A Mixed Methods Exploration of Prenatal Polysubstance Use - Substance use during pregnancy can lead to negative maternal and infant outcomes, contributing to the U.S. overdose crisis. Polysubstance use in pregnancy is particularly salient considering that the increase in number of substances used carries the compounded risk for both the mother and fetus of each individual substance, as well as potential negative interactions between substances. Prenatal polysubstance use in the U.S. is increasing, and characterization of use patterns is critical. Current research supports the relationship between prenatal individual substance use and environmental factors such as geographic location. However, there is limited research examining relationships between such factors and prenatal polysubstance use. The overall objective of this research will be to better understand prenatal polysubstance use in the U.S. by approaching the characterization in two ways (qualitative and quantitative), and triangulating findings. Specifically, this project will: 1) conduct qualitative interviews among pregnant or postpartum women engaging in prenatal polysubstance use, and 2) utilize an existing national pregnancy survey (CDC PRAMS) to quantitatively establish outcomes of polysubstance use behaviors among pregnant women. First, 20 qualitative interviews will be conducted with pregnant or postpartum women engaging in polysubstance use to understand practices of such use. Second, the findings of these interviews will inform an exploration of present-day patterns of pregnant polysubstance use using CDC PRAMS data. These patterns will be characterized using latent class analysis (LCA) to define unique groups of polysubstance use, using the following environmental factors as external validators: economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social environment. The strength of this approach lies in the specificity of quantitative analyses, while being complemented by depth of qualitative data. This research will be the first to our knowledge to assess prenatal polysubstance use in the U.S. using both quantitative and qualitative methods. This dissertation project will lay the foundation for future research to identify modifiable factors for prevention and treatment, with the goal of decreasing the burden of prenatal polysubstance use and addressing the overdose crisis.
