Racialized & Structurally Urbanized Risk Environments for Pregnant/Postpartum Women who Use Drugs: a longitudinal qualitative study

摘要：在美国，女性吸毒(WWUD)的孕期和产后月份是 生活中最危险的国家之一：美国的孕产妇死亡率是所有工业化国家中最高的-- 在多个州，高达26%的孕产妇死亡归因于药物使用。差距是复杂的。 尽管黑人妇女的全因孕产妇死亡率更高，但与毒品有关的孕产妇死亡率- 白人女性的忠诚度要高得多。城乡不平等现象十分明显，而且还在不断扩大。公共卫生学家 很大程度上忽视了这场危机。自2010年以来，主要成瘾杂志上只有1.6%的文章涉及 妊娠期或产后期；孕产妇健康研究中也存在类似的沉默。建议的4- 因此，为期一年的纵向定性研究旨在帮助为多学科研究的新领域奠定基础。 帮助黑人、白人、城市和农村WWUD生存的各级流行病学研究和干预措施 在怀孕期间和产后。跨部门风险环境模型(IREM)的四大支柱指导着这一点 新的调查：减少危害、跨部门公平、跨部门风险环境和抵抗力。 减少伤害的原则让我们认识到，怀孕/产后WWUD对 毒品和性/生殖(SR)是毒品对他们造成的危害，并可能精心制作了有效的治疗方法。 预防这些伤害的技巧(例如，改变药物使用频率)。跨部门公平坚持认为怀孕/ 产后WWUD的药物和SR的健康问题和做法可能会随着交叉维度的不同而不同 他们的社会地位(例如，种族和乡村/城市)。Irem认为WWUD的社会、生态和 经济、物理、政策和医疗保健/刑事法律干预风险环境造成了这些差异， 这些环境是种族主义的和结构性的城市化--即资源已经被排斥-- 有条件地分配给城市和/或白人占多数的地区，并对农村和/或黑人占多数的地区造成危险。 Irem认为，可以通过个人和集体行动来抵抗危险。由IREM和咨询公司指导 WWUD董事会，我们将使用建构主义扎根理论和定性纵向研究 方法与一群生活在4个种族和结构中的黑人、白人、城市和农村WWUD“同行”。 佐治亚州城市化地区在怀孕和产后，收集了5波数据，以： 目标1.探索怀孕WWUD的(A)与药物和SR相关的健康问题和做法，以及它们如何变化 跨孕期和按种族、乡村/城市化和社会经济地位(SES)；以及(B)对其 民族化和结构性城市化的风险环境，它们在怀孕期间是如何演变的，以及这些 不断变化的环境塑造了WWUD的关切和实践。目的2.分析产后WWUD(A) 与药物和SR相关的问题和做法，以及它们在产后几个月中如何因种族、乡村/您- 平庸，和社会经济地位；以及(B)对其种族主义和结构性城市化风险环境的看法，如何 他们在产后不断演变，以及这些不断演变的环境如何塑造WWUD的关切和实践。

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.