Differences in Prenatal Tobacco Exposure Patterns among 13 Race/Ethnic Groups in California

Abstract

Prenatal tobacco exposure is a significant, preventable cause of childhood morbidity, yet little is known about exposure risks for many race/ethnic subpopulations. We studied active smoking and environmental tobacco smoke (ETS) exposure in a population-based cohort of 13 racially/ethnically diverse pregnant women: white, African American, Hispanic, Native American, including nine Asian/Pacific Islander subgroups: Chinese, Japanese, Korean, Filipino, Cambodian, Vietnamese, Laotian, Samoan, and Asian Indians (N = 3329). Using the major nicotine metabolite, cotinine, as an objective biomarker, we analyzed mid-pregnancy serum from prenatal screening banked in 1999–2002 from Southern California in an effort to understand differences in tobacco exposure patterns by race/ethnicity, as well as provide a baseline for future work to assess secular changes and longer-term health outcomes. Prevalence of active smoking (based on age- and race-specific cotinine cutpoints) was highest among African American, Samoan, Native Americans and whites (6.8–14.1%); and lowest among Filipinos, Chinese, Vietnamese and Asian Indians (0.3–1.0%). ETS exposure among non-smokers was highest among African Americans and Samoans, followed by Cambodians, Native Americans, Vietnamese and Koreans, and lowest among Filipinos, Japanese, whites, and Chinese. At least 75% of women had detectable cotinine. While for most groups, levels of active smoking corresponded with levels of ETS, divergent patterns were also found. For example, smoking prevalence among white women was among the highest, but the group’s ETS exposure was low among non-smokers; while Vietnamese women were unlikely to be active smokers, they experienced relatively high ETS exposure. Knowledge of race/ethnic differences may be useful in assessing disparities in health outcomes and creating successful tobacco interventions.

Pregnant Women's Perception of Secondhand Smoke Exposure

“…A primary focus of recommendations is specific to reducing firsthand prenatal smoking (American College of Obstetricians and Gynecologists, 2020). Despite smoking restrictions in public places, pregnant women may be exposed to secondhand smoke at home, especially in populations with higher smoking environmental exposure at home such as was found among African American and Native American cultures (Hawkins et al, 2014; Hoshiko et al, 2019). Among nonsmoking pregnant women with secondhand smoke exposure, over 75% had detectable levels of serum cotinine levels indicating high exposure in nonsmoking women (Hoshiko et al, 2019).…”

“…Despite smoking restrictions in public places, pregnant women may be exposed to secondhand smoke at home, especially in populations with higher smoking environmental exposure at home such as was found among African American and Native American cultures (Hawkins et al, 2014; Hoshiko et al, 2019). Among nonsmoking pregnant women with secondhand smoke exposure, over 75% had detectable levels of serum cotinine levels indicating high exposure in nonsmoking women (Hoshiko et al, 2019). Over half of pregnant women living with smokers reported not having a complete smoking ban in their homes and cars, or restricting smoking to reduce exposure (Stotts et al, 2014).…”

A Systematic Review of Racial and Ethnic Disparities in Maternal Health Outcomes among Asians/Pacific Islanders

“…Higher levels of VOC exposure were consistently observed to increase the odds of gestational diabetes mellitus (GDM) among API women, adding to the growing research on the associations between adverse pregnancy outcomes and preconception and prenatal VOC exposure. Similarly, Hoshiko et al (2019) indicated that active smoking and ETS exposure patterns were discordant across groups. For example, Korean, Cambodian, and Vietnamese women had moderate to low active smoking, but high ETS exposure.…”

“…Furthermore, three studies in the review investigated environmental exposures including volatile organic compounds (VOCs) and environmental tobacco smoke (ETS), and found disproportionate exposure levels for API women (Hoshiko et al, 2019;Williams et al, 2019). Williams et al's 2019 study found that nearly 51% of API women were exposed to significantly higher levels of VOCs in both the preconception and first-trimester windows compared to approximately 24% of white, black, and Hispanic women.…”

Methods in Public Health Environmental Justice Research: a Scoping Review from 2018 to 2021

“…Examples of this include studies assessing the association between individual income and residential air pollution exposure [ 60 ], the association between individual race/ethnicity and volatile organic compound metabolite levels [ 150 ], or the association between block group level racial/ethnic composition and income and ambient temperature [ 118 ]. Descriptive analyses were the next most common (32%) and included analyses such as calculating the prevalence of environmental tobacco smoke exposure by the racial/ethnic identity of the birthing person [ 151 ] or the correlation between neighborhood educational attainment and noise levels [ 83 ]. Thirty (14%) exposure-only studies used effect modification methods, either stratification or statistical interaction to test for differential relationships by the health disparity population.…”