title: Women's perspectives on screening for alcohol and drug use in prenatal care.
abstract: BACKGROUND
  Screening for alcohol and drug use in prenatal care is widely promoted in the United States as a public health strategy for reducing alcohol and drug use during pregnancy. However, the published literature does not consider women's perspectives or the potential negative ramifications of screening.
  
  
  METHODS
  Twenty semistructured interviews and two focus groups (n = 38) were conducted with a racially/ethnically diverse sample of low-income pregnant and parenting women using alcohol and/or drugs in a northern California county.
  
  
  RESULTS
  Most women were averse to having drug but not alcohol use identified and were mistrustful of providers' often inconspicuous efforts to discover drug use. Women expected psychological, social, and legal consequences from being identified, including feelings of maternal failure, judgment by providers, and reports to Child Protective Services. Women did not trust providers to protect them from these consequences. Rather, they took steps to protect themselves. They avoided and emotionally disengaged from prenatal care, attempted to stop using substances that could be detected by urine tests before prenatal care visits, and shared strategies within social networks for gaining the benefits of prenatal care while avoiding its negative consequences.
  
  
  CONCLUSIONS
  Considerations of the public health impact of screening for drug use in prenatal care should account for the implications of women's physical avoidance of and emotional disengagement from prenatal care, specifically the direct effects of late, limited, and no prenatal care on pregnancy outcomes and missed opportunities for health promoting interventions.
authors.affiliation: Alcohol Research Group, Emeryville, California 94608, USA. sroberts@arg.org
authors.forename: Sarah C M
authors.initials: SC
authors.lastname: Roberts
authors.forename: Amani
authors.initials: A
authors.lastname: Nuru-Jeter
mesh_terms: D000328:Adult; D000428:Alcohol Drinking; D001294:Attitude to Health; D002140:California; D002648:Child; D005260:Female; D017144:Focus Groups; D015438:Health Behavior; D006293:Health Promotion; D006801:Humans; D007407:Interviews as Topic; D008403:Mass Screening / Q000523:psychology*; D008875:Middle Aged; D011203:Poverty; D011247:Pregnancy; D011295:Prenatal Care / Q000523:psychology*; D012648:Self Care; D019966:Substance-Related Disorders / Q000175:diagnosis; D055815:Young Adult
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