Honors Theses and Capstones

Date of Award

Spring 2022

Project Type

Senior Honors Thesis

College or School




Program or Major


Degree Name

Bachelor of Science

First Advisor

Alyssa O'Brien

Second Advisor

Kerry Nolte


From 2014 to 2016, NH ranked first for fentanyl and all opioid-related overdose deaths per capita in the United States (Moore et al., 2021). In 2016 the New Hampshire Department of Health and Human Services (NH DHHS) found that there are many repercussions of this opioid crisis including overdose deaths, child and elder abuse, and newborns experiencing withdrawal. In utero substance exposure places a child at a higher risk for developmental, behavioral, and physical health concerns. To address this gap, a secondary data analysis using NH Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2013 to 2020 was conducted. PRAMS data identifies groups of infants and women at high risk for health problems (CDC, 2021). Variables from three domains were analyzed; what healthcare providers talked about with the patient during pregnancy, reported risk behaviors in pregnancy, and postpartum outcomes. The data analysis revealed that over time, more participants have reported conversations with their care providers regarding the substance use risk factors of smoking and abuse. This finding called for a further investigation as to what happened between 2014 and 2017 in terms of prenatal care and healthcare provider conversations. Perinatal care bundles from the Alliance for Innovation on Maternal Health (AIM) work to best address the leading causes of preventable maternal morbidity and mortality (AIM, 2020). The increase and improvement in risk assessment by perinatal providers continues due to the emergence of care bundles that improve the quality and safety of care provided to pregnant women with substance use disorders.