Age and racial/ethnic disparities in prepregnancy smoking among women who delivered live births

Abstract

Introduction: Prenatal smoking prevalence remains high in the United States. To reduce prenatal smoking prevalence, efforts should focus on delivering evidence-based cessation interventions to women who are most likely to smoke before pregnancy. Our objective was to identify groups with the highest prepregnancy smoking prevalence by age within 6 racial/ethnic groups.

Methods: We analyzed data from 186,064 women with a recent live birth from 32 states and New York City from the 2004-2008 Pregnancy Risk Assessment Monitoring System (PRAMS), a population-based survey of postpartum women. We calculated self-reported smoking prevalence during the 3 months before pregnancy for 6 maternal racial/ethnic groups by maternal age (18-24 y or ≥25 y). For each racial/ethnic group, we modeled the probability of smoking by age, adjusting for education, Medicaid enrollment, parity, pregnancy intention, state of residence, and year of birth.

Results: Younger women had higher prepregnancy smoking prevalence (33.2%) than older women (17.6%), overall and in all racial/ethnic groups. Smoking prevalences were higher among younger non-Hispanic whites (46.4%), younger Alaska Natives (55.6%), and younger American Indians (46.9%). After adjusting for confounders, younger non-Hispanic whites, Hispanics, Alaska Natives, and Asian/Pacific Islanders were 1.12 to 1.50 times as likely to smoke as their older counterparts.

Conclusion: Age-appropriate and culturally specific tobacco control interventions should be integrated into reproductive health settings to reach younger non-Hispanic white, Alaska Native, and American Indian women before they become pregnant.

Figure 1.

Prepregnancy smoking prevalence by maternal race/ethnicity and age among women who recently delivered a live birth, 32 states and New York City, Pregnancy Risk Assessment Monitoring System, 2004-2008. Prepregnancy smoking prevalence is defined as the percentage of women who recently delivered a live birth who self-reported smoking during the 3 months before pregnancy; error bars represent 95% confidence intervals (CIs) for prepregnancy smoking prevalence. Prepregnancy prevalence comparing women aged 18 to 24 years with women aged 25 years or older was significant (P < .05, χ² test) for the overall study population and within all racial/ethnic groups. PRAMS data available for 2004-2008, except where noted: Alaska, Arkansas, Colorado, Delaware (2007-2008), Florida (2004-2005), Georgia, Hawaii, Illinois, Louisiana (2004), Maine, Maryland, Massachusetts (2007-2008), Michigan, Minnesota, Mississippi (2004, 2006, 2008), Missouri (2007), Nebraska, New Jersey, New Mexico (2004-2005), New York (excluding New York City), New York City (2004-2007), North Carolina (2004-2005, 2007-2008), Ohio (2005-2008), Oklahoma, Oregon, Rhode Island, South Carolina (2004-2007), Tennessee (2008), Utah, Washington, West Virginia, Wisconsin (2007-2008), and Wyoming (2007-2008).

Figure 2.

Proportion of prepregnancy smokers by average number of cigarettes smoked per day, by maternal race/ethnicity and age among women who recently delivered a live birth, 32 states and New York City, Pregnancy Risk Assessment Monitoring System (PRAMS), 2004-2008. Prepregnancy smoking is defined as self-reported smoking of any amount of cigarettes during the 3 months before pregnancy. Proportion of prepregnancy smokers by average number of cigarettes smoked per day was significant (P < .05, χ² test) comparing women aged 18 to 24 years with women aged 25 years or older for the overall study population and among non-Hispanic whites. PRAMS data available for 2004-2008, except where noted: Alaska, Arkansas, Colorado, Delaware (2007-2008), Florida (2004-2005), Georgia, Hawaii, Illinois, Louisiana (2004), Maine, Maryland, Massachusetts (2007-2008), Michigan, Minnesota, Mississippi (2004, 2006, 2008), Missouri (2007), Nebraska, New Jersey, New Mexico (2004-2005), New York (excluding New York City), New York City (2004-2007), North Carolina (2004-2005, 2007-2008), Ohio (2005-2008), Oklahoma, Oregon, Rhode Island, South Carolina (2004-2007), Tennessee (2008), Utah, Washington, West Virginia, Wisconsin (2007-2008), and Wyoming (2007-2008).