Social Ecology of Maternal Substance Use

母亲物质使用的社会生态学

• 批准号: 8186216
• 负责人: Elizabeth A Mumford
• 金额: $ 23.27万
• 依托单位: NATIONAL OPINION RESEARCH CENTER
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-15 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8186216
• 关键词: Accounting; Affect; Alcohol abuse; Alcohol consumption; Alcohol or Other Drugs use; Alcohols; Attention; Behavior; Birth; Censuses; Characteristics; Child; Child health care; Cigarette; Clinical; Communities; Complex; Conceptions; Data; Data Set; Development; Diffusion; Disadvantaged; Ecology; Environment; Environmental Risk Factor; Epidemiology; Exhibits; Family; Feedback; Friends; Glass; Goals; Growth; Guidelines; Health; Health Services; Heterogeneity; Household; Individual; Intervention; Life; Longitudinal Surveys; Maternal and Child Health; Measures; Mediating; Mediation; Modeling; Mothers; Neighborhoods; Outcome; Parenting behavior; Pathway interactions; Pattern; Perception; Perinatal; Policies; Postnatal Care; Postpartum Period; Pregnancy; Pregnant Women; Prenatal care; Process; Process Measure; Public Health; Public Policy; Relapse; Research; Research Personnel; Resources; Risk; Risk Behaviors; Risk Factors; Role; Sampling; Smoking; Smoking Behavior; Social Characteristics; Social Environment; Social Interaction; Social Network; Socioeconomic Status; Subgroup; Techniques; Time; Tobacco; Tobacco use; Woman; Women' s Health; Work; base; cohesion; cohort; contagion; critical period; deprivation; drinking; drinking behavior; early childhood; health disparity; improved; infant outcome; interest; intergenerational; maternal cigarette smoking; multidisciplinary; population survey; postnatal; prenatal; reduced alcohol use; smoking cessation; smoking prevalence; smoking relapse; social; social capital; socioeconomics; theories; transmission process

DESCRIPTION (provided by applicant): Pregnancy is a key opportunity to affect the epidemiology and to enhance reduction of women's tobacco and problem alcohol use. The opportunities to provide pregnant women with tobacco and alcohol cessation resources appear to be strongest when integrated into community-based health services, with attention to generating support in mothers' networks of family and friends. Ecological models of maternal substance use to date have tended to examine a limited set of social processes or neighborhood structural characteristics but not both, to focus on smoking only, and to focus on infant outcomes, while studies of neighborhood effects on birth outcomes may fail to include maternal substance use. The limited development of contextual theory focused on maternal substance use as an outcome is part of the problem. The goal of the proposed research is to investigate the role of neighborhood structural aspects and social processes in association with maternal alcohol and tobacco use in the perinatal and early childhood parenting periods. Specifically, we will investigate the relationship between individual characteristics of mothers (in a nationally representative dataset) and the social ecology of neighborhoods as predictors of maternal alcohol and tobacco use patterns over time. The availability of a rich set of neighborhood social process variables in the Birth Cohort of the Early Childhood Longitudinal Survey dataset will be augmented by constructs of neighborhood socioeconomic status and material deprivation based on data from the 2000 Census, and neighborhood smoking prevalence estimates from the Current Population Survey-Tobacco Use Supplement 2000. Our proposed research will examine how neighborhood structural characteristics and social processes relate to each other and to individual characteristics that are the proximate determinants of maternal substance use from preconception through the early childhood parenting period. Diverging from most research to date, we will apply latent class analysis and growth mixture modeling to characterize profiles of mothers according to both their alcohol and tobacco use and individual trajectories of use over time. Individual and neighborhood measures will be examined for direct effects associated with these patterns and trajectories. Subsequently, we will apply latent variable pathway analyses to assess potential mediation of neighborhood latent variables by individual characteristics, and we will analyze whether results of pathway analyses apply to different subgroups of our sample (moderation analyses). The results will be applied toward further research in three directions: policy and interventions for mothers, the study of child health outcomes, and enhanced research in social processes, structural effects, and policy inputs during a critical period for women's and children's health. PUBLIC HEALTH RELEVANCE: Public health and clinical initiatives to protect maternal and child health by reducing alcohol and tobacco use during pregnancy work for some but not all women, and even women who reduce use during pregnancy tend to relapse after the birth of their child. It is essential to have a better understanding of the patterns of women's substance use from pre-conception through early childhood parenting, elucidating the social context that supports or hinders healthy behaviors. This research will inform clinical guidelines for prenatal and postnatal care (key intervention opportunities), particularly in terms of targeting specific subpopulations and reducing maternal and child health disparities.

描述（由申请人提供）：怀孕是影响流行病学和促进减少妇女吸烟和酗酒的关键机会。如果将戒烟和戒酒资源纳入社区保健服务，向孕妇提供戒烟和戒酒资源的机会似乎最大，同时注意在母亲的家庭和朋友网络中获得支持。到目前为止，产妇物质使用的生态模型往往会检查一组有限的社会过程或邻里结构特征，但不是两者兼而有之，只关注吸烟，并专注于婴儿的结果，而对出生结果的邻里影响的研究可能无法包括产妇物质的使用。背景理论的有限发展集中在母亲的物质使用作为一个结果是问题的一部分。拟议的研究的目标是调查邻里结构方面的作用和社会进程与母亲的酒精和烟草的使用在围产期和幼儿养育期。具体来说，我们将调查母亲的个人特征（在全国代表性的数据集）和社区的社会生态之间的关系，随着时间的推移，母亲的酒精和烟草使用模式的预测。一组丰富的邻里社会过程变量的出生队列的早期儿童纵向调查数据集的可用性将增加邻里社会经济地位和物质匮乏的基础上，从2000年人口普查的数据，和邻里吸烟流行率估计从当前人口调查烟草使用补充2000年的结构。我们提出的研究将探讨邻里结构特征和社会过程如何相互关联，以及与个体特征的关系，这些特征是从孕前到幼儿养育期母亲使用物质的直接决定因素。与迄今为止的大多数研究不同，我们将应用潜在类别分析和增长混合模型来描述母亲的个人资料，根据她们的酒精和烟草使用情况以及随着时间的推移的个人使用轨迹。将检查与这些模式和轨迹相关的直接影响的个人和邻里措施。随后，我们将应用潜变量路径分析来评估个体特征对邻域潜变量的潜在中介作用，并分析路径分析的结果是否适用于我们样本的不同亚组（适度分析）。研究结果将应用于三个方向的进一步研究：针对母亲的政策和干预措施，儿童健康结果的研究，以及在妇女和儿童健康的关键时期加强对社会过程、结构影响和政策投入的研究。 公共卫生相关性：通过减少怀孕期间饮酒和吸烟来保护孕产妇和儿童健康的公共卫生和临床举措对一些但不是所有妇女都有效，即使是怀孕期间减少吸烟的妇女在孩子出生后也往往会复发。必须更好地了解妇女从受孕前到幼儿养育的物质使用模式，阐明支持或阻碍健康行为的社会背景。这项研究将为产前和产后护理（关键的干预机会）提供临床指导，特别是在针对特定亚群和减少孕产妇和儿童健康差距方面。