title: Which women are missed by primary health-care based interventions for alcohol and drug use?
abstract: BACKGROUND
  Women of reproductive age who binge drink or have alcohol-related problem symptoms (APS) and who do not use contraception are considered at risk of an alcohol-exposed pregnancy (AEP). In the U.S., efforts to prevent AEPs focus largely on delivering interventions in primary health care settings. While research suggests that these interventions are efficacious for women reached, it is unclear to what extent these interventions are likely to reach women at risk of AEPs.
  
  
  METHODS
  Data are from the Turnaway Study, a study of 956 women seeking pregnancy termination at 30 U.S. facilities between 2008 and 2010, some of whom received and some of whom were denied terminations because they were past the gestational limit. We examined associations between binge drinking, APS, and drug use prior to pregnancy recognition and having a usual source of health care (USOC).
  
  
  RESULTS
  Overall, 59% reported having a USOC. A smaller proportion with than without an APS reported a USOC (44 vs. 60%, p<.05) and a smaller proportion using than not using drugs reported a USOC (51 vs. 61%, p<.05). This pattern was not observed for binge drinking. In multivariate analyses, an APS continued to be associated with lack of a USOC, while drug use was no longer associated with lack of a USOC.
  
  
  CONCLUSIONS
  As more than 40% did not have a USOC, with higher proportions among women with an APS, primary health-care based approaches to AEP prevention seem unlikely to reach the majority of women who have an APS and are at risk of an unintended pregnancy.
authors.affiliation: Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94706, USA. Electronic address: sarah.roberts@ucsf.edu.
authors.forename: S C M
authors.initials: SC
authors.lastname: Roberts
authors.affiliation: Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94706, USA.
authors.forename: L J
authors.initials: LJ
authors.lastname: Ralph
authors.affiliation: Department of Clinical Neuroscience, University of North Dakota School of Medicine & Health Sciences, 501 North Columbia Road Stop 9037, Grand Forks, ND 58202-9037, USA.
authors.forename: S C
authors.initials: SC
authors.lastname: Wilsnack
authors.affiliation: Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94706, USA.
authors.forename: D G
authors.initials: DG
authors.lastname: Foster
mesh_terms: D000028:Abortion, Induced / Q000706:statistics & numerical data*; D000328:Adult; D019973:Alcohol-Related Disorders / Q000150:complications; D015331:Cohort Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D011247:Pregnancy; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000150:complications*; D014481:United States
keywords: Alcohol; Illicit drug use; Pregnancy