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.
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.
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.
Most policies targeting alcohol use during pregnancy do not seem to be associated with less alcohol consumption during pregnancy.
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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.
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.
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.
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.
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.
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.
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.
Published online: March 12, 2019
Accepted: February 1, 2019
Received in revised form: January 28, 2019
Received: June 26, 2018
© 2019 Jacobs Institute of Women's Health. Published by Elsevier Inc.