PDF(Pubmed)
Abstract：
BACKGROUND: Punitive legal responses to prenatal drug use may be associated with unintended adverse health consequences. However, in a rapidly shifting policy climate, current information has not been summarized. We conducted a survey of U.S. state policies that utilize criminal or civil legal system penalties to address prenatal drug use. We then systematically identified empirical studies evaluating these policies and summarized their potential public health impacts.
METHODS: Using existing databases and original statutory research, we surveyed current U.S. state-level prenatal drug use policies authorizing explicit criminalization, involuntary commitment, civil child abuse substantiation, and parental rights termination. Next, we systematically identified quantitative associations between these policies and health outcomes, restricting to U.S.-based peer-reviewed research, published January 2000-December 2022. Results described study characteristics and synthesized the evidence on health-related harms and benefits associated with punitive policies. Validity threats were described narratively.
RESULTS: By 2022, two states had adopted policies explicitly authorizing criminal prosecution, and five states allowed pregnancy-specific and drug use-related involuntary civil commitment. Prenatal drug use was grounds for substantiating civil child abuse and terminating parental rights in 22 and five states, respectively. Of the 16 review-identified articles, most evaluated associations between punitive policies generally (k = 12), or civil child abuse policies specifically (k = 2), and multiple outcomes, including drug treatment utilization (k = 6), maltreatment reporting and foster care entry (k = 5), neonatal drug withdrawal syndrome (NDWS, k = 4) and other pregnancy and birth-related outcomes (k = 3). Most included studies reported null associations or suggested increases in adverse outcome following punitive policy adoption.
CONCLUSIONS: Nearly half of U.S. states have adopted policies that respond to prenatal drug use with legal system penalties. While additional research is needed to clarify whether such approaches engender overt health harms, current evidence indicates that punitive policies are not associated with public health benefits, and therefore constitute ineffective policy.
METHODS: Using existing databases and original statutory research, we surveyed current U.S. state-level prenatal drug use policies authorizing explicit criminalization, involuntary commitment, civil child abuse substantiation, and parental rights termination. Next, we systematically identified quantitative associations between these policies and health outcomes, restricting to U.S.-based peer-reviewed research, published January 2000-December 2022. Results described study characteristics and synthesized the evidence on health-related harms and benefits associated with punitive policies. Validity threats were described narratively.
RESULTS: By 2022, two states had adopted policies explicitly authorizing criminal prosecution, and five states allowed pregnancy-specific and drug use-related involuntary civil commitment. Prenatal drug use was grounds for substantiating civil child abuse and terminating parental rights in 22 and five states, respectively. Of the 16 review-identified articles, most evaluated associations between punitive policies generally (k = 12), or civil child abuse policies specifically (k = 2), and multiple outcomes, including drug treatment utilization (k = 6), maltreatment reporting and foster care entry (k = 5), neonatal drug withdrawal syndrome (NDWS, k = 4) and other pregnancy and birth-related outcomes (k = 3). Most included studies reported null associations or suggested increases in adverse outcome following punitive policy adoption.
CONCLUSIONS: Nearly half of U.S. states have adopted policies that respond to prenatal drug use with legal system penalties. While additional research is needed to clarify whether such approaches engender overt health harms, current evidence indicates that punitive policies are not associated with public health benefits, and therefore constitute ineffective policy.
摘要：
背景：对产前用药的惩罚性法律反应可能与意外的不良健康后果有关。然而,在快速变化的政策环境中，当前信息尚未汇总。我们对美国国家政策进行了调查，这些政策利用刑事或民事法律制度处罚来解决产前药物使用问题。然后，我们系统地确定了评估这些政策的实证研究，并总结了其潜在的公共卫生影响。
方法：使用现有的数据库和原始的法定研究，我们调查了当前美国州级产前药物使用政策，授权明确定罪，非自愿承诺，民事虐待儿童的证据，和父母权利终止。接下来,我们系统地确定了这些政策与健康结果之间的数量关联，仅限于美国的同行评审研究，2000年1月至2022年12月发布。结果描述了研究特征，并综合了与惩罚性政策相关的健康相关危害和益处的证据。对有效性威胁进行了叙述描述。
结果：到2022年，两个州通过了明确授权刑事起诉的政策，和五个州允许怀孕特定和药物使用相关的非自愿民事承诺。产前吸毒是22个州和5个州证实民事虐待儿童和终止父母权利的理由，分别。在16篇审查确定的文章中，通常，惩罚性政策之间评估最多的关联(k=12)，或民事虐待儿童政策(k=2)，和多个结果，包括药物治疗利用(k=6)，虐待报告和寄养登记(k=5)，新生儿戒断综合征（NDWS，k=4）以及其他与妊娠和分娩相关的结局（k=3）。大多数纳入研究报告了无效关联或建议采取惩罚性政策后不良结果增加。
结论：将近一半的美国州采取了政策，对产前用药采取法律制度处罚。虽然需要更多的研究来澄清这种方法是否会导致公开的健康危害，目前的证据表明，惩罚性政策与公共卫生福利无关，因此构成无效的政策。
方法：使用现有的数据库和原始的法定研究，我们调查了当前美国州级产前药物使用政策，授权明确定罪，非自愿承诺，民事虐待儿童的证据，和父母权利终止。接下来,我们系统地确定了这些政策与健康结果之间的数量关联，仅限于美国的同行评审研究，2000年1月至2022年12月发布。结果描述了研究特征，并综合了与惩罚性政策相关的健康相关危害和益处的证据。对有效性威胁进行了叙述描述。
结果：到2022年，两个州通过了明确授权刑事起诉的政策，和五个州允许怀孕特定和药物使用相关的非自愿民事承诺。产前吸毒是22个州和5个州证实民事虐待儿童和终止父母权利的理由，分别。在16篇审查确定的文章中，通常，惩罚性政策之间评估最多的关联(k=12)，或民事虐待儿童政策(k=2)，和多个结果，包括药物治疗利用(k=6)，虐待报告和寄养登记(k=5)，新生儿戒断综合征（NDWS，k=4）以及其他与妊娠和分娩相关的结局（k=3）。大多数纳入研究报告了无效关联或建议采取惩罚性政策后不良结果增加。
结论：将近一半的美国州采取了政策，对产前用药采取法律制度处罚。虽然需要更多的研究来澄清这种方法是否会导致公开的健康危害，目前的证据表明，惩罚性政策与公共卫生福利无关，因此构成无效的政策。
