Racial Differentials in the Impact of Maternal Cigarette Smoking During Pregnancy on Fetal Development and Mortality: Concerns for Black Psychologists

Abstract

Data from more than 60,000 births in the United States were reevaluated by statistical power analysis to determine if racial differentials existed in the impact of maternal cigarette smoking during pregnancy on low birth weight and infant mortality. The risk of mortality was significantly greater for infants of Black maternal smokers than Black nonsmokers. But the same relationship was not evident for Whites. The most dramatic increase in mortality was exhibited among infants of Black mothers who smoked more than one pack of cigarettes per day. Recent estimates indicate that the rate of smoking among pregnant Blacks now surpasses that of Whites, and the number of Black women who smoke more than one pack of cigarettes per day during pregnancy has increased. Racism, sexism, and associated increased levels of psychosocial stress appear to be implicated in the etiology of these racial differentials.

Perceived Discrimination and Substance Use in African American Parents and Their Children: A Panel Study.

“…Equally plausible, but also largely unsupported, is the belief that there is a causal relation between discrimination and substance use among African Americans. It has been suggested, for example, that experience with racism increases the likelihood that African Americans will smoke cigarettes (Singleton, Harrell, & Kelly, 1986), drink alcohol (Brown & Tooley, 1989; Sanders-Phillips, 1999), and use and abuse substances in general (Clark et al, 1999; Curtis-Boles & Jenkins-Monroe, 2000; Williams & Neighbors, 2001; Windle, Shope, & Bukstein, 1996; Wright, 2001). In fact, a number of studies have found evidence of positive correlations between substance use and either perceived discrimination or a belief that racism toward African Americans continues to exist in the United States (Sanders-Phillips, 1999), but these studies have also used cross-sectional designs.…”

Ethnic minority women, health behaviors, and drug abuse: A continuum of psychosocial risks.

“…Singleton, Harrell, and Kelly (1986) also have reported that smoking among Black women is related to psychosocial stress and experiences of racism. They have noted that smoking in Black women may be related to gender role difficulties, including problems of assertion, independence, rebellion, or identification in relationships with men.…”

“…This conclusion is supported by findings that women who quit smoking are more likely to be married, to have spousal support, and to be employed (U.S. Public Health Service, 1980). Conversely, Black women, who are more likely to be single and live in environments of high stress, are less likely to quit smoking than White women(Singleton et al, 1986).…”

Maternal and infant demographics and health status: a comparison of Black, Caucasian, and Hispanic families

“…Although studies of these predictor variables have been conducted in different ethnic groups, direct ethnic comparisons have rarely been made. When ethnic comparisons have been reported, as, for example, in infant health status as a function of alcohol ingestion and smoking, ethnicity has often been confounded with social class (Bingol et al, 1987;Singleton, Harrell, & Kelly, 1986), thereby obscuring conclusions about ethnic differences. Similarly, predisposing demographic, reproductive, and health factors have rarely been studied in populations of low socioeconomic status (SES) but not at high risk.…”