Table 2. Adjusted Models Estimating Odds of Neonatal Abstinence Syndrome Among Neonates in 8 Statesa.
| Covariate | Punitive Policies | Reporting Policies | ||
|---|---|---|---|---|
| aOR (95% CI) | P Value | aOR (95% CI) | P Value | |
| Time since policy went into effect | ||||
| No policyb | 1 [Reference] | 1 [Reference] | ||
| ≤1 y | 1.25 (1.06-1.46) | .007 | 1.14 (0.82-1.60) | .43 |
| >1 y | 1.33 (1.17-1.51) | <.001 | 1.13 (0.96-1.34) | .14 |
| Individual Covariates | ||||
| Sex | ||||
| Boys | 1 [Reference] | <.001 | 1 [Reference] | <.001 |
| Girls | 0.90 (0.87-0.94) | 0.90 (0.87-0.94) | ||
| Race/ethnicity | ||||
| Non-Hispanic white | 1 [Reference] | 1 [Reference] | ||
| Non-Hispanic black | 0.20 (0.16-0.26) | <.001 | 0.20 (0.16-0.26) | <.001 |
| Hispanic | 0.19 (0.14-0.26) | <.001 | 0.19 (0.14-0.26) | <.001 |
| Other or unknown | 0.37 (0.26-0.51) | <.001 | 0.37 (0.26-0.52) | <.001 |
| Primary payer | ||||
| Commercially insured | 1 [Reference] | 1 [Reference] | ||
| Public coverage | 11.83 (7.67-18.24) | <.001 | 11.81 (7.65-18.22) | <.001 |
| Uninsured or self-pay | 5.21 (3.92-6.93) | <.001 | 5.20 (3.92-6.89) | <.001 |
| Preterm birth | 2.44 (2.13-2.80) | <.001 | 2.44 (2.13-2.80) | <.001 |
| County-Level Covariatesc | ||||
| Rurality | ||||
| Metropolitan | 1 [Reference] | 1 [Reference] | ||
| Rural adjacent | 0.68 (0.47-0.99) | .04 | 0.68 (0.47-0.99) | .04 |
| Rural remote | 1.22 (0.90-1.67) | .20 | 1.22 (0.90-1.66) | .21 |
| Unemployment rated | ||||
| Bottom 3 quartiles | 1 [Reference] | .01 | 1 [Reference] | .01 |
| Top quartile | 1.44 (1.08-1.91) | 1.46 (1.09-1.95) | ||
| Substance use treatment programs for pregnant and postpartum women | ||||
| Absent | 1 [Reference] | <.001 | 1 [Reference] | <.001 |
| Present | 1.38 (1.16-1.64) | 1.38 (1.15-1.65) | ||
Abbreviation: aOR: adjusted odds ratio.
a
All logistic regression models are adjusted for the variables listed in the table and include state and year fixed effects with SEs clustered at the state level.
b
No policy either represents a state-year that did not have the policy in effect, or the year in which a policy went into effect; ≤1 y, the first full calendar year after the policy went into effect; >1 y, more than 1 full calendar year after the policy went into effect.
c
Birth hospital county was used if neonate county of residence was unavailable.
d
Quartiles of county percentage of unemployment were divided as 4th quartile (highest), 8.1% to 29.9% unemployment; all other quartiles, 0.8% to 8.0% unemployment.