Prenatal cigarette smoking as a mediator between racism and depressive symptoms: The Biosocial Impact on Black Births Study.
Carmen Giurgescu, Liying Zhang, Mercedes A Price and 7 others
PMID 32734603WHAT IT FOUND
Pregnant Black women reporting more racial discrimination were more likely to smoke and have more depressive symptoms.
Smoking was part of the link from discrimination to symptoms, but the data were from a one-time survey, so cause is not shown.
Key findings
01Among 200 pregnant Black women, 33 (16.5%) smoked during pregnancy, 54 (27.0%) had CES-D scores of 23 or higher, and 118 (59.0%) reported racial discrimination in at least one situation.
02Racial discrimination was associated with smoking during pregnancy (adjusted OR = 1.31) and with higher CES-D scores (β = 0.60).
03Path analysis indicated smoking mediated the association, with standardized effects of 0.22 from discrimination to smoking, 0.14 from smoking to CES-D scores, and an indirect effect of 0.03 (95% CI 0.001 to 0.094).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The data were collected at one time, so the study cannot show whether discrimination led to smoking, whether smoking led to depression, or whether depression led to smoking. Only 33 women reported smoking during pregnancy, and they had a median of 4.5 cigarettes per day, so the smoking pathway rests on a small group. Women were recruited from two Midwest metropolitan areas, and most had a high school level of education or less and public insurance, so results may not apply to all pregnant Black women. Smoking, discrimination, and depression were self-reported, so answers could be affected by recall or social desirability. The smoking questions did not capture menthol use, reasons for smoking, or changes in smoking across pregnancy.
Declared interests
The supplied metadata lists NIH extramural research support. The article text does not provide an author conflict-of-interest declaration.
The easy way to misread this
Do not conclude that smoking causes depression or that quitting smoking will reduce depressive symptoms. The study measured discrimination, smoking, and depression at one time, only 33 women reported smoking, and the authors state that causal interpretations are precluded.