Health insurance, alcohol and tobacco use among pregnant and non-pregnant women of reproductive age

Background 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. Methods 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. Results 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). Conclusion 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.