Associations Between Residential Segregation and Smoking During Pregnancy Among Urban African-American Women

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 AfricanAmerican 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 sociodemographic 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.

The impact of regional economic reliance on the tobacco industry on current smoking in China

“…A large body of work in western countries has documented the significance of cultural and social practices on smoking initiation and cessation (e.g., Bell et al, 2007;Christakis and Fowler, 2008). This work has emphasised that smoking is a learned behaviour and that people's smoking habits will be influenced by local social norms with respect to its acceptability (e.g., Ross, 2000).…”

Racial Differences in Age at First Sexual Intercourse: Residential Racial Segregation and the Black-White Disparity among U.S. Adolescents

“…Segregation indices were categorized at values established previously by segregation demographers: very low (#0.30), low (.0.30-0.40), moderate (.0.40-0.60), and high (.0.60). 29,32,40 MAs that were highly segregated on four or five dimensions were categorized as hypersegregated. 17,28 MA-level covariates.…”

“…19,27 While studies have found that living in more segregated areas is associated with poorer health outcomes, 20,22,23,[28][29][30][31] limited studies have examined the association between segregation and health behaviors. [32][33][34] To the best of our knowledge, only two studies have empirically examined the association between segregation and sexual health outcomes. First, using national surveillance data, our research group found that certain dimensions of segregation were associated with gonorrhea rates among black people in the U.S. 35 Second, we found that among adolescents and young adults, hypersegregation was not associated with a sexual risk index, which included measures of sexual activity, condom use, and number of partners.…”

Racial Residential Segregation and Low Birth Weight in Michigan's Metropolitan Areas

“…First, mothers in racially segregated neighborhoods could have a higher prevalence of medical conditions or health behaviors related to intrauterine growth restriction. 58 However, individual-level factors such as smoking or nutrition depend to some degree on structural factors that contribute to vulnerability in segregated neighborhoods, such as targeted tobacco advertising or a lack of healthy food options.…”