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Neighborhood Deprivation is Associated with Increased Risk of Prenatal Smoke Exposure

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Abstract

Despite years of advisories against the behavior, smoking among pregnant women remains a persistent public health issue in the USA. Recent estimates suggest that 9.4% of women smoke before pregnancy and 7.1% during pregnancy in the USA. Epidemiological research has attempted to pinpoint individual-level and neighborhood-level factors for smoking during pregnancy, including educational attainment, employment status, housing conditions, poverty, and racial demographics. However, most of these studies have relied upon self-reported measures of smoking, which are subject to reporting bias. To more accurately and objectively assess smoke exposure in mothers during pregnancy, we used Bayesian index models to estimate a neighborhood deprivation index (NDI) for block groups in Durham County, North Carolina, and its association with cotinine, a marker of smoke exposure, in pregnant mothers (n = 887 enrolled 2005–2011). Results showed a significant positive association between NDI and log cotinine (beta = 0.20, 95% credible interval = [0.11, 0.29]) after adjusting for individual covariates (e.g., race/ethnicity and education). The two most important variables in the NDI according to the estimated index weights were percent females without a high school degree and percent Black population. At the individual level, Hispanic and other race/ethnicity were associated with lowered cotinine compared with non-Hispanic Whites. Higher education levels were also associated with lowered cotinine. In summary, our findings provide stronger evidence that the socio-geographic variables of educational attainment and neighborhood racial composition are important factors for smoking and secondhand smoke exposure during pregnancy and can be used to target intervention efforts.

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Funding

Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Number R01CA239595. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Biostatistics, One Capitol Square, Virginia Commonwealth University, 7th Floor, 830 East Main St, Richmond, VA, 23298, USA

    David C. Wheeler & Joseph Boyle

  2. Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, 23298-0032, USA

    D. Jeremy Barsell, Bassam Dahman & Bernard F. Fuemmeler

  3. Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, 27710, USA

    Rachel L. Maguire & Susan K. Murphy

  4. Department of Biological Sciences, Center for Human Health and the Environment, North Carolina State University, Raleigh, NC, 27695, USA

    Rachel L. Maguire & Cathrine Hoyo

  5. Duke Global Health Institute, Durham, NC, 27708, USA

    Jim Zhang

  6. Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, 27701, USA

    Jason A. Oliver & Joseph McClernon

  7. TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, 73104, USA

    Jason A. Oliver

  8. Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, 74136, USA

    Jason A. Oliver

  9. Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, 23298, USA

    Bernard F. Fuemmeler

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  1. David C. Wheeler
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Wheeler, D.C., Boyle, J., Barsell, D.J. et al. Neighborhood Deprivation is Associated with Increased Risk of Prenatal Smoke Exposure. Prev Sci 23, 1078–1089 (2022). https://doi.org/10.1007/s11121-022-01355-7

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