Social Ecological Contexts of Opioid Overdose and Hospital Readmission in the Postpartum Period

项目概要/摘要 这个F31奖学金的目标是准备我成为一个独立的研究人员谁可以有效地 有助于解决使妇女面临使用阿片类药物风险的个人和社会生态环境问题 以及产后用药过量在美国，怀孕期间的阿片类药物使用障碍（OUD） 自1999年以来翻了两番，过量用药成为非妊娠相关死亡的主要原因， 孕妇和产后妇女。虽然在怀孕期间识别和治疗OUD是一项公共卫生 优先，有限的关注已经给予过量和医院再入院的风险， 患有OUD的妇女（此处定义为分娩后第一年内）。流行病学数据表明 妇女在分娩后7 - 12个月的过量风险最高，比怀孕前高出25%。 不太了解的是共病的健康问题，系统的社会条件，和有限的健康和社会 OUD妇女在分娩后继续在其社区面临的服务。在我的指导下， 导师团队和加强从这个奖学金的培训，我将利用住院医院的数据， 宾夕法尼亚州卫生保健成本控制理事会（PHC4）评估女性再次入院情况 在分娩后一年内发生OUD。数据将与社区级数据源合并，例如 美国人口普查和SAMSHA的行为健康治疗服务，以确定如何社区 背景影响产后阿片类药物的结果。本研究的具体目的是：1）确定 分娩时患有OUD的女性产后总体和阿片类药物特异性住院的风险增加; 2） 检查社区层面的因素和个人类成员之间的关联，以及它们的 对产后阿片类药物相关住院的独立影响;和3）检查 OUD妇女的住院分娩和产后阿片类药物相关再入院，并确定 社区因素与邮政编码水平的交付和再入院计数。完成 建议的研究，我将实施一个全面的培训和指导计划，将建立在我以前的 物质使用知识，研究经验和博士培训。具体而言，我的培训目标将 重点是扩大我在以下方面的知识和/或技能：1）生殖健康和孕妇和孕妇中的阿片类药物使用， 产后妇女; 2）物质使用的社会和生态决定因素; 3）潜在类别分析; 4） 多水平分析; 5）空间分析。这些目标将通过一系列的课程来实现， 研讨会、临床观察、会议、期刊阅读和来自承诺团队的定制指导 跨学科的研究人员。辅以专门的研究和培训环境的支持 在匹兹堡大学公共卫生研究生院，这项奖学金将加速我在 成为一名独立的研究人员，专注于减少与产妇药物使用相关的不公平现象。

PROJECT SUMMARY/ABSTRACT The goal of this F31 fellowship is to prepare me to become an independent researcher who can effectively contribute to addressing the individual and social ecological contexts that place women at risk for opioid use and overdose in the postpartum period. In the United States, opioid use disorder (OUD) during pregnancy has quadrupled since 1999, with overdose becoming a leading cause of non-pregnancy related death among pregnant and postpartum women. While identifying and treating OUD during pregnancy is a public health priority, limited attention has been given to the overdose and hospital readmission risks among postpartum women (defined here as being within the first year after childbirth) with OUD. Epidemiological data suggest women are at highest risk of overdose 7-12 months post-delivery with rates 25% higher than at pre-conception. Less understood are the co-morbid health issues, systemic social conditions, and limited health and social services women with OUD continue to face in their communities after childbirth. Under the guidance of my mentorship team and enhanced by the training from this fellowship, I will utilize inpatient hospital data from the Pennsylvania Health Care Cost Containment Council (PHC4) to assess hospital readmissions among women with OUD within one year of childbirth. Data will be merged with community-level data sources, such as the U.S. Census and SAMSHA’s Behavioral Health Treatment Services Locator, to determine how community context impacts postpartum opioid outcomes. The Specific Aims of this study are to: 1) Identify subgroups of women with OUD at delivery at increased risk of overall and opioid-specific hospitalizations postpartum; 2) Examine the association between community-level factors and individual class memberships, as well as their independent effects on postpartum opioid-related hospitalizations; and 3) Examine the spatial distribution of hospital births and postpartum opioid-related readmissions among women with OUD, and identify the community factors associated with ZIP code-level counts of deliveries and readmissions. To accomplish the proposed research, I will implement a comprehensive training and mentorship plan that will build on my prior substance use knowledge, research experience, and doctoral training. Specifically, my Training Goals will focus on expanding my knowledge and/or skills in: 1) reproductive health and opioid use among pregnant and postpartum women; 2) social and ecological determinants of substance use; 3) latent class analyses; 4) multilevel analyses; and 5) spatial analyses. These goals will be accomplished through a range of coursework, seminars, clinical observations, conferences, journal readings, and tailored mentoring from a committed team of interdisciplinary researchers. Complemented by support from a dedicated research and training environment at the University of Pittsburgh Graduate School of Public Health, this fellowship will accelerate my trajectory in becoming an independent researcher focused on reducing inequities associated with maternal substance use.