Neighborhood Deprivation is Associated with Increased Risk of Prenatal Smoke Exposure

Prevention Science - Tập 23 - Trang 1078-1089 - 2022
David C. Wheeler1, Joseph Boyle1, D. Jeremy Barsell2, Rachel L. Maguire3,4, Bassam Dahman2, Susan K. Murphy3, Cathrine Hoyo4, Jim Zhang5, Jason A. Oliver6,7,8, Joseph McClernon6, Bernard F. Fuemmeler2,9
1Department of Biostatistics, One Capitol Square, Virginia Commonwealth University, Richmond, USA
2Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
3Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, USA
4Department of Biological Sciences, Center for Human Health and the Environment, North Carolina State University, Raleigh, USA
5Duke Global Health Institute, Durham, USA
6Department of Psychiatry and Behavioral Sciences, Duke University, Durham, USA
7TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, USA
8Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, USA
9Massey Cancer Center, Virginia Commonwealth University, Richmond, USA

Tóm tắt

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.

Tài liệu tham khảo

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