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.

翻译后摘要：在美国使用药物（WWUD）的妇女，他们怀孕和产后的月份是 其中最危险的生活：美国有最高的孕产妇死亡率的所有工业化国家， 在多个州，高达26%的孕产妇死亡归因于吸毒。差异是复杂的。 虽然黑人妇女的全因孕产妇死亡率较高，但与毒品有关的孕产妇死亡率- 在白色女性中的比例要高得多。农村/城市的不平等现象十分严重，而且在不断扩大。公共卫生科学家 在很大程度上忽视了这场危机。自2010年以来，主要成瘾期刊上只有1.6%的文章涉及 怀孕或产后期间;产妇保健研究方面存在类似的沉默。建议4- 因此，设计了一年的纵向定性研究，以帮助为穆尔的新竞技场奠定基础， 帮助黑人、白色人、城市人和农村人在WWUD生存的三级流行病学研究和干预措施 在怀孕和产后期间。交叉风险环境模型（IREM）的四大支柱指导这一点。 新颖的调查：减少伤害，交叉公平，交叉风险环境和阻力。 减少伤害的原则要求我们认识到，怀孕/产后WWUD对 毒品和性/生殖（SR）伤害，毒品可以为他们创造，并可能制定有效的实践， 防止这些伤害的方法（例如，改变药物使用频率）。交叉公平坚持认为怀孕/ 产后WWUD的药物和SR健康问题和实践可能会沿着 他们的社会地位（例如，种族和农村/城市化）。IREM认为，WWUD的社会，生态， 经济、物理、政策和医疗保健/刑事法律的干预风险环境产生了这些变化， 而且这些环境是种族化和结构化的城市化--即，资源被滥用- 分配给城市和/或白色占多数的地区的危险品，分配给农村和/或黑人占多数的地区的危险品。 IREM认为，可以通过个人和集体行动抵御危害。以IREM和咨询为指导 WWUD的董事会，我们将使用建构主义扎根理论和定性纵向研究 方法“走在一起”的黑人，白色，城市和农村WWUD生活在4个种族化和结构化的队列， 格鲁吉亚的城市化地区，而他们怀孕和产后，收集5波数据，以： 目标1。探索怀孕WWUD的（a）药物和SR相关的健康问题和做法，以及它们如何变化 在怀孕期间和种族，农村/城市和社会经济地位（SES）;和（B）他们的看法 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，以及这些风险如何在 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（a） 药物和SR相关的问题和做法，以及它们在产后几个月内如何按种族、农村/乌尔- 平庸，和社会经济地位;和（B）他们的种族化和结构城市化的风险环境的看法，如何 它们在产后演变，以及这些不断演变的环境如何塑造WWUD的关注点和实践。