The Relation of Neighborhood Income to the Age-Related Patterns of Preterm Birth Among White and African-American Women: The Effect of Cigarette Smoking.

Abstract

Objectives We investigated the contributions of cigarette smoking to the age-related patterns of preterm (<37weeks) birth (PTB) rates among African-American and White women within the context of lifelong neighborhood income. Methods Stratified and multilevel logistic regression analyses were performed on an Illinois transgenerational dataset of non-Hispanic White and African-American infants (1989-1991) and their mothers (1956-1976) with appended US census income information. Among non-smoking African-American women (n=20,107) with a lifelong residence in lower income neighborhoods, PTB rates decreased from 18.5% for teens to 15.0% for 30-35year-olds, p<0.0001. The opposite pattern occurred among African-American women smokers (n=5936) with a lifelong residence in lower income neighborhoods, p<0.01. Among upwardly mobile African-American women smokers (n=756), PTB rates increased from 11.1% for teens to 24.9% for 30-35year-olds, p<0.05. Cigarette smoking was not associated with an age-related increase in PTB rates among African-American women with a lifelong residence in upper income neighborhoods. No subgroup of White women, even cigarette smokers with a lifelong residence in lower income neighborhoods, exhibited weathering with regard to PTB. Conclusions A weathering pattern of rising PTB rates with advancing age occurs only among African-American women cigarette smokers with an early-life or lifelong residence in lower income neighborhoods, underscoring the public health policy importance of targeted smoking cessation programs in eliminating the racial disparity in the age-related patterns of PTB rates.