Racialized & Structurally Urbanized Risk Environments for Pregnant/Postpartum Women who Use Drugs: a longitudinal qualitative study

种族化

• 批准号: 10639425
• 负责人: Hannah LF Cooper
• 金额: $ 69.93万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10639425
• 关键词: Address; Area; Black race; Cessation of life; Collaborations; Communities; Complex; Data; Developed Countries; Dimensions; Disease; Disparity; Drug usage; Drug user; Economics; Environment; Equity; Etiology; Fostering; Foundations; Frequencies; General Population; Generations; Harm Reduction; Health; Health Promotion; Healthcare; Individual; Inequity; Intervention; Investigation; Journals; Learning; Legal Intervention; Link; Longitudinal Studies; Maternal Health; Maternal Mortality; Methods; Modeling; Needle-Exchange Programs; Pathway interactions; Perception; Pharmaceutical Preparations; Policies; Postpartum Period; Postpartum Women; Pregnancy; Pregnant Women; Public Health; Publishing; Qualitative Methods; Race; Reproductive Health; Research; Research Methodology; Resistance; Resources; Review Committee; Risk; Rural; Sampling; Scientist; Shapes; Social status; Socioeconomic Status; Testing; Time; Urbanicity; Urbanization; Variant; Walking; Woman; addiction; amphetamine use; black women; cohort; constructivism; design; effective intervention; epidemiology study; experience; hazard; insight; neglect; novel; opioid use disorder; overdose death; pregnant; prenatal; prevent; reproductive; rural area; rurality; scale up; social; theories; therapy development; Address; Area; Black race; Cessation of life; Collaborations; Communities; Complex; Data; Developed Countries; Dimensions; Disease; Disparity; Drug usage; Drug user; Economics; Environment; Equity; Etiology; Fostering; Foundations; Frequencies; General Population; Generations; Harm Reduction; Health; Health Promotion; Healthcare; Individual; Inequity; Intervention; Investigation; Journals; Learning; Legal Intervention; Link; Longitudinal Studies; Maternal Health; Maternal Mortality; Methods; Modeling; Needle-Exchange Programs; Pathway interactions; Perception; Pharmaceutical Preparations; Policies; Postpartum Period; Postpartum Women; Pregnancy; Pregnant Women; Public Health; Publishing; Qualitative Methods; Race; Reproductive Health; Research; Research Methodology; Resistance; Resources; Review Committee; Risk; Rural; Sampling; Scientist; Shapes; Social status; Socioeconomic Status; Testing; Time; Urbanicity; Urbanization; Variant; Walking; Woman; addiction; amphetamine use; black women; cohort; constructivism; design; effective intervention; epidemiology study; experience; hazard; insight; neglect; novel; opioid use disorder; overdose death; pregnant; prenatal; prevent; reproductive; rural area; rurality; scale up; social; theories; therapy development

Abstract: For women who use drugs (WWUD) in the US, the months they are pregnant and postpartum are among the most hazardous of their lives: the US has the highest maternal mortality rate of all industrialized na- tions, and up to 26% of maternal deaths in multiple states are attributed to drug use. Disparities are complex. Though all-cause maternal mortality rates are higher for Black women, rates of drug-related maternal mortal- ity are far higher among White women. Rural/urban inequities are stark and widening. Public health scientists have largely neglected this crisis. Since 2010, just 1.6% of articles in major addiction journals have addressed pregnancy or the postpartum period; a parallel silence exists in maternal health research. The proposed 4- year longitudinal qualitative study is thus designed to help lay the foundations for a new arena of mul- tilevel epidemiologic research and interventions to help Black, White, urban, and rural WWUD survive while pregnant and postpartum. Four pillars of the Intersectional Risk Environment Model (IREM) guide this novel inquiry: harm reduction, intersectional equity, intersectional risk environments, and resistance. Harm reduction principles invite us to recognize that pregnant/postpartum WWUD have vital insights into the drug and sexual/reproductive (SR) harms that drugs can create for them, and may have crafted effective prac- tices to prevent these harms (e.g., altering drug use frequency). Intersectional equity insists that pregnant/ postpartum WWUD’s drug and SR health concerns and practices may vary along intersecting dimensions of their social position (e.g., race and rurality/urbanicity). IREM suggests that features of WWUD’s social, eco- nomic, physical, policy, and healthcare/criminal legal intervention risk environments create these variations, and that these environments are racialized and structurally urbanized–i.e., resources have been dispropor- tionately allocated to urban and/or majority White areas, and hazards to rural and/or majority Black areas. IREM posits that hazards can be resisted via individual and collective action. Guided by IREM and Advisory Boards of WWUD, we will use Constructivist Grounded Theory and Qualitative Longitudinal Research methods to “walk alongside” a cohort of Black, White, urban, and rural WWUD living in 4 racialized and struc- turally urbanized regions of Georgia while they are pregnant and postpartum, gathering 5 waves of data, to: Aim 1. Explore pregnant WWUDs’ (a) drug- and SR-related health concerns and practices, and how they vary across pregnancy and by race, rurality/urbanicity, and socioeconomic status (SES); and (b) perceptions of their racialized and structurally urbanized risk environments, how they evolve during pregnancy, and how these evolving environments shape WWUD’s concerns and practices. Aim 2. Analyze postpartum WWUD’s (a) drug- and SR-related concerns and practices, and how they vary in the postpartum months by race, rurality/ur- banicity, and SES; and (b) perceptions of their racialized and structurally urbanized risk environments, how they evolve postpartum, and how these evolving environments shape WWUD’s concerns and practices.

摘要：对于在美国使用毒品（WWUD）的女性，她们怀孕的月和产后的月份 在他们一生中最危险的一家：美国在所有工业化的NA-中的孕产妇死亡率最高 多个州的孕产妇死亡中最多26％归因于毒品使用。差异很复杂。 尽管黑人妇女的全因孕产妇死亡率更高，但与药物相关的孕产性凡人的率 白人妇女中它要高得多。农村/城市不平等现象很明显，正在扩大。公共卫生科学家 在很大程度上忽略了这一危机。自2010年以来，主要成瘾期刊中只有1.6％的文章已经解决 怀孕或产后期；母校健康研究中存在平行的沉默。提议的4- 因此，一年的纵向定性研究旨在帮助建立新的Mul-领域的基础 瓷砖流行病学研究和干预措施，以帮助黑色，白色，城市和粗糙生存 怀孕和产后。交叉风险环境模型（IREM）指南的四个支柱 新颖的调查：减少危害，交叉平等，交叉风险环境和抵抗力。 减少危害原则邀请我们认识到怀孕/产后WWUD对 药物和性/生殖（SR）损害药物可以为它们创造的药物，并可能制定了有效的prac- 防止这些危害的TICE（例如改变药物使用频率）。交叉权益坚持认为怀孕/ 产后WWUD的药物和SR健康问题和实践可能会随着相交的范围而有所不同 他们的社会地位（例如种族和乡村/城市化）。 IREM建议WWUD的社交，生态 - 官员，身体，政策和医疗/刑事法律干预风险环境创造了这些变化， 这些环境是种族化的，结构化的城市化 - i。 分配给城市和/或多数白人地区，以及对黑色和/或多数黑色地区的危害。 IREM认为可以通过个人和集体行动抵抗危害。由IREM和咨询指导 WWUD董事会，我们将使用建构主义的理论和定性纵向研究 “同行”一组黑色，白色，城市和粗糙的wwud的方法生活在4种种族化和结构中 - 佐治亚州的特拉利城市化地区怀孕和产后，收集了5个数据浪潮， AIM 1。探索孕妇的wwuds’（a）毒品和SR相关的健康问题和实践，以及它们如何变化 整个怀孕以及种族，农村/城市化和社会经济地位（SES）； （b）对他们的看法 种族化和结构化的城市化风险环境，它们在怀孕期间如何发展以及如何发展 不断发展的环境塑造了WWUD的关注和实践。目标2。分析产后WWUD（a） 与药物和SR相关的关注和实践，以及它们在产后按种族，粗糙度/ur-的变化 卑鄙的人和SES； （b）对其种族化和结构化城市化风险环境的看法，如何 他们进化产后，以及这些进化环境如何塑造WWUD的关注和实践。