Research Design

This study uses legal epidemiological methods to assess the relationships between state-level alcohol policies and health outcomes related to alcohol consumption during pregnancy. Researchers on this team have used both existing policy data and also rigorously coded policy data using state-of-the art policy surveillance methods for the purposes of this project. All of the pregnancy-specific alcohol policy data and some of the general population alcohol policy data are available on the National Institute on Alcohol Abuse and Alcoholism’s (NIAAA) Alcohol Policy Information System. Data on birth and health outcomes come from multiple sources including the Behavioral Risk Factor Surveillance System, the National Alcohol Survey, Vital Statistics Birth Data, the Treatment Episode Dataset, and private (Marketscan) and public (Medicaid) health insurance claims data.

Policies Analyzed:

• Pregnancy-specific policies
  • Reporting requirements: Require reporting suspicion of or evidence of alcohol use or “abuse” by women during pregnancy to Child Protective Services (CPS) or health authority. Reporting may be for 1) child welfare purposes (child abuse/neglect investigation), 2) referral for assessment and/or treatment, or 3) data gathering purposes.
  • Mandatory warning signs: Require that notices warning of harm from consumption during pregnancy be posted in licensed settings, where alcohol is sold.
  • Child abuse/child neglect: Address legal significance of woman’s conduct prior to birth of a child and of damage caused in utero and, in some cases, define alcohol use during pregnancy as child abuse or neglect.
  • Civil commitment: Mandatory involuntary commitment of a pregnant woman to treatment or mandatory involuntary placement of a pregnant woman in protective custody of the state for the protection of a fetus from prenatal exposure to alcohol.
  • Prohibitions against criminal prosecution: Prohibit use of medical test results, such as prenatal screenings or toxicology tests, as evidence in criminal prosecutions of women who may have caused harm to a fetus or a child.
  • Priority treatment: Mandate priority access to substance use disorder treatment for 1) pregnant women who “abuse alcohol” and 2) pregnant women who “abuse alcohol” and women with children.
• General-populations policies
  • Blood Alcohol concentration (BAC) law for general population: Blood alcohol concentration limits for drivers age 21 or older.
  • Minimum legal drinking age for alcohol possession and/or consumption with or without family exceptions: Prohibition of possession and/or consumption of alcoholic beverages by those under age 21, with statutory exceptions for minors when a parent or guardian consents and/or is present.
  • Government monopoly of alcohol sales: Monopoly control of retail spirits sales by State government.
  • Grocery store and/or gas station sales, heavy beer or spirits prohibited: Prohibition of sales of spirits and/or heavy beer in grocery stores and/or gas stations.
  • Off-premise alcohol sales prohibited after 10PM: Ban on sales of spirits for off-premises consumption after 10PM.
  • Sunday off-premise alcohol sales prohibited: Bans on sales of spirits for off-premises consumption on Sundays.
  • Taxes on beer, wine, and spirits: 
    • Ad valorem: taxes levied as a percentage of the beverages retail price. Different ad valorem tax rates may apply to on- and off-premises sales.
    • Volume-based: taxes levied per gallon at wholesale or retail level.
    • Sales: a tax on goods in general rather than a tax that specifically applies to alcoholic beverages. Not all states that have sales tax apply their sales tax to alcohol. Some states instead have sales tax specific to each beverage.

Outcome Datasets: