Understanding maternal smoking during pregnancy: does residential context matter?

The goal of this paper was to investigate whether or not the factors beyond individual characteristics were associated with maternal smoking during pregnancy. Social capital has been found to have both negative and positive implications for health behaviors, and this study attempted to understand its association with maternal smoking during pregnancy. Specifically, the association between county-level social capital and rurality and maternal smoking during pregnancy was investigated. In this study, Putman's definition of social capital was used (e.g., connections among individuals-social networks and the norms of reciprocity and trustworthiness that arise from them). The ecological dimension of rurality was used to define rurality, where rural areas are smaller in population size and are less densely populated when compared to non-rural areas. Using data for all women who gave birth during the year 2007 in the United States, we implemented a series of multilevel logistic regression models. The results showed that social capital was significantly associated with maternal smoking during pregnancy. Specifically, higher social capital in a county was associated with higher odds that women smoked during their pregnancy. However, in rural counties, higher social capital was associated with a decrease in the odds that a woman smoked during her pregnancy. A one unit increase in the social capital index was found to reduce the risk of smoking during pregnancy among those women living in rural counties by 11 percent. The results also showed that improvement of the socioeconomic status of the counties in which women live reduced the risk of maternal smoking during pregnancy. As this study found that factors beyond individual characteristics are important for reducing the risk that women smoked during pregnancy, county characteristics should be taken into account when developing policies focused on intervening maternal smoking during pregnancy.