Abstract
Prenatal passive smoke exposure raises risk for negative birth outcomes. Legislation regulating public smoking has been shown to impact exposure levels, though fewer studies involving pregnant women have been conducted within the U.S. where bans are inconsistent across regions. This study examined the effect of a ban enacted in the southeastern U.S. on pregnant women’s cotinine levels. Additional analyses compared self-reported exposure to cotinine and identified characteristics associated with passive exposure. Pregnant women (N = 851) were recruited prospectively between 2005 and 2011 in North Carolina. Sociodemographic and health data were collected via surveys; maternal blood samples were assayed for cotinine. Among non-active smokers who provided self-report data regarding passive exposure (N = 503), 20% were inconsistent with corresponding cotinine. Among all non-smokers (N = 668), being unmarried, African American, and less educated were each associated with greater passive exposure. Controlling for covariates, mean cotinine was higher prior to the ban compared to after, F(1, 640) = 24.65, p < 0.001. Results suggest that banning smoking in public spaces may reduce passive smoke exposure for non-smoking pregnant women. These data are some of the first to examine the impact of legislation on passive smoke exposure in pregnant women within the U.S. using a biomarker and can inform policy in regions lacking comprehensive smoke-free legislation.
Highlights
Comprehensive smoke-free legislation is inconsistent across the United States [1], and marked disparities remain regarding risk for passive smoke exposure [2]
Several individual-level characteristics were associated with increased risk for passive smoke exposure, including being African American, unmarried, and lower educational attainment
American samples have been attributed to several factors, including a greater density of tobacco retail outlets located in areas with racial/ethnic minority populations [52], a history of targeted marketing and promotion of tobacco products in African American publications [53], differences in nicotine metabolism [54], and relative preferences for mentholated cigarettes [55], which some studies have associated with higher nicotine levels [56]. Replicating these findings in a sample of pregnant women is especially important as African Americans experience a disproportionate rate of disease burden compared to Caucasians, and the current results indicate that disparities in the effects of smoke exposure begin in utero even among non-active smokers
Summary
Comprehensive smoke-free legislation is inconsistent across the United States [1], and marked disparities remain regarding risk for passive smoke exposure [2]. Public Health 2018, 15, 83; doi:10.3390/ijerph15010083 www.mdpi.com/journal/ijerph
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