Master's Project Title:

Preterm Birth in Appalachian Ohio: An evaluation of the role of smoking during pregnancy for births from 2006 – 2011

MCH Student:

Kirsten Bean

Date of Defense:

February 19, 2013


Preterm birth rates are a leading Maternal and Child Health indicator and they vary substantially by demographic group and geographic region. One of the key modifiable behaviors that elevates a woman’s risk for preterm birth is smoking during pregnancy. Smoking rates in Appalachia are known to be high, and this compounds other health disparities in the region that are fueled by poverty, infrastructure deficits and lack of access to affordable healthcare.

This study examines regional variations in the rates of maternal smoking and the rate of preterm  birth, focusing on associations between maternal smoking, residence in Appalachian Ohio and preterm birth. The analysis was conducted with vital statistics records from all singleton births in the state of Ohio from 2006 – 2011. Regression analysis was used  to determine if residence in Appalachian Ohio was predictive of preterm birth and if there was a stronger association between prenatal smoking and preterm birth in Appalachia when compared to other regions of the state.

This study analyzed 859,408 single ton birth records and found that residence in Appalachia increased the risk for preterm birth when compared to residence in any other region of the state (OR=1.028, p = 0.014). In addition, women in Ohio’s Appalachian counties had the highest rates of prenatal smoking, and these rates were higher than state averages. The results also showed that prenatal smoking increased the risk of preterm birth in all regions of the state, but the strength of the association between prenatal smoking and preterm birth showed little variation across Appalachian, Rural non – Appalachian, Suburban and Metropolitan counties.