Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Ave, Baltimore, MD 21209, United States; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Ave, Baltimore, MD 21209, United States.
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Ave, Baltimore, MD 21209, United States.
Int J Drug Policy. 2022 Oct;108:103806. doi: 10.1016/j.drugpo.2022.103806. Epub 2022 Jul 27.
Over the past decade, states have passed several laws on prenatal drug use, including "maltreatment laws" deeming prenatal drug use child maltreatment, "reporting laws" requiring providers to report prenatal drug use to Child Protective Services (CPS) and "criminalization laws" that criminalize prenatal drug use.
We examined the association between a 2012 Utah maltreatment law, a 2013 Alabama maltreatment and criminalization law, and a 2014 Maryland reporting law on the rate of infant CPS reports using 2010-2017 National Child Abuse and Neglect Data System data. We conducted an event study comparing CPS reporting pre/post law in each treatment state with reporting in a pool of control states over the same period. Regression models included state and year fixed effects and state-level demographics. We triangulated quantitative results with qualitative interviews of 11 state leaders whose professional responsibilities included implementation of the state law.
We found no association between Alabama's simultaneous maltreatment and criminalization laws and infant reporting. Maryland's reporting law (28.2 fewer reports per 1000 infants, 95%CI: [-42.9, -13.6], 4-years post-law) and Utah's maltreatment laws (31.0 fewer CPS reports per 1000 infants, 95%CI: [-61.2, -0.8], 6-years post-law) were associated with declines in infant CPS reports. Qualitative results suggest that the reduced reporting associated with Maryland's reporting and Utah's maltreatment laws may be due to increased perceived stigma resulting from the law, and health providers' distrust of CPS and/or confusion about reporting to CPS.
Future research should characterize differential policy implementation across states and counties and identify policy impacts on treatment seeking behavior.
在过去的十年中，各州通过了几项关于产前药物使用的法律，包括将产前药物使用视为虐待儿童的“虐待法”、要求提供者向儿童保护服务机构（CPS）报告产前药物使用情况的“报告法”以及将产前药物使用定为犯罪的“刑事定罪法”。
我们使用 2010-2017 年全国儿童虐待和忽视数据系统的数据，研究了 2012 年犹他州虐待法、2013 年阿拉巴马州虐待和刑事定罪法以及 2014 年马里兰州报告法与婴儿 CPS 报告率之间的关联。我们进行了一项事件研究，比较了每个治疗州在法律颁布前后与同期一组对照州的 CPS 报告情况。回归模型包括州和年份固定效应以及州级人口统计数据。我们将定量结果与对 11 位州领导的定性访谈结果进行了三角剖分，这些州领导的专业职责包括实施州法律。
我们没有发现阿拉巴马州同时实施的虐待和刑事定罪法与婴儿报告之间存在关联。马里兰州的报告法（每 1000 名婴儿减少 28.2 例报告，95%CI：[-42.9，-13.6]，法律颁布后 4 年）和犹他州的虐待法（每 1000 名婴儿减少 31.0 例 CPS 报告，95%CI：[-61.2，-0.8]，法律颁布后 6 年）与婴儿 CPS 报告减少有关。定性结果表明，马里兰州的报告法和犹他州的虐待法导致报告减少，可能是由于法律引起的感知耻辱感增加，以及医疗服务提供者对 CPS 的不信任和/或对向 CPS 报告的困惑。
未来的研究应描述各州和县之间政策实施的差异，并确定政策对治疗寻求行为的影响。
