW to BW percentile trajectories. The primary outcome, longitudinal wPCT, was compared between individuals with and without MJ use in a linear mixed-effects regression model adjusting for tobacco. For modeling, wPCT was smoothed across gestational age; MJ was estimated as an intercept and linear difference in the slope of gestational age. UtA Doppler notching, resistance index (RI), and pulsatility index (PI) at 16w0d-21w6d were compared using t-test and χ2. SGA at delivery was also compared. RESULTS Nine thousand one hundred and sixty-three individuals met inclusion criteria; 136 (1.5%) used MJ during pregnancy. Individuals who used MJ were more likely to be younger, identify as non-Hispanic Black, and have had less education. Fetuses exposed to MJ had lower wPCT beginning at 28 weeks using population-based and customized standards, when compared to those without exposure. UtA notching, PI, and RI were similar between groups. SGA was more frequent in neonates exposed to MJ using both population-based (22 vs. 9%, p<.001) and customized (25 vs. 14%, p<.001) curves. CONCLUSIONS MJ-exposed fetuses were estimated to be smaller than unexposed fetuses starting at 28 weeks' gestation across both growth standards without a difference in UtA Doppler parameters.
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Affiliation(s)
- Ann M. Bruno
- Department of Obstetrics & Gynecology, University of Utah Health, Salt Lake City, UT, USA
- Department of Obstetrics & Gynecology, Intermountain Healthcare, Murray, UT, USA
| | - Nathan R. Blue
- Department of Obstetrics & Gynecology, University of Utah Health, Salt Lake City, UT, USA
- Department of Obstetrics & Gynecology, Intermountain Healthcare, Murray, UT, USA
| | - Amanda A. Allshouse
- Department of Obstetrics & Gynecology, University of Utah Health, Salt Lake City, UT, USA
| | - David M. Haas
- Department of Obstetrics & Gynecology, Indiana University, Indianapolis, IN, USA
| | - Anthony L. Shanks
- Department of Obstetrics & Gynecology, Indiana University, Indianapolis, IN, USA
| | - William A. Grobman
- Department of Obstetrics & Gynecology, Northwestern University, Chicago, IL, USA
| | - Hyagriv Simhan
- Department of Obstetrics & Gynecology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Uma M. Reddy
- Department of Obstetrics & Gynecology, Yale University, New Haven, CT, USA
| | - Robert M. Silver
- Department of Obstetrics & Gynecology, University of Utah Health, Salt Lake City, UT, USA
- Department of Obstetrics & Gynecology, Intermountain Healthcare, Murray, UT, USA
| | - Torri D. Metz
- Department of Obstetrics & Gynecology, University of Utah Health, Salt Lake City, UT, USA
- Department of Obstetrics & Gynecology, Intermountain Healthcare, Murray, UT, USA
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Dauber S, Hammond C, Hogue A, Henderson C, Nugent J, Ford V, Brown J, Scott L, Ondersma S. Development of an Electronic Screening and Brief Intervention to Address Perinatal Substance Use in Home Visiting: Qualitative User-Centered Approach. JMIR Form Res 2022; 6:e37865. [PMID: 36346648 PMCID: PMC9682454 DOI: 10.2196/37865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 09/06/2022] [Accepted: 09/29/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Perinatal substance use (SU) is prevalent during pregnancy and the postpartum period and may increase the risks to maternal and child health. Many pregnant and postpartum women do not seek treatment for SU because of fear of child removal. Home visiting (HV), a voluntary supportive program for high-risk families during the perinatal period, is a promising avenue for addressing unmet SU needs. Confidential delivery of screening and brief intervention (BI) for SU via computers has demonstrated high user satisfaction among pregnant and postpartum women as well as efficacy in reducing perinatal SU. This study describes the development of the electronic screening and BI for HV (e-SBI-HV), a digital screening and BI program that is adapted from an existing electronic screening and BI (e-SBI) for perinatal SU and tailored to the HV context. OBJECTIVE This study aimed to describe the user-centered intervention development process that informed the adaptation of the original e-SBI into the e-SBI-HV, present specific themes extracted from the user-centered design process that directly informed the e-SBI-HV prototype and describe the e-SBI-HV prototype. METHODS Adaptation of the original e-SBI into the e-SBI-HV followed a user-centered design process that included 2 phases of interviews with home visitors and clients. The first phase focused on adaptation and the second phase focused on refinement. Themes were extracted from the interviews using inductive coding methods and systematically used to inform e-SBI-HV adaptations. Participants included 17 home visitors and 7 clients across 3 Healthy Families America programs in New Jersey. RESULTS The e-SBI-HV is based on an existing e-SBI for perinatal SU that includes screening participants for SU followed by a brief motivational intervention. On the basis of the themes extracted from the user-centered design process, the original e-SBI was adapted to address population-specific motivating factors, address co-occurring problems, address concerns about confidentiality, acknowledge fear of child protective services, capitalize on the home visitor-client relationship, and provide information about SU treatment while acknowledging that many clients prefer not to access the formal treatment system. The full e-SBI-HV prototype included 2 digital intervention sessions and home visitor facilitation protocols. CONCLUSIONS This study describes a user-centered approach for adapting an existing e-SBI for SU for use in the HV context. Despite the described challenges, home visitors and clients generally reacted favorably to the e-SBI-HV, noting that it has the potential to fill a significant gap in HV services. If proven effective, the e-SBI-HV could provide a way for clients to receive help with SU within HV, while maintaining their privacy and avoiding the overburdening of home visitors. The next step in this study would be to test the feasibility and preliminary efficacy of the e-SBI-HV.
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Affiliation(s)
- Sarah Dauber
- Partnership to End Addiction, New York, NY, United States
| | - Cori Hammond
- Partnership to End Addiction, New York, NY, United States
| | - Aaron Hogue
- Partnership to End Addiction, New York, NY, United States
| | | | | | - Veronica Ford
- Prevent Child Abuse New Jersey, New Brunswick, NJ, United States
| | - Jill Brown
- New Jersey Department of Children and Families, Trenton, NJ, United States
| | - Lenore Scott
- New Jersey Department of Children and Families, Trenton, NJ, United States
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Schiff DM, Work EC, Muftu S, Partridge S, MacMillan KDL, Gray JR, Hoeppner BB, Kelly JF, Greenfield SF, Jones HE, Wilens TE, Terplan M, Bernstein J. "You have to take this medication, but then you get punished for taking it:" lack of agency, choice, and fear of medications to treat opioid use disorder across the perinatal period. J Subst Abuse Treat 2022; 139:108765. [PMID: 35341614 PMCID: PMC9187596 DOI: 10.1016/j.jsat.2022.108765] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/28/2022] [Accepted: 03/01/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Medications to treat opioid use disorder (MOUD) during pregnancy and in the postpartum period remain underutilized. A need exists to enhance our understanding of modifiable factors, facilitators, and barriers to MOUD utilization and adherence in the perinatal period to improve maternal and child outcomes. METHODS The study conducted semi-structured qualitative interviews with recently pregnant people with opioid use disorder (OUD) to explore experiences as a pregnant and/or parenting person with OUD, perceptions of enabling factors and barriers to treatment utilization, incentivizing factors for maintaining adherence, and acceptability of ongoing supports to sustain treatment adherence. The study team used constant comparative methods to analyze transcripts and develop the codebook. The team double coded the transcripts, with an overall kappa coefficient of 0.88. RESULTS The study team interviewed twenty-six women on average 10.1 months after delivery. All women had some prior experience using MOUD. Four unique themes emerged as barriers to medication utilization and adherence in the perinatal period: 1) Lack of agency and autonomy surrounding medication decisions because pregnancy or parenting status affected treatment adherence; 2) Hesitancy to use MOUD to minimize risk of newborn withdrawal; 3) Concern about increased scrutiny and potential loss of custody due to mandated child protective services reporting for opioid-exposure at delivery in Massachusetts; and 4) Perception that treatment environments, particularly methadone clinics, did not provide gender-responsive or equitable care, and standardized, inflexible visit regulations were particularly difficult to comply with in the early postpartum period. CONCLUSIONS Women with OUD experienced a double bind when making perinatal treatment decisions, describing pressure to use MOUD with negative consequences after delivery. Key areas for possible intervention emerged from interviews. These areas include improving uptake of shared decision-making to increase patient autonomy and agency, particularly among those in the earliest stages of recovery during pregnancy; ongoing education around perinatal MOUD safety and efficacy; detangling MOUD and neonatal withdrawal signs from mandated child protective services reporting; and improving gender-responsive and equitable care in substance use disorder treatment programs, including incorporating the utilization of home visiting services for dosing assessments and administration in the early postpartum period.
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Affiliation(s)
- Davida M Schiff
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, 125 Nashua St Suite 860, Boston, MA, 02114, United States of America.
| | - Erin C Work
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, 125 Nashua St Suite 860, Boston, MA, 02114, United States of America
| | - Serra Muftu
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, 125 Nashua St Suite 860, Boston, MA, 02114, United States of America
| | - Shayla Partridge
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, 125 Nashua St Suite 860, Boston, MA, 02114, United States of America
| | - Kathryn Dee L MacMillan
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, 02115, United States of America
| | - Jessica R Gray
- Division General of Internal Medicine, MassGeneral Hospital for Children, Boston, MA, 02114, United States of America; Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA, 02114, United States of America
| | - Bettina B Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, United States of America
| | - John F Kelly
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, United States of America
| | - Shelly F Greenfield
- Division of Women's Mental Health and Division of Alcohol, Drugs, and Addiction, McLean Hospital, 115 Mill St, Belmont, MA 02478, United States of America; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States of America
| | - Hendrée E Jones
- UNC Horizons and Department of Obstetrics and Gynecology, University of North Carolina Chapel Hill, 410 North Greensboro St., Carrboro, NC, United States of America
| | - Timothy E Wilens
- Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States of America
| | - Mishka Terplan
- Friends Research Institute, 1040 Park Ave, Suite 103, Baltimore, MD 21202, United States of America
| | - Judith Bernstein
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States of America
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Peltier MR, Roberts W, Verplaetse TL, Burke C, Zakiniaeiz Y, Moore K, McKee SA. Licit and illicit drug use across trimesters in pregnant women endorsing past-year substance use: Results from National Survey on Drug Use and Health (2009-2019). Arch Womens Ment Health 2022; 25:819-827. [PMID: 35737132 PMCID: PMC9359119 DOI: 10.1007/s00737-022-01244-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/08/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Given the health consequences, perinatal substance use is a significant public health concern, especially as substance use rates increase among women; ongoing data regarding the rates of substance use across trimesters of pregnancy is needed. METHODS The present study utilized cross-sectional population-based data from the National Survey of Drug Use and Health (NSDUH) between 2009 and 2019. We aimed to explore both licit and illicit substance use assessed within each trimester among women endorsing past-year substance use. The NSDUH sample included 8,530 pregnant women. RESULTS Perinatal substance use was less prevalent among women in later trimesters; however, past-month substance use was observed for all substances across trimesters. The prevalence of past-month licit substance use among pregnant women ranged from 5.77 to 22.50% and past-month illicit substance use ranged from 4.67 to 14.81%. In the second trimester, lower odds of past-month substance use were observed across tobacco, alcohol, and marijuana (odds ratios [ORs] ranging from 0.29 to 0.47), when compared to the first trimester. A similar lower rate of past-month substance use was observed in the third trimester compared to the first trimester, across tobacco, alcohol, and marijuana use, as well as cocaine, prescription pain medication, and tranquilizer use (ORs ranging from 0.02 to 0.42). The likelihood of polysubstance use was lower among women in the second and third trimesters compared to the first trimester (ORs ranging from 0.09 to 0.46). CONCLUSION Findings indicate that a minority of women continue to use substances across all trimesters. This is especially true among women using licit substances and marijuana. These results highlight the need for improved interventions and improved access to treatment for these women.
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Affiliation(s)
- MacKenzie R Peltier
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT, 06519, USA.
- Psychology Section, VA Connecticut Healthcare System, West Haven, CT, USA.
| | - Walter Roberts
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT, 06519, USA
| | - Terril L Verplaetse
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT, 06519, USA
| | - Catherine Burke
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT, 06519, USA
| | - Yasmin Zakiniaeiz
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT, 06519, USA
| | - Kelly Moore
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT, 06519, USA
- Department of Psychology, East Tennessee State University, Johnson City, TN, USA
| | - Sherry A McKee
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT, 06519, USA
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Kim S. Exploring the Patterns of Substance Use Behaviors in a Nationally Representative Sample of Pregnant Women: a Latent Class Approach. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00886-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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MacDonald AM, Gabos S, Braakman S, Cheperdak L, Lee B, Hrudey SE, Le XC, Li XF, Mandal R, Martin JW, Schopflocher D, Lyon ME, Cheung PY, Ackah F, Graydon JA, Reichert M, Lyon AW, Jarrell J, Benadé G, Charlton C, Huang D, Bennett MJ, Kinniburgh DW. Maternal and child biomonitoring strategies and levels of exposure in western Canada during the past seventeen years: The Alberta Biomonitoring Program: 2005-2021. Int J Hyg Environ Health 2022; 244:113990. [PMID: 35714548 DOI: 10.1016/j.ijheh.2022.113990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/13/2022] [Accepted: 05/31/2022] [Indexed: 10/18/2022]
Abstract
The Alberta Biomonitoring Program (ABP) was created in 2005 with the initial goal of establishing baseline levels of exposure to environmental chemicals in specific populations in the province of Alberta, Canada, and was later expanded to include multiple phases. The first two phases focused on evaluating exposure in pregnant women (Phase One, 2005) and children (Phase Two, 2004-2006) by analyzing residual serum specimens. Phase Three (2013-2016) employed active recruitment techniques to evaluate environmental exposures using a revised list of chemicals in paired serum pools from pregnant women and umbilical cord blood. These three phases of the program monitored a total of 226 chemicals in 285 pooled serum samples representing 31,529 individuals. Phase Four (2017-2020) of the ABP has taken a more targeted approach, focusing on the impact of the federal legalization of cannabis on the exposure of pregnant women in Alberta to cannabis, as well as tobacco and alcohol using residual prenatal screening serum specimens. Chemicals monitored in the first three phases include herbicides, neutral pesticides, metals, metalloids, and micronutrients, methylmercury, organochlorine pesticides, organophosphate pesticides, parabens, phthalate metabolites, perfluoroalkyl substances (PFAS), phenols, phytoestrogens, polybrominated compounds, polychlorinated biphenyls (PCBs), dioxins and furans, polycyclic aromatic hydrocarbons (PAHs), and tobacco biomarkers. Phase Four monitored six biomarkers of tobacco, alcohol, and cannabis. All serum samples were pooled. Mean concentrations and 95% confidence intervals (CIs) were calculated for the chemicals detected in ≥25% of the sample pools. cross the first three phases, the data from the ABP has provided baseline exposure levels for the chemicals in pregnant women, children, and newborns across the province. Comparison within and among the phases has highlighted differences in exposure levels with age, geography, seasonality, sample type, and time. The strategies employed throughout the program phases have been demonstrated to provide effective models for population biomonitoring.
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Affiliation(s)
- Amy M MacDonald
- Alberta Centre for Toxicology, Department of Physiology & Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Stephan Gabos
- Alberta Centre for Toxicology, Department of Physiology & Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Bonita Lee
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Steve E Hrudey
- Division of Analytical and Environmental Toxicology, Department of Laboratory Medicine and Pathology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - X Chris Le
- Division of Analytical and Environmental Toxicology, Department of Laboratory Medicine and Pathology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Xing-Fang Li
- Division of Analytical and Environmental Toxicology, Department of Laboratory Medicine and Pathology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Rupasri Mandal
- The Metabolomics Innovation Centre, Faculty of Science, University of Alberta, Edmonton, Alberta, Canada
| | - Jonathan W Martin
- Science for Life Laboratory, Department of Environmental Sciences, Stockholm University, Sweden
| | - Don Schopflocher
- Faculty of Nursing, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Martha E Lyon
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Po-Yin Cheung
- Division of Neonatal-Perinatal Care (NICU), Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Fred Ackah
- Alberta Government, Strategic Data & Analytic Branch, Edmonton, Alberta, Canada
| | | | - Megan Reichert
- Alberta Health, Health Protection Branch, Edmonton, Alberta, Canada
| | - Andrew W Lyon
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - John Jarrell
- Department of Obstetrics & Gynaecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gerhard Benadé
- Emergency, Public Health & Preventive Medicine, Alberta Health Services, Edmonton, Alberta, Canada
| | - Carmen Charlton
- Alberta Precision Laboratory - Public Health Laboratory, University of Alberta Hospitals, Edmonton, Alberta, Canada
| | - Dorothy Huang
- Alberta Centre for Toxicology, Department of Physiology & Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Melissa J Bennett
- Alberta Centre for Toxicology, Department of Physiology & Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David W Kinniburgh
- Alberta Centre for Toxicology, Department of Physiology & Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Cioffi CC, Schweer-Collins ML, Leve LD. Pregnancy and miscarriage predict suicide attempts but not substance use among dual-systems involved female adolescents. CHILDREN AND YOUTH SERVICES REVIEW 2022; 137:106494. [PMID: 37089705 PMCID: PMC10118061 DOI: 10.1016/j.childyouth.2022.106494] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Background To examine the associations between adolescent pregnancy and pregnancy outcomes on substance use and suicide attempts in a sample who is at greater risk for substance use and suicide attempts - those who have been involved with the uvenile justice and child welfare systems. Methods Using a prospective, longitudinal design, we examined the role of adolescent pregnancy outcomes on risk for suicide attempts and substance use among a sample of 166 female adolescents with juvenile justice system and child welfare involvement. Results Of participants, 36% (n = 60) reported at least one adolescent pregnancy with a total of 109 pregnancies reported. Adolescent pregnancy was associated with an increase in later suicide attempts (aOR = 1.68, 95% CI 1.06-2.72). Miscarriage was associated with a 2-fold increase in the likelihood of later suicide attempts, (aOR = 2.12, 95% CI 1.10-4.12). No participants who reported induced abortion (n = 13) reported suicide attempts. Adolescent pregnancy, miscarriage, and abortion were not significantly associated with later substance use (Ps > 0.05). Conclusions Healthcare professionals should conduct routine screening for suicidality in the months following a miscarriage, offer education to caregivers about how to support youth who experience pregnancy loss, provide additional social supports and familiarize themselves with local and virtual behavioral health resources to prevent suicide attempts among female adolescents who are at high risk and experience miscarriage.
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Guille C, Hall C, King C, Sujan A, Brady K, Newman R. Listening to women and pregnant and postpartum people: Qualitative research to inform opioid use disorder treatment for pregnant and postpartum people. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 3:100064. [PMID: 36845990 PMCID: PMC9948937 DOI: 10.1016/j.dadr.2022.100064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 04/13/2022] [Accepted: 05/09/2022] [Indexed: 11/22/2022]
Abstract
Background The diagnosis of Opioid Use Disorder (OUD) during pregnancy has increased 2-to-5-fold over the past decade and barriers to treatment are significant. Technology-based solutions have the potential to overcome these barriers and deliver evidence-based treatment. However, these interventions need to be informed by end-users. The goal of this study is to gain feedback from peripartum people with OUD and obstetric providers about a web-based OUD treatment program. Methods Qualitative interviews were conducted with peripartum people with OUD (n = 18) and focus groups were conducted with obstetric providers (n = 19). Feedback from these interviews informed the development of text message-based screening, brief phone-based intervention and referral to treatment program, called Listening to Women and Pregnant and Postpartum People (LTWP). Once developed, further qualitative interviews with peripartum people with OUD (n = 12) and obstetric providers (n = 21) were conducted to gather feedback about the LTWP program. Results Patients reported that a relationship with a trusted provider is paramount for treatment engagement. Providers reported that time constraints and complex patient needs prohibit them from treating OUD and that evidence-based Screening, Brief Intervention and Referral to Treatment (SBIRT) are not implemented effectively in routine prenatal care. Neither patients nor providers were enthusiastic about our web-based intervention for OUD; thus, results were used to guide the development of LTWP to improve implementation of SBIRT during prenatal care. Conclusions End-user informed, technology-enhanced SBIRT has the potential to improve the implementation of SBIRT during routine prenatal care, and in turn, improve maternal and child health.
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Affiliation(s)
- Constance Guille
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St, 5 South, MSC861, Charleston, SC 29425, USA
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - Casey Hall
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - Courtney King
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St, 5 South, MSC861, Charleston, SC 29425, USA
| | - Ayesha Sujan
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St, 5 South, MSC861, Charleston, SC 29425, USA
- Department of Psychological and Brain Sciences, Indiana University – Bloomington, Bloomington, IN, USA
| | - Kathleen Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St, 5 South, MSC861, Charleston, SC 29425, USA
- Department of Psychological and Brain Sciences, Indiana University – Bloomington, Bloomington, IN, USA
| | - Roger Newman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
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Rankin L, Mendoza NS, Grisham L. Unpacking Perinatal Experiences with Opioid Use Disorder: Relapse Risk Implications. CLINICAL SOCIAL WORK JOURNAL 2022; 51:34-45. [PMID: 35611138 PMCID: PMC9119270 DOI: 10.1007/s10615-022-00847-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 06/15/2023]
Abstract
While pregnancy presents a strong motivation to seek and comply with treatment for opioid use disorder (OUD), many women relapse within the first year of childbirth. Addressing relapse risk, we examined the perinatal experiences of mothers with OUD through 6 months postpartum. We recruited mothers (N = 42) with a history of OUD into the Newborn Attachment and Wellness study, all of whom met with a child welfare worker immediately after giving birth. In qualitative interviews, mothers described their social, physical, emotional, and psychological perinatal experiences. Seven themes categorically informed relapse risk (i.e., related to childhood bond, mother-infant attachment, birth support, child protective services, breastfeeding, mental health, and recovery planning). In conclusion, we noted a critical window in which clinical social workers and other health/behavioral health providers have the opportunity to capitalize on mothers' desire not to "ever want to touch it again." We outline specific avenues for directed support in the perinatal and postpartum period associated with reduced risk for relapse, and we make recommendations to enhance risk assessment practices.
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Affiliation(s)
- Lela Rankin
- School of Social Work, Watts College of Public Service and Community Solutions, Arizona State University, Phoenix, USA
| | - Natasha S. Mendoza
- School of Social Work, Watts College of Public Service and Community Solutions, Arizona State University, Phoenix, USA
| | - Lisa Grisham
- Banner University Medical Center –Tucson, College of Medicine, University of Arizona, Tucson, USA
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Morris E, Bardsley T, Schulte K, Seidel J, Shakib JH, Buchi KF, Fung CM. Hospital Outcomes of Infants with Neonatal Opioid Withdrawal Syndrome at a Tertiary Care Hospital with High Rates of Concurrent Nonopioid (Polysubstance) Exposure. Am J Perinatol 2022; 39:387-393. [PMID: 32892326 PMCID: PMC8632549 DOI: 10.1055/s-0040-1716490] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Neonatal opioid withdrawal syndrome (NOWS) describes infants' withdrawal signs and symptoms after birth due to an interruption of prenatal opioid exposure. Many infants with NOWS are also exposed to nonopioids, however. This study was to determine hospital outcomes of infants exposed to opioids alone or coexposed with nonopioid substances (polysubstance). STUDY DESIGN We reviewed infants of ≥34 weeks of gestation with prenatal opioid exposure from April 2015 to May 2018. We compared the median lengths of stay (LOS) and treatment (LOT) and the percentages of infants requiring pharmacologic and adjunctive treatment in infants exposed to opioids alone or polysubstance. We used Wilcoxon's test for continuous outcomes or Chi-squared test for categorical outcomes to determine statistical significance. We used multivariable regression model to calculate each drug category's estimates of adjusted mean ratios for LOS and LOT plus estimates of adjusted odds ratios for pharmacologic/adjunctive treatments. RESULTS Of the 175 infants, 33 (19%) infants had opioid exposure alone. Opioid exposure included short- and/or long-acting opioids. A total of 142 (81%) had polysubstance exposure with 47% of mothers using nicotine products. We saw similar hospital outcomes between infants exposed to opioids alone or polysubstance; however, a higher percentage of infants with both short- and long-acting opioid exposure required pharmacologic treatment compared with either opioid alone. Focusing on individual drug categories, we detected differential hospital outcomes in which short-acting opioids decreased LOT, whereas long-acting opioids increased LOS, LOT, and need for pharmacologic and adjunctive treatment. Coexposure of opioids with stimulants decreased LOT and reduced need for adjunctive treatment. Coexposures with antidepressants increased LOT, while with antiepilepetics increased LOS. CONCLUSION Because infants with NOWS often have coexposures to other nonopioid substances, appreciating the associated risks of individual or combination of drugs in modulating hospital outcomes may help counsel families on their infants' expected hospital course. KEY POINTS · Hospital outcomes were similar between infants exposed to opioids alone or polysubstance including opioids.. · Infants with short- and long-acting opioids required pharmacologic treatment more often than either opioid alone.. · Differential hospital outcomes exist for various co-exposures of opioids with nonopioids..
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Affiliation(s)
- Erin Morris
- Department of Pediatrics, Residency & Fellowship Program, Salt Lake City, Utah
| | - Tyler Bardsley
- Division of Epidemiology, University of Utah Study Design and Biostatistics Center, University of Utah School of Medicine, Salt Lake City, Utah
| | - Krista Schulte
- College of Nursing, University of Utah, Salt Lake City, Utah
| | - Jeanette Seidel
- College of Nursing, University of Utah, Salt Lake City, Utah
| | - Julie H. Shakib
- Division of General Pediatrics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Karen F. Buchi
- Division of General Pediatrics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Camille M. Fung
- Division of Pediatric Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
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What Obstetrician–Gynecologists Should Know About Substance Use Disorders in the Perinatal Period. Obstet Gynecol 2022; 139:317-337. [DOI: 10.1097/aog.0000000000004657] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/01/2021] [Indexed: 11/26/2022]
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Dauber S, Beacham A, Hammond C, West A, Thrul J. Adaptive Text Messaging for Postpartum Risky Drinking: Conceptual Model and Protocol for an Ecological Momentary Assessment Study (Preprint). JMIR Res Protoc 2022; 11:e36849. [PMID: 35373778 PMCID: PMC9016512 DOI: 10.2196/36849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/01/2022] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background Risky drinking is prevalent among women of childbearing age. Although many women reduce their drinking during pregnancy, more than half return to prepregnancy levels during the early postpartum period. Risky drinking in new mothers may be associated with negative child and maternal health outcomes; however, new mothers are unlikely to seek treatment for risky drinking because of stigma and fear of child protective service involvement. SMS text messaging is a promising approach for reaching non–treatment-seeking new mothers at risk because of risky drinking. SMS text messaging interventions (TMIs) are empirically supported for alcohol use, but a tailored intervention for new mothers does not exist. This study aims to fill this gap by developing a just-in-time adaptive TMI for postpartum risky drinking. Objective The objectives of this paper are to present a preliminary conceptual model of postpartum risky drinking and describe the protocol for conducting an ecological momentary assessment (EMA) study with new mothers to inform the refinement of the conceptual model and development of the TMI. Methods This paper presents a preliminary conceptual model of postpartum risky drinking based on the motivational model of alcohol use, social cognitive theory, and temporal self-regulation theory. The model proposes three primary intervention targets: motivation, self-efficacy, and self-regulation. Theoretical and empirical literature in support of the conceptual model is described. The paper also describes procedures for a study that will collect EMA data from 30 participants recruited via social media and the perinatal Central Intake system of New Jersey. Following the baseline assessment, EMA surveys will be sent 5 times per day for 14 days. The assessment instruments and data analysis procedures are described. Results Recruitment is scheduled to begin in January 2022 and is anticipated to conclude in March 2022. Study results are estimated to be published in July 2022. Conclusions The study findings will enhance our understanding of daily and momentary fluctuations in risk and protective factors for risky drinking during the early postpartum period. The findings will be used to refine the conceptual model and inform the development of the TMI. The next steps for this work include the development of intervention components via an iterative participatory design process and testing of the resulting intervention in a pilot microrandomized trial. International Registered Report Identifier (IRRID) PRR1-10.2196/36849
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Affiliation(s)
- Sarah Dauber
- Partnership to End Addiction, New York, NY, United States
| | - Alexa Beacham
- Partnership to End Addiction, New York, NY, United States
| | - Cori Hammond
- Partnership to End Addiction, New York, NY, United States
| | - Allison West
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Johannes Thrul
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, United States
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
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Symons M, Finlay-Jones A, Meehan J, Raymond N, Watkins R. Nurturing families: One year pilot outcomes for a modified Parent Child Assistance Program in Australia. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000580. [PMID: 36962438 PMCID: PMC10022323 DOI: 10.1371/journal.pgph.0000580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 07/11/2022] [Indexed: 11/18/2022]
Abstract
Alcohol and Other Drug (AOD) exposure during pregnancy is linked to serious adverse child outcomes, including Fetal Alcohol Spectrum Disorder (FASD). The Parent-Child Assistance Program (PCAP) supports women with problematic AOD use, who are pregnant or have young children, and are not effectively engaging with services. PCAP has been shown to reduce alcohol exposed pregnancies, promote AOD abstinence, increase employment and family planning and improve child outcomes. This manuscript reports the first pilot evaluation of the PCAP program delivered in Australia. A pre-post-intervention repeated measures design was used. Eleven women receiving PCAP from a not-for-profit organisation were invited to take part in the study, with eight providing complete pre-post data. Home visitation case management was provided by trained and experienced case-managers. Clients were assisted to engage with existing services effectively to meet their own goals via a combination of relational theory, motivational interviewing and harm reduction concepts. The PCAP Modified Addiction Severity Index 5th Edition was adapted for use in Australia and was used to measure domains of addiction severity related problems as the primary outcome. Secondary outcomes included client satisfaction and program fidelity. There were significant changes in composite addiction severity scores from baseline to one year. 80% of participants had periods of abstinence of longer than four months. All clients had better connection to services, no subsequent AOD exposed pregnancies, and were highly satisfied with the program. Four had children returned to their care. Implementation was similar to the original PCAP program with major differences including case-managers relying on training manuals only without undertaking in-person training; being more experienced; providing more direct AOD counselling; and having less supervision. The findings will inform future program delivery and methodology for a larger longitudinal study assessing outcomes at program exit.
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Affiliation(s)
- Martyn Symons
- National Health and Medical Research Council FASD Research Australia Centre of Research Excellence, West Perth, Australia
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Amy Finlay-Jones
- National Health and Medical Research Council FASD Research Australia Centre of Research Excellence, West Perth, Australia
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | | | | | - Rochelle Watkins
- National Health and Medical Research Council FASD Research Australia Centre of Research Excellence, West Perth, Australia
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
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Dauber S, West A, Hammond C, Cohen I, Thrul J. Postpartum heavy episodic drinking: A survey to inform development of a text messaging intervention. Drug Alcohol Rev 2022; 41:182-187. [PMID: 34192391 PMCID: PMC8716644 DOI: 10.1111/dar.13341] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/30/2021] [Accepted: 06/04/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Text messaging interventions (TMI) are promising for addressing heavy episodic drinking (HED) in non-treatment-seeking postpartum women. Their anonymous delivery can overcome fear of consequences that often prevents postpartum women from seeking treatment for HED. We assessed feasibility and acceptability of text messaging to inform the development of a tailored TMI for postpartum HED. METHODS We surveyed 165 postpartum women recruited via a national Qualtrics panel on their drinking behaviours, mobile technology use and TMI preferences. RESULTS Twenty-five percent of the sample (N = 41) were classified as heavy episodic drinkers, with significant drinking reported before, during and after pregnancy, supporting the need for intervention. Feasibility of text messaging was supported by nearly universal mobile phone ownership and text messaging. Attitudes and intervention preferences varied, with 30% of HEDs likely to participate in an intervention asking them to receive automated messages, and 46% likely to participate in an intervention that included live texting with a counsellor. Respondents were more likely to participate in a study that asked them to respond to messages about mood and stress (63%) than daily drinking behaviours (35%), and were most interested in a TMI that included live texting with a counsellor. Nearly half the sample endorsed fear of child removal as a significant barrier to participation. DISCUSSION AND CONCLUSIONS Findings support the feasibility of text messaging as an intervention approach for postpartum HEDs. Postpartum women may have unique concerns and preferences that differ from other groups of HEDs, making a user-centred design approach critical.
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Affiliation(s)
| | - Allison West
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | - Ilana Cohen
- Johns Hopkins School of Medicine, Baltimore, USA
| | - Johannes Thrul
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA,Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, USA,Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
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Suntai Z. Substance use among women who are pregnant: Examining treatment completion by race and ethnicity. J Subst Abuse Treat 2021; 131:108437. [PMID: 34098297 DOI: 10.1016/j.jsat.2021.108437] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/22/2021] [Accepted: 04/22/2021] [Indexed: 11/23/2022]
Abstract
Substance use during pregnancy is a critical public health issue that affects both the mother and the fetus. While research has assessed racial differences in treatment completion among women who are pregnant for specific types of substances, few studies have evaluated treatment completion for a variety of substances. As such, the purpose of this study was to examine racial differences in substance use treatment completion among women who are pregnant. The study derived data from the 2017 Treatment Episode Data-Discharges (TEDS-D) of the Substance Abuse and Mental Health Services Administration (SAMHSA). TEDS-D documents annual discharges from publicly funded substance use treatment programs in the United States, collected by each state and aggregated by SAMHSA. The study used Chi square tests for bivariate analyses and used logistic regression models to predict treatment completion by race and ethnicity. After accounting for other explanatory factors, Black and Hispanic women who were pregnant were significantly less likely to complete treatment compared to Whites. These differences were evident even after examining the interaction between race and substance of use. The study found no differences between Indigenous and Other race women who were pregnant and Whites. Results indicate the need to examine cultural, historical, and systemic factors that could affect lower treatment completion among Black and Hispanic women who are pregnant. Interventions should, therefore, move beyond the impact of socioeconomic factors and focus on the role of social support, external responsibilities, and the criminalizing of substance use during pregnancy.
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Affiliation(s)
- Zainab Suntai
- University of Alabama, School of Social Work, United States of America.
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Henry MC, Sanjuan PM, Stone LC, Cairo GF, Lohr-Valdez A, Leeman LM. Alcohol and other substance use disorder recovery during pregnancy among patients with posttraumatic stress disorder symptoms: A qualitative study. DRUG AND ALCOHOL DEPENDENCE REPORTS 2021; 1:100013. [PMID: 36843908 PMCID: PMC9948915 DOI: 10.1016/j.dadr.2021.100013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/22/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
Background About 5% of women are pregnant at substance use disorder (SUD) treatment entry, and pregnant women with SUD often belong to marginalized groups experiencing social, economic, and health care barriers associated with stigma from prenatal substance use. Pregnant women in SUD treatment have high rates of trauma and posttraumatic stress disorder (PTSD). This study sought to (1) examine the lived experiences of pregnant individuals with PTSD symptoms in SUD treatment and (2) understand the roles of systematic or contextual barriers to the pursuit of prenatal abstinence. Methods We draw upon in-depth semi-structured interviews to examine relationships between SUD, psychological trauma/PTSD experience, social resources, and lived experiences among patients in prenatal SUD treatment with PTSD symptoms. Our sample was pregnant patients (N = 13) with prior DSM-5 Criterion A trauma and current PTSD symptoms enrolled in a comprehensive program integrating prenatal care, substance use counseling, medication for opioid use disorder and case management at three sites affiliated with an urban academic medical center in New Mexico. Results Using thematic analysis, four main themes identified structural forces influencing alcohol and drug use: (a) lack of access or ability to obtain resources, (b) substance use to cope with negative affect, (c) social stigma, and (d) interpersonal relationships. Conclusions Despite receiving high-quality integrated prenatal and SUD care, these pregnant patients with PTSD symptoms in SUD treatment still experienced substantial social and structural hurdles to achieving abstinence during pregnancy.
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Affiliation(s)
- Melissa C. Henry
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, 2650 Yale Boulevard, SE, Albuquerque, NM 87106, United States
| | - Pilar M. Sanjuan
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, 2650 Yale Boulevard, SE, Albuquerque, NM 87106, United States
- Department of Family and Community Medicine, University of New Mexico School of Medicine MSC08 4720, 1 University of New Mexico, Albuquerque, NM 87131, United States
| | - Lisa Cacari Stone
- College of Population Health, University of New Mexico Health Science Center, 1001 Medical Arts Ave NE, Albuquerque, NM 87102, United States
| | - Grace F. Cairo
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, 2650 Yale Boulevard, SE, Albuquerque, NM 87106, United States
| | - Anthony Lohr-Valdez
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, 2650 Yale Boulevard, SE, Albuquerque, NM 87106, United States
| | - Lawrence M. Leeman
- Department of Family and Community Medicine, University of New Mexico School of Medicine MSC08 4720, 1 University of New Mexico, Albuquerque, NM 87131, United States
- Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, MSC08 4720, 1 University of New Mexico, Albuquerque, NM 87131, United States
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Schiff DM, Nielsen TC, Hoeppner BB, Terplan M, Hadland SE, Bernson D, Greenfield SF, Bernstein J, Bharel M, Reddy J, Taveras EM, Kelly JF, Wilens TE. Methadone and buprenorphine discontinuation among postpartum women with opioid use disorder. Am J Obstet Gynecol 2021; 225:424.e1-424.e12. [PMID: 33845029 DOI: 10.1016/j.ajog.2021.04.210] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 03/12/2021] [Accepted: 04/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The postpartum year is a vulnerable period for women with opioid use disorder, with increased rates of fatal and nonfatal overdose; however, data on the continuation of medications for opioid use disorder on a population level are limited. OBJECTIVE This study aimed to examine the effect of discontinuing methadone and buprenorphine in women with opioid use disorder in the year following delivery and determine the extent to which maternal and infant characteristics are associated with time to discontinuation of medications for opioid use disorder. STUDY DESIGN This population-based retrospective cohort study used linked administrative data of 211,096 deliveries in Massachusetts between 2011 and 2014 to examine the adherence to medications for opioid use disorder. Individuals receiving medications for opioid use disorder after delivery were included in the study. Here, demographic, psychosocial, prenatal, and delivery characteristics are described. Kaplan-Meier survival analysis and Cox regression modeling were used to examine factors associated with medication discontinuation. RESULTS A total of 2314 women who received medications for opioid use disorder at delivery were included in our study. Overall, 1484 women (64.1%) continued receiving medications for opioid use disorder for a full 12 months following delivery. The rate of continued medication use varied from 34% if women started on medications for opioid use disorder the month before delivery to 80% if the medications were used throughout pregnancy. Kaplan-Meier survival curves differed by maternal race and ethnicity (the 12-month continuation probability was .65 for White non-Hispanic women and .51 for non-White women; P<.001) and duration of use of prenatal medications for opioid use disorder (12-month continuation probability was .78 for women with full prenatal engagement and .60 and .44 for those receiving medications for opioid use disorder ≥5 months [but not throughout pregnancy] and ≤4 months prenatally, respectively; P<.001). In all multivariable models, duration of receipt of prenatal medications for opioid use disorder (≤4 months vs throughout pregnancy: adjusted hazard ratio, 3.26; 95% confidence interval, 2.72-3.91) and incarceration (incarceration during pregnancy or after delivery vs none: adjusted hazard ratio, 1.79; 95% confidence interval, 1.52-2.12) were most strongly associated with the discontinuation of medications for opioid use disorder. CONCLUSION Almost two-thirds of women with opioid use disorder continued using medications for opioid use disorder for a full year after delivery; however, the rates of medication continuation varied significantly by race and ethnicity, degree of use of prenatal medications for opioid use disorder, and incarceration status. Prioritizing medication continuation across the perinatal continuum, enhancing sex-specific and family-friendly recovery supports, and expanding access to medications for opioid use disorder despite being incarcerated can help improve postpartum medication adherence.
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Affiliation(s)
- Davida M Schiff
- Division of General Academic Pediatrics, MassGeneral Hospital for Children and Harvard Medical School, Boston, MA.
| | - Timothy C Nielsen
- Faculty of Medicine and Health, Children's Hospital Westmead Clinical School, University of Sydney, Camperdown, Australia
| | | | | | - Scott E Hadland
- Department of Pediatrics, Boston University School of Medicine, Boston, MA; Grayken Center for Addiction, Boston Medical Center, Boston, MA
| | - Dana Bernson
- Massachusetts Department of Public Health, Boston, MA
| | - Shelly F Greenfield
- Division of Women's Mental Health and Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, MA; Harvard Medical School, Boston, MA, Division of Community Health Sciences, Boston University School of Public Health, Boston, MA
| | - Judith Bernstein
- Harvard Medical School, Boston, MA, Division of Community Health Sciences, Boston University School of Public Health, Boston, MA
| | - Monica Bharel
- Massachusetts Department of Public Health, Boston, MA
| | - Julia Reddy
- Massachusetts Department of Public Health, Boston, MA
| | - Elsie M Taveras
- Division of General Academic Pediatrics, MassGeneral Hospital for Children and Harvard Medical School, Boston, MA
| | - John F Kelly
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Timothy E Wilens
- Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston, MA
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Olding M, Cook A, Austin T, Boyd J. "They went down that road, and they get it": A qualitative study of peer support worker roles within perinatal substance use programs. J Subst Abuse Treat 2021; 132:108578. [PMID: 34373170 DOI: 10.1016/j.jsat.2021.108578] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 07/25/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Perinatal substance use programs employ multidisciplinary teams to support women who use drugs through pregnancies and parenting, with some programs expanding to include peer support workers with lived experience of parenting and substance use. Research has shown peer support to enhance care in substance use treatment; however, little research exists that examines this model of support within perinatal substance use programs. We explore the current and potential role of peer support workers within perinatal substance use programs, from the perspectives of mothers accessing these programs. METHODS We conducted focus groups with 20 mothers enrolled in three perinatal substance use programs serving the greater Vancouver area, including two community-based programs that employed peer workers and an acute care maternity ward that did not. We recorded focus groups, had them professionally transcribed, and analyzed them thematically. RESULTS Participants characterized peer support workers as extending and complementing informal care practices already occurring within programs, including mother-to-mother support with breastfeeding, childcare, and system navigation. Integrating peer workers shifted care relations and practices in ways that participants found beneficial. Participants emphasized how support workers with similar social locations and life experiences-beyond just their substance use-helped to foster trust and safety for mothers in the program. Indigenous mothers discussed the importance of having Indigenous support workers whose practice is grounded in their cultures and experiences under colonization. Participants ascribed an aspirational status to peer support workers, conveying that it was motivational to see other mothers working in the program, and described the role as a means of maintaining connection and community. However, some expressed concerns about managing professional-personal boundaries and being emotionally "triggered" by the work. CONCLUSION This study evidences benefits of employing peer support workers within perinatal substance use programs, while also indicating the need for organizational processes to ensure that peer staff are integrated equitably and supported adequately.
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Affiliation(s)
- Michelle Olding
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | - Ainslie Cook
- BC Women's Hospital + Health Centre, Vancouver, BC, Canada
| | - Tamar Austin
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Jade Boyd
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Smid MC, Saitz R. Postpartum Treatment of Individuals With Opioid Use Disorder: Maternal Risk and Need for Evidence Do Not End When Pregnancy Ends. J Addict Med 2021; 15:267-268. [PMID: 34397779 DOI: 10.1097/adm.0000000000000878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Marcela C Smid
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT (MCS), Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT (MCS), Department of Community Health Sciences, Boston University School of Public Health, Boston, MA (RS), Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, and the Grayken Center for Addiction, Boston Medical Center, Boston, MA (RS)
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Khan B, Sharif A, Qayyum Z. Neuropsychiatric Effects of In-Utero Substance Exposure. Psychiatr Ann 2021. [DOI: 10.3928/00485713-20210610-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Young-Wolff KC, Sarovar V, Tucker LY, Goler N, Conway A, Weisner C, Armstrong MA, Alexeeff S. Validity of Self-reported Cannabis Use Among Pregnant Females in Northern California. J Addict Med 2021; 14:287-292. [PMID: 31688149 PMCID: PMC7931632 DOI: 10.1097/adm.0000000000000581] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Most clinical and epidemiologic estimates of prenatal cannabis use are based on self-report, and the validity of self-reported cannabis use has not been examined in a large, representative population of pregnant women. We determined the validity of self-reported prenatal cannabis use and predictors of nondisclosure using data from Kaiser Permanente Northern California's (KPNC) healthcare system with universal prenatal cannabis screening during prenatal care. METHODS Validation study using data from 281,025 pregnancies in KPNC among females aged ≥11 years who completed a self-administered questionnaire on prenatal cannabis use and a cannabis urine toxicology test from 2009 to 2017. We calculated sensitivity, specificity, positive predictive value, and negative predictive value of self-reported prenatal cannabis use using urine toxicology testing as the criterion standard, and sensitivity of urine toxicology testing using self-reported use as the criterion standard. We compared sociodemographics of those who disclosed versus did not disclose prenatal cannabis use. RESULTS Urine toxicology testing identified more instances of prenatal cannabis use than self-report (4.9% vs 2.5%). Sensitivity of self-reported use was low (33.9%). Sensitivity of the toxicology test was higher (65.8%), with greater detection of self-reported daily (83.9%) and weekly (77.4%) than monthly or less use (54.1%). Older women, those of Hispanic race/ethnicity, and those with lower median neighborhood incomes were most likely to be misclassified as not using cannabis by self-reported screening. CONCLUSIONS Given that many women choose not to disclose prenatal cannabis use, clinicians should educate all prenatal patients about the potential risks and advise them to quit cannabis use during pregnancy.
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Affiliation(s)
- Kelly C. Young-Wolff
- Division of Research, Kaiser Permanente Northern California, Oakland CA
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA
| | - Varada Sarovar
- Division of Research, Kaiser Permanente Northern California, Oakland CA
| | - Lue-Yen Tucker
- Division of Research, Kaiser Permanente Northern California, Oakland CA
| | - Nancy Goler
- Regional Offices, Kaiser Permanente Northern California, Oakland CA
| | - Amy Conway
- Early Start Program, Kaiser Permanente Northern California, Oakland CA
| | - Constance Weisner
- Division of Research, Kaiser Permanente Northern California, Oakland CA
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA
| | | | - Stacey Alexeeff
- Division of Research, Kaiser Permanente Northern California, Oakland CA
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