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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Drinking During Pregnancy.

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Strategy. Policy and Legislation

Approach. Support state policies and regulations that require warning signs on the risks associated with drinking alcohol while pregnant be placed in locations where women are likely to read them

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Overview. Most states have at least one policy focused on alcohol use during pregnancy. However, most of these do not appear to be associated with less alcohol consumption during pregnancy. One exception is mandatory alcohol warning signs, which have been associated with a statistically significant reduction in prenatal alcohol consumption.[1,2] The precise wording of the warning sign, the design, and location of the warning varies from state to state or territory, although U.S. Alcoholic Beverage Warning Label Act of 1988 stipulates that the language must highlight the association between drinking while pregnant and the risk of birth defects.[2] Alcohol warning labels have been implemented in multiple states and territories and appear to effectively reduce the likelihood that women will report consuming alcohol during pregnancy.[1,2,3]

Evidence. Mixed Evidence. Strategies with this rating have been tested more than once with results that sometimes trend positive...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Health and Health Behaviors/Behavior Change. This strategy improves individuals' physical and mental health and their adoption of healthy behaviors (e.g., healthy eating, physical activity).

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Population/Systems-Focused

Examples from the Field. There are currently no ESMs that use this strategy. Search similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of meetings led by Title V with policymakers to discuss warning sign regulations. (Measures engagement efforts to build policy support) Number of organizations partnering with Title V to support warning sign requirements. (Shows breadth of partnerships supporting the policy)

Quadrant 2:
Measuring Quality of Effort (“How well did we do it?”)

  • Percent of meetings led by Title V with policymakers to discuss warning sign regulations. (Measures engagement efforts to build policy support) Percent of organizations partnering with Title V to support warning sign requirements. (Shows breadth of partnerships supporting the policy)

Quadrant 3:
Measuring Quantity of Effect (“Is anyone better off?”)

  • Number of healthcare providers trained on counseling about alcohol risks during pregnancy alongside policy implementation. (Measures capacity to support behavior change) Number of local health departments launching complementary warning dissemination efforts that result in an increase in knowledge and/or skill. (Shows alignment of state and local activities) Number of individuals of reproductive age reporting seeing alcohol warning signs at points of sale produced by Title V. (Assesses exposure to educational information) Number of alcohol retailers partnered with Title V improving compliance with warning sign posting requirements. (Demonstrates policy adoption by tailored entities)

Quadrant 4:
Measuring Quality of Effect (“How are they better off?”)

  • Percent of individuals with access to alcohol warning signs in their communities who report an increase in knowledge and/or skill. (Assesses implementation) Percent of retailers in communities with high rates of alcohol-exposed pregnancies receiving tailored outreach that result in an increase in knowledge and/or skill. (Measures focus on areas with significant health challenges) Percent reduction in alcohol use during pregnancy among multiple communities as a result of warning signs developed by Title V. (Shows policy impact on health outcomes) Percent decrease in adverse birth outcomes associated with prenatal alcohol exposure, disaggregated by key factors. (Assesses effect on maternal-child health)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

[1] Roberts, S. C. M., Mericle, A. A., Subbaraman, M. S., Thomas, S., Treffers, R. D., Delucchi, K. L., & Kerr, W. C. (2019). State Policies Targeting Alcohol Use during Pregnancy and Alcohol Use among Pregnant Women 1985-2016: Evidence from the Behavioral Risk Factor Surveillance System. Women's health issues: official publication of the Jacobs Institute of Women's Health, 29(3), 213–221.

[2] Cil G. (2017). Effects of posted point-of-sale warnings on alcohol consumption during pregnancy and on birth outcomes. Journal of health economics, 53, 131–155.

[3] Zhao, J., Stockwell, T., Vallance, K., & Hobin, E. (2020). The Effects of Alcohol Warning Labels on Population Alcohol Consumption: An Interrupted Time Series Analysis of Alcohol Sales in Yukon, Canada. Journal of studies on alcohol and drugs, 81(2), 225–23.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.