Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #111771

Pamela J. Salsberry, RN, PhD, College of Nursing, Ohio State University, 1585 Neil Ave, Columubs, OH 43215, 614.2921.4907, salsberry.1@osu.edu and Patricia Reagan, PhD, Department of Economics, Ohio State University, 1585 Neil Ave, Columubs, OH 43215.

Introduction/Purpose: Public health nurses have first hand knowledge of the importance of the broader context that neighborhood and state-level supports play in assisting vulnerable groups in maintaining and improving their health. However, we need to move beyond the anecdotes to research that can illuminate the mechanisms between these broader social contexts and the health of individuals. This paper explores these relationships by using research completed by the authors, which examined the influence of the broader social context on birth outcomes, specifically preterm births, in a national sample. Methods: Using the National Longitudinal Survey of Youth, 1979 cohort (the mother-child file) we examined how preterm births among blacks, whites and Hispanics was influenced by neighborhood disadvantage and cumulative exposure to state-level income inequality, controlling for individual risk factors. Neighborhood disadvantage was determined by Census tract data. Cumulative exposure to income inequality was measured by the fraction of the mother's life since age 14 spent residing in states with a state-level Gini coefficient above the median. Results: We found an association between neighborhood disadvantage and preterm births in all groups, but these results were highly sensitive to the measure of neighborhood disadvantage used. Neighborhood poverty rates and housing vacancy rates increased the rate of very preterm birth and decreased the rate of moderately preterm birth for blacks. The rate of very preterm increased with the fraction of female-headed households for Hispanics and decreased with the fraction of people employed in professional occupations for whites. There were direct effects of cumulative exposure to income inequality only for Hispanics. However, there were indirect effects of context broadly defined on behaviors that increased the risk of preterm birth. Conclusion: These findings are important because they provide empirical support for an influence of the broader social context on health. Within a theoretical framework of life course and social determinants they also provide insight into the mechanisms through which social context may be operating.

Learning Objectives:

• To recognize the importance of research to understand the mechanisms operating between the broader social context and the health of disadvantaged groups.
• To identify individual and broader social context factors (upstream) that are related to preterm births.
• To discuss how a better understanding of the mechanisms through which the broader factors operate may improve interventions and ultimately health.

Keywords: Birth Outcomes, Social Inequalities

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.