1. Racial differences in the relationship between alcohol/pregnancy policies and birth outcomes and prenatal care utilization: A legal epidemiology study
- Author
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Sue Thomas, William C. Kerr, Nancy F. Berglas, Amy A. Mericle, Meenakshi S. Subbaraman, and Sarah C. M. Roberts
- Subjects
Adult ,medicine.medical_specialty ,Adolescent ,Prenatal care ,Health benefits ,Toxicology ,Logistic regression ,White People ,Article ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Epidemiology ,medicine ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,Pharmacology ,Black women ,Legal Epidemiology ,Singleton ,business.industry ,Infant, Newborn ,Pregnancy Outcome ,Prenatal Care ,Middle Aged ,medicine.disease ,Black or African American ,Psychiatry and Mental health ,Female ,Racial differences ,business ,030217 neurology & neurosurgery ,Demography - Abstract
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.
- Published
- 2019