Sarah Bricker

CCHS 315
Due 11/26/13

Article Analysis Paper

Part I: Article Information
Individual and Community Predictors of Maternal Smoking in the City of Baltimore:
What can be Learned From a Predominantly Minority Case Controlled Study?
Web address (found within Ferris Library):
http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=2011496026&site=e
host-live
Citation:
Acquavita S, DeForge B, Burry C, Boyd S. Individual and Community Predictors of
Maternal Smoking in the City of Baltimore: What Can Be Learned From a Predominantly
Minority Case Controlled Study?. Social Work In Health Care [serial online]. March
2012;51(3):197-212. Available from: CINAHL, Ipswich, MA. Accessed October 31,
2013.

Part II: Article Summary

The article used for this analysis researched whether or not there were factors that
closely correlated with maternal smoking. The state of Maryland had a lower rate of
maternal smoking than the United States as a whole in the year 1999, but the rate in the
city of Baltimore was higher. Since pregnant smokers have a higher risk of spontaneous
abortion, pre-term birth, low birth rate, ectopic pregnancy and stillbirth compared to nonsmokers, there is an initiative through Healthy People 2010 to reduce the prevalence of
maternal smoking. Some research has been done on individual factors (such as marital
status, education, socioeconomic status, race, ethnicity, and age) affecting these rates,
but not much assessment had been done on community factors. This study aimed to
identify what individual and community factors predicted tobacco use in low income
minority mothersin Baltimore.
This case control study was limited to data from the year 2000 in Baltimore,
Maryland. 1,000 birth certificates were reviewed, using only single births so as not to
skew the results. A computer program was used to make estimations from the sample
size and the census data. There were multiple variables due to the data retrieved from the
birth certificates. Individual variables included race, age, and medical assistance status
(Medicaid). Community variables were found by mapping the womens addresses and
included data on arrests, community poverty level, and community education.
The results of this research demonstrated that the community factors of crime and
community education, as well as the individual factor of medical assistance status, were
not found to be in correlation with smoking status. However, individual variables of
race, age, and community poverty were found to be significantly related to maternal

smoking status. Women who were white and older were more likely to smoke, as well as
those in higher levels of poverty. Minority women were more likely to take up smoking
as they got older, whereas white women started smoking at a younger age but their use of
tobacco diminished as they got older.
The article closed by reviewing issues that are related to tobacco use such as lost
wages, health problems, and outcomes in pregnancy. They state that only 18 to 25% of
maternal smokers [are] successful in stopping smoking. The article ends with a call to
various disciplines to address this important issue.

Part III: Statistical Information

Statistic #1 Percentage
1. How many times was the statistic used in the article? 34

2. Why do you think this statistic was used in the article? Because a percentage is the
easiest way for the author to quickly and clearly convey their results and methods.
By using percentages taken from their data they can easily compare different things.
3. What did this statistic show and/or prove in your article AND what are some
examples of this statistic in your article? Percentages were use frequently in this
article in a few different ways. They were used in describing the goals and outcomes
of prior studies related to maternal smoking. They were also used to describe what
portions of those being studied fell into each variable such as age, poverty level, etc.
It proved, for example, that the majority of the participants were African American,
not married, receiving medical assistance, had less than a high school education, and
were living in areas of poverty.
4. Was there an associated P value? Yes
5. If yes, what was the P value number; state if this value would be considered highly
significant, significant, or not significant; and what did this significance or lack
of significance actually mean in reference to your specific article? p < 0.005
This is considered highly significant. In this instance it means that results showing
that race, age, and poverty were significant predictors of smoking status have a very
low probability of being the result of chance. It shows that there is very likely a link
between smoking status and race, age, and poverty.
Statistic #2 - Rate
1. How many times was the statistic used in the article? 12
2. Why do you think this statistic was used in the article? Rates were used to compare
statistics of smoking in both the city of Baltimore and the state of Maryland. They
were used to discus the number of teen pregnancies within this study. They were
also used to analyze the number of arrests, as well as the amount of crime and
poverty, within the communities in question.
3. What did this statistic show and/or prove in your article AND what are some
examples of this statistic in your article? One example of this statistic is the
comparison of Baltimores rate of maternal smoking (which was 14-16%) to the
state of Marylands (which was 9.8%). The comparison of rates within this study
showed that white women were more likely to smoke as the rate of poverty
increased, while for minority women, smoking was unrelated to whether they lived
in higher of lower poverty areas.

4. Was there an associated P value? Yes

5. If yes, what was the P value number; state if this value would be considered highly
significant, significant, or not significant; and what did this significance or lack
of significance actually mean in reference to your specific article? p=0.606 and p=0.60
This value is not considered significant. In this article it specifically means that the
arrest rate and education rate were not strongly related as a factor in maternal
smoking.
Statistic #3 Odds ratio
1. How many times was the statistic used in the article? 12
2. Why do you think this statistic was used in the article? Odds ratios were calculated
for each variable studied including race, age, medical assistance status, arrest rate,
percent poverty, and education rate, as well as race by age and race by poverty.
These were also compared with the odds ratios used in previous studies.
3. What did this statistic show and/or prove in your article AND what are some
examples of this statistic in your article? There were many different odds ratios in this
study ranging from 0.14 to 1141.63. They showed that the interaction of race and
age was significant in that white women tended to start smoking earlier that
minority women. They also showed that white women were more likely to smoke as
the rate of poverty increased, but poverty areas did not seem to be a factor in
minority women who smoked.
4. Was there an associated P value? Yes
5. If yes, what was the P value number; state if this value would be considered highly
significant, significant, or not significant; and what did this significance or lack
of significance actually mean in reference to your specific article? p values ranged
from <0.0005 to 0.606. Many of these were not significant and indicated that arrest
rate, education rate, and medical assistance status were not closely correlated with
maternal smoking. The p values that were <0.0005 showed that the results of race,
age, and poverty being significant predictors of smoking status have a very low
probability of being the result of chance.
Statistic #4 Raw data
1. How many times was the statistic used in the article? Multiple
2. Why do you think this statistic was used in the article? You cannot do research
without first finding data and then studying it! This study pulled data from the year
2000 census as well as the birth certificates that they selected. All of this data was
simply raw numbers until the researchers began to analyze it.

3. What did this statistic show and/or prove in your article AND what are some
examples of this statistic in your article? This raw data was the material which the
researchers used to analyze and do calculations with. And example would be the
7,802 birth certificates available or the 500 smokers and 500 non-smokers records
selected for the study. The numbers themselves prove the outcomes of the study but
no one can see that until it is converted into rates, ratios, means, and so on.
4. Was there an associated P value? No
Statistic #5 Logistic regression
1. How many times was the statistic used in the article? Once
2. Why do you think this statistic was used in the article? Conditional multinomial
logistic regression was done using software to compare each of the case control pairs
(matched) which were used in the study. The dependent variable used for these
calculations was smoking status and the independent variables used have already
been discussed. Two different models were used.
3. What did this statistic show and/or prove in your article AND what are some
examples of this statistic in your article? Using logistic regression provided the
researchers with further statistics to analyze and interpret such as odds ratio, mean,
average, and percentage. These statistics were then analyzed and the results showed
that the majority of the participants were African American, not married, receiving
medical assistance, had less than a high school education, and were living in areas of
poverty. They also showed that white women were more likely to smoke, especially
as they got older and the poverty level increased.
4. Was there an associated P value? Yes
5. If yes, what was the P value number; state if this value would be considered highly
significant, significant, or not significant; and what did this significance or lack
of significance actually mean in reference to your specific article? p values were
calculated for each variable and ranged from <0.0005 to 0.606. Many of these were
not significant and indicated that arrest rate, education rate, and medical assistance
status were not closely correlated with maternal smoking. The p values that were
<0.0005 showed that the results of race, age, and poverty being significant
predictors of smoking status have a very low probability of being the result of
chance.
Statistic #6 - Mean
1. How many times was the statistic used in the article? 2

2. Why do you think this statistic was used in the article? Mean was used to discuss the
ages of participants in the study, which ranged from 13 to 45. They chose to include
teen moms in the study because teen pregnancy is so prevalent in Baltimore. Mean
was also used to discuss the arrest rate in each of the census blocks.
3. What did this statistic show and/or prove in your article AND what are some
examples of this statistic in your article? The mean age was found to be 24.8 years and
the mean arrest rate was 7.8%. These numbers gave the researchers further insight
into the participants being studied and their community.
4. Was there an associated P value? No
Statistic #7 Standard deviation
1. How many times was the statistic used in the article? 3
2. Why do you think this statistic was used in the article? Standard deviation was used
in connection to the mean age of participants, the average percent of women living
below the poverty level, and the mean arrest rate for the communities in question.
Since all of these values are a reflection of a spread of data points it is helpful to
know the standard deviation in order to determine if data points are grouped closely
to the mean/average or if they are quite spread out.
3. What did this statistic show and/or prove in your article AND what are some
examples of this statistic in your article? The standard deviation for age was 6.6 years,
showing that the ages were clustered relatively near to the mean between 18.2 and
31.4 years. The rates for arrest had a standard deviation of 21.8%, reflecting a
wider spread from the mean.
4. Was there an associated P value? No
Statistic #8 Confidence interval
1. How many times was the statistic used in the article? 14
2. Why do you think this statistic was used in the article? Confidence intervals were
calculated for all of the variables studied in this research. It was necessary to do so
in order to evaluate the reliability of the findings.
3. What did this statistic show and/or prove in your article AND what are some
examples of this statistic in your article? The confidence intervals for race, age,
poverty level, interaction of race by age, and interaction of race by poverty were all
95%. This shows those statistics indicating a correlation between an increase in
smoking and an increase in poverty level, etc. are fairly reliable.
4. Was there an associated P value? Yes

5. If yes, what was the P value number; state if this value would be considered highly
significant, significant, or not significant; and what did this significance or lack
of significance actually mean in reference to your specific article? p values ranged
from <0.0005 to 0.606. Many of these were not significant and indicated that arrest
rate, education rate, and medical assistance status were not closely correlated with
maternal smoking. The p values that were <0.0005 showed that the results of race,
age, and poverty being significant predictors of smoking status have a very low
probability of being the result of chance.