Social Determinants of Health in Research of Native American Prenatal Drug Use: A Scoping Review Study

Background and Purpose: Prenatal drug use is recognized as a concern of Native American (NA) women. Social and structural contexts that disproportionately impact women’s drug use have received increasing public health and scholarly attention. However, there is limited comprehensive knowledge of social determinants of health (SDOH) associated with drug use among pregnant NA women. The SDOH framework of the Healthy People 2030 identifies economic stability, education and healthcare access and quality, neighborhood and built environment, and social and community context as structural drivers of health. This scoping review study synthesized emerging knowledge on SDOH that have been explored in empirical literature on NA women’s prenatal drug use.

Methods: Eligible studies through November 2023 were searched using PubMed, CINAHL, APA PsycArticles, APA PsycInfo, ISI Web of Science, Social Work Abstracts, Google Scholar, and OSF. To be included in our review, the sources had to assess prenatal drug use, including alcohol and tobacco use, among NA women. Articles unavailable in English and/or that focused exclusively on birth outcomes were excluded. Two researchers independently assessed each article, and team discussion resolved conflicting decisions. After deduplicating the searches, 1,857 articles were screened. Of those screened, 157 were assessed for eligibility. Of the full-text articles, 37 studies were included into our review.

Results: The included studies were published between 1992 and 2023, with 30% published in the last five years. Eleven studies featured only NA samples, while the remaining compared NA to other race/ethnicity groups on prenatal drug use. Education emerged as the most extensively explored SDOH in the literature of NA women’s prenatal drug use (62%, e.g., years of school completed), followed by healthcare (54%, e.g., prenatal care), economic (43%, e.g., household income), environment (41%, e.g., past incarceration), and social domains (13%, e.g., marital status). Although the majority of quantitative studies (n=31) narrowly focused on individual SDOH, studies that explored multiple SDOH domains were more likely to report the intersecting association of structural racism with NA women’s prenatal drug use. Studies with a qualitative component (n=6) revealed a social context domain of SDOH specific to NA women, highlighting protective roles of peer influence and indigenous community resilience in preventing prenatal drug use.

Conclusions and Implications: Our current review results suggest the need for further expansion of our knowledge of SDOH related to prenatal drug use among NA women. Particularly, additional examination of multiple SDOH across domains will help explicate the interconnectedness among structural drivers significantly associated with NA women's drug use during pregnancy. Our findings further indicate that current SDOH constructs do not fully account for the systemic drivers underlying drug use specific to pregnant NA women, and have not adequately included unique social context factors, such as indigenous community resilience. Cultural validations of SDOH in collaboration with NA communities may lead to more innovative and targeted intervention strategies that prioritize SDOH-informed approaches to promote prenatal health equality and better serve NA populations.