Substance Use
Association between social determinants of health and substance use disorder among reproductive-aged women Ishu Karki* Ishu Karki Karki University of Arkansas for Medical Sciences
Background: Substance use disorder (SUD) is a significant public health concern in the U.S. Prior research has documented associations between social determinants of health (SDOH) and SUD. Although recent evidence indicates an increase in SUD among women, studies examining the relationship between SDOH and SUD among reproductive-aged and pregnant women remain limited.
Objective: To examine the association between SDOH and past-year SUD among women and assess whether pregnancy status moderates these associations.
Methods: We conducted a secondary analysis of the 2024 National Survey on Drug Use and Health, restricting the sample to females aged 12-49 years (N = 24,714). The primary outcome was past-year SUD. SDOH proxy measures included poverty, employment, high school graduation, enrollment in higher education, health insurance, English speaking, and lifetime arrest history. Multiple logistic regression models examined the main effects of SDOH on SUD and tested interactions with pregnancy status.
Results: Overall, 16.9% of women had past-year SUD. In the main effects model, lifetime arrest history was the strongest SDOH associated with SUD (AOR = 3.007, 95% CI = 2.53-3.56). In the interaction model, pregnancy status significantly moderated the relationship between arrest history and SUD (B = -0.95, p = 0.02), such that arrest history was not as strong of a predictor of SUD among pregnant women.
Conclusion: Criminal justice involvement was associated with increased SUD risk among women. The weaker association observed among pregnant women may reflect greater engagement with healthcare services, increased motivation to reduce substance use due to health concerns, or the influence of policies related to substance use during pregnancy. The findings suggest that pregnancy may represent a critical window for intervention, during which enhanced access to healthcare and social support could help mitigate the elevated risk of SUD associated with arrest history among women.