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Correlates of Pregnant Women’s Participation in a Substance Use Assessment and Counseling Intervention Integrated into Prenatal Care

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Abstract

Introduction

Screening and referral for substance use are essential components of prenatal care. However, little is known about barriers to participation in substance use interventions that are integrated within prenatal care.

Methods

Our study examines demographic and clinical correlates of participation in an initial assessment and counseling intervention integrated into prenatal care in a large healthcare system. The sample comprised Kaiser Permanente Northern California pregnant women with a live birth in 2014 or 2015 who screened positive for prenatal substance use via a self-reported questionnaire and/or urine toxicology test given as part of standard prenatal care (at ~ 8 weeks gestation).

Results

Of the 11,843 women who screened positive for prenatal substance use (median age = 30 years; 42% white; 38% screened positive for alcohol only, 20% for cannabis only, 5% nicotine only, 17% other drugs only, and 19% ≥ 2 substance categories), 9836 (83%) completed the initial substance use assessment and counseling intervention. Results from multivariable logistic regression analyses indicated that younger age, lower income, single marital status, and a positive urine toxicology test predicted higher odds of participation, while other/unknown race/ethnicity, greater parity, receiving the screening later in pregnancy, and screening positive for alcohol only or other drugs only predicted lower odds of participation (all Ps < .05).

Discussion

Findings suggest that integrated substance use interventions can successfully reach vulnerable populations of pregnant women (e.g., younger, lower income, racial/ethnic minorities). Future research should address whether differences in participation are due to patient (e.g., type of substance used, perceived stigma) or provider factors (e.g., working harder to engage traditionally underserved patients).

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References

  1. American College of Obstetricians Gynecologists Committee on Health Care for Undeserved Women. (2006). ACOG Committee Opinion No. 343: Psychosocial risk factors: Perinatal screening and intervention. Obstetrics and Gynecology,108, 469–477.

  2. Armstrong, M. A., Gonzales Osejo, V., Lieberman, L., Carpenter, D. M., Pantoja, P. M., & Escobar, G. J. (2003). Perinatal substance abuse intervention in obstetric clinics decreases adverse neonatal outcomes. Journal of Perinatology,23, 3–9.

  3. Armstrong, M. A., Lieberman, L., Carpenter, D. M., Gonzales, V. M., Usatin, M. S., Newman, L., et al. (2001). Early Start: An obstetric clinic-based, perinatal substance abuse intervention program. Quality Management in Health Care,9, 6–15.

  4. Clark, K. A., Dee, D. L., Bale, P. L., & Martin, S. L. (2001). Treatment compliance among prenatal care patients with substance abuse problems. American Journal of Drug and Alcohol Abuse,27, 121–136.

  5. Committee on Obstetric Practice. (2017a). Committee opinion no. 711: Opioid use and opioid use disorder in pregnancy. Obstetrics and Gynecology,130, e81–e94.

  6. Committee on Obstetric Practice. (2017b). Committee opinion no. 722: Marijuana use during pregnancy and lactation. Obstetrics and Gynecology,130, e205–e209.

  7. Corrarino, J. E., Williams, C., Campbell, W. S., Amrhein, E., LoPiano, L., & Kalachik, D. (2000). Linking substance-abusing pregnant women to drug treatment services: a pilot program. Journal of Obstetric, Gynecologic, and Neonatal Nursing,29, 369–376.

  8. Department of Health and Human Services. (2008). The Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020, Phase I report: Recommendations for the framework and format of Healthy People 2020. Retrieved January 31, 2020, from https://www.healthypeople.gov/sites/default/files/PhaseI_0.pdf.

  9. Goler, N. C., Armstrong, M. A., Taillac, C. J., & Osejo, V. M. (2008). Substance abuse treatment linked with prenatal visits improves perinatal outcomes: a new standard. Journal of Perinatology,28, 597–603.

  10. Goler, N. C., Armstrong, M. A., Osejo, V. M., Hung, Y. Y., Haimowitz, M., & Caughey, A. B. (2012). Early start: a cost-beneficial perinatal substance abuse program. Obstetrics and Gynecology,119, 102–110.

  11. Haller, D. L., Miles, D. R., & Dawson, K. S. (2003). Factors influencing treatment enrollment by pregnant substance abusers. American Journal of Drug and Alcohol Abuse,29, 117–131.

  12. Haug, N. A., Duffy, M., & McCaul, M. E. (2014). Substance abuse treatment services for pregnant women: psychosocial and behavioral approaches. Obstetrics and Gynecology Clinics of North America,41, 267–296.

  13. Howell, E. M., & Chasnoff, I. J. (1999). Perinatal substance abuse treatment. Findings from focus groups with clients and providers. Journal of Substance Abuse Treatment,17, 139–148.

  14. Jackson, A., & Shannon, L. (2012). Barriers to receiving substance abuse treatment among rural pregnant women in Kentucky. Maternal and Child Health Journal,16, 1762–1770.

  15. Krans, E. E., Bobby, S., England, M., Gedekoh, R. H., Chang, J. C., Maguire, B., et al. (2018). The Pregnancy Recovery Center: A women-centered treatment program for pregnant and postpartum women with opioid use disorder. Addictive Behaviors,86, 124–129.

  16. Messer, K., Clark, K. A., & Martin, S. L. (1996). Characteristics associated with pregnant women's utilization of substance abuse treatment services. American Journal of Drug and Alcohol Abuse,22, 403–422.

  17. Ordean, A., & Kahan, M. (2011). Comprehensive treatment program for pregnant substance users in a family medicine clinic. Canadian Family Physician,57, e430–435.

  18. Paine, L. L., & Garceau, L. M. (1999). Health behaviors during pregnancy: risks and interventions. In M. C. McCormick & J. E. Siegel (Eds.), Prenatal care effectiveness and implementation (pp. 33–62). New York: Cambridge University Press.

  19. Polakowski, L. L., Akinbami, L. J., & Mendola, P. (2009). Prenatal smoking cessation and the risk of delivering preterm and small-for-gestational-age newborns. Obstetrics and Gynecology,114, 318–325.

  20. Salas-Wright, C. P., Vaughn, M. G., Ugalde, J., & Todic, J. (2015). Substance use and teen pregnancy in the United States: evidence from the NSDUH 2002–2012. Addictive Behaviors,45, 218–225.

  21. Substance Abuse and Mental Health Services Administration. (2013). Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings. NSDUH Series H-46, HHS Publication No. (SMA) 13–4795. Retrieved January 31, 2020, from https://www.samhsa.gov/data/sites/default/files/NSDUHresults2012/NSDUHresults2012.pdf.

  22. Sutter, M. B., Gopman, S., & Leeman, L. (2017). Patient-centered care to address barriers for pregnant women with opioid dependence. Obstetrics and Gynecology Clinics of North America,44, 95–107.

  23. Sweeney, P. J., Schwartz, R. M., Mattis, N. G., & Vohr, B. (2000). The effect of integrating substance abuse treatment with prenatal care on birth outcome. Journal of Perinatology,20, 219–224.

  24. Terplan, M., McNamara, E. J., & Chisolm, M. S. (2012). Pregnant and non-pregnant women with substance use disorders: The gap between treatment need and receipt. Journal of Addictive Diseases,31, 342–349.

  25. Young-Wolff, K. C., Tucker, L. Y., Alexeeff, S., Armstrong, M. A., Conway, A., Weisner, C., et al. (2017). Trends in self-reported and biochemically tested marijuana use among pregnant females in California from 2009–2016. JAMA,318, 2490–2491.

  26. Young-Wolff, K. C., Sarovar, V., Tucker, L. Y., Avalos, L. A., Conway, A., Armstrong, M. A., et al. (2018). Association of nausea and vomiting in pregnancy with prenatal marijuana use. JAMA Internal Medicine,178, 1423–1424.

  27. Young-Wolff, K. C., Sarovar, V., Tucker, L. Y., Avalos, L. A., Alexeeff, S., Conway, A., et al. (2019a). Trends in marijuana use among pregnant women with and without nausea and vomiting in pregnancy, 2009–2016. Drug and Alcohol Dependence,196, 66–70.

  28. Young-Wolff, K. C., Sarovar, V., Tucker, L. Y., Conway, A., Alexeeff, S., Weisner, C., et al. (2019b). Self-reported daily, weekly, and monthly cannabis use among women before and during pregnancy. JAMA Network Open,2, e196471.

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Funding

This study was supported by a NIH NIDA K01 Award (DA043604) and a grant from the Kaiser Permanente Northern California Community Benefit Program.

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Correspondence to Kelly C. Young-Wolff.

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All authors declare that they no conflicts of interest.

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Young-Wolff, K.C., Tucker, L., Armstrong, M.A. et al. Correlates of Pregnant Women’s Participation in a Substance Use Assessment and Counseling Intervention Integrated into Prenatal Care. Matern Child Health J (2020). https://doi.org/10.1007/s10995-020-02897-4

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Keywords

  • Prenatal substance use
  • Pregnancy
  • Screening
  • Socioeconomic status
  • Self report
  • Urine toxicology test
  • Integrated healthcare
  • Prenatal care