Researchers study link between health insurance, tobacco and alcohol use among reproductive age women

Researchers at Columbia University's Mailman School of Public Health studied the relationship between health insurance coverage and tobacco and alcohol use among reproductive age women in the United States, and whether there were differences according to pregnancy status. The findings showed that pregnant women with insurance coverage had lower odds of alcohol use in the past month; however the odds of tobacco use were not affected. For non-pregnant women, insurance coverage resulted in higher odds of alcohol use but lower odds of using tobacco. The study is published online in the journal Drug and Alcohol Dependence.

"Prenatal substance use is a major public health concern, and poses significant threats to maternal and child health," said Dr. Qiana L. Brown, postdoctoral research fellow in the Department of Epidemiology, and the study's first author. "The widespread availability of health insurance through the Affordable Care Act may serve as a universal prevention intervention to help reduce prenatal substance use."

The researchers studied data from 97,788 women ages 12 to 44 years old who participated in the U.S. National Survey of Drug Use and Health from 2010 to 2014. Among these women, 3 percent were pregnant. Controlling for age, race, and ethnicity, education, marital status, and poverty, there were significant differences between pregnant and non-pregnant women in the relationship between health insurance and alcohol use and health insurance and tobacco use.

A larger proportion of pregnant women used alcohol and tobacco in their first trimester as compared to the second and third trimesters, regardless of insurance status: 19 percent drank alcohol in the past month during the first trimester, and 22 percent used tobacco in the past month during the first trimester. For all women of reproductive age, 22 percent with insurance reported tobacco use in the last 30 days versus 33 percent of the women without coverage. Additionally, among all reproductive age women, 50 percent of those with insurance reported alcohol use in the past month, compared to 47 percent of uninsured women.

"Prenatal visits may present a good opportunity for screening and brief intervention regarding tobacco and particularly alcohol use," noted co-author Deborah Hasin, PhD, professor of Epidemiology at the Mailman School of Public Health and in the Department of Psychiatry at Columbia University Medical Center. "Particularly for alcohol, evidence indicates that screening and brief advice can be surprisingly effective for medical patients whose drinking is greater than advisable levels but who are not alcohol dependent."

"In addition, there is the need for greater health provider attention to smoking among pregnant women," said Silvia Martins, MD, PhD, associate professor of Epidemiology at the Mailman School of Public Health, and a co-author of the paper. "Our results suggest missed opportunities for tobacco prevention in prenatal visits."