State-level opioid policies and policies that regulate substance use duringpregnancy: a mixed methods exploration of their effects on maternal and infantoutcomes

国家级阿片类药物政策和规范怀孕期间药物使用的政策：混合方法探讨其对孕产妇和婴儿结局的影响

• 批准号: 10460791
• 负责人: Silvia Saboia Martins
• 金额: $ 78.13万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10460791
• 关键词: Address; Affect; Categories; Charge; Child Abuse; Child Care; Chronic; Climate; Communities; Consolidated Framework for Implementation Research; Data; Data Set; Databases; Ethnic Origin; Ethnography; Face; Factor Analysis; Female of child bearing age; Health; Health Promotion; Hospitals; Individual; Infant; Insurance; Intervention; Interview; Knowledge; Laws; Life; Maps; Maternal Health; Medicaid; Medical; Methods; Modification; Morbidity - disease rate; Naloxone; National Institute of Drug Abuse; Neonatal Abstinence Syndrome; Newborn Infant; Opioid; Outcome; Pathway interactions; Pattern; Personal Satisfaction; Pharmaceutical Preparations; Policies; Population; Postnatal Care; Postpartum Women; Pregnancy; Pregnant Women; Prenatal care; Privatization; Provider; Race; Reporting; Research; Risk; Services; Strategic Planning; Surveys; System; Taxonomy; Testing; Time; United States; Variant; Woman; base; care delivery; child neglect; climate impact; cohort; design; insurance claims; maternal opioid use; mortality; neonatal health; opioid misuse; opioid overdose; opioid policy; opioid use; opioid use disorder; opioid use in pregnancy; pregnant; prenatal; prescription opioid; response; social stigma; substance use

The opioid and overdose crisis in the United States (US) disproportionately affects women of childbearing age (15–44 years), particularly pregnant women and their newborns: 20% of pregnant women are prescribed opioids during pregnancy.1,2 States have enacted both general opioid policies (e.g., access to medication for opioid use disorder (MOUD)) and policies specific to substance use during pregnancy, but the effects of these policies on pregnant women’s opioid use and newborn outcomes remain poorly defined. States’ policy responses to prenatal opioid use vary widely, resulting in inconsistent approaches to pregnant women’s opioid use. In this mixed- methods project, we will apply a convergent parallel design to examine the separate and combined impacts and consequences of state opioid policies on pregnant women and their newborns using Medicaid and commercial insurance databases (MarketScan). We aim to: 1. Examine the separate effects of general and prenatal state opioid policies on pregnant/postpartum women and newborns. We will: 1a) systematically map all 50 states’ prenatal opioid policies (2011–2020) to categorize policy variations and build a publicly available time-varying dataset; 1b) use this prenatal policy dataset and existing data on general opioid policies to explore the individual- level impact of general and prenatal opioid policies on opioid use disorder (OUD), MOUD access, and neonatal opioid withdrawal syndrome (NOWS) for pregnant women and their newborns; and 1c) test for effect modification by maternal race/ethnicity and age. 2. Investigate the combined effects of general and prenatal state opioid policies on pregnant/postpartum women and their newborns (2011-2020). To move beyond the impact of single policies in isolation, we will: 2a) use a modified Delphi approach to create a time-varying taxonomy of each state’s overall opioid policy climate relevant to pregnant women, ranging from penalizing to health- promoting, based on states’ combination of prenatal and general opioid policies; and 2b) explore the individual- level impact of states’ overall policy climates on pregnant/postpartum women and newborns using the same outcomes and effect modification as Aim 1. 3. Explore how prenatal policy implementation affects daily life for pregnant women and their newborns. We will: 3a) apply the Consolidated Framework for Implementation Research (CFIR) to interviews with 60 key stakeholders across states that vary by their overall policy climate to explore multilevel drivers of prenatal opioid policy implementation and how variations in implementation affect maternal and newborn health; and 3b) create an ethnographic cohort of 40 pregnant women who use opioids across states with four different prenatal policy climates (punitive, prosocial, mixed, inaction) and conduct three interviews with each over one year. We will explore how variations in prenatal opioid policy implementation affect how women navigate pre- and postnatal care, MOUD use, and state services. Findings will have concrete real- world impacts by describing the effects of state opioid policies on pregnant/postpartum women and their newborns and by identifying intervention points and policy changes that promote maternal and infant wellbeing.

美国的阿片类药物和过量危机（美国）不成比例地影响育龄的妇女 （15-44岁），特别是孕妇及其新生儿：20％的孕妇被处方阿片类药物 怀孕期间。1,2个州颁布了一般的阿片类药物政策（例如，使用阿片类药物的药物 疾病（MOUD））和特定于怀孕期间药物使用的政策，但这些政策对 孕妇的阿片类药物使用和新出生的结果的定义较差。国家对产前的政策回应 Opioid的使用差异很大，导致孕妇使用寿司的方法不一致。在这个混合 方法项目，我们将采用收敛的平行设计来检查单独和组合的影响，并 使用医疗补助和商业商业的国家阿片类药物政策对孕妇及其新生儿的后果 保险数据库（MarketScan）。我们的目标是：1。检查一般和产前状态的单独影响 关于怀孕/产后妇女和新生儿的阿片类药物政策。我们将：1a）系统地绘制所有50个州 产前阿片类药物政策（2011- 2020年），分类政策变化并建立公开可用的时间变化 数据集; 1b）使用此产前策略数据集和一般阿片类药物政策的现有数据来探索个体 一般和产前OIOID政策对OIOID使用障碍（OUD），MOUD访问和新生儿的水平影响 阿片类药物戒断综合征（现在）孕妇及其新生儿；和1C）测试效果修改 按孕产妇/种族和年龄。 2。研究一般和产前状态阿片类药物的综合作用 关于怀孕/产后妇女及其新生儿的政策（2011-2020）。超越 孤立的单一政策，我们将：2a）使用修改后的Delphi方法来创建时间变化的分类法 每个州与孕妇相关的整体阿片类药物政策环境，从处罚到健康 - 基于国家产前和一般阿片类药物政策的结合；和2b）探索个人 - 国家总体政策气候对怀孕/产后妇女和新生儿的水平影响使用相同 结果和效果修改作为目标1。3。探索产前政策实施如何影响日常生活 对于孕妇及其新生儿。我们将：3A）应用合并框架进行实施 研究（CFIR）访谈与各州的60个主要利益相关者的访谈因其整体政策攀升而异 探索产前阿片类药物政策实施的多级驱动因素以及实施的变化如何影响 孕产妇和新生儿健康；和3b）创建一个民族志组，由40位使用阿片类药物的孕妇组成 在具有四个不同产前政策气候（惩罚性，亲社会，混血，无所作为）的各州，并进行三个 每年都有一年的访谈。我们将探讨产前阿片类药物政策实施的变化如何影响 妇女如何在产前和产后护理，MOUD使用和州服务中度过。调查结果将具有具体的房地产 通过描述国家阿片类药物政策对怀孕/产后妇女及其其影响的影响，从而产生影响 新生儿以及通过确定促进材料和婴儿福祉的干预点和政策变化。