Alcohol and pregnancy: do state-level punitive and supportive policies matter?

 描述（由申请人提供）：该项目的主要目的是评估针对怀孕期间饮酒的州一级政策的影响，以及影响是否因种族/民族和社会经济地位（SES）而异。酒精是一种已知的致畸剂，会导致胎儿酒精综合征和一系列其他对胎儿的伤害。怀孕期间饮酒很常见，约12%的孕妇报告有任何饮酒行为，近2%的孕妇报告在过去一个月内酗酒。自1980年以来，几乎所有的州都颁布了一项或多项针对怀孕期间饮酒的政策。这些政策包括惩罚性政策，即允许对滥用酒精的孕妇作出民事承诺，将怀孕期间使用酒精界定为虐待/忽视儿童，并规定向儿童保护服务机构报告。它们还颁布了支持性政策，即要求提供关于怀孕期间饮酒影响的警告标志，禁止对怀孕期间饮酒进行刑事起诉，并给予孕妇接受药物滥用治疗的优先权。这些政策继续在州一级颁布，其中的一些内容现已开始纳入联邦立法。这些政策可能会影响酒精 在怀孕期间以及早产和低出生体重等分娩结果中使用。惩罚性政策也可能产生意想不到的后果，例如阻止妇女接受产前护理。如果妇女不愿接受产前护理，提供其他促进健康的干预措施的机会就会减少，这可能会抵消原本可以预期的健康改善。以前的研究已经描述了这些政策，并研究了与采用这些政策相关的社会和政治因素。然而，到目前为止，研究人员还没有全面研究这些政策对怀孕期间饮酒，产前护理利用和出生结果的影响。他们也没有研究任何影响是否在种族/族裔和社会经济地位之间存在差异，这是一个重要的考虑因素，因为总体有效的政策不一定会减少种族/族裔和社会经济地位的差异。缺乏关于这些政策影响的信息阻碍了公共卫生和医疗决策，即支持哪些政策，反对哪些政策。本研究将使用20世纪80年代至今的行为风险因素监测系统，20世纪70年代至今的出生率出生数据，NIAAA的酒精政策信息系统和其他政策数据来源的数据，并将进行一系列广义最小二乘固定和随机效应分析。这项研究的结果将用于为正在进行的政策辩论以及妇幼保健专业人员和产科医生和妇科医生的宣传和专业教育工作提供信息。

 DESCRIPTION (provided by applicant): The primary purpose of this project is to assess effects of state-level policies targeting alcohol use during pregnancy and whether effects vary by race/ethnicity and socioeconomic status (SES). Alcohol is a known teratogen that causes fetal alcohol syndrome and a range of other harms to fetuses. Alcohol use during pregnancy is common, with about 12% of pregnant women reporting any alcohol use and almost 2% of pregnant women reporting binge drinking in the past month. Since 1980, almost all states have enacted one or more policies targeting alcohol use during pregnancy. These policies include punitive policies, i.e. allowing civil commitment of pregnant women for alcohol abuse, defining use during pregnancy as child abuse/neglect, and mandating reporting to Child Protective Services. They have also enacted supportive policies, i.e. requiring warning signs about effects of alcohol use during pregnancy, prohibiting criminal prosecutions for alcohol use during pregnancy, and giving pregnant women priority in entering substance abuse treatment. These policies continue to be enacted at the state-level and some components of them are now beginning to be included in federal legislation. These policies could potentially influence alcohol use during pregnancy as well as birth outcomes such as preterm birth and low birthweight. Punitive policies could also have unintended consequences, such as deterring women from prenatal care. If women are deterred from prenatal care, there will be fewer opportunities to provide other health-promoting interventions, and it is possible that this could negate any health improvements that might otherwise be expected. Previous research has described these policies and examined social and political factors associated with adopting them. However, to date, researchers have not yet comprehensively examined the effects of these policies on alcohol use during pregnancy, prenatal care utilization, and birth outcomes. They also have not examined whether any effects are differential across race/ethnicity and socioeconomic status, an important consideration given that policies that are effective overall do not necessarily reduce racial/ethnic and socioeconomic status disparities. The lack of information about effects of these policies hinders public health and medical decision-making about which policies to support and which to counter. This study will use data from the Behavioral Risk Factor Surveillance System from the 1980s-present, Natality Birth Data from the 1970s-present, NIAAA's Alcohol Policy Information System, and other policy data sources and will conduct a series of generalized least squares fixed and random effects analyses. Findings from this study will be used to inform ongoing policy debates as well as advocacy and professional education efforts by maternal and child health professionals and obstetricians and gynecologists.