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1 – 2 of 2Laura Curran and Jennifer Manuel
This study aims to examine the relationship between medication for opioid use disorder (MOUD) among pregnant individuals, referral source, mental health, political affiliation and…
Abstract
Purpose
This study aims to examine the relationship between medication for opioid use disorder (MOUD) among pregnant individuals, referral source, mental health, political affiliation and substance use policies in all 50 states in the USA.
Design/methodology/approach
This study describes MOUD receipt among pregnant people with an opioid use disorder (OUD) in 2018. The authors explored sociodemographic differences in MOUD receipt, referrals and co-occurring mental health disorders. The authors included a comparison of MOUD receipt among states that have varying substance use policies and examined the impact of these policies and the political affiliation on MOUD. The authors used multilevel binary logistic regression to examine effects of individual and state-level characteristics on MOUD.
Findings
Among 8,790 pregnant admissions with OUD, the majority who received MOUD occurred in the Northeast region (71.52%), and 14.99% were referred by the criminal justice system (n = 1,318). Of those who were self-referred, 66.39% received MOUD, while only 30.8% of referrals from the criminal justice system received MOUD. Those referred from the criminal justice system or who had a co-occurring mental health disorder were least likely to receive MOUD. The multilevel model showed that while policies were not a significant predictor, a state’s political affiliation was a significant predictor of MOUD.
Research limitations/implications
The study has some methodological limitations; a state-level analysis, even when considering the individual factors, may not provide sufficient description of community-level or other social factors that may influence MOUD receipt. This study adds to the growing literature on the ineffectiveness of prenatal substance use policies designed specifically to increase the use of MOUD. If such policies are consistently assessed as not contributing to substantial increase in MOUD among pregnant women over time, it is imperative to investigate potential mechanisms in these policies that may not facilitate MOUD access the way they are intended to.
Practical implications
Findings from this study aid in understanding the impact that a political affiliation may have on treatment access; states that leaned more Democratic were more likely to have higher rates of MOUD, and this finding can lead to research that focuses on how and why this contributes to greater treatment utilization. This study provides estimates of underutilization at a state level and the mechanisms that act as barriers, which is a stronger assessment of how state-specific policies and practices are performing in addressing prenatal substance use and a necessary step in implementing changes that can improve the links between pregnant women and MOUD.
Originality/value
To the best of the authors’ knowledge, this is the first study to explore individual-level factors that include mental health and referral sources to treatment that lead to MOUD use in the context of state-level policy and political environments. Most studies estimate national-level rates of treatment use only, which can be useful, but what is necessary is to understand what mechanisms are at work that vary by state. This study also found that while substance use policies were designed to increase MOUD for pregnant women, this was not as prominent a predictor as other factors, like mental health, being referred from the criminal justice system, and living in a state with more Democratic-leaning affiliations.
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Political Corporate Social Responsibility (CSR), based on ideas about deliberative democracy, have been criticised for increasing corporate power and democratic deficits. Yet…
Abstract
Purpose
Political Corporate Social Responsibility (CSR), based on ideas about deliberative democracy, have been criticised for increasing corporate power and democratic deficits. Yet, deliberative ideals are flourishing in the corporate world in the form of dialogues with a broad set of stakeholders and engagement in wider societal issues. Extractive industry areas, with extensive corporate interventions in weak regulatory environments, are particularly vulnerable to asymmetrical power relations when businesses engage with society. This paper aims to illustrate in what way deliberative CSR practices in such contexts risk enhancing corporate power at the expense of community interests.
Design/methodology/approach
This paper is based on a retrospective qualitative study of a Canadian oil company, operating in an Albanian oilfield between 2009 and 2016. Through a study of three different deliberative CSR practices – market-based land acquisition, a grievance redress mechanism and dialogue groups – it highlights how these practices in various ways enforced corporate interests and prevented further community mobilisation.
Findings
By applying Laclau and Mouffe’s theory of hegemony, the analysis highlights how deliberative CSR activities isolated and silenced community demands, moved some community members into the corporate alliance and prevented alternative visions of the area to be articulated. In particular, the close connection between deliberative practices and monetary compensation flows is underlined in this dynamic.
Originality/value
The paper contributes to critical scholarship on political CSR by highlighting in what way deliberative practices, linked to monetary compensation schemes, enforce corporate hegemony by moving community members over to the corporate alliance.
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