Brown Qiana L, Hasin Deborah S, Keyes Katherine M, Fink David S, Ravenell Orson, Martins Silvia S
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
Drug Alcohol Depend. 2016 Sep 1;166:116-24. doi: 10.1016/j.drugalcdep.2016.07.001. Epub 2016 Jul 12.
Understanding the relationship between health insurance coverage and tobacco and alcohol use among reproductive age women can provide important insight into the role of access to care in preventing tobacco and alcohol use among pregnant women and women planning to become pregnant.
We examined the association between health insurance coverage and both past month alcohol use and past month tobacco use in a nationally representative sample of women age 12-44 years old, by pregnancy status. The women (n=97,788) were participants in the National Survey of Drug Use and Health (NSDUH) in 2010-2013. Logistic regression models assessed the association between health insurance (insured versus uninsured), past month tobacco and alcohol use, and whether this was modified by pregnancy status.
Pregnancy status significantly moderated the relationship between health insurance and tobacco use (p-value≤0.01) and alcohol use (p-value≤0.01). Among pregnant women, being insured was associated with lower odds of alcohol use (adjusted odds ratio [AOR]=0.47; 95% confidence interval [CI]=0.27-0.82), but not associated with tobacco use (AOR=1.14; 95% CI=0.73-1.76). Among non-pregnant women, being insured was associated with lower odds of tobacco use (AOR=0.67; 95% CI=0.63-0.72), but higher odds of alcohol use (AOR=1.23; 95% CI=1.15-1.32).
Access to health care, via health insurance coverage is a promising method to help reduce alcohol use during pregnancy. However, despite health insurance coverage, tobacco use persists during pregnancy, suggesting missed opportunities for prevention during prenatal visits.
了解育龄妇女的医疗保险覆盖范围与烟酒使用之间的关系，有助于深入洞察获得医疗服务在预防孕妇及计划怀孕的妇女烟酒使用方面所起的作用。
我们通过怀孕状况，对全国具有代表性的12 - 44岁女性样本中上个月的酒精使用情况和上个月的烟草使用情况与医疗保险覆盖范围之间的关联进行了研究。这些女性（n = 97,788）是2010 - 2013年全国药物使用和健康调查（NSDUH）的参与者。逻辑回归模型评估了医疗保险（参保与未参保）、上个月的烟草和酒精使用情况之间的关联，以及这种关联是否因怀孕状况而有所改变。
怀孕状况显著调节了医疗保险与烟草使用（p值≤0.01）以及酒精使用（p值≤0.01）之间的关系。在孕妇中，参保与较低的酒精使用几率相关（调整后的优势比[AOR] = 0.47；95%置信区间[CI] = 0.27 - 0.82），但与烟草使用无关（AOR = 1.14；95% CI = 0.73 - 1.76）。在非孕妇中，参保与较低的烟草使用几率相关（AOR = 0.67；95% CI = 0.63 - 0.72），但与较高的酒精使用几率相关（AOR = 1.23；95% CI = 1.15 - 1.32）。
通过医疗保险获得医疗服务是帮助减少孕期酒精使用的一种有前景的方法。然而，尽管有医疗保险覆盖，孕期烟草使用仍然存在，这表明产前检查期间存在预防机会的错失。
