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Noghanibehambari H, Noghani F. Long-run intergenerational health benefits of women empowerment: Evidence from suffrage movements in the US. HEALTH ECONOMICS 2023; 32:2583-2631. [PMID: 37482956 PMCID: PMC10592160 DOI: 10.1002/hec.4744] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 06/22/2023] [Accepted: 07/04/2023] [Indexed: 07/25/2023]
Abstract
An ongoing body of research documents that women empowerment is associated with improved outcomes for children. However, little is known about the long-run effects on health outcomes. This paper adds to this literature and studies the association between maternal exposure to suffrage reforms and children's old-age longevity. We utilize changes in suffrage laws across US states and over time as a source of incentivizing maternal investment in children's health and education. Using the universe of death records in the US over the years 1979-2020 and implementing a difference-in-difference econometric framework, we find that cohorts exposed to suffrage throughout their childhood live 0.6 years longer than unexposed cohorts. Furthermore, we show that these effects are not driven by preexisting trends in longevity, endogenous migration, selective fertility, and changes in the demographic composition of the sample. Additional analysis reveals that improvements in education and income are candidate mechanisms. Moreover, we find substantial improvements in early-adulthood socioeconomic standing, height, and height-for-age outcomes due to childhood exposure to suffrage movements. A series of state-level analyses suggest reductions in infant and child mortality following suffrage law change. We also find evidence that counties in states that passed the law experienced new openings of County Health Departments and increases in physicians per capita.
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Affiliation(s)
- Hamid Noghanibehambari
- Center for Demography of Health and Aging, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Farzaneh Noghani
- Department of Management, College of Business, University of Houston-Clear Lake, Houston, Texas, USA
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2
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Noghanibehambari H, Fletcher J. In utero and childhood exposure to alcohol and old age mortality: Evidence from the temperance movement in the US. ECONOMICS AND HUMAN BIOLOGY 2023; 50:101276. [PMID: 37473539 PMCID: PMC10529527 DOI: 10.1016/j.ehb.2023.101276] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/20/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023]
Abstract
Previous research suggests the relevance of in-utero insults and early-life circumstances for a wide array of life cycle outcomes. This research note joins this strand of studies by exploring the long-run mortality effects of in-utero and early-life exposure to alcohol accessibility. In so doing, we take advantage of the prohibition movement during the early part of the twentieth century that generated quasi-natural reductions in alcohol consumption. We use Social Security Administration Death Master Files linked to the full-count 1940 census and compare the longevity of male individuals exposed to the prohibition during in-utero and early childhood (1900-1930) as a result of statewide and federal alcohol ban to those wet counties after the law change to before. The results suggest an intent-to-treat effect of 0.17 years higher longevity as a result of prohibition. A back-of-an-envelope calculation suggests a minimum treatment-on-treated effect of 1.7 years impact. Furthermore, we show that these effects are not driven by other county-level demographic and socioeconomic changes, endogenous selection of births, and preexisting trends in the outcome. Our findings contribute to the growing body of research that explores the in-utero and childhood circumstances on long-term health outcomes.
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Affiliation(s)
- Hamid Noghanibehambari
- Center for Demography of Health and Aging, University of Wisconsin-Madison, 1180 Observatory Drive, Madison, WI 53706, USA.
| | - Jason Fletcher
- La Follette School of Public Affairs, University of Wisconsin-Madison, 1225 Observatory Drive, Madison, WI 53706-1211, USA.
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Conway KS, Menclova AK. You'll never walk alone - The effects of walkability on pregnancy behaviors and outcomes. ECONOMICS AND HUMAN BIOLOGY 2023; 50:101269. [PMID: 37418829 DOI: 10.1016/j.ehb.2023.101269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 02/14/2023] [Accepted: 06/21/2023] [Indexed: 07/09/2023]
Abstract
This study investigates the relationship between local walkability and physical activity and subsequent health outcomes among pregnant women - for whom walking is the recommended, and by far most common, form of exercise. Using an EPA measure of walkability at the county level (as well as other county-level characteristics) combined with rich individual-level data on pregnant women yields evidence that higher walkability translates into improvements in maternal and infant health outcomes as well as physical activity. Using the 2011 Natality Detail Files with geographic identifiers and controlling for the overall health of women in the community as well as the individual mother's pre-pregnancy BMI, we show that women residing in more walkable counties are less likely to experience preterm birth, low birth weight, gestational diabetes and hypertension. While one potential mechanism is through improved gestational weight gain, the evidence points to more general improvements in health as walkability does not seem to prevent excessive weight gain or macrosomic babies. Evidence that these general improvements derive at least in part from greater physical activity comes from analyses using the 2011 Behavioral Risk Factor Surveillance System, in which higher walkability translates into more physical activity among pregnant women (and also relative to their non-pregnant counterparts). Our study suggests more broadly that pregnant women's physical activity responds to factors that facilitate it and that such activity makes a difference to birth outcomes.
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Affiliation(s)
- Karen S Conway
- Department of Economics, University of New Hampshire, 10 Garrison Avenue, Durham, NH 03824, USA
| | - Andrea K Menclova
- Department of Economics and Finance, University of Canterbury, Private Bag 4800, Christchurch, New Zealand.
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Wolfson L, Poole N. Supportive alcohol policy as a key element of fetal alcohol spectrum disorder prevention. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231151838. [PMID: 36718116 PMCID: PMC9893348 DOI: 10.1177/17455057231151838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In Canada, a Four-Part Model of Fetal Alcohol Spectrum Disorder (FASD) Prevention has been developed that describes a continuum of multi-sectoral efforts, including broad awareness campaigns, safe and respectful conversations around pregnancy and alcohol use, and holistic and wraparound support services for pregnant and postpartum women with alcohol, and other health and social concerns. Supportive alcohol policy is at the centre of the four mutually reinforcing levels of prevention. The purpose of this narrative review is to describe alcohol policies related to specific levels of FASD prevention, and to consider the implications of alcohol policies on FASD prevention and women's and fetal health. The majority of the evidence focused on alcohol in pregnancy guidelines, alcohol warning labels, and knowledge and uptake of national or regional alcohol and pregnancy guidelines. Several US studies described shifts in alcohol and pregnancy policy over the 7-year period, including moves to punitive approaches that criminalize women's substance use or prompt child apprehension. This review indicates that more attention could be paid to the role of alcohol policy in FASD prevention and in promoting women's and fetal health, and that policy actions and advocacy could be important catalysts for both FASD prevention and women's health promotion. Moving forward, it is essential that alcohol policies are rooted in evidence; attend to and promote women's health including health during pregnancy; and are collaborative in order to prompt a higher standard of care, and more holistically respond to the factors that contribute to women's alcohol use during pregnancy.
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Affiliation(s)
- Lindsay Wolfson
- Centre of Excellence for Women’s Health, Vancouver, BC, Canada,Canada FASD Research Network, Vancouver, BC, Canada,Lindsay Wolfson, Centre of Excellence for Women’s Health, E209-4500 Oak Street Box 48, Vancouver, BC V6H 3N1, Canada.
| | - Nancy Poole
- Centre of Excellence for Women’s Health, Vancouver, BC, Canada,Canada FASD Research Network, Vancouver, BC, Canada
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Afraid to Seek Care? A fixed effects analysis of State Fetal Protection Legislation and prenatal healthcare utilization from 2002 to 2015. SSM Popul Health 2022; 20:101273. [DOI: 10.1016/j.ssmph.2022.101273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 09/18/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
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Budenz A, Moser RP, Eck R, Agurs-Collins T, McNeel TS, Klein WMP, Berrigan D. Awareness of Alcohol and Cancer Risk and the California Proposition 65 Warning Sign Updates: A Natural Experiment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11862. [PMID: 36231178 PMCID: PMC9564772 DOI: 10.3390/ijerph191911862] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/06/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
In 1986, California enacted Proposition 65 (P65), requiring businesses to display warning signs informing consumers that specific chemicals and alcohol exposure increase the risk of cancer and reproductive harm. In 2018, the P65 alcohol warning signs were updated to include an informational P65 website link, and the update was associated with media coverage and increased enforcement of warning requirements. This study examines knowledge of the association between alcohol use and cancer risk in California compared to the rest of the US before and after the 2018 P65 update. We analyzed state-level data on alcohol and cancer knowledge from the Health Information National Trends Survey from 2017 (n = 3285), 2019 (n = 5438), and 2020 (n = 3865). We performed multinomial logistic regressions to examine knowledge levels by survey year and location (California vs. all other states) and reported the predicted marginals of knowledge by survey year and location. The adjusted prevalence of respondents who reported an association between alcohol and cancer risk was higher in California (41.6%) than the remaining states (34.1%) (p = 0.04). However, knowledge levels decreased significantly over survey years, and there was no evidence for an effect of the P65 update on knowledge in California compared to other states based on the testing of an interaction between state and year (p = 0.32). The 1986 warning signs may have had an enduring effect on awareness, though the update, so far, has not. Further efforts are needed to determine how to increase alcohol and cancer knowledge to address the burden of alcohol-attributable cancers.
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Affiliation(s)
- Alexandra Budenz
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA
| | - Richard P. Moser
- Office of the Associate Director, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA
| | - Raimee Eck
- Health Behaviors Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA
| | - Tanya Agurs-Collins
- Health Behaviors Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA
| | - Timothy S. McNeel
- Information Management Services, Inc., 3901 Calverton Blvd #200, Calverton, MD 20705, USA
| | - William M. P. Klein
- Office of the Associate Director, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA
| | - David Berrigan
- Health Behaviors Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA
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Giesbrecht N, Reisdorfer E, Rios I. Alcohol Health Warning Labels: A Rapid Review with Action Recommendations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11676. [PMID: 36141951 PMCID: PMC9517222 DOI: 10.3390/ijerph191811676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Abstract
A rapid review of research on health warning labels located on alcohol containers (AWLs) was conducted. Using five search engines (Embase, Medline, Pubmed, Scopus, Psyinfo), 2975 non-duplicate citations were identified between the inception date of the search engine and April 2021. Of those, 382 articles were examined and retrieved. We selected 122 research papers for analysis and narrative information extraction, focusing on population foci, study design, and main outcomes. Research included public opinion studies, surveys of post-AWL implementation, on-line and in-person experiments and real-world quasi-experiments. Many studies focused on the effects of the 1989 United States Alcoholic Beverage Labeling Act on perceptions, intentions and behavior. Others focused on Australia, Canada, the United Kingdom, England or Scotland, Italy and France. There was substantial variation in the design of the studies, ranging from small-scale focus groups to on-line surveys with large samples. Over time, evidence has been emerging on label design components, such as large size, combination of text and image, and specific health messaging, that is likely to have some desired impact on knowledge, awareness of risk and even the drinking behavior of those who see the AWLs. This body of evidence provides guidance to policy-makers, and national and regional authorities, and recommendations are offered for discussion and consideration.
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Affiliation(s)
- Norman Giesbrecht
- Centre for Addiction and Mental Health, 33 Ursulla Franklin St., Toronto, ON M5S 2S1, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON M5T 3M7, Canada
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The Universal and Primary Prevention of Foetal Alcohol Spectrum Disorders (FASD): A Systematic Review. JOURNAL OF PREVENTION 2022; 43:297-316. [PMID: 35286547 PMCID: PMC9114092 DOI: 10.1007/s10935-021-00658-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 10/24/2022]
Abstract
AbstractFoetal alcohol spectrum disorder (FASD) comprises multiple neurodevelopmental disorders caused by alcohol consumption during pregnancy. With a global prevalence rate of 7.7 per 1000 population, FASD is a leading cause of prenatal developmental disorders. The extent of physical, mental, and social consequences for individuals with FASD can be vast and negatively affect their social environment, daily life, school, relationships, and work. As treatment for FASD is labour- and cost-intensive, with no cure available, prevention is key in reducing FASD prevalence rates. As most systematic reviews conducted so far have focused on specific FASD risk groups, we investigated the effectiveness of universal FASD prevention and primary preventive strategies. We identified a total of 567 potentially pertinent records through PubMed, Cochrane Library, EBSCO, PubPsych, and DAHTA published from 2010 to May 2020, of which 10 studies were included in this systematic review. Results showed a substantial heterogeneity in the studies’ quality, although all preventive measures, except one, proved effective in both increasing knowledge and awareness of FASD, as well as decreasing the risk of an alcohol exposed pregnancy. Limiting factors such as small sample sizes and a lack of behavioural change testing require further studies to support existing evidence for FASD prevention and its implementation, as well as detecting the best course of action for FASD prevention when creating and implementing prevention and intervention approaches.
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Variations by Education Status in Relationships Between Alcohol/Pregnancy Policies and Birth Outcomes and Prenatal Care Utilization: A Legal Epidemiology Study. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2021; 26 Suppl 2, Advancing Legal Epidemiology:S71-S83. [PMID: 32004225 DOI: 10.1097/phh.0000000000001069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Previous research finds that some state policies regarding alcohol use during pregnancy (alcohol/pregnancy policies) increase low birth weight (LBW) and preterm birth (PTB), decrease prenatal care utilization, and have inconclusive relationships with alcohol use during pregnancy. OBJECTIVE This research examines whether effects of 8 alcohol/pregnancy policies vary by education status, hypothesizing that health benefits of policies will be concentrated among women with more education and health harms will be concentrated among women with less education. METHODS This study uses 1972-2015 Vital Statistics data, 1985-2016 Behavioral Risk Factor Surveillance System data, policy data from National Institute on Alcohol Abuse and Alcoholism's Alcohol Policy Information System and original legal research, and state-level control variables. Analyses include multivariable logistic regressions with education-policy interaction terms as main predictors. RESULTS The impact of alcohol/pregnancy policies varied by education status for PTB and LBW for all policies, for prenatal care use for some policies, and generally did not vary for alcohol use for any policy. Hypotheses were not supported. Five policies had adverse effects on PTB and LBW for high school graduates. Six policies had adverse effects on PTB and LBW for women with more than high school education. In contrast, 2 policies had beneficial effects on PTB and/or LBW for women with less than high school education. For prenatal care, patterns were generally similar, with adverse effects concentrated among women with more education and beneficial effects among women with less education. Although associations between policies and alcohol use during pregnancy varied by education, there was no clear pattern. CONCLUSIONS Effects of alcohol/pregnancy policies on birth outcomes and prenatal care use vary by education status, with women with more education typically experiencing health harms and women with less education either not experiencing the harms or experiencing health benefits. New policy approaches that reduce harms related to alcohol use during pregnancy are needed. Public health professionals should take the lead on identifying and developing policy approaches that reduce harms related to alcohol use during pregnancy.
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Mamluk L, Jones T, Ijaz S, Edwards HB, Savović J, Leach V, Moore THM, von Hinke S, Lewis SJ, Donovan JL, Lawlor DA, Davey Smith G, Fraser A, Zuccolo L. Evidence of detrimental effects of prenatal alcohol exposure on offspring birthweight and neurodevelopment from a systematic review of quasi-experimental studies. Int J Epidemiol 2021; 49:1972-1995. [PMID: 31993631 PMCID: PMC7825937 DOI: 10.1093/ije/dyz272] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/25/2019] [Accepted: 01/08/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Systematic reviews of prenatal alcohol exposure effects generally only include conventional observational studies. However, estimates from such studies are prone to confounding and other biases. OBJECTIVES To systematically review the evidence on the effects of prenatal alcohol exposure from randomized controlled trials (RCTs) and observational designs using alternative analytical approaches to improve causal inference. SEARCH STRATEGY Medline, Embase, Web of Science, PsychINFO from inception to 21 June 2018. Manual searches of reference lists of retrieved papers. SELECTION CRITERIA RCTs of interventions to stop/reduce drinking in pregnancy and observational studies using alternative analytical methods (quasi-experimental studies e.g. Mendelian randomization and natural experiments, negative control comparisons) to determine the causal effects of prenatal alcohol exposure on pregnancy and longer-term offspring outcomes in human studies. DATA COLLECTION AND ANALYSIS One reviewer extracted data and another checked extracted data. Risk of bias was assessed using customized risk of bias tools. A narrative synthesis of findings was carried out and a meta-analysis for one outcome. MAIN RESULTS Twenty-three studies were included, representing five types of study design, including 1 RCT, 9 Mendelian randomization and 7 natural experiment studies, and reporting on over 30 outcomes. One study design-outcome combination included enough independent results to meta-analyse. Based on evidence from several studies, we found a likely causal detrimental role of prenatal alcohol exposure on cognitive outcomes, and weaker evidence for a role in low birthweight. CONCLUSION None of the included studies was judged to be at low risk of bias in all domains, results should therefore be interpreted with caution. SYSTEMATIC REVIEW REGISTRATION This study is registered with PROSPERO, registration number CRD42015015941.
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Affiliation(s)
- Loubaba Mamluk
- MRC Integrative Epidemiology Unit, Department of Population Health Sciences, University of Bristol, Bristol, UK
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR ARC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Timothy Jones
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR ARC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Sharea Ijaz
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR ARC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Hannah B Edwards
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR ARC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Jelena Savović
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR ARC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Verity Leach
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR ARC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Theresa H M Moore
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR ARC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Stephanie von Hinke
- Department of Economics, School of Economics, Finance and Management, University of Bristol, Bristol, UK
| | - Sarah J Lewis
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jenny L Donovan
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR ARC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit, Department of Population Health Sciences, University of Bristol, Bristol, UK
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR ARC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, Department of Population Health Sciences, University of Bristol, Bristol, UK
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Abigail Fraser
- MRC Integrative Epidemiology Unit, Department of Population Health Sciences, University of Bristol, Bristol, UK
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Luisa Zuccolo
- MRC Integrative Epidemiology Unit, Department of Population Health Sciences, University of Bristol, Bristol, UK
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Opioid exposure in newborns: lessons learned from fetal alcohol spectrum disorder. J Public Health Policy 2020; 41:529-534. [PMID: 32728093 DOI: 10.1057/s41271-020-00239-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The increasing incidence of opioid-exposed pregnancies in the United States is a concerning public health challenge. Analysis of the public health responses to prenatal alcohol exposure may inform future prevention and treatment strategies. Behavioral interventions, improved screening, and prenatal education may be effective measures to reduce prenatal exposure to opioids. Medicaid coverage should be expanded to cover substance misuse treatments for pregnant women.
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Woodruff K, Roberts SCM. "Alcohol During Pregnancy? Nobody Does That Anymore": State Legislators' Use of Evidence in Making Policy on Alcohol Use in Pregnancy. J Stud Alcohol Drugs 2020. [PMID: 31250804 DOI: 10.15288/jsad.2019.80.380] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE In recent years, U.S. states have passed many laws addressing alcohol use in pregnancy, despite limited evidence on the impact of such policies. This study explores how state legislators use evidence when making policy on alcohol use in pregnancy. METHOD Study data are drawn from semistructured interviews with 29 state lawmakers and their aides in Maryland, North Carolina, and Virginia, conducted in March through July 2017. Interview transcripts were coded and analyzed by inductive and deductive methods. RESULTS Despite evidence on the harms of alcohol use in pregnancy, most lawmakers did not express concern about this topic. Instead, they expressed concern about opioid use in pregnancy. Personal experiences, anecdotes, and known contacts influenced legislators' views on substance use in pregnancy, whereas evidence, for the most part, did not. The intermediaries who typically bring evidence about problems and solutions to legislators did not appear to be raising the issue of alcohol use in pregnancy on legislators' agenda. CONCLUSIONS Basic evidence on the prevalence and harms of alcohol use in pregnancy did not appear to influence state lawmakers' policy priorities. Concern over opioid use in general may provide a window of opportunity to educate legislators on the relative scope and harms of alcohol and opioid use in pregnancy. It remains unclear why states are passing alcohol-in-pregnancy policies. More research is needed to explore how state lawmakers form their understanding of substance use in pregnancy and related policies.
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Affiliation(s)
- Katie Woodruff
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland, California
| | - Sarah C M Roberts
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland, California
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Hasin DS, Shmulewitz D, Keyes K. Alcohol use and binge drinking among U.S. men, pregnant and non-pregnant women ages 18-44: 2002-2017. Drug Alcohol Depend 2019; 205:107590. [PMID: 31600616 PMCID: PMC6893082 DOI: 10.1016/j.drugalcdep.2019.107590] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Drinking during pregnancy dropped sharply in the U.S. in the 1980s. More recent time trends in adult drinking and binge drinking in men, non-pregnant and pregnant women have not been directly compared. METHODS Using logistic regression and National Surveys on Drug Use and Health (NSDUH) 2002-2017 data on any drinking and 2002-2014 data on binge drinking, trends in men, non-pregnant and pregnant women were compared. Analyses of any drinking included 470,309 participants (221,344 men; 236,197 non-pregnant women; 12,768 pregnant women); of binge drinking, 379,379 participants (178,869 men; 189,923 non-pregnant women; 10,587 pregnant women). RESULTS In all participants, drinking decreased (62.2%-60.3%). Among adults ages 18-20, drinking decreased in men, non-pregnant women, and pregnant women (-18.4%; -11.1%; -5.3%), as did binge drinking (-11.8%; -5.6%; -3.7%). Among adults ages 21-44, drinking increased in non-pregnant women (+2.3%), and decreased in men and pregnant women (-2.6% and -3.3%), while binge drinking increased in non-pregnant women (+2.7%), but not in pregnant women (-1.8%) or men (0.0%). CONCLUSIONS Drinking increased in U.S. women ages 21-44, but not those who were pregnant. Increases in women and continuing high rates in men indicate the need for better public health efforts. Divergent trends in men, non-pregnant, and pregnant women ages 21-44 suggest differential influences on drinking. Continued low rates in pregnant women are encouraging, but maintaining public health messages about drinking during pregnancy and innovative efforts to prevent such drinking are needed. Different results in ages 18-20 and 21-44 highlight the importance of developmental stages in drinking.
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Affiliation(s)
- Deborah S Hasin
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA; Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA; Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA.
| | - Dvora Shmulewitz
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA; Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Katherine Keyes
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
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Romero-Rodríguez E, Cuevas L, Simón L, Bermejo-Sánchez E, Galán I. Changes in Alcohol Intake During Pregnancy in Spain, 1980 to 2014. Alcohol Clin Exp Res 2019; 43:2367-2373. [PMID: 31509616 DOI: 10.1111/acer.14193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 08/20/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Even small amounts of alcohol consumed during pregnancy can have adverse effects on the embryo and the fetus. We estimated how alcohol intake among pregnant women in Spain changed between 1980 and 2014, and identified factors associated with alcohol use. METHODS Data came from the Spanish Collaborative Study of Congenital Malformations (ECEMC). The sample includes ECEMC's control mothers, 40,268 pregnant women from all regions of Spain. We classified alcohol consumption during pregnancy into 3 categories: no consumption; sporadic consumption of small amounts of alcohol; and regular consumption, or sporadic but in large quantities including drunkenness. Independent variables included sociodemographic factors, planned/unplanned pregnancy, maternal chronic diseases, gestational diabetes, and tobacco and illegal drug use during pregnancy. Trend analyses were performed using data from 1980 to 2014. The multinomial logistic regression models designed to identify associated factors differentiated between 2 periods: 1994 to 2004 and 2005 to 2014. RESULTS Prevalence of alcohol consumption declined from 29.6% (95% CI: 27.1 to 32.2) in 1980 to 5.4% (95% CI: 3.7 to 7.6) in 2014, mostly due to the reduction in regular intake. This decline was especially acute between 1980 and 1994. Sporadic and regular consumption increased among women working outside the home, born outside Spain, those whose pregnancy was unplanned, and those reporting using tobacco or other drugs. Comparing 1994 to 2004 versus 2005 to 2014, a stronger association was observed between regular alcohol consumption and tobacco consumption in the latter period (interaction p = 0.003). CONCLUSIONS Alcohol consumption among expectant mothers has declined substantially in the last 35 years. However, it is worth highlighting the significant and substantial associations between alcohol use and consumption of tobacco, which have become stronger in the most recent years.
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Affiliation(s)
- Esperanza Romero-Rodríguez
- From the, National Centre for Epidemiology, (ER-R, LS, IG), Instituto de Salud Carlos III, Madrid, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), (ER-R), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Lourdes Cuevas
- ECEMC, Research Center on Congenital Anomalies (CIAC), (LC, EB-S), Instituto de Salud Carlos III, Madrid, Spain
| | - Lorena Simón
- From the, National Centre for Epidemiology, (ER-R, LS, IG), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Eva Bermejo-Sánchez
- ECEMC, Research Center on Congenital Anomalies (CIAC), (LC, EB-S), Instituto de Salud Carlos III, Madrid, Spain.,Institute of Rare Diseases Research (IIER), (EB-S), Instituto de Salud Carlos III, Madrid, Spain
| | - Iñaki Galán
- From the, National Centre for Epidemiology, (ER-R, LS, IG), Instituto de Salud Carlos III, Madrid, Spain.,Universidad Autónoma de Madrid/IdiPAZ, (IG), Madrid, Spain
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Roberts SCM, Berglas NF, Subbaraman MS, Mericle A, Thomas S, Kerr WC. Racial differences in the relationship between alcohol/pregnancy policies and birth outcomes and prenatal care utilization: A legal epidemiology study. Drug Alcohol Depend 2019; 201:244-252. [PMID: 31255852 PMCID: PMC6774667 DOI: 10.1016/j.drugalcdep.2019.04.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/28/2019] [Accepted: 04/02/2019] [Indexed: 11/25/2022]
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.
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Affiliation(s)
- Sarah C M Roberts
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, United States.
| | - Nancy F Berglas
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, United States
| | - Meenakshi S Subbaraman
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, United States
| | - Amy Mericle
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, United States
| | - Sue Thomas
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, United States
| | - William C Kerr
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, United States
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Subbaraman MS, Roberts SCM. Costs associated with policies regarding alcohol use during pregnancy: Results from 1972-2015 Vital Statistics. PLoS One 2019; 14:e0215670. [PMID: 31067248 PMCID: PMC6505739 DOI: 10.1371/journal.pone.0215670] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 04/06/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVE As of 2016, 43 US states have policies regarding alcohol use during pregnancy. A recent study found that out of eight state-level alcohol/pregnancy policies, six are significantly associated with poorer birth outcomes, and two are not associated with any outcomes. Here we estimate the excess numbers of low birthweight (LBW) and preterm births (PTB) related to these policies and their associated additional costs in the first year of life. METHODS Cost study using birth certificate data for 155,446,714 singleton live births in the United States between 1972-2015. Exposures were state- and month/year-specific indicators of having each of eight alcohol/pregnancy policies in place. Outcomes were excess numbers of LBW and PTB and associated costs in the first year of life. Fixed effects regressions with state-specific time trends were used for statistical analyses in 2018. RESULTS In 2015, policies mandating warning signs were associated with an excess of 7,375 LBW; policies defining alcohol use during pregnancy as child abuse/neglect were associated with an excess of 12,372 PTB; these excess adverse outcomes are associated with additional costs of $151,928,002 and $582,698,853 in the first year of life, respectively. CONCLUSIONS Multiple state-level alcohol pregnancy policies lead to increased prevalence of LBW and PTB, which cost hundreds of millions of dollars annually. Policymakers should consider adverse public health impacts of alcohol/pregnancy policies before expanding extant policies to new substances or adopting existing policies in new states.
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Affiliation(s)
| | - Sarah C. M. Roberts
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, Oakland, CA, United States of America
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State Policies Targeting Alcohol Use during Pregnancy and Alcohol Use among Pregnant Women 1985-2016: Evidence from the Behavioral Risk Factor Surveillance System. Womens Health Issues 2019; 29:213-221. [PMID: 30876695 DOI: 10.1016/j.whi.2019.02.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 01/28/2019] [Accepted: 02/01/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Most states have at least one policy targeting alcohol use during pregnancy. The public health impact of these policies has not been examined. We sought to examine the relationship between state-level policies targeting alcohol use during pregnancy and alcohol use among pregnant women. METHODS Data include state-level alcohol and pregnancy policy data and individual-level U.S. Behavioral Risk Factor Surveillance System data about pregnant women's alcohol use from 1985 to 2016 (N = 57,194). Supportive policies include mandatory warning signs, priority substance abuse treatment, reporting requirements for data and treatment purposes, and prohibitions on criminal prosecution. Punitive policies include civil commitment, Child Protective Services reporting requirements, and child abuse/neglect. Analyses include logistic regression models that adjust for individual- and state-level controls, include fixed effects for state and year, account for clustering by state, and weight by probability of selection. RESULTS Relative to having no policies, supportive policy environments were associated with more any drinking, but not binge or heavy drinking. Of individual supportive policies, only the following relationships were statistically significant: mandatory warning signs was associated with lower odds of binge drinking, and priority treatment for pregnant women and women with children was associated with higher odds of any drinking. Relative to no policies, punitive policy environments were also associated with more drinking, but not with binge or heavy drinking. Of individual punitive policies, only child abuse/neglect was associated with lower odds of binge and heavy drinking. Mixed policy environments were not associated with any alcohol outcome. CONCLUSIONS Most policies targeting alcohol use during pregnancy do not seem to be associated with less alcohol consumption during pregnancy.
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Roberts SCM, Mericle AA, Subbaraman MS, Thomas S, Treffers RD, Delucchi KL, Kerr WC. Differential Effects of Pregnancy-Specific Alcohol Policies on Drinking Among Pregnant Women by Race/Ethnicity. Health Equity 2018; 2:356-365. [PMID: 30560228 PMCID: PMC6296158 DOI: 10.1089/heq.2018.0059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: Alcohol use during pregnancy is a significant public health concern. Nearly all U.S. states have enacted policies targeting alcohol use during pregnancy, but there has been little research examining their impact, particularly across racial/ethnic groups. Methods: Using data from the Behavioral Risk Factor Surveillance System and about eight state-level, pregnancy-specific alcohol policies from 1985 to 2016, the aim of this study was to examine the differential effects of these policies on drinking among pregnant women by race/ethnicity. Results: We found evidence of differential effects for priority treatment, prohibitions on criminal prosecution, and civil commitment policies. In relation to priority treatment policies, effects benefited versus harmed different racial/ethnic groups depending on whether the priority treatment policies were for pregnant women only or if they gave priority to both pregnant women and pregnant women with children. Conclusions: Findings from this study suggest that benefits and harms from these policies do not appear to be equitably distributed across different racial/ethnic groups. Research considering the impact of alcohol/pregnancy policies should consider differential effects by race/ethnicity.
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Affiliation(s)
- Sarah C M Roberts
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland, California
| | - Amy A Mericle
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | | | - Sue Thomas
- Pacific Institute for Research and Evaluation (PIRE), Santa Cruz, California
| | - Ryan D Treffers
- Pacific Institute for Research and Evaluation (PIRE), Santa Cruz, California
| | - Kevin L Delucchi
- Department of Psychiatry, University of California, San Francisco, San Francisco, California
| | - William C Kerr
- Alcohol Research Group, Public Health Institute, Emeryville, California
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Subbaraman MS, Thomas S, Treffers R, Delucchi K, Kerr WC, Martinez P, Roberts SC. Associations Between State-Level Policies Regarding Alcohol Use Among Pregnant Women, Adverse Birth Outcomes, and Prenatal Care Utilization: Results from 1972 to 2013 Vital Statistics. Alcohol Clin Exp Res 2018; 42:10.1111/acer.13804. [PMID: 29912478 PMCID: PMC6298847 DOI: 10.1111/acer.13804] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/21/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Policies regarding alcohol use during pregnancy continue to be enacted and debated in the United States. However, no study to date has examined whether these policies are related to birth outcomes-the outcomes they ultimately aim to improve. Here, we assessed whether state-level policies targeting alcohol use during pregnancy are related to birth outcomes, which has not been done comprehensively before. METHODS The study involved secondary analyses of birth certificate data from 148,048,208 U.S. singleton births between 1972 and 2013. Exposures were indicators of whether the following 8 policies were in effect during gestation: Mandatory Warning Signs (MWS), Priority Treatment for Pregnant Women, Priority Treatment for Pregnant Women/Women with Children, Reporting Requirements for Data and Treatment Purposes, Prohibitions Against Criminal Prosecution, Civil Commitment, Reporting Requirements for Child Protective Services Purposes, and Child Abuse/Child Neglect. Outcomes were low birthweight (<2,500 g), premature birth (<37 weeks), any prenatal care utilization (PCU), late PCU, inadequate PCU, and normal (≥7) APGAR score. Multivariable fixed-effect logistic regressions controlling for both maternal- and state-level covariates were used for statistical analyses. RESULTS Of the 8 policies, 6 were significantly related to worse outcomes and 2 were not significantly related to any outcomes. The policy requiring MWS was related to the most outcomes: specifically, living in a state with MWS was related to 7% higher odds of low birthweight (p < 0.001); 4% higher odds of premature birth (p < 0.004); 18% lower odds of any PCU (p < 0.001); 12% higher odds of late PCU (p < 0.002); and 10% lower odds of a normal APGAR score (p < 0.001) compared to living in a state without MWS. CONCLUSIONS Most policies targeting alcohol use during pregnancy do not have their intended effects and are related to worse birth outcomes and less PCU.
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Affiliation(s)
| | - Sue Thomas
- Pacific Institute of Research and Evaluation
| | | | - Kevin Delucchi
- Department of Psychiatry, University of California, San Francisco
| | - William C. Kerr
- Alcohol Research Group, 6001 Shellmound Ave, Suite 450, Emeryville, CA 94608, United States
| | - Priscilla Martinez
- Alcohol Research Group, 6001 Shellmound Ave, Suite 450, Emeryville, CA 94608, United States
| | - Sarah C.M. Roberts
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, San Francisco, Department of Obstetrics, Gynecology & Reproductive Sciences
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Tinawi G, Gray T, Knight T, Glass C, Domanski N, Wilson N, Hoek J, Thomson G. Highly deficient alcohol health warning labels in a high-income country with a voluntary system. Drug Alcohol Rev 2018; 37:616-626. [DOI: 10.1111/dar.12814] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 01/17/2018] [Accepted: 04/15/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Georges Tinawi
- Department of Public Health; University of Otago; Wellington New Zealand
| | - Tessa Gray
- Department of Public Health; University of Otago; Wellington New Zealand
| | - Thomas Knight
- Department of Public Health; University of Otago; Wellington New Zealand
| | - Chayce Glass
- Department of Public Health; University of Otago; Wellington New Zealand
| | - Nina Domanski
- Department of Public Health; University of Otago; Wellington New Zealand
| | - Nick Wilson
- Department of Public Health; University of Otago; Wellington New Zealand
| | - Janet Hoek
- Department of Public Health; University of Otago; Wellington New Zealand
- Department of Marketing; University of Otago; Dunedin New Zealand
| | - George Thomson
- Department of Public Health; University of Otago; Wellington New Zealand
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