Abstract
Background
Most states have at least one policy targeting alcohol use during pregnancy. The public
health impact of these policies has not been examined. We sought to examine the relationship
between state-level policies targeting alcohol use during pregnancy and alcohol use
among pregnant women.
Methods
Data include state-level alcohol and pregnancy policy data and individual-level U.S.
Behavioral Risk Factor Surveillance System data about pregnant women's alcohol use
from 1985 to 2016 (N = 57,194). Supportive policies include mandatory warning signs, priority substance
abuse treatment, reporting requirements for data and treatment purposes, and prohibitions
on criminal prosecution. Punitive policies include civil commitment, Child Protective
Services reporting requirements, and child abuse/neglect. Analyses include logistic
regression models that adjust for individual- and state-level controls, include fixed
effects for state and year, account for clustering by state, and weight by probability
of selection.
Results
Relative to having no policies, supportive policy environments were associated with
more any drinking, but not binge or heavy drinking. Of individual supportive policies,
only the following relationships were statistically significant: mandatory warning
signs was associated with lower odds of binge drinking, and priority treatment for
pregnant women and women with children was associated with higher odds of any drinking.
Relative to no policies, punitive policy environments were also associated with more
drinking, but not with binge or heavy drinking. Of individual punitive policies, only
child abuse/neglect was associated with lower odds of binge and heavy drinking. Mixed
policy environments were not associated with any alcohol outcome.
Conclusions
Most policies targeting alcohol use during pregnancy do not seem to be associated
with less alcohol consumption during pregnancy.
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Biography
Sarah C.M. Roberts, DrPH, is Associate Professor at University of California, San Francisco. Dr. Roberts studies how policies and our health care system punish rather than support vulnerable pregnant women, including women seeking abortion and women who use alcohol and/or drugs.
Biography
Amy A. Mericle, PhD, is a Scientist at the Alcohol Research Group, Public Health Institute. Dr. Mericle studies recovery support services for alcohol and drug use disorders as well as research methods and measurement issues in psychiatric services research.
Biography
Meenakshi S. Subbaraman, PhD, MS, is a Biostatistician and Co-Director of Statistical and Data Services at the Alcohol Research Group, Public Health Institute. Dr. Subbaraman studies cannabis and alcohol policy and the methods for studying mediators/mechanisms of action.
Biography
Sue Thomas, PhD, is Senior Research Scientist and Director, PIRE-Santa Cruz. She specializes in the intersection of law and social science research. Her specialties include fetal alcohol spectrum disorders policy, reproductive rights, and methodologic questions about using legal data for research.
Biography
Ryan D. Treffers, JD, is a legal policy researcher for the Pacific Institute for Research and Evaluation. His work largely involves conducting legal research where the law and public health intersect.
Biography
Kevin L. Delucchi, PhD, is Professor at the University of California, San Francisco. Dr. Delucchi is a quantitative research expert whose research focuses on using sophisticated statistical methods for addressing problems common in human-based research, including missing data and comorbid conditions.
Biography
William C. Kerr, PhD, is a Senior Scientist and Center Director at the Alcohol Research Group, Public Health Institute. Dr. Kerr is an expert in alcohol control policy and policy evaluation as well as in the methodology of alcohol use measurement.
Article info
Publication history
Published online: March 12, 2019
Accepted:
February 1,
2019
Received in revised form:
January 28,
2019
Received:
June 26,
2018
Identification
Copyright
© 2019 Jacobs Institute of Women's Health. Published by Elsevier Inc.
