Abstract
Approximately 10% of African-American women smoke during pregnancy compared to 16% of White women. While relatively low, the prevalence of smoking during pregnancy among African-American women exceeds the Healthy People 2010 goal of 1%. In the current study, we address gaps in extant research by focusing on associations between racial/ethnic residential segregation and smoking during pregnancy among urban African-American women. We linked measures of segregation to birth certificates and data from the 2000 census in a sample of US-born African-American women (n = 403,842) living in 216 large US Metropolitan Statistical Areas (MSAs). Logistic regression models with standard errors adjusted for multiple individual observations within MSAs were used to examine associations between segregation and smoking during pregnancy and to control for important socio-demographic confounders. In all models, a u-shaped relationship was observed. Both low segregation and high segregation were associated with higher odds of smoking during pregnancy when compared to moderate segregation. We speculate that low segregation reflects a contagion process, whereby salutary minority group norms are weakened by exposure to the more harmful behavioral norms of the majority population. High segregation may reflect structural attributes associated with smoking such as less stringent tobacco control policies, exposure to urban stressors, targeted marketing of tobacco products, or limited access to treatment for tobacco dependence. A better understanding of both deleterious and protective contextual influences on smoking during pregnancy could help to inform interventions designed to meet Healthy People 2010 target goals.
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References
Pollack H, Lantz PM, Frohna JG. Maternal smoking and adverse birth outcomes among singletons and twins. Am J Public Health. 2000;90(3):395–400.
Salihu HM, Aliyu MH, Pierre-Louis BJ, Alexander GR. Levels of excess infant deaths attributable to maternal smoking during pregnancy in the United States. Matern Child Health J. 2003;7(4):219–227.
Wisborg K, Kesmodel U, Henriksen TB, Olsen SF, Secher NJ. Exposure to tobacco smoke in utero and the risk of stillbirth and death in the first year of life. Am J Epidemiol. 2001;154(4):322–327.
Walsh RA. Effects of maternal smoking on adverse pregnancy outcomes: examination of the criteria of causation. Hum Biol. 1994;66(6):1059–1092.
Ernst M, Moolchan ET, Robinson ML. Behavioral and neural consequences of prenatal exposure to nicotine. J Am Acad Child Adolesc Psych. 2001;40(6):630–641.
Cunningham J, Dockery DW, Speizer FE. Maternal smoking during pregnancy as a predictor of lung function in children. Am J Epidemiol. 1994;139(12):1139–1152.
Medical-care expenditures attributable to cigarette smoking during pregnancy—United States, 1995. MMWR. 1997;46(44):1048–1050.
Keppel KG, Pearcy JN, Klein RJ. Measuring progress in Healthy People 2010. Hyattsville, MD: National Center for Health Statistics; September 2004.
Floyd RL, Rimer BK, Giovino GA, Mullen PD, Sullivan SE. A review of smoking in pregnancy: effects on pregnancy outcomes and cessation efforts. Annu Rev Public Health. 1993;14:379–411.
Ebrahim SH, Floyd RL, Merritt RK, 2nd, Decoufle P, Holtzman D. Trends in pregnancy-related smoking rates in the United States, 1987–1996. JAMA. 2000;283(3):361–366.
Phares TM, Morrow B, Lansky A, et al. Surveillance for disparities in maternal health-related behaviors—selected states, Pregnancy Risk Assessment Monitoring System (PRAMS), 2000–2001. MMWR Surveill Summ. 2004;53(4):1–13.
Mathews TJ. Smoking during pregnancy, 1990–96. National Vital Statistics Reports. 1998;47(10):1–12.
Ross CE. Walking, exercising, and smoking: does neighborhood matter? Soc Sci Med. 2000;51(2):265–274.
Cubbin C, Hadden WC, Winkleby MA. Neighborhood context and cardiovascular disease risk factors: the contribution of material deprivation. Ethn Dis. 2001;11(4):687–700.
Pickett KE, Wakschlag LS, Rathouz PJ, Leventhal BL, Abrams B. The working-class context of pregnancy smoking. Health Place. 2002;8(3):167–175.
Lee RE, Cubbin C. Neighborhood context and youth cardiovascular health behaviors. Am J Public Health. 2002;92(3):428–436.
Reijneveld SA. Neighbourhood socioeconomic context and self reported health and smoking: a secondary analysis of data on seven cities. J Epidemiol Community Health. 2002;56(12):935–942.
Reijneveld SA. The impact of individual and area characteristics on urban socioeconomic differences in health and smoking. Int J Epidemiol. 1998;27(1):33–40.
Datta GD, Subramanian SV, Colditz GA, Kawachi I, Palmer JR, Rosenberg L. Individual, neighborhood, and state-level predictors of smoking among US Black women: a multilevel analysis. Soc Sci Med. 2006;63(4):1034–1044.
National Center for Health Statistics. Health, United States 2004 with Chartbook on Trends in the Health of Americans. Hyattsville, Maryland: U.S. Government Printing Office; 2004.
Smoking during pregnancy—United States, 1990–2002. MMWR Morb Mortal Wkly Rep. 2004;53(39):911–915.
Osypuk TL, Kawachi I, Subramanian SV, Acevedo-Garcia D. Are state patterns of smoking different for different racial/ethnic groups? An application of multilevel analysis. Public Health Rep. 2006;121(5):563–577.
King G, Polednak AP, Bendel R. Regional variation in smoking among African Americans. Prev Med. 1999;29(2):126–132.
King G, Polednak A, Fagan P, et al. Heterogeneity in the smoking behavior of African American women. Am J Health Behav. 2006;30(3):237–246.
King G. The “race” concept in smoking: a review of the research on African Americans. Soc Sci Med. 1997;45(7):1075–1087.
Iceland J, Weinberg DH, Steinmetz E. Racial and Ethnic Segregation in the United States: 1980–2000. Washington, D.C.: U.S. Government Printing Office: U.S. Census Bureau; 2002.
Acevedo-Garcia D, Lochner KA, Osypuk TL, Subramanian SV. Future directions in residential segregation and health research: a multilevel approach. Am J Public Health. 2003;93(2):215–221.
Link BG, Phelan J. Social conditions as fundamental causes of disease. J Health Soc Behav. 1995;(Spec No):80–94.
Williams DR, Collins C. Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Rep. 2001;116(5):404–416.
Massey DS, Fischer MJ. How segregation concentrates poverty. Ethn Racial Stud. 2000;23(4):670–691.
Acevedo-Garcia D, Lochner K. Residential segregation and health. In: Kawachi I, L. B, eds. Neighborhoods and Health. New York: Oxford University Press; 2003:265–287.
National Center for Health Statistics. Natality Detail Files Documentation. Available at: http://www.cdc.gov/nchs/products/elec_prods/subject/natality.htm). Accessed Oct 17, 2006.
U.S. Census Bureau, Housing and Household Economic Statistics Division. Housing Patterns. Available at: http://www.census.gov/hhes/www/housing/housing_patterns/gettable_msa.html. Accessed October 17, 2006.
U.S. Census Bureau. U.S. Census Summary File 3. Available at: http://www.census.gov/Press-Release/www/2002/sumfile3.html. Accessed May 15, 2006.
Tax Policy Center. Cigarette Rates 2001-2006. Available at: http://www.taxpolicycenter.org/TaxFacts/TFDB/TFTemplate.cfm?Docid=433&Topic2id=90. Accessed Oct 17, 2006.
Acevedo-Garcia D, Pan J, Jun HJ, Osypuk TL, Emmons KM. The effect of immigrant generation on smoking. Soc Sci Med. 2005;61(6):1223–1242.
Massey DS, White MJ, Phua VC. The dimensions of segregation revisited. Sociol Methods Res. 1996;25(2):172–206.
Dietz PM, Adams MM, Kendrick JS, Mathis MP. Completeness of ascertainment of prenatal smoking using birth certificates and confidential questionnaires: variations by maternal attributes and infant birth weight. PRAMS Working Group. Pregnancy Risk Assessment Monitoring System. Am J Epidemiol. 1998;148(11):1048–1054.
Lieberson S. A piece of the pie: blacks and white immigrants since 1880. Berkeley: University of California Press; 1980.
Lieberson S. An asymmetrical approach to segregation. In: Peach C, Robinson V, Smith S, eds. Ethnic Segregation in Cities. London: Croon Helm; 1981:61–82.
White MJ. The measurement of spatial segregation. Am J Sociol. 1983;88(1008–1018).
Bell JF, Zimmerman FJ, Almgren GR, Mayer JD, Huebner CE. Birth outcomes among urban African-American women: a multilevel analysis of the role of racial residential segregation. Soc Sci Med. 2006;63(12):3030–3045.
Chang VW. Racial residential segregation and weight status among US adults. Soc Sci Med. 2006;63(5):1289–1303.
Subramanian SV, Acevedo-Garcia D, Osypuk TL. Racial residential segregation and geographic heterogeneity in black/white disparity in poor self-rated health in the US: a multilevel statistical analysis. Soc Sci Med. 2005;60(8):1667–1679.
Massey DS, Denton NA. The dimensions of residential segregation. Soc Forces. 1988;67(2):281–315.
Fischer CS, Stockmayer G, Stiles J, Hout M. Distinguishing the geographic levels and social dimensions of U.S. metropolitan segregation, 1960–2000. Demography. 2004;41(1):37–59.
Acevedo-Garcia D. Zip code-level risk factors for tuberculosis: neighborhood environment and residential segregation in New Jersey, 1985–1992. Am J Public Health. 2001;91(5):734–741.
Acevedo-Garcia D. Residential segregation and the epidemiology of infectious diseases. Soc Sci Med. 2000;51(8):1143–1161.
Ellen I. Is Segregation Bad for Your Health? The Case of Low Birth Weight. Brookings-Wharton Papers on Urban Affairs. 2000:203–238.
Polednak AP. Trends in US urban black infant mortality by degree of residential segregation. Am J Public Health. 1996;86(5):723–726.
Polednak AP. Segregation, Poverty, and Mortality in Urban African Americans. New York: Oxford University Press; 1997.
Guest AM, Almgren G, Hussey JM. The ecology of race and socioeconomic distress: infant and working-age mortality in Chicago. Demography. 1998;35(1):23–34.
Wilkes R, Iceland J. Hypersegregation in the twenty-first century. Demography. 2004;41(1):23–36.
Levy DT, Hyland A, Higbee C, Remer L, Compton C. The role of public policies in reducing smoking prevalence in California: results from the California Tobacco Policy Simulation Model. Health Policy. 2006.
Levy DT, Chaloupka F, Gitchell J. The effects of tobacco control policies on smoking rates: a tobacco control scorecard. J Public Health Manag Pract. 2004;10(4):338–353.
Schroeder SA. Tobacco control in the wake of the 1998 master settlement agreement. N Engl J Med. 2004;350(3):293–301.
Deaton A. The Analysis of Household Surveys. Baltimore: Johns Hopkins University Press; 1997.
Massey DS, Denton NA. American Apartheid: Segregation and the Making of the Underclass. Cambridge: Harvard University Press; 1993.
Macintyre S, Ellaway A, Cummins S. Place effects on health: how can we conceptualise, operationalise and measure them? Soc Sci Med. 2002;55(1):125–139.
Diehr P, Koepsell T, Cheadle A, Psaty BM, Wagner E, Curry S. Do communities differ in health behaviors? J Clin Epidemiol. 1993;46(10):1141–1149.
Pickett KE, Collins JW, Jr., Masi CM, Wilkinson RG. The effects of racial density and income incongruity on pregnancy outcomes. Soc Sci Med. 2005;60(10):2229–2238.
Sugrue TJ. Crabgrass-roots politics: race, rights, and the reaction against liberalism in the urban north, 1940–1964. J Am Hist. 1995;82(2):551–578.
Smoking during Pregnancy—United States 1990–2002: Centers for Disease Control and Prevention; 2004.
Moher M, Hey K, Lancaster T. Workplace interventions for smoking cessation. Cochrane Database Syst Rev. 2005(2):CD003440.
Janzon E, Engstrom G, Lindstrom M, Berglund G, Hedblad B, Janzon L. Who are the “quitters”? A cross-sectional study of circumstances associated with women giving up smoking. Scand J Public Health. 2005;33(3):175–182.
Lumley J, Oliver SS, Chamberlain C, Oakley L. Interventions for promoting smoking cessation during pregnancy. Cochrane Database Syst Rev. 2004(4):CD001055.
Levy DT, Romano E, Mumford E. The relationship of smoking cessation to sociodemographic characteristics, smoking intensity, and tobacco control policies. Nicotine Tob Res. 2005;7(3):387–396.
Frieden TR, Mostashari F, Kerker BD, Miller N, Hajat A, Frankel M. Adult tobacco use levels after intensive tobacco control measures: New York City, 2002–2003. Am J Public Health. 2005;95(6):1016–1023.
Wildey MB, Young RL, Elder JP. Cigarette point-of-sale advertising in ethnic neighborhoods in San Diego. Health Values. 1992;16:23–28.
Woodruff SI, Agro AD, M.B. W. Point-of-purchase tobacco advertising: prevalence, correlates, and a brief intervention. Health Values. 1995;19:56–62.
Klonoff EA, Fritz JM, Landrine H, Riddle RW, Tully-Payne L. The problem and sociocultural context of single-cigarette sales. JAMA. 1994;271(8):618–620.
McCormick MC, Brooks-Gunn J, Shorter T, Holmes JH, Wallace CY, Heagarty MC. Factors associated with smoking in low-income pregnant women: relationship to birth weight, stressful life events, social support, health behaviors and mental distress. J Clin Epidemiol. 1990;43(5):441–448.
Emmons KM. Health Behaviors in a Social Context. In: Berkman L, Kawachi I, eds. Social Epidemiology. New York: Oxford University Press; 2000.
Brown TT, Scheffler RM, Seo S, Reed M. The empirical relationship between community social capital and the demand for cigarettes. Health Econ. 2006;15(11):1159–1172.
Krieger N, Williams DR, Moss NE. Measuring social class in US public health research: concepts, methodologies, and guidelines. Annu Rev Public Health. 1997;18:341–378.
Coulton CJ, Korbin J, Chan T, Su M. Mapping residents’ perceptions of neighborhood boundaries: a methodological note. Am J Community Psychol. 2001;29(2):371–383.
O’Campo P. Invited commentary: advancing theory and methods for multilevel models of residential neighborhoods and health. Am J Epidemiol. 2003;157(1):9–13.
Acknowledgements
JF Bell and FJ Zimmerman initiated the study. JF Bell conducted the data analysis in collaboration with FJ Zimmerman. All authors contributed to the study design, interpretation of findings, and manuscript preparation. Dr. Bell’s work on this study was funded, in part, by the Agency for Healthcare Research and Quality (grant number: T32-HS013853-01). A Certificate of Exemption was granted for the research by the University of Washington Human Subjects Division’s Institutional Review Board.
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Bell, Zimmerman, Mayer, and Huebner are with the Department of Health Services, University of Washington, Seattle, WA, USA; Bell and Zimmerman are with the Child Health Institute, University of Washington, Seattle, WA, USA; Zimmerman and Huebner are with the Maternal and Child Health Program, University of Washington, Seattle, WA, USA; Mayer is with the Department of Geography, University of Washington, Seattle, WA, USA; Mayer is with the School of Medicine (Allergy and Infectious Diseases), University of Washington, Seattle, WA, USA; Mayer is with the Department of Epidemiology, University of Washington, Seattle, WA, USA; Almgren is with the School of Social Work, University of Washington, Seattle, WA, USA; Mayer and Almgren are with the Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, USA; Mayer is with the Department of Family Medicine, University of Washington, Seattle, WA, USA.
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Bell, J.F., Zimmerman, F.J., Mayer, J.D. et al. Associations Between Residential Segregation and Smoking During Pregnancy Among Urban African-American Women. J Urban Health 84, 372–388 (2007). https://doi.org/10.1007/s11524-006-9152-4
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DOI: https://doi.org/10.1007/s11524-006-9152-4