Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)


Policy Studies

Committee Chair/Advisor

Dr. Lori Dickes

Committee Member

Dr. Laura Olson

Committee Member

Dr. Rachel Mayo

Committee Member

Dr. Lu Zhang

Committee Member

Dr. Lior Rennert


Substance use disorder (SUD) during pregnancy, which includes opioid use disorder (OUD), has developed into a significant medical and social concern, as it can cause a range of complications for pregnant women, fetuses, and infants. One common condition resulting from OUD is neonatal abstinence syndrome (NAS), a withdrawal syndrome experienced by infants after being exposed to opioids in the womb. NAS can cause visual physiological or neurodevelopmental complications or outcomes in newborns. Unfortunately, large-scale studies focusing on long-term neurodevelopmental outcomes of infants with NAS are minimal. NAS consists of indications and symptoms that can also affect the autonomic nervous, gastrointestinal, and respiratory systems, often requiring extended hospitalization and extensive pharmacological treatment. Despite the increase in the number of children suffering from NAS and the healthcare utilization consumed by their treatment, little is known about these children' outcomes and diagnoses behind the utilizations after their initial hospitalization. Additionally, pregnant women with SUD and their children are often stigmatized, mainly through the perpetuation of stigmatizing words and inaccurate beliefs. Unfortunately, extensive use of stigmatizing language exists on social media platforms, with Twitter containing a substantive portion of the posts.

This dissertation consists of three manuscripts that provide a comprehensive understanding of neurodevelopmental outcome, healthcare utilization, and stigmatizing language around NAS. The first manuscript compares neurodevelopmental diagnosis and screening of children treated with a NAS innovation program and children treated with traditional NAS care in South Carolina from birth to 4.5 years of age. It applies Kaplan-Meier survival curves to demonstrate and compare the survival (outcome), and Cox Proportional Hazard (PH) survival analysis models to identify how often neurodevelopmental screenings and diagnosis occur for children with NAS treated with and without the innovation program. The second manuscript explores two healthcare utilization outcomes, hospital readmission and hospital length of stay (LOSD), among children with NAS and children born late preterm in South Carolina, with follow-up years from 0–3 years of age. The risk of hospital readmission was examined using logistic regression, and unadjusted and adjusted negative binomial regression analyses were used to model the relationship between hospital LOSD for children with NAS and those born late preterm. Finally, the third manuscript examines social media data around OUD and NAS to expand understanding of the general population's views and the potential unintended impacts of this communication environment on mothers and infants. This study consists of an event analysis of Twitter data, generated by a social media listening platform Sprinklr, to describe the use of stigmatizing language around OUD and NAS. The event was divided into three timeframes and the tests of significance were performed across all three timeframes using chi-square tests. In conclusion, this dissertation synthesized and discussed the results from the three studies. It also provided a broad discussion on the potential policy implications for clinical practice and possible directions for future research. For instance, increase insurance coverage through Medicaid and the state children’s health insurance programs, and the need for reaching a consensus on a specially established “addiction-ary,” particularly for NAS-related language.

Author ORCID Identifier




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