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对育龄妇女的影响尤为严重 （15-44 岁），尤其是孕妇及其新生儿：20% 的孕妇服用阿片类药物 1,2 各国颁布了一般阿片类药物政策（例如，获得用于阿片类药物使用的药物 障碍（MOUD））和针对怀孕期间物质使用的特定政策，但这些政策对 孕妇的阿片类药物使用和新生儿结局仍然不明确。 阿片类药物的使用差异很大，导致孕妇使用阿片类药物的方法不一致。 方法项目，我们将应用收敛并行设计来检查单独和组合的影响和 州阿片类药物政策对使用医疗补助和商业的孕妇及其新生儿的影响 保险数据库 (MarketScan) 我们的目标是： 1. 检查一般状态和产前状态的单独影响。 针对孕妇/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 个州的政策。 产前阿片类药物政策（2011-2020），对政策变化进行分类并建立公开的时变政策 数据集；1b) 使用此产前政策数据集和一般阿片类药物政策的现有数据来探索个体- 一般和产前阿片类药物政策对阿片类药物使用障碍 (OUD)、MOUD 获取和新生儿的影响 孕妇及其新生儿的阿片类药物戒断综合征 (NOWS) 和 1c) 效果修正测试； 按母亲种族/民族和年龄分类 2. 研究一般和产前状态阿片类药物的综合影响。 针对孕妇/产后妇女及其新生儿的政策（2011-2020 年）。 孤立地使用单个策略，我们将： 2a）使用修改后的 Delphi 方法来创建随时间变化的分类法 每个州与孕妇相关的总体阿片类药物政策氛围，从惩罚到健康—— 根据各州的产前和一般阿片类药物政策相结合，促进并 2b) 探索个人- 各国总体政策环境对孕妇/产后妇女和新生儿的影响水平 目标 1 的结果和效果修改。 3. 探讨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) 应用综合实施框架。 研究 (CFIR) 对各州 60 个主要利益相关者进行访谈，这些利益相关者因总体政策环境而异， 探讨产前阿片类药物政策实施的多层次驱动因素以及实施差异如何影响 孕产妇和新生儿健康；3b) 创建一个由 40 名使用阿片类药物的孕妇组成的人种学队列 各州实施四种不同的产前气候政策（惩罚性、亲社会性、混合性、不作为），并开展三种政策 我们将探讨产前阿片类药物政策实施的变化如何影响。 妇女如何进行产前和产后护理、MOUD 的使用和国家服务的调查结果将具有具体的现实意义。 通过描述国家阿片类药物政策对孕妇/产后妇女及其妇女的影响来描述世界影响 新生儿，并确定促进孕产妇和婴儿福祉的干预点和政策变化。