Associations between racial discrimination, smoking during pregnancy and low birthweight among Roma

Teresa Janevic, Theresa Osypuk, Kristefer Stojanovski, Janko Jankovic, Daniel Gundersen, Maggie Rogers

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Background: 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. Methods: 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. Results: 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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)410-415
Number of pages6
JournalEuropean journal of public health
Issue number3
StatePublished - 2017

Bibliographical note

Funding Information:
This study was funded by the New Jersey Health Foundation. We thank the organizations Bibija, Roma SOS, Lil, Zar and Nexus for their contributions.

Publisher Copyright:
© 2017 The Author.


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