Neighborhood deprivation and maternal smoking and drinking during pregnancy: an analysis of the Georgia PRAMS survey, 2009 - 2011 Open Access

Kaiser, Emma (2017)

Permanent URL: https://etd.library.emory.edu/concern/etds/jm214p840?locale=en
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Abstract

Background: Many studies have indicated that living in a deprived neighborhood may increase the risk of smoking or drinking during pregnancy, when these two behaviors are examined separately. This study investigated the effect of neighborhood deprivation on smoking and drinking during pregnancy as separate outcomes, and also examined the effect of neighborhood on both smoking and drinking during pregnancy.

Methods: Georgia Pregnancy Risk Assessment Monitoring System Phase 6 survey data from 2009 - 2011 was linked to birth certificate information from these same years, and this dataset was then linked to a dataset containing neighborhood deprivation information. Logistic regression was performed using SAS complex survey design procedures.

Results: The final analysis dataset contained 3,325 observations, and in the study population 264 women smoked during pregnancy, 143 drank during pregnancy, and 34 women smoked and drank during pregnancy. The association between NDI and drinking or smoking during pregnancy was modified by several individual level characteristics. The association between a 1 standard deviation increase in NDI and drinking during pregnancy among women enrolled in Medicaid was 0.97 (95% CI: 0.61, 1.53), and the association among those not enrolled in Medicaid was 0.63 (95% CI: 0.40, 0.98). Among women of non-Hispanic black race, the association between a one standard deviation increase in NDI and smoking during pregnancy was 1.66 (95% CI: 1.08, 2.55), however, among women of non-Hispanic white race, the association between a one standard deviation increase in NDI and smoking during pregnancy was 0.95 (95% CI: 0.69, 1.32). The association between a one standard deviation increase in NDI and smoking and drinking during pregnancy was 1.36 (95% CI: 0.65, 2.87).

Conclusion: High neighborhood deprivation is associated with higher odds of smoking during pregnancy among women of non-Hispanic black race, and with lower odds of drinking during pregnancy among women not enrolled in Medicaid. Low neighborhood deprivation is associated with lower odds of smoking and drinking during pregnancy. Interventions aimed at reducing smoking and drinking during pregnancy should consider the level of neighborhood deprivation when targeting women of certain races.

Table of Contents

Literature Review………………………………………..…………………………………………1

Summary………………………………………………………………………….1

Neighborhood Socioeconomic Deprivation…………………………………………...…..1

Neighborhood Studies and Measuring Neighborhood deprivation………………1

Standardized Neighborhood Deprivation Index………………………………….3

Effects of Neighborhood Deprivation on Health……………………………...….4

Effects of Neighborhood Deprivation on Birth Outcomes…………………….....5

Smoking during Pregnancy………………………………………………………………..6

Prevalence and Measurement………………………………………………….....6

Adverse Health Outcomes for Smoking during Pregnancy…………………...….7

Individual Risk Factors……………………………………………………….…..8

Neighborhood Deprivation and Smoking during Pregnancy……………………..9

Drinking during Pregnancy………………………………………………………...…….10

Prevalence and Measurement………………………………………………...…10

Adverse Health Outcomes for Drinking during Pregnancy……………………..11

Individual Risk Factors………………………………………………………….12

Neighborhood Deprivation and Drinking during Pregnancy………………..…..13

Smoking and Drinking Co-occurrence……………………………………………….….14

Neighborhood Deprivation on Smoking and Drinking during Pregnancy in Georgia…………………………………………………………………………..15

Study Objectives……………………………………………………………..….15

Introduction……………………………………………………………………………………….17

Neighborhood Deprivation……………………………………………………………....17

Smoking and drinking during Pregnancy…………………………………………..……18

Methods……………………………………………………………………………………..…….21

Study Design……………………………………………………………………………..21

Study Population……………………………………………………………………..…..21

Measures and Variables…………………………………………………………….……22

Smoking and drinking during Pregnancy…………………………………...…..22

Neighborhood Deprivation………………………………………………….…..22

Causal Diagrams…………………………………………………………….…..23

Covariates…………………………………………………………………...…..26

Potential Interactions………………………………………………………..…..27

Statistical Analysis………………………………………………………………….……28

Results……………………………………………………………………………………….……30

Descriptive Statistics……………………………………………………………………..30

Model Results…………………………………………………………………………....32

Model Fit…………………………………………………………………………………34

Discussion……………………………………………………………………………………...…36

Strengths and Limitations………………………………………………………………..37

Future Research……………………………………………………………………...…..38

References…………………………………………………………………………………….…..39

Tables………………………………………………………………………………………..……46

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