Overall, combined tobacco and alcohol use among reproductive-aged and pregnant
women decreased in late 1980s and leveled off in the 1990s Despite overall
decreases in joint use of alcohol and tobacco among US women of childbearing
age achieved during the 1980s, the rates remained unchanged during the 1990s.
Younger women are as likely as older women to use both substances and are less
likely to stop during pregnancy. The findings, based on 10 years of data (1987-
1997) from the Centers for Disease Control and Prevention's (CDC) Behavioral
Risk Factor Surveillance System (BRFSS), a state-based monthly telephone survey
of adults in the United States, were reported in the November 2000 issue of
Obstetrics & Gynecology.
Among women 18-20 years old who were pregnant, joint use of tobacco and
alcohol remained unchanged at 4% during the 1990s, after declines in the 1980s.
For 18-20 year old women who were not pregnant, use of both substances
increased from 13.5% to 13.7%. In 1997, only 74% of pregnant women in this age
group stopped using alcohol and tobacco compared with 83% of older pregnant
"We cannot rest in our efforts to reduce the number of young people who start
using tobacco and alcohol," said CDC Director Jeffrey P. Koplan. "Alcohol and
tobacco use not only threaten the health of a young woman over time, but can
prevent her from becoming pregnant, and if she is pregnant, harm her child."
Overall, although the percentage of women who reported using both alcohol and
tobacco decreased during the 1980s, the rates remained unchanged during the
1990s both among pregnant women (3%) and nonpregnant women (14%). From 1987 to
1997, the percentage of women who said they stopped using tobacco and alcohol
because of a pregnancy increased slightly, but insignificantly from 70% to 82%.
Pregnant women who used both substances were much more likely to report that
they stopped using alcohol (74%) than tobacco (52%).
Other characteristics associated with joint use of both substances were
education and marital status. Joint use of alcohol and tobacco was more common
among pregnant and nonpregnant women who had less than a high school education
and who were not married. Among nonpregnant women, nonwhite race and
unemployment were risk factors for using both alcohol and tobacco.
"Counseling on avoiding tobacco and alcohol misuse should be an important part
of care for women of childbearing age," said the lead author, Dr. Shahul H.
Ebrahim of the CDC.
Adverse reproductive effects of alcohol and tobacco for women of reproductive
age include infertility, pre-term birth, spontaneous abortion, and cancers.
Adverse effects for children of women who use alcohol and tobacco include fetal
alcohol syndrome, birth defects, growth deficits, developmental disabilities,
and learning disorders.
Prevention of alcohol and tobacco-exposed pregnancies requires targeting high
risk women for interventions before pregnancy. One CDC study currently
underway, Project CHOICES, is testing the efficacy of this approach by
combining behavioral interventions to reduce preconceptional alcohol use and
encourage effective contraception until risk drinking is resolved.
The Centers for Disease Control and Prevention (CDC) protects people's health
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decisions by providing credible information on critical health issues; and
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