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. 2003 Aug;57(8):606–611. doi: 10.1136/jech.57.8.606

Preterm birth among African American and white women: a multilevel analysis of socioeconomic characteristics and cigarette smoking

J Ahern 1, K Pickett 1, S Selvin 1, B Abrams 1
PMCID: PMC1732558  PMID: 12883067

Abstract

Study objective: Research shows that neighbourhood socioeconomic factors are associated with preterm delivery. This study examined whether cigarette smoking and individual socioeconomic factors modify the effects of neighbourhood factors on preterm delivery.

Design: Case-control study.

Setting: Moffit Hospital in San Francisco, California.

Participants: 417 African American and 1244 white women, including all preterm and a random selection of term deliveries 1980–1990, excluding non-singleton pregnancies, congenital anomolies, induced deliveries, and women transported for special care. US census data from 1980 and 1990 were used to characterise the women's neighbourhoods, defined as census tracts.

Results: Cigarette smoking increased the risk of preterm delivery among both African American (OR=1.77, 95% confidence intervals (CI) (1.12 to 2.79)) and white women (OR=1.25, 95% CI (1.01 to 1.55)). However, cigarette smoking did not attenuate or modify the association of neighbourhood factors with preterm delivery. Among African American women, having public insurance modified the relation between neighbourhood unemployment and preterm delivery; among women without public insurance, the risk of preterm delivery was low in areas with low unemployment and high in areas with high unemployment, while among women with public insurance the risk of preterm delivery was highest at low levels of neighbourhood unemployment.

Conclusions: Cigarette smoking was associated with preterm delivery, especially among African Americans. Adverse neighbourhood conditions had an influence on preterm delivery beyond that of cigarette smoking. The effects of some neighbourhood characteristics were different depending on individual socioeconomic status. Examining socioeconomic and behavioural/biological risk factors together may increase understanding of the complex causes of preterm delivery.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abrams B., Carmichael S., Selvin S. Factors associated with the pattern of maternal weight gain during pregnancy. Obstet Gynecol. 1995 Aug;86(2):170–176. doi: 10.1016/0029-7844(95)00119-c. [DOI] [PubMed] [Google Scholar]
  2. Andres R. L., Day M. C. Perinatal complications associated with maternal tobacco use. Semin Neonatol. 2000 Aug;5(3):231–241. doi: 10.1053/siny.2000.0025. [DOI] [PubMed] [Google Scholar]
  3. Berkowitz G. S., Papiernik E. Epidemiology of preterm birth. Epidemiol Rev. 1993;15(2):414–443. doi: 10.1093/oxfordjournals.epirev.a036128. [DOI] [PubMed] [Google Scholar]
  4. Blackwell A. L. Vaginal bacterial phaginosis? Sex Transm Infect. 1999 Oct;75(5):352–353. doi: 10.1136/sti.75.5.352. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Catalano R., Hansen H. T., Hartig T. The ecological effect of unemployment on the incidence of very low birthweight in Norway and Sweden. J Health Soc Behav. 1999 Dec;40(4):422–428. [PubMed] [Google Scholar]
  6. Collins J. W., Jr, Herman A. A., David R. J. Very-low-birthweight infants and income incongruity among African American and white parents in Chicago. Am J Public Health. 1997 Mar;87(3):414–417. doi: 10.2105/ajph.87.3.414. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Cu-Uvin S., Hogan J. W., Warren D., Klein R. S., Peipert J., Schuman P., Holmberg S., Anderson J., Schoenbaum E., Vlahov D. Prevalence of lower genital tract infections among human immunodeficiency virus (HIV)-seropositive and high-risk HIV-seronegative women. HIV Epidemiology Research Study Group. Clin Infect Dis. 1999 Nov;29(5):1145–1150. doi: 10.1086/313434. [DOI] [PubMed] [Google Scholar]
  8. Ekwo E. E., Moawad A. Maternal age and preterm births in a black population. Paediatr Perinat Epidemiol. 2000 Apr;14(2):145–151. doi: 10.1046/j.1365-3016.2000.00234.x. [DOI] [PubMed] [Google Scholar]
  9. Goldenberg R. L., Klebanoff M. A., Nugent R., Krohn M. A., Hillier S., Andrews W. W. Bacterial colonization of the vagina during pregnancy in four ethnic groups. Vaginal Infections and Prematurity Study Group. Am J Obstet Gynecol. 1996 May;174(5):1618–1621. doi: 10.1016/s0002-9378(96)70617-8. [DOI] [PubMed] [Google Scholar]
  10. Hillier S. L., Nugent R. P., Eschenbach D. A., Krohn M. A., Gibbs R. S., Martin D. H., Cotch M. F., Edelman R., Pastorek J. G., 2nd, Rao A. V. Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant. The Vaginal Infections and Prematurity Study Group. N Engl J Med. 1995 Dec 28;333(26):1737–1742. doi: 10.1056/NEJM199512283332604. [DOI] [PubMed] [Google Scholar]
  11. Horta B. L., Victora C. G., Menezes A. M., Halpern R., Barros F. C. Low birthweight, preterm births and intrauterine growth retardation in relation to maternal smoking. Paediatr Perinat Epidemiol. 1997 Apr;11(2):140–151. doi: 10.1046/j.1365-3016.1997.d01-17.x. [DOI] [PubMed] [Google Scholar]
  12. Istvan J. Stress, anxiety, and birth outcomes: a critical review of the evidence. Psychol Bull. 1986 Nov;100(3):331–348. [PubMed] [Google Scholar]
  13. Järvelin M. R., Elliott P., Kleinschmidt I., Martuzzi M., Grundy C., Hartikainen A. L., Rantakallio P. Ecological and individual predictors of birthweight in a northern Finland birth cohort 1986. Paediatr Perinat Epidemiol. 1997 Jul;11(3):298–312. doi: 10.1111/j.1365-3016.1997.tb00007.x. [DOI] [PubMed] [Google Scholar]
  14. Katz V. L., Jenkins T., Haley L., Bowes W. A., Jr Catecholamine levels in pregnant physicians and nurses: a pilot study of stress and pregnancy. Obstet Gynecol. 1991 Mar;77(3):338–342. [PubMed] [Google Scholar]
  15. Katz V. L., Miller N. H., Bowes W. A., Jr Pregnancy complications of physicians. West J Med. 1988 Dec;149(6):704–707. [PMC free article] [PubMed] [Google Scholar]
  16. Krieger N., Rowley D. L., Herman A. A., Avery B., Phillips M. T. Racism, sexism, and social class: implications for studies of health, disease, and well-being. Am J Prev Med. 1993 Nov-Dec;9(6 Suppl):82–122. [PubMed] [Google Scholar]
  17. Krieger N. Women and social class: a methodological study comparing individual, household, and census measures as predictors of black/white differences in reproductive history. J Epidemiol Community Health. 1991 Mar;45(1):35–42. doi: 10.1136/jech.45.1.35. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Kyrklund-Blomberg N. B., Cnattingius S. Preterm birth and maternal smoking: risks related to gestational age and onset of delivery. Am J Obstet Gynecol. 1998 Oct;179(4):1051–1055. doi: 10.1016/s0002-9378(98)70214-5. [DOI] [PubMed] [Google Scholar]
  19. Llahi-Camp J. M., Rai R., Ison C., Regan L., Taylor-Robinson D. Association of bacterial vaginosis with a history of second trimester miscarriage. Hum Reprod. 1996 Jul;11(7):1575–1578. doi: 10.1093/oxfordjournals.humrep.a019440. [DOI] [PubMed] [Google Scholar]
  20. Martinez J. C., Garcia H. O., Otheguy L. E., Drummond G. S., Kappas A. Control of severe hyperbilirubinemia in full-term newborns with the inhibitor of bilirubin production Sn-mesoporphyrin. Pediatrics. 1999 Jan;103(1):1–5. doi: 10.1542/peds.103.1.1. [DOI] [PubMed] [Google Scholar]
  21. Mathews T. J. Smoking during pregnancy in the 1990s. Natl Vital Stat Rep. 2001 Aug 28;49(7):1–14. [PubMed] [Google Scholar]
  22. Matteson D. W., Burr J. A., Marshall J. R. Infant mortality: a multi-level analysis of individual and community risk factors. Soc Sci Med. 1998 Dec;47(11):1841–1854. doi: 10.1016/s0277-9536(98)00229-9. [DOI] [PubMed] [Google Scholar]
  23. Meis P. J., Michielutte R., Peters T. J., Wells H. B., Sands R. E., Coles E. C., Johns K. A. Factors associated with preterm birth in Cardiff, Wales. I. Univariable and multivariable analysis. Am J Obstet Gynecol. 1995 Aug;173(2):590–596. doi: 10.1016/0002-9378(95)90287-2. [DOI] [PubMed] [Google Scholar]
  24. Meis P. J., Michielutte R., Peters T. J., Wells H. B., Sands R. E., Coles E. C., Johns K. A. Factors associated with preterm birth in Cardiff, Wales. II. Indicated and spontaneous preterm birth. Am J Obstet Gynecol. 1995 Aug;173(2):597–602. doi: 10.1016/0002-9378(95)90288-0. [DOI] [PubMed] [Google Scholar]
  25. Morgan M., Chinn S. ACORN group, social class, and child health. J Epidemiol Community Health. 1983 Sep;37(3):196–203. doi: 10.1136/jech.37.3.196. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. O'Campo P., Xue X., Wang M. C., Caughy M. Neighborhood risk factors for low birthweight in Baltimore: a multilevel analysis. Am J Public Health. 1997 Jul;87(7):1113–1118. doi: 10.2105/ajph.87.7.1113. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Olsën P., Lärä E., Rantakallio P., Järvelin M. R., Sarpola A., Hartikainen A. L. Epidemiology of preterm delivery in two birth cohorts with an interval of 20 years. Am J Epidemiol. 1995 Dec 1;142(11):1184–1193. doi: 10.1093/oxfordjournals.aje.a117577. [DOI] [PubMed] [Google Scholar]
  28. Pastore L. M., Royce R. A., Jackson T. P., Thorp J. M., Jr, Savitz D. A., Kreaden U. S. Association between bacterial vaginosis and fetal fibronectin at 24-29 weeks' gestation. Obstet Gynecol. 1999 Jan;93(1):117–123. doi: 10.1016/s0029-7844(98)00336-6. [DOI] [PubMed] [Google Scholar]
  29. Peacock J. L., Bland J. M., Anderson H. R. Preterm delivery: effects of socioeconomic factors, psychological stress, smoking, alcohol, and caffeine. BMJ. 1995 Aug 26;311(7004):531–535. doi: 10.1136/bmj.311.7004.531. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Pearl M., Braveman P., Abrams B. The relationship of neighborhood socioeconomic characteristics to birthweight among 5 ethnic groups in California. Am J Public Health. 2001 Nov;91(11):1808–1814. doi: 10.2105/ajph.91.11.1808. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Perkins S. L., Belcher J. M., Livesey J. F. A Canadian tertiary care centre study of maternal and umbilical cord cotinine levels as markers of smoking during pregnancy: relationship to neonatal effects. Can J Public Health. 1997 Jul-Aug;88(4):232–237. doi: 10.1007/BF03404788. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Pickett K. E., Abrams B., Selvin S. Defining preterm delivery--the epidemiology of clinical presentation. Paediatr Perinat Epidemiol. 2000 Oct;14(4):305–308. doi: 10.1046/j.1365-3016.2000.00293.x. [DOI] [PubMed] [Google Scholar]
  33. Pickett K. E., Pearl M. Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review. J Epidemiol Community Health. 2001 Feb;55(2):111–122. doi: 10.1136/jech.55.2.111. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Pickett Kate E., Ahern Jennifer E., Selvin Steve, Abrams Barbara. Neighborhood socioeconomic status, maternal race and preterm delivery: a case-control study. Ann Epidemiol. 2002 Aug;12(6):410–418. doi: 10.1016/s1047-2797(01)00249-6. [DOI] [PubMed] [Google Scholar]
  35. Pickett Kate E., Wakschlag Lauren S., Dai Lanting, Leventhal Bennett L. Fluctuations of maternal smoking during pregnancy. Obstet Gynecol. 2003 Jan;101(1):140–147. doi: 10.1016/s0029-7844(02)02370-0. [DOI] [PubMed] [Google Scholar]
  36. Pickett Kate E., Wakschlag Lauren S., Rathouz Paul J., Leventhal Bennett L., Abrams Barbara. The working-class context of pregnancy smoking. Health Place. 2002 Sep;8(3):167–175. doi: 10.1016/s1353-8292(01)00042-9. [DOI] [PubMed] [Google Scholar]
  37. Quigley M. E., Sheehan K. L., Wilkes M. M., Yen S. S. Effects of maternal smoking on circulating catecholamine levels and fetal heart rates. Am J Obstet Gynecol. 1979 Mar 15;133(6):685–690. doi: 10.1016/0002-9378(79)90019-x. [DOI] [PubMed] [Google Scholar]
  38. Riduan J. M., Hillier S. L., Utomo B., Wiknjosastro G., Linnan M., Kandun N. Bacterial vaginosis and prematurity in Indonesia: association in early and late pregnancy. Am J Obstet Gynecol. 1993 Jul;169(1):175–178. doi: 10.1016/0002-9378(93)90157-e. [DOI] [PubMed] [Google Scholar]
  39. Rolett A., Kiely J. L. Maternal sociodemographic characteristics as risk factors for preterm birth in twins versus singletons. Paediatr Perinat Epidemiol. 2000 Jul;14(3):211–218. doi: 10.1046/j.1365-3016.2000.00268.x. [DOI] [PubMed] [Google Scholar]
  40. Rowley D. L., Hogue C. J., Blackmore C. A., Ferre C. D., Hatfield-Timajchy K., Branch P., Atrash H. K. Preterm delivery among African-American women: a research strategy. Am J Prev Med. 1993 Nov-Dec;9(6 Suppl):1–6. [PubMed] [Google Scholar]
  41. Shah N. R., Bracken M. B. A systematic review and meta-analysis of prospective studies on the association between maternal cigarette smoking and preterm delivery. Am J Obstet Gynecol. 2000 Feb;182(2):465–472. doi: 10.1016/s0002-9378(00)70240-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Sloggett A., Joshi H. Deprivation indicators as predictors of life events 1981-1992 based on the UK ONS Longitudinal Study. J Epidemiol Community Health. 1998 Apr;52(4):228–233. doi: 10.1136/jech.52.4.228. [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Tchoudomirova K., Stanilova M., Garov V. Clinical manifestations and diagnosis of bacterial vaginosis in a clinic of sexually transmitted diseases. Folia Med (Plovdiv) 1998;40(1):34–40. [PubMed] [Google Scholar]
  44. Wang X., Tager I. B., Van Vunakis H., Speizer F. E., Hanrahan J. P. Maternal smoking during pregnancy, urine cotinine concentrations, and birth outcomes. A prospective cohort study. Int J Epidemiol. 1997 Oct;26(5):978–988. doi: 10.1093/ije/26.5.978. [DOI] [PubMed] [Google Scholar]
  45. Wasserman C. R., Shaw G. M., Selvin S., Gould J. B., Syme S. L. Socioeconomic status, neighborhood social conditions, and neural tube defects. Am J Public Health. 1998 Nov;88(11):1674–1680. doi: 10.2105/ajph.88.11.1674. [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Wisborg K., Henriksen T. B., Hedegaard M., Secher N. J. Smoking during pregnancy and preterm birth. Br J Obstet Gynaecol. 1996 Aug;103(8):800–805. doi: 10.1111/j.1471-0528.1996.tb09877.x. [DOI] [PubMed] [Google Scholar]
  47. Wu T., Buck G., Mendola P. Can regular multivitamin/mineral supplementation modify the relation between maternal smoking and select adverse birth outcomes? Ann Epidemiol. 1998 Apr;8(3):175–183. doi: 10.1016/s1047-2797(97)00201-9. [DOI] [PubMed] [Google Scholar]
  48. ZUSPAN F. P., CIBILS L. A., POSE S. V. Myometrial and cardiovascular responses to alterations in plasma epinephrine and norepinephrine. Am J Obstet Gynecol. 1962 Oct 1;84:841–851. doi: 10.1016/0002-9378(62)90057-1. [DOI] [PubMed] [Google Scholar]
  49. Zeger S. L., Liang K. Y. Longitudinal data analysis for discrete and continuous outcomes. Biometrics. 1986 Mar;42(1):121–130. [PubMed] [Google Scholar]
  50. Zhang H., Bracken M. B. Tree-based risk factor analysis of preterm delivery and small-for-gestational-age birth. Am J Epidemiol. 1995 Jan 1;141(1):70–78. doi: 10.1093/oxfordjournals.aje.a117347. [DOI] [PubMed] [Google Scholar]

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