Document Type
Article
Abstract
Purpose: Drug overdoses are now a leading cause of pregnancy-related deaths in the United States. Despite evidence of rural–urban disparities in substance use, there has not yet been a nationally representative examination of rural–urban differences in perinatal substance use. This study provides a comprehensive examination of rural–urban disparities in perinatal substance use. Methods: This study uses cross-sectional data to examine 3499 pregnant women from the 2015–2019 National Survey on Drug Use and Health (NSDUH). Rural (nonmetro)–urban (metro) differences in past-month tobacco use, alcohol use, binge drinking, illicit drug use, and marijuana use were examined using Rao–Scott chi-square tests and multivariable logistic regression using complex survey weights. Findings: In 2015–2019, past-month tobacco use varied geographically, as rural pregnant participants were more likely to have used tobacco than those in small and large urban areas (24.7% vs. 15.2% and 8.2%, respectively, p < 0.0001). After controlling for sociodemographic and health care needs, rural pregnant women were more likely to report tobacco use (adjusted odds ratio [aOR]: 2.32, 95% confidence interval [CI]: 1.66, 3.25) but were less likely to report alcohol use (aOR: 0.58, 95% CI: 0.34, 0.98) than their large urban counterparts. There were no rural–urban differences in the odds of binge drinking, illicit drug use, or marijuana-only use in the past month. Conclusions: Geographic variations in perinatal substance use highlight the need for tailored interventions targeting substance use prevention during pregnancy, prioritizing tobacco in rural areas and alcohol in urban areas.
Digital Object Identifier (DOI)
Publication Info
Published in Journal of Rural Health, Volume 41, Issue 2, 2025.
Rights
© 2025 The Author(s). The Journal of Rural Health published by Wiley Periodicals LLC on behalf of National Rural Health Association.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
APA Citation
Boswell, E. K., Hinds, O. M., Odahowski, C., Crouch, E., Hung, P., & Andrews, C. M. (2025). Rural–urban differences in substance use during pregnancy. The Journal of Rural Health, 41(2).https://doi.org/10.1111/jrh.70018