{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T04:33:06Z","timestamp":1793075586333,"version":"4.5.0"},"reference-count":53,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T00:00:00Z","timestamp":1777075200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"JPB Environmental Health Fellowship","id":[{"id":"https:\/\/ror.org\/0590fg074","id-type":"ROR","asserted-by":"crossref"}]},{"DOI":"10.13039\/100008548","name":"Harvard T.H. Chan School of Public Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008548","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Ewha Frontier 10-10 Research Grant"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Smoking and recreational drug use during pregnancy are significant public health challenges with multifactorial etiology. Most research focuses on the independent contributions of single risk factors. Grounded in the socio-ecological model and the problem behavior theory, this study aimed to identify the broad range of life course individual, interpersonal, and social-contextual factors influencing smoking and recreational drug use during pregnancy among a socioeconomically disadvantaged and racial\/ethnic diverse study population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Participants were 291 pregnant women from the Albany Infant and Mother Study (NY, USA). We employed a multimodal design incorporating participant self-reports, physician-assessed clinical characteristics, and area-level measures of neighborhood context.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>15.1% of participants reported smoking, and 21.0% reported recreational drug use during pregnancy. Pregnancy conditions were linked to lower odds of smoking during pregnancy (OR\u2009=\u20090.36), while experience of discrimination increased the odds (OR\u2009=\u20091.34). Higher parity (OR\u2009=\u20094.27), pre-pregnancy physical health conditions (OR\u2009=\u20091.39), adverse childhood experiences (OR\u2009=\u20091.21), and a poor home physical environment (OR\u2009=\u20091.15) were all associated with increased odds of recreational drug use during pregnancy. In addition, both adverse childhood experiences (OR = 1.58) and experiences of discrimination (OR = 1.77) were significantly associated with an increased likelihood of poly-substance use during pregnancy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Several different psychosocial, physical health, and socio-environmental factors were associated with tobacco and substance use behaviors among pregnant women, thereby providing a holistic understanding of these behaviors. The study offers insights for the development of interventions thereby contributing to improved maternal and fetal health outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications<\/jats:title>\n                    <jats:p>Smoking and recreational drug use during pregnancy are significant public health concerns with multifactorial causes, posing risks to both maternal health and fetal development. Existing studies highlight individual, interpersonal, and social-contextual factors, but few examine their collective impact. Much of the literature focuses on sociodemographic and psychosocial factors, often neglecting critical perinatal indicators like pregnancy health conditions and home environmental exposures. This study is among the first to adopt a multidimensional approach, integrating novel physical health and environmental variables alongside psychosocial factors, providing a comprehensive understanding of substance use during pregnancy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ntr\/ntag092","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T11:44:10Z","timestamp":1777031050000},"page":"1843-1854","source":"Crossref","is-referenced-by-count":0,"title":["Socio-ecological factors impacting smoking and recreational drug use during pregnancy: insights from the Albany Infant and Mother Study"],"prefix":"10.1093","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3051-6625","authenticated-orcid":false,"given":"Serim","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Social Welfare, Ewha Womans University , Seoul 03760 ,","place":["Republic of Korea"]},{"name":"College of Integrated Health Sciences, University at Albany, State University of New York , Rensselaer, NY 12144 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0430-2554","authenticated-orcid":false,"given":"Allison A","family":"Appleton","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, College of Integrated Health Sciences, University at Albany, State University of New York , Rensselaer, NY 12144 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,4,25]]},"reference":[{"key":"2026102623593043500_ref1","doi-asserted-by":"publisher","first-page":"1477","DOI":"10.1007\/s10995-018-2543-9","article-title":"Cigarette smoking status and substance use in pregnancy","volume":"22","author":"Oga","year":"2018","journal-title":"Matern Child Health J"},{"key":"2026102623593043500_ref2","doi-asserted-by":"publisher","first-page":"887","DOI":"10.12688\/f1000research.7645.1","article-title":"Substance use during pregnancy","volume":"5","author":"Forray","year":"2016","journal-title":"F1000Res."},{"issue":"Pt B","key":"2026102623593043500_ref3","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1016\/j.bpobgyn.2022.07.008","article-title":"Epidemiology of opioid use in pregnancy","volume":"85","author":"Cook","year":"2022","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"key":"2026102623593043500_ref4","volume-title":"Prevalence of Marijuana and Opioid Use during Pregnancy in the United States from 2017\u20132019 [Dissertation]","author":"Brumley","year":"2024"},{"issue":"10","key":"2026102623593043500_ref5","doi-asserted-by":"publisher","first-page":"1311","DOI":"10.1055\/s-0042-1753502","article-title":"The impact of self-reported alcohol, tobacco, and recreational drug use during pregnancy on adverse pregnancy outcomes in first-time mothers","volume":"41","author":"Daggy","year":"2022","journal-title":"Am J Perinatol"},{"issue":"8","key":"2026102623593043500_ref6","doi-asserted-by":"publisher","first-page":"918","DOI":"10.1177\/1933719114556486","article-title":"Smoking and preterm birth","volume":"22","author":"Ion","year":"2015","journal-title":"Reprod Sci"},{"issue":"7","key":"2026102623593043500_ref7","doi-asserted-by":"publisher","first-page":"807","DOI":"10.1093\/aje\/kwt334","article-title":"Systematic review and meta-analysis of miscarriage and maternal exposure to tobacco smoke during pregnancy","volume":"179","author":"Pineles","year":"2014","journal-title":"Am J Epidemiol"},{"issue":"3","key":"2026102623593043500_ref8","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1111\/j.1479-828X.2005.00379.x","article-title":"Substance use during pregnancy: risk factors and obstetric and perinatal outcomes in South Australia","volume":"45","author":"Kennare","year":"2005","journal-title":"Aust N Z J Obstet Gynaecol"},{"issue":"4","key":"2026102623593043500_ref9","doi-asserted-by":"publisher","first-page":"1765","DOI":"10.1353\/hpu.2020.0131","article-title":"Socio-ecological factors of adolescent substance use in Nigeria: a systematic review of literature","volume":"31","author":"Jacobs","year":"2020","journal-title":"J Health Care Poor Underserved"},{"key":"2026102623593043500_ref10","volume-title":"StatPearls [Internet]","author":"Prince","year":"2013"},{"key":"2026102623593043500_ref11","doi-asserted-by":"crossref","DOI":"10.4159\/9780674028845","volume-title":"The Ecology of Human Development: Experiments by Nature and Design","author":"Bronfenbrenner","year":"1979"},{"key":"2026102623593043500_ref12","volume-title":"Problem Behavior and Psychosocial Development: A Longitudinal Study of Youth","author":"Jessor","year":"1977"},{"key":"2026102623593043500_ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.childyouth.2020.105591","article-title":"Impacts of multilevel factors on depressive symptoms among adolescents in South Korea","volume":"119","author":"Jeon","year":"2020","journal-title":"Child Youth Serv Rev"},{"key":"2026102623593043500_ref14","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1016\/j.jad.2023.08.011","article-title":"Factors associated with Korean adolescent\u2019s e-cigarette use by the severity level of generalized anxiety disorder (GAD-7)","volume":"340","author":"Kim","year":"2023","journal-title":"J Affect Disord"},{"issue":"1\u20133","key":"2026102623593043500_ref15","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.drugalcdep.2008.07.010","article-title":"Factors associated with substance use during pregnancy: results from a national sample","volume":"99","author":"Havens","year":"2009","journal-title":"Drug Alcohol Depend"},{"key":"2026102623593043500_ref16","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1186\/s12884-020-2748-y","article-title":"Trends in smoking during pregnancy by socioeconomic characteristics in the United States, 2010\u20132017","volume":"20","author":"Azagba","year":"2020","journal-title":"BMC Pregnancy Childbirth"},{"issue":"2","key":"2026102623593043500_ref17","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1089\/jwh.2022.0118","article-title":"Characteristics of individuals in the United States who used opioids during pregnancy","volume":"32","author":"Nguyen","year":"2023","journal-title":"J Women\u2019s Health"},{"issue":"1","key":"2026102623593043500_ref18","doi-asserted-by":"publisher","first-page":"e12247","DOI":"10.1111\/appy.12247","article-title":"Alcohol consumption, smoking, and drug use in pregnancy: prevalence and risk factors in Southern Thailand","volume":"9","author":"Assanangkornchai","year":"2016","journal-title":"Asia Pac Psychiatry"},{"key":"2026102623593043500_ref19","doi-asserted-by":"publisher","DOI":"10.1016\/j.ntt.2023.107162","article-title":"Factors associated with ever using cannabidiol in a cohort of younger pregnant people","volume":"96","author":"De Genna","year":"2023","journal-title":"Neurotoxicol Teratol"},{"issue":"7","key":"2026102623593043500_ref20","first-page":"557","article-title":"The relationships between health behaviors, mental health and smoking among Korean adolescents (in Korean)","volume":"17","author":"Song","year":"2017","journal-title":"J Korea Contents Assoc"},{"issue":"4","key":"2026102623593043500_ref21","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1016\/S0749-3797(98)00017-8","article-title":"Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the adverse childhood experiences (ACE) study","volume":"14","author":"Felitti","year":"1998","journal-title":"Am J Prev Med"},{"issue":"2","key":"2026102623593043500_ref22","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1001\/jamacardio.2020.5390","article-title":"Association of adverse childhood experiences with cardiovascular disease later in life: a review","volume":"6","author":"Godoy","year":"2021","journal-title":"JAMA Cardiol"},{"issue":"Suppl 1","key":"2026102623593043500_ref23","doi-asserted-by":"publisher","first-page":"S152","DOI":"10.1007\/s10995-023-03768-4","article-title":"The effect of maternal adverse childhood experiences (ACEs) on substance use during pregnancy","volume":"27","author":"Duka","year":"2023","journal-title":"Matern Child Health J"},{"key":"2026102623593043500_ref24","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2023.107656","article-title":"Adverse childhood experiences, antenatal stressful life events, and marijuana use during pregnancy: a population-based study","volume":"174","author":"Thomas","year":"2023","journal-title":"Prev Med"},{"issue":"4","key":"2026102623593043500_ref25","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1136\/jech.2009.107516","article-title":"Influence of experiences of racial discrimination and ethnic identity on prenatal smoking among urban black and Hispanic women","volume":"66","author":"Nguyen","year":"2012","journal-title":"J Epidemiol Community Health"},{"key":"2026102623593043500_ref26","doi-asserted-by":"publisher","DOI":"10.4172\/2167-0420.1000179","article-title":"Social support and smoking during pregnancy","volume":"3","author":"Masho","year":"2014","journal-title":"J Women's Health"},{"issue":"10","key":"2026102623593043500_ref27","doi-asserted-by":"publisher","first-page":"1132","DOI":"10.1016\/j.addbeh.2012.05.011","article-title":"Neighborhood safety as a correlate of tobacco use in a sample of urban, pregnant women","volume":"37","author":"Patterson","year":"2012","journal-title":"Addict Behav"},{"key":"2026102623593043500_ref28","doi-asserted-by":"publisher","DOI":"10.1016\/j.addbeh.2022.107425","article-title":"A systematic review of socio-ecological factors influencing current e-cigarette use among adolescents and young adults","volume":"135","author":"Han","year":"2022","journal-title":"Addict Behav"},{"issue":"3","key":"2026102623593043500_ref29","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1007\/s10995-018-02706-z","article-title":"Social support during pregnancy modifies the association between maternal adverse childhood experiences and infant birth size","volume":"23","author":"Appleton","year":"2019","journal-title":"Matern Child Health J"},{"issue":"11","key":"2026102623593043500_ref30","doi-asserted-by":"publisher","first-page":"6161","DOI":"10.3390\/ijerph18116161","article-title":"Parental exposure to favorable social and environmental neighborhood conditions is associated with healthy pregnancy and infant outcomes","volume":"18","author":"Appleton","year":"2021","journal-title":"Int J Environ Res Public Health"},{"issue":"13","key":"2026102623593043500_ref31","doi-asserted-by":"publisher","first-page":"1905","DOI":"10.1080\/15592294.2022.2090657","article-title":"Maternal depression and adverse neighbourhood conditions during pregnancy are associated with gestational epigenetic age deceleration","volume":"17","author":"Appleton","year":"2022","journal-title":"Epigenetics."},{"issue":"2","key":"2026102623593043500_ref32","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.earlhumdev.2004.04.014","article-title":"Is pregnancy anxiety a distinctive syndrome?","volume":"79","author":"Huizink","year":"2004","journal-title":"Early Hum Dev"},{"issue":"4","key":"2026102623593043500_ref33","doi-asserted-by":"crossref","first-page":"385","DOI":"10.2307\/2136404","article-title":"A global measure of perceived stress","volume":"24","author":"Cohen","year":"1983","journal-title":"J Health Soc Behav"},{"issue":"7","key":"2026102623593043500_ref34","doi-asserted-by":"crossref","first-page":"1576","DOI":"10.1016\/j.socscimed.2005.03.006","article-title":"Experiences of discrimination: validity and reliability of a self-report measure for population health research on racism and health","volume":"61","author":"Krieger","year":"2005","journal-title":"Soc Sci Med"},{"key":"2026102623593043500_ref35","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1007\/978-94-009-5115-0_5","volume-title":"Social Support: Theory, Research and Applications","author":"Cohen","year":"1985"},{"issue":"6","key":"2026102623593043500_ref36","doi-asserted-by":"publisher","first-page":"e38893","DOI":"10.1371\/journal.pone.0038893","article-title":"Prenatal and early life exposure to stressful life events and risk of autism spectrum disorders: population-based studies in Sweden and England","volume":"7","author":"Rai","year":"2012","journal-title":"PLoS One"},{"issue":"12","key":"2026102623593043500_ref37","doi-asserted-by":"publisher","first-page":"2482","DOI":"10.2105\/AJPH.2015.302793","article-title":"Health benefits of green public housing: associations with asthma morbidity and building-related symptoms","volume":"105","author":"Colton","year":"2015","journal-title":"Am J Public Health"},{"issue":"11","key":"2026102623593043500_ref38","doi-asserted-by":"crossref","first-page":"1948","DOI":"10.1377\/hlthaff.2014.0679","article-title":"The child opportunity index: improving collaboration between community development and public health","volume":"33","author":"Acevedo-Garcia","year":"2014","journal-title":"Health Aff (Millwood)"},{"key":"2026102623593043500_ref39","volume-title":"Child Opportunity Index 2.0 Technical Documentation [Internet]","author":"Noelke","year":"2020"},{"issue":"2","key":"2026102623593043500_ref40","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1080\/13811118.2019.1678539","article-title":"Suicidality among gender minority youth: analysis of 2017 youth risk behavior survey data","volume":"25","author":"Jackman","year":"2021","journal-title":"Arch Suicide Res"},{"key":"2026102623593043500_ref41","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1016\/j.jad.2023.08.100","article-title":"Differentiating the associations between alcohol use, cigarette smoking, and conditional suicidal behaviors among adolescents","volume":"341","author":"Wang","year":"2023","journal-title":"J Affect Disord"},{"key":"2026102623593043500_ref42","volume-title":"Data Analysis Using SPSS","author":"Jung","year":"2023"},{"issue":"3","key":"2026102623593043500_ref43","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1046\/j.1365-3016.2000.00266.x","article-title":"Socio-economic disparities in pregnancy outcome: why do the poor fare so poorly?","volume":"14","author":"Kramer","year":"2001","journal-title":"Paediatr Perinat Epidemiol"},{"issue":"3","key":"2026102623593043500_ref44","doi-asserted-by":"publisher","first-page":"410","DOI":"10.1093\/eurpub\/ckw214","article-title":"Associations between racial discrimination, smoking during pregnancy and low birthweight among Roma","volume":"27","author":"Janevic","year":"2017","journal-title":"Eur J Pub Health"},{"issue":"8","key":"2026102623593043500_ref45","doi-asserted-by":"publisher","first-page":"654","DOI":"10.1080\/01639625.2013.872523","article-title":"Poor health, strain, and substance use","volume":"35","author":"Ford","year":"2014","journal-title":"Deviant Behav"},{"issue":"8","key":"2026102623593043500_ref46","doi-asserted-by":"publisher","first-page":"526","DOI":"10.7196\/SAMJ.2022.v112i8.16480","article-title":"The tragedy of smoking, alcohol, and multiple substance use during pregnancy","volume":"112","author":"Brink","year":"2022","journal-title":"S Afr Med J"},{"issue":"2","key":"2026102623593043500_ref47","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1016\/j.amepre.2019.03.018","article-title":"Housing disadvantage and poor mental health: a systematic review","volume":"57","author":"Singh","year":"2019","journal-title":"Am J Prev Med"},{"issue":"5","key":"2026102623593043500_ref48","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1080\/02646838.2021.1916815","article-title":"Substance use and mental health in pregnant women during the COVID-19 pandemic","volume":"40","author":"Smith","year":"2022","journal-title":"J Reprod Infant Psychol"},{"key":"2026102623593043500_ref49","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1186\/s13063-018-2624-5","article-title":"Optimizing a community-engaged multi-level group intervention to reduce substance use: an application of the multiphase optimization strategy","volume":"19","author":"Windsor","year":"2018","journal-title":"Trials."},{"key":"2026102623593043500_ref50","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1186\/s12888-017-1571-0","article-title":"Randomised control trial of the effectiveness of an integrated psychosocial health promotion intervention aimed at improving health and reducing substance use in established psychosis (IMPaCT)","volume":"17","author":"Gaughran","year":"2017","journal-title":"BMC Psychiatry"},{"key":"2026102623593043500_ref51","doi-asserted-by":"crossref","first-page":"e94","DOI":"10.1097\/AOG.0000000000004326","article-title":"Caring for patients who have experienced trauma","volume":"137","author":"Committee on Health Care for Underserved Women","year":"2021","journal-title":"Obstet Gynecol"},{"key":"2026102623593043500_ref52","doi-asserted-by":"publisher","first-page":"e2340859","DOI":"10.1001\/jamanetworkopen.2023.40859","article-title":"E-cigarette use among US adults in the 2021 behavioral risk factor surveillance system survey","volume":"6","author":"Erhabor","year":"2023","journal-title":"JAMA Netw Open"},{"key":"2026102623593043500_ref53","doi-asserted-by":"publisher","first-page":"820","DOI":"10.1111\/1471-0528.15056","article-title":"Partner smoking influences whether mothers quit smoking during pregnancy: a prospective cohort study","volume":"125","author":"Rom\u00e1n-G\u00e1lvez","year":"2018","journal-title":"BJOG."}],"container-title":["Nicotine and Tobacco Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ntr\/advance-article-pdf\/doi\/10.1093\/ntr\/ntag092\/68159163\/ntag092.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ntr\/article-pdf\/28\/11\/1843\/68159163\/ntag092.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ntr\/article-pdf\/28\/11\/1843\/68159163\/ntag092.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T03:59:39Z","timestamp":1793073579000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ntr\/article\/28\/11\/1843\/8662432"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,25]]},"references-count":53,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,4,25]]},"published-print":{"date-parts":[[2026,10,22]]}},"URL":"https:\/\/doi.org\/10.1093\/ntr\/ntag092","relation":{},"ISSN":["1469-994X"],"issn-type":[{"value":"1469-994X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,11]]},"published":{"date-parts":[[2026,4,25]]}}}