ately fewer African American women than white women smoke cigarettes during pregnancy (Beck et al., 2002; Lu et al., 2005). Similarly, the reported prevalence of alcohol and drug use among pregnant African American women appears to be no greater than that among pregnant white women (Serdula et al., 1991). Although it is possible that studies may not have considered all risk behaviors (e.g., douching) or interactions between race and behaviors, a few studies have concluded that the contributions of behavioral risk factors during pregnancy to racial disparities in birth outcomes such as preterm birth or low birth weight appear to be modest (Goldenberg et al., 1996a).

Similarly, the delayed and inadequate use of prenatal care among African American women has been identified as an important risk factor for the excess adverse birth outcomes among African American infants, including preterm birth. The expectation that increased access to and use of prenatal care will improve birth outcomes and reduce disparities has shaped national policy for nearly 2 decades (IOM, 1985); however, the effectiveness of prenatal care for the prevention of preterm birth has yet to be demonstrated conclusively (Alexander and Kotelchuck, 2001). A recent review concluded that the standard prenatal care provided today does little that could be expected to reduce preterm birth rates (Lu and Halfon, 2003), and the substantial increased use of early and adequate prenatal care over the past decade has not led to a significant decline in preterm birth rates for either African American or white women (CDC, 2005i). By using NCHS data for the 1998 to 2000 birth cohort, it was found that non-Hispanic African American women who initiated prenatal care in the first trimester or who had adequate prenatal care still experienced higher rates of preterm birth than non-Hispanic white women (Table 4-3).