The effect of race on provider decisions to test for illicit drug use in the peripartum setting.
BACKGROUND
Testing for illicit drugs may expose women who test positive to severe legal and social consequences. It is unknown whether racial disparities in drug testing practices underlie observed disparities in legal and social consequences of positive tests.


METHODS
Using administrative hospital and birth certificate data, we analyzed factors associated with both receipt and results of illicit drug testing among women with live births during 2002-2003. We assessed the independent association of race and other sociodemographic factors with both receipt of a drug test by the mother or her newborn infant and positive maternal or neonatal toxicology results, after controlling for obstetrical conditions and birth outcomes associated with maternal substance abuse.


RESULTS
Of the 8487 women with live births, 244 mother-newborn pairs (3%) were tested for illicit drug use. Black women and their newborns were 1.5 times more likely to be tested for illicit drugs as nonblack women in multivariable analysis. However, race was not independently associated with a positive result.


CONCLUSIONS
We identified racial differences in rates of testing for illicit drug use between black and nonblack women. We found equivalent positivity rates among tested black and nonblack women. The prevalence of drug use among untested women is unknown, however, so although tested women had equivalent rates of substance use detected, whether black and nonblack substance users are equally likely to be identified in the course of peripartum care remains uncertain.
Kunins
Hillary Veda
HV
Albert Einstein College of Medicine/Montefiore Medical Center Bronx, New York 10467, USA. hkunins@montefiore.org
Bellin
Eran
E
Chazotte
Cynthia
C
Du
Evelyn
E
Arnsten
Julia Hope
JH
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D008425:Maternal Behavior; D008429:Maternal Welfare / Q000706:statistics & numerical data*; D011181:Postnatal Care / Q000379:methods / Q000706:statistics & numerical data*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000208:ethnology; D011297:Prenatal Exposure Delayed Effects / Q000175:diagnosis; D012044:Regression Analysis; D012107:Research Design; D012189:Retrospective Studies; D012923:Social Class; D012959:Socioeconomic Factors; D015813:Substance Abuse Detection; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data