Men's influence of maternal substance use before, during, and after pregnancy: A qualitative study of men with criminal-legal involvement.

Background: While the adverse effects of substance use during pregnancy are well-established, the impact men with criminal-legal involvement who use substances have on their partner's substance-using behaviors is not well characterized. We aim to understand men's experiences and perspectives about how their substance use impacts romantic partner substance use in the preconception period, before a potential or actual pregnancy.

Methods: We conducted semi-structured interviews with men residing in a transition center in the Midwestern US with a substance use disorder (SUD) who partnered with women. Interview questions were informed by the Health Belief Model (HBM) and included questions about perceived susceptibility, severity, benefits, barriers, cues to action, and self-efficacy in relation to substance use and pregnancy. Participants were asked about desired SUD interventions. Transcripts were analyzed using a modified grounded theory approach.

Findings: Thirty participants were interviewed (mean age=37, SD=10.3). Major themes were mapped onto HBM constructs: (1) Partners did not consider the chance of pregnancy while using together; (2) using together can escalate use before/during pregnancy; (3) quitting can strengthen relationships; (4) lack of preconception health knowledge inhibits quitting; (5) having a pregnant partner may promote quitting; and (6) knowledge of potential negative outcomes increases confidence in quitting.

Conclusion: Men in carceral settings face multi-factorial barriers to substance use cessation and have differing perspectives on the impact of their use on their partner in relation to potential or actual pregnancy. Clinicians should consider interpersonal relationship factors that may impede or promote substance use when caring for people with SUD.