Affordable Care Act standards for race and ethnicity mask disparities in maternal smoking during pregnancy.
OBJECTIVE
This study compared maternal smoking during pregnancy between the new Patient Protection and Affordable Care Act (ACA) data collection standards and Federal Office of Management and Budget (OMB) standards.


METHODS
Data were from the Massachusetts Standard Certificate of Live Births on 1,156,472 babies from 1996 to 2010. A parent reported whether the mother smoked during pregnancy (yes/no), her race (5 options) and, separately, her ethnicity (39 categories). Prenatal smoking rates were compared between the ACA and OMB standards. Detailed ethnicity from the birth certificate was then examined within all broad categories of the ACA standards: White, Black/African American, Other Hispanic, Other Asian/Pacific Islander, and Other categories.


RESULTS
For Hispanic/Latina and Asian mothers, the ACA standards captured the variability in smoking across and within racial/ethnic groups more than the OMB standards. However, for White and Black/African American mothers, the broad ACA categories masked striking differences in prenatal smoking. While the overall prevalence among Whites was 10.2%, this ranged from 0.8% for Iranians to 21.0% for Cape Verdeans. Among Black/African Americans (7.6%), this ranged from 0.5% for Nigerians to 12.9% for African Americans. The ACA standards also combined ethnic groups with sizeable populations into Other Hispanics and Other Asian/Pacific Islanders.


CONCLUSIONS
When population health surveys and other reporting tools are being revised, state and federal agencies should consider expanding all race/ethnicity categories to capture detailed ethnicity on everyone.
Boston College, Graduate School of Social Work, McGuinn Hall, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA. Electronic address: summer.hawkins@bc.edu.
Summer Sherburne
SS
Hawkins
Division of Research and Epidemiology, Bureau of Health Information, Statistics, Research and Evaluation, Massachusetts Department of Public Health, 250 Washington St., 6th floor, Boston, MA 02108-4619, USA. Electronic address: Bruce.Cohen@state.ma.us.
Bruce B
BB
Cohen
D001719:Birth Certificates / Q000331:legislation & jurisprudence; D003625:Data Collection / Q000379:methods; D005006:Ethnicity / Q000145:classification* / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D005260:Female; D006077:Government Agencies / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008404:Massachusetts / Q000453:epidemiology; D058991:Patient Protection and Affordable Care Act / Q000592:standards* / Q000706:statistics & numerical data; D011247:Pregnancy; D037841:Pregnant People / Q000208:ethnology*; D012907:Smoking / Q000208:ethnology* / Q000331:legislation & jurisprudence; D014481:United States
Ethnic groups; Patient Protection and Affordable Care Act; Pregnancy; Smoking