Matson Pamela A, Calihan Jessica B, Bagley Sarah M, Adger Hoover
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (Matson, Adger); Department of Pediatrics (Calihan, Bagley), and Department of Medicine (Bagley), Chobanian & Avedisian School of Medicine, Boston University, Boston; Department of Pediatrics (Calihan, Bagley), and Grayken Center for Addiction (Bagley), Boston Medical Center, Boston.
Focus (Am Psychiatr Publ). 2024 Oct;22(4):464-473. doi: 10.1176/appi.focus.20240026. Epub 2024 Oct 15.
Prevention of substance misuse and substance use disorders is a national public health priority. The home environment can represent risk or protective factors for development of substance misuse. Children in homes with caregiver substance use are biologically, developmentally, interpersonally, and environmentally vulnerable to substance misuse and associated consequences, making it necessary for substance use prevention to focus on families early. Children and families who are minoritized, marginalized, and disenfranchised experience disproportionate consequences of substance use, through experiences of poverty, racism, trauma, and the built environment. Strengthening protective factors in early childhood by improving the health of caregivers and supporting the caregiver-child relationship can have enduring benefits over the life course. Pediatric primary care practices are an important setting for adopting a family-focused approach to prevention and early intervention of substance use. By engaging families early, identifying substance use in the family and household, recognizing the intersection of social needs and substance use, providing culturally tailored, trauma-informed, evidence-based care, and advising and supporting families on ways to minimize substance-related harm, pediatric care providers can play an important role in preventing substance use and substance-related consequences to children and families. Pediatric care providers are ideally suited to deliver prevention messages in a nonstigmatizing manner and serve as a conduit to evidence-based, family-focused intervention programs.
预防药物滥用和药物使用障碍是国家公共卫生的重点。家庭环境可能是药物滥用发展的风险因素或保护因素。照顾者有药物使用问题的家庭中的儿童在生理、发育、人际和环境方面容易受到药物滥用及相关后果的影响，因此药物使用预防有必要尽早关注家庭。少数族裔、边缘化和被剥夺权利的儿童和家庭，由于贫困、种族主义、创伤和建筑环境等经历，在药物使用方面承受着不成比例的后果。通过改善照顾者的健康状况和支持照顾者与儿童的关系来加强幼儿期的保护因素，在人的一生中会有持久的益处。儿科初级保健机构是采用以家庭为中心的方法预防和早期干预药物使用的重要场所。通过尽早让家庭参与，识别家庭和家庭中的药物使用情况，认识到社会需求与药物使用的交叉点，提供符合文化特点、考虑创伤因素、基于证据的护理，并就如何尽量减少与药物相关的危害向家庭提供建议和支持，儿科护理人员可以在预防儿童和家庭药物使用及与药物相关的后果方面发挥重要作用。儿科护理人员非常适合以非歧视的方式传递预防信息，并成为基于证据、以家庭为中心的干预项目的渠道。
