Open AccessNeighborhood Deprivation is Associated with Increased Risk of Prenatal Smoke Exposure
Author(s) -
David C. Wheeler,
Joseph Boyle,
D. Jeremy Barsell,
Rachel L. Maguire,
Bassam Dahman,
Susan K. Murphy,
Cathrine Hoyo,
Jim Zhang,
Jason A. Oliver,
F. Joseph McCler,
Bernard F. Fuemmeler
Publication year - 2022
Publication title -
prevention science
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.785
H-Index - 85
eISSN - 1573-6695
pISSN - 1389-4986
DOI - 10.1007/s11121-022-01355-7
Subject(s) - cotinine , medicine , demography , pregnancy , educational attainment , public health , epidemiology , population , health psychology , ethnic group , environmental health , gerontology , nicotine , genetics , economic growth , nursing , sociology , biology , anthropology , economics
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.