A Preconception Health Intervention to Reduce Substance Exposed Pregnancies among Incarcerated Women

减少被监禁妇女怀孕期间接触药物的孕前健康干预

• 批准号: 10369477
• 负责人: Jennifer Bello Kottenstette
• 金额: $ 17.33万
• 依托单位: SAINT LOUIS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-01 至 2027-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10369477
• 关键词: Address; Affect; Age; Alcohol consumption; Alcohols; American; Awareness; Behavior Therapy; Behavioral Model; Birth; Cessation of life; Child; Child Custody; Community Health; Contraceptive Usage; Contraceptive methods; County; Coupled; Criminal Justice; Diagnosis; Drug usage; Elements; Ensure; Environment; Exposure to; Family; Family Practice; Family health status; Fetal Alcohol Exposure; Fetal Growth Retardation; Focus Groups; Future; Goals; Health; Illicit Drugs; Imprisonment; Incidence; Intervention; Jail; Justice; Legal; Life; Live Birth; Longevity; Medicine; Mental Depression; Mission; Mothers; Motivation; National Institute of Drug Abuse; Neonatal Abstinence Syndrome; Newborn Infant; Outcome; Palpable; Parents; Patients; Pharmaceutical Preparations; Population; Pregnancy; Prevalence; Preventive; Public Health; Recording of previous events; Reproductive Health; Research; Research Activity; Research Assistant; Research Personnel; Risk; Sexually Transmitted Diseases; Societies; Statistical Methods; Substance Use Disorder; Supervision; Surveys; System; Target Populations; Testing; Time; Tobacco Use Cessation; Tobacco Use Disorder; Touch sensation; Training; United States National Institutes of Health; Woman; Work; addiction; adverse birth outcomes; adverse outcome; alcohol consequences; alcohol exposure; alcohol intervention; alcohol risk; alcohol use disorder; base; birth control; brief advice; clinical practice; clinically significant; condoms; contraceptive efficacy; court; drug abstinence; drug relapse; education planning; efficacy outcomes; efficacy testing; evidence base; experience; group intervention; health equity; high risk; high risk drinking; high risk population; high risk sexual behavior; illicit drug use; improved; in utero; innovation; interest; motivational enhancement therapy; opioid epidemic; pilot test; pregnant; premature; recruit; reproductive; sex; sexual encounter; substance use; therapy design; therapy development; treatment program; treatment strategy; unintended pregnancy

PROJECT SUMMARY The devastating effects of illicit substance use during pregnancy on mothers and children is widespread, affecting more than 500,000 births between 2017 and 2018. Adverse birth outcomes can include fetal growth restriction, neonatal abstinence syndrome, prematurity, and death. Illicit drug use during pregnancy puts women at risk of activities that expose them to sexually transmitted infections and legal consequences including loss of child custody and incarceration. Long-term negative consequences for children exposed to substances in-utero range from growing up in an environment where one or both parents have substance use disorders (SUD) to increased risk of depression, developing SUD themselves, and suffering from abuse. While the American Society of Addiction Medicine recommends reproductive planning education be incorporated into SUD treatment programs, interventions have primarily focused on increasing access to birth control and treatment strategies for women already pregnant. A proactive approach to address substance use prior to pregnancy, in the preconception period, is needed. Preconception interventions that address alcohol and tobacco cessation have been found effective. However, to our knowledge, there are no interventions to address preconception illicit substance use. The prevalence of SUD among women in jail is as high as 63% and this population is at risk of both drug relapse and pregnancy after release. There is an optimal period of time (prior to release) when preconception SUD interventions are feasible and ideal for this population. Using a proactive approach for women in jail and before pregnancy will reduce the risk of substance exposed pregnancies (SEPs) and mitigate the numerous negative consequences for mothers, newborns, and families. The proposed study will be the first to adapt an evidence-based preconception intervention, CHOICES, for use among incarcerated women with illicit SUD. CHOICES was developed to reduce the risk of alcohol- exposed pregnancies by targeting both risky drinking and effective contraceptive use.1 The proposed study will adapt CHOICES for use among incarcerated women with illicit SUD who are at risk for an SEP when they are released. The specific aims of this project are to: (1) adapt CHOICES for use among incarcerated women with illicit drug-related SUD to create a manualized intervention, CHOICES-PLEAS (Pregnancy Liberated from Exposure to Alcohol and Substances) and (2) evaluate the feasibility, acceptability, and efficacy of CHOICES- PLEAS at reducing the risk of SEPs (continued drug abstinence and/or reduction in risky sexual behavior) among women in a court-mandated SUD treatment program. Through completion of these aims and additional training in behavioral intervention design, advanced statistical methods, and SUD treatment for reproductive-age women, the trainee, Dr. Bello, will gain the expertise necessary to be an independent investigator. Her long-term goal is to establish herself as an independent investigator with expertise in addressing the reproductive health needs of women with SUD.

项目摘要 怀孕期间使用非法药物对母亲和儿童的破坏性影响是普遍的， 2017年至2018年间影响了50多万名新生儿。不良的出生结果可能包括胎儿生长 限制，新生儿禁欲综合征，早产和死亡。怀孕期间使用非法药物 有可能从事使她们受到性传播感染的活动的妇女及其法律的后果 包括失去孩子监护权和监禁对儿童的长期不利影响 从在父母一方或双方都有物质使用的环境中长大， 抑郁症（SUD）的风险增加，发展SUD本身，并遭受虐待。 虽然美国成瘾医学会建议生殖计划教育， 纳入SUD治疗计划，干预措施主要集中在增加生育机会 对已怀孕妇女的控制和治疗策略。采取积极主动的办法解决物质使用问题 在怀孕前，在怀孕前，是必要的。针对酒精的孕前干预措施 戒烟是有效的。然而，据我们所知，没有干预措施， 解决怀孕前非法使用药物的问题。在监狱中的女性中，SUD的患病率高达63%。 这一人群在释放后有复吸和怀孕的风险。有一个最佳时期， 孕前SUD干预对该人群可行且理想的时间（发布前）。使用 对监狱中和怀孕前的妇女采取积极主动的做法将减少接触药物的风险 这是一个非常有效的方法，可以帮助孕妇（SEPs），并减轻对母亲、新生儿和家庭的许多负面影响。 这项拟议的研究将是第一个采用基于证据的受孕干预措施（选择）的研究， 在患有非法SUD的被监禁妇女中使用。选择是为了减少酒精的风险而开发的- 通过针对危险饮酒和有效避孕措施的使用，1这项拟议的研究将 调整选择，用于患有非法SUD的被监禁妇女，这些妇女在 发布该项目的具体目标是：（1）调整《选择》，供被监禁妇女使用， 与非法药物有关的SUD，以创建一个手动干预，选择-PLEAS（ 暴露于酒精和物质）和（2）评估选择的可行性，可接受性和有效性- PLEAS降低SEP风险（持续戒毒和/或减少危险性行为） 在法庭强制的SUD治疗项目中的女性中。 通过完成这些目标和行为干预设计的额外培训， 统计方法和育龄女性的SUD治疗，学员Bello博士将获得 具备成为独立调查员所需的专业知识。她的长期目标是建立自己作为一个 在满足SUD妇女生殖健康需求方面具有专业知识的独立调查员。