Letteratura scientifica selezionata sul tema "And the Laws and Regulations Affecting Them Which Have Been Passed"

In the Italian context, the first law directly affecting the urban planning and building sector dates back to approximately 160 years ago, precisely Law 2248/1865. It established the administrative unification of the Kingdom of Italy, empowering municipal councils to deliberate on ‘hygiene, building and local police regulations’, and was followed a few months later by Law 2359/1865 on expropriations for public purpose. By contrast, the first regulations for the protection of artistic, historical, archaeological and ethnographic heritage (1089/1938), and natural beauty (1497/1939), are just over 80 years old. From that time onwards, the rules governing planning and design actions have been considerably enriched and developed. Hence, it is worth reflecting on the effectiveness and efficiency of a regulatory framework that has been governing territorial, urban and building transformations in an increasingly articulated and specialised manner with a view to improving the quality and sustainability of natural and anthropic habitats. Moreover, its ability to govern the ways, times and cultural and technical contents of the project production process to carry out high quality creations is worthy of consideration. Perhaps the issue of standardisation has never been the centre of attention in all sectors of civil life as today: in public administration and scientific research, among economic operators, planners, and citizens themselves. Regulatory systems are increasingly pervasive in regulating design activity and the characteristics of works in response to a general «increase in the variety and complexity of public interests that appear worthy of protection, such as the quality of the environment, the safeguarding of the natural and historical-artistic heritage, the protection of health, the safety of persons, and security […]» (Bassanini et al., 2005). Changing interests require frequent updates to adapt regulations to rapid socio-economic, cultural, and technological changes. The centres of regulatory production have also multiplied, breaking up into different levels and sectors of regulation, namely with multi-level (international, EU, national, regional, local), sectoral (economy, environment, territory, landscape, infrastructure, cultural heritage, health, etc.) and institutional governance structures, with corresponding different interests (public/private, collective/individual) and complicated relationships of interconnection, conditionality and/or competition (Raveraira, 2009). The scenario is even more complex, if we broaden the scope to include, in addition to prescriptive and binding rules, the vast universe of guiding principles, voluntary standards, guidelines, best practices, etc. Moreover, also due to the nature of the legal system model of reference (civil law derived from Roman law, as opposed to the common law of English-speaking countries, founded on the binding force of practice and judgements), Italian legislation has been stratified by an anomalous number of rules, which are often not mutually coordinated, sometimes contradictory or bearing inconsistent definitions. They are either incapable of producing the desired results, or are not the cause of effects even diametrically opposed to those expected. The attempt to solve every problem through a special regulation results in limiting the free and responsible action of citizens (and planners). Indeed, as Marco Romano points out, «to reduce people’s desires to rights codified in the doctrine of planning, imposed by enlightened and pedagogical governments on rebellious citizens unaware of their own good, is to erase what makes them citizens: the diversity of their individual life projects» (Romano, 2013). On the other hand, the discrepancy between this regulatory approach and the reality that surrounds us is evident. On Alessandro Pizzorno’s death, Fabrizio Schiaffonati recalled how, back in the 1960s, the doyen of Italian political sociology had already warned that in Italy «everything must be regulated so that everything can be conceded», pointing out that «this is still the case nowadays, more than half a century later, with good peace for the quality of the project, which is overwhelmed by constraints and contradictory procedures that are obstructive to a necessary qualitative transformation of the anthropic environment within proper time and costs» (Schiaffonati, 2019). This hypertrophic growth of laws and regulations (a true ‘legislative inflation’ or ‘regulatory pollution’) is accompanied by their rapid variability over time, so much so that a building intervention begun within a given legislative framework risks being completed in the presence of a different regulatory framework, which would not have allowed its execution, and vice versa. Not to mention the «badly written, lengthy regulations that are difficult to read and even more difficult to apply, (which) now represent a constant factor with which even the most prepared and motivated operator must come to terms» (Gorlani, 2022), which lead to confusion and interpretative doubts. This makes bureaucratic formalities unnecessarily complex, overloads administrative action, and increases the regulatory and management costs for citizens, businesses and the public institutions themselves, including those dedicated to monitoring and control actions (which, in a context of shrinking public resources, are often the first to be lacking…). Legal uncertainty leads to opaque, if not arbitrary decisions, facilitates corruption, increases discrimination and social conflict, and limits economic development, sometimes to the point of inhibiting it (Bassanini et al., 2005). A vulnus with dramatic effects, if it is true that certainty does not have to be of the law, but: «certainty is law, just as, vice versa, law is certainty, if it is true that law […], is constituted for the specific purpose of giving certainty, or rather: certainties» (emphasis added; Ruggeri, 2005). The body of urban planning legislation has expanded considerably, imposing on city and regional planning new objectives and constraints aimed at protecting and improving the quality of the environment and landscape. Strategic environmental and impact assessments, regulations to limit land consumption, to increase climate resilience and to regenerate the built environment have been in use for many years now, with their rich set of analyses and tools to manage knowledge, build scenarios, compare alternatives, and quantify their effects through indicators (environmental, socioeconomic, etc.). And yet, all this does not seem to have produced the expected effects, as witnessed by the continuing degradation of urban suburbs, the continuous increase in soil erosion by new urbanisations and infrastructures, the abandonment of ‘inland areas’, and the hydrogeological instability of the most ‘fragile’ territories. Instead, by moving more and more on the level of so-called policies, planning seems to have lost its technical capacity to conform the quality of spaces, even in their cultural value and use, in a sort of throwback of illiteracy forgetting the grammatical and syntactical rules of construction of the European city. The disciplinary crisis of the plan is evident, incapable of governing land uses and built forms, as well as the quality of public space, relying, instead, on the abstraction of ‘tactical squares’ and social streets totally inadequate to determine an organic configuration of the urban structure. There is no large city that does not have a plan for climate resilience or sustainable mobility, nor is there a major project that cannot boast top-level environmental and/or energy performance, duly certified even when it plans to replace a tree-lined park of more than 50,000 square metres with green roofs on a shopping centre (for example, San Siro in Milan). Greenwashing operations often characterise the private actions of real estate operators, in the absence of checks and controls by the public authorities. The public works sector has long been searching for a better balance of time, cost and quality of works. «A long journey, which has allowed for advances […] and regulatory innovations during the Nineties» (Schiaffonati, 2006) and which, after thirty years of conjunctural measures (suspensions, temporary derogations, emergency decrees, special procedures and competences, variations of thresholds, etc.1) has led to the new Procurement Code (legislative decree no. 36/2023). It features a text of more than 150,000 words, to which the regulatory and procedural innovations introduced by the PNRR must be added, with the related set of regulations, guidelines, explanatory circulars, protocols and technical instructions2. It is a seemingly unstoppable process of continuous correction and integration to reform the reform, in the absence of the indispensable monitoring activity that should, instead, verify and assess the effects of the application of the regulation to correctly finalise its amendment. Nevertheless, there has been no lack of significant precedents in this regard, as in the case of the French experimentation of the Spinetta Law on construction insurance systems3. If we apply to the standard the historical notion of “quality as fitness for intended use” (Juran, 1951), or to the more recent notion of «the set of properties and characteristics of a product or service that provide the capacity to satisfy expressed or implicit needs» (UNI EN ISO 8402:1995), it clearly appears that the challenge to be faced concerns not so much or only regulatory and administrative simplification, or the replacement of redundant, obsolete or unjustified regulations, but precisely the “quality of regulation”. A direction undertaken since 2001 by OECD and Apec countries with a Regulatory Reform (reference criteria to ensure quality and transparency in regulatory activity), in line with the obligation to formulate rules that are conceptually and semantically precise, clear and comprehensible in the terms used, in the objectives set, in the required behaviour (Constitutional Court, ruling no. 364 of 1988) and, above all, with contents derived from consensual and shared planning (Raveraira, 2009). Responsibility, consensus and collaboration are, I believe, the key words to possibly rethink the relationship between design and regulation. In fact, I agree with Marco Dugato’s observation in this Dossier when he argues that «the fault of normative hypertrophy cannot be attributed to the omnipotence of the regulator by itself, rather it is attributable to the contribution of the ones regulated». If it is true that architectural design is constrained by regulations, it certainly cannot be mechanically determined by them for mere reasons of conformity. Conversely, as Maria Chiara Torricelli emphasises again in the Dossier, the norm is a tool that provides valid and shared knowledge to the project; and the project itself, as a projective activity, contributes proactively to its definition. There are many examples spanning technical directives regulating the implementation cycles of the INA Casa, the result of design research in support of the political project, and the various procedural and meta design regulations derived from research in the Architectural Technology Field. Such design experiences have unfolded in an experimental manner, in derogation of the regulations and leading to their renewal. Instead, deductive design approaches seem to prevail today, due to the growing availability of algorithmic procedures that do not merely support the design process, but develop it in an almost automated manner through conditioning and prevailing indicators and parameters. These tools legitimise choices where conformity to the standard acts as a screen for the assumption of precise responsibilities. There is a conceptual and operational reversal with respect to creative, responsibly inductive design action, which experiments and innovates, putting the principles of adequate performance and compliance with needs over the criteria of formal conformity. This is evident in the relationship between technical regulations and techno-typological innovation for evolutions that move the parameters of regulatory congruity “forward”, but sometimes even “sideways”. This also counteracts the phenomena of norm obsolescence. In consideration of the pervasiveness of the regulatory systems that rule design action, it is, finally, disturbing to observe the very limited importance assigned to this subject in the education of new designers. The didactics of design, which have long been the focus of Architecture studies, rarely envisage a structured discussion on regulatory and normative aspects, leaving them to the discretion of professors. Hence, at the end of the course, a large proportion of students have never heard about the Code of Procurement, environmental impact assessment or minimum environmental criteria… Whereas it is, instead, essential to solicit, from the first year, critical attention to the normative paradigm, also for the ethical, social and professional responsibilities it entails, and to encourage the assumption of norms and constraints as factors that nourish the entire design process. The norm thus becomes a «tool for guiding and controlling design choices», which as such «must be assumed in the organisation of the starting data» (Del Nord, 1992). Not to mention the need for qualifying training programmes, as Mario Avagnina points out, so that all those involved in the process, particularly public clients, are able to carry out their tasks. The objective is far from being achieved, and «necessarily passes through the training of the figures involved, starting with the RUPs». Figures characterised not only by technical knowledge of the building process and its rules, but also by a culture of standards and conscious responsibility that can only derive from a design practice, which is continually verified in the real context, and by design actions based on an experimental method that aims to face the issues of society. Figures characterised not only by technical know-how of the building process and its rules, but also by a culture of standards and conscious responsibility, which can only derive from a practice continually verified by comparison with reality, and by design actions marked by an experimental method that finds its arguments in taking on the problems of society.

<p>Currently there are more than 150 local and international franchise businesses operating in Jordan. Franchise business in Jordan has been a crucial investment market contributing to the country’s Gross Domestic Product (GDP) and developing its economic growth and trade. Nevertheless, legal challenges to the investors which have existed may hinder them from opening up a franchise business in Jordan. One of these challenges is the lack of specific legal framework regulating franchise business. Jordanian legal system does not have specific legislation to regulate the franchise agreement (which is known as the “license agreement” in Jordan) between a franchisor and a franchisee. The lack of specific legislation may deter or at least slow down the progress of foreign and local investors in setting up franchise businesses in Jordan, as they could not reasonably anticipate the relevant laws and regulatory enforcements relating to franchise. Therefore, this paper examines the current laws and regulations governing franchise business in Jordan. The paper concludes that existing laws affecting franchise in Jordan fail to address comprehensively the legal aspects of franchise. Thus, there is a dire need for specific legal framework to govern franchise business in Jordan.</p>

This study aims to evaluate and find forms of legal protection and factors that affect law enforcement against children as victims of sexual exploitation practices in Makassar City. This research is empirical legal research using a statutory approach. Data were analyzed using descriptive qualitative analysis. The results of this study indicate that: (1) the form of legal protection against children follows Law Number 35 of 2014 concerning Child Protection which provides children's rights in the form of legal assistance, rehabilitation, and prevention; (2) Factors affecting law enforcement against child victims of sexual exploitation practices in Gorontalo City are legal substance factors, law enforcers, facilities, society, and legal culture. All of them have not been run optimally by the laws and regulations.

Introduction. Children’s preventive healthcare legislation in noncommunicable diseases strictly determines departments’ interaction: there is a distinction in responsibilities, functions, and work standards for public health services and educational institutions. However, it is hard to distinguish which department or institution is responsible for preventive healthcare implementation in practice. This topic shows a lack of understanding of how to segregate responsibilities, establish effective communication channels, and create audit standards for preventing noncommunicable diseases and health literacy. Our aim was to analyze the legal, practical, and social aspects of preventive healthcare. Materials and methods. We studied correspondences in legal regulations and real-life healthcare activities, examined morbidity cases and affecting factors, and evaluated parental attitudes towards Russia’s preventive healthcare system. We surveyed national, sectoral, and regional statutory regulations. Regarding current laws, we analyzed children physical examination data (form № 030-ПО/о-12 (2017), form № 030-ПО/о-17 (2018)). We also questioned parents about children’s preventive healthcare and healthy lifestyle (1320 participants). All empirical data was collected in the 2017-2018 years in Moscow. Results. As a result, inconsistencies in the legal regulations and practical realization of preventive healthcare activities have been found. The critical problem is that there were no adequate implementation mechanisms, no standard criteria, and control methods for specific healthcare events. There was a difference in statutory healthcare activities, treatment as it is, and parental expectations (the most noticeable discrepancies were in the healthcare sphere): there is a noticeable growth of children morbidity; parents mostly feel themselves dissatisfied with the healthcare system. Conclusion. It is vital to develop control and implementation mechanisms of national legal regulations, to adapt them in regional preventive healthcare programs, considering region peculiarities.

Although rainwater harvesting would appear to be a win-win solution to the problem of developing new sources of water, implementing rainwater harvesting in the American West has been fraught with tensions that have pitted rural farmers and other agricultural interests against urban and suburban homeowners. The water law of the western states is based on the prior appropriation doctrine, which creates a “first in time, first in right” system of water rights tied to when a user diverts surface water for beneficial use. Since water rights are property rights, state statutes and regulations that “go too far” in affecting them risk giving senior appropriators a takings claim. Based on the nature of rainwater harvesting and judicial interpretations of federal and state constitutional takings clauses, the most likely claims by downstream agricultural irrigators in the West are that state statutes authorizing rainwater harvesting are per se physical takings. Such takings require compensation, even though they do not result in the total loss of the right to use water or have a minimal economic impact on a senior appropriator. To avoid a taking, state legislatures need to draft these statutes in ways that take advantage of how existing state laws implement the prior appropriation doctrine. Colorado’s most recent rainwater harvesting statute leverages how the no-injury requirement placed on junior appropriators ultimately limits the scope of the senior appropriators’ water rights and avoids a taking.

India's foundation is its agriculture. With over 60% of the workforce employed and producing over 18% of the nation's GDP, it is a vital sector of the Indian economy. Although there are many ways in which we can use technology to increase product production, a farmer can only profit if he is able to sell his crops. Three laws have been passed by the Indian government to encourage the export of agricultural products across the nation. But today, we witness farmers all over the nation fighting against these regulations to protect their rights. Farmers worry that big merchants will exploit them as puppets and undercut the price at which they sell their goods. After doing a thorough analysis of the situation, we developed the concept of creating an agricultural produce application that facilitates direct communication between farmers and retailers, allows for product reviews and crop yielding rate prediction, and predicts the price of agricultural produce based on quantity produced and previous years' sales rates. Unpredictable rains, unexpected temperature decreases, and heat waves have all been brought on by the shifting climate, and the ecosystem has suffered significant harm. Thankfully, machine learning has produced useful methods for tackling international problems, such as agriculture. These climate change-related agricultural issues can be resolved by using various machine learning methods. The purpose of this piece is to Create a method to identify crop diseases and suggest crops. For both objectives, publicly accessible datasets were utilized. Regarding the crop recommendation system, feature extraction was done, and a variety of machine learning methods were used to train the dataset, including Support Vector Machine (SVM), Random Forest, Decision Tree, Logistic Regression, and Multilayer Perceptron. 99.30% accuracy was attained via the random forest algorithm.CNN architectures such as ResNet50, and EfficientNetV2 were trained and compared for the plant disease identification system. EfficientNetV2 outperformed the rest, with a high accuracy of 96.08%.

In the wake of the 2008 economic financial crisis, several corporate governance issues have became more relevant in the daily corporate life, among them Gender Diversity. Institutional investors, due to the critical environment began to scrupulously analyze the companies, in which they invest, monitoring the level of compliance with corporate governance best practices, something which has been neglected in the past. This lead to the view that companies in line with best practice were able to reduce risks and consequently become more stable enabling them to increase company value. Starting from 1977 several aspects of the gender diversity have been analyzed and several theories have been produced by experts in this field. In 1977, the author of Men and Women of the Corporation, Kanter, showed evidence of the benefits for a company to have a more balanced boardroom. In the last decade many researchers have dedicated their study on how more women directors could affect corporate value. The flow of theories can be classified in two categories. At the beginning, gender diversity was considered as simply the need to have more women on board, then and more recently as diversity of skills, expertise, culture and backgrounds. The interest for this argument has become wide spread, grabbing the attention of entities at different levels, including those in charge of regulating markets. Many European countries amended their Corporate Governance Codes and laws pushing for the increase of women on boards. With the intensification of different regulations, the European Commission issued a regulation, with the aim of encouraging higher participation of women at board level. Their aim was also to align all European countries rules, conscious of the relevance for companies operating in the same European environment, to work in a global market with common rules. The increased attention towards gender diversity also partly derived from the actions of proxy advisors and institutional investors. All European countries implemented their regulations at different levels, giving suggestions of targets to be reached through their corporate governance codes or through laws, as far as establishing punitive measures in case of failure to reach the established target on time. The present paper focuses on the Spanish market, an interesting jurisdiction because of the methods implemented and the progress witnessed at company level to reach the proposed targets. From 2007 to 2013 the percentage of women on boards passed from 5,78% to 14,56%. Significant the progress done in the last six years and, at the same time there is evidence that Spain moved earlier towards a balanced boardroom at legislative level, but without eliminates strong impact at corporate level except in very few cases. Country regulations did not have an effective impact on the level of women serving on boards at executive and non-executive levels due to the particular market structure. Directors can serve on the board for twelve years maintaining the status of independent director and frequently directors are re-appointed for many subsequent years. Furthermore there is not any rule for the number of boards in which a director can serve. Due to this many directors participate in more than one company board. This together with the twelve years of board tenure is obstacles to the increase of women participating to the board life. Another characteristic of the Spanish market that limits female presence on the boardrooms is the strong presence of families controlling the market. In this case many seats are covered by family representatives. This practice does not leave, much space, for external candidates to seat on the board and consequently limits the presence of women on boards. A stronger level of compliance with gender diversity is more evident from the perspective of mix of background and expertise. This level increased by 29,33% during the period considered in this study (from 2007 to 2013) and reaching 30,79% in 2013. A board that experiences a good balance in gender mix and international directors together with experts in transversal fields bring to the board expertise and knowledge to develop the company business in a more proficiency direction. This is considered to be the right recipe to enhance on corporate governance and avoid risks that could affect company value. Once more in Spain main shareholders or founding families are an obstacle to the circulation of new experience and ideas, able to ensure that the board is provided with the adequate people to take better decision in the company’s interest. Moreover, all board members have a background, in terms of academic qualifications, in line with the business of the company while there is a lack of transversal expertise. The current Spanish situation shows that regulations at local or European level are not enough to reach a balanced boardroom for gender and professional profile of board diversity. Neither of the regulations coming from the European Commission and the Spain are considered punitive measures in case of no compliance. Records provided by Catalyst at the beginning of March 2014, highlight that Norway is the country with the highest level of compliance with 40,90% of board seats held by women . Norway can be considered an example of how mandatory quota rules can work for companies. Spain could reach a high level of compliance by adopting restrictive measures, in this case, neither those characteristic elements as the Directors’ tenure or family owners, could limit or reduce the effectiveness of the measures proposed.

PurposeAlthough there has been much research on government support for export in China and other emerging economies, considerably less attention has been given to government subsidy-related importing activity in China. This study aims to propose that the government subsidies as the source of financial resources produce a significant increase of imports, as the firms are more likely to engage actively in importing technology-related products which are conducive for China’s future innovation. However, state ownership in firms negatively moderates this relationship and holds back technology imports. Improved formal regulatory institutions do not help to improve but rather weaken this relationship.Design/methodology/approachTo investigate how government policy affects imports of strategic resources in China, all of the listed firms on Chinese stock markets (from 2008 to 2014) have been selected, the firms that are engaged in exporting and importing activities. The data from the China Stock Market & Accounting Research database have been selected and merged with those of the General Administration Customs in China. A panel analysis has been done with several robustiness tests.FindingsFirst, the study indicates that government subsidies are a driving force for the development of importing activities. Second, it finds conflicts of interests between government subsidies and state ownership of a firm, as increased ownership will weaken and even negate the positive effect of a government policy, thus negatively affecting the national competitiveness in the long run. Third, it is important to take into account the issue on different levels of institutional development, even allowing for the fact that a nationwide government policy is applied to the firms located in all corners of the country.Research limitations/implicationsThe authors suggested a regional difference in regulatory development but did not find the proposed direction. In their future study, the authors will validate and generalize this intriguing substitutional effect. They expect the results will help the government to ensure that it can fulfill a policy (e.g. regulation) down to every gross-roots organization so the development of regulatory infrastructure will help the firm to obtain and accumulate strategic resources through increased imports of them. Another direction of their future study will explore how government policy will prompt the firms to increase their spending so that they can possess plenty of “stamina” for their future development.Practical implicationsDifferent levels of institutional development exist in China even allowing for the fact that a nationwide government policy should be applied to all firms within the territory. This certainly has impacts on technology imports and thus creates difficulties for firms located in the western parts of China about which the government is particularly concerned. The government needs to ensure that its policies (laws and regulations) can be fulfilled down to every gross-roots organization so that the development of regulatory infrastructure can be inclusive and pervasive, given its influence on technology importation and indigenization.Originality/valueBoth of the theoretical and empirical work centered on policy initiatives and particularly government subsidies in emerging economies that significantly influence imports of strategic resources, a means with which the firm is better able to maintain and develop its competitive advantages, particularly in an economy with institutional void. Relatedly, the results on a causal relationship help envision a transcending trajectory of China’s economy, suggesting that businesspeople should capitalize on the policy advantage so that they are better able to sustain their long-term development. The results also present implications for policymakers to encourage and support strategic move toward such import endeavors.

Purpose – Trust in financial institutions has been eroded through the collapse of mortgage-related securities, with confidence further denuded through well publicized cases of rogue traders and rate fixing cases, such as with the Lehman brothers, the Libor rate-fixing scandals, and the hypo real estate breakdown. In response to these events, governments have introduced a range of distinct policy initiatives designed to restore trust in this sector. Thus, the question arises: are these regulations and control mechanisms sufficient in isolation, or are there other elements that this sector needs to pay attention to in efforts to build and sustain customers’ trust? The paper aims to discuss these issues. Design/methodology/approach – There is a compelling agenda for both financial organizations and academics to understand better organizational trust in this context especially the role and impact of regulatory mechanisms in its development and repair. The paper therefore examines the special facets of the financial services sector in comparison to other sectors, such as manufacturing, to consider whether trust is fundamentally different in this context than others, and thus address how far there are special challenges concerning trust and the banking industry. The paper analyses, by using a meta-analytical design, 93 studies (N=38,631), of which 20 empirically investigate organizational trust in the financial sector with a combined N of 11,224 respondents. Findings – The paper shows that the banking sector is heavily affected by two distinct forces: first, customers’ perception of an organization's level of compliance and conformity with laws and regulations is a necessity for banks’ sociopolitical legitimization, and second it is also related to how non-compliance is dealt with. Importantly, this meta-analysis indicates that regulation is just one of a suite of devices that organizations need to deploy in their efforts to restore trust. The paper identified two further elements of significance: customers require direct evidence, derived either from their own or others’ satisfaction with the goods or services provided, and customers do take note of the external endorsement of the firm, especially in Asia, where customers place huge emphasis on the firm's reputation. Research limitations/implications – First, meta-analysis is inherently reliant on the earlier studies and therefore retains their weaknesses. Some of the relationships included self-report variables collected at the same point in time and therefore may be inflated by common method bias. Second, due to the focus and because of the limited number of studies in this sector, and a paucity of attention on some key topics, such as perceptions of regulation, second-order sampling error may also be a limitation. Third, some relationships were not investigated frequently enough in studies to enable us to include them in the review, such as cooperation, opportunistic behaviour or quality. Finally, despite calls for trust scholars to include propensity to trust measures within their studies, many of these studies do not include this measure and therefore it is more difficult to identify and control individual difference factors. Practical implications – The results show the merit of multi-strand trust development strategies. There is a striking paucity of financial institutions, which have examined how far their trust deficit may be related to their internal culture, and whether recent corporate corruption could be the product of bonuses and the internal short-term individualized reward systems. The analysis reveals that although external regulations and controls are an effective and powerful devise for organizational trust, over the last two periods of significant crisis, their impact appears to be warning; Yet reassuring customers of their expectations of the other party's future behaviour is central to trust. Alternative remedies need to be considered, such as the establishment of a more effective regulator, or board of governors who oversee and assure compliance. Monitoring and surveillance offer a further external means of reducing the possibility of future misbehaviours. However, as the analysis indicates, other strands are required to build trust, including greater attention by firms on customers’ direct experiences, which in turn would enhance the third part endorsement of their competence and goodwill intentions of organizations. Social implications – Significantly, the results indicate the potentially partial erosion of credence factors, and thus confidence, in this sector over the last 20 years, during what has been a period of repeated exposure to trust breaches. The paper shows that single strand solutions, such as improvements to customer communication, are no longer sufficient, nor, more importantly, do they have the same impact. Instead, the paper shows the necessity to utilize more effectively and target attention towards three distinct antecedents: external regulations and their enforcement; third party and expert endorsements, and therefore external reputations; and customer satisfaction in terms of the effective delivery of customer expectations. Originality/value – Organizational trust has been shown as critical in positively affecting and repairing broken relationships through uncertainty reduction and confidence enhancement. In the past, different meta-analyses of trust have been undertaken, but this, to the authors knowledge, is the first meta-analytic study measuring trust on an organizational level in the context of the financial services sector and its regulatory environment. This meta-analysis indicates that regulation is just one of a suite of devices that organizations need to deploy in their efforts to restore trust. The paper identified two further elements: customers require direct evidence, and do take note of the external endorsement of the firm.

Photo by 14825144 © Alita Xander | Dreamstime.com ABSTRACT The US government's approach to the War on Drugs has created laws to deter people from using illicit drugs through negative punishment. These laws have not controlled illicit drug use, nor has it stopped the opioid pandemic from growing. Instead, these laws have created a negative bias surrounding addiction and have negatively affected particularly vulnerable patient populations, including pregnant women with substance use disorder and newborns with neonatal abstinence syndrome. This article highlights some misconceptions and underscores the challenges they face as they navigate the justice and healthcare systems while also providing possible solutions to address their underlying addiction. INTRODUCTION Pregnant women with substance use disorder require treatment that is arguably for the benefit of both the mother and the fetus. Some suggest that addiction is a choice; therefore, those who misuse substances should not receive treatment. Proponents of this argument emphasize social and environmental factors that lead to addiction but fail to appreciate how chronic substance use alters the brain’s chemistry and changes how it responds to stress, reward, self-control, and pain. The medical community has long recognized that substance use disorder is not simply a character flaw or social deviance, but a complex condition that requires adequate medical attention. Unfortunately, the lasting consequences of the War on Drugs have created a stigma around addiction medicine, leading to significant treatment barriers. There is still a pervasive societal bias toward punitive rather than rehabilitative approaches to addiction. For example, many women with substance use disorder lose custody of their baby or face criminal penalties, including fines and jail time.[1] These punitive measures may cause patients to lose trust in their physicians, ultimately leading to high-risk pregnancies without prenatal care, untreated substance misuse, and potential lifelong disabilities for their newborns.[2] As a medical student, I have observed the importance of a rehabilitative approach to addiction medicine. Incentivizing pregnant women with substance use disorder to safely address their chronic health issues is essential for minimizing negative short-term and long-term outcomes for women and their newborns. This approach requires an open mind and supportive perspective, recognizing that substance use disorder is truly a medical condition that requires just as much attention as any other medical diagnosis.[3] BACKGROUND The War on Drugs was a government-led initiative launched in 1970 by President Richard M. Nixon with the aim of curtailing illegal drug use, distribution, and trade by imposing harsher prison sentences and punishments.[4] However, it is worth noting that one can trace the roots of this initiative back further. In 1914, Congress enacted the Harrison Narcotics Tax Act to target the recreational use of drugs such as morphine and opium.[5] Despite being in effect for over four decades, the War on Drugs failed to achieve its intended goals. In 2011, the Global Commission on Drug Policy released a report that concluded that the initiative had been futile, as “arresting and incarcerating tens of millions of these people in recent decades has filled prisons and destroyed lives and families without reducing the availability of illicit drugs or the power of criminal organizations.”[6] One study published in the International Journal of Drug Policy in the same year found that funding drug law enforcement paradoxically contributed to increasing gun violence and homicide rates.[7] The Commission recommended that drug policies focus on reducing harm caused by drug use rather than solely on reducing drug markets. Recognizing that many drug policies were of political opinion, it called for drug policies that were grounded in scientific evidence, health, security, and human rights.[8] Unfortunately, policy makers did not heed these recommendations. In 2014, Tennessee’s legislature passed a “Fetal Assault Law,” which made it possible to prosecute pregnant women for drug use during pregnancy. If found guilty, pregnant women could face up to 15 years in prison and lose custody of their child. Instead of deterring drug use, the law discouraged pregnant women with substance use disorder from seeking prenatal care. This law required medical professionals to report drug use to authorities, thereby compromising the confidentiality of the patient-physician relationship. Some avoided arrest by delivering their babies in other states or at home, while others opted for abortions or attempted to go through an unsafe withdrawal prior to receiving medical care, sacrificing the mother's and fetus's wellbeing. The law had a sunset provision and expired in 2016. During the two years this law was in effect, officials arrested 124 women.[9] The fear that this law instilled in pregnant women with substance use disorder can still be seen across the US today. Many pregnant women with substance use disorders stated that they feared testing positive for drugs. Due to mandatory reporting, they were not confident that physicians would protect them from the law.[10] And if a woman tried to stop using drugs before seeking care to avoid detection, she often ended up delaying or avoiding care.[11] The American College of Obstetricians and Gynecologists (ACOG) recognizes the fear those with substance use disorders face when seeking appropriate medical care and emphasizes that “obstetric–gynecologic care should not expose a woman to criminal or civil penalties, such as incarceration, involuntary commitment, loss of custody of her children, or loss of housing.”[12] Mandatory reporting strains the patient-physician relationship, driving a wedge between the doctor and patient. Thus, laws intended to deter people from using substances through various punishments and incarceration may be doing more harm than good. County hospitals that mainly serve lower socioeconomic patients encounter more patients without consistent health care access and those with substance use disorders.[13] These hospitals are facing the consequences of the worsening opioid pandemic. At one county hospital where I recently worked, there has been a dramatic increase in newborns with neonatal abstinence syndrome born to mothers with untreated substance use disorders during pregnancy. Infants exposed to drugs prenatally have an increased risk of complications, stillbirth, and life-altering developmental disabilities. At the hospital, I witnessed Child Protective Services removing two newborns with neonatal abstinence syndrome from their mother’s custody. Four similar cases had occurred in the preceding month. In the days leading up to their placement with a foster family, I saw both newborns go through an uncomfortable drug withdrawal. No baby should be welcomed into this world by suffering like that. Yet I felt for the new mothers and realized that heart-wrenching custody loss is not the best approach. During this period, I saw a teenager brought to the pediatric floor due to worsening psychiatric symptoms. He was born with neonatal abstinence syndrome that neither the residential program nor his foster family could manage. His past psychiatric disorders included attention deficit disorder, conduct disorder, major depressive disorder, anxiety disorder, disruptive mood dysregulation disorder, intellectual developmental disorder, and more. During his hospitalization, he was so violent towards healthcare providers that security had to intervene. And his attitude toward his foster parents was so volatile that we were never sure if having them visit was comforting or agitating. Throughout his hospital course, it was difficult for me to converse with him, and I left every interview with him feeling lost in terms of providing an adequate short- and long-term assessment of his psychological and medical requirements. What was clear, however, was that his intellectual and emotional levels did not match his age and that he was born into a society that was ill-equipped to accommodate his needs. Just a few feet away from his room, behind the nurses’ station, were the two newborns feeling the same withdrawal symptoms that this teenager likely experienced in the first few hours of his life. I wondered how similar their paths would be and if they would exhibit similar developmental delays in a few years or if their circumstance may follow the cases hyped about in the media of the 1980s and 1990s regarding “crack babies.” Many of these infants who experienced withdrawal symptoms eventually led normal lives.[14] Nonetheless, many studies have demonstrated that drug use during pregnancy can adversely impact fetal development. Excessive alcohol consumption can result in fetal alcohol syndrome, characterized by growth deficiency, facial structure abnormalities, and a wide range of neurological deficiencies.[15] Smoking can impede the development of the lungs and brain and lead to preterm deliveries or sudden infant death syndrome.[16] Stimulants like methamphetamine can also cause preterm delivery, delayed motor development, attention impairments, and a wide range of cognitive and behavioral issues.[17] Opioid use, such as oxycodone, morphine, fentanyl, and heroin, may result in neonatal opioid withdrawal syndrome, in which a newborn may exhibit tremors, irritability, sleeping problems, poor feeding, loose stools, and increased sweating within 72 hours of life.[18] In 2014, the American Association of Pediatrics (AAP) reported that one newborn was diagnosed with neonatal abstinence syndrome every 15 minutes, equating to approximately 32,000 newborns annually, a five-fold increase from 2004.[19] The AAP found that the cost of neonatal abstinence syndrome covered by Medicaid increased from $65.4 million to $462 million from 2004 to 2014.[20] In 2020, the CDC published a paper that showed an increase in hospital costs from $316 million in 2012 to $572.7 million in 2016.[21] Currently, the impact of the COVID-19 pandemic on the prevalence of newborns with neonatal abstinence syndrome is unknown. I predict that the increase in opioid and polysubstance use during the pandemic will increase the number of newborns with neonatal abstinence syndrome, thereby significantly increasing the public burden and cost.[22] In the 1990s, concerns arose about the potentially irreparable damage caused by intrauterine exposure to cocaine on the development of infants, which led to the popularization of the term “crack babies.”[23] Although no strong longitudinal studies supported this claim at the time, it was not without merit. The Maternal Lifestyle Study (NCT00059540) was a prospective longitudinal observational study that compared the outcomes of newborns exposed to cocaine in-utero to those without.[24] One of its studies revealed one month old newborns with cocaine exposure had “lower arousal, poorer quality of movements and self-regulation, higher excitability, more hypertonia, and more nonoptimal reflexes.”[25] Another study showed that at one month old, heavy cocaine exposure affected neural transmission from the ear to the brain.[26] Long-term follow up from the study showed that at seven years old, children with high intrauterine cocaine exposure were more likely to have externalizing behavior problems such as aggressive behavior, temper tantrums, and destructive acts.[27] While I have witnessed this behavior in the teenage patient during my pediatrics rotation, not all newborns with intrauterine drug exposure are inevitably bound to have psychiatric and behavioral issues later in life. NPR recorded a podcast in 2010 highlighting a mother who used substances during pregnancy and, with early intervention, had positive outcomes. After being arrested 50 times within five years, she went through STEP: Self-Taught Empowerment and Pride, a public program that allowed her to complete her GED and provided guidance and encouragement for a more meaningful life during her time in jail. Her daughter, who was exposed to cocaine before birth, had a normal childhood and ended up going to college.[28] From a public health standpoint, more needs to be done to prevent the complications of substance misuse during pregnancy. Some states consider substance misuse (and even prescribed use) during pregnancy child abuse. Officials have prosecuted countless women across 45 states for exposing their unborn children to drugs.[29] With opioid and polysubstance use on the rise, the efficacy of laws that result in punitive measures seems questionable.[30] So far, laws are not associated with a decrease in the misuse of drugs during pregnancy. Millions of dollars are being poured into managing neonatal abstinence syndrome, including prosecuting women and taking their children away. Rather than policing and criminalizing substance use, pregnant women should get the appropriate care they need and deserve. I. Misconception One: Mothers with Substance Use Disorder Can Get an Abortion If an unplanned pregnancy occurs, one course of action could be to terminate the pregnancy. On the surface, this solution seems like a quick fix. However, the reality is that obtaining an abortion can be challenging due to two significant barriers: accessibility and mandated reporting. Abortion laws vary by state, and in Tennessee, for instance, abortions are banned after six weeks of gestation, typically when fetal heart rhythms are detected. An exception to this is in cases where the mother's life is at risk.[31] Unfortunately, many women with substance use disorders are from lower socioeconomic backgrounds and cannot access pregnancy tests, which could indicate they are pregnant before the six-week cutoff. If a Tennessee woman with substance use disorder decides to seek an abortion after six weeks, she may need to travel to a neighboring state. However, this is not always a feasible option, as the surrounding states (WV, MO, AR, MI, AL, and GA) also have restrictive laws that either prohibit abortions entirely or ban them after six weeks. Moreover, she may be hesitant to visit an obstetrician for an abortion, as some states require physicians by law to report their patients' substance use during pregnancy. For example, Virginia considers substance use during pregnancy child abuse and mandates that healthcare providers report it. This would ultimately limit her to North Carolina if she wants to remain in a nearby state, but she must go before 20 weeks gestation.[32] For someone who may or may not have access to reliable transportation, traveling to another state might be impossible. Without resources or means, these restrictive laws have made it incredibly difficult to obtain the medical care they need. II. Misconception Two: Mothers with SUD are Not Fit to Care for Children If a woman cannot take care of herself, one might wonder how she can take care of another human being. Mothers with substance use disorders often face many adversities, including lack of economic opportunity, trauma from abuse, history of poverty, and mental illness.[33] Fortunately, studies suggest keeping mother and baby together has many benefits. Breastfeeding, for example, helps the baby develop a strong immune system while reducing the mother’s risk of cancer and high blood pressure.[34] Additionally, newborns with neonatal abstinence syndrome who are breastfed by mothers receiving methadone or buprenorphine require less pharmacological treatment, have lower withdrawal scores, and experience shorter hospital stays.[35] Opioid concentration in breastmilk is minimal and does not pose a risk to newborns.[36] Moreover, oxytocin, the hormone responsible for mother-baby bonding, is increased in breastfeeding mothers, reducing withdrawal symptoms and stress-induced reactivity and cravings while also increasing protective maternal instincts.[37] Removing an infant from their mother’s care immediately after birth would result in the loss of all these positive benefits for both the mother and her newborn. The newborns I observed during my pediatrics rotation probably could have benefited from breastfeeding rather than bottle feeding and being passed around from one nurse to the next. They probably would have cried less and suffered fewer withdrawal symptoms had they been given the opportunity to breastfeed. And even if the mothers were lethargic and unresponsive while going through withdrawal, it would still have been possible to breastfeed with proper support. Unfortunately, many believe mothers with substance use disorder cannot adequately care for their children. This pervasive societal bias sets them up for failure from the beginning and greatly inhibits their willingness to change and mend their relationship with their providers. It is a healthcare provider’s duty to provide non-judgmental care that prioritizes the patient’s well-being. They must treat these mothers with the same empathy and respect as any other patient, even if they are experiencing withdrawal. III. Safe Harbor and Medication-Assisted Treatment Addiction is like any other disease and society should regard treatment without stigma. There is no simple fix to this problem, given that it involves the political, legal, and healthcare systems. Punitive policies push pregnant women away from receiving healthcare and prevent them from receiving beneficial interventions. States need to enact laws that protect these women from being reported to authorities. Montana, for example, passed a law in 2019 that provides women with substance use disorders safe harbor from prosecution if they seek treatment for their condition.[38] Medication-assisted treatment with methadone or buprenorphine is the first line treatment option and should be available to all pregnant women regardless of their ability to pay for medical care.[39] To promote continuity of care, health officials could include financial incentives to motivate new mothers to go to follow-up appointments. For example, vouchers for groceries or enrollment in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) may offset financial burdens and allow a mother to focus on taking care of her child and her recovery. IV. Mandated Substance Abuse Programs Although the number of people sentenced to state prisons for drug related crimes has been declining, it is still alarming that there were 171,300 sentencings in 2019.[40] Only 11 percent of the 65 percent of our nation’s inmates with substance use disorder receive treatment, implying that the other 89 percent were left without much-needed support to overcome their addiction.[41] It is erroneous to assume that their substance use disorder would disappear after a period without substance use while behind bars. After withdrawal, those struggling with substance use disorder may still have cravings and the likelihood of relapsing remains high without proper medical intervention. Even if they are abstinent for some time during incarceration, the underlying problem persists, and the cycle inevitably continues upon release from custody. In line with the recommendations by Global Commission on Drug Policy and the lessons learned from the failed War on Drugs, one proposed change in our criminal justice system would be to require enrollment and participation in assisted alcohol cessation programs before legal punishment. Policy makers must place emphasis on the safety of the patient and baby rather than the cessation of substance use. This would incentivize people to actively seek medical care, restore the patient-physician relationship, and ensure that they take rehabilitation programs seriously. If the patient or baby is unsafe, a caregiver could intervene while the patient re-enrolls in the program. Those currently serving sentences in prisons and jails can treat their substance use disorder through medication assisted treatment, cognitive behavioral therapy, and programs like Self Taught Empowerment and Pride (STEP). Medication assisted treatment under the supervision of medical professionals can help inmates achieve and maintain sobriety in a healthy and safe way. Furthermore, cognitive behavioral therapy can help to identify triggers and teach healthier coping mechanisms to prepare for stressors outside of jail. Finally, multimodal empowerment programs can connect people to jobs, education, and support upon release. People often leave prisons and jail without a sense of purpose, which can lead to relapse and reincarceration. Structured programs have been shown to decrease drug use and criminal behavior by helping reintegrate productive individuals into society.[42] V. Medical Education: Narcotic Treatment Programs and Suboxone Clinics Another proactive approach could be to have medical residency programs register with the Drug Enforcement Administration (DEA) as Narcotic Treatment Programs and incorporate suboxone clinics into their education and rotations. Rather than family medicine, OB/GYN, or emergency medicine healthcare workers having to refer their patients to an addiction specialist, they could treat patients with methadone for maintenance or detoxification where they would deliver their baby. Not only would this educate and prepare the future generation of physicians to handle the opioid crisis, but it would allow pregnant women to develop strong patient-physician relationships. CONCLUSION Society needs to change from the mindset of tackling a problem after it occurs to taking a proactive approach by addressing upstream factors, thereby preventing those problems from occurring in the first place. Emphasizing public health measures and adequate medical care can prevent complications and developmental issues in newborns and pregnant women with substance use disorders. Decriminalizing drug use and encouraging good health habits during pregnancy is essential, as is access to prenatal care, especially for lower socioeconomic patients. Many of the current laws and regulations that policy makers initially created due to naïve political opinion and unfounded bias to serve the War on Drugs need to be changed to provide these opportunities. To progress as a society, physicians and interprofessional teams must work together to truly understand the needs of patients with substance use disorders and provide support from prenatal to postnatal care. There should be advocation for legislative change, not by providing an opinion but by highlighting the facts and conclusions of scientific studies grounded in scientific evidence, health, security, and human rights. There can be no significant change if society continues to view those with substance use disorders as underserving of care. Only when the perspective shifts to compassion can these mothers and children receive adequate care that rehabilitates and supports their future and empowers them to raise their children. - [1] NIDA. 2023, February 15. Pregnant People with Substance Use Disorders Need Treatment, Not Criminalization. https://nida.nih.gov/about-nida/noras-blog/2023/02/pregnant-people-substance-use-disorders-need-treatment-not-criminalization [2] Substance Use Disorder Hurts Moms and Babies. National Partnership for Women and Families. June 2021 [3] All stories have been fictionalized and anonymized. [4] A History of the Drug War. Drug Policy Alliance. https://drugpolicy.org/issues/brief-history-drug-war [5] The Harrison Narcotic Act (1914) https://www.druglibrary.org/Schaffer/library/studies/cu/cu8.html [6] The War on Drugs. The Global Commission on Drug Policy. Published June 2011. https://www.globalcommissionondrugs.org/reports/the-war-on-drugs [7] Werb D, Rowell G, Guyatt G, Kerr T, Montaner J, Wood E. Effect of drug law enforcement on drug market violence: A systematic review. Int J Drug Policy. 2011;22(2):87-94. doi:10.1016/j.drugpo.2011.02.002 [8] Global Commission on Drug Policy, 2011 [9] Women NA for P. Tennessee’s Fetal Assault Law: Understanding its impact on marginalized women - New York. Pregnancy Justice. Published December 14, 2020. https://www.pregnancyjusticeus.org/tennessees-fetal-assault-law-understanding-its-impact-on-marginalized-women/ [10] Roberts SCM, Nuru-Jeter A. Women’s perspectives on screening for alcohol and drug use in prenatal care. Womens Health Issues Off Publ Jacobs Inst Womens Health. 2010;20(3):193-200. doi:10.1016/j.whi.2010.02.003 [11] Klaman SL, Isaacs K, Leopold A, et al. Treating Women Who Are Pregnant and Parenting for Opioid Use Disorder and the Concurrent Care of Their Infants and Children: Literature Review to Support National Guidance. J Addict Med. 2017;11(3):178-190. doi:10.1097/ADM.0000000000000308 [12] Substance Abuse Reporting and Pregnancy: The Role of the Obstetrician–Gynecologist. https://www.acog.org/en/clinical/clinical-guidance/committee-opinion/articles/2011/01/substance-abuse-reporting-and-pregnancy-the-role-of-the-obstetrician-gynecologist [13] R. Ghertner, G Lincoln The Opioid Crisis and Economic Opportunity: Geographic and Economic Trends. ASPE. Office of Assistant Secretary for Planning and Evaluation. DHHS Revised September 11, 2018 https://aspe.hhs.gov/reports/economic-opportunity-opioid-crisis-geographic-economic-trends [14] Midon, M. Z., Gerzon, L. R., & de Almeida, C. S. (2021). Crack and motor development of babies living in an assistance shelter. ABCS Health Sciences, 46, e021215-e021215. And for example, see Crack Babies: Twenty Years Later : NPR https://www.npr.org/templates/story/story.php?storyId=126478643 [15] Williams JF, Smith VC, the Committee on Substance Abuse. Fetal Alcohol Spectrum Disorders. Pediatrics. 2015;136(5):e20153113. doi:10.1542/peds.2015-3113 [16] CDC Tobacco Free. Smoking During Pregnancy. Centers for Disease Control and Prevention. Published April 11, 2022. https://www.cdc.gov/tobacco/basic_information/health_effects/pregnancy/index.htm [17] Abuse NI on D. What are the risks of methamphetamine misuse during pregnancy? National Institute on Drug Abuse. https://nida.nih.gov/publications/research-reports/methamphetamine/what-are-risks-methamphetamine-misuse-during-pregnancy [18] CDC. Basics About Opioid Use During Pregnancy | CDC. Centers for Disease Control and Prevention. Published July 21, 2021. https://www.cdc.gov/pregnancy/opioids/basics.html [19] Honein MA, Boyle C, Redfield RR. Public Health Surveillance of Prenatal Opioid Exposure in Mothers and Infants. Pediatrics. 2019;143(3):e20183801. doi:10.1542/peds.2018-3801 [20] Winkelman TNA, Villapiano N, Kozhimannil KB, Davis MM, Patrick SW. Incidence and Costs of Neonatal Abstinence Syndrome Among Infants with Medicaid: 2004–2014. Pediatrics. 2018;141(4):e20173520. doi:10.1542/peds.2017-3520 [21] Strahan AE, Guy GP Jr, Bohm M, Frey M, Ko JY. Neonatal Abstinence Syndrome Incidence and Health Care Costs in the United States, 2016. JAMA Pediatr. 2020;174(2):200-202. doi:10.1001/jamapediatrics.2019.4791 [22] Ghose R, Forati AM, Mantsch JR. Impact of the COVID-19 Pandemic on Opioid Overdose Deaths: a Spatiotemporal Analysis. J Urban Health Bull N Y Acad Med. 2022;99(2):316-327. doi:10.1007/s11524-022-00610-0 [23] Mayes LC, Granger RH, Bornstein MH, Zuckerman B. The Problem of Prenatal Cocaine Exposure: A Rush to Judgment. JAMA. 1992;267(3):406-408. doi:10.1001/jama.1992.03480030084043 [24] NICHD Neonatal Research Network. The Maternal Lifestyle Study. clinicaltrials.gov; 2016. https://clinicaltrials.gov/ct2/show/study/NCT00059540 [25] Lester BM, Tronick EZ, LaGasse L, et al. The maternal lifestyle study: effects of substance exposure during pregnancy on neurodevelopmental outcome in 1-month-old infants. Pediatrics. 2002;110(6):1182-1192. doi:10.1542/peds.110.6.1182 [26] Lester BM, Lagasse L, Seifer R, et al. The Maternal Lifestyle Study (MLS): effects of prenatal cocaine and/or opiate exposure on auditory brain response at one month. J Pediatr. 2003;142(3):279-285. doi:10.1067/mpd.2003.112 [27] Bada HS, Bann CM, Bauer CR, et al. Preadolescent behavior problems after prenatal cocaine exposure: Relationship between teacher and caretaker ratings (Maternal Lifestyle Study). Neurotoxicol Teratol. 2011;33(1):78-87. doi:10.1016/j.ntt.2010.06.005 [28] N, P, R. Crack Babies: Twenty Years Later. NPR. Published May 3, 2010. https://www.npr.org/templates/story/story.php?storyId=126478643 [29] Miranda L, Dixon V, September CRP on, 30, 2015. How States Handle Drug Use During Pregnancy http://projects.propublica.org/graphics/maternity-drug-policies-by-state [30] NCDAS: Substance Abuse and Addiction Statistics [2023]. NCDAS. https://drugabusestatistics.org/ [31] (Tenn. Code Ann. § 39-15-216). [32] Institute G. Interactive Map: US Abortion Policies and Access After Roe. https://states.guttmacher.org/policies/ [33] Whitesell M, Bachand A, Peel J, Brown M. Familial, Social, and Individual Factors Contributing to Risk for Adolescent Substance Use. J Addict. 2013;2013:579310. doi:10.1155/2013/579310 [34] CDC. Five Great Benefits of Breastfeeding. Centers for Disease Control and Prevention. Published July 27, 2021. https://www.cdc.gov/nccdphp/dnpao/features/breastfeeding-benefits/index.html [35] Welle-Strand GK, Skurtveit S, Jansson LM, Bakstad B, Bjarkø L, Ravndal E. Breastfeeding reduces the need for withdrawal treatment in opioid-exposed infants. Acta Paediatr. 2013;102(11):1060-1066. doi:10.1111/apa.12378 [36] Ilett KF, Hackett LP, Gower S, Doherty DA, Hamilton D, Bartu AE. Estimated dose exposure of the neonate to buprenorphine and its metabolite norbuprenorphine via breastmilk during maternal buprenorphine substitution treatment. Breastfeed Med Off J Acad Breastfeed Med. 2012;7:269-274. doi:10.1089/bfm.2011.0096 [37] Pedersen CA, Smedley KL, Leserman J, et al. Intranasal Oxytocin Blocks Alcohol Withdrawal in Human Subjects. Alcohol Clin Exp Res. 2013;37(3):484-489. doi:10.1111/j.1530-0277.2012.01958.x [38] Montana SB0289. https://leg.mt.gov/bills/2019/billhtml/SB0289.htm [39] Mullins N, Galvin SL, Ramage M, Gannon M, Lorenz K, Sager B, Coulson CC. Buprenorphine and Naloxone Versus Buprenorphine for Opioid Use Disorder in Pregnancy: A Cohort Study. J Addict Med. 2020 May/Jun;14(3):185-192. doi: 10.1097/ADM.0000000000000562. PMID: 31567599. [40] Drug Related Crime Statistics [2023]: Offenses Involving Drug Use. NCDAS. https://drugabusestatistics.org/drug-related-crime-statistics/ [41] Association APH. Online only: Report finds most U.S. inmates suffer from substance abuse or addiction. Nations Health. 2010;40(3):E11-E11. [42] Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition) | NIDA Archives. Published January 17, 2018. http://archives.nida.nih.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition