Identifying Disparities and Evaluating Prevention Programs Related to Perinatal Substance Use at the Local Level

Background: Substance use during pregnancy is known to have adverse effects on an unborn child. Northern California women show higher rates of alcohol use and smoking during pregnancy compared to the statewide average, but local data were needed to determine local risk factors for perinatal substance use, evaluate prevention programs, and inform future interventions.

Methods: Mothers of six-month old babies (n=367) were surveyed via telephone on substance use behaviors and the screening and intervention practices of their prenatal care providers. Logistic regression models were used to assess the association between educational attainment, race/ethnicity, and payment source for prenatal care, and outcomes such as alcohol and tobacco use during pregnancy, exposure to secondhand smoke, and the practices of respondents' prenatal care providers.

Results: Non-Hispanic white women were significantly more likely than Hispanic women to smoke while pregnant, while women with Medicaid (compared to women with private insurance) and women of lower educational attainment showed increased odds of smoking though non-significant associations. Women with private insurance were significantly more likely than women with Medicaid to use alcohol while pregnant. Prenatal care providers screened almost universally for alcohol use and smoking but in some cases implemented brief interventions with women less likely to use these substances.

Implications: Results will be used to evaluate the impact of local programs addressing perinatal substance use, to inform future interventions, and to advocate for continued universal screening by prenatal care providers. Results may also be included in the upcoming Healthy Shasta County 2020 Strategic Planning process.