Identifying social determinants of tobacco and alcohol use during pregnancy is critical to improving health outcomes for the next generation. This is especially important on a rural Tribal Nation where influences such as isolation, cultural barriers, and historical trauma have made it uniquely challenging to prevent substance use during pregnancy. The purpose of this study is to identify population-specific factors that are protective against smoking and drinking during pregnancy. We used data from 421 pregnancies collected as a part of the Safe Passages study from a rural Tribal Nation in the central United States. Pregnant women were classified as women who did not smoke (n = 84), women who quit during pregnancy (n = 23), women who smoked during pregnancy (n = 314), and women who both smoked and drank alcohol during pregnancy (n = 149). Demographic data revealed that 28.8% of the mothers were currently employed, and 91.8% of mothers reported a household income of less than $3,000 per year. Substance use rates were higher than national averages: 74.6% smoked during pregnancy and 35.4% of the women both smoked and drank alcohol during pregnancy. Five factors were identified as being protective against substance use during pregnancy: 1) living with someone (81% less likely to smoke and 92% less likely to smoke and drink), 2) having at least 12 years of education (128% less likely to smoke, and 126% less likely to smoke and drink), 3) having over 12 years of education (235% less likely to smoke, and 206% less likely to smoke and drink), 4) being employed (158% less likely to smoke, and 111% less likely to smoke and drink), and 5) not being depressed (214% less likely to smoke, and 229% less likely to smoke and drink). These social determinants should be considered for intervention research to decrease rates of substance use during pregnancy.

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Background: Prenatal exposure to alcohol and tobacco are both associated with increased risk for adverse outcomes. American Indians experience disproportionate rates of adverse birth outcomes. The Indian people living in the Great Plains Area of the Indian Health Services have increased exposure to alcohol and smoking during pregnancy. This study aims to assess the relationship between prenatal alcohol and tobacco exposure and early hospitalization in a rural Tribal Nation. Methods: We used data from the prospective Safe Passage Study on pregnancies and hospitalizations within the first year of life. The relationship between time to hospitalization and prenatal tobacco/alcohol exposure, maternal demographics, post-traumatic stress disorder and depression were evaluated. The analysis utilized Chi-square tests. Kaplan-Meier curves were used to estimate the likelihood of hospitalization during the first year of life by substance use category. Results: From a sample of 432 infants, we identified 260 (60.2%) who had a hospitalization. We found no significant effect from that if mother drank, amount drank, amount smoked or if mother smoked, on the risk of hospitalization. We did identify an effect for exposure to alcohol or smoking and age to hospitalization. Exposure was associated with younger age at hospitalization. However, after controlling for mother's age, this effect was not significant. Mother's age was significant in all models of hospitalization risk from parental exposure. Discussion: Reducing prenatal exposure to tobacco and alcohol may decrease hospitalization rates for infants from this Tribal Nation, especially among young mothers.