Keywords

Pregnancy, Unprescribed Opioids, Stigma, Women, Social Support

Abstract

Substance use and misuse among women who are pregnant is a growing public health concern in the United States. Overdose deaths are now a leading cause of death among pregnant and postpartum women, and neonatal abstinence syndrome rates have increased to 23 per 1000 births. A barrier addressing substance use among these women is social stigma, which in part is driven by punitive drug policies that criminalize substance use during pregnancy and societal gender roles and norms surrounding women’s substance use. Social support, including emotional, instrumental, and informational support, can serve to mitigate the negative impacts of stigma on health outcomes, including among people who use drugs. We conducted a secondary data analysis to examine associations among drug user-related stigma and lifetime substance use during pregnancy among women who use unprescribed opioids within a cohort study in New York City, 2019-2020. We also examined whether social support (e.g., instrumental, informational, and emotional) may moderate the association. In analyses adjusted for sociodemographic characteristics, sex work status, living status, healthcare status, and past 30-day misuse of prescription and injection misuse, high levels of drug-use related stigma were associated with 0.93 times (95% CI 0.60, 1.45) the prevalence of lifetime substance use while pregnant. Drug use-related stigma appeared to be negatively associated with the prevalence of lifetime substance use while pregnant among women with emotional support from drug-using social networks and positively associated among those without that form of support. Other forms of social support did not appear to modify the association. Findings suggest emotional support among drug-using networks may be a protective factor against the negative effects of drug use-related stigma. Social support’s role in reducing stigma within community-based treatment, such as through peer-recovery support, can guide public health strategies that emphasize supportive rather than punitive approaches.

Completion Date

2026

Semester

Spring

Committee Chair

Scheidell, Joy

Degree

Master of Science (M.S.)

College

College of Health Professions and Sciences

Department

Health Promotion and Behavioral Science

Document Type

Dissertation/Thesis

Identifier

DP0053234

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