Community Factors and Maternal Smoking: Contributing to the Problem or Helping with the Solution?

Maternal smoking has been recognized as one of the most modifiable causes of mother-infant morbidity and mortality in the United States (CDC, 2005). Pregnancy presents a window of opportunity to help women stop smoking as women are more likely to attempt to quit smoking during pregnancy then at any other point in their lifetime (Sit & Wisner, 2004). Examining both individual and community factors provides richer detail of the factors that impact smoking. While there has been studies conducted examining individual factors in relation to maternal smoking, research is lacking on community factors.

This case control study examined what individual and community factors were related to maternal smoking in Baltimore City. A total of 1000 singleton Birth certificates (500 pregnant smokers, 500 pregnant non-smokers) from the year 2000 were geocoded on census block level, randomly selected, and matched on education and marital status. Individual factors examined included race, age, and medical assistance status. Community factors consisted of crime rate by census block group, and education rate,and poverty rate by census tract. Geographic Information Systems (GIS) methodology was used to link community factors to the census blocks of the pregnant women.

Conditional logistic regression results indicated women who smoked were more likely to be White, older, and living in areas with higher percentage of poverty. Interactions found significant differences between White and minority women for starting smoking and rate of poverty. Specifically, White women where more likely to start smoking as youth, while minority women were more likely to start smoking later in life. Also, White women were more likely to smoke when living in areas with higher levels of poverty, while for minorities, smoking status was unrelated to living in high or low poverty areas.

Findings demonstrate the benefit of using GIS methodology when examining health behaviors. They also provide valuable information in designing maternal smoking interventions for women living in urban areas. Further research is needed on individual and community factors in relation to maternal smoking to support the results found in this study.