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.

Background: Rates of preterm delivery, a major proximate cause of perinatal morbidity and mortality, have been increasing. Prenatal alcohol exposure has been implicated in preterm delivery, although results have been inconsistent due to inadequate control for confounding factors, insufficient power, unreliable and inaccurate assessment of both exposure and gestational age, and lack of stratification of prematurity into severity levels. The purpose of this study was to examine the relation between maternal alcohol, cocaine and cigarette use during pregnancy, and extreme and mild preterm birth. Methods: Three thousand one hundred thirty consecutive gravidas were followed prospectively for antenatal substance use and had ultrasound confirmed pregnancy dating. Results: Alcohol and cocaine, but not cigarette use, were associated with increased risk of extreme preterm delivery after control for potential confounders. For every unit increase in alcohol exposure, risk of extreme preterm delivery increased significantly [odds ratio (OR) 34.8]. Furthermore, in women aged 30+, alcohol exposure was associated with mild prematurity. Abstention from alcohol while continuing to use cocaine and tobacco was related to a decrease in extreme prematurity of 41%. Conclusions: The risk of extreme preterm delivery associated with alcohol use is substantial and similar in magnitude to other well-recognized risks. Increased accuracy in identifying exposure and the use of ultrasound to confirm gestational age dating likely contributed to the findings of the current study. These findings suggest that eliminating pregnancy alcohol use might substantially reduce the risk of preterm delivery.