Globally, increasing alcohol consumption has exacerbated health problems and social burdens [1]. In particular, rising alcohol consumption among women has emerged as a significant public health concern [2,3]. According to the 2022 National Health Statistics, the prevalence of high-risk drinking among women—defined as consuming five or more drinks per occasion on 2 or more days per week—was highest among women in their 20s (8.8%) and 30s (9.3%), underscoring high-risk alcohol use among women of childbearing age as a critical issue [4]. In contrast, when drinking patterns are compared by sex and age, men in their 40s demonstrate the highest rates of high-risk drinking, reflecting clear differences in drinking patterns across sex and age groups [5].

Women of childbearing age are in a critical life stage during which pregnancy may be possible or planned. Health management during this period can substantially influence fetal development and overall family well-being [6,7]. At the individual level, alcohol use can adversely affect women’s reproductive health by reducing fertility and increasing the risk of menstrual irregularities [8]. Alcohol consumption is also associated with high-risk sexual behaviors, which may indirectly increase the risk of sexually transmitted infections, including human immunodeficiency virus and human papillomavirus [9]. In the context of pregnancy, alcohol use is linked to adverse maternal and fetal outcomes, and even moderate intake has been shown to increase the risk of fetal growth restriction and low birth weight, raising concerns about long-term fetal development [7]. Furthermore, alcohol consumption among women of childbearing age may affect family functioning, as drinking-related behaviors can contribute to emotional strain, relationship conflict, and reduced overall family well-being [10]. Taken together, these interconnected effects indicate that alcohol consumption in this population represents an important public health concern.

Given these concerns, preventive health management among women of childbearing age warrants particular attention [11]. Preventive health behaviors are fundamental to disease prevention and health promotion and play an important role in preparing for healthy pregnancy and childbirth in this population [12]. Regular health check-ups and vaccinations contribute to the maintenance of overall health and the protection of maternal and fetal health before and after pregnancy [13,14]. In addition, a healthy diet and regular physical activity can help mitigate health risks associated with alcohol consumption and support the maintenance of a healthy lifestyle [15].

Previous studies on women’s alcohol consumption have shown that drinking behavior is influenced by multiple factors [2]. Stress, social environment, mental health, and cultural factors have been consistently identified as major determinants [3,16]. Stress, in particular, has been recognized as a key driver of alcohol consumption among women, often arising from pressures related to work and family responsibilities [17]. Social environments, including prevailing drinking cultures, further shape women’s drinking patterns, while mental health conditions such as depression and anxiety are strongly associated with high-risk drinking [3,18]. In addition, increasing economic participation and growing awareness of gender equality in modern society have been closely linked to changes in women’s drinking patterns [3]. However, most prior studies have focused primarily on the causes of alcohol use or drinking patterns themselves, whereas research explicitly examining the relationship between preventive health management and high-risk drinking remains limited [2,18]. Preventive health behaviors may function not only as isolated health-promoting actions but also as moderating factors that influence the likelihood or severity of risky behaviors, including high-risk drinking [9]. Individuals who regularly engage in health-promoting behaviors tend to be more aware of their overall health status, which may reduce tendencies toward harmful alcohol use [19]. Conversely, limited engagement in preventive care may reflect a broader pattern of risk-prone behaviors, including problematic drinking [2]. Supporting this perspective, a recent study reported that reduced oral hygiene practices, such as infrequent tooth brushing and limited dental check-ups, were significantly associated with increased alcohol consumption and unhealthy dietary habits among university students [20]. Regular general health check-ups, dental check-ups, vaccinations, and healthy dietary behaviors are therefore essential components of preventive health management that may help mitigate alcohol-related health risks. Examining these factors is critical for understanding the interaction between drinking behavior and health management among women of childbearing age [9,19].

This study aimed to examine the association between high-risk drinking behavior and preventive health management among women of childbearing age using data from the Korea National Health and Nutrition Examination Survey (KNHANES). By addressing this relationship, the study seeks to contribute to efforts to promote health among women of childbearing age and to prevent adverse outcomes related to alcohol consumption. Ultimately, the findings are intended to provide a foundation for the development of tailored intervention strategies aimed at reducing alcohol use and safeguarding the well-being of women of childbearing age, their fetuses, and their families.

This study analyzed the relationship between preventive health behaviors and high-risk drinking among women of childbearing age. Factors associated with high-risk drinking were categorized into two domains: general characteristics, including education level and employment status, and preventive health behaviors, such as smoking status, skipping breakfast, and dental check-up participation. Among all participants, the overall alcohol consumption rate was 82.5%, with 73.0% identified as moderate drinkers and 9.5% as high-risk drinkers. In the multiple logistic regression analysis, smoking status, skipping breakfast in the past 2 days, dental check-up status, employment status, and education level were significantly associated with high-risk drinking behavior.

Smoking status showed the strongest association with high-risk drinking, with current smokers being approximately four times more likely to engage in high-risk drinking than nonsmokers. This finding is consistent with previous research indicating that smoking and drinking frequently co-occur as clustered health-risk behaviors [5,18]. Furthermore, this co-occurrence has been reported to be particularly pronounced among women in their 20s and 30s [22]. Taken together, these findings support the need for integrated intervention programs that simultaneously address both high-risk drinking and smoking behaviors.

Skipping breakfast in the past 2 days also demonstrated a notable association with high-risk drinking. Irregular eating patterns may reflect broader profiles of unhealthy behaviors, consistent with prior evidence showing that irregular dietary habits are linked to risky behaviors, including problematic alcohol use [2,23]. Accordingly, interventions aimed at improving lifestyle behaviors should emphasize the importance of regular meals, particularly breakfast, as part of an integrated approach to health management.

Dental check-up status was another significant predictor, with women who did not undergo dental check-ups being more likely to engage in high-risk drinking. This finding suggests that dental check-up participation may reflect not only attention to oral health but also broader attitudes toward preventive health management [20]. Previous studies have shown that individuals who do not participate in preventive health services are less likely to engage in healthy behaviors and often have limited awareness of the need for ongoing health management [24,25]. In addition, prior research has demonstrated a significant association between high-risk drinking and periodontal disease, with alcohol consumption potentially exacerbating oral health problems by impairing immune responses and accelerating periodontal tissue damage [26]. For women of childbearing age, dental check-ups may therefore provide valuable opportunities for nurses to identify risky drinking patterns early and to guide patients toward appropriate counseling or support services.

Employment status was also associated with high-risk drinking, with employed women demonstrating a higher likelihood of hazardous alcohol use. This finding aligns with previous research indicating that gender norms and workplace environmental factors play an important role in shaping drinking patterns among female employees [3]. Moreover, qualitative studies have reported that young workers often use alcohol as a means of coping with work-related stress and as a tool for maintaining social relationships within workplace culture [16]. These findings underscore the importance of workplace-centered interventions that address stress management and organizational drinking norms.

Education level demonstrated the weakest, yet still statistically significant, association with high-risk drinking. Women with lower educational attainment were more likely to engage in high-risk drinking, which is consistent with earlier findings that health-risk behaviors such as depression, smoking, and binge drinking often cluster together [2]. These results highlight the importance of tailoring alcohol-related interventions according to educational background and health literacy levels.

In contrast, influenza vaccination status, participation in general health check-ups, participation in cancer screening programs, perceived stress level, and physical activity intensity were not significantly associated with high-risk drinking in the multivariate analysis. Although some of these variables showed significant differences in univariate analyses, their associations may have been attenuated by stronger predictors such as smoking status. Participation in national screening programs may not fully capture individual health attitudes or motivations, which could weaken their observed relationship with drinking patterns. Previous research has also suggested that physical activity may occur in social contexts where alcohol consumption is common or may function as a coping strategy for stress, indicating a more complex relationship with alcohol use [27]. These findings underscore the importance of including theoretically relevant variables in analyses, even when they do not retain statistical significance in multivariate models.

This study has several limitations. Because cross-sectional KNHANES data were used, causal relationships between preventive health behaviors and high-risk drinking could not be established. In addition, reliance on self-reported data introduces the possibility of underreporting or overreporting alcohol consumption and preventive health behaviors due to recall bias or social desirability bias. Future studies should employ longitudinal designs to clarify causal pathways linking preventive health behaviors with high-risk drinking and should consider linking survey data with objective health check-up records to improve measurement accuracy. Qualitative research exploring the mechanisms underlying non-significant associations may also provide valuable insights into the complex patterns of high-risk drinking and health behaviors.

Despite these limitations, this study contributes to a more nuanced understanding of the relationship between high-risk drinking and preventive health behaviors among women of childbearing age. By identifying key predictors such as smoking status, skipping breakfast in the past 2 days, dental check-up status, employment status, and education level, the findings underscore the need for targeted interventions. Increasing participation in dental check-ups and using these encounters as opportunities for health counseling may be particularly effective. In addition, integrated and multifaceted intervention strategies that address complex patterns of co-occurring health behaviors are needed to prevent and manage high-risk drinking and to promote healthier lifestyles among women.

In conclusion, this study demonstrates that both preventive health behaviors and general characteristics significantly influence high-risk drinking among women of childbearing age, underscoring the need for policy-level strategies that promote healthier lifestyles and facilitate early identification of individuals at risk. The findings have several practical and policy implications. Health promotion programs targeting women of childbearing age should prioritize education about the risks of high-risk drinking, particularly among women with lower educational attainment, employed women, and smokers. Promoting dental check-up participation and incorporating brief, nurse-led alcohol use counseling into dental visits may represent a novel approach to improving both oral health and overall health management. Workplace-focused interventions addressing drinking culture and healthy eating practices may also be effective. Finally, interventions should account for the clustering of risky health behaviors, such as smoking and high-risk drinking, and implement integrated strategies to address these behaviors simultaneously.