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Associations Between Residential Segregation and Smoking During Pregnancy Among Urban African-American Women

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Abstract

Approximately 10% of African-American women smoke during pregnancy compared to 16% of White women. While relatively low, the prevalence of smoking during pregnancy among African-American women exceeds the Healthy People 2010 goal of 1%. In the current study, we address gaps in extant research by focusing on associations between racial/ethnic residential segregation and smoking during pregnancy among urban African-American women. We linked measures of segregation to birth certificates and data from the 2000 census in a sample of US-born African-American women (n = 403,842) living in 216 large US Metropolitan Statistical Areas (MSAs). Logistic regression models with standard errors adjusted for multiple individual observations within MSAs were used to examine associations between segregation and smoking during pregnancy and to control for important socio-demographic confounders. In all models, a u-shaped relationship was observed. Both low segregation and high segregation were associated with higher odds of smoking during pregnancy when compared to moderate segregation. We speculate that low segregation reflects a contagion process, whereby salutary minority group norms are weakened by exposure to the more harmful behavioral norms of the majority population. High segregation may reflect structural attributes associated with smoking such as less stringent tobacco control policies, exposure to urban stressors, targeted marketing of tobacco products, or limited access to treatment for tobacco dependence. A better understanding of both deleterious and protective contextual influences on smoking during pregnancy could help to inform interventions designed to meet Healthy People 2010 target goals.

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Acknowledgements

JF Bell and FJ Zimmerman initiated the study. JF Bell conducted the data analysis in collaboration with FJ Zimmerman. All authors contributed to the study design, interpretation of findings, and manuscript preparation. Dr. Bell’s work on this study was funded, in part, by the Agency for Healthcare Research and Quality (grant number: T32-HS013853-01). A Certificate of Exemption was granted for the research by the University of Washington Human Subjects Division’s Institutional Review Board.

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Correspondence to Janice F Bell.

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Bell, Zimmerman, Mayer, and Huebner are with the Department of Health Services, University of Washington, Seattle, WA, USA; Bell and Zimmerman are with the Child Health Institute, University of Washington, Seattle, WA, USA; Zimmerman and Huebner are with the Maternal and Child Health Program, University of Washington, Seattle, WA, USA; Mayer is with the Department of Geography, University of Washington, Seattle, WA, USA; Mayer is with the School of Medicine (Allergy and Infectious Diseases), University of Washington, Seattle, WA, USA; Mayer is with the Department of Epidemiology, University of Washington, Seattle, WA, USA; Almgren is with the School of Social Work, University of Washington, Seattle, WA, USA; Mayer and Almgren are with the Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, USA; Mayer is with the Department of Family Medicine, University of Washington, Seattle, WA, USA.

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Bell, J.F., Zimmerman, F.J., Mayer, J.D. et al. Associations Between Residential Segregation and Smoking During Pregnancy Among Urban African-American Women. J Urban Health 84, 372–388 (2007). https://doi.org/10.1007/s11524-006-9152-4

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