The Prevalence of Socioeconomic and Behavioral Characteristics and their Impact on Very Low Birth Weight in Black and White Infants in Georgia


Objectives: We examined possible reasons for the disparity in the rate of very low birth weight (VLBW) delivery (<1500 g) in the United States between black women and white women. Methods: Using data from a population-based, case–control study of very low birth weight infants, we compared the prevalence of sociodemographic and behavioral characteristics between black and white mothers of normal birth weight infants; the difference in these characteristics between case and control mothers; and, using logistic regression, calculated odds ratios for VLBW for black versus white infants, adjusting for these characteristics. Results: Although black women were disadvantaged on every variable examined, they did not report more behavioral risk factors. Among white women, several traditional risk factors were associated with VLBW, while among black women, only marital status, cigarette smoking, and vitamin nonuse were associated with VLBW delivery. Controlling for the socioeconomic and behavioral factors reduced the odds ratio for VLBW delivery among black mothers from 3.7 to 3.3. Conclusions: Racial disparity in socioeconomic status may be greater than our current ability to adjust for it in epidemiologic studies. The fact that traditional risk factors were not associated with VLBW delivery in black women may be due to the very high prevalence of these risk factors among black women or to different or additional risks or stresses experienced by black women.

This is a preview of subscription content, access via your institution.


  1. 1.

    National Center for Health Statistics. Births: Final data for 1997. Nat Vit Stat Rep 1999;47:18.

    Google Scholar 

  2. 2.

    Solomon I, Becerra JE, Rowley DL, Hogue CJR. Impact of very low birth weight on the black-white infant mortality gap. Am J Prev Med 1992;8:271–7.

    Google Scholar 

  3. 3.

    Lieberman E, Ryan KJ, Monson RR, Schoenbaum SC. Risk factors accounting for racial differences in the rate of premature birth. N Engl J Med 1987;317:743–8.

    Google Scholar 

  4. 4.

    Kempe A, Wise PH, Barkan SE, Sappenfield WM, Sachs B, Gortmaker SL, Sobol AM, First LR, Pursley D, Rinehart H, Kotelchuck M, Cole FS, Gunter N, Stockbauer JW. Clinical determinants of the racial disparity in very low birth weight. N Engl J Med 1992;327:969–73.

    Google Scholar 

  5. 5.

    Goldenberg RL, Cliver SP, Mulvihill FX, Hickey CA, Hoffman HJ, Klerman LV, Johnson MJ. Medical, psychosocial and behavioral risk factors do not explain the increased risk for low birthweight among black women.AmJ Obstet Gynecol 1996;175:1317–24.

    Google Scholar 

  6. 6.

    Collins JW, David RJ. The differential effect of traditional risk factors on infant birth weight among blacks and whites in Chicago. Am J Public Health 1990;80:679–81.

    Google Scholar 

  7. 7.

    Gould JB, LeRoy S. Socioeconomic status and low birth weight: A racial comparison. Pediatrics 1988;82:896–904.

    Google Scholar 

  8. 8.

    Kleinman JC, Kessel SS. Racial differences in low birthweight–trends and risk factors. N Engl J Med 1987;317: 749–53.

    Google Scholar 

  9. 9.

    Starfield B, Shapiro S, Weiss J, Liang KY, Ra K, Paige D, Wang X. Race, family income, and low birth weight.AmJ Epidemiol 1991;134:1167–74.

    Google Scholar 

  10. 10.

    Stanfield R. The other side of poverty. Natl J 1992;43:2456.

    Google Scholar 

  11. 11.

    Kleinman JC, Fingerhut LA, Prager K. Differences in infant mortality by race, nativity status, and other maternal characteristics. Am J Dis Child 1991;145:194–9.

    Google Scholar 

  12. 12.

    Spurlock CW, Hinds W, Skaggs JW, Hernandez CE. Infant death rates among the poor and nonpoor in Kentucky, 1982 to 1983. Pediatrics 1987;80:262–9.

    Google Scholar 

  13. 13.

    Nelson MD. Socioeconomic status and childhood mortality in North Carolina. Am J Public Health 1992;82:1131–3.

    Google Scholar 

  14. 14.

    Jaynes GD, Williams RM, editors. A common destiny–Blacks and American society. Washington, DC: National Academy Press, 1989.

    Google Scholar 

  15. 15.

    Updegrave W. Race and money. Money, December 1989:152–172.

  16. 16.

    McGrady GA, Sung JF, Rowley DL, Hogue CJR. Preterm delivery and low birth weight among first-born infants of black and white college graduates.AmJ Epidemiol 1992;136:266–76.

    Google Scholar 

  17. 17.

    Institute of Medicine. Preventing lowbirthweight. Washington, DC: National Academy Press, 1985.

    Google Scholar 

  18. 18.

    Chasnoff IJ, Landress HJ, Barrett ME.The prevalence of illicit-drug or alcohol use during pregnancy and discrepancies in mandatory reporting in Pinellas County, Florida. N Engl J Med 1990;332:1202–6.

    Google Scholar 

  19. 19.

    Neuspiel DR. Racism and perinatal addiction. Ethn Dis 1996;6:47–55.

    Google Scholar 

  20. 20.

    CDC. Pregnancy risks determined from birth certificate data–United States, 1989. MMWR 1992;41:556–63.

    Google Scholar 

  21. 21.

    Floyd RL, Rimer BK, Giovino G, 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.

    Google Scholar 

  22. 22.

    Serdula M, Williamson DF, Kendrick JS, Anda RF, Byers T. Trends in alcohol consumption by pregnant women–1985 through 1988. JAMA 1991;265:876–9.

    Google Scholar 

  23. 23.

    Arnold CC, Kramer MS, Hobbs CA, McLean FH, Usher RH. Very low birth weight: A problematic cohort for epidemiologic studies of very small or immature neonates. Am J Epidemiol 1991;134:604–13.

    Google Scholar 

  24. 24.

    Berg CJ, Zupan J, d'Almada PJ. Proximate causes of delivery in a geographically based very low birthweight population. Paediatr Perinat Epidemiol 1993;7:A20.

    Google Scholar 

  25. 25.

    Kramer MS. Birthweight and infant mortality: Perceptions and pitfalls. Paediatr Perinat Epidemiol 1990;4:381–90.

    Google Scholar 

  26. 26.

    Tresserras R, Canela J, Alvarez J, Sentis J, Salleras L. Infant mortality, per capita income, and adult illiteracy: An ecological approach. Am J Public Health 1992;82:435–8.

    Google Scholar 

  27. 27.

    Keil JE, Sutherland SE, Knapp RG, Tyroler HA. Does equal socioeconomic status in black and white men mean equal risk of mortality? Am J Public Health 1992;82:1133–6.

    Google Scholar 

  28. 28.

    Margolis PA, Greenberg RA, Keyes LL, LaVange LM, Chapman RS, Denny FW, Baumen KE, Boat BW. Lower respiratory illness in infants and low socioeconomic status. Am J Public Health 1992;82:1119–26.

    Google Scholar 

  29. 29.

    Rantakallio P. Inequalities in children's deaths in the country with the lowest infant mortality? Public Health 1986;100: 152–5.

    Google Scholar 

  30. 30.

    Nordstrom M-L, Cnattingius S, Haglund B. Social differences in Swedish infant mortality by cause of death, 1983 to 1986. Am J Public Health 1993;83:26–30.

    Google Scholar 

  31. 31.

    Rothman KJ, Poole C. A strengthening program for weak associations. Int J Epidemiol 1988;17(Suppl.):955–9.

    Google Scholar 

  32. 32.

    Schoendorf KC, Hogue CJR, Kleinman JC, Rowley D. Mortality among infants of black as compared with white collegeeducated parents. N Engl J Med 1992;326:1522–6.

    Google Scholar 

  33. 33.

    Collins JW, David RJ, Symons R, Handler A, Wall SN, Dwyer L. Low-income African-American mothers' perception of exposure to racial discrimination and infant birth weight. Epidemiology 2000;11:337–9.

    Google Scholar 

  34. 34.

    Wise PH, Pursley DM. Infant mortality as a social mirror. N Engl J Med 1992; 326:1558–60.

    Google Scholar 

  35. 35.

    David RJ, Collins JW Jr. Bad outcomes in black babies: Race or racism? Ethn Dis 1991;1:236–44.

    Google Scholar 

  36. 36.

    Kreiger N, Rowley DL. Re: “Race, family income, and low birth weight.” Am J Epidemiol 1992;136:501.

    Google Scholar 

  37. 37.

    Hogue CJR, Hargraves MA. Class, race, and infant mortality in the United States. Am J Public Health 1993;83:9–12.

    Google Scholar 

  38. 38.

    Petros-Barvazian A, Behar M. Low birth-weight–a major global problem. In: Sterky G, Mellander L, editors. Birth-weight distribution–an indicator of social development. Uppsala: Swedish Agency for Research Cooperation with Developing countires, 1978. (SAREC Report No. R:2, 1978).

    Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Cynthia J. Berg.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Berg, C.J., Wilcox, L.S. & d'Almada, P.J. The Prevalence of Socioeconomic and Behavioral Characteristics and their Impact on Very Low Birth Weight in Black and White Infants in Georgia. Matern Child Health J 5, 75–84 (2001).

Download citation

  • low birth weight
  • infant
  • socioeconomic status
  • race
  • poverty
  • Georgia