Della 'Dee' Campbell
Della (Dee) Campbell

Urban Health


Work Position
Associate Professor

Date passed dissertation defense
March 2007


Dr. Campbell has acquired a broad base of leadership experience in the managerial, administrative, and clinical services within major health care organizations and academic settings. She is currently an Associate Professor in the Division of Nursing and Health Management at Felician College in  Lodi, NJ and is a Clinical Programs and Medical Management Consultant at Onicol, Livingston, NJ. Dr. Campbell was former COO and Assistant Professor at UMDNJ School of Nursing, Newark, NJ (2002-2010), former Chief Nursing Officer at Womens’ Integrated Network, Harrison, NY (1999-2002), and Administrator of Women’s Services at St Peters University Hospital, New Brunswick, NJ (1991-1999).

Title of the Dissertation

The Impact of Combined Maternal Alcohol and Tobacco Use on Low Birth Weight in Singleton Pregnancies: A Population Based Study in the US, 2003

Dissertation Abstract

Background: The Black-White disparity in birth outcomes in the United States remains embedded.  Non-Hispanic Black women had a low birth weight rate of 11.44% in 2002, while only 5.02% of babies born to Non-Hispanic White women were of low birthweight.  The World Health Organization (WHO) defines low birth weight (LBW) as birthweight less than 2500 grams/5.5 pounds or below the 10th percentile for gestational age.  LBW is a frequent marker of poor maternal/infant health outcome and a major public health initiative is to reduce the incidence of LBW in the United States and a Healthy People 2010 objective is to demonstrate a reduction from 7.6% (1998 baseline) to 5% by 2010.

Purpose: The purpose of this study was to examine the self-reported risk taking behaviors of maternal tobacco use and alcohol use during pregnancy among American born White and Black women and explore their joint impact on neonatal outcome as measured by birthweight.

Objective:  The objective of the study was to determine the magnitude of risk for low birth weight, defined in this study as neonatal birth weight less than 2500 grams, in relation to combined maternal alcohol and tobacco use.  The impact of the combined risk taking behaviors was explored to determine their role in contributing to the racial disparity in low birth weight within the context of the Black woman’s cumulative socioeconomic disadvantage and exposure to chronic stressors of the urban environment.

Methods:  Study Design:  A population-based study of singleton births born to US –born Black and White women delivered in the USA in 2003.  Sample:   The natality files produced by the National Center for Health Statistics (NCHS) of the U.S. Department of Health and Human Services.          Questions: This study addressed the following questions: (1) What is the incidence and relative risk for LBW in relation to combined maternal alcohol and tobacco use?     (2) Does LBW increase with the advancing maternal age of the Black woman?  (3) Are there any similarities in maternal age, highest educational attainment by the mother, or population of the place of maternal residence within the Black and White LBW groups reporting the highest incidence of tobacco and/or alcohol use? Theoretical Framework:  the weathering hypothesis described by Arlene Geronimus as the health of African-American women may begin to deteriorate in early adulthood as a physical consequence of cumulative socioeconomic disadvantage, served as the underpinning for exploring the study variables. The concept of weathering is relatively new to the body of work that seeks to understand and promote sound intervention into health disparities.  It grew out of the neo-activist 1990’s, when new attention was turned toward the cultural context of urban poverty and the role of the built environment and health.  Yet, ‘weathering’ has the potential to guide the development of comprehensive strategies to improve the health of socioeconomically disadvantaged women and reduce the social inequalities that exist in today’s healthcare environment. Weathering is a concept of explaining a Black women’s health as a process over time that is reflective of insults and injuries from her conception to the current state.  It is indicative of her life experiences that either promote or retard health. 

Analysis: Secondary analysis of this data set was performed with SAS V9.  Logistic regression was used to calculate the relative risk of the investigational variable (LBW) while controlling for race, age, smoking and drinking status, and geographic place of residence (city population).

Results: Black non-Hispanic women who were both tobacco and alcohol users were 3.2 times more likely to have a LBW neonate and White non-Hispanic women were 2.9 times more likely to have a LBW neonate than non-users.  Despite the increased odds for having a LBW infant with concomitant substance abuse of tobacco and alcohol, the rate in the Black women was 2.2 times more than the White women.  This risk taking behavior clearly increases the incidence of LBW, but affects both races in a similar fashion.
The Black-White disparity in low birth weight is a complex research question with little consensus regarding the exact medical etiology or the pathways through which social environmental factors contribute to the disparity.  What is supported in the literature is that the risk taking behaviors of tobacco and alcohol use are highly associated with an increased risk of LBW and that living in a highly deprived neighborhood increases your likelihood in partaking in those behaviors.
This dissertation, in light of the support of the major construct of the weathering hypothesis of advanced maternal aging of the Black woman, suggests that the direction for future research must examine the complex interplay of the multiple factors of the environment, biologic characteristics, and stress.  Interdisciplinary collaboration among health researchers, urban planners, and policy experts will be the key to understanding what measures must be employed to eliminate the Black-White disparity in low birth weight.


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