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. 2022 Oct;23(7):1078-1089.
doi: 10.1007/s11121-022-01355-7. Epub 2022 Feb 18.

Neighborhood Deprivation is Associated with Increased Risk of Prenatal Smoke Exposure

David C Wheeler  1 , Joseph Boyle  2 , D Jeremy Barsell  3 , Rachel L Maguire  4   5 , Bassam Dahman  3 , Susan K Murphy  4 , Cathrine Hoyo  5 , Jim Zhang  6 , Jason A Oliver  7   8   9 , Joseph McClernon  7 , Bernard F Fuemmeler  3   10
Affiliations

Neighborhood Deprivation is Associated with Increased Risk of Prenatal Smoke Exposure

David C Wheeler et al. Prev Sci. 2022 Oct.

Abstract

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.

Keywords: Bayesian analysis; Neighborhood; Smoke exposure; Socioeconomic status.

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Conflict of interest statement

Conflicts of interest/Competing interests: The authors have no conflicts of interest to declare that are relevant to the content of this article.

Figures

Figure 1.
Figure 1.
Cotinine levels for NEST mothers in Durham County
Figure 2.
Figure 2.
Estimated weights from Bayesian index models with a dashed line for the equal weight value (0.063)
Figure 3.
Figure 3.
Neighborhood deprivation index at the block group level in Durham County estimated from the Bayesian index model for all subjects
See this image and copyright information in PMC

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