Substance Use
Educational Attainment and Prenatal Substance Use Cessation: A National Analysis of PRAMS Data, 2016-2021 Rylie Fode* Andrew Williams Williams Williams Williams University of North Dakota
Background: In the United States, 6.5% of pregnancies are exposed to cigarettes, 3.8% to e-cigarettes, and 5.4% to cannabis. Women with low education are more likely to use substances prenatally. This study aimed to examine the association between educational attainment and perinatal substance use, and whether healthcare provider conversations about nicotine and cannabis use moderate these associations.
Methods: National 2016-2021 PRAMS participants (weighted n=110,568) self-reported cigarette smoking, e-cigarette use, and marijuana use for the 3-months preconception and during pregnancy. Substance use change categories were derived from preconception to pregnancy: (never used, no change, increased use, decreased use, quit using). Education was derived from birth certificates linked to PRAMS. Participants reported whether healthcare providers discussed nicotine or cannabis use during pregnancy. Logistic regression estimated odds ratios and 95% confidence intervals for the association between education and substance use. Healthcare provider discussions were included to estimate effect modification in the association between educational attainment and substance use. Regression models were adjusted for maternal factors and weighted to account for survey design.
Results: Participants with >high school education were 2.5 times more likely to quit using marijuana (OR:2.51; CI:1.32,4.76), 1.6 times to quit smoking tobacco (OR:1.56; CI:1.34,1.85), and 1.4 times to quit smoking e-cigarettes (OR:1.37; CI:1.04,1.81) than those with ≤high school education. Healthcare provider discussions did not significantly moderate any outcomes.
Conclusion: Low educational attainment is a strong predictor of prenatal substance use, and healthcare provider discussions did not modify substance use. Prenatal substance use discussions require improvement to benefit this high-risk group.