Abstract for: Reduce drinking, increase birth control, or both? Simulating the long-term efficacy of preconceptual alcohol-exposed pregnancy

Substantial efforts have been made to reduce alcohol use during pregnancy (e.g., alcohol exposed pregnancy; AEP), which is associated with a wide range of negative outcomes. Preconceptual AEP-prevention programs are highly regarded as a promising strategy for reducing AEP, by dually promoting both increased birth control use and reduced alcohol consumption. However, these programs appear to have a stronger effect on changing birth control use compared to alcohol use, which may not be as effective for longer-term prevention of AEP. The current study simulates an implementation of a preconceptual AEP-prevention program, in which we compare differences in effect sizes for changing either alcohol use or birth control use, and differences in the proportion of individuals who change either behavior or both behaviors. Results indicated that birth control use was more important as an initial strategy (intercept), but was less resilient over time (slope). Shifting proportions of individuals between alcohol use and birth control, versus birth control only, also impacted the slopes, in which greater shifts between groups created less stable effects. Furthermore, the impact of programs was greater, but less stable, when evaluating risky drinking and alcohol use disordered AEP compared to all AEP over time.