OVAL: Overdoses Among Black pregnant/Postpartum People and Laws Governing Drug Use in Pregnancy: A Mixed-Methods Project to Support Mobilization

OVAL：黑人怀孕/产后人群用药过量和妊娠期吸毒法律：支持动员的混合方法项目

• 批准号: 10755459
• 负责人: Hannah LF Cooper
• 金额: $ 70.42万
• 依托单位: MOREHOUSE SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-17 至 2030-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10755459
• 关键词: Accountability; American College of Obstetricians and Gynecologists; Area; Birth; Black Populations; Black race; Caring; Case Study; Child Abuse and Neglect; Communities; Country; Discrimination; Drug usage; Epidemic; Epidemiology; Harm Reduction; Health Personnel; Healthcare; Income; Inequity; Intervention; Justice; Laws; Legal; Location; Maternal Health; Maternal Mortality; Medicaid; Medicine; Methods; Modeling; Outcome; Overdose; Pathway interactions; Persons; Pharmaceutical Preparations; Postnatal Care; Postpartum Period; Postpartum Women; Poverty; Pregnant Women; Public Health; Reporting; Research; Shapes; Social Workers; Substance Use Disorder; Theoretical model; Time; United States Substance Abuse and Mental Health Services Administration; Variant; Woman; Women' s Health; administrative database; analytical method; behavioral health; black women; child protective service; community organizations; coral; design; drug classification; drug use in pregnancy; evidence base; experience; fighting; health service use; interest; mortality; neglect; overdose risk; pregnant; prenatal; reduced substance use; reproductive; spatiotemporal; treatment program

Abstract: Pregnant and postpartum women who are Black and use drugs are fighting to survive at the inter- section of 3 of the gravest public health crises of the 21st century US: (1) the maternal mortality epidemic; (2) an evolving overdose epidemic; and (3) intersectional discrimination. In a nation with the highest maternal mor- tality rate of all high-income countries, US Black women suffer mortality rates threefold higher than White women. Dire as this inequity is, a recent epidemiologic transformation of the US overdose epidemic is poised to widen it. While overdose mortality rates were markedly higher among White people for most of the 2000s, overdoses among Black people have surged recently, and since 2018 Black/White inequities have emerged. State legislatures have been actively responding to this crisis: 44 states have enacted >1 law governing drug use in pregnancy. Some laws are punitive, and seek to deter prenatal drug use through criminal sanctions (e.g., classifying drug use in pregnancy as child abuse/neglect). Others seek to expand substance use disorder (SUD) treatment for pregnant women (e.g., require that treatment programs prioritize pregnant women). Unfortunately, we know remarkably little about how these ubiquitous laws shape overdose or related health service use among Black pregnant/postpartum women who use drugs. In part, this silence reflects intersec- tional discrimination in medicine/public health: the field of maternal health has largely ignored people with be- havioral health conditions, and harm reduction has neglected pregnant/postpartum women, particularly Black women. The scant evidence that does exist is, however, alarming. The handful of studies on punitive laws largely confirm ACOG, CDC, and SAMHSA warnings that these laws undermine Black women’s health and healthcare use. The few studies of laws seeking to increase SUD treatment opportunities for pregnant women find that they have no effects or may actually reduce SUD treatment use among Black pregnant women. Guided by two Community Accountability Boards, the proposed study applies a mixed-methods sequential explanatory “QUAN qual” design to inaugurate a line of high-impact research and action into the possible ef- fects of select laws governing drug use in pregnancy on overdoses, SUD treatment use, and prenatal/ postna- tal care use among Black pregnant/postpartum women. Aims 1-3 are national in scope, and analyze multiple administrative databases to trace, for the first time, the pathways through which these 3 laws might shape Black pregnant/ postpartum women’s overdose risk and health service use. Aim 4 will explain and enrich Aim 1-3 findings through an in-depth qualitative case study of these pathways in one Metro Area (Atlanta). Aim 5 applies evidence-based community organizing methods to support community mobilization in Atlanta around select intervention targets identified in Aims 1-4. The proposed project will have high impact: it will help Black pregnant/ postpartum women who use drugs survive the collision of the Black maternal mortality and overdose epidemics, by either optimizing the benefits of laws governing drug use in pregnancy or mitigating their harms.

摘要：吸毒的黑人孕妇和产后妇女在中间挣扎着生存。 21 世纪美国 3 个最严重的公共卫生危机部分：(1) 孕产妇死亡流行病；(2) 不断发展的药物过量流行；(3) 在一个孕产妇死亡率最高的国家。 所有高收入国家的死亡率，美国黑人妇女的死亡率是白人的三倍 尽管这种不平等现象十分严重，但美国药物过量流行病最近的流行病学转变即将发生。 尽管在 2000 年代的大部分时间里，白人服药过量死亡率明显较高， 最近，黑人吸毒过量现象激增，自 2018 年以来，黑人与白人之间的不平等现象开始出现。 州立法机构一直在积极应对这场危机：44 个州颁布了 >1 法律管辖 一些法律是惩罚性的，旨在通过刑事制裁来阻止产前吸毒。 （例如，将怀孕期间吸毒归类为虐待/忽视儿童）。 (SUD) 对孕妇的治疗（例如，要求治疗计划优先考虑孕妇）。 不幸的是，我们对这些普遍存在的法律如何影响用药过量或相关健康知之甚少 在使用毒品的黑人孕妇/产后妇女中使用服务的情况在一定程度上反映了不同群体之间的关系。 医学/公共卫生领域的歧视：孕产妇保健领域在很大程度上忽视了患有以下疾病的人： 行为健康状况和减少伤害忽视了孕妇/产后妇女，特别是黑人 然而，关于惩罚性法律的研究却很少，令人震惊。 很大程度上证实了 ACOG、CDC 和 SAMHSA 的警告，即这些法律损害了黑人妇女的健康和健康 寻求增加孕妇 SUD 治疗机会的法律研究很少。 发现它们没有任何影响，或者实际上可能减少黑人孕妇中 SUD 治疗的使用。 在两个社区责任委员会的指导下，拟议的研究采用了混合方法顺序 解释性的“QUAN qual”设计开创了一系列高影响力的研究和行动，以实现可能的效果 管理妊娠期药物使用的特定法律对药物过量、SUD 治疗使用以及产前/产后的影响 黑人孕妇/产后妇女的护理使用情况 目标 1-3 是全国性的，并分析了多项。 行政数据库首次追踪这三项法律可能形成的途径 黑人孕妇/产后妇女的用药过量风险和卫生服务使用情况将解释和丰富目标 4。 1-3 通过对一个都会区（亚特兰大）的这些路径进行深入定性案例研究得出的结果。 应用基于证据的社区组织方法来支持亚特兰大周围的社区动员 选择目标 1-4 中确定的干预目标 拟议项目将产生重大影响：它将帮助布莱克。 使用毒品的孕妇/产后妇女在黑人孕产妇死亡和吸毒过量的冲突中幸存下来 通过优化妊娠期吸毒法律的好处或减轻其危害来控制流行病。