The isolated impacts of alcohol policies on birth outcomes

项目摘要 确定减少胎儿在怀孕期间接触酒精的政策是公共卫生的一个高度优先事项。更 超过85%的美国州有针对怀孕的酒精和/或毒品政策作为威慑。我们中的一半 各州已制定政策，将怀孕期间饮酒和/或吸毒界定为虐待儿童/吸毒。 这些政策已被证明会产生意想不到的不良健康影响--包括早产增加 低出生体重和产前护理利用率下降。然而，这些影响的程度 由于酒精政策单独与酒精和毒品政策的结合在一起，是不清楚的。一 这种不确定性的原因是，大多数州要么同时制定了酒精和毒品政策， 时间，或者没有政策。我们建议估计儿童出生结局的孤立影响 单独的滥用/滥用酒精政策与酒精和毒品政策的综合影响。只有一 州（亚利桑那州）在不同年份颁布了酒精和毒品儿童虐待/吸毒政策。这 变异提供了一个独特的机会来区分酒精与酒精加药物的影响儿童 关于生育结果和产前护理利用的虐待/虐待政策（目标1），并评估 与白色妇女相比，只饮酒与饮酒加吸毒政策对黑人妇女的影响不同（目标2）。 分析将使用疾病控制中心常规收集的高质量出生证明数据， 预防国家卫生统计中心和严格的当代因果推理方法， 包括差中差方法和综合控制方法。这项研究将提供 虐待儿童/酗酒政策对出生结果的潜在意外影响的证据，并告知 关于全国各地通过针对怀孕的酒精和毒品政策的持续辩论。 从这一建议中获得的知识将推进NIAAA的使命，以了解“公共政策如何可能 通过对行为和结果的影响，作为改善公共卫生和福利的工具 关于酒精和其他毒品的问题”。拟议的培训由一个模范辅导小组指导，将 提高申请人的方法技能，研究能力，和内容的专业知识需要她 作为一名未来的独立学术研究人员，他的职业生涯专注于酒精政策如何影响健康。 妇女、新生儿和儿童以及减轻饮酒对人口健康的不利影响的战略 健康不平等。

Project Summary 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.