Disparities in Maternal Child and Health Outcomes Attributable to Prenatal Tobacco Use

Abstract

Objectives Previous estimates of smoking-attributable adverse outcomes, such as preterm births (PTBs), low birth weight (LBW) and Sudden Infant Death Syndrome (SIDs) generally do not address disparities by maternal age, racial/ethnic group or socioeconomic status (SES). This study develops estimates of smoking-attributable PTB, LBW and SIDS for the US by age, SES and racial/ethnic groupings. Methods Data on the number of births and the prevalence of PTB, LBW and SIDS were used to develop the number of outcomes by age, race/ethnicity, and SES. The prevalence of prenatal smoking by age, race/ethnic and education and the relative risk of outcomes for smokers were used to calculate smoking-attributable fractions of outcomes. Results Prenatal smoking among ages 15-24 is above 12%, with 20-24 year olds representing at least 35% of PTB, LBW SIDS cases. Women with a high school education or less represented more than 50% of PTB and LBW births, and 44% of SIDS cases. While non-Hispanic Whites had the majority of smoking-attributable outcomes, non-Hispanic Blacks represented a disproportionately high percentage of PTBs (18%), LBW births (22%), and SIDS cases (13%). Conclusions: Reducing prenatal smoking has the potential to reduce adverse birth outcomes and costs with long-term implications, especially among the young, non-Hispanic Blacks and those of lower SES. Stricter tobacco control policies, especially higher cigarette taxes, higher minimum purchase ages for tobacco and improved cessation interventions can help reduce disparities and the cost to insurers, especially public costs through Medicaid.

Continued smoking versus spontaneous quitting among pregnant women living in a high risk environment

“…The worst PTB outcome was detected among smoking Roma women living above the deep poverty level. According to a recent study of smoking-attributable adverse outcomes, our results are similar to those of the US non-Hispanic Blacks who represent a disproportionately higher percentage of PTBs (18%) and LBW cases (22%) when compared to whites (26).…”

Black Pregnant Women “Get the Most Judgment”: A Qualitative Study of the Experiences of Black Women at the Intersection of Race, Gender, and Pregnancy

“…Black infants have 2.5 times the infant mortality rate (deaths in the first year of life/1,000 live births) (Xu et al, 2018), 1.5 times the preterm birth rate, and two times the low birth weight rate of White infants (Martin et al, 2018b). Neither maternal factors such as socioeconomic status (SES), health behaviors, and prenatal care (Braveman et al, 2015;Goldenberg et al, 1996;Mohlman & Levy, 2016) nor macrosocial determinants of health disproportionately affecting marginalized populations, such as neighborhood poverty and unemployment (Morenoff, 2003;O'Campo, Xue, Wang, & Caughy, 1997;Pearl, Braveman, & Abrams, 2001), completely explain these disparities.…”

Racial and ethnic disparities in adverse birth outcomes: Differences by racial residential segregation

“…In 2003, Misra and colleagues proposed a multilevel, life course framework for perinatal health (Misra, Guyer, & Allston, 2003). However, the majority of studies on racial and ethnic disparities in adverse birth outcomes have focused on individual maternal factors (Braveman et al, 2017; Braveman et al, 2015; Dunlop, Kramer, Hogue, Menon, & Ramakrishan, 2011; Harville, Knoepp, Wallace, & Miller, 2018; Hogue, Menon, Dunlop, & Kramer, 2011; Hong et al, 2017; Kramer, Hogue, Dunlop, & Menon, 2011; Menon, Dunlop, Kramer, Fortunato, & Hogue, 2011; Mohlman & Levy, 2016; Straughen, Sipahi, Uddin, Misra, & Misra, 2015; Strutz et al, 2014; Zhao et al, 2015), which only accounted for one-third of black-white differences (Goldenberg et al, 1996). Area-level factors such as racial residential segregation may further explain these disparities.…”