Pregnancy-specific alcohol policies and admissions to substance use disorder treatment for pregnant people in the USA

The Relationship Between Alcohol Availability and Drink-Driving Policies and Admissions to Substance Use Disorder Treatment During Pregnancy

OBJECTIVE

Pregnancy-specific alcohol policies are widely adopted yet have limited effectiveness and established risks. It is unknown whether general population alcohol policies are effective during pregnancy. This study investigated associations between general population policies and alcohol treatment admission rates for pregnant people specifically.

METHOD

Data are from the Treatment Episodes Data Set-Admissions and state-level policy data for 1992-2019 (n = 1,331 state-years). The primary outcome was treatment admissions where alcohol was the primary substance, and the secondary outcome included admissions where alcohol was any substance. There were five policy predictors: (a) government spirits monopoly, (b) ban on Sunday sales, (c) grocery store sales, (d) gas station sales, and (e) blood alcohol concentration (BAC) laws. Covariates included poverty, unemployment, per capita cigarette consumption, state and year fixed effects, and state-specific time trends.

RESULTS

In models with alcohol as the primary substance, prohibiting spirits sales in grocery stores (vs. allowing heavy beer [>3.2% alcohol by volume] and spirits) had lower treatment admission rates (incidence rate ratio [IRR] = 0.88, 95% CI [0.78, 0.99], p = .028). States with BAC laws at .10% (vs. no law) had higher treatment admission rates (IRR = 1.24, 95% CI [1.08, 1.43], p = .003). When alcohol was any substance, prohibiting spirits sales in grocery stores (vs. allowing heavy beer and spirits) was again associated with lower treatment admission rates (IRR = 0.89, 95% CI [0.80, 0.98], p = .021), but there was no association for BAC laws.

CONCLUSIONS

Restrictions on grocery store spirits sales and BAC laws were associated with lower and higher alcohol treatment admission rates among pregnant people, respectively, suggesting that general population alcohol policies are relevant for pregnant people's treatment utilization.

Understanding the effects of alcohol policies on treatment admissions and birth outcomes among young pregnant people

BACKGROUND

This study examines whether state-level alcohol policy types in the United States relate to substance use disorder treatment admissions and birth outcomes among young pregnant and birthing people.

METHODS

We used data from the Treatment Episode Data Set: Admissions (TEDS-A) and Vital Statistics birth data for 1992-2019. We examined 16 state-level policies, grouped into three types: youth-specific, general population, and pregnancy-specific alcohol policies. Using Poisson and logistic regression, we assessed policy effects for those under 21 (aged 15-20) and considered whether effects differed for those just over 21 (aged 21-24).

RESULTS

Youth-specific policies were not associated with treatment admissions or preterm birth. There were statistically significant associations between family exceptions to minimum legal drinking age (MLDA) policies and low birthweight, but findings were in opposite directions across possession-focused and consumption-focused (MLDA) policies and did not differentially apply to people 15-20 versus 21-24. Most pregnancy-specific policies were not associated with treatment admissions, and none were significantly associated with birth outcomes. A few general population policies were associated with improved birth outcomes and/or increased treatment admissions. Specifically, both government spirits monopolies and prohibitions of spirits and heavy beer sales in gas stations were associated with decreased low birthweight among people 15-20 and among people 21-24. Effects of Blood Alcohol Concentration (BAC) limits varied by age, with slight reductions in adverse birth outcomes among people 15-20, as BAC limits get stronger, but slight increases for those 21-24. Although treatment admissions rates across ages were similar when BAC limits were in place, treatment admissions were greater for pregnant people 21-24 than for 15-20 when there were no BAC limits.

CONCLUSIONS

General population policies also appear effective for reducing the adverse effects of drinking during pregnancy for young people, including those under 21. Policies that target people based on age or pregnancy status appear less effective.

Trends in U.S. State Alcohol and Other Drug Use During Pregnancy Policies from 2016 to 2020: Policymaking in the Comprehensive Addiction and Recovery Act Era

Background: Prior to the U.S. Comprehensive Addiction and Reovery Act of 2016 (CARA) , policymaking on alcohol and drug use during pregnancy was more concentrated on alcohol than drug use policy - although the overlap between the two types of policy was high. Further, the highest levels of legislative activity were requirements to report pregnant women who used alcohol or other drugs and child abuse/neglect policy.

Methods: This research brief uses rigorous legal epidemiology methodology to explore state policy activity on alcohol and other drug use during pregnancy after the U.S. Comprehensive Addiction and Recovery Act of 2016 (CARA) amended the 2010 Child Abuse Prevention and Treatment Act Reauthorization (CAPTA).

Results: Since CARA, policymaking has been more concentrated on drug policy than alcohol policy, although the overlap between the two is still high. Further, since CARA, states have concentrated policy activity on priority treatment for drugs and reporting requirements.

Conclusions: Even though CARA does not require reporting for the purposes of child welfare investigations, several states adopted such requirements during these years.

Relationships Between Alcohol Policies and Infant Morbidities and Injuries

INTRODUCTION

Previous research has found that policies specifically focused on pregnant people's alcohol use are largely ineffective. Therefore, the purpose of this study is to analyze the relationships between general population policies regulating alcohol physical availability and outcomes related to pregnant people's alcohol use, specifically infant morbidities and injuries.

METHODS

Outcome data were obtained from Merative MarketScan, a longitudinal commercial insurance claims data set. Policy data were obtained from the National Institute on Alcohol Abuse and Alcoholism's Alcohol Policy Information System, the National Alcohol Beverage Control Association, and Liquor Handbooks and merged using policies in effect during the estimated year of conception. Relationships between state-level policies regulating sites, days/hours, and government monopoly of liquor sales and infant morbidities and injuries were examined. Analyses used logistic regression with individual controls, fixed effects for state and year, state-specific time trends, and SEs clustered by state. The study analysis was conducted from 2021 to 2023.

RESULTS

The analytic sample included 1,432,979 infant-birthing person pairs, specifically people aged 25-50 years who gave birth to a singleton between 2006 and 2019. A total of 3.1% of infants had a morbidity and 2.1% of infants had an injury. State government monopoly on liquor sales was associated with reduced odds of infant morbidities and injuries, whereas gas station liquor sales were associated with increased odds of infant morbidities and injuries. Allowing liquor sales after 10PM was associated with increased odds for infant injuries. No effect was found for allowing liquor sales in grocery stores or on Sundays.

CONCLUSIONS

Findings suggest that limiting alcohol availability for the general population may help reduce adverse infant outcomes related to pregnant people's alcohol use.

Associations between alcohol taxes and varied health outcomes among women of reproductive age and infants

OBJECTIVE

No studies have examined whether alcohol taxes may be relevant for reducing harms related to pregnant people's drinking.

METHOD

We examined how beverage-specific ad valorem, volume-based, and sales taxes are associated with outcomes across three data sets. Drinking outcomes came from women of reproductive age in the 1990-2020 US National Alcohol Surveys (N = 11 659 women $\le$ 44 years); treatment admissions data came from the 1992-2019 Treatment Episode Data Set: Admissions (N = 1331 state-years; 582 436 pregnant women admitted to treatment); and infant and maternal outcomes came from the 2005-19 Merative Marketscan® database (1 432 979 birthing person-infant dyads). Adjusted analyses for all data sets included year fixed effects, state-year unemployment and poverty, and accounted for clustering by state.

RESULTS

Models yield no robust significant associations between taxes and drinking. Increased spirits ad valorem taxes were robustly associated with lower rates of treatment admissions [adjusted IRR = 0.95, 95% CI: 0.91, 0.99]. Increased wine and spirits volume-based taxes were both robustly associated with lower odds of infant morbidities [wine aOR = 0.98, 95% CI: 0.96, 0.99; spirits aOR = 0.99, 95% CI: 0.98, 1.00] and lower odds of severe maternal morbidities [wine aOR = 0.91, 95% CI: 0.86, 0.97; spirits aOR = 0.95, 95% CI: 0.92, 0.97]. Having an off-premise spirits sales tax was also robustly related to lower odds of severe maternal morbidities [aOR = 0.78, 95% CI: 0.64, 0.96].

CONCLUSIONS

Results show protective associations between increased wine and spirits volume-based and sales taxes with infant and maternal morbidities. Policies that index tax rates to inflation might yield more public health benefits, including for pregnant people and infants.