Alcohol Policy, Social Context, and Infant Health: The Impact of Minimum Legal Drinking Age

Abstract: Objective: The minimum legal drinking age (MLDA) was increased in the U.S. in the late 1980s in an effort to reduce intoxication-associated injuries, especially those related to motor vehicle accidents. This paper explores distal (secondary) effects of changing MLDA on indices of infant health, and whether changes in drinking behaviors or birth composition contributed to these effects. Methods: State- and year-fixed-effects models are used to analyze the relationship between MLDA, drinking behaviors, and birth outcomes. We studied the effects of different MLDA (age 18, 19, 20, or 21 years) when potential mothers were 14 years old by merging two population-based datasets, the Natality Detailed Files and the Behavioral Risk Factor Surveillance System between 1985 and 2002. Results: A MLDA of 18 years old (when potential mothers were 14 years old) increased the prevalence of low birth weight, low Apgar scores, and premature births. Effects were stronger among children born to black women compared with white women. Moreover, a younger MLDA was associated with an increasing proportion of very young and high school dropouts for black women. Furthermore, older MLDA laws at age 14 years decreased the prevalence of binge drinking among black women. Conclusions: Increasing the MLDA had longer term, distal impacts beyond the initially intended outcomes, specifically on birth outcomes (particularly among infants born to black women) as well as school drop-outs and binge drinking patterns among black young females. The older MLDA, intended initially to reduce problematic drinking behaviors, appeared to alter broader social contexts that influenced young women during their early childbearing years.