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Schiff DM, Li WZM, Work EC, Goullaud L, Vazquez J, Paulet T, Dorfman S, Selk S, Hoeppner BB, Wilens T, Bernstein JA, Diop H. Multiple marginalized identities: A qualitative exploration of intersectional perinatal experiences of birthing people of color with substance use disorder in Massachusetts. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 163:209346. [PMID: 38789329 DOI: 10.1016/j.josat.2024.209346] [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: 10/07/2023] [Revised: 01/29/2024] [Accepted: 03/01/2024] [Indexed: 05/26/2024]
Abstract
INTRODUCTION Racial and ethnic inequities persist in receipt of prenatal care, mental health services, and addiction treatment for pregnant and postpartum individuals with substance use disorder (SUD). Further qualitative work is needed to understand the intersectionality of racial and ethnic discrimination, stigma related to substance use, and gender bias on perinatal SUD care from the perspectives of affected individuals. METHODS Peer interviewers conducted semi-structured qualitative interviews with recently pregnant people of color with SUD in Massachusetts to explore the impact of internalized, interpersonal, and structural racism on prenatal, birthing, and postpartum experiences. The study used a thematic analysis to generate the codebook and double coded transcripts, with an overall kappa coefficient of 0.89. Preliminary themes were triangulated with five participants to inform final theme development. RESULTS The study includes 23 participants of diverse racial/ethnic backgrounds: 39% mixed race/ethnicity (including 9% with Native American ancestry), 30% Hispanic or Latinx, 26% Black/African American, 4% Asian. While participants frequently names racial and ethnic discrimination, both interpersonal and structural, as barriers to care, some participants attributed poor experiences to other marginalized identities and experiences, such as having a SUD. Three unique themes emerged from the participants' experiences: 1) Participants of color faced increased scrutiny and mistrust from clinicians and treatment programs; 2) Greater self-advocacy was required from individuals of color to counteract stereotypes and stigma; 3) Experiences related to SUD history and pregnancy status intersected with racism and gender bias to create distinct forms of discrimination. CONCLUSION Pregnant and postpartum people of color affected by perinatal SUD faced pervasive mistrust and unequal standards of care from mostly white healthcare staff and treatment spaces, which negatively impacted their treatment access, addiction medication receipt, postpartum pain management, and ability to retain custody of their children. Key clinical interventions and policy changes identified by participants for antiracist action include personalizing anesthetic plans for adequate peripartum pain control, minimizing reproductive injustices in contraceptive counseling, and addressing misuse of toxicology testing to mitigate inequitable Child Protective Services (CPS) involvement and custody loss.
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Affiliation(s)
- Davida M Schiff
- Division of General Academic Pediatrics, MassGeneral for Children, 125 Nashua St. Suite 860, Boston, MA 02114, United States of America; Division of Newborn Medicine, MassGeneral for Children, Boston, MA, 02114, United States of America.
| | - William Z M Li
- Harvard Medical School, Boston, MA, United States of America
| | - Erin C Work
- University of California, Schools of Public Health and Social Welfare, Los Angeles, CA, United States of America
| | - Latisha Goullaud
- Institute for Health and Recovery, Watertown, MA, United States of America
| | | | - Tabhata Paulet
- Rutgers New Jersey Medical School, Newark, NJ, United States of America
| | - Sarah Dorfman
- Division of General Academic Pediatrics, MassGeneral for Children, 125 Nashua St. Suite 860, Boston, MA 02114, United States of America
| | - Sabrina Selk
- National Network of Public Health Initiatives, Washington, DC, United States of America
| | - Bettina B Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Timothy Wilens
- Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, United States of America
| | - Judith A Bernstein
- Division of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States of America
| | - Hafsatou Diop
- Massachusetts Department of Public Health, Boston, MA, 02108, United States of America
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D'Souza RR, Cooper HL, Chang HH, Rogers E, Wien S, Blake SC, Kramer MR. Person-centered hospital discharge data: Essential existing infrastructure to enhance public health surveillance of maternal substance use disorders in the midst of a national maternal overdose crisis. Ann Epidemiol 2024; 94:64-71. [PMID: 38677568 DOI: 10.1016/j.annepidem.2024.04.007] [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: 12/15/2023] [Revised: 04/04/2024] [Accepted: 04/16/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVES As crises of drug-related maternal harms escalate, US public health surveillance capacity remains suboptimal for drug-related maternal morbidities. Most state hospital discharge databases (HDDs) are encounter-based, and thus limit ascertainment of morbidities to delivery visits and ignoring those occurring during the 21 months spanning pregnancy and postpartum year. This study analyzes data from a state that curates person-centered HDD to compare patterns of substance use disorder (SUD) diagnoses at delivery vs. the full 21 pregnancy/postpartum months, overall and by maternal social position. METHODS Among people who experienced an in-hospital birth in New York State between 9/1/2016 and 1/1/2018 (N = 330,872), we estimated SUD diagnosis (e.g., opioids, stimulants, benzodiazepines, cannabis) prevalence at delivery; across the full 9 months of pregnancy and 12 postpartum months; and by trimester and postpartum quarter. Risk ratio and risk difference estimated disparities by race/ethnicity, age, rurality, and payor. RESULTS The 21-month SUD prevalence rate per 100,000 was 2671 (95% CI 2616-2726), with 31% (29.5%-31.5%) missing SUD indication when ascertained at delivery only (1866; 95% CI 1820-1912). Quarterly rates followed a roughly J-shaped trajectory. Structurally marginalized individuals suffered the highest 21-month SUD prevalence (e.g., Black:White risk ratio=1.80 [CI:1.73-1.88]). CONCLUSION By spanning the full 21 months of pregnancy/postpartum, person-centered HDD reveal than the maternal SUD crisis is far greater than encounter-based delivery estimates had revealed. Generating person-centered HDD will improve efforts to tailor interventions to help people who use drugs survive while pregnant and postpartum, and eliminate inequities.
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Affiliation(s)
- Rohan R D'Souza
- Emory University Rollins School of Public Health, Biostatistics, USA
| | - Hannah Lf Cooper
- Emory University, Department of Behavioral Sciences and Health Education, USA
| | - Howard H Chang
- Emory University Rollins School of Public Health, Biostatistics, USA
| | - Erin Rogers
- Emory University Rollins School of Public Health, Epidemiology, USA
| | - Simone Wien
- Emory University Rollins School of Public Health, Epidemiology, USA
| | - Sarah C Blake
- Rollins School of Public Health, Emory University, Health Policy & Management, USA
| | - Michael R Kramer
- Emory University Rollins School of Public Health, Epidemiology, USA
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Gissandaner TD, Wen A, Gette JA, Perry KJ, Mutignani LM, Regan T, Malloch L, Tucker LC, White CB, Fry TB, Lim CS, Annett RD. Considerations and Determinants of Discharge Decisions among Prenatal Substance Exposed Infants. CHILD MALTREATMENT 2024; 29:246-258. [PMID: 36917045 PMCID: PMC10500030 DOI: 10.1177/10775595231161996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Limited research has examined a comprehensive set of predictors when evaluating discharge placement decisions for infants exposed to substances prenatally. Using a previously validated medical record data extraction tool, the current study examined prenatal substance exposure, infant intervention (i.e., pharmacologic, or non-pharmacologic), and demographic factors (e.g., race and ethnicity and rurality) as predictors of associations with discharge placement in a sample from a resource-poor state (N = 136; 69.9% Non-Hispanic White). Latent class analysis (LCA) was used to examine whether different classes emerged and how classes were differentially related to discharge placement decisions. Logistic regressions were used to determine whether each predictor was uniquely associated with placement decisions. Results of the LCA yielded a two-class solution comprised of (1) a Low Withdrawal Risk class, characterized by prenatal exposure to substances with low risk for neonatal abstinence syndrome (NAS) and non-pharmacologic intervention, and (2) a High Withdrawal Risk class, characterized by a high risk of NAS and pharmacologic intervention. Classes were not related to discharge placement decisions. Logistic regressions demonstrated that meth/amphetamine use during pregnancy was associated with greater odds of out of home placement above other substance types. Future research should replicate and continue examining the clinical utility of these classes.
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Affiliation(s)
- Tre D. Gissandaner
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Alainna Wen
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jordan A. Gette
- Center of Alcohol and Substance Use Studies, Rutgers, the State University of New Jersey, New Brunswick, NJ, USA
| | - Kristin J. Perry
- Edna Bennett Pierce Prevention Research Center, Pennsylvania State University, University Park, PA, USA
| | - Lauren M. Mutignani
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Timothy Regan
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lacy Malloch
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Lauren C. Tucker
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Taylor B. Fry
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Crystal S. Lim
- Department of Health Psychology, University of Missouri, Columbia, MO, USA
| | - Robert D. Annett
- University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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Witcraft SM, Johnson E, Eitel AE, Moreland AD, King C, Terplan M, Guille C. Listening to Black Pregnant and Postpartum People: Using Technology to Enhance Equity in Screening and Treatment of Perinatal Mental Health and Substance Use Disorders. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01989-z. [PMID: 38605223 DOI: 10.1007/s40615-024-01989-z] [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: 01/08/2024] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/13/2024]
Abstract
Perinatal mood and anxiety disorders (PMADs), perinatal substance use disorders (PSUDs), and intimate partner violence (IPV) are leading causes of pregnancy-related deaths in the United States. Screening and referral for PMADs, PSUDs and IPV is recommended, however, racial disparities are prominent: Black pregnant and postpartum people (PPP) are less likely to be screened and attend treatment compared to White PPP. We conducted qualitative interviews to better understand the experience of Black PPP who used a text/phone-based screening and referral program for PMADs/PSUDs and IPV-Listening to Women and Pregnant and Postpartum People (LTWP). We previously demonstrated that LTWP led to a significant reduction in racial disparities compared to in-person screening and referral, and through the current study, sought to identify facilitators of PMAD/PSUD symptom endorsement and treatment attendance. Semi-structured interviews were conducted with 68 Black PPP who were or had been pregnant within the last 24 months, and who either had or did not have a PMAD or PSUD. Participants were enrolled in LTWP and provided feedback on their experience. Using a grounded theory approach, four themes emerged: usability, comfort, necessity, and recommendations. Ease of use, brevity, convenience, and comfort in discussing mental health and substance use via text were highlighted. Need for a program like LTWP in Black communities was discussed, given the reduction in perceived judgement and access to trusted information and resources for PMADs/PSUDs, which may lessen stigma. These qualitative findings illuminate how technology-based adaptations to behavioral health screening and referral can reduce perceived negative judgment and facilitate identification and referral to treatment, thereby more adequately meeting needs of Black PPP.
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Affiliation(s)
- Sara M Witcraft
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, 67 President Street, MSC 861, 29425, Charleston, SC, USA.
| | - Emily Johnson
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street, MSC 160, 29425, Charleston, SC, USA
| | - Anna E Eitel
- College of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 617, 29425, Charleston, SC, USA
| | - Angela D Moreland
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, 67 President Street, MSC 861, 29425, Charleston, SC, USA
| | - Courtney King
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, 67 President Street, MSC 861, 29425, Charleston, SC, USA
| | - Mishka Terplan
- Friends Research Institute, 1040 Park Avenue, Ste. 103, 21201, Baltimore, MD, USA
| | - Constance Guille
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, 67 President Street, MSC 861, 29425, Charleston, SC, USA
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston South Carolina, 171 Ashley Ave, 29425, Charleston, SC, USA
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Scott SE, Jenkins G, Mickievicz E, Saladino J, Rick AM, Levenson R, Chang JC, Randell KA, Duplessis V, Miller E, Ragavan M. Creating Healing-Centered Spaces for Intimate Partner Violence Survivors in the Postpartum Unit: Examining Current Practices and Desired Resources Among Health Care Providers and Postpartum People. J Womens Health (Larchmt) 2024; 33:204-217. [PMID: 37971822 PMCID: PMC10880269 DOI: 10.1089/jwh.2023.0347] [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: 11/19/2023] Open
Abstract
Background: Intimate partner violence (IPV) has negative health impacts for pregnant people and their infants. Although inpatient postpartum units offer an opportunity to provide support and resources for IPV survivors and their families, to our knowledge, such interventions exist. The goal of this study is to explore (1) how IPV is currently discussed with postpartum people in the postpartum unit; (2) what content should be included and how an IPV intervention should be delivered; (3) how best to support survivors who disclose IPV; and (4) implementation barriers and facilitators. Materials and Methods: We used individual, semistructured interviews with postpartum people and health care providers (HCPs). Interview transcripts were coded and analyzed using an inductive-deductive thematic analysis. Results: While HCPs reported using a variety of practices to support survivors, postpartum people reported that they did not recall receiving resources or education related to IPV while in the inpatient postpartum unit. While HCPs identified a need for screening and disclosure-driven resource provision, postpartum people identified a need for universal IPV resource provision in the postpartum unit to postpartum people and their partners. Participants identified several barriers (i.e., staff capacity, education already provided in the postpartum unit, and COVID-19 pandemic) and facilitators (i.e., continuity of care, various HCPs) to supporting survivors in the postpartum unit. Conclusion: The inpatient postpartum unit is a promising setting to implement an intervention to support IPV survivors and their infants. Future research and intervention development should focus on facilitating universal education and promoting resource provision to IPV survivors.
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Affiliation(s)
- Sarah E Scott
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Genelle Jenkins
- Division of General Academic Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Erin Mickievicz
- Division of General Academic Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jackie Saladino
- Division of General Academic Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anne-Marie Rick
- Division of General Academic Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Judy C Chang
- Department of Obstetrics, Gynecology & Reproductive Sciences, and Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kimberly A Randell
- Division of Emergency Medicine, Children's Mercy, Kansas City, Missouri, USA
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
- Department of Pediatrics, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | | | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Maya Ragavan
- Division of General Academic Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Perry KJ, Mutignani LM, Gette J, Kinney KL, Gissandaner TD, Penner F, Wen A, Regan T, Lim C. The Paper Chase: A Team Science Training Exercise. TRAINING AND EDUCATION IN PROFESSIONAL PSYCHOLOGY 2024; 18:13-20. [PMID: 38487794 PMCID: PMC10936699 DOI: 10.1037/tep0000448] [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] [Indexed: 03/17/2024]
Abstract
Over the past few decades of psychological research, there has been an important increase in both the application of multidisciplinary or collaborative science and in training and research that emphasizes social justice and cultural humility. In the current paper, we report on the use of the "Paper Chase" as a team science training and research experience that also facilitates cultural humility in research and when working in teams. The Paper Chase is a synchronous writing exercise originally conceptualized by a cohort of health service psychology interns to reduce lag time between manuscript writing and submission (Schaumberg et al., 2015). The Paper Chase involves a group of trainees coming together for a predetermined amount of time (e.g., 9 or more hours) with the aim of writing and submitting a full manuscript for publication. In the current paper, we extend a previous report on the Paper Chase by formally linking the training experience to the four phases of team science: development, conceptualization, implementation, and translation. We also discuss ways in which the Paper Chase as a training experience can promote cultural humility. Finally, we provide updated recommendations for successfully completing a Paper Chase project. Overall, the authors of this manuscript who were predoctoral psychology interns across two recent cohorts at one academic medical center reported positive experiences from the Paper Chase. In addition, the current study suggests the Paper Chase can be used as one activity that facilitates critical training in team science.
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Affiliation(s)
- Kristin J. Perry
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, 314 Biobehavioral Health Building, University Park, PA 16802
| | - Lauren M. Mutignani
- University of Rochester Medical Center, Department of Psychiatry, 300 Crittenden Blvd., Rochester, NY 14642
| | - Jordan Gette
- Center of Alcohol and Substance Use Studies, Rutgers the State University of New Jersey, 607 Allison Road Piscataway, NJ 08854
| | - Kerry L. Kinney
- Department of Psychiatry and Human Behavior, School of Medicine, University of Mississippi Medical Center, 2500 N. State St. Jackson, MS 39216
| | - Tre D. Gissandaner
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University Irving Medical Center, 1051 Riverside Dr, New York, NY 10032
| | - Francesca Penner
- Yale Child Study Center, Yale University, 230 S Frontage Rd, New Haven, CT 06519
| | - Alainna Wen
- Department of Psychology, University of California – Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095
| | - Timothy Regan
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St., Baltimore, MD 21205
| | - Crystal Lim
- Department of Health Psychology, School of Health Professions, University of Missouri, 535 Clark Hall, Columbia, MO
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Franz DJ, Schweer-Collins ML, Cioffi CC, Leve LD. Adolescent child custody loss and substance use treatment as predictors of young adult substance use trajectories among females with foster care and juvenile justice involvement. CHILDREN AND YOUTH SERVICES REVIEW 2024; 157:107421. [PMID: 38371910 PMCID: PMC10868730 DOI: 10.1016/j.childyouth.2023.107421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
This study aimed to identify trajectories of substance use from adolescence to young adulthood among 166 females with dual child welfare and juvenile justice system involvement, and to explore the influence of adolescent child custody status and substance use treatment on substance use trajectories. Results identified four substance use trajectory groups (stable moderate substance use, decreasing substance use, increasing substance use, stable high substance use). Custody loss during adolescence predicted membership in the stable high substance use trajectory group (log odds estimate = 2.99, p = < 0.01). No significant associations were found with adolescent substance use treatment. The findings can inform policymakers, foster care professionals, and law enforcement officers to promote the delivery of timely and appropriate substance use services that respond to the unique needs of females across the child welfare and juvenile justice system populations.
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Affiliation(s)
- Daschel J. Franz
- Prevention Science Institute, University of Oregon, 1600 Millrace Dr, Eugene, OR 97403, USA
| | | | - Camille C. Cioffi
- Prevention Science Institute, University of Oregon, 1600 Millrace Dr, Eugene, OR 97403, USA
| | - Leslie D. Leve
- Prevention Science Institute, University of Oregon, 1600 Millrace Dr, Eugene, OR 97403, USA
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Reed A, Redmon-Greene J, Thompson H, Lusero I. Drug Use and Human Milk: Legal and Child Welfare Considerations. Matern Child Health J 2023; 27:2059-2063. [PMID: 37548911 DOI: 10.1007/s10995-023-03743-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Preventing new parents who use drugs from bonding with and bodyfeeding their babies undermines public health. Because U.S. culture treats substance use as a moral failing rather than a health concern, punitive responses to perinatal substance use continue to dominate. This is particularly true for families of color, who are more likely to be targeted by the family regulation system. These approaches fail to protect families, and cause their own, separate harm. This article will lay out existing evidence surrounding bodyfeeding. Then, it will debunk harmful mythologies about drug use and human milk, and compare the risks associated with using drugs while bodyfeeding to those inherent in family separation. Finally, it will make the case for harm-reduction approaches over criminal ones. OBJECTIVES The health risks associated with family separation are only rarely weighed against those associated with drug exposure through human milk. Our objective for this paper is to contribute new ways of framing the importance of keeping families together at birth, even when perinatal substance use is detected. METHODS This manuscript is not based upon clinical study or patient data, and exclusively references studies and research publications that have been approved by the appropriate ethics committee and which have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. RESULTS Significant research data support the position that the risks associated with family separation are arguably greater than those associated with exposure to substance use in human milk. CONCLUSIONS FOR PRACTICE Harm reduction approaches should be favored over criminal approaches when perinatal substance use is detected or confirmed.
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Akbarali S, Dronamraju R, Simon J, Echols A, Collins S, Kaeberle B, Chaudhry A. Promoting Innovation in State and Territorial Maternal and Child Health Policymaking. Matern Child Health J 2023; 27:5-13. [PMID: 37792151 PMCID: PMC10692248 DOI: 10.1007/s10995-023-03779-1] [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: 09/23/2023] [Indexed: 10/05/2023]
Abstract
INTRODUCTION The Association of Maternal & Child Health Programs (AMCHP) and the Association of State and Territorial Health Officials (ASTHO) launched the PRISM (Promoting Innovation in State and Territorial MCH Policymaking) Learning Community, funded by the U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). The goal of PRISM was to build state and territorial health agency program and policy-making capacity to address substance use and mental health in the maternal and child health (MCH) population. Expanding access to care and treatment for perinatal substance use disorders (SUD) emerged as the issue of greatest need for state teams. METHODS The PRISM Learning Community consisted of three major components: (1) intensive capacity building for cross-agency state teams, which involved action planning, peer-to-peer learning, and technical assistance; (2) programming to inform the MCH field broadly about innovations in perinatal SUD policy and practice; and (3) a program evaluation involving pre-, mid-, and post-assessments and follow-up key informant interviews with state teams. This manuscript is not based on clinical study or patient data, therefore IRB approval was not required. RESULTS States reported that their knowledge of perinatal SUDs increased and their cross-agency partnerships were strengthened as a result of their participation in PRISM. States identified four key priorities for their continued work: to improve multisector collaborations, to institute equitable SUD screening practices for pregnant people, to strengthen the perinatal behavioral health workforce, and to enhance Medicaid coverage for perinatal SUD prevention and treatment services. The need to respond to urgent demands of COVID-19 and the stigma associated with perinatal SUDs were the most significant barriers to advancing state action plan goals. DISCUSSION Since 2018, the PRISM project has supported nine jurisdictions across two cohorts. Participation in PRISM advanced state policies and programs to improve perinatal SUD care through capacity building, technical assistance, and virtual programming. Findings and lessons learned from PRISM may inform the activities of other states seeking to address perinatal substance use disorders.
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Affiliation(s)
- Sanaa Akbarali
- Association of State and Territorial Health Officials, 2231 Crystal Drive, Suite 450, Arlington, VA, 22202, USA.
| | - Ramya Dronamraju
- Association of State and Territorial Health Officials, 2231 Crystal Drive, Suite 450, Arlington, VA, 22202, USA
| | - Jessica Simon
- Association of Maternal and Child Health Programs, 1825 K Street NW, Suite 250, Washington, D.C, 20006, USA
| | - Amani Echols
- Association of Maternal and Child Health Programs, 1825 K Street NW, Suite 250, Washington, D.C, 20006, USA
| | - Stacy Collins
- Association of Maternal and Child Health Programs, 1825 K Street NW, Suite 250, Washington, D.C, 20006, USA
| | - Betsy Kaeberle
- Association of State and Territorial Health Officials, 2231 Crystal Drive, Suite 450, Arlington, VA, 22202, USA
| | - Atyya Chaudhry
- Association of Maternal and Child Health Programs, 1825 K Street NW, Suite 250, Washington, D.C, 20006, USA
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Saadi A, Ray VE. Police Violence in Health Care Settings in US Media Coverage. JAMA Netw Open 2023; 6:e2342998. [PMID: 37955898 PMCID: PMC10644214 DOI: 10.1001/jamanetworkopen.2023.42998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/03/2023] [Indexed: 11/14/2023] Open
Abstract
Importance Hospitals do not collect or share data tracking their policing and security activities despite their reliance on police and security personnel, including armed officers. Thus, little is known about how hospital security is associated with patient and staff safety. Objective To examine the harms exerted by health care-affiliated police and security personnel. Design, Setting, and Participants For this qualitative study, data were collected using a systematic Media Cloud search for US news media coverage from January 2011 to May 2022. A total of 18 987 articles on policing and hospitals were screened and a content and thematic analysis of articles that met the search criteria was conducted, which involved incidents that revealed harm to patients, patients' families, and staff. Data were analyzed from October 2022 to April 2023. Main Outcomes and Measures Incident year, incident location (hospital name, city, state), survivor and victim characteristics (race and ethnicity, presence of mental illness), and a narrative description of the incident focusing on outcomes of harm exerted by police and security personnel in the health care setting. Results A total of 48 unique stories across 25 US states were included. The median (range) year published was 2017 (2009-2022). Harms reported to have been perpetuated by health care-affiliated police and security personnel were identified within 5 domains from 48 unique incidents: (1) patients shot by police or security personnel (17 patients); (2) patients subject to excessive use of force (17 patients); (3) patients arrested (7 patients); (4) patients subject to sexual assault (2 patients); and (5) hospital personnel or those considered collateral damage shot, injured, or arrested (5 individuals). Most survivors and victims were Black, although the race and/or ethnicity of involved individuals was not routinely reported across the news stories. Mental illness was the most documented medical condition among patients injured or killed by health care-affiliated police and security personnel. Conclusions and Relevance This qualitative study of US news media found that police and security personnel in hospitals were reported to have perpetuated harm via excessive force, sexual assaults, injuring patients and health care workers, and fatal shootings. Compounded by a lack of transparency and accountability mechanisms, this may represent an underrecognized manifestation of structural racism at the organizational level. Policy suggestions include introducing accountability measures, deescalation techniques, and removing arms from hospital security personnel to reduce harm and fulfill health care's healing mission.
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Affiliation(s)
- Altaf Saadi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Victor E. Ray
- Department of Sociology and Criminology, University of Iowa, Iowa City
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Olaniyan A, Hawk M, Mendez DD, Albert SM, Jarlenski M, Chang JC. Racial Inequities in Drug Tests Ordered by Clinicians for Pregnant People Who Disclose Prenatal Substance Use. Obstet Gynecol 2023; 142:1169-1178. [PMID: 37769307 DOI: 10.1097/aog.0000000000005385] [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] [Received: 04/18/2023] [Accepted: 07/06/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVE To measure racial inequities in drug testing among pregnant people during the first prenatal visit based on their drug use disclosure pattern. METHODS We used data from a cohort study of patient-clinician communication patterns regarding substance use in first prenatal visits from February 2011 to August 2014. We assessed racial differences (Black-White) in the receipt of urine toxicology testing, stratifying on patients' drug use disclosure to the clinician. RESULTS Among 341 study participants (205 Black [60.1%] and 136 White [39.9%] participants), 70 participants (33 Black [47.1%] and 37 White [52.9%] participants) disclosed drug use, and 271 participants (172 Black [63.5%] and 99 White [36.5%] participants) did not disclose drug use during their first obstetric visit. Of 70 participants who disclosed drug use, 50 (28 Black [56.0%] and 22 White [44.0%] White) had urine drug testing conducted. Black pregnant patients who disclosed drug use were more likely to be tested for drugs than their White counterparts in the adjusted regression analysis (adjusted odds ratio [aOR] 8.9, 95% CI 1.3-58.6). Among the 271 participants who did not disclose drug use, 38 (18 Black [47.4%] and 20 White [52.6%] participants) had urine drug testing conducted. For those who did not disclose drug use, the adjusted model showed no statistically significant differences in urine drug testing by patients' race (aOR 0.7, 95% CI 0.3-1.6). CONCLUSION When pregnant people disclosed drug use, clinicians were more likely to order urine drug testing for Black pregnant people compared with their White counterparts, suggesting clinician racial bias. Current practice patterns and protocols such as urine drug testing in pregnancy care deserve review to identify and mitigate areas of potential clinician discrimination.
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Affiliation(s)
- Abisola Olaniyan
- Department of Behavioral and Community Health Sciences, the Department of Epidemiology, and the Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, the Center for Innovative Research on Gender Health Equity, University of Pittsburgh, and the Department of Medicine and the Department of Obstetrics, Gynecology, & Reproductive Science, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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12
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Landis RK, Stein BD, Griffin BA, Saloner BK, Terplan M, Faherty LJ. Disparities in Perinatal and Emergency Care Receipt Among Women With Perinatal Opioid Use Disorder in Medicaid, 2007 to 2012. J Addict Med 2023; 17:654-661. [PMID: 37934525 PMCID: PMC10759200 DOI: 10.1097/adm.0000000000001199] [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: 07/02/2023]
Abstract
OBJECTIVES This study aimed to better understand receipt of perinatal and emergency care among women with perinatal opioid use disorder (OUD) and explore variation by race/ethnicity. METHODS We used 2007-2012 Medicaid Analytic eXtract (MAX) data from all 50 states and the District of Columbia to examine 6,823,471 deliveries for women 18 to 44 years old. Logistic regressions modeled the association between (1) OUD status and receipt of perinatal and emergency care, and (2) receipt of perinatal and emergency care and race/ethnicity, conditional on OUD diagnosis and controlling for patient and county characteristics. We used robust SEs, clustered at the individual level, and included state and year fixed effects. RESULTS Women with perinatal OUD were less likely to receive adequate prenatal care (adjusted odds ratio [aOR], 0.45; 95% confidence interval [CI], 0.44-0.46) and attend the postpartum visit (aOR, 0.46; 95% CI, 0.45-0.47) and more likely to seek emergency care (aOR, 1.48; 95% CI, 1.45-1.51) than women without perinatal OUD. Among women with perinatal OUD, Black, Hispanic, and American Indian and Alaskan Native (AI/AN) women were less likely to receive adequate prenatal care (aOR, 0.68 [95% CI, 0.64-0.72]; aOR, 0.86 [95% CI, 0.80-0.92]; aOR, 0.71 [95% CI, 0.64-0.79]) and attend the postpartum visit (aOR, 0.85 [95% CI, 0.80-0.91]; aOR, 0.86 [95% CI, 0.80-0.93]; aOR, 0.83 [95% CI, 0.73-0.94]) relative to non-Hispanic White women. Black and AI/AN women were also more likely to receive emergency care (aOR, 1.13 [95% CI, 1.05-1.20]; aOR, 1.12 [95% CI, 1.00-1.26]). CONCLUSIONS Our findings suggest that women with perinatal OUD, in particular Black, Hispanic, and AI/AN women, may be missing opportunities for preventive care and comprehensive management of their physical and behavioral health during pregnancy.
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Affiliation(s)
- Rachel K Landis
- From the RAND Corporation, Arlington, VA (RKL, BAG); RAND Corporation, Pittsburgh, PA (BDS); Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (BKS); Friends Research Institute, Baltimore, MD (MT); RAND Corporation, Boston, MA (LJF); and Department of Pediatrics, Maine Medical Center, Portland, ME (LJF)
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13
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Morehouse E, Ingoldsby E, Newburg-Rinn S, Bertrand J, Usher K. Knowledge, Training, and Support Needs for Identification and Appropriate Care of Children with Prenatal Alcohol and Other Drug Exposures in the Child Welfare System. CHILD WELFARE 2023; 101:51-76. [PMID: 38415275 PMCID: PMC10896263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Increased awareness of the conditions associated with prenatal substance exposure may enhance care delivery among professionals working in child welfare. The ways in which prenatal substance exposure intersects with child welfare are critically important, yet prenatal substance exposure knowledge is uneven among these professionals. Also, caregivers may lack information that prepares them to care for children with prenatal substance exposure, particularly children with prenatal alcohol exposure. This study explores what professionals working in child welfare and caregivers know about prenatal substance exposure and prenatal alcohol exposure and their training and support needs.
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Affiliation(s)
| | | | - Sharon Newburg-Rinn
- Children's Bureau, Administration for Children and Families U.S. Department of Health and Human Services
| | - Jacquelyn Bertrand
- National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention
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14
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Darlington CK, Clark R, Jacoby SF, Terplan M, Alexander K, Compton P. Outcomes and experiences after child custody loss among mothers who use drugs: A mixed studies systematic review. Drug Alcohol Depend 2023; 251:110944. [PMID: 37713979 DOI: 10.1016/j.drugalcdep.2023.110944] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Mothers who use drugs are more likely to experience child custody loss than mothers who do not use drugs. The negative impact of removal on children has been well characterized in current literature while less is known about the impact of custody loss on mothers. The purpose of this mixed studies systematic review is to describe the state of science on the maternal outcomes and experiences after child custody loss among mothers who use drugs. METHODS PubMed, PsycINFO, CINAHL, and Social Work Abstract databases were systematically searched between June 2022 to January 2023. Article eligibility criteria centered on the outcomes and experiences of mothers who use drugs after losing child custody. Studies were analyzed using results-based convergent synthesis methodology for mixed studies reviews. Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT). A visual synthesis model was derived from combined results across all studies. RESULTS Of 2434 articles screened, 22 relevant scientific articles were selected for inclusion. Longitudinal, cohort studies (n=4) and a cross-sectional study (n=1) identified positive associations between custody loss and poorer mental health, increased drug use and overdose risk, less treatment engagement, and worsened social factors. Qualitative studies (n=17) identified themes that described re-traumatization after child custody loss and the development of coping mechanisms through identity negotiation. CONCLUSION Our findings indicate that child custody loss associated with drug use may exacerbate trauma and worsen maternal health. Immediate implications are provided for maternal health policy and practice in healthcare, child welfare, and legal professions.
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Affiliation(s)
- Caroline K Darlington
- University of Pennsylvania School of Nursing, Philadelphia, PA, United States; Leonard Davis Institute of Health Economics, Philadelphia, PA, United States.
| | - Rebecca Clark
- University of Pennsylvania School of Nursing, Philadelphia, PA, United States; Leonard Davis Institute of Health Economics, Philadelphia, PA, United States; Pennsylvania Hospital, Philadelphia, PA, United States
| | - Sara F Jacoby
- University of Pennsylvania School of Nursing, Philadelphia, PA, United States; Leonard Davis Institute of Health Economics, Philadelphia, PA, United States
| | - Mishka Terplan
- Friends Research Institute, Baltimore, MD, United States
| | | | - Peggy Compton
- University of Pennsylvania School of Nursing, Philadelphia, PA, United States; Leonard Davis Institute of Health Economics, Philadelphia, PA, United States
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15
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Harris M, Schiff DM, Saia K, Muftu S, Standish KR, Wachman EM. Academy of Breastfeeding Medicine Clinical Protocol #21: Breastfeeding in the Setting of Substance Use and Substance Use Disorder (Revised 2023). Breastfeed Med 2023; 18:715-733. [PMID: 37856658 PMCID: PMC10775244 DOI: 10.1089/bfm.2023.29256.abm] [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] [Indexed: 10/21/2023]
Abstract
Background: The Academy of Breastfeeding Medicine (ABM) revised the 2015 version of the substance use disorder (SUD) clinical protocol to review the evidence and provide updated literature-based recommendations related to breastfeeding in the setting of substance use and SUD treatments. Key Information: Decisions around breastfeeding are an important aspect of care during the peripartum period, and there are specific benefits and risks for substance-exposed mother-infant dyads. Recommendations: This protocol provides breastfeeding recommendations in the setting of nonprescribed opioid, stimulant, sedative-hypnotic, alcohol, nicotine, and cannabis use, and SUD treatments. Additionally, we offer guidance on the utility of toxicology testing in breastfeeding recommendations. Individual programs and institutions should establish consistent breastfeeding approaches that mitigate bias, facilitate consistency, and empower mothers with SUD. For specific breastfeeding recommendations, given the complexity of breastfeeding in mothers with SUD, individualized care plans should be created in partnership with the patient and multidisciplinary team with appropriate clinical support and follow-up. In general, breastfeeding is recommended among mothers who stop nonprescribed substance use by the time of delivery, and they should continue to receive ongoing postpartum care, such as lactation support and SUD treatment. Overall, enhancing breastfeeding education regarding substance use in pregnancy and lactation is essential to allow for patient-centered guidance.
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Affiliation(s)
- Miriam Harris
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
| | - Davida M. Schiff
- Divisions of Newborn Medicine and Mass General Hospital for Children, Boston, Massachusetts, USA
- Divisions of General Academic Pediatrics, Mass General Hospital for Children, Boston, Massachusetts, USA
| | - Kelley Saia
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
- Department of Obstetrics and Gynecology, Chobanian & Avedisian Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Serra Muftu
- Divisions of Newborn Medicine and Mass General Hospital for Children, Boston, Massachusetts, USA
- Divisions of General Academic Pediatrics, Mass General Hospital for Children, Boston, Massachusetts, USA
| | - Katherine R. Standish
- Department of Family Medicine, and Chobanian & Avedisian Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Elisha M. Wachman
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
- Department of Pediatrics, Chobanian & Avedisian Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
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Karvonen KL, Anunwah E, Chambers Butcher BD, Kwarteng L, Mathis-Perry T, McLemore MR, Oh S, Pantell MS, Smith O, Rogers E. Structural Racism Operationalized via Adverse Social Events in a Single-Center Neonatal Intensive Care Unit. J Pediatr 2023; 260:113499. [PMID: 37211208 DOI: 10.1016/j.jpeds.2023.113499] [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: 09/20/2022] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To evaluate structural racism in the neonatal intensive care unit (NICU) by determining if differences in adverse social events occur by racialized groups. STUDY DESIGN Retrospective cohort study of 3290 infants hospitalized in a single center NICU between 2017 and 2019 in the Racial and Ethnic Justice in Outcomes in Neonatal Intensive Care (REJOICE) study. Demographics and adverse social events including infant urine toxicology screening, child protective services (CPS) referrals, behavioral contracts, and security emergency response calls were collected from electronic medical records. Logistic regression models were fit to test the association of race/ethnicity and adverse social events, adjusting for length of stay. Racial/ethnic groups were compared with a White referent group. RESULTS There were 205 families (6.2%) that experienced an adverse social event. Black families were more likely to have experienced a CPS referral and a urine toxicology screen (OR, 3.6; 95% CI, 2.2-6.1 and OR, 2.2; 95% CI, 1.4-3.5). American Indian and Alaskan Native families were also more likely to experience CPS referrals and urine toxicology screens (OR, 15.8; 95% CI, 6.9-36.0 an OR, 7.6; 95% CI, 3.4-17.2). Black families were more likely to experience behavioral contracts and security emergency response calls. Latinx families had a similar risk of adverse events, and Asian families were less likely to experience adverse events. CONCLUSIONS We found racial inequities in adverse social events in a single-center NICU. Investigation of generalizability is necessary to develop widespread strategies to address institutional and societal structural racism and to prevent adverse social events.
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Affiliation(s)
- Kayla L Karvonen
- Department of Pediatrics, University of California San Francisco, San Francisco, CA; California Preterm Birth Initiative, San Francisco, CA.
| | - Erica Anunwah
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Brittany D Chambers Butcher
- California Preterm Birth Initiative, San Francisco, CA; Department of Human Ecology, University of California Davis, Sacramento, CA
| | - Lydia Kwarteng
- University of California San Francisco School of Medicine, San Francisco, CA
| | | | - Monica R McLemore
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, WA
| | - Sally Oh
- University of California San Francisco School of Medicine, San Francisco, CA
| | - Matthew S Pantell
- Department of Pediatrics, University of California San Francisco, San Francisco, CA; California Preterm Birth Initiative, San Francisco, CA
| | - Olga Smith
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA
| | - Elizabeth Rogers
- Department of Pediatrics, University of California San Francisco, San Francisco, CA; California Preterm Birth Initiative, San Francisco, CA
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Kao L, Lee C, Parayil T, Kramer C, Sufrin CB. Assessing provision of MOUD and obstetric care in U.S. jails: A content analysis of policies submitted by 59 jails. Drug Alcohol Depend 2023; 248:109877. [PMID: 37244223 PMCID: PMC10330906 DOI: 10.1016/j.drugalcdep.2023.109877] [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: 02/06/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 05/29/2023]
Abstract
AIMS AND BACKGROUND Thousands of pregnant people with opioid use disorder (OUD) interface with the United States (US) carceral system annually. However, little is known about the consistency and breadth of medications for opioid use disorder (MOUD) for incarcerated pregnant people in jail, even at facilities that offer treatment; the goal of our study is to illuminate the current practices for OUD management in US jails. METHODS We collected and analyzed 59 self-submitted jail policies related to OUD and/or pregnancy from a national, cross-sectional survey of reported MOUD practices for pregnant people in a geographically diverse sample of US jails. Policies were coded for MOUD access, provision, and scope, then compared to respondents' submitted survey responses. RESULTS Of 59 policies, 42 (71%) mentioned OUD care during pregnancy. Among these 42 polices that mentioned OUD care during pregnancy, 41 (98%) allowed MOUD treatment, 24 (57%) expressed continuing pre-existing MOUD treatment that was started in the community pre-arrest, 17 (42%) initiated MOUD in custody, and only 2 (5%) mentioned providing MOUD continuation post-partum. Facilities varied in MOUD duration, provision logistics, and discontinuation policies. Only 11 (19%) policies were completely concordant with their survey response regarding MOUD provision in pregnancy. CONCLUSIONS The conditions, criteria, and the comprehensiveness of MOUD provision and protocols for pregnant people in jail remain variable. The findings demonstrate the need to develop a universal comprehensive MOUD framework for incarcerated pregnant people to reduce the increased likelihood of death from opioid overdose upon release and in the peripartum period.
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Affiliation(s)
- Lynn Kao
- Johns Hopkins University School of Medicine, Department of Gynecology and Obstetrics, 4940 Eastern Ave., A101, Baltimore, MD21224, United States.
| | - Chanel Lee
- Johns Hopkins University School of Medicine, Department of Gynecology and Obstetrics, 4940 Eastern Ave., A101, Baltimore, MD21224, United States
| | - Trisha Parayil
- Johns Hopkins University School of Medicine, Department of Gynecology and Obstetrics, 4940 Eastern Ave., A101, Baltimore, MD21224, United States
| | - Camille Kramer
- Johns Hopkins University School of Medicine, Department of Gynecology and Obstetrics, 4940 Eastern Ave., A101, Baltimore, MD21224, United States
| | - Carolyn B Sufrin
- Johns Hopkins University School of Medicine, Department of Gynecology and Obstetrics, 4940 Eastern Ave., A101, Baltimore, MD21224, United States; Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 4940 Eastern Ave., A101, Baltimore, MD21224, United States
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Mayer S, Boyd J, Fairbairn N, Chapman J, Brohman I, Jenkins E, McNeil R. Women's experiences in injectable opioid agonist treatment programs in Vancouver, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 117:104054. [PMID: 37192557 PMCID: PMC10330495 DOI: 10.1016/j.drugpo.2023.104054] [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: 01/19/2023] [Revised: 04/18/2023] [Accepted: 04/30/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Injectable opioid agonist treatment (iOAT) has recently been expanded in some geographical contexts in Canada as part of a response to the escalating overdose crisis. Complex gendered dynamics, including power differentials, violence, and social norms, shape the overdose crisis and drug treatment programs which can adversely impact women's experiences. This qualitative study examines how social (e.g., gender, income, housing) and structural factors (e.g., program policies) impact women's experiences of iOAT. METHODS Qualitative interviews were completed with 16 women enrolled in four iOAT programs in Vancouver, Canada. Approximately 50 hours of ethnographic observations were conducted. Interview transcripts and ethnographic fieldnotes were analyzed using a critical feminist lens by applying the concepts of embodiment, relationality, and social control to understand women's engagement and self-reported treatment outcomes. RESULTS Initial iOAT engagement was a relational process, including initiating treatment with a partner and engaging with iOAT to (re)build personal relationships. Relationships with iOAT providers, including flexibility and support with medication administration, were important to women, providing an affirming embodied experience and a greater sense of agency. However, program operations (e.g., mandated daily attendance, program crowding) incompatible with women's needs (e.g., employment) could undermine these positive experiences. Women's reported outcomes highlight a tension between achieving more agency and the constraints of intensive and stigmatized treatment. CONCLUSION This study highlights how iOAT is both a source of care and control for women from a relational and embodied perspective. Findings underscore the need for gender-attentive and flexible drug treatment services to meet the varied needs of women and the importance of providing relational care for women accessing iOAT.
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Affiliation(s)
- Samara Mayer
- British Columbia Centre on Substance Use, 717 East Hastings St. Vancouver, BC V6Z 2A9, Canada; Interdisciplinary Studies Graduate Program, University of British Columbia, 170-6371 Crescent Road, Vancouver, BC V6T 1Z2, Canada
| | - Jade Boyd
- British Columbia Centre on Substance Use, 717 East Hastings St. Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street. Vancouver, BC V6Z 1Y6, Canada
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use, 717 East Hastings St. Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street. Vancouver, BC V6Z 1Y6, Canada
| | - Jules Chapman
- British Columbia Centre on Substance Use, 717 East Hastings St. Vancouver, BC V6Z 2A9, Canada
| | - Isabella Brohman
- British Columbia Centre on Substance Use, 717 East Hastings St. Vancouver, BC V6Z 2A9, Canada
| | - Emily Jenkins
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall. Vancouver, BC V6T 2B5, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, 717 East Hastings St. Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street. Vancouver, BC V6Z 1Y6, Canada; Internal Medicine, Yale School of Medicine, New Haven, 06510, United States; Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, 06510, United States; Department of Anthropology, Yale University, New Haven, 06510, United States.
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Cénat JM, Kogan CS, Kebedom P, Ukwu G, Moshirian Farahi SMM, Darius WP, Mulopo Bakombo S, Dalexis RD, Ndengeyingoma A, Noorishad PG, Labelle PR. Prevalence and risk factors associated with psychostimulant use among Black individuals: A meta-analysis and systematic review. Addict Behav 2023; 138:107567. [PMID: 36521424 DOI: 10.1016/j.addbeh.2022.107567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/16/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Psychostimulants (e.g., cocaine, amphetamine) are among the most widely used drugs globally with detrimental short and long-term physical, psychological and social consequences. There is limited data on psychostimulant use for various racial and ethnic groups, including Black people, and the challenges they face living as minorities overcoming historical challenges including increased incarceration associated with drug possession. METHODS Peer-reviewed articles were identified in five databases (APA PsycInfo, CINAHL, Cochrane CENTRAL, Embase, MEDLINE). Eligible studies were published in French or English, provided empiral data on psychostimulant use in Black individuals living in a minority context. The PRISMA guideline was used for structuring the review. Random-effects meta-analyses were generated to estimate the pooled prevalence of lifetime and periodic psychostimulant use among Black individuals using STATA 16. RESULTS Sixty-three studies published from 1991 to 2022 with a sample size of 139,683 Black individuals were included in the current meta-analysis. Results indicate a pooled prevalence estimate of 11.4% for any form of psychostimulant use among Black individuals. The pooled prevalence estimates were 12.4% (95% CI, 8.4% - 16.4%) for cocaine, 8.3% (95% CI, 0% - 19.1%) for amphetamines, and 11.4% (95% CI, 4.6% - 18.1%) for other stimulants. Prediction intervals for all psychostimulant types were highly heterogenous ranging from 0% to as high as 51.2% for amphetamine suggesting prevalence of use in some studies of Black people could be found to be as low as zero. Subgroup analyses were conducted to examine differences between age groups, gender, reference period, and type of assessment. CONCLUSIONS High prevalence rates of psychostimulant use among Black people argues for greater access to evidence-based treatments. However, current psychosocial interventions are suboptimal, warranting further study. Consideration needs to be given to the challenges of the large range of prediction intervals, living in urban areas, racial discrimination experiences, race-based stress, and sociodemographic characteristics, including poverty, education level, age, gender.
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Affiliation(s)
- Jude Mary Cénat
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada; Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada; University of Ottawa Research Chair on Black Health, Ottawa, Ontario, Canada.
| | - Cary S Kogan
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada; Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Philmona Kebedom
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Gloria Ukwu
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Wina Paul Darius
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Rose Darly Dalexis
- Interdisciplinary School of Health Sciences, University of Ottawa, Ontario, Canada
| | - Assumpta Ndengeyingoma
- Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada; Department of Nursing, Université du Québec en Outaouais, Quebec, Canada
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Newman SD, Moss K, Pichon M, Scott D, Rogers K, Orr A, Bui C, Payne-Foster P. The health of rural Black communities during COVID: Some affirmations, some surprises. Front Public Health 2023; 11:932451. [PMID: 37124765 PMCID: PMC10133505 DOI: 10.3389/fpubh.2023.932451] [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: 04/29/2022] [Accepted: 03/23/2023] [Indexed: 05/02/2023] Open
Abstract
Background and objective There are overwhelming health disparities in the Deep South. It is important to include the voice of communities affected by these disparities when developing interventions. The goal of the current study was to develop an academic community engaged partnership to strengthen the ability to address priority health concerns of rural African American communities with a focus on health literacy and health advocacy. Methods A community-based participatory research approach was used to administer a 15-item community health survey in five rural communities led by African American mayors in Alabama (N = 752). The survey assessed the health concerns and the potential behaviors that may be associated with those health concerns. Results The five communities demonstrated similarities as well as differences in both the health concerns endorsed and the potential health behaviors that may contribute to those concerns. All five communities identified cardiovascular disease as a health concern with three endorsing mental health issues and 2 dental health. With respect to behaviors, all five communities identified either unhealthy eating/exercise and substance use as concerns with one community identifying racism as a risky behavior affecting health. Conclusion The results presented replicate CBPR studies demonstrating that communities are important sources of information about local health priorities and concerns.
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Affiliation(s)
- Sharlene D. Newman
- Alabama Life Research Institute, The University of Alabama, Tuscaloosa, AL, United States
- Advancing Health Literacy in the Alabama Black Belt, HHS, Fort Deposit, AL, United States
- *Correspondence: Sharlene D. Newman,
| | - Kimberly Moss
- Advancing Health Literacy in the Alabama Black Belt, HHS, Fort Deposit, AL, United States
| | - Melonie Pichon
- Advancing Health Literacy in the Alabama Black Belt, HHS, Fort Deposit, AL, United States
| | - Deborah Scott
- Advancing Health Literacy in the Alabama Black Belt, HHS, Fort Deposit, AL, United States
| | - Kileema Rogers
- Advancing Health Literacy in the Alabama Black Belt, HHS, Fort Deposit, AL, United States
| | - Angela Orr
- Advancing Health Literacy in the Alabama Black Belt, HHS, Fort Deposit, AL, United States
| | - Chuong Bui
- Alabama Life Research Institute, The University of Alabama, Tuscaloosa, AL, United States
| | - Pamela Payne-Foster
- Advancing Health Literacy in the Alabama Black Belt, HHS, Fort Deposit, AL, United States
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, AL, United States
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Riley T, Zia Y, Samari G, Sharif MZ. Abortion Criminalization: A Public Health Crisis Rooted in White Supremacy. Am J Public Health 2022; 112:1662-1667. [PMID: 36223577 PMCID: PMC9558193 DOI: 10.2105/ajph.2022.307014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
The Supreme Court decision to overturn Roe v. Wade and the growing onslaught of state laws that criminalize abortion are part of a long history of maintaining White supremacy through reproductive control of Black and socially marginalized lives. As public health continues to recognize structural racism as a public health crisis and advances its measurement, it is imperative to explicate the connection between abortion criminalization and White supremacy. In this essay, we highlight how antiabortion policies uphold White supremacy and offer concrete strategies for addressing abortion criminalization in structural racism measures and public health research and practice. (Am J Public Health. 2022;112(11):1662-1667. https://doi.org/10.2105/AJPH.2022.307014).
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Affiliation(s)
- Taylor Riley
- Taylor Riley and Yasaman Zia are with the Department of Epidemiology, School of Public Health, University of Washington, Seattle. Goleen Samari is with the Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY. Mienah Z. Sharif is with the Department of Epidemiology, School of Public Health, University of Washington, Seattle, and the Center for the Study of Racism, Social Justice and Health, University of California, Los Angeles
| | - Yasaman Zia
- Taylor Riley and Yasaman Zia are with the Department of Epidemiology, School of Public Health, University of Washington, Seattle. Goleen Samari is with the Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY. Mienah Z. Sharif is with the Department of Epidemiology, School of Public Health, University of Washington, Seattle, and the Center for the Study of Racism, Social Justice and Health, University of California, Los Angeles
| | - Goleen Samari
- Taylor Riley and Yasaman Zia are with the Department of Epidemiology, School of Public Health, University of Washington, Seattle. Goleen Samari is with the Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY. Mienah Z. Sharif is with the Department of Epidemiology, School of Public Health, University of Washington, Seattle, and the Center for the Study of Racism, Social Justice and Health, University of California, Los Angeles
| | - Mienah Z Sharif
- Taylor Riley and Yasaman Zia are with the Department of Epidemiology, School of Public Health, University of Washington, Seattle. Goleen Samari is with the Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY. Mienah Z. Sharif is with the Department of Epidemiology, School of Public Health, University of Washington, Seattle, and the Center for the Study of Racism, Social Justice and Health, University of California, Los Angeles
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22
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Barrett D, Stoicescu C, Thumath M, Maynard E, Turner R, Shirley-Beavan S, Kurcevič E, Petersson F, Hasselgård-Rowe J, Giacomello C, Wåhlin E, Lines R. Child-centred harm reduction. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 109:103857. [PMID: 36174409 DOI: 10.1016/j.drugpo.2022.103857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/05/2022] [Accepted: 09/08/2022] [Indexed: 11/30/2022]
Abstract
Harm reduction has become increasingly influential in drug policy and practice, but has developed primarily around adult drug use. Theoretical, practical, ethical and legal issues pertaining to children and adolescents under the age of majority - both relating to their own use and the effects of drug use among parents or within the family - are less clear. This commentary proposes a sub-field of drug policy at the intersection of harm reduction and childhood which we refer to as 'child-centred harm reduction'. We provide a definition and conceptual model, as well as illustrative questions that emerge through a child-centred harm reduction lens. Many people in different countries are already working on these kinds of issues, whose work needs greater recognition, analysis and support. In beginning to name and define this sub-field we hope to improve this situation, and inspire further international debate, collaboration, and innovation.
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Affiliation(s)
- Damon Barrett
- School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
| | | | | | | | - Russell Turner
- Department of Social Work, University of Gothenburg, Sweden
| | | | | | | | | | | | - Ella Wåhlin
- Hilary Rodham Clinton School of Law, Swansea University, United Kingdom
| | - Rick Lines
- Hilary Rodham Clinton School of Law, Swansea University, United Kingdom
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23
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Challenges in Perinatal Drug Testing. Obstet Gynecol 2022; 140:163-166. [DOI: 10.1097/aog.0000000000004808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/17/2022] [Indexed: 11/26/2022]
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Reddy J, Williams-Isom A, Putnam-Hornstein E. Racial sensitivity training: An inadequate solution to systemic racial disparities in child protection systems. CHILD ABUSE & NEGLECT 2022; 128:105584. [PMID: 35313126 DOI: 10.1016/j.chiabu.2022.105584] [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: 10/03/2021] [Revised: 02/16/2022] [Accepted: 02/24/2022] [Indexed: 06/14/2023]
Abstract
Calls continue for staff training as an instrumental response to racially based differences in rates of child protection system interactions and outcomes. These recommendations echo a reliance on implicit bias and diversity training (referred to broadly as "anti-bias and racial sensitivity training") across disciplines of social and human services in the United States as a feasible and politically expedient solution to racial disparities. But focusing on anti-bias training to address racial disparities in child protection systems will almost certainly fail to achieve desired objectives for at least three reasons: (a) there is no evidence that implicit bias or racial sensitivity trainings change behavior; (b) personnel training initiatives misapply an individual behavioral solution to an institutional and structural problem; and (c) an emphasis on internal training initiatives distracts and reduces the accountability of other systems of care better positioned to produce change. We conclude that if the goal is to reduce racial disparities, systemic innovations and broader policy reforms both internal and external to the child protection system are needed. Training will not meaningfully shift the downstream effects of structural racism.
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Affiliation(s)
- Julia Reddy
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States of America.
| | - Anne Williams-Isom
- Graduate School of Social Service, Fordham University, United States of America.
| | - Emily Putnam-Hornstein
- School of Social Work, University of North Carolina at Chapel Hill, United States of America.
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Jaynes S, Brathwaite D, Tully KP. Systematic Review of the Effect of Technology-Mediated Education Intervention on Maternal Outcomes in the First Year After Birth. J Obstet Gynecol Neonatal Nurs 2022; 51:278-289. [PMID: 35331669 DOI: 10.1016/j.jogn.2022.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To synthesize the findings on the effect of technology-mediated education intervention in the first year after birth on maternal health outcomes and to evaluate interventions for participant perspectives and health equity. DATA SOURCES We conducted a systematic review of the literature using the electronic databases PubMed, Embase, and CINAHL for articles published between 2010 and 2020. The search strategy was developed by a health sciences librarian. STUDY SELECTION We included articles if the following criteria were met: they reported studies conducted in the United States or a resource-similar nation on the evaluation of a technology-mediated education intervention within the first year after birth and they included the assessment of at least one maternal health outcome. DATA EXTRACTION The lead author extracted data from the full-text articles and entered them into Microsoft Excel. We assessed the quality and risk of bias using the Cochrane Collaboration's tool for examining the potential risk of bias. DATA SYNTHESIS We identified 21 articles that met the inclusion criteria. Videos were the most commonly reported technology-mediated education intervention, followed by text messages, phone calls, and websites. Maternal health outcomes addressed in the included articles were mental health, weight loss, breastfeeding, general postpartum education, perineal care, and substance use. Technology-mediated education interventions positively affected mental health, weight loss, and breastfeeding outcomes. CONCLUSION The current evidence suggests that technology-mediated education intervention is beneficial for the physical and mental health outcomes of women during the first year after birth. Future work may benefit from more attention to health equity and design in collaboration with women to gain a better understanding of the information needs and desired technology features.
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Schrode K, Poareo E, Li M, Harawa NT. Minority Stress and Sexual Functioning Among African American Women With At-Risk Partners in South Los Angeles. J Sex Med 2022; 19:603-612. [PMID: 35272947 PMCID: PMC8995363 DOI: 10.1016/j.jsxm.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Preliminary evidence indicates that acute and chronic psychological stress affect sexual arousal and satisfaction. African American women, in particular, are vulnerable to the impacts of gender- and race-related stress, given their socially constructed identities as African Americans and as women. AIM We examined associations between minority stress and sexual function using data from 248 African American women. METHODS Surveys were conducted with 248 African American women in South LA with male partners at risk for acquiring HIV. We analyzed self-reports on (i) stress indicators: chronic burden, perceived racism/sexism, and histories of trauma/sexual abuse; (ii) Female Sexual Function Index domains: desire, arousal, and satisfaction; and (iii) potential moderators: social support and spirituality. We used multiple regression, adjusting for potential confounding factors, to examine the relationships between stress indictors, potential moderators, and sexual function domains. OUTCOMES The outcomes were the female sexual function index domains of desire, arousal, and satisfaction. RESULTS This largely low-income sample experienced significant chronic and acute stressors, was highly spiritual and reported strong social support. Moderate-high chronic burden and increasing sexism scores were independently associated with decreased arousal (B = -0.38, 95%CI = -0.75, -0.02) and satisfaction (B = -0.03, 95%CI = -0.06, 0.00) scores, respectively. CLINICAL IMPLICATIONS Providers may want to explore chronic burden in patients who complain about low sexual arousal. Additionally, to develop effective HIV- and other STI-related interventions that impact behaviors that can confer sexual risk, prevention strategies are needed that either reduce contextual stressors or mitigate their impact. STRENGTHS Strengths of this research are that it focuses on sexual function among previously under-studied, low-income African American women and that it takes into account the unique set of stressors faced by these women. LIMITATIONS A limitation is that the sample size may have been too small to capture the effects of potential moderators. CONCLUSIONS Low-income African American women accumulate life stressors that may harm sexual function. Schrode K, Poareo E, Li M, et al. Minority Stress and Sexual Functioning Among African American Women With At-Risk Partners in South Los Angeles. J Sex Med 2022;19:603-612.
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27
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Winchester ML, Shahiri P, Boevers-Solverson E, Hartmann A, Ross M, Fitzgerald S, Parrish M. Racial and Ethnic Differences in Urine Drug Screening on Labor and Delivery. Matern Child Health J 2022; 26:124-130. [PMID: 34988865 DOI: 10.1007/s10995-021-03258-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This study evaluates racial and ethnic differences in urine drug screening and patient consent to urine drug screening at a single tertiary care center. METHODS We conducted a retrospective cohort study of all deliveries at a single tertiary care center from January 1, 2015 to December 31, 2019. Medical records were queried for demographic data, performance of urine drug screening, commonly used diagnoses that prompted screening, documentation of patient consent, and result of screen. Associations between these outcomes were then assessed using Chi-square analysis and logistic regression. RESULTS During the study period, 685 of 9953 (6.9%) of patients had a urine drug screen performed. Non-Hispanic Black patients comprised 33.6% of patients receiving screening, but only 16.6% of the total population. Of examined indications for urine drug screening, only insufficient prenatal care and trauma differed significantly between groups. After adjusting for commonly used diagnoses prompting screening, non-Hispanic black patients were significantly more likely to have urine drug screening performed (OR 2.0, 95% CI 1.6-2.4). Non-Hispanic Black and Hispanic patients were not significantly more likely to have a positive screen result when compared to Non-Hispanic White patients. Consent to urine drug screening was poorly documented (only 11.7% of patients had documented consent). This did not differ significantly between the major racial or ethnic groups. CONCLUSION Non-Hispanic Black and Hispanic patients experience differences in urine drug screening during admission for delivery that cannot be solely explained by differences in incidence of diagnoses that typically trigger screening. Documentation of patient consent to urine drug screening is poor.
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Affiliation(s)
- Mae-Lan Winchester
- Department of Obstetrics & Gynecology, Medical Center, University of Kansas, Kansas City, KS, USA.
| | - Parmida Shahiri
- School of Medicine, University of Kansas, Kansas City, KS, USA
| | - Emily Boevers-Solverson
- Department of Obstetrics & Gynecology, Medical Center, University of Kansas, Kansas City, KS, USA
| | | | - Meghan Ross
- School of Medicine, University of Kansas, Kansas City, KS, USA
| | - Sharon Fitzgerald
- Department of Population Health, Medical Center, University of Kansas, Kansas City, KS, USA
| | - Marc Parrish
- Department of Obstetrics & Gynecology, Medical Center, University of Kansas, Kansas City, KS, USA
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28
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Harris MTH, Laks J, Stahl N, Bagley SM, Saia K, Wechsberg WM. Gender Dynamics in Substance Use and Treatment: A Women's Focused Approach. Med Clin North Am 2022; 106:219-234. [PMID: 34823732 PMCID: PMC8881090 DOI: 10.1016/j.mcna.2021.08.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Gender impacts substance use initiation, substance use disorder development, engagement with treatment, and harms related to drug and alcohol use. Using the biopsychosocial model of addiction, this review provides a broad summary of barriers and facilitators to addiction services among women. It also reviews substance use among pregnant and parenting women and approaches to care. Given the increasing rates of substance use among women, there is a need to implement and scale-up gender-responsive addiction programming and pursue advocacy at the policy level that addresses the root drivers of substance use inequities among women.
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Affiliation(s)
- Miriam T H Harris
- Grayken Center for Addiction, Boston Medical Center, 801 Massachusetts Avenue, 1st Floor, Boston, MA 02118, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA.
| | - Jordana Laks
- Grayken Center for Addiction, Boston Medical Center, 801 Massachusetts Avenue, 1st Floor, Boston, MA 02118, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA
| | - Natalie Stahl
- Yale Program in Addiction Medicine, Yale University School of Medicine, E.S. Harkness Memorial Building A, 367 Cedar Street, Suite 417A, New Haven, CT 06520-8023, USA
| | - Sarah M Bagley
- Grayken Center for Addiction, Boston Medical Center, 801 Massachusetts Avenue, 1st Floor, Boston, MA 02118, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA; Division of General Pediatrics, Department of Pediatrics, 801 Albany Street, Boston, MA 02118, USA
| | - Kelley Saia
- Department of Obstetrics and Gynecology, Boston Medical Center, 850 Harrison Avenue 5th Floor, Boston, MA 02118, USA
| | - Wendee M Wechsberg
- Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC 27709-2194, USA; Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA; Department of Psychology, North Carolina State University, Raleigh, NC 27599-7400, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27701, USA
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29
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Hagle HN, Martin M, Winograd R, Merlin J, Finnell DS, Bratberg JP, Gordon AJ, Johnson C, Levy S, MacLane-Baeder D, Northup R, Weinstein Z, Lum PJ. Dismantling racism against Black, Indigenous, and people of color across the substance use continuum: A position statement of the association for multidisciplinary education and research in substance use and addiction. Subst Abus 2021; 42:5-12. [PMID: 33465013 DOI: 10.1080/08897077.2020.1867288] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The Association for Multidisciplinary Education and Research in Substance Use and Addiction (AMERSA) acknowledges that racism profoundly affects persons who use alcohol and other drugs. Racism's deadly effects compounded with other social determinants of health result in a cascade of negative impacts. The AMERSA Board of Directors (BOD) proposes an initial set of strategies to promote diversity, equity, and inclusion using a framework that speaks to four key AMERSA experiences: engagement, education, mentorship, and leadership. Through these strategies, AMERSA commits to promoting equity and inclusion to dismantle the individual, institutional, and structural racism that has permeated the United States for centuries.
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Affiliation(s)
- Holly N Hagle
- School of Nursing and Health Studies, University of Missouri, Kansas City, Missouri, USA
| | - Marlene Martin
- School of Medicine, University of California, San Francisco, California, USA
| | - Rachel Winograd
- Missouri Institute of Mental Health, University of Missouri, St. Louis, Missouri, USA
| | - Jessica Merlin
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Jeffrey P Bratberg
- Department of Pharmacy, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
| | - Adam J Gordon
- Department of Substance Abuse, University of Utah, Salt Lake City, Utah, USA
- Department of Internal Medicine, Division of Epidemiology, Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), VAMC, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Cheyenne Johnson
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Sharon Levy
- Department of Pediatrics, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Doreen MacLane-Baeder
- Association for Multidisciplinary Education and Research in Substance Use and Addiction, Cranston, Rhode Island, USA
| | - Rebecca Northup
- Association for Multidisciplinary Education and Research in Substance Use and Addiction, Cranston, Rhode Island, USA
| | - Zoe Weinstein
- Clinical Addiction Research and Education Unit, Boston Medical Center, Boston, Massachusetts, USA
| | - Paula J Lum
- HIV/AIDS Division, Positive Health Program, University of California, San Francisco, California, USA
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