Modifying effects of pregnancy on the association of heavy alcohol consumption with e-cigarette, cigarette, and dual...

We examined the association of heavy alcohol consumption with e-cigarette, cigarette, or dual use among females of reproductive age and stratified by pregnancy status.

Cross-sectional data from 2021 (n = 13 744), 2022 (n = 38 021), and 2023 (n = 38 765) Behavioral Risk Factor Surveillance System were analyzed for females aged 18-44 years. Heavy alcohol consumption (>7 drinks/week) was categorized as Yes or No (reference). Current nicotine/tobacco product use (everyday/somedays) was categorized as nonuse of either cigarette or e-cigarette (reference), e-cigarette-only, cigarette-only, or dual use. Weighted multinomial logistic regression was used to examine the association between alcohol consumption and tobacco use, adjusting for sociodemographic factors, self-rated health, current smokeless tobacco use, pregnancy status, and survey year. Interaction effects between pregnancy status and alcohol consumption were analyzed.

Findings showed that heavy alcohol consumption was associated with a higher likelihood of e-cigarette (aRRR: 5.57, [95% CI, 4.70-6.61]), cigarette (aRRR: 4.88, [95% CI, 4.03-5.91]), or dual (aRRR: 6.95, [95% CI, 5.59-8.64]) use. Pregnancy significantly modified the association for dual use (P = .002) only. Stratified analysis indicated that pregnant (vs non-pregnant) females with heavy alcohol consumption had much higher likelihood of e-cigarette (aRRR: 10.35, [95% CI, 2.59-41.33] vs aRRR: 5.52, [95% CI, 4.65-6.55]), cigarette (aRRR: 6.56, [95% CI, 1.16-37.05] vs aRRR: 4.88, [95% CI, 4.02-5.92]), and dual aRRR: 15.82, [95% CI, 4.56-54.84] vs aRRR: 6.81, [95% CI, 5.45-8.50]) use.

Heavy alcohol consumption is strongly associated with a higher likelihood of e-cigarette, cigarette, or dual use among reproductive-age females, with pregnancy significantly amplifying this relationship. Comprehensive substance use screening and tailored cessation support are essential for pregnant females and those of reproductive age.

Females who are pregnant with heavy alcohol consumption form a vulnerable subgroup, underscoring the need for integrated substance use interventions in prenatal care. Tailored programs addressing alcohol and nicotine/tobacco product use may reduce the compounded risks of adverse maternal and fetal outcomes. Additionally, early screening protocols and culturally sensitive public health messaging could enhance identification and support for high-risk pregnant females. Prioritizing holistic approaches in healthcare policies may improve overall maternal and child health and foster better long-term outcomes for families affected by dual substance use. Comprehensive substance use screening and tailored cessation support are needed for all females of reproductive age.