Race/ethnicity and nativity differences in alcohol and tobacco use during pregnancy.

OBJECTIVES We examined race/ethnicity and nativity correlates of prenatal substance use. METHODS Using data on a nationally representative cohort of pregnant women in US cities (N=4185), we evaluated the relative importance of socioeconomic status, paternal health behaviors, social support, and maternal stress and health history in explaining variations in prenatal substance use by race/ethnicity and nativity. RESULTS Maternal stress and health history appeared to fully explain differences in alcohol use by nativity, but these and other factors could not explain differences in prenatal smoking. For all races/ethnicities, paternal health behaviors were most strongly associated with maternal substance use. Except among Black women, socioeconomic background bore little relation to prenatal substance use after adjustment for more proximal risk factors (e.g., paternal and maternal health behaviors). Social support was most protective among Hispanic women. CONCLUSIONS Foreign-born immigrant women are at equal risk of prenatal alcohol use compared with similarly situated US-born women and should not be overlooked in the design of interventions for at-risk women. Furthermore, the inclusion of fathers and the development of social support structures for at-risk women can strengthen interventions.