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.

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

AIMS: We examined relationships between pregnancy-specific alcohol policies and admissions to substance use disorder treatment for pregnant people in the USA. METHODS: We merged state-level policy and treatment admissions data for 1992-2019. We aggregated data by state-year to examine effects of nine pregnancy-specific alcohol policies on the number of admissions of pregnant women where alcohol was reported as the primary, secondary, or tertiary substance related to the treatment episode (N = 1331). We fit Poisson models that included all policy variables, state-level controls, fixed effects for state and year, state-specific time trends, and an offset variable of the number of pregnancies in the state-year to account for differences in population size and fertility. RESULTS: When alcohol was reported as the primary substance, civil commitment [incidence rate ratio (IRR) 1.45, 95% CI: 1.10-1.89] and reporting requirements for assessment and treatment purposes [IRR 1.36, 95% CI: 1.04-1.77] were associated with greater treatment admissions. Findings for alcohol as primary, secondary, or tertiary substance were similar for civil commitment [IRR 1.31, 95% CI: 1.08-1.59] and reporting requirements for assessment and treatment purposes [IRR 1.21, 95% CI: 1.00-1.47], although mandatory warning signs [IRR 0.84, 95% CI: 0.72-0.98] and priority treatment for pregnant women [IRR 0.88, 95% CI: 0.78-0.99] were associated with fewer treatment admissions. Priority treatment findings were not robust in sensitivity analyses. No other policies were associated with treatment admissions. CONCLUSIONS: Pregnancy-specific alcohol policies related to greater treatment admissions tend to mandate treatment rather than make voluntary treatment more accessible, raising questions of ethics and effectiveness.

Lesbian, Gay, Bisexual, Queer, Questioning and Transgender, Nonbinary, Genderqueer, and Gender Questioning Adult Alcohol Use Outcomes Associated with State Alcohol-Related Laws During the Coronavirus Pandemic in the United States.

Purpose: We assessed how COVID-19-related alcohol sales policies influenced alcohol use behaviors during the pandemic for U.S. adults of diverse sexual (lesbian, gay, bisexual, queer, questioning [LGBQ]) and gender identities (transgender, nonbinary, genderqueer, and gender questioning [T/NB/GQ]). Methods: Time-specific, state-level, restaurant, bar, and off-premise alcohol policy data were collected from the National Institute on Alcohol Abuse and Alcoholism-sponsored Alcohol Policy Information System and merged with the 2020 Behavioral Risk Factor Surveillance System survey data. Treatments included bar, restaurant, and delivery alcohol sales policies. Outcomes included past 30-day drinking frequency, quantity, and heavy episodic drinking (HED). We fitted negative binomial regression models for all outcomes, clustered standard errors by state and used sample weights. We also controlled for seasonality, state Alcohol Policy Scale scores, pre-/postpandemic time period, and included demographic control variables in our cross-sectional analyses. Results: The sample included 10,505 adults identifying as LGBQ and 809 as T/NB/GQ from 32 states. Restaurant and bar closures were associated with less alcohol use for LGBQ respondents. Outdoor-only policies at bars were also associated with significantly less quantity of use and HED for T/NB/GQ adults in the sample. Off-premise home delivery was associated with greater quantity of use for LGBQ respondents and less frequency for T/NB/GQ respondents. Conclusion: The COVID-19-related alcohol sales policy changes offer an opportunity to better understand alcohol policy and availability's influence on drinking behaviors among sexual and gender-diverse populations in the United States.

Covid-19 shelter-in-place, modified reopening orders, and order compliance impact on adolescent alcohol use and drinking contexts in California: A longitudinal analysis.

INTRODUCTION: This study evaluated how Shelter-in-Place (SIP), modified reopening orders, and self-reported compliance with these orders have affected adolescent alcohol frequency and quantity of use across contexts during the COVID-19 pandemic. MATERIALS AND METHODS: Differences-in-differences (DID) models and multi-level modeling analyses were conducted on longitudinal data collected as part of a larger study on alcohol use among adolescents in California. 1,350 adolescents at baseline contributed 7,467 observations for a baseline and 5 six-month follow-up surveys. Analytic samples ranged from 3,577-6,245 participant observations based on models. Alcohol use outcomes included participant frequency (days) and quantity (number of whole drinks) of alcohol use in past 1-month and past 6-month periods. Context-specific alcohol use outcomes included past 6-month frequency and quantity of use at: restaurants, bars/nightclubs, outside, one's own home, another's home, and fraternities/sororities. Participant self-reported compliance with orders in essential business/retail spaces and at outdoor/social settings were also assessed. RESULTS: Our DID results indicated that being under a modified reopening order was associated with decreases in past 6-month quantity of alcohol use (IRR = 0.72, CI = 0.56-0.93, p < 0.05). Higher self-reported compliance with SIP orders related to social outdoor/social settings was associated with decreases in overall drinking frequency and quantity as well as decreases in frequency and quantity of alcohol use in all contexts in the past six months. Compliance with SIP orders impacting essential businesses and retail spaces was associated with decreased frequency and quantity of use at other's home and outdoors. CONCLUSIONS: Results suggest that SIP and modified reopening policies may not directly affect adolescent alcohol use or drinking contexts, and that individual compliance with such orders may be a protective factor for alcohol use.

Parkinson's disease and palliative care: a quality of care Delphi study.

OBJECTIVES: Extending palliative care services to those with long-term neurological conditions is a current aim of UK health policy. Lack of holistic guidelines for palliative and end-of-life care, and differing models of service provision, has resulted in heterogeneity in care access and quality. There is a need for evidence-based standards of care to audit Parkinson's services and drive improvements. METHODS: A two-stage Delphi process was used to achieve consensus on statements that define quality standards in palliative care for patients with Parkinson's disease (PD). An expert panel was selected to comprise healthcare professionals, patients and carers based in the UK; this panel evaluated the statements via a Delphi survey. Quantitative and qualitative analysis of the results informed modifications between the Delphi rounds. RESULTS: A final set of 16 statements was produced, reflecting aspirational standards of palliative care in PD. These statements, split into four domains ('Structures and processes of care', 'Preparing for the end of life', ' Care in the last weeks of life' and 'Care in the last days of life') underline the importance of joint working between generalist and specialist services, individualised care and early and regular advance care planning. CONCLUSIONS: The Delphi process has established a set of standards which can be integrated within and guide services, helping to improve the quality and equality of care. Further work remains to establish the effectiveness of different models of service provision, including the implementation of keyworkers and telemedicine.

The neurogenic bladder: developing a consensus bladder and bowel management pathway for people with MS.

This article outlines how the bladder can be affected in neurological conditions such as multiple sclerosis (MS) and the impact this has on patient quality of life and NHS resources. A group of MS and bladder and bowel nurse specialists has developed consensus bladder pathways in the hope that all nurses in contact with patients who are likely to have neurogenic bladder symptoms become 'bladder aware'.

Fetal alcohol spectrum disorder resources for health professionals: a scoping review protocol.

INTRODUCTION: People with fetal alcohol spectrum disorder (FASD) encounter a range of health and allied health providers and require specialised support to ensure health services are provided safely and effectively. Not all health professionals possess the knowledge or expertise required for the identification, assessment, referral and management of FASD. Accessible resources for understanding and managing FASD can help create awareness in health professionals and ensure patients receive the correct diagnosis and timely access to the necessary supports and services. The aim of this scoping review is to identify and analyse FASD resources for health professionals. METHODS AND ANALYSIS: A comprehensive search of eight databases (MEDLINE, Scopus, PsycINFO, CINAHL, PubMED, EMBASE, Web of Science and Trip Medical Database) and nine grey literature databases (FASD Hub, NOFASD Australia, National Organisation for FASD, FASD United, HealthInfoNet, Proof Alliance, Child Family Community Australia, Foundation for Alcohol Research & Education and the Australian Department of Health websites) will be conducted using three search engines including PubMed, Ovid and Google advanced search (search dates: October 2021 to May 2022). Consultations will also be carried out with international and national experts in the diagnosis/management of FASD to obtain any additional relevant published or unpublished resources. Inclusion criteria were developed to guide the selection of resources that are publicly available, primarily focused on FASD and curated for health professionals for the identification, management or referral of FASD. Critical appraisal process will be executed using the Appraisal of Guidelines for REsearch & Evaluation II (AGREE II) tool to assess the quality of selected resources. ETHICS AND DISSEMINATION: Ethical approval is not required for the scoping review. Scoping review results will be presented at relevant national and international conferences and published in peer-reviewed journals. Search results will be made available to ensure reproducibility and transparency.

Bigiswun Kid Project: a longitudinal study of adolescents living with high rates of prenatal alcohol exposure, fetal alcohol spectrum disorder and early life trauma in remote Australian Aboriginal communities.

INTRODUCTION: The Lililwan Project was the first Australian population-based prevalence study of fetal alcohol spectrum disorder (FASD) using active case ascertainment. Conducted in 2010-2011, the study included 95% of all eligible children aged 7-9 years living in the very remote Aboriginal communities of the Fitzroy Valley, Western Australia. Women from Marninwarntikura Women's Resource Centre, a local Aboriginal-led organisation, are concerned that some participants from the study are struggling in adolescence so partnered with researchers from the University of Sydney to follow up the Lililwan cohort in 2020-2022 at age 17-19 years.The overarching aim of the Bigiswun Kid Project is to identify adolescents' needs and build knowledge to inform services to improve the health and well-being of adolescents in remote Aboriginal communities. The specific aims are to: (1) provide a voice to adolescents and their families to understand the health and well-being status of the Lililwan cohort at 17-19 years. (2) Examine relationships between exposures during pregnancy, birth characteristics, and health and neurodevelopment at 7-9 years, and positive/adverse adolescent outcomes at 17-19 years. This information will identify prenatal and early life factors that predict good health and well-being in adolescence. (3) Determine whether management plans provided in the Lililwan Project were followed, and identify past and present service gaps, support needs and barriers to service use. (4) Determine if key physical characteristics of FASD change between childhood and adolescence in this Aboriginal population. ETHICS AND DISSEMINATION: Approved by the Kimberley Aboriginal Health Planning Forum and relevant ethics committees.

The importance of community nurses in supporting Parkinson's patients on complex therapies.

A newly updated non-oral treatment pathway for people with Parkinson's who have complex needs provides clear, instructive guidance on identifying, assessing, treating and managing individuals on these therapies. While specialists provide much of the care within these pathways, district and community nurses are essential to ensure that patients progressing to more complex phases of the condition are identified and referred for specialist assessment, as well as being instrumental in the monitoring and ongoing management required once a new therapy is in place.

Fetal alcohol spectrum disorder resources for educators: A scoping review.

Children with foetal alcohol spectrum disorder (FASD) can experience neurodevelopmental, physical, psychological and behavioural impairments that can result in a disrupted school experience. However, educators often have limited knowledge or experience in the identification and support of students with FASD, and there is a critical need for effective tools and resources to ensure students with FASD are supported in their ongoing learning and development. This scoping review aimed to identify and evaluate publicly available educator resources that aid in the identification, and support of students with FASD in primary/elementary school. In addition, educators and FASD experts were consulted to obtain feedback on currently available resources, and key issues and priorities for FASD resources. In total, 124 resources were identified by searching peer-reviewed and grey literature databases, app stores, podcast services and contacting FASD experts. Information was found on identification (23 resources) and support of students with FASD (119 resources). No resources provided information on the referral. Most resources were average (40%) to good (33%) quality, as measured by a composite tool based on adaptions of the NHMRC FORM Framework and iCAHE Guideline Quality Checklist. A minority of resources had been formally evaluated (7%). Review findings and consultations with experts and educators indicate a critical need for referral guides, evidence-based short-format resources and centralised access for school communities to high-quality resources. Taken together, this study has identified key areas for future resource development and research to better support primary school students with FASD.

Fetal Alcohol Spectrum Disorder resources for educators working within primary school settings: a scoping review protocol.

INTRODUCTION: Many children affected by Fetal Alcohol Spectrum Disorder (FASD) exhibit neurocognitive delays that contribute to secondary consequences, including a disrupted school experience. Educators often have limited knowledge or experience in the identification, referral, management and accommodation of students with FASD. Effective resources and tools for educators are crucial to ensure these students are supported in their ongoing learning, development and school participation. This scoping review aims to identify and evaluate resources for educators that aid in the identification, management, or accommodation of students with FASD. METHODS AND ANALYSIS: A search will be conducted in 9 peer-reviewed and 11 grey literature databases, Google search engine, two app stores and two podcast streaming services (planned search dates: November 2020 to February 2021). Relevant experts, including researchers, health professionals and individuals with lived experience of FASD, will be contacted in February and March 2021 to identify additional (including unpublished) resources. Resources will be selected based on registered, prespecified inclusion-exclusion criteria, and the quality of included resources will be critically appraised using a composite tool based on adaptions of the National Health and Medical Research Council FORM Framework and the iCAHE Guideline Quality Checklist. Relevant experts will also be requested to provide feedback on included resources. ETHICS AND DISSEMINATION: Ethical approval for this scoping review was obtained from the University of Sydney Human Research Ethics Committee (2020/825). Results of the review will be disseminated through a peer-reviewed publication, conference presentations, and seminars targeting audiences involved in the education sector. TRIAL REGISTRATION: Open Science Framework: osf.io/73pjh.

Personalized Care Management for Persons with Parkinson's Disease.

There is a growing awareness that delivery of integrated and personalized care is necessary to meet the needs of persons living with Parkinson's disease. In other chronic diseases than Parkinson's disease, care management models have been deployed to deliver integrated and personalized care, yielding positive effects on patients' health outcomes, quality of life and health care utilization. However, care management models have been highly heterogeneous, as there is currently no clear operationalization of its core elements. In addition, most care management models are disease-specific and not tailored to the individual needs and preferences of a patient. In this viewpoint we present an integrated and personalized care management model for persons with Parkinson's disease costing of five core elements: (1) care coordination, (2) patient navigation, (3) information provision, (4) early detection of signs and symptoms through proactive monitoring and (5) process monitoring. Following the description of each core element, implications for implementing the model into practice are discussed. Finally, we provide clinical and methodological considerations on the evaluation of care management models.

Personalized care management for persons with Parkinson's disease: A telenursing solution.

Poor recognition and inadequate treatment of motor and non-motor symptoms negatively impact on the quality of life of persons with Parkinson's Disease (PD). Furthermore, failure to incorporate timely detection and management of symptoms increases the risk of partially avoidable complications. A promising approach to overcome these pitfalls is telenursing, which entails proactive care delivery by a PD Nurse Specialist (PDNS) through telephone contacts. We hypothesized that adding telenursing to usual care could fill a gap in currently available services, including offering patients easy accessibility to a nurse with specific expertise in PD. We explored this hypothesis by prospectively assessing the effects of a telenursing intervention on motor and non-motor symptoms in a patient with PD. During a threemonth intervention period which comprised 13 telephone contacts, the patient reported a remarkable reduction in number of falls, from 99 falls per three months to 3 falls per three months; and a reduction in non-motor symptoms. The main working mechanism was presumably rather indirect and mediated via alleviation of anxiety, achieved by the individually tailored information and problem-solving strategies provided by the PDNS. Our observations should encourage large-scale evaluations to assess the long-term effectiveness and cost-effectiveness of telenursing interventions in persons with PD.

Variations by Education Status in Relationships Between Alcohol/Pregnancy Policies and Birth Outcomes and Prenatal Care Utilization: A Legal Epidemiology Study.

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.

Jandu Yani U 'For All Families' Triple P-positive parenting program in remote Australian Aboriginal communities: a study protocol for a community intervention trial.

INTRODUCTION: The population-based (Lililwan) study of fetal alcohol spectrum disorder (FASD) revealed a high prevalence of FASD in the remote communities of the Fitzroy Valley, Western Australia (WA) and confirmed anecdotal reports from families and teachers that challenging child behaviours were a significant concern. In response, Marninwarntikura Women's Resource Centre initiated a partnership with researchers from The University of Sydney to bring the positive parenting program (Triple P) to the Valley. Triple P has been effective in increasing parenting skills and confidence, and improving child behaviour in various Indigenous communities. METHODS AND ANALYSIS: Extensive consultation with community leaders, service providers, Aboriginal health networks and academic institutions was undertaken and is ongoing. Based on community consultations, the intervention was adapted to acknowledge local cultural, social and language complexities. Carers of children born after 1 January 2002 and living in the Fitzroy Valley are invited to participate in Group Triple P, including additional Stepping Stones strategies for children with complex needs. Programme are delivered by local community service workers, trained and accredited as Triple P providers or 'parent coaches'. Assessments for parent coach pretraining and post-training includes their perceived ability to deliver the intervention and the cultural appropriateness of the programme. Carers complete preintervention and postintervention and 6-month follow-up assessments of parenting practices, self-efficacy and child behaviour. ETHICS AND DISSEMINATION: Approval was granted by the University of Sydney Human Ethics Committee, WA Aboriginal Health Ethics Committee, WA Country Health Services Ethics Committee and Kimberley Aboriginal Health Planning Forum. Consultation with community is imperative for efficacy, engagement, community ownership and sustainability of the programme, and will be ongoing until findings are disseminated. Anonymous findings will be disseminated through peer-reviewed journals, community feedback sessions and scientific forums.

Racial differences in the relationship between alcohol/pregnancy policies and birth outcomes and prenatal care utilization: A legal epidemiology study.

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.

Mindfulness based intervention with an attentional comparison group in at risk young adolescents: a pilot randomized controlled trial.

BACKGROUND: Risky behaviors are related to poor outcomes among young adolescents. This study piloted a mindfulness based intervention, Learning 2 Breath Mindfulness Curriculum, focusing on the feasibility of programming and intervention effects on coping, affect, and trait mindfulness among at-risk adolescents. Further, the mindfulness based intervention was compared to an attention intervention. METHODS: Sixth-grade level female students in a boarding school for at-risk youth randomly allocated to either the mindfulness intervention (n = 12) or an attention intervention (n = 11) for six weeks. Outcomes (i.e., primary coping, positive affect, and trait mindfulness) were assessed before and after the interventions. RESULTS: Intervention groups did not differ in demographics or outcomes at baseline. Twenty-two of 23 (95.7%) registered participants attended all of the sessions. Participants completed 86.4% of study tools. Separate repeated measures ANOVAs revealed no significant interactions among group and time for primary coping, positive affect, or mindfulness. However, positive affect did increase [F(1, 17) = 10.675, p = 0.005, partial η 2 = 0.39] over time for both groups and there was a slight increase in trait mindfulness over time (although not statistically significant; p = 0.095, partial η 2 = 0.155]). Primary coping did not change with time. CONCLUSION: The mindfulness intervention utilized in the present study exhibited feasibility in this population. Although preliminary, mindfulness based interventions may contribute to positive affect among at-risk youth in a boarding school. Limitations and future directions are discussed.

State Policies Targeting Alcohol Use during Pregnancy and Alcohol Use among Pregnant Women 1985-2016: Evidence from the Behavioral Risk Factor Surveillance System.

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.