{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T02:18:34Z","timestamp":1773281914912,"version":"3.50.1"},"reference-count":70,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,3,24]],"date-time":"2025-03-24T00:00:00Z","timestamp":1742774400000},"content-version":"vor","delay-in-days":23,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Rural Health"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Drug overdoses are now a leading cause of pregnancy\u2010related deaths in the United States. Despite evidence of rural\u2013urban disparities in substance use, there has not yet been a nationally representative examination of rural\u2013urban differences in perinatal substance use. This study provides a comprehensive examination of rural\u2013urban disparities in perinatal substance use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study uses cross\u2010sectional data to examine 3499 pregnant women from the 2015\u20132019 National Survey on Drug Use and Health (NSDUH). Rural (nonmetro)\u2013urban (metro) differences in past\u2010month tobacco use, alcohol use, binge drinking, illicit drug use, and marijuana use were examined using Rao\u2013Scott chi\u2010square tests and multivariable logistic regression using complex survey weights.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>In 2015\u20132019, past\u2010month 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%\u00a0vs. 15.2% and 8.2%, respectively, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.0001). 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\u2013urban differences in the odds of binge drinking, illicit drug use, or marijuana\u2010only use in the past month.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jrh.70018","type":"journal-article","created":{"date-parts":[[2025,3,26]],"date-time":"2025-03-26T08:42:53Z","timestamp":1742978573000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Rural\u2013urban differences in substance use during pregnancy"],"prefix":"10.1111","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-3704-1182","authenticated-orcid":false,"given":"Emma Kathryn","family":"Boswell","sequence":"first","affiliation":[{"name":"University of South Carolina Rural Health Research Center, Arnold School of Public Health University of South Carolina Columbia South Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olivia M.","family":"Hinds","sequence":"additional","affiliation":[{"name":"Department of Health Services Policy and Management, Arnold School of Public Health University of South Carolina Columbia South Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cassie","family":"Odahowski","sequence":"additional","affiliation":[{"name":"University of South Carolina Rural Health Research Center, Arnold School of Public Health University of South Carolina Columbia South Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5380-8391","authenticated-orcid":false,"given":"Elizabeth","family":"Crouch","sequence":"additional","affiliation":[{"name":"University of South Carolina Rural Health Research Center, Arnold School of Public Health University of South Carolina Columbia South Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1529-0819","authenticated-orcid":false,"given":"Peiyin","family":"Hung","sequence":"additional","affiliation":[{"name":"University of South Carolina Rural Health Research Center, Arnold School of Public Health University of South Carolina Columbia South Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina M.","family":"Andrews","sequence":"additional","affiliation":[{"name":"Department of Health Services Policy and Management, Arnold School of Public Health University of South Carolina Columbia South Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,3,24]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.15620\/cdc:124678"},{"key":"e_1_2_9_3_1","unstructured":"Rural Health Information Hub (RHIHub).Rural Maternal Health. 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