MedicalResearch.com Interview with:
Dr. Qiana L. Brown, PhD, MPH, LCSW
Postdoctoral Research Fellow
Mailman School of Public Health
Department of Epidemiology
Substance Abuse Epidemiology Training Program
MedicalResearch.com: What is the background for this study?
Dr. Brown: Prenatal substance use is a major public health concern, and poses significant threats to maternal and child health. Tobacco and alcohol are the most commonly used substances among pregnant women and non-pregnant women of reproductive age, and are leading causes of preventable adverse health outcomes for both mother and baby. Women with health insurance have more prenatal visits, and present for prenatal care earlier than uninsured women, which may increase their exposure to health messaging around substance abuse prevention at prenatal visits. Additionally, treatment for substance use disorders and maternal and child health care are part of the Essential Health Benefits covered by the Affordable Care Act, which may encourage patients and providers to engage in discussions around alcohol and tobacco use prevention during pregnancy.
Given these factors, we examined the relationship between health insurance coverage and both past month tobacco use and past month alcohol use among a nationally representative sample of reproductive age women in the United States. We sampled 97,788 women ages 12 to 44 years old who participated in the U.S. National Survey of Drug Use and Health in 2010 to 2014. Among these women, 3.28% (n=3,267) were pregnant. We specifically investigated whether the relationship between health insurance and alcohol or tobacco use differed between pregnant and non-pregnant women.
MedicalResearch.com: What are the main findings?
Dr. Brown: A larger proportion of pregnant women used tobacco and alcohol in their first trimester as compared to the second and third trimesters, regardless of insurance status. Additionally, the relationship between health insurance coverage and tobacco and alcohol use, varied significantly by pregnancy status, such that after controlling for age, race/ethnicity, education, marital status, and poverty, among pregnant women insurance coverage was associated with lower odds of past month alcohol use, but not associated with tobacco use; whereas among non-pregnant women insurance coverage was associated with lower odds of tobacco use, but higher odds of alcohol use.
MedicalResearch.com: What should readers take away from your report?
Dr. Brown: Health insurance coverage is a promising preventive measure to help reduce alcohol use during pregnancy. However, the large proportion of pregnant women who used tobacco and alcohol early in pregnancy, and the fact that tobacco use persists during pregnancy despite health insurance coverage indicate missed opportunities for prevention during prenatal visits.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Brown: The pervasiveness of tobacco use throughout pregnancy, despite insurance coverage, calls for future research to examine mechanisms and interventions that can explain and help reduce tobacco use among pregnant women.
MedicalResearch.com: Is there anything else you would like to add?
Dr. Brown: Health providers state that lack of time is a major barrier to tobacco cessation interventions during prenatal visits. Therefore systems of care should be modified so that physicians and other health care providers have the time they need to engage pregnant women in tobacco use prevention efforts.
This research was supported by research grants from the National Institute on Drug Abuse grant number T32DA031099 (P.I. Deborah S. Hasin, PhD);1R01DA037866 (P.I. Silvia S. Martins, MD, PhD), the National Institute on Alcohol Abuse and Alcoholism K01AA021511 (P.I. Katherine M. Keyes, PhD) and the New York State Psychiatric Institute (Deborah S. Hasin, PhD).
Citation: Brown, Q.L., Hasin, D.S., Keyes, K.M., Fink, D.S., Ravenell, O., Maritns, S.S. Health insurance, alcohol and tobacco use among pregnant and non-pregnant women of reproductive age. Drug Alcohol Depend. (2016), http://dx.doi.org/10.1016/j.drugalcdep.2016.07.001
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