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1.
Vaccine ; 39(35): 4938-4948, 2021 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-34312009

RESUMO

OBJECTIVE: The objectives of this review were to summarize existing data on racial disparities in maternal immunization for influenza in the U.S. and to review the literature on interventions to improve the uptake of the influenza vaccine among Black pregnant women. DATA SOURCES: U.S. survey data on maternal influenza immunization by racial and ethnic group were summarized in narrative form. To review intervention studies, PubMed, CINAHL, EMBASE, and the Cochrane Library databases were searched for English language articles published 2017 to 2021, in addition to studies identified by a previous systematic review. STUDY ELIGIBILITY CRITERIA: Peer-reviewed studies conducted in the U.S. and reporting interventions designed to increase the uptake of the influenza vaccine in pregnancy with study populations including at least 20% of participants identifying as Black were included. STUDY APPRAISAL AND SYNTHESIS METHODS: Studies were grouped and reviewed in a narrative manner according to whether they were conducted in predominantly Black populations or in more racially diverse populations, and whether they tested multicomponent or single-component interventions. RESULTS: A decade of survey data show that Black women in the U.S. consistently have the lowest rate of influenza immunization in pregnancy. Black women report a lower rate of being recommended or offered the vaccine, and provider recommendation is associated with greater vaccine uptake. Intervention studies to increase influenza immunization among Black pregnant women have reported mixed results. Successful interventions include multicomponent practice-based interventions, group prenatal care, and culturally competent patient educational messages. CONCLUSIONS: Racial disparities in maternal uptake of the influenza vaccine are long-standing, but not intractable. More research is needed to test interventions to address this disparity, with a focus on increasing provider recommendation and offer of the vaccine, addressing patients' concerns about vaccine safety and efficacy, improving providers' cultural competence, and building trust between providers and patients.


Assuntos
Vacinas contra Influenza , Influenza Humana , Grupos de Populações Continentais , Feminino , Humanos , Influenza Humana/prevenção & controle , Gravidez , Gestantes , Estados Unidos , Vacinação
2.
J Addict Med ; 14(5): 423-430, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32032210

RESUMO

BACKGROUND: Screening for prenatal drug use is recommended. The NIDA-modified Alcohol, Smoking, and Substance Involvement Screening Test (NM-ASSIST) is a screener for drug use that has not yet been validated with pregnant women. This study aims to assess the substance-specific diagnostic validity of the NM-ASSIST (not including tobacco or alcohol) in pregnant women and determine optimal cut-points for substance-specific substance involvement (SI) scores. METHODS: Five hundred (500) pregnant women were recruited from 2 obstetric practices as part of a larger study of substance use screeners. Participants completed the NM-ASSIST, and provided urine and hair samples for testing. Receiver-operating characteristic curves were derived to determine the optimal SI score cut-points for each drug. FINDINGS: Prevalence estimates of prenatal drug use as determined by hair/urine drug testing were: cannabis (32.0%), cocaine (9.9%), benzodiazepines (1.0%), prescription opioids (4.3%), and street opioids (1.7%). The proportion of participants screening positive based on optimal SI score cut-points were as follows: cannabis (39.1%), cocaine (2.3%), benzodiazepines (0.8%), prescription opioids (2.7%), and street opioids (1.7%). There were no screen positives for amphetamines, but 6 (1.2%) women had a positive amphetamine hair or urine test. Optimal cut-points to identify prenatal drug use were: cannabis, 2 (area under the curve [AUC] 0.87; sensitivity 0.82; specificity 0.85; diagnostic odds ratio [DOR] 26.9); cocaine, 2 (AUC 0.58; sensitivity 0.17; specificity 0.99; DOR 29.0); benzodiazepines, 15 (AUC 0.59; sensitivity 0.20; specificity 0.99; DOR 38.8); prescription opioids, 3 (AUC 0.61; sensitivity 0.25; specificity 0.98; DOR 18.3); and street opioids, 4 (AUC 0.55; sensitivity 0.13; specificity 0.99; DOR 9.3). CONCLUSIONS: The NM-ASSIST reliably distinguished pregnant women who use cannabis from those who do not, but performed poorly for all other substances. More research is needed to identify screeners that reliably detect all prenatal drug use. Although more cost-prohibitive, a combination of self-report and toxicological screening may be preferable for detecting prenatal drug use.


Assuntos
Nitrosaminas , Preparações Farmacêuticas , Transtornos Relacionados ao Uso de Substâncias , Feminino , Humanos , Programas de Rastreamento , Gravidez , Detecção do Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Estados Unidos/epidemiologia
3.
Drug Alcohol Depend ; 206: 107729, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31760250

RESUMO

BACKGROUND: The use, misuse and co-use of alcohol, cannabis, tobacco, and other licit and illicit controlled substances has increased in past decades leading to higher rates of morbidity, overdose, and mortality in women of reproductive age. Co-use compounds the adverse health effects of substance use compared to single-use of similar substances. Little is known about the full range of substance combinations used by pregnant and non-pregnant women. We sought to describe patterns of co-use of alcohol, tobacco, and controlled substances, and examine correlates of co-use in a nationally-representative sample of women. METHODS: Cross-sectional study using self-reported survey data from 2006 to 2014 for women ages 18-49 years (N = 160,371) in National Survey on Drug Use and Health data. We use weighted proportions and 95% confidence intervals (CI) to report differences in substance use patterns in pregnant and non-pregnant women. Multivariate logistic regression models assessed association between characteristics and type of substance use pattern. RESULTS: Prevalence of substance co-use among pregnant women is 5.1% and among non-pregnant women is 23.6%. Nearly all of the most frequent co-use patterns included alcohol, cannabis, or tobacco. Determinants of co-use among pregnant women included: younger age (18-25 years) compared to ≥ 26 years [AOR (95% CI): 1.81 (1.18, 2.80)]; and past year history of substance use [AOR 5.42 (3.59, 8.20)]. CONCLUSIONS: Co-use of several substances, including and especially of tobacco, alcohol and cannabis, persists among pregnant women in the United States. Efforts that aim to improve maternal and child health should address the complexity of substance use during pregnancy, including and beyond opioids.


Assuntos
Alcoolismo/epidemiologia , Substâncias Controladas , Complicações na Gravidez/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Uso de Tabaco/epidemiologia , Adolescente , Adulto , Alcoolismo/psicologia , Comorbidade , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Pessoa de Meia-Idade , Gravidez , Complicações na Gravidez/psicologia , Prevalência , Transtornos Relacionados ao Uso de Substâncias/psicologia , Uso de Tabaco/psicologia , Estados Unidos/epidemiologia , Adulto Jovem
4.
J Addict Med ; 14(2): 139-144, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31090554

RESUMO

OBJECTIVE: There is a need to identify an acceptable and comprehensive substance use screening tool for pregnant women in the United States. This qualitative study sought to better understand prenatal practice staff perceptions of three existing substance use screening tools for use among pregnant women in an outpatient practice setting. METHODS: Eight focus groups with 40 total participants were conducted with clinical and administrative staff of 2 diverse Maryland prenatal practices to determine the acceptability and usability of 3 substance use screening tools (4P's Plus, NIDA-Modified Alcohol, Smoking and Substance Involvement Screening Test, and the Substance Use Risk Profile-Pregnancy scale). The focus groups were digitally recorded, transcribed, coded, and analyzed using thematic analysis. RESULTS: Participant perceptions of screening tools were dependent upon screening tool length, tone, comprehensiveness, subjectivity, time frame of questions, and scoring and clinician instructions. Most participants preferred the 4P's Plus screening tool because it is brief, comprehensive, easy for the patient to understand, and excludes judgmental language and subjective questions. CONCLUSIONS: These results provide valuable insight into the specific needs and preferences of prenatal practice staff as it relates to prenatal substance use screening and provides evidence that the 4P's Plus may be a preferred screening tool for standardized use in prenatal care.


Assuntos
Atitude do Pessoal de Saúde , Programas de Rastreamento , Complicações na Gravidez/diagnóstico , Gestantes , Cuidado Pré-Natal , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Feminino , Humanos , Maryland , Gravidez
5.
Obstet Gynecol ; 133(5): 952-961, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30969217

RESUMO

OBJECTIVE: To compare and evaluate the accuracy of three screening tools in identifying illicit drug use and prescription drug misuse among a diverse sample of pregnant women. METHODS: This prospective cross-sectional study enrolled a consecutive sample of 500 pregnant women, stratified by trimester, receiving care in two prenatal clinical settings in Baltimore, Maryland, from January 2017 to January 2018. All participants were administered three index tests: 4P's Plus, NIDA Quick Screen-ASSIST (Modified Alcohol, Smoking and Substance Involvement Screening Test), and the SURP-P (Substance Use Risk Profile-Pregnancy) scale, and administered reference tests (urine and hair drug testing) at the in-person baseline visit. To assess test-retest reliability of the index tests, screening tool administrations were repeated 1 week later by telephone. For each screening tool, sensitivity, specificity, positive predictive value, negative predictive value and test-retest reliability were computed. Results were stratified by age, race, and trimester of pregnancy. RESULTS: Of the 500 enrolled pregnant women, 494 completed the index screening tools, 497 completed reference testing, and 453 underwent test-retest analysis. For the 4P's Plus, sensitivity=90.2% (84.5, 93.8), and specificity=29.6% (24.4, 35.2). For the NIDA Quick Screen-ASSIST, sensitivity=79.7% (71.2, 84.2), and specificity=82.8% (78.1, 87.1). For the SURP-P, sensitivity=92.4% (87.6, 95.8) and specificity=21.8% (17.4, 27.2). Test-retest reliability (phi correlation coefficients) was 0.84, 0.77, and 0.79 for the 4P's Plus, NIDA Quick Screen-ASSIST and the SURP-P, respectively. For all screening tools, there were differences in validity indices by age and race, but no differences by trimester. CONCLUSION: The SURP-P and 4P's Plus had high sensitivity and negative predictive values, making them more ideal screening tests than the NIDA Quick Screen-ASSIST. A clear recommendation for a clinically useful screening tool for prenatal substance use is crucial to allow for prompt and appropriate follow-up and intervention.


Assuntos
Complicações na Gravidez/diagnóstico , Diagnóstico Pré-Natal , Detecção do Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Adulto , Estudos Transversais , Feminino , Humanos , Gravidez , Complicações na Gravidez/prevenção & controle , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Inquéritos e Questionários
6.
Matern Child Health J ; 23(2): 250-257, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30523484

RESUMO

Background Prenatal substance use screening is recommended. The 4 P's Plus screener includes questions on perceived problematic substance use in parents and partner that are not considered in risk stratification. Objectives This research examined the: (1) prevalence of self-reported problematic parental and partner substance use and associations with biochemically-verified prenatal substance use; (2) utility of self-reported perceptions of parent/partner substance use as proxies for prenatal substance use; and (3) degree to which the sensitivity of the 4P's Plus can be augmented with consideration of parent/partner questions in risk stratification. Methods A convenience sample of 500 pregnant women was recruited between January 2017 and January 2018. Participants completed the 4P's Plus and provided urine for drug testing. Diagnostic utility of problematic parent/partner substance use questions was assessed, then compared to the 4P's Plus used as designed, and to the 4P's Plus used with these 2 questions included in risk stratification. Results Half (51%) of respondents reported either partner or parental problematic substance use. When partner or parent problematic substance use were considered as proxies for prenatal substance use, sensitivity was 65% and specificity was 55%. When used as intended, sensitivity was 94% and specificity was 29%. Including partner/parent questions increased sensitivity to 96% but lowered specificity (19%). Partner substance use and combined partner/parent use were associated with prenatal substance use [adjusted odds ratio (aOR): 2.0 (1.2, 2.4; p = 0.006); aOR = 1.6 (1.1, 2.5, p = 0.04)]. Conclusions for Practice Sensitivity of the 4P's Plus may improve with inclusion of self-reported problematic partner/parent substance use items in risk stratification.


Assuntos
Pais/psicologia , Percepção , Transtornos Relacionados ao Uso de Substâncias/complicações , Adolescente , Adulto , Distribuição de Qui-Quadrado , Feminino , Humanos , Gravidez , Gestantes/psicologia , Diagnóstico Pré-Natal/métodos , Autorrelato , Transtornos Relacionados ao Uso de Substâncias/psicologia
7.
Prev Med ; 116: 1-5, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30171964

RESUMO

The objective of the current narrative literature review is to provide an epidemiological, developmental and clinical overview on cannabis use during pregnancy. Cannabis use in pregnancy poses major health concerns for pregnant mothers and their developing children. Although studies on the short- and long-term consequences of prenatal cannabis exposure are increasing, findings have been inconsistent or difficult to interpret due to methodological issues. Thus, consolidating these findings into clinical recommendations based on the mixed studies in the literature remains a challenge. Synthesizing the available observational studies is also difficult, because some of the published studies have substantial methodological weaknesses. Improving observational studies will be an important step toward understanding the extent to which prenatal exposure to cannabis influences neurodevelopment in the offspring. Therefore, further research on prenatal cannabis exposure and the long-term consequences to offspring health in representative samples are needed to guide and improve clinical care for pregnant women and their children. Future research should also investigate the role of policies on prenatal cannabis use.


Assuntos
Cannabis/efeitos adversos , Abuso de Maconha/epidemiologia , Fumar Maconha/efeitos adversos , Efeitos Tardios da Exposição Pré-Natal , Feminino , Humanos , Gravidez
8.
Int Rev Psychiatry ; 30(3): 238-250, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-30179535

RESUMO

The legalization of medical and recreational cannabis use has occurred ahead of science. The current evidence base has poor utility for determining if cannabis products can meet the standards of safety, efficacy, and quality intrinsic to modern medicine, and for informing regulation of cannabis as a legal intoxicant. Individual jurisdictions that pass cannabis reforms may not have adequate resources to support the level of new scientific research needed to inform regulatory actions; this could make it difficult to keep a rapidly growing multi-billion-dollar cannabis industry in check. Further, the present lack of evidence-based regulatory oversight for cannabis parallels the climates that gave rise to the tobacco and prescription opioid epidemics, suggesting that continued omission may result in negative public health consequences. However, translating a methodological framework developed through research on these compounds may promote rapid advances in cannabis science germane to regulatory knowledge gaps. The present review highlights specific advancements in these areas, as well as in alcohol regulation, that are prime for informing policy-relevant cannabis science, and also offers some recommendations for evidence-based regulatory policy. Resulting progress may directly inform both regulation of cannabis in both medical and licit recreational drug frameworks, and new cannabis-related public health initiatives.


Assuntos
Bebidas Alcoólicas , Analgésicos Opioides , Pesquisa Biomédica , Cannabis , Legislação de Medicamentos , Saúde Pública , Produtos do Tabaco , Humanos , Estados Unidos
10.
Matern Child Health J ; 22(10): 1477-1483, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29882032

RESUMO

Objectives Substance use during pregnancy is a significant public health issue. Prenatal substance use increased in the past decade while prenatal cigarette smoking has remained stable. Co-use of tobacco and other drugs is a concern because of potential additive risks. This study aims to describe the prevalence rates of substance use among pregnant women and examine the association between smoking status (nonsmoker, recent quitter and current smoker) and other drug use. Methods In this cross-sectional study, pregnant women (n = 500) were recruited from two obstetric practices to complete three substance use screeners and have their urine tested for 12 different drug classes, including cannabis, opioids and cocaine. Participants were divided into three groups based on survey responses: nonsmokers, recent quitters (smoked in the month prior to pregnancy but not past month) and current smokers (past-month). Results Approximately 29% of participants reported smoking in the month before pregnancy. During pregnancy, 17, 12 and 71% were current smokers, recent quitters and nonsmokers respectively. Overall prevalence of illicit or prescription drug use in pregnancy was 27%. Cannabis was the most common drug used in pregnancy with prevalence of 22%, followed by opioids (4%), cocaine (1%), tricyclic antidepressants (TCAs) (1%), amphetamines (1%), and benzodiazepines (1%). On multivariable logistic regression, smoking in pregnancy was associated with a positive urine drug screen; with adjusted odds ratio (aOR) 4.7 (95% CI 2.6-8.3) for current smokers and 1.6 (95% CI 0.8-3.3) for recent quitters. Factors negatively associated with positive drug screen were second and third trimester pregnancies, 0.5 (0.3-0.9) and 0.3 (0.2-0.6) respectively; and employment, 0.5 (0.3-0.8). Conclusions for Practice Co-use of tobacco and illicit drugs, particularly cannabis, is relatively high during pregnancy. Additional research is needed to understand the health implications of co-use versus use of tobacco only. Given the strong association between smoking and other drug use, clinicians should routinely assess for illicit drug use in women who smoke during pregnancy.


Assuntos
Fumar Cigarros/epidemiologia , Complicações na Gravidez/epidemiologia , Gestantes/psicologia , Abandono do Hábito de Fumar/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Abandono do Uso de Tabaco/estatística & dados numéricos , Adulto , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Cannabis/efeitos adversos , Estudos Transversais , Feminino , Humanos , Drogas Ilícitas , Gravidez , Prevalência , Detecção do Abuso de Substâncias
11.
Am J Public Health ; 108(8): 1073-1075, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29927645

RESUMO

OBJECTIVES: To assess trends in prevalence of cigar and blunt use in relation to cigarette use among pregnant and nonpregnant women of reproductive age. METHODS: We used 2006 to 2016 data from the US National Survey on Drug Use and Health to assess past-month use of cigarettes, cigars, and blunts among a total of 8695 pregnant women and 162 451 nonpregnant women aged 18 to 44 years. RESULTS: Cigarette use was more prevalent than cigar or blunt use in pregnant and nonpregnant women, with higher prevalence in nonpregnant women for each product. Among all women, cigarette use decreased and blunt use increased over time, whereas cigar use remained stable. Smoking prevalence was highest in the first trimester. CONCLUSIONS: The health implications of the increase in blunt use are not well known in the scientific literature or by the general public. Given the rapid changes in state marijuana laws, this issue should be a public health priority.


Assuntos
Fumar Charutos/epidemiologia , Fumar Maconha/epidemiologia , Gravidez/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Humanos , Estados Unidos/epidemiologia
12.
Neurotoxicol Teratol ; 68: 84-90, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29883744

RESUMO

Use of Cannabis and use of tobacco overlap, and co-use of Cannabis and tobacco has increased over the past decade among adults. The current study aims to document the prevalence and correlates of co-use of Cannabis and tobacco cigarettes among adult pregnant women utilizing secondary data from a larger study that compared and validated screeners for illicit and prescription drug use during pregnancy. Pregnant women (N = 500; 71% African American; 65% never married, average age of 28 years) were recruited from two urban University obstetric clinics between January and December 2017. Participants self-reported demographic, Cannabis, and tobacco cigarette use characteristics, and provided urine and hair samples for drug testing. Within two weeks after due date, research staff reviewed participants' electronic medical records to collect birth outcome data. Results showed that 9.0% reported co-use of Cannabis and tobacco, 12.1% reported Cannabis only use, 7.8% reported tobacco cigarette only use, and 71.1% reported no Cannabis or tobacco cigarette use in the past month. The birth outcomes to emerge as significant correlates of co-use of Cannabis and tobacco cigarettes were small head circumference, and the occurrence of birth defects, with the co-use group having the highest odds of a small head circumference [aOR: 5.7 (1.1-28.9)] and birth defects [aOR: 3.1 (1.2-8.3)] compared with other use groups. The Cannabis only group had 12 times higher odds of a stillbirth or miscarriage (aOR = 12.1). Screening and interventions to address concurrent Cannabis and tobacco use during pregnancy are needed, particularly among subpopulations with higher co-use rates. It is imperative to further explore and highlight the possible health implications of maternal co-use given the high prevalence rates found in this study sample.


Assuntos
Cannabis/toxicidade , Fumar Maconha/epidemiologia , Resultado da Gravidez , Fumar/epidemiologia , Tabaco/toxicidade , Aborto Espontâneo/epidemiologia , Adulto , Comorbidade , Interações Medicamentosas , Feminino , Cabelo/metabolismo , Cabeça/anormalidades , Humanos , Fumar Maconha/metabolismo , Fumar Maconha/urina , Maryland/epidemiologia , Gravidez , Prevalência , Fumar/metabolismo , Fumar/urina , Natimorto/epidemiologia , Adulto Jovem
14.
BMJ Open ; 8(2): e020248, 2018 02 17.
Artigo em Inglês | MEDLINE | ID: mdl-29455170

RESUMO

INTRODUCTION: Prescription-drug use in the USA has increased by more than 60% in the last three decades. Prevalence of prescription-drug use among pregnant women is currently estimated around 50%. Prevalence of illicit drug use in the USA is 14.6% among pregnant adolescents, 8.6% among pregnant young adults and 3.2% among pregnant adults. The first step in identifying problematic drug use during pregnancy is screening; however, no specific substance-use screener has been universally recommended for use with pregnant women to identify illicit or prescription-drug use. This study compares and validates three existing substance-use screeners for pregnancy-4 P's Plus, National Institute on Drug Abuse (NIDA) Quick Screen/Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) and the Substance Use Risk Profile-Pregnancy (SURP-P) scale. METHODS AND ANALYSIS: This is a cross-sectional study designed to evaluate the sensitivity, specificity and usability of existing substance-use screeners. Recruitment occurs at two obstetrics clinics in Baltimore, Maryland, USA. We are recruiting 500 participants to complete a demographic questionnaire, NIDA Quick Screen/ASSIST, 4 P's Plus and SURP-P (ordered randomly) during their regularly scheduled prenatal appointment, then again 1 week later by telephone. Participants consent to multidrug urine testing, hair drug testing and allowing access to prescription drug and birth outcome data from electronic medical records. For each screener, reliability and validity will be assessed. Test-retest reliability analysis will be conducted by examining the results of repeated screener administrations within 1 week of original screener administrations for consistency via correlation analysis. Furthermore, we will assess if there are differences in the validity of each screener by age, race and trimester. ETHICS AND DISSEMINATION: This study is approved by the Institutional Review Board of the University of Maryland (HP-00072042), Baltimore, and Battelle Memorial Institute (0619-100106433). All participants are required to give their informed consent prior to any study procedure.


Assuntos
Programas de Rastreamento/métodos , Complicações na Gravidez/diagnóstico , Autorrelato , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Adolescente , Adulto , Instituições de Assistência Ambulatorial , Estudos Transversais , Feminino , Cabelo/química , Humanos , Modelos Logísticos , Maryland , Projetos Piloto , Gravidez , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Urina/química , Adulto Jovem
15.
J Addict Med ; 12(3): 193-200, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29351139

RESUMO

OBJECTIVES: To pilot-test a Phone-based Postpartum Continuing Care (PPCC) protocol developed from existing evidence-based approaches to address both postpartum smoking relapse among low-income women who quit smoking during pregnancy and postpartum smoking increase among those who had cut down. METHODS: One hundred thirty low-income pregnant women who were current or recently quit tobacco smokers were recruited at their first prenatal appointment and randomized to either a Control (standard care) or Experimental (standard care + PPCC) group. An intent-to-treat analysis was conducted on biochemically verified data from 6 in-person interviews during pregnancy and postpartum. Feasibility with regard to recruitment, randomization, assessment, and implementation of PPCC were assessed, along with acceptability among the target population. RESULTS: PPCC was found to be feasible and acceptable to some participants, but not all. There were no significant differences in tobacco products per day at 6 months postpartum between groups; however, effect sizes differed at 6 weeks compared with 6 months postpartum. Similarly, there were no significant differences between groups in cessation rate (24% in each group) and past 90-day tobacco use (59 vs 55 days, for Control and Experimental groups, respectively). CONCLUSIONS: The PPCC intervention did not differentially reduce tobacco use postpartum compared with a controlled comparison group, though it was found to be acceptable among a subpopulation of low-income pregnant women and feasible with regard to recruitment, randomization, assessment procedures, and implementation. Further research is needed to identify an intervention that significantly improves smoking relapse rates postpartum.


Assuntos
Fissura , Período Pós-Parto , Abandono do Hábito de Fumar/métodos , Prevenção do Hábito de Fumar/métodos , Telefone , Adulto , Cotinina/urina , Feminino , Humanos , Projetos Piloto , Pobreza , Gravidez , Recidiva , Fumar/psicologia , Adulto Jovem
16.
Drug Alcohol Depend ; 177: 130-135, 2017 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-28599211

RESUMO

BACKGROUND: Marijuana and tobacco are the most commonly used illicit and licit drugs during pregnancy. This study aimed to examine a nationally representative sample of US pregnant women and to: (1) determine the prevalence of past month marijuana and tobacco co-use, (2) identify characteristics that distinguish marijuana and tobacco co-users from users of marijuana only, tobacco only, or neither, and (3) compare characteristics that differ between pregnant and non-pregnant co-users of marijuana and tobacco. METHODS: Data were obtained from 497,218 US women (8721 pregnant) ages 12-49 who participated in the 2005-2014 National Survey on Drug Use and Health. Prevalence and demographic and substance use characteristics were compared across groups using weighted estimates and chi-squared tests. Multinomial logistic regression identified demographic and substance use correlates of co-use. RESULTS: Co-use among pregnant and non-pregnant women was significantly more prevalent than marijuana-only use but was less common than tobacco-only use. In unadjusted frequencies, pregnant co-users significantly differed from non-pregnant co-users across several domains. Among pregnant women, multivariate correlates of co-use of tobacco and marijuana vs. tobacco-only use were ages 12-17, non-Hispanic black race, Hispanic ethnicity, and past month polytobacco, any alcohol, and other drug use (all adjusted odds ratios≥2.0). CONCLUSIONS: In this first examination of the prevalence and correlates of co-use of marijuana and tobacco among a nationally representative group of pregnant women, pregnant co-users were more likely to report other high risk behaviors compared with non-pregnant co-users and users of a single substance, suggesting disparities worthy of further investigation.


Assuntos
Fumar Maconha/epidemiologia , Fumar Maconha/tendências , Gestantes , Inquéritos e Questionários , Uso de Tabaco/epidemiologia , Uso de Tabaco/tendências , Adolescente , Adulto , Feminino , Humanos , Fumar Maconha/efeitos adversos , Gravidez , Prevalência , Produtos do Tabaco/efeitos adversos , Uso de Tabaco/efeitos adversos , Tabagismo/diagnóstico , Tabagismo/epidemiologia , Estados Unidos/epidemiologia
17.
Subst Abuse ; 10(Suppl 1): 55-61, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27980414

RESUMO

Substance use in pregnancy can have adverse effects on mother and fetus alike. Australia and the US are countries with high levels of substance use and policies advising abstinence, although the Australian approach occurs within a broader framework of harm minimization. Less attention has been paid to treatment of the mothers' substance use and what is considered gold standard. This is despite evidence that prior substance use in pregnancy is the most important factor in predicting future substance use in pregnancy. This paper draws together information from both the peer-reviewed and gray literature to provide a contemporary overview of patterns and outcomes of the three main drugs, alcohol, tobacco, and cannabis, used in Australia and the US during pregnancy and discusses what are considered gold standard screening and treatment approaches for these substances. This paper does not set out to be a comprehensive review of the area but rather aims to provide a concise summary of current guidelines for policy makers and practitioners who provide treatment for women who use substances in pregnancy.

18.
Matern Child Health J ; 20(5): 1054-60, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26649884

RESUMO

OBJECTIVES: To compare pregnant women who are current smokers at their first prenatal visit with those who recently quit smoking in the 90 days prior to their first prenatal visit (i.e., spontaneous quitters) to identify differences between them and factors that predict their intake smoking status. METHODS: One hundred and thirty participants were enrolled in this cross-sectional research study. The sample was drawn from a population of pregnant women attending their first prenatal visit at a low-income obstetrics clinic in Baltimore, Maryland; the large majority of which have characteristics that previous research has identified as putting them at high-risk of continued smoking during pregnancy. Participants were recruited through referrals from clinical staff. Intake data collection occurred between March and December, 2013. RESULTS: Of the 130 pregnant women enrolled in the study, 126 had complete intake data. The sample included 86 current smokers and 40 recent quitters. The large majority of participants were African American with an average age of 26. Current smokers were significantly more likely than recent quitters to have: more depression symptoms; self-perceived stress; internalizing and externalizing disorder symptoms; substance use disorders; and tobacco dependence. The most significant predictors of smoking status at first prenatal visit were depressive symptoms, readiness to quit, and number of children. CONCLUSIONS: for Practice Differences were identified at intake among this sample of pregnant women already considered to be at high-risk for continued smoking throughout their pregnancy. This study identified relevant factors associated with whether or not a woman had recently quit smoking in early pregnancy or was continuing to smoke at her first prenatal visit. Knowledge of these factors may benefit physicians in understanding and promoting smoking cessation throughout the perinatal period and specifically intervening to decrease depressive symptoms and increasing readiness to quit may improve outcomes.


Assuntos
Gestantes/psicologia , Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar/epidemiologia , Adolescente , Adulto , Afro-Americanos , Baltimore , Estudos Transversais , Feminino , Humanos , Maryland , Pobreza , Gravidez , Gestantes/etnologia , Cuidado Pré-Natal , Fumar/efeitos adversos , Fumar/psicologia , Abandono do Hábito de Fumar/etnologia , Abandono do Hábito de Fumar/psicologia
19.
J Addict Med ; 9(4): 266-72, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25974378

RESUMO

OBJECTIVE: Electronic cigarettes (e-cigarettes) are a relatively recent phenomenon, serving dual roles as an alternative vehicle for nicotine delivery and a smoking-cessation tool. The purpose of this study was to determine pregnant women's knowledge, attitudes, and practice regarding electronic cigarettes. STUDY DESIGN: A voluntary, anonymous survey was distributed to a convenience sample of pregnant women presenting to a university-based outpatient clinic. After survey completion, participants received information about smoking cessation and e-cigarettes. Data were examined using χ² and Fisher exact tests and analysis of variance. Stata was used for the analysis. RESULTS: Of the 326 surveys distributed, 316 were completed (97%). Of the 316 participants, 42 (13%) reported having ever used e-cigarettes. Only 2 (0.6%) reported current daily use. Ever users were slightly older (27.3 years vs 25.4 years; P = 0.007) and more likely to be current smokers (43% vs. 14%; P < 0.001) compared with women who had never used electronic cigarettes. Knowledge of the harms of smoking was similar between the 2 groups. Overall, 57% of all respondents believed that e-cigarettes contain nicotine, 61% that e-cigarettes can be addictive, and 43% that e-cigarettes are less harmful to a fetus than traditional cigarettes. Among ever users, the most common reasons given for the use of e-cigarettes were the perception of less harm than traditional cigarettes (74%) and help with smoking cessation (72%). CONCLUSIONS: Misconceptions about e-cigarettes are common among pregnant women, potentially motivating use that may pose risks to both maternal and child health. Screening and education regarding e-cigarettes should be included in prenatal care. Future research in this area is necessary, including research examining pregnancy outcomes among women who use e-cigarettes.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Conhecimentos, Atitudes e Prática em Saúde , Complicações na Gravidez/induzido quimicamente , Adulto , Feminino , Humanos , Gravidez
20.
J Addict Med ; 8(1): 14-24, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24317354

RESUMO

OBJECTIVES: To assess current obstetrician-gynecologist (ob-gyn) practice patterns related to the management of and barriers to smoking cessation during pregnancy and postpartum. METHODS: A smoking cessation questionnaire was mailed to 1024 American College of Obstetricians and Gynecologists Fellows in 2012. χ(2) analyses were used to assess for categorical differences between groups, Pearson r was used to conduct correlational analysis, and analysis of variance was used to assess for mean differences between groups. RESULTS: The analyses included 252 practicing ob-gyns who see pregnant patients who returned a completed survey. Ob-gyns estimated that 23% of their patients smoke before pregnancy, 18% smoke during first trimester, 12% during second trimester, and 11% during third trimester. They approximated that 32% quit during pregnancy, but 50% return to smoking postpartum. A large majority of ob-gyns feel that it is important for pregnant and postpartum women to quit smoking, and report asking all pregnant patients about tobacco use at the initial prenatal visit. Fewer ob-gyns follow-up on tobacco use at subsequent visits when the patient has admitted to use at a prior visit. The primary barrier to intervention was reported as time limitations, though other barriers were noted that may be addressable through the provision of additional training and resources offered to physicians. CONCLUSIONS: Compared with findings from a similar study conducted in 1998, physicians are less likely to adhere to the 5 As smoking cessation guideline at present. As we know that brief intervention is effective, it is imperative that we work toward addressing practice gaps and providing additional resources to address the important public health issue of smoking during pregnancy and postpartum.


Assuntos
Cuidado Pós-Natal/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Complicações na Gravidez/prevenção & controle , Cuidado Pré-Natal/estatística & dados numéricos , Abandono do Hábito de Fumar/estatística & dados numéricos , Prevenção do Hábito de Fumar , Adulto , Distribuição de Qui-Quadrado , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Médicos/psicologia , Médicos/estatística & dados numéricos , Gravidez , Inquéritos e Questionários
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