Identifying policies to reduce fetal exposure to alcohol during pregnancy is a high public health priority. More than 85% of US states have pregnancy-specific alcohol and/or drug policies in place as a deterrent. Half of US states have policies in place that define alcohol and/or drug use during pregnancy as Child Abuse/Neglect. These policies have been shown to have unintended adverse health effects?including increased preterm birth and low birthweight?and decreased prenatal care utilization. However, the extent to which these effects are due to alcohol policies alone vs the combination of both alcohol and drug policies together, is unclear. One reason for this uncertainty is that most states have either enacted both alcohol and drug policies at the same time, or neither policy. We propose to estimate the isolated effects on birth outcomes of the Child Abuse/Neglect alcohol policy alone vs the combined effect of alcohol and drug policies together. Only one state (Arizona) has enacted both alcohol and drug Child Abuse/Neglect policies in different years. This variation provides a unique opportunity to differentiate the effects of alcohol vs alcohol plus drug Child Abuse/Neglect policies on birth outcomes and prenatal care utilization (Aim 1) and assess whether the alcohol-only vs alcohol plus drug policies have differential effects on Black compared to White women (Aim 2). Analyses will use high-quality birth certificate data routinely collected by the Center for Disease Control and Prevention National Center for Health Statistics and rigorous contemporary causal inference methods, including a difference-in-difference approach and a synthetic control method. The proposed study will provide evidence of potential unintended effects of Child Abuse/Neglect alcohol policies on birth outcomes and inform ongoing debates about the passing of pregnancy-specific alcohol and drug policies around the country. Knowledge gained from this proposal will advance the NIAAA's mission to understand ?how public policy may serve as a tool for improving public health and welfare through its effects on behaviors and outcomes pertaining to alcohol and other drugs?. The proposed training, guided by an exemplary mentorship team, will enhance the applicant's methodological skills, research competency, and content expertise needed for her career as a future independent academic researcher focused on how alcohol policies influence the health of women, newborns, and children and strategies to mitigate adverse effects of alcohol use on population health and health inequalities.
Over the past 40 years, half of US states have enacted policies defining alcohol and/or drug use during pregnancy as Child Abuse/Neglect. Prior evidence indicates that such punitive policies increase adverse birth outcomes and reduce prenatal care utilization, but it is unclear whether these effects would occur with alcohol- specific policies that did not apply to drug use. This study will evaluate if the passing of alcohol-only policies influences birth outcomes and prenatal care utilization and disparities of effects in these outcomes.
