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Influence of experiences of racial discrimination and ethnic identity on prenatal smoking among urban black and Hispanic women
  1. Kim Hanh Nguyen1,
  2. S V Subramanian2,
  3. Glorian Sorensen2,3,
  4. Kathy Tsang4,
  5. Rosalind J Wright4,5
  1. 1Helen Diller Family Comprehensive Cancer Center, Department of Medicine, University of California, San Francisco, USA
  2. 2Department of Society, Health and Human Development, Harvard School of Public Health, Boston, Massachusetts, USA
  3. 3Dana Farber Cancer Institute, Boston, Massachusetts, USA
  4. 4Channing Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
  5. 5Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA
  1. Correspondence to Kim Hanh Nguyen, Helen Diller Family Comprehensive Cancer Center, University of California, 1450 3rd Street, San Francisco 94111, USA; nguyenk{at}


Background Although the prevalence of prenatal smoking among minority women exceeds the projected 2010 national objective, data on the determinants of prenatal smoking among minorities remain sparse.

Methods We examined associations between self-reported experiences of racial discrimination on prenatal smoking among urban black and Hispanic women aged 18–44 years (n=677). Our main independent variable was created from the Experiences of Discrimination (EOD) scale. Multivariable logistic regression models were estimated to examine the relationship between EOD (moderate EOD as the referent group) and smoking for the entire sample and then separately by race/ethnicity adjusted for sociodemographic variables. We also examined the role of ethnic identity (EI) as a buffer to racial discrimination (n=405).

Results The prevalence of smoking was 18.1% versus 10% for black and Hispanic women, respectively (p=0.002). There were no significant differences in the level of EOD based on race. In multivariate regressions, compared to those reporting moderate EOD, women reporting high discrimination (OR 2.64, 95% CI 1.25 to 5.60) had higher odds of smoking. In stratified analyses, this relationship remained significant only in black women. Results suggest that foreign-born Hispanic women with higher EI were less likely to smoke compared to their low-EI counterparts (3.5 vs 10.1%; p=0.08).

Conclusion These are the first data in pregnant minority women showing an association between discrimination and increased risk of smoking particularly among black women. Ethnic identity and nativity status were also associated with smoking risk. Smoking cessation programmes should consider such factors among childbearing minority women.

  • Ethnic minorities SI
  • smoking & pregnancy
  • social differences
  • social science
  • urban health

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  • Funding The Asthma Coalition on Community, Environment, and Social Stress (ACCESS) study was funded by National Institutes of Health grants R01 ES10932, U01 HL072494, and R01 HL080674. Dr. Subramanian is supported by the National Institutes of Health Career Development Award (NHLBI 1 K25 HL081275). Dr. Nguyen is supported by the National Institutes of Health Diversity Supplement Award (NCI 3R01CA129096).

  • Competing interests None declared.

  • Ethics approval This study was conducted with the approval of the Brigham & Women's Hospital and Harvard School of Public Health.

  • Provenance and peer review Not commissioned; externally peer reviewed.