Background:
Substance abuse is among the 10 leading indicators for the United States Healthy People 2010 initiative. The social environment has been shown to be associated with health outcomes such as substance abuse. Social cohesion, one component of the social environment, is a collective community-level characteristic measured by the levels of trust, norms of reciprocity and social bonds within the local social structure.

Objectives:
To assess the relationship between substance abuse and social cohesion among nonpregnant women of childbearing age.

Methods:
Using data from the 2003 National Survey on Drug Use and Health, based on the responses to 11 questions, women were grouped into three categories of social cohesion; low, moderate, and high. We obtained the percentage of nonpregnant women aged 18 through 44 years of age who reported use of one or more of the following substances: tobacco, alcohol, and illicit drugs. We then assessed the association between substance use and social cohesion using multiple logistic regression models.

Results:
Of the 15,469 nonpregnant women of childbearing age in the dataset, the majority reported a high level of social cohesion (64%) while one-fourth reported a moderate level (27%), and the remainder reported a low level (9%). Overall, tobacco was the most commonly used product (30.8%). One tenth (10.0%) of women reported consuming an average of more than a drink a day, and 22.9% reported binge drinking. Over one-tenth (11.9%) of the women reported illicit drug use, and marijuana accounted for 61.6% (or 7.3% of all women). We found an inverse relationship between social cohesion and reported prevalence of substance abuse. In the multiple logistic regression model, the odds of substance abuse was significantly lower among the group of women who had high levels of social cohesion after controlling for other sociodemographic factors including age, race, income, marital status, education, and insurance status.

Conclusion and implications for practice:
Nationally representative data from nonpregnant women of childbearing age indicate that social cohesion and substance abuse are inversely related. Additional research is needed to determine whether low social cohesion leads to substance abuse or is a by-product of substance abuse.