Association for Public Policy Analysis & Management

Background: Prescription opioid misuse and addiction have increased significantly among women of reproductive age over the last 15 years. In addition, rates of neonatal abstinence syndrome, which describes the constellation of symptoms associated with opioid withdrawal in newborns, increased three-fold nationwide between 2000 and 2009. News media and public attention have focused on the implications of this trend with state policy responses varying in the extent to which they are punitive or public health-oriented. The types of solutions that the public perceives as appropriate for addressing prescription opioid addiction during pregnancy may be informed by the way that the causes and consequences of this issue are framed in public discourse. Narratives, or stories about individuals, are often used by the media, by policymakers, and in educational campaigns to frame social and public health issues.

Methods: We conducted a six-group randomized experiment among a nationally representative sample of U.S. adults (N=1,620) in order to test the effects of narratives portraying a pregnant woman addicted to prescription opioids on public attitudes. Participants were exposed to three different narrative features: 1) portrayal of a pregnant woman as high or low socioeconomic status (SES), 2) portrayal of the barriers to addiction treatment access faced by a woman during her pregnancy; and 3) portrayal of a successfully treated pregnant woman. Outcomes were measured on 7-point Likert scales. We used ordered logistic regression models to test how the narrative exposures affected study participants’ beliefs about persons with prescription opioid addiction, perceptions of addiction treatment effectiveness, support for public policies to address prescription opioid misuse and addiction during pregnancy, and emotional reactions.

Results: Portraying a high SES woman in the narrative lowered perceptions of individual blame for addiction and decreased public support for punitive policies. Depicting the barriers to treatment faced by a low SES woman reduced support for punitive policies and increased support for expanded insurance coverage for addiction treatment. The extent to which narratives portraying successfully treated addiction affected public attitudes depended on the SES of the woman portrayed. In comparison to the narrative depicting a high SES woman who is not treated, the narrative depicting a successfully treated high SES woman increased perceptions that addiction treatment can be effective. In comparison to the narrative depicting an untreated low SES woman, portraying a successfully treated low SES woman decreased support for punitive policy. Emotional responses mediated many of the relationships between narrative exposure and public attitudes.

Conclusions: These findings can inform the development of communication strategies to reduce stigma toward this population, reduce support for punitive policies, and increase support for more public health oriented approaches to addressing this problem.