J Rural Health. 2025 Mar;41(2):e70018. doi: 10.1111/jrh.70018.
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.
PMID:40128129 | DOI:10.1111/jrh.70018
