ALCOHOL AND SUBSTANCE USE AMONG AMERICAN INDIAN/ALASKA NATIVE BIRTHING PEOPLE: A MIXED METHODS STUDY OF PUNITIVE VERSUS TREATMENT STATE POLICIES AND COMMUNITY LEVEL RISK FACTORS.
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MLA
Coleman, Addie Katherine. Alcohol And Substance Use Among American Indian/alaska Native Birthing People: A Mixed Methods Study Of Punitive Versus Treatment State Policies And Community Level Risk Factors. 2024. https://doi.org/10.17615/6e6r-3r32APA
Coleman, A. (2024). ALCOHOL AND SUBSTANCE USE AMONG AMERICAN INDIAN/ALASKA NATIVE BIRTHING PEOPLE: A MIXED METHODS STUDY OF PUNITIVE VERSUS TREATMENT STATE POLICIES AND COMMUNITY LEVEL RISK FACTORS. https://doi.org/10.17615/6e6r-3r32Chicago
Coleman, Addie Katherine. 2024. Alcohol And Substance Use Among American Indian/alaska Native Birthing People: A Mixed Methods Study Of Punitive Versus Treatment State Policies And Community Level Risk Factors. https://doi.org/10.17615/6e6r-3r32- Creator
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Coleman, Addie Katherine
- Affiliation: Gillings School of Global Public Health, Department of Health Policy and Management
- Abstract
- The main research objective of this dissertation was to better understand the policy, predisposing and enabling factors related to prenatal alcohol and substance use among the American Indian/Alaska Native (AI/AN) birthing population in the United States. Aim 1 assessed the impact of state prenatal substance use policies (PSUP) on prenatal care timing and adequacy for American Indian/Alaska Native (AI/AN) birthing people compared to NH-white birthing people. Aim 2 assessed barriers to prenatal care among AI/AN birthing people compared to their NH-white counterparts and examined the association of interpersonal violence (IPV) and alcohol and substance use (A/SU) with barriers to prenatal care. Aim 3 utilized a convergent mixed-methods approach to quantitatively assess factors influencing A/SU during pregnancy among AI/AN birthing people, with qualitative insights providing a deeper understanding of the interplay between prenatal A/SU, IPV, and adverse childhood experiences (ACEs) within the AI/AN community. Aim 1 revealed that across exposure to both punitive and treatment-oriented prenatal substance use policies, AI/AN birthing people had significantly greater odds of experiencing inadequate prenatal care and late prenatal care initiation compared to their NH-white counterparts. Exposure to punitive policies appeared to exacerbate the inadequacy of care for Indigenous birthing people compared to NH-white birthing people. Exposure to treatment policy was also found to be particularly beneficial within Indigenous populations leading to significantly more adequate care. Aim 2 revealed that Indigenous birthing people face significantly more structural/personal barriers and clinical/access barriers to prenatal care compared to NH-white people, but fewer financial/insurance barriers to prenatal care. Prenatal drug use exacerbated structural/personal as well as financial/access barriers to care for the AI/AN population. Interpersonal violence exacerbated structural/personal barriers to care for the NH-white birthing population. Aim 3 mixed methods results agreed that exposure to interpersonal violence, parental substance abuse, and multiple adverse childhood experiences was associated with increased risks of prenatal A/SU. Qualitative findings suggested that support, cultural values, Indigenous identity, and practice of traditions were all protective factors against prenatal A/SU. Lastly, one emergent qualitative finding reveled sub-themes of healthcare/Western medicine that exacerbated risks of prenatal A/SU among Indigenous birthing people.
- Date of publication
- 2024
- Keyword
- DOI
- Resource type
- Rights statement
- In Copyright - Educational Use Permitted
- Advisor
- Frerichs, Leah
- Austin, Anna
- Deutsch, Arielle
- Hassmiller Lich, Kristen
- Shea, Chris
- Degree
- Doctor of Philosophy
- Degree granting institution
- University of North Carolina at Chapel Hill Graduate School
- Graduation year
- 2024
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