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

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：对于美国吸毒女性（WWUD）来说，她们怀孕和产后的月份是 其中最危险的国家之一：美国是所有工业化国家中孕产妇死亡率最高的国家 且多个州高达 26% 的孕产妇死亡归因于药物使用，差异十分复杂。 尽管黑人妇女的全因孕产妇死亡率较高，但与毒品相关的孕产妇死亡率 - 农村/城市的不平等现象在白人女性中要高得多，而且公共卫生科学家的不平等现象还在不断扩大。 自 2010 年以来，主要的成瘾期刊中只有 1.6% 的文章讨论了这一危机。 怀孕或产后期；孕产妇健康研究中也存在类似的沉默。 4- 因此，年度纵向定性研究旨在帮助为多元研究的新领域奠定基础。 旨在帮助黑人、白人、城市和农村 WWUD 生存的流行病学研究和干预措施 跨部门风险环境模型 (IREM) 的四大支柱指导这一点。 新颖的探究：减少危害、交叉公平、交叉风险环境和抵抗力。 减少危害原则让我们认识到，孕期/产后 WWUD 对于以下问题有着重要的见解： 毒品和毒品可能对他们造成的性/生殖（SR）伤害，并且可能已经制定了有效的实践 防止这些伤害的措施（例如，改变药物使用频率）坚持认为怀孕/ 产后 WWUD 的药物和 SR 健康问题和实践可能会因交叉维度而异 他们的社会地位（例如种族和乡村/城市）表明 WWUD 的社会、生态特征。 经济、物理、政策和医疗保健/刑事法律干预风险环境造成这些变化， 而且这些环境是种族化的和结构城市化的——即资源不成比例 分配给城市和/或大多数白人地区，以及对农村和/或大多数黑人地区的危害。 IREM 认为可以通过 IREM 和咨询指导下的个人和集体行动来抵御危险。 WWUD 董事会，我们将使用建构主义扎根理论和定性纵向研究 方法来“并肩”生活在 4 个种族化和结构化的黑人、白人、城市和乡村的 WWUD 群体中 格鲁吉亚的城市化地区在怀孕和产后期间收集了 5 波数据，以便： 目标 1. 探索怀孕 WWUD 的 (a) 药物和 SR 相关健康问题和做法，以及它们如何变化 不同怀孕期、不同种族、农村/城市和社会经济地位 (SES)；以及 (b) 对她们的看法； 种族化和结构性城市化的风险环境，它们在怀孕期间如何演变，以及这些风险环境如何 不断变化的环境塑造了 WWUD 的关注点和实践 目标 2. 分析产后 WWUD 的 (a)。 与药物和 SR 相关的问题和做法，以及它们在产后几个月如何因种族、农村/地区而异 (b) 对种族化和结构性城市化风险环境的看法，如何 它们在产后发生变化，以及这些不断变化的环境如何影响 WWUD 的关注点和实践。