Identifying Risk Factors for Prenatal Substance and Polysubstance Use

识别产前药物和多种药物使用的风险因素

• 批准号: 9891038
• 负责人: Kelly Corinne Young-Wolff
• 金额: $ 18.16万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-05-01 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9891038
• 关键词: Accounting; Address; Adult; Age; Alcohol consumption; Alcohol or Other Drugs use; Award; Behavioral; Big Data; Birth; California; Centers for Disease Control and Prevention (U.S.); Characteristics; Child; Clinical; Clinical Data; Complex; Congenital Abnormality; Data; Data Reporting; Development; Drug Screening; Drug Withdrawal Symptoms; Electronic Health Record; Elements; Environment; Epidemic; Ethics; Foundations; Funding; Goals; Gold; Grant; Guidelines; Healthcare; Healthcare Systems; High Risk Woman; Infant; Integrated Delivery of Health Care; Intervention; Judgment; Laws; Learning; Light; Low Birth Weight Infant; Low income; Medicaid; Medical Marijuana; Mental Health; Mental disorders; Mentored Research Scientist Development Award; Mentors; Methodology; Mothers; Newborn Infant; Opioid; Outcome; Patient Self-Report; Patients; Perinatal; Perinatal Epidemiology; Pharmaceutical Preparations; Phase; Pregnancy; Pregnant Women; Premature Labor; Prenatal care; Psyche structure; Psychologist; Public Health; Reporting; Research; Research Personnel; Risk; Risk Factors; Sample Size; San Francisco; Scientist; Second Pregnancy Trimester; Social Environment; Statistical Models; System; Testing; Third Pregnancy Trimester; Time; Time trend; Tobacco use; Toxicology; Training; Universities; Urine; Vulnerable Populations; Woman; Work; base; career; career development; cigarette smoking; combat; effective therapy; experience; illicit drug use; improved; innovation; intimate partner violence; marijuana legalization; marijuana use; meetings; opioid abuse; opioid use in pregnancy; perinatal outcomes; postnatal; predictive modeling; pregnant; prenatal; prenatal risk factor; prevent; screening; skills; stillbirth; substance use prevention; success; symposium; tool; trend

ABSTRACT This K01 proposal will provide Dr. Young-Wolff with the protected time and training she needs to transition to an independently funded researcher in the field of prenatal substance use (SU). Dr. Young-Wolff is a clinical psychologist and Research Scientist at the Kaiser Permanente Northern California (KPNC) Division of Research (DOR). The proposal builds on her background in preventing and treating SU in vulnerable populations and leverages the rich training environment afforded by DOR and the University of California, San Francisco to improve our understanding and treatment of prenatal SU. Prenatal SU has reached epidemic proportions. Up to half of women report illicit drug use, alcohol use, or cigarette smoking at some point during pregnancy. This is troubling as prenatal SU has significant and devastating consequences to both mother and infant. Existing research on prenatal SU, however, is often limited to older, self-reported data with women selected for SU screening based on clinician judgement, leaving the true scope of the problem unclear. Using KPNC’s rich electronic health record, the proposed study addresses these limitations using gold-standard (self-report and urine toxicology) data from universal prenatal SU screening with >376,000 pregnant women. Specifically, this study will: 1) establish trends in prenatal substance and polysubstance use from 2009-2017, 2) develop predictive models using clinical and demographic characteristics to identify women at greatest risk for continued prenatal SU, and 3) conduct a qualitative study among women who quit vs. persisted in SU during pregnancy to identify barriers to and facilitators of quitting. With high potential to be scalable, findings will provide the foundation for two R01 studies. The first will examine specific perinatal and postnatal outcomes related to prenatal SU by trimester of exposure, accounting for polysubstance use and socioenvironmental risk factors, and the second will develop and test a SU intervention targeted to the needs of women at greatest risk for continuing SU during pregnancy. Dr. Young-Wolff’s career development goals outline parallel training that is critical to the success of her future research, including training in: 1) perinatal epidemiology and prenatal SU prevention, treatment and ethics, 2) predictive statistical modeling, 3) leveraging complex EHR-derived clinical data, and 4) qualitative methodologies. These goals will be accomplished through support from an outstanding team of mentors, formal didactics, seminars, meetings, and conferences. Importantly, the proposed work is realistic and feasible within the award period and will allow Dr. Young-Wolff to continue to build research skills, generate preliminary data, create additional collaborative relationships, and compete for R01 funding. In summary, this K01 award will support and accelerate the career development activities of Dr. Young-Wolff and allow her to successfully launch the next phase of her career as an independently funded investigator.

摘要 这项K01计划将为杨-沃尔夫博士提供她需要的保护时间和培训 转变为产前物质使用(SU)领域的独立资助研究人员。杨-沃尔夫博士是 临床心理学家和研究科学家，在北加州凯撒永久(KPNC)分部 研究(DOR)。这项建议是建立在她预防和治疗脆弱的SU的背景之上的 并利用国防部和加州大学旧金山分校提供的丰富培训环境 以提高我们对围产期苏的认识和治疗。 产前SU已经达到了流行的程度。多达一半的女性报告使用非法药物，酗酒， 或在怀孕期间的某个时候吸烟。这是令人担忧的，因为产前SU具有显著的 对母亲和婴儿都造成了毁灭性的后果。然而，现有的关于产前SU的研究往往是 仅限于年龄较大的自我报告的数据，其中女性根据临床医生的判断选择进行SU筛查，离开 问题的真正范围尚不清楚。利用KPNC丰富的电子健康记录，拟议的研究 使用来自全球产前的黄金标准(自我报告和尿毒学)数据解决这些限制 对376,000名孕妇进行SU筛查。具体地说，这项研究将：1)建立产前趋势 2009-2017年物质和多物质使用情况，2)开发预测模型，使用临床和 人口学特征，以确定持续产前SU的最高风险女性，以及3)进行 在妊娠期戒烟与坚持服用SU的妇女中进行定性研究，以确定障碍和 戒烟的促进者。由于具有很高的可扩展性，这些发现将为两个R01提供基础 学习。第一项研究将通过妊娠三个月来检查与产前SU相关的特定围产期和出生后结局 暴露，考虑到多物质使用和社会环境风险因素，第二个将会发展 并针对妊娠期持续SU风险最高的女性的需求，测试SU干预措施。 杨-沃尔夫博士的职业发展目标勾勒出了对她的成功至关重要的平行培训 未来研究，包括以下方面的培训：1)围产期流行病学和产前SU预防、治疗和 伦理学，2)预测性统计建模，3)利用复杂的电子病历衍生的临床数据，以及4)定性 方法论。这些目标将通过一个杰出的导师团队的支持来实现， 正式的教学、研讨会、会议和会议。重要的是，拟议的工作是现实和可行的。 并将允许杨-沃尔夫博士继续培养研究技能，产生初步的 数据，创建更多的协作关系，并争夺R01资金。总而言之，这一K01奖项 将支持和加速杨-沃尔夫博士的职业发展活动，并使她成功地 开始她职业生涯的下一个阶段，成为一名独立资助的调查员。