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Economic Stress and Substance Use During Pregnancy: The Buffering Role of Public Assistance Programs
Veronica Brtek1, Xingya Ma1, Pilar Sanjuan1
1At the time this work was initiated, Veronica Brtek, Xingya Ma, and Ludmila N. Bakhireva were with the Substance Use Research and Education Center, College of Pharmacy, University of New Mexico, Albuquerque. Ludmila N. Bakhireva is now with the School of Pharmacy & Pharmaceutical Sciences, University of California-Irvine, Irvine, California. Pilar Sanjuan was with the Department of Family and Community Medicine, University of New Mexico, Albuquerque.
Abstract:
Objectives. To examine whether receipt of public assistance among pregnant populations moderates the association between economic stress and prenatal substance use. Methods. The HEALthy Brain and Child Development (HBCD) Study is a 27-site ongoing US longitudinal cohort investigation. We analyzed 2023-2024 data from 1422 pregnant participants who completed their first HBCD visits. We used logistic regression to examine the association between economic stress and substance use (alcohol, tobacco, opioids, cannabis) during pregnancy, stratified by number of public assistance programs from which participants received benefits. Results. Economic stress was positively associated with substance use (odds ratio [OR] = 1.41; 95% confidence interval [CI] = 1.33, 1.50). This relationship was strongest among participants with no public assistance (OR = 1.25; 95% CI = 1.05, 1.44) and remained positive in the low- and medium-assistance groups; however, it was negative in the highest receipt category (OR = 0.70; 95% CI = 0.50, 0.97). Conclusions. Our findings suggest that increased receipt of public assistance corresponded to a weaker association between economic stress and substance use during pregnancy. Public Health Implications. Reduced access to safety-net programs may compound economic stressors related to prenatal substance use, with potential downstream implications for maternal and child outcomes. (Am J Public Health. Published online ahead of print August 20, 2026:e1-e10. https://doi.org/10.2105/AJPH.2026.308628).
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