The information presented in this study was based on 4,828 questionnaires, collected at the first prenatal visit. Most (58.5%) of the respondents were in their first trimester, some (26.2%) in the second, and a few (15.2%) in their third trimester. The surveys were collected from sites in North Dakota (n = 1,688), South Dakota (n = 1,638), and Montana (n = 1,502). The average age of the pregnant women completing the PNQ was 26.7 (sd = 5.8) years with age ranging from 14 to 47. Women completing the PNQ averaged 13.4 (sd = 2.5) years of education. The women had a mean of 1.1 (sd = 1.1) children with responses ranging from zero to fifteen. The survey participants reported an average of 1.7 (sd = 1.7) pregnancies, which was consistent across states. Of those responding, 8.6 percent had a previous abortion and 24.6 percent reported a miscarriage from a prior pregnancy.
As would be expected based on population values for these three rural states, a vast majority (88.7%) of the respondents were 'White,' and 8.9 percent were Native Americans (Table
1). The total percent by 'Race/Ethnicity' equals more than 100 percent because respondents were able to select multiple 'Race/Ethnicity' categories. Most (65.7%) were 'Married,' some were 'Single' (19.0%) or 'Living Together' (13.4%), and a few (2.7%) were 'Divorced' or 'Separated.' Some persons had multiple responses to these categories. Also, a majority (69.4%) of survey participants declared themselves as employed with 15.8 percent indicating 'A full-time house wife and not looking for employment,' and 10.4 percent identified themselves as unemployed. Finally, more than one-half (54.1%) reported total family income over $30,000, and some (14.7%) reported annual family incomes less than $10,000.
Table 1
Demographic Factors: Overall and by State – Frequencies
Race/Ethnicity
| | | | |
American Indian | 8.9% | 12.4% | 7.9% | 6.7% |
Asian | 0.8% | 0.4% | 1.0% | 0.9% |
Black | 0.5% | 0.1% | 0.6% | 0.7% |
Pacific Islander | 0.4% | 0.4% | 0.3% | 0.4% |
White | 88.7% | 86.3% | 88.9% | 90.7% |
Hispanic | 3.2% | 4.3% | 3.0% | 2.4% |
Other | 1.1% | 1.6% | 0.8% | 0.8% |
Marital Status
| | | | |
Single | 19.0% | 20.0% | 17.1% | 20.1% |
Married | 65.7% | 59.3% | 71.7% | 65.4% |
Living together | 13.4% | 18.3% | 10.0% | 12.5% |
Separated | 1.3% | 2.1% | 0.7% | 1.1% |
Divorced | 1.4% | 1.6% | 1.2% | 1.6% |
Employment
| | | | |
Unemployed | 10.4% | 14.2% | 9.1% | 8.2% |
Full-time housewife | 15.8% | 18.9% | 15.5% | 13.2% |
Employed | 69.4% | 61.7% | 70.7% | 75.0% |
Income
| | | | |
$0–$10,000 | 14.7% | 20.7% | 10.5% | 13.7% |
$10,001–$20,000 | 15.5% | 20.2% | 13.1% | 13.8% |
$20,001–$30,000 | 15.7% | 16.9% | 14.4% | 16.0% |
$30,001–$50,000 | 27.0% | 23.1% | 28.7% | 28.7% |
Over $50,000 | 27.1% | 19.0% | 33.3% | 27.7% |
Overall Health
| | | | |
Excellent | 15.6% | 15.1% | 16.5% | 15.1% |
Very good | 45.1% | 41.2% | 49.5% | 44.1% |
Good | 36.3% | 39.4% | 32.0% | 37.9% |
Fair | 2.9% | 4.1% | 2.0% | 2.8% |
Poor | 0.1% | 0.2% | 0.0% | 0.2% |
Felt Sad, Discouraged, Hopeless, etc., in Last Month
| | | | |
Extremely | 1.0% | 1.6% | 0.7% | 0.8% |
Very much | 2.6% | 4.1% | 1.6% | 2.2% |
Quite a bit | 4.4% | 5.0% | 3.2% | 5.1% |
Some | 10.9% | 13.9% | 9.0% | 10.1% |
A little bit | 26.5% | 25.6% | 26.2% | 27.8% |
Not at all | 54.6% | 49.8% | 59.3% | 54.0% |
Nearly all who responded to the health question felt that they had 'Good', 'Very Good' or 'Excellent' health. Almost one-half (45.1%) of those completing the survey indicated that their health was 'Very Good' and 3.0 percent reported their health status as 'Fair' or 'Poor.' About one-fifth (18.9%) reported at least some feelings of discouragement and hopelessness in the last month. Most of the respondents from each state reported that in the last month they did not have feelings of sadness, hopelessness, discouragement, or had so many problems that they wondered if everything was worthwhile.
Significant dichotomous factors – univariate analysis
The significance of factors predictive of drinking was determined by univariate and multivariate factors with chi square and logistic procedures, respectively. Univariate statistics were used to determine the total number of significant factors, and multivariate procedures were used to determine a smaller set of questions that retain predictive validity. Probability values equal to or less than .05 were considered statistically significant. Probabilities were adjusted, as noted, to accommodate multiple comparisons.
Based on all persons in the sample (n = 4,828), some demographic factors were found statistically significantly related to drinking status, although group differences were modest and have limited clinical utility. The drinkers had more abortions (means were .16 and .09, t = -5.03, p = .001) and fewer children (means were .94 and 1.09, t = 3.62, p = .001) than the comparison (non-drinking) group.
Income was significantly (χ2 = 16.2, p = .03) related to drinking classification. In examining the percent drinking by income category, it was noted that those with low ($0–$20,000) income and high income ($50,000 or more) had the highest drinking rates. Also, survey respondents who were younger (ages 21–25) were more likely to drink than were all other age groups (χ2 = 14.67, p < .001). Unemployment (χ2 = 9.3, p < .04) was another demographic factor predictive of drinking status.
Factors found to be protective of drinking included: married (χ2 = 26.1, p < .001), full-time housewife status (χ2 = 27.4, p < 001), and employed (χ2 = 9.3, p <.002). Married women had the lowest drinking rate (χ2 = 26.1, p < .001) of the marital status categories, and the single women had the highest (χ2 = 15.3, p < .001) rate, suggesting that marriage is a protective factor for maternal substance use and being single a risk factor. Sexual abuse (χ2 = 27.1, p < .001) and physical abuse in the past year (χ2 = 35.3, p < .001) were significant risk factors. Amount of alcohol consumption was another category of risk factors. Women, who believed any amount of alcohol was safe for pregnant women to drink (χ2 = 67.7, p < .001) or felt that they could hold more than four drinks (χ2 = 169.0, p < .001), had elevated risk levels.
The concurrent and past use of other drugs (χ2 = 255.7, p < .001) and tobacco (χ2 = 31.2, p < .001) were related to drinking or risk status. Additionally, being around others who used substances was correlated with risk status. Partners or mates using substances (χ2 = 172.9, p < .001) and persons in household drinking or using drugs (χ2 = 100.3, p < .001) were two factors related to drinking when pregnant. If partner or mate substance use was viewed as a problem by the pregnant women, the drinking risk was increased (χ2 = 4.4, p = .04).
Other factors found to be predictive of drinking status were: being sad or discouraged in the last month (χ2 = 32.1, p < .001), could use treatment at present time (χ2 = 15.0, p < .001), and had previous participation in substance abuse treatment programs (χ2 = 22.2, p < .001).
Multivariate analysis
Logistic regression was used to assess the significance of the dichotomous demographic and social-psychological related risk factors in predicting drinking and to establish a smaller number of questions, using a backward stepwise procedure (e.g., backward likelihood ratio). Significant factors were determined for blocks (i.e., demographic, social-psychological, and past substance use and TACE-type questions) of related questions. The significant factors for each block were used in the final regression analysis phase. With this procedure, only factors that added predictive information were included in the final regression model. In the final logistic regression model, eleven factors (Table
2) were retained. These demographic, social-psychological and related factors accounted for a modest amount (
Nagelkerke R Square = .13) of the predictability of the binary dependent measure, indicating that there are many other psychological, social, or demographic factors that are related to substance use during pregnancy.
Table 2
Logistic Regression Results-Risk Factors
Ever had an abortion | -.48 | 15.95 | .001 |
Full-time housewife | .28 | 6.34 | .01 |
Physical abuse in last year | -.63 | 9.40 | .002 |
Physical abuse this pregnancy | .93 | 7.61 | .006 |
How many drinks can you hold | -.43 | 30.00 | .001 |
Need to cut down on drinking | -.85 | 31.85 | .001 |
Don't remember events | -.37 | 12.56 | .001 |
Partner uses | -.67 | 76.82 | .001 |
Safely drink | -.76 | 30.09 | .001 |
Past drug use | -.26 | 7.45 | .006 |
The final factors in the logistic regression model were: previous abortion, full-time housewife, physical abuse, perception of how many drinks a person can hold, need to cut down on drinking, mate was user of alcohol, used drugs before this pregnancy, believed that some alcohol use while pregnant was acceptable, and had experienced difficulty remembering events after drinking.