Search

Objectives State policies regarding alcohol use during pregnancy (alcohol/pregnancy policies) have been in effect for more than 40 years. Previous research finds some policies increase adverse birth outcomes and decrease prenatal care utilization. This research examines whether effects of alcohol/pregnancy policies vary by race; the general hypothesis is that health benefits of policies are concentrated among White women and health harms of policies are concentrated among Black women. Methods This study uses 1972–2015 Vital Statistics data and policy data from NIAAA’s Alcohol Policy Information System and original legal research. The dataset includes more than 150 million singleton births. Outcomes are preterm birth (PTB), low birthweight (LBW), and prenatal care utilization. Logistic regression models include raceXpolicy interaction terms as main predictors, adjust for individual- and state-level controls, include fixed effects for state, year and state-specific time trends, and account for clustering by state. Results The impact of alcohol/pregnancy policies varied by race for preterm birth, varied in a few cases for low birthweight, and generally did not vary for prenatal care utilization. The hypothesis regarding the direction of differential effects was not supported. Six policies had an adverse impact on PTB and/or LBW for White women. Findings differed for Black women; for Black women, four policies had a beneficial impact for PTB and one had an adverse impact for LBW. Conclusions The impact of alcohol/pregnancy policies on birth outcomes varies by race. Future research should explore why some policies appear to have opposite effects for White v. Black women.

Background Prior research shows that cannabis use during treatment for Alcohol Use Disorders (AUD) is related to fewer abstinent days from alcohol, although only among those who use cannabis 1-2x/month. Here we extend prior research by assessing the relationship between the frequency of cannabis use during AUD treatment and post-treatment alcohol-related consequences. Methods Data come from the Combined Pharmacotherapies and Behavioral Interventions (COMBINE) Study, a large US randomized control trial of treatments for AUD. The current analyses include 206 cannabis users and 999 cannabis abstainers and compare longitudinal drinking data between those who used cannabis versus those who abstained during COMBINE treatment. The primary exposure was quartiles of cannabis use (Q1: less than 1x/month during treatment, Q2: 1-2x/month, Q3: 4-8x/month, Q4: 12x/month or more), with cannabis abstainers as the reference group. Outcomes were alcohol-related problems at the end of treatment and one-year post-treatment as measured by the Drinker Inventory Consequences. Results Compared to cannabis abstinence, the most frequent use during treatment was related to 1.44 times as many physical consequences one-year post-treatment. Cannabis use was not related to physical consequences immediately after treatment, or to intrapersonal, interpersonal, social responsibility or impulse control problems at either post-treatment time point. Conclusions In a sample of individuals in treatment for AUD, using cannabis 12x/month or more during treatment is associated with increased rates of physical consequences attributed to alcohol use. Individuals in treatment for AUD who also use cannabis might benefit from reducing or stopping cannabis use to avoid alcohol-related physical problems.

A recent trial (n=508) of “Making Alcoholics Anonymous Easier” (MAAEZ), a group-format 12-step facilitation program, showed that MAAEZ participants had increased odds of abstinence (OR = 1.58, p = 0.063). Effects were especially marked in several subgroups, including those with more prior AA/NA/CA exposure, and those with severe psychiatric problems. This paper examines whether the effects of MAAEZ were explained by higher engagement in particular Alcoholics Anonymous (AA) and other 12-step organization activities. Mediation analyses were performed, estimating MAAEZ effects attributable to AA/NA/CA meeting attendance, overall AA/NA/CA involvement, having a sponsor, and engaging in 12-step service. The only variable that appeared to mediate MAAEZ effects in the sample overall was doing service at either 6 months or at both 6 and 12 months. Among those with high prior AA/NA/CA attendance, both having a sponsor and doing service emerged as mediators, with having a sponsor explaining approximately 25% of the MAAEZ effect. Doing service also partially explained the MAAEZ effect among those with high psychiatric severity. Results highlight the value of studying specific AA/NA/CA activities as mediators of treatment effects, and demonstrate the importance of exploring subgroups when trying to understand treatment mechanisms. Findings also suggest that treatment programs should emphasize specific activities for particular clients. For example, individuals may have attended many AA/NA/CA meetings, but never known how to ask for a sponsor or get involved in service; doing service may represent a non-threatening way of connecting with 12-step members for clients with psychiatric problems such as social anxiety.