Background: The majority of women who are pregnant with opioid use disorder (OUD) also smoke tobacco but are rarely offered tobacco cessation counseling. While the effects of exposure to opioids and nicotine in utero are well-understood separately, understanding the impact of the combined exposure to these substances on neonatal outcomes is lacking. Methods: A scoping review was conducted using PubMed and Scopus databases for studies addressing the combined exposure to opioids and nicotine during pregnancy published between 1 January 1980 and 9 July 2019. A total of 29 papers met the eligibility criteria for inclusion, with nine being identified as clinical trials (three from the MOTHER study) and two as secondary data analysis of clinical trial data. Results: Neonatal outcomes for infants who had a combined exposure to opioids and nicotine in utero indicated a reduction in birth weight and birth length. Findings in infants exposed to both nicotine and opioids were mixed with regard to the duration of neonatal abstinence syndrome (NAS), the likelihood of treatment for NAS, doses of medicine used to treat NAS, and NAS scores when compared with infants who had opioid exposure without nicotine. Conclusions: The combined exposure to nicotine and opioids during pregnancy may lead to a reduction in neonatal birth weight and birth length and more severe NAS signs, compared with opioid use alone, but more research is necessary to identify the minimum dosage and length of nicotine exposure to accurately predict these outcomes.

Purpose: Women who are pregnant or parenting while recovering from substance use disorder (SUD) are at risk for insufficient recovery support. With the federal mandate, implementation has been left to each state for the Plan of Safe Care (POSC), leading to challenges in providing comprehensive care coordination and meeting federal reporting requirements.Methods: This research tests the usability and acceptability of a POSC platform, called SAFE4BOTH, which combines a mobile health (mHealth) app for use by mothers with substance use disorder (MSUD) with a web-based case management system for use by stakeholders to reduce the issue of fragmented postnatal maternal and infant care. The platform was designed to enable access to services, improve reporting task workflow, and assist in improving interactions between mothers and service providers.After applying a user-centered design approach, the usability and acceptability of the SAFE4BOTH platform were evaluated using focus groups, interviews, and a System Usability Scale (SUS). The evaluation involved four staff members from a Medication for Addiction Treatment clinic (comprising of three case management workers and one peer counselor), four state employees of the Delaware Division of Family Services, and 20 mothers with MSUD who had delivered infants in need of a POSC.Features tested in the SAFE4BOTH platform included a secure, web-based POSC, a contingency management-based reward system, a micro-learning library, a resources locator, a chat messaging and videoconferencing system, a directory for contact management, a QR code reader, use of an appointment compliance system engaging geofencing, and an enhanced calendar. Family services and treatment center staff accessed SAFE4BOTH from their laptops or tablets, and MSUD accessed SAFE4BOTH from their phones.Results: Family services staff, treatment center staff, and MSUD participants rated SAFE4BOTH as usable and acceptable with average System Usability Scale scores of 68.1 (SD 8.5), 92.5 (SD 11.73), and 78.4 (SD 12.5) (respectively).Conclusion: The platform was judged both usable and acceptable by all three target populations (family services staff, treatment center staff, and MSUD). Further studies are planned to explore the efficacy of longitudinally supporting the mother’s recovery and the infant’s healthy development.

Background: Women of childbearing age (aged 18-44 years) face multiple barriers to receiving screening and treatment for unhealthy alcohol and substance use, depression, and anxiety, including lack of screening in the primary care setting and lack of support in accessing care. The Women Empowered to Connect with Addiction Resources and Engage in Evidence-based Treatment (WE-CARE) mobile app was developed to test universal screening with women of childbearing age and linkage to care after an anonymous assessment. Objective: In this study, we aimed to investigate the feasibility and acceptability of providing anonymous screening instruments through mobile phones for alcohol and substance use, as well as depression and anxiety, for women of childbearing age. Methods: We used agile development principles based on previous formative research to test WE-CARE mobile health app with women of childbearing age (N=30) who resided in 1 of 6 counties in central Florida. WE-CARE included screening instruments (for alcohol, substance use, depression, and anxiety), a moderated discussion forum, educational microlearning videos, a frequently asked questions section, and resources for linkage to treatment. Individuals were recruited using flyers, academic listserves, and a commercial human subject recruiting company (Prolific). Upon completion of the screening instruments, women explored the educational and linkage to care features of the app and filled out a System Usability Scale to evaluate the mobile health app’s usability and acceptability. Postpilot semistructured interviews (n=4) were conducted to further explore the women’s reactions to the app. Results: A total of 77 women downloaded the application and 30 completed testing. Women of childbearing age gave the WE-CARE app an excellent System Usability Scale score of 86.7 (SD 12.43). Our results indicate elevated risk for substance use in 18 of the 30 (60%) participants, 9/18 (50%) also had an elevated risk for anxiety or depression, and 11/18 (61%) had an elevated risk for substance use, anxiety, or depression. Participants reported that WE-CARE was easy to navigate and use but they would have liked to see more screening questions and more educational content. Linkage to care was an issue; however, as none of the women identified as “at-risk” for substance use disorders contacted the free treatment clinic for further evaluation. Conclusions: The mobile health app was highly rated for acceptability and usability, but participants were not receptive to seeking help at a treatment center after only a few brief encounters with the app. The linkage to care design features was likely insufficient to encourage them to seek treatment. The next version of WE-CARE will include normative scores for participants to self-evaluate their screening status compared with their age- and gender-matched peers and enhanced linkages to care features. Future development will focus on enhancing engagement to improve change behaviors and assess readiness for change.

Objective: Formative research was conducted to identify barriers to universal screening for alcohol/substance use, depression, and anxiety in women of childbearing age (WOCA,18–44 years of age) drawn from the general population and from women in a residential treatment program for alcohol and/or drug use. Methods: E-surveys ( n = 467), focus groups with women aged 18–44 ( n = 30), and in-depth interviews (IDIs) with healthcare providers (HCPs, n = 8) were conducted to create a user-centered design for a mHealth application. Results: E-surveys revealed that 80% of the women were asked about alcohol use at a visit with their HCP, while 70% were asked about drug use. Only 35% of the respondents indicated an HCP discussed their answers with them. Two focus groups with WOCA revealed minimal to no prior knowledge of risk factors related to alcohol and substance use. Barriers to treatment identified included a lack of readiness to change, cost, minimal social support systems, and a perceived sense of public stigma. In-depth interviews with HCPs revealed not all HCPs use screenings for substance use due to lack of time to conduct a screening, unfamiliarity with standardized screening tools, insufficient training to provide proper follow-up care, no mandates requiring such screenings, and a concern that asking follow-up questions may negatively impact their relationship with the client. Conclusion: Results from the formative research studies were used to inform the design and development of the WE-CARE app prototype. The prototype, which includes educational content on alcohol and substance use disorders (SUDs), a moderated discussion forum, FAQs, and a Chatbot to encourage participants to make an appointment with an SUD treatment center if indicated, is undergoing pilot testing.

BACKGROUND Women of childbearing age (WOCA,18-44 years of age) face multiple barriers to receiving screening and treatment for unhealthy alcohol and substance use, depression, and anxiety, including lack of screening in the primary care setting and lack of support in accessing care. The Women Empowered to Connect with Addiction Resources and Engage in Evidence-based Treatment (WE-CARE) mobile app was developed to test universal screening with WOCA and linkage to care after an assessment for substance use disorder (SUD). OBJECTIVE In this study, we aimed to investigate the feasibility and acceptability of providing anonymous screening instruments for alcohol and substance use, as well as depression and anxiety, for women of childbearing age through mobile phones. METHODS We used Agile development principles based on prior formative research to create an alpha version of a WE-CARE mobile health application that was piloted with WOCA (N = 30) who resided in one of six counties in Central Florida. WE-CARE included screening instruments (for substance use, depression, and anxiety), a moderated discussion forum, educational micro-learning videos, an FAQ section, and resources for linkage to treatment. Individuals were recruited using flyers, academic listservs, and a commercial human subject survey company (Prolific). Upon completion of the screening instruments, women explored the educational and linkage to care features of the app and filled out a System Usability Scale (SUS) to evaluate the mobile health app’s usability and acceptability. Post-pilot semi-structured interviews (n = 4) were conducted to further explore the women’s reactions to the application. RESULTS Seventy-seven women downloaded the application and 30 completed testing. WOCA gave the WE-CARE app an excellent SUS score of 86.7 + 12.43 (SD). Out of the 30 participants (African American (N=1, 3.3%), Hispanic (N=6, 20%), more than one race (N=5,16.7%), White (N=14, 46.7%), Unknown (N=7, 23.3%)), 60% (n=18) had results indicating elevated risk for substance use, 50% of these 18 (n=9/18) indicated elevated risk also for anxiety or depression, and 61% (n=11/18) indicated elevated risk for substance use and/or anxiety or depression. Participants reported that WE-CARE was easy to navigate and use but they would like to see more screening questions and more educational content. However, linkage to care was an issue, as none of the women identified as ‘at-risk’ for SUDs contacted the free treatment clinic for further evaluation. CONCLUSIONS The mobile health application was highly rated for acceptability and usability, but participants were not receptive to seeking help at a treatment center after only a few brief encounters with the application. The linkage to care design features was likely insufficient to encourage them to seek treatment. The beta version of WE-CARE will include normative scores for participants to self-evaluate their screening status compared to their age- and gender-matched peers and enhanced linkages to care features. Future development will focus on improving engagement to change behaviors and assess readiness for change.