title: Associations between racial discrimination, smoking during pregnancy and low birthweight among Roma.
abstract: Racial discrimination may increase the risk of low birthweight (LBW), but has not been studied among Roma, the largest minority population in Europe. Moreover, few studies test both institutional and interpersonal forms of racial discrimination on health. Our objective was to examine associations between institutional and interpersonal racial discrimination with LBW, and to test potential mediation by smoking during pregnancy. In 2012-2013, Romani women interviewers surveyed 410 Romani women in Serbia and Macedonia. We measured institutional discrimination (neighborhood segregation, legal status of housing and neighborhood socioeconomic status), interpersonal discrimination [Everyday Discrimination Scale (EDS)], birthweight and smoking by self-report or interviewer report. We estimated relative risks for discrimination on LBW and separately on smoking during pregnancy using log-binomial regression, adjusting for age, parity, years at residence and wealth. The indirect effect of high EDS via smoking on LBW was estimated using inverse odds weighting mediation. Living in a low SES neighborhood showed a 2-fold risk of LBW [adjusted risk ratio (aRR) = 2.4, 95% CI = 1.2, 5.0]; aRRs for segregation and illegal housing were weaker (aRR = 1.8, 95% CI = 0.7, 4.3; aRR = 1.3, 95% CI = 0.6, 2.6, respectively). Institutional measures were not associated with smoking. High EDS was associated with LBW (aRR = 2.4, 95% CI = 1.1, 5.2) and smoking during pregnancy (aRR = 1.4, 95% CI = 1.1, 1.8); the indirect effect of EDS on LBW via smoking was not significant. Interpersonal discrimination and living in a low SES neighborhood were associated with LBW among Roma. Interventions to improve Romani health may benefit from a human rights approach.
authors.affiliation: Department of Population Health Science and Health Policy, Icahn School of Medicine at Mount Sinai, New York, New York 10029.
authors.forename: Teresa
authors.initials: T
authors.lastname: Janevic
authors.affiliation: Department of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, United States.
authors.forename: Theresa
authors.initials: T
authors.lastname: Osypuk
authors.affiliation: Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States.
authors.forename: Kristefer
authors.initials: K
authors.lastname: Stojanovski
authors.affiliation: Faculty of Medicine University of Belgrade, Institute of Social Medicine, Belgrade, Serbia.
authors.forename: Janko
authors.initials: J
authors.lastname: Jankovic
authors.affiliation: Division of Population Sciences, Dana-Farber/Harvard Cancer Center, Dana-Farber Cancer Institute, Boston, MA, United States.
authors.forename: Daniel
authors.initials: D
authors.lastname: Gundersen
authors.affiliation: Department of Population Health Science and Health Policy, Icahn School of Medicine at Mount Sinai, New York, New York 10029.
authors.forename: Maggie
authors.initials: M
authors.lastname: Rogers
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000523:psychology; D063505:Racism / Q000523:psychology / Q000706:statistics & numerical data*; D018843:Republic of North Macedonia / Q000453:epidemiology; D006178:Romani People / Q000523:psychology / Q000706:statistics & numerical data*; D055771:Serbia / Q000453:epidemiology; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology; D012959:Socioeconomic Factors; D055815:Young Adult