Friday, January 15, 2010
* noted as presenting author
Background and Purpose: There are known fetal complications associated with alcohol-exposed pregnancies (AEP) and nicotine-exposed pregnancies (NEP). Likewise, there is a well-documented association between alcohol and tobacco use (Kahler et al., 2008; Pelucchi et al, 2006). The CDC-funded Project CHOICES Epidemiology Survey, conducted in six settings with increased prevalence of women at-risk for AEP, found that women at-risk for AEP were 4.3 times more likely to smoke than women not at-risk (Project CHOICES Research Group, 2002). Settings included primary care, university-hospital based OB/GYN practices, an urban jail, substance abuse treatment programs, and a media-recruited sample in three large cities. Secondary analyses of data from this study suggest that many women at-risk for AEP may also be at-risk for NEP. This is concerning, as the consumption of both alcohol and nicotine have been found to result in a multiplicative increase in negative health outcomes for mothers and infants (De Leon et al., 2007; Odendall et al., 2009). This study utilized data from the original CHOICES epidemiological survey (N=2672) to identify unique factors associated with the risk of NEP and compare these risk-factors with those associated with risk of AEP. Methods: Bivariate and multivariate logistic regression analyses were used to identify variables correlated with being at-risk for NEP, defined as being a current smoker and being at-risk for an unplanned pregnancy. Respondents at-risk for NEP were compared with sexually active respondents who were not at-risk. Risk factors found to be associated with NEP were then examined in a model with AEP risk as the criterion variable. AEP risk was defined by drinking at risky levels and being at-risk for pregnancy. Results: A total of 333 women (12.5%) were at-risk for AEP, while 469 women (17.6%) were at-risk for NEP. Of the women at-risk for AEP, seventy-five percent were also at-risk for NEP; over half (53%) of women at-risk for NEP were at-risk for AEP. More women were at-risk of both NEP and AEP in the jail and treatment center subsamples than in OB/GYN or health clinic settings. In the multivariate model, significant correlates (p<.05) for women at-risk for both AEP and NEP included: drug use in the last 6 months, prior alcohol and drug treatment, physical abuse in the last year, and multiple sexual partners in the last 6 months. Unique to risk for NEP was the greater likelihood of being at-risk for women who were married or living with their partner (O.R. 2.00, 95% CI 1.5, 2.7) and lower likelihood of being at-risk for women with more education (O.R. 0.86, 95% CI 0.81-.914). Conclusions and Implications: These findings suggest that many women at-risk for AEP are also at-risk for NEP, and women at-risk for both share similar risk factors and characteristics. Future AEP prevention interventions in similar high-risk settings should also target smoking cessation.