The Unequal Effects of Maternal Smoking on Infant Health by Race/Ethnicity and Nativity.

• In Event: Medical Sociology Section Roundtables
  In Refereed Roundtable (90 minute): Table 6. Reproductive and Women's Health

Abstract

Racial/ethnic and nativity disparities in adverse birth outcomes remain persistent in the United States, yet less is known about how structural positions of race/ethnicity, nativity and behavioral risk jointly shapes vulnerability. Drawing on Fundamental Cause Theory (FCT) and the Weathering hypothesis, this study investigates how race/ethnicity and nativity intersect with maternal smoking to shape disparities in low birthweight (LBW) and preterm birth (PTB). Using 2023 National Vital Statistics System (NVSS) natality data (N = 2,839,258), the analysis employs logistic regression models and interaction terms to assess baseline disparities and smoking-related risks.
Results reveal that the effect of maternal smoking is significantly patterned by structural position. US-born Black women face the highest baseline risks of LBW and PTB; however, total effects and predicted probabilities demonstrate that smoking-related absolute risk is disproportionately concentrated among US-born Black, foreign-born Black, and US-born Asian women. This concentration reflects an “unequal vulnerability” where marginalized structural positions amplify the harmful effects of behavioral risks. Conversely, foreign-born White and Hispanic women exhibit lower risks, suggesting that certain nativity-based social resources may act as countervailing mechanisms against behavioral hazards.
These findings demonstrate that maternal smoking is not a uniform risk factor within broader systems of stratification that act as fundamental causes of health. Crucially, the structural disadvantage of being a US-born Black non-smoker often carries a greater risk for infants than the behavioral risk of smoking among US-born White women. Thus, addressing these disparities require integrated strategies that combine smoking cessation with efforts to address systemic inequalities.

Authors

• John Whesu, Case Western Reserve University

• Oluwatimileyin Aborisade, Case Western Reserve University