| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
RESEARCH AND PRACTICE |
Krista M. Perreira is with the Department of Public Policy, University of North Carolina, Chapel Hill, and the Carolina Population Center, Chapel Hill. Kalena E. Cortes is with the Office of Population Research, Princeton University, Princeton, NJ.
Correspondence: Requests for reprints should be sent to Krista M. Perreira, PhD, Department of Public Policy, University of North Carolina, Abernethy Hall, CB#3435, Chapel Hill, NC 27599-3435 (e-mail: perreira{at}email.unc.edu).
 |
ABSTRACT |
|---|
 TOP ABSTRACT INTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
|---|
Objectives. We examined race/ethnicity and nativity correlates of prenatal substance use.
Methods. Using data on a nationally representative cohort of pregnant women in US cities (N=4185), we evaluated the relative importance of socioeconomic status, paternal health behaviors, social support, and maternal stress and health history in explaining variations in prenatal substance use by race/ethnicity and nativity.
Results. Maternal stress and health history appeared to fully explain differences in alcohol use by nativity, but these and other factors could not explain differences in prenatal smoking. For all races/ethnicities, paternal health behaviors were most strongly associated with maternal substance use. Except among Black women, socioeconomic background bore little relation to prenatal substance use after adjustment for more proximal risk factors (e.g., paternal and maternal health behaviors). Social support was most protective among Hispanic women.
Conclusions. Foreign-born immigrant women are at equal risk of prenatal alcohol use compared with similarly situated US-born women and should not be overlooked in the design of interventions for at-risk women. Furthermore, the inclusion of fathers and the development of social support structures for at-risk women can strengthen interventions.
|
INTRODUCTION |
|---|
|
TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
|---|
The size of racial/ethnic minority and immigrant populations in the United States has increased dramatically during the last decade.8,9 Black, Hispanic, and Asian women now account for 42% of all US live births.10 This demographic change makes it imperative that we evaluate the etiology and epidemiology of prenatal substance use within these populations. Because of the youth and high fertility of immigrant and minority women in the United States relative to US-born Whites, an increasing proportion of substance-exposed infants are likely to be born to them.11,12 Moreover, as immigrant women acculturate to the United States, their risk of substance use during pregnancy increases.13,14
Most national data sets (e.g., the Natality Detail Files, the Pregnancy Risk Assessment Monitoring System) provide information on maternal substance use. Few (e.g., the National Maternal and Infant Health Survey, the National Pregnancy and Health Survey) provide information on both maternal substance use and the socioeconomic and psychosocial risk factors for substance use during pregnancy.15,16 However, studies based on the latter 2 surveys, with their small samples of Hispanics, have not had sufficient data to comprehensively model individual risk and protective factors within racial/ethnic groups and to compare the relative importance of these factors across groups. These limitations can lead to biased estimations and erroneous conclusions about risk and protective factors within minority populations.
Previous state and clinic-based studies have identified 5 sets of factors that influence substance use during pregnancy: (1) demographic factors (e.g., immigrant status,12–14 race/ethnicity,5,11,17,18 age19,20), (2) socioeconomic background (i.e., income, education),14,21 (3) psychosocial resources (especially family and nonfamily social support),17,22–29 (4) paternal behaviors (e.g., domestic violence, substance use history)5,30,31 and (5) maternal stress (especially related to pregnancy wantedness)20,22,25 and health history (e.g., parity, previous drug use, use of prenatal care).6,14,32,33
Using newly available data from the Fragile Families and Child Wellbeing Study,34 we now offer the fullest accounting to date of differences in alcohol and tobacco use during pregnancy by race/ethnicity (non-Hispanic White, non-Hispanic Black, or Hispanic) and nativity (US-born or foreign-born). We identified the prevalence of maternal alcohol, tobacco, and illicit drug use during pregnancy. We then evaluated the relative importance of socioeconomic status, paternal health behaviors, social support, and maternal stress and health history in explaining differences in substance use by race/ethnicity and nativity. Finally, we identified the effects of these risk and protective factors on alcohol and tobacco use within each racial/ethnic group.
|
METHODS |
|---|
|
TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
|---|
Because of their small sample size (n = 154) and ethnic heterogeneity, we excluded "other" races from our analyses. Thus, the analysis focuses on maternal substance use among non-Hispanic Whites, non-Hispanic Blacks, and Hispanics. The deletion of observations with missing values for other covariates reduced our analytic sample to 4185 women. Because of missing weights, the analytic sample was reduced to 3311 women when the data were weighted. To ensure generalizability, prevalence estimates are reported using the weighted sample. To improve the power of our analysis within racial/ethnic groups, the unweighted sample was used in logit analyses. To account for sample design effects, we calculated robust standard errors and adjusted estimates for clustering.
Measures
Outcomes.
Mothers were asked (1) "During your pregnancy, how often did you drink alcoholic beverages (nearly every day, several times a week, several times a month, less than once a month, or never)?" (2) "During your pregnancy, how many cigarettes did you smoke (
2 packs a day, 1 but < 2, < 1, or 0)?" and (3) "During your pregnancy, how often did you use drugs such as marijuana, crack cocaine, or heroine (nearly every day, several times a week, several times a month, once a month, or never)?" Because of recall bias, women are generally more accurate in their report of whether they used substances during pregnancy than in reporting how frequently they used substances during pregnancy.17 Therefore, for our bivariate analyses, we categorized use of each substance as frequent, infrequent, or never. For our multivariate analyses, we dichotomized the responses into 4 variables indicating any alcohol use, any tobacco use, any illicit drug use, and any substance use.
Demographic variables. Self-reported race and ethnicity data were combined to create 3 groups (non-Hispanic White, non-Hispanic Black, Hispanic). Respondents born in the United States or to US citizens in a foreign country were classified as US-born. Respondents born in a US territory (e.g., Puerto Rico) or to non–US citizens in a foreign country were classified as foreign-born. Because of the high correlation between maternal and paternal nativity (r = 0.69) and ethnicity (r = 0.74), only maternal values were used in the analysis. To account for nonlinear age trends, we categorized mother’s age at delivery into 3 groups (< 21 y, 21–30 y, > 30 y). The age 21 cutpoint accounted for differences in legal drinking and smoking ages. The age 30 cut-point allowed for increasing risk of substance use among older women and ensured an adequate cell size for estimations within each racial/ethnic group.
Socioeconomic variables. Maternal education (< 12 y, 12 y, some college, college graduate), welfare status (yes, no), and homeownership (yes, no) were reported by the mother in her interview. Although mothers also reported income, concern about biased self-reports and missing values led us to focus on maternal education, welfare status, and home-ownership as measures of socioeconomic status. In additional analyses (not shown), income never contributed to our estimations after controlling for these 3 socioeconomic status measures. Analyses of correlations among covariates indicated that being a high-school dropout (< 12 y of education) was correlated with welfare receipt (r = 0.21), and college graduation was correlated with home-ownership (r = 0.23).
Social support variables. We considered both family and nonfamily social support. Family support was determined by a mother’s marital relationship to the father of her newborn (married, cohabiting, single/uninvolved); whether her newborn’s father often expressed love and affection for her (i.e., father support); and whether she could count on someone in her family for financial or in-kind assistance (i.e., kin support). Nonfamily support was determined by whether the mother worked while she was pregnant; whether she had lived in her current community for more than 1 year; and whether she attended church at least several times each month (i.e., religious support). Among social support variables, only the correlation between single/uninvolved marital status and father support was significant (r = –0.26).
Paternal health behaviors. With reference to the past 3 months, fathers were asked the same questions as mothers regarding their use of alcohol, tobacco, and illicit drugs. Following our coding of maternal substance use, we dichotomized these into 3 variables indicating any alcohol use, any tobacco use, or any illicit drug use. Domestic violence was indicated if a mother reported that her newborn’s father had previously hit or slapped her when angry. Domestic violence was not highly correlated with other paternal health behaviors. But paternal drinking, smoking, and drug use were correlated with one another (r = 0.26 to r = 0.31).
Maternal stress and health history. Using maternal self-reports, we created 2 indicators of stress associated with the mother’s pregnancy. First, a pregnancy was categorized as unwanted if the mother reported having considered an abortion, having been asked by the father to consider an abortion, or having developed a worsening relationship with the father because of the pregnancy. Second, a mother was identified as experiencing additional stress if she lived in a neighborhood where she felt unsafe. These 2 variables were not highly correlated (r = 0.09).
Measures of maternal health history included whether this was the mother’s first birth (yes, no), whether the mother received prenatal care within the first trimester (yes, no), and whether the mother had previously received treatment for drug or alcohol abuse (yes, no). In previous research, large age differences between mothers and their babies’ fathers have been associated with intimate partner violence and unwanted pregnancies.35,36 Therefore, we also controlled for whether a mother was 10 or more years older or younger than her partner as part of this set of variables. Correlations on maternal health variables ranged from –0.06 to 0.11.
Analysis
We began by using the weighted data to estimate the prevalence of substance use by race/ethnicity and nativity. Calculations of standard errors took the sampling design into effect and adjusted for clustering within cities. Differences in prevalence rates were tested with Student–Newman–Keuls adjustments (a 2-tailed test) for multiple comparisons. Because of the relatively low prevalence of maternal illicit drug use and small expected frequencies, we did not evaluate risk factors for maternal illicit drug use in the multivariate analyses; we focused only on maternal alcohol and tobacco use during pregnancy.
We used logits to estimate the independent associations of race/ethnicity and nativity with alcohol and tobacco use. To maximize the power of our analysis, we used the unweighted data but calculated robust standard errors and adjusted for clustering. We report adjusted odds ratios and 95% confidence intervals after (1) adjusting only for the age of the mother (baseline model); (2) adding only socioeconomic factors to the baseline model; (3) adding only social support factors to the baseline model; (4) adding only paternal health behaviors to the baseline model; and (5) adding only maternal stress and health history to the baseline model. We report the adjusted odds of alcohol and tobacco use by race/ethnicity and nativity after adjusting for all 5 sets of covariates and dichotomous indicators for each city. The inclusion of city indicators allowed us to control for unobserved variations by city of residence (e.g., alcohol or cigarette taxes37–42) that are associated with a mother’s substance use. In sum, this analysis provided us with information on how well each set of variables may explain differences in patterns of alcohol and tobacco use by race/ethnicity and nativity. Finally, we present logit models for alcohol and tobacco use by race/ethnicity.
We used Stata 8.0 (Stata Corp, College Station, Tex) for all analyses. All logit analyses using the unweighted data were recalculated using the weighted data. There were no substantial differences in adjusted odds ratios when the weighted data were used, but the results were less precise. In addition, we also estimated multinomial logits on the level (frequent, infrequent, never) of alcohol and tobacco use during pregnancy. Results (available upon request) showed that the primary risk and protective factors for frequent use were the same as for infrequent use. However, because of small numbers of frequent users, confidence intervals were much wider.
|
RESULTS |
|---|
|
TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
|---|
). Among foreign-born women, alcohol use was 4 times as prevalent as tobacco use during pregnancy (8% vs 2%). Among US-born women, this pattern was reversed. Newborns with White mothers were most at risk of alcohol and tobacco exposure; newborns with Black mothers were most at risk of exposure to illicit drugs; and newborns with Hispanic mothers were the least likely to be exposed to any drugs in utero.
|
1 pack/day), and 1% reported frequent illicit drug use (> 1 use/mo). US-born women and Black women were most likely to be frequent users of any substance.
Determinants of Differences in Alcohol and Tobacco Use by Nativity
After adjusting for mother’s age at birth, foreign-born women were 38% less likely to drink (Table 2, Alcohol use). Adjustments for maternal stress and health history explained 24% of the initial differences in alcohol use by nativity. Adjustments for socioeconomic factors, social support, and paternal health behaviors each accounted for substantially less of the variation in alcohol use by nativity, but when combined with maternal stress and health history (column 6) we identified no remaining significant differences in alcohol use by nativity.
|
, Tobacco use). Adjusting for socioeconomic background and other factors slightly accentuated the differences in prenatal smoking behaviors between foreign-born and US-born mothers.
Determinants of Differences in Alcohol and Tobacco Use by Race/Ethnicity
Adjustments for our covariates (i.e., socioeconomic background, social supports, paternal health behaviors, maternal stress and health history) magnified differences in substance use between Whites and non-Whites (Table 2). All else being equal, Black mothers were 71% less likely than Whites to smoke during pregnancy and 41% less likely to drink. Likewise, Hispanic mothers were 76% less likely to smoke during pregnancy and 58% less likely to drink alcohol than their White counterparts. By contrast, once we adjusted for differences between Blacks and Hispanics regarding maternal stress and health history, no significant differences in alcohol use (
B–H2 = 3.74; P < .06) or tobacco use (B–H2 = 3.39; P < .07) remained between these 2 populations.
Correlates of Alcohol and Tobacco Use by Race/Ethnicity
The persistence of differences in alcohol and tobacco use between Whites and non-Whites suggested that our models could be improved by including interactions between race/ethnicity and each of our covariates. A test of the equality of coefficients across logit estimates for our different racial/ethnic sub-samples confirmed that alcohol use (Table 3) and tobacco use (Table 4) for each racial/thnic group were differentially influenced by covariates in our model.43
|
|
Socioeconomic factors. For Blacks, our results showed that both the least and most educated women were at risk for prenatal alcohol use. Among Whites, only wealthier and more educated persons were at risk for pre-natal alcohol use. On the other hand, tobacco use during pregnancy was concentrated among less educated and poorer women (especially those receiving welfare) in both populations. Socioeconomic factors did not help to explain prenatal substance use among Hispanic women.
Social support. The importance of social support differed significantly between Hispanic and non-Hispanic women. Among non-Hispanic White and Black women, marriage to a partner and having family to count on for financial support were associated with less prenatal substance use. In contrast, what mattered most for Hispanic women was not their marital status but the supportiveness of their newborn’s father. Hispanic women with partners who consistently expressed love and affection for them were less likely to engage in alcohol or smoking behaviors that might harm their fetuses.
Our results indicated that, outside of the family, social support from coworkers, religious peers, and neighbors reduced the likelihood of any prenatal substance use. Religious support was the most instrumental form of social support for Hispanics. Time in residence was relatively more important for Black and White women, especially with respect to alcohol use.
Paternal health behaviors. All women were more likely to report prenatal substance use if their newborn’s father also reported substance use. Paternal alcohol and drug use were associated most strongly with maternal alcohol use, and paternal smoking was associated most strongly with maternal smoking. Women, especially Black and White women, who had experienced domestic violence were also more likely to report prenatal alcohol or tobacco use than those who reported no domestic violence history.
Maternal stress and health history. For all women, previous alcohol or drug treatment was associated with smoking, and to a lesser extent, with alcohol use during pregnancy. Black and Hispanic women with significantly older or younger husbands and an unwanted pregnancy were also more likely to have smoked or drunk during their pregnancy. Early prenatal care was associated with a lower likelihood of prenatal substance use among all but Hispanic women.
Combined risks.
Many of these risk factors clustered together. Focusing on modifiable risk factors (i.e., paternal and maternal health variables) that significantly influenced substance use, we calculated actual and predicted prevalence rates by race/ethnicity. These risk factors included (1) a partner who either smoked, drank, or used illicit drugs; (2) a partner with a history of domestic violence; (3) an unwanted pregnancy; (4) mother’s previous alcohol or drug treatment; (5) no prenatal care in the first trimester, (6) a partner 10 or more years older or younger; and (7) low educational status (< 12 y). Eleven percent of the sample had none of these risk factors; 34% had 1; 32% had 2; and 23% had 3 or more. Women with 0, 2, and 3 or more of these risk factors drank at rates of 4%, 10%, and 18%, respectively (rtrend < 0.0001). They smoked at rates of 5%, 20%, and 37%, respectively (rtrend < 0.0001). For all ethnic groups, the predicted prevalence rates (all else equal) for high-risk women with these 7 risk factors set equal to 1 were at least 10 times the predicted prevalence rates for low-risk women with none of these risk factors (Tables 3 and 4).
|
DISCUSSION |
|---|
|
TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
|---|
First, our research confirmed that, adjusted for key confounders, US-born and foreign-born (mostly Hispanic) women were at equal risk of alcohol use during pregnancy.12 We also confirmed that Hispanic and Black women did not differ significantly in their adjusted risks for smoking during pregnancy.16 Thus, despite the overall lower prevalence rates of substance use during pregnancy among Hispanic women, interventions should be designed and evaluated for high-risk women within this population. These women include US-born Hispanics over age 21 with an unwanted pregnancy and a partner who smokes regularly or has used illicit drugs, who is significantly older or younger, and who is not emotionally supportive.
Second, regardless of marital status, a woman’s substance use during pregnancy was highly correlated with her partner’s substance use and the degree of emotional support he provided. Among Black and White women, a history of partner violence was associated with substance use. Among Hispanic women, the absence of domestic violence (i.e., receiving love and affection from their partner) was associated with less risk of prenatal substance use. Given the significance of this finding, attention should be given to intervention efforts that include women’s partners.
Third, many risk factors clustered together. Women at risk for prenatal substance use tended to have partners with a history of substance use, an unwanted pregnancy, and previous participation in alcohol or drug treatment programs. Moreover, they were women who typically had not received early prenatal care. Prenatal care and health education programs can be most cost-effective when focused on these high-risk women.44–46
Although the Fragile Families and Child Wellbeing Study data have allowed us to evaluate the relative importance of a wide variety of factors that influence alcohol and tobacco use during pregnancy, the substance use data rely on retrospective self-reports and do not provide information on the timing of substance use during pregnancy. Although no other method of measuring substance use during pregnancy—medical records, clinical interviews, laboratory assessments—can be considered a gold standard,17,21,29 self-reports are subject to recall biases that may lead to underreporting, especially with respect to level of use.47 If nonresponders are also more at risk of substance use, then this would further decrease our prevalence estimates. Despite these potential limitations, prevalence estimates from the Fragile Families and Child Wellbeing Study data were comparable to those estimated from the 1999 National Household Survey on Drug Abuse. According to this survey, 13.8% of pregnant women reported alcohol use, 17.6% reported tobacco use, and 3.4% reported illegal drug use.47
Our research shows the importance of identifying risk and protective factors within racial/ethnic groups. We were able to conduct separate analyses for Black, White, and Hispanic populations. Future data collection efforts should include larger subsamples of Asians, the second fastest growing population group in the United States,4 and should collect information on immigrant status and country of origin, which will allow researchers to move away from treating Asian and Hispanic populations as panethnic groups. This information is needed to ensure that prevention and intervention programs are well targeted and responsive to changes in population demographics.
|
Acknowledgments |
|---|
The authors thank Sara McLanahan, David Savitz, and William Vega for their support of this research and contributions to the study.
Human Participant Protection
This study was approved by the institutional review board of the University of North Carolina at Chapel Hill.
|
Footnotes |
|---|
Contributors
K. M. Perreira was responsible for study conception, data analysis and interpretation, and article preparation. K. E. Cortes contributed to the study conception and analysis.
Accepted for publication October 21, 2005.
|
References |
|---|
|
TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
|---|
2. Centers for Disease Control and Prevention. State Prenatal Smoking Databook, 1999. Atlanta, Ga: Centers for Disease Control and Prevention; 2002.
3. Office of Behavioral and Social Sciences Research. Progress and Promise in Research on Social and Cultural Dimensions of Health: A Research Agenda. Bethesda, Md: National Institutes of Health; 2001. NIH Publication 01-5020.
4. National Institutes of Health. Social and Cultural Dimensions of Health. Bethesda, Md: National Institutes of Health; 2002. Program Announcement PA-02-043.
5. Wallace JM. The social ecology of addiction: race, risk, and resilience. Pediatrics. 1999;103:1122–1127.
6. Kaskutas LA. Understanding drinking during pregnancy among urban American Indians and African Americans: health messages, risk beliefs, and how we measure consumption. Alcohol Clin Exp Res. 2000; 24:1241–1250.[CrossRef][Web of Science][Medline]
7. Vega WA, Gil AG. Drug Use and Ethnicity in Early Adolescence. New York, NY: Plenum Press; 1998.
8. US Census Bureau. Demographic Trends in the 20th Century. Washington, DC: Government Printing Office; 2002. Census 2000 Special Reports, Series CNSR-4.
9. US Census Bureau. Profile of the Foreign-Born Population in the United States, 2000. Washington, DC: Government Printing Office; 2001. Current Population Report P23–206.
10. Martin JA, Hamilton BE, Ventura SJ, Menacker F, Park MM, Sutton PD. Births: final data for 2001. Natl Vital Stat Rep. 2002;51:1–102.[Medline]
11. Vega WA, Kolody B, Hwang J, Noble A. Prevalence and magnitude of perinatal substance exposures in California. N Engl J Med. 1993;329:850–854.
12. Vega WA, Kolody B, Hwang J, Noble A, Porter P. Perinatal drug use among immigrant and native-born Latinas. Subst Use Misuse. 1997;32:43–62.[Web of Science][Medline]
13. Finch BK, Boardman JD, Vega WA, Kolody B. Contextual effects of acculturation on perinatal substance exposure among immigrant and native-born Latinas. Soc Sci Q. 2000;81:421–438.[Medline]
14. Finch BK, Vega WA, Kolody B. Substance use during pregnancy in the state of California, USA. Soc Sci Med. 2001;52:571–583.[CrossRef][Web of Science][Medline]
15. Mathias R. NIDA survey provides first national data on drug use during pregnancy. NIDA Notes. 1995;10(1):6.
16. Kahn RS, Certain L, Whitaker RC. A reexamination of smoking before, during, and after pregnancy. Am J Public Health. 2002;92:1801–1808.
17. Hutchins E. Drug use during pregnancy. J Drug Issues. 1997;27:463–485.
18. Wiemann CM, Berenson AB, Landwehr BM. Racial and ethnic correlates of tobacco, alcohol, and illicit drug use in a pregnant population. J Reprod Med. 1995;40:571–578.[Web of Science][Medline]
19. Perham-Hester KA, Gessner BD. Correlates of drinking during the third trimester of pregnancy in Alaska. Matern Child Health J. 1997;1(3):165–172.[CrossRef][Medline]
20. Marcenko MO, Spence M. Social and psychological correlates of substance abuse among pregnant women. Soc Work Res. 1995;19(2):103–109.
21. Cornelius M, Day N, Richardson G, Taylor P. Epidemiology of substance abuse during pregnancy. In: Ott P, Tarter R, Ammerman R, eds. Sourcebook on Substance Abuse: Etiology, Epidemiology, Assessment, and Treatment. Boston, Mass: Allyn and Bacon; 1999:1–13.
22. Lindenberg CS, Strickland O, Solorzano R, Galvis C, Dreher M, Darrow VC. Correlates of alcohol and drug use among low-income Hispanic immigrant childbearing women living in the United States. Int J Nurs Stud. 1999;36:3–11.[CrossRef][Web of Science][Medline]
23. Coleman JS. Social capital in the creation of human capital. Am J Sociol. 1988;94(suppl):S95–S120.[CrossRef]
24. Syme L. Control and health: a perspective. In: Steptoe A, Appels AD, eds. Stress, Personal Control and Health. New York, NY: John Wiley & Sons; 1989:3–18.
25. Cohen S, Wills T. Stress, social support, and the buffering hypothesis. Psychol Bull. 1985;98:310–357.[CrossRef][Web of Science][Medline]
26. Donovan J, Jessor R, Costa F. Adolescent problem drinking: stability of psychosocial and behavioral correlates across a generation. J Stud Alcohol. 1999; 60:352–361.[Web of Science][Medline]
27. Jessor R, Jessor SL. Problem Behavior and Psychosocial Development: A Longitudinal Study of Youth. San Diego, Calif: Academic Press; 1977.
28. Elder GH. Family Structure and Socialization. New York, NY: Arno Press; 1980.
29. Kokotailo PK, Langhough RE, Cox NS, Davidson SR, Fleming MF. Cigarette, alcohol and other drug use among small city pregnant adolescents. J Adolesc Health. 1994;15:366–373.[CrossRef][Web of Science][Medline]
30. Amaro H, Fried L, Cabral H, Zuckerman B. Violence during pregnancy and substance use. Am J Public Health. 1990;80:575–579.
31. McBride CM, Curry SJ, Grothaus LC, Nelson JC, Lando H, Pirie PL. Partner smoking status and pregnant smoker’s perceptions of support for and likelihood of smoking cessation. Health Psychol. 1998;17:63–69.[CrossRef][Web of Science][Medline]
32. Westphal L. Prenatal alcohol use among urban American Indian/Alaska Native women. Am Indian Alsk Native Ment Health Res. 2000;9(3):38–38.[Medline]
33. Jones-Webb R, McKiver M, Pirie P, Miner K. Relationships between physician advice and tobacco and alcohol use during pregnancy. Am J Prev Med. 1999; 16:244–247.[CrossRef][Web of Science][Medline]
34. Reichman N, Teitler J, Garfinkel I, McLanahan S. Fragile Families: sample and design. Child Youth Serv Rev. 2001;23:303–326.[CrossRef][Web of Science]
35. Coker AL, Smith PH, McKeown RE, King MJ. Frequency and correlates of intimate partner violence by type: physical, sexual, and psychological battering. Am J Public Health. 2000;90:553–559.
36. Le LC, Magnani R, Rice J, Speizer I, Bertrand W. Reassessing the level of unintended pregnancy and its correlates in Vietnam. Stud Fam Plann. 2004;35:15–26.[CrossRef][Web of Science][Medline]
37. Becker GS, Murphy KM. A theory of rational addiction. J Polit Econ. 1988;96:675–700.[CrossRef][Web of Science]
38. Chaloupka FJ. Rational addictive behavior and cigarette smoking. J Polit Econ. 1991;99:722–742.[CrossRef]
39. Colman G, Grossman M, Joyce T. The effect of cigarette excise taxes on smoking before, during, and after pregnancy. J Health Econ. 2003;22:1053–1072.[CrossRef][Web of Science][Medline]
40. Colman GJ, Joyce T. Trends in smoking before, during, and after pregnancy in ten states. Am J Prev Med. 2003;24:29–35.[CrossRef][Web of Science][Medline]
41. Ringel JS, Evans WN. Cigarette taxes and smoking during pregnancy. Am J Public Health. 2001;91:1851–1856.
42. Moskowitz JM. The primary prevention of alcohol problems: a critical review of the literature. J Stud Alcohol. 1989;50:54–88.[Web of Science][Medline]
43. Davidson R, MacKinnon JG. Estimation and Inference in Econometrics. New York, NY: Oxford University Press; 1993.
44. Lu MC, Lin YG, Prietto NM, Garite TJ. Elimination of public funding of prenatal care for undocumented immigrants in California: a cost/benefit analysis. Am J Obstet Gynecol. 2000;182:233–239.[CrossRef][Web of Science][Medline]
45. Schramm WF. Weighing costs and benefits of adequate prenatal care for 12 023 births in Missouri’s Medicaid program, 1988. Public Health Rep. 1992; 107:647–652.[Web of Science][Medline]
46. Marks JS, Koplan JP, Hogue CJ, Dalmat ME. A cost-benefit/cost-effectiveness analysis of smoking cessation for pregnant women. Am J Prev Med. 1990;6: 282–289.[Web of Science][Medline]
47. Lester BM, Andreozzi L, Appiah L. Substance use during pregnancy: time for policy to catch up with research. Harm Reduct J. 2004;1(5)1–44.[CrossRef][Medline]
This article has been cited by other articles:
|
|
 |
|
  S. M. Engel, T. M. Janevic, C. R. Stein, and D. A. Savitz Maternal Smoking, Preeclampsia, and Infant Health Outcomes in New York City, 1995-2003 Am. J. Epidemiol., January 1, 2009; 169(1): 33 - 40. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Ma Paternal Race/Ethnicity and Birth Outcomes Am J Public Health, December 1, 2008; 98(12): 2285 - 2292. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. J. Sharma, M. E. Cogswell, and R. Li Dose-Response Associations Between Maternal Smoking During Pregnancy and Subsequent Childhood Obesity: Effect Modification by Maternal Race/Ethnicity in a Low-Income US Cohort Am. J. Epidemiol., November 1, 2008; 168(9): 995 - 1007. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. M Perreira Migration and health behaviour during pregnancy BMJ, May 10, 2008; 336(7652): 1027 - 1028. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
