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.