1. Variations by Education Status in Relationships Between Alcohol/Pregnancy Policies and Birth Outcomes and Prenatal Care Utilization: A Legal Epidemiology Study
- Author
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Roberts, Sarah CM, Mericle, Amy A, Subbaraman, Meenakshi S, Thomas, Sue, Kerr, William, and Berglas, Nancy F
- Subjects
Midwifery ,Public Health ,Health Sciences ,Preterm ,Low Birth Weight and Health of the Newborn ,Substance Misuse ,Prevention ,Clinical Research ,Infant Mortality ,Conditions Affecting the Embryonic and Fetal Periods ,Perinatal Period - Conditions Originating in Perinatal Period ,Alcoholism ,Alcohol Use and Health ,Pediatric ,3.1 Primary prevention interventions to modify behaviours or promote wellbeing ,Prevention of disease and conditions ,and promotion of well-being ,Reproductive health and childbirth ,Good Health and Well Being ,Quality Education ,Adult ,Alcohol Drinking ,Educational Status ,Female ,Humans ,Infant ,Low Birth Weight ,Infant ,Newborn ,Legal Epidemiology ,Patient Acceptance of Health Care ,Pregnancy ,Pregnancy Complications ,Pregnancy Outcome ,Premature Birth ,Prenatal Care ,State Government ,alcohol ,disparities ,legal epidemiology ,policy ,pregnancy ,Public Health and Health Services ,Health services and systems ,Public health - Abstract
ContextPrevious research finds that some state policies regarding alcohol use during pregnancy (alcohol/pregnancy policies) increase low birth weight (LBW) and preterm birth (PTB), decrease prenatal care utilization, and have inconclusive relationships with alcohol use during pregnancy.ObjectiveThis research examines whether effects of 8 alcohol/pregnancy policies vary by education status, hypothesizing that health benefits of policies will be concentrated among women with more education and health harms will be concentrated among women with less education.MethodsThis study uses 1972-2015 Vital Statistics data, 1985-2016 Behavioral Risk Factor Surveillance System data, policy data from National Institute on Alcohol Abuse and Alcoholism's Alcohol Policy Information System and original legal research, and state-level control variables. Analyses include multivariable logistic regressions with education-policy interaction terms as main predictors.ResultsThe impact of alcohol/pregnancy policies varied by education status for PTB and LBW for all policies, for prenatal care use for some policies, and generally did not vary for alcohol use for any policy. Hypotheses were not supported. Five policies had adverse effects on PTB and LBW for high school graduates. Six policies had adverse effects on PTB and LBW for women with more than high school education. In contrast, 2 policies had beneficial effects on PTB and/or LBW for women with less than high school education. For prenatal care, patterns were generally similar, with adverse effects concentrated among women with more education and beneficial effects among women with less education. Although associations between policies and alcohol use during pregnancy varied by education, there was no clear pattern.ConclusionsEffects of alcohol/pregnancy policies on birth outcomes and prenatal care use vary by education status, with women with more education typically experiencing health harms and women with less education either not experiencing the harms or experiencing health benefits. New policy approaches that reduce harms related to alcohol use during pregnancy are needed. Public health professionals should take the lead on identifying and developing policy approaches that reduce harms related to alcohol use during pregnancy.
- Published
- 2020