Geographic Variation in Maternal Smoking during Pregnancy in the Missouri Adolescent Female Twin Study (MOAFTS)

Abstract

ObjectiveDespite well-known adverse health effects of maternal smoking during pregnancy (MSP), it is still unclear if MSP varies geographically and if neighborhood socioeconomic deprivation (SED) plays an important role in MSP. This study aims to investigate small-area geographic variation in MSP and examine the association of SED with MSP.MethodsThe Missouri Adolescent Female Twin Study (MOAFTS) is a cohort study of female like-sex twins born in Missouri to Missouri-resident parents during 1975–1985. Biological mothers completed a baseline interview in 1995–1998 and reported MSP with the twins. Residential address of the mother at birth was geocoded. We developed a census tract-level SED index using a common factor approach based on 21 area-level socioeconomic variables from the 1980 Census data. Multilevel logistic regressions estimated geographic heterogeneity (random effect) in MSP and the odds ratios (ORs, fixed effects) of neighborhood SED associated with MSP.ResultsOf 1658 MOAFTS mothers, 35.2% reported any MSP and 21.9% reported MSP beyond the first trimester. Neighborhood SED was associated with any MSP (the highest vs. the lowest quartile: OR = 1.90, 95% confidence interval [CI] = 1.40–2.57, Ptrend<0.001) and MSP beyond the first trimester (OR = 1.98, 95% CI = 1.38–2.85, Ptrend = 0.002) in unadjusted analyses. After adjusting for individual covariates (demographics, socioeconomic conditions, alcohol use, and parents’ cohabitation), neighborhood SED was not associated with MSP, but geographic variation still persisted in MSP (variance = 0.41, P = 0.003) and in MSP beyond the first trimester (variance = 0.82, P<0.001).ConclusionsNeighborhood SED was associated with MSP in unadjusted analyses but this association could be explained by individual socioeconomic conditions. Nonetheless, significant geographic variation in MSP persisted and was not accounted for by differences in neighborhood SED. To develop effective interventions to reduce MSP, further studies are necessary to explore underlying reasons for its geographic variation.

Neighborhood affluence protects against antenatal smoking: Evidence from a spatial multiple membership model

“…Residence in an economically deprived neighborhood may be a risk factor for antenatal smoking (Finch et al, 2001;Sellström et al, 2008;Nkansah-Amankra, 2010;Räisänen et al, 2014), although Lian et al (2016) find no effect of neighborhood socioeconomic deprivation. Pickett et al (2002) have shown that living in a primarily working-class neighborhood in California increases the risk of antenatal smoking, above and beyond mother's own social class status (here, a working-class neighborhood was indicated by the proportion of residents in administrative support, sales, service, operator and laborer occupations).…”

Adolescent Pregnancy and Smoking in West Virginia: Pregnancy Risk Assessment Monitoring System (PRAMS) 2005–2010

“…The highest SED quartile signified a neighborhood with the most deprived category of socioeconomic condition. The study found that mothers who lived in neighborhoods with the highest SED quartiles were more likely to smoke during pregnancy than those in neighborhoods with the lowest SED quartiles [31].…”

Single Motherhood, Alcohol Dependence, and Smoking During Pregnancy: A Propensity Score Analysis

“…Mothers who reported smoking 100 or more cigarettes were asked if they smoked while pregnant and, if so, for how many weeks or months. Consistent with prior work (Lian et al, 2016), two variables were coded: (a) whether mother smoked during the fi rst trimester, even before knowing she was pregnant and (b) whether mother continued smoking beyond the fi rst trimester, the latter to refl ect chronicity of SDP. Mothers who never smoked or smoked fewer than 100 cigarettes in their lifetime were included in the reference group, along with mothers who smoked 100 or more cigarettes but did not smoke while pregnant.…”

“…A number of sociodemographic predictors were also modeled as covariates in PSAs: maternal educational attainment (years of schooling), maternal age at twins' birth, maternal year of birth, parity (whether twins are mother's fi rstborn), and socioeconomic deprivation of the neighborhood at the time of twins' birth. Using common factor principal components analysis, a neighborhood (census tract) socioeconomic deprivation variable was constructed using eight items identifi ed from 20 census tract-level socioeconomic indicators from 1980 Census data, and matched to residential addresses listed on twins' birth records (Lian et al, 2016). Resulting composite scores for neighborhood socioeconomic deprivation ranged from -1.12 to 6.45, with higher values representing greater deprivation.…”