Neighborhood Deprivation and Contrasting Patterns of Prenatal Alcohol, Cannabis, and Nicotine Use.

Abstract

Neighborhood context is an important social determinant of health behaviors, including substance use, but less is known about whether neighborhood deprivation is similarly or differentially related to prenatal use of alcohol, cannabis, and nicotine. Using electronic health record data from Kaiser Permanente Northern California, this retrospective observational study examined geographic variation in prenatal alcohol, cannabis, and nicotine use and evaluated whether neighborhood deprivation was associated with use of these substances during pregnancy. The sample included 173,578 pregnancies (November 2020-December 2024) among members with prenatal screening for substance use during early pregnancy as part of standard care. Neighborhood deprivation index (NDI) from geocoded census data was categorized into quartiles. Choropleth maps visualized tract-level prevalence of prenatal substance use, and modified Poisson regression models estimated associations between NDI quartiles and prenatal substance use using individual-level data. Data were analyzed July 2025-Feburary 2026. Prevalence of prenatal alcohol, cannabis, and nicotine was 9.6%, 8.9% and 2.0%, respectively. Compared with pregnancies in the least deprived neighborhoods, those in the most deprived neighborhoods had a lower prevalence of prenatal alcohol use (aPR [95% CI] = 0.87 [0.84, 0.92]), but higher prevalence of prenatal cannabis (aPR [95% CI] =1.80 [1.70, 1.90]) and nicotine use (aPR [95% CI] = 1.96 [1.74, 2.20]). Neighborhood deprivation showed opposing associations across substances, with lower alcohol use but substantially higher cannabis and nicotine use in more deprived neighborhoods. Findings underscore the importance of considering neighborhood context and type of substance when developing preventive interventions.