Abstract
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.