Date of Award

Spring 2023

Degree Type



Health Services and Policy Management

Director of Thesis

Dr. Peiyin Hung

First Reader

Dr. Sara Corwin

Second Reader

Dr. Sara Corwin


Importance: Though detrimental consequences, many pregnant individuals are still binging alcohol, smoking, and/or using illicit drug. Yet, little is known regarding variations in such behaviors across pregnant people in the United States.

Objective: To examine alcohol, tobacco, and drug use during pregnancy in 2015-2020 and assess their racial, ethnic, and rural disparities.

Design: This cross-sectional descriptive study derived maternal characteristics and self-reported prenatal substance use data from 2015 and 2020 National Survey on Drug Use and Health, considering the complex sampling weight per participant per year produced by NSDUH.

Setting: United States.

Participants: A scientific random sample of non-institutionalized residents who reported pregnancy at the time of survey in 2015 (n=421)-2020 (n=790).

Primary outcomes: Polysubstance use during pregnancy defined as reporting any alcohol, tobacco, and/or illicit drug use within the past 30 days among pregnant participants.

Results: Of the study pregnant participants (accounted for ~2.27 million US pregnant population annually), polysubstance use during pregnancy decreased from 5.82% in 2015 to 4.51% in 2020, with substantial variations across residential rurality and race. Urban Hispanic showed the highest increase in polysubstance use from 3.2% to 7.8%, yielding a 143.6% increase, whereas rural Hispanic reported the highest decrease (7.2% to

Conclusion: Urban and racial disparities in prenatal substance use highlight the importance of developing tailored interventions to address prenatal substance use in these communities. Self reported NSDUH data might hinder our abilities to estimate the accurate prevalence of substance use during pregnancy, especially among rural pregnant participants who face higher stigma associated with prenatal substance use.

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