Prenatal substance use: Religious women report lower use rates, but do they use less?

An inverse relationship exists between self-reported religiousness and substance use. However, we question whether religious culture impacts the veracity of self-reported substance use. The primary aim of this study of low-income pregnant women in South Central Appalachia was to determine the accuracy of self-reported substance use in pregnant women as well as to determine whether there were differences in use rates and/or differences in the degree to which women would accurately report substance use depending on their religiousness. Self-reported use and toxicology screening results taken from a larger prospective, longitudinal, smoking cessation study were compared for five substances (cannabinoids [marijuana or other cannabinoids], benz/barb/sed [including benzodiazepines, barbiturates, or any sedative], opioids [including heroin, methadone or other medication-assisted treatment medications, or other opiates], crack/cocaine [crack or cocaine], and meth/amph [including methamphetamine or any other amphetamine]). Women who attend church frequently reported lower rates of substance use than infrequent or nonattenders, as did women who rated themselves as high in intrinsic religiosity (IR), although the difference between high and low groups is less extreme for IR as opposed to attendance. Women who attended church frequently were far less likely to report use or to have use confirmed than any of the other groups including those high in IR. Rates of positive toxicology screens did not differ statistically across religiousness groupings, but the pattern of proportionally fewer positive toxicology results was seen in frequent attenders but not in women self-reporting as high IR. Women's tendency to underreport substance use was unrelated to religiousness variables, indicating underreporting is not necessarily driving this difference in reported substance use.