ACUFF Prenatal substance abuse has generated controversy among public health and legal scholars as well as significant activity in state legislatures and courts. Since the mid-1980s, states have modified child abuse and neglect statutes to include prenatal drug exposures and have criminally prosecuted women whose newborns have tested positive for drugs. Others have adopted a services-oriented model of care in which reporting of prenatal drug use is mandated for assessment and provision of services. Some states have adopted both punitive and service assessment approaches. State laws concerning prenatal substance abuse are necessarily dependent upon the cooperation of health care providers and social workers in identifying and reporting prenatal drug use. Despite the central importance of hospitals and their personnel to the impact of legislation on prenatal substance abuse, little is known about their response to legal regulation of prenatal substance abuse. This dissertation research will focus on this important, yet neglected issue by surveying key personnel in a 50% random sample of hospitals having more than 500 births per year in New York, New Jersey, Florida, California, Texas, and Minnesota. In addition to describing the range of hospital personnel practices across a range of jurisdictions, the research will also focus on whether the presence of a drug assessment policy is related to such factors as the legal climate in the jurisdiction, hospital size, percentage of medicaid patients, the availabilty of on-site drug treatment facilities, and other sociolegal factors. Also, for those hospitals with drug assessment policies, aspects of race and class will be investigated to further understand the mediating practices of hospitals in influencing the impact of prenatal drug use laws. Therefore, the study will fill an important empirical gap in knowledge about the impact of legal actions on hospital policies and practices. Also, the dissertation research holds promise for advancing basic knowledge about the social regulation of women and children.
