158947 Neighborhood effects on birth weight: An exploration of psychosocial and behavioral pathways

Monday, November 5, 2007: 11:30 AM

Ashley Schempf, PhD , Office of Epidemiology, Policy and Evaluation, Maternal and Child Health Bureau, Rockville, MD
Donna Strobino, PhD , Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Patricia O'Campo, PhD , Centre for Research on Inner City Health, University of Toronto, Toronto, ON, Canada
Neighborhood characteristics have been proposed to influence birth outcomes through psychosocial and behavioral pathways, yet empirical evidence is lacking. Using data from an urban, low-income sample, this study examined the impact of the neighborhood environment on birth weight and evaluated mediation by psychosocial and behavioral factors. The sample included 726 women who delivered a live birth at Johns Hopkins Hospital between 1995 and 1996. Census tract data were used to create a principal component index of neighborhood risk based on racial and economic stratification (% Black, % poverty), social disorder (violent crime rate), and physical deterioration (% boarded-up housing) (α=0.82). Information on sociodemographic, psychosocial, and behavioral factors was gathered from a postpartum interview and medical records. Random intercept multilevel models were used to estimate neighborhood effects and assess potential mediation. Controlling for sociodemographic characteristics, a standard deviation increase in neighborhood risk conferred a 76 gram birth weight decrement (p=0.01), with a 298 gram difference between the best and worst neighborhood risk deciles. Although stress, locus of control, and social support were related to birth weight, their adjustment reduced the neighborhood coefficient by only 12%. In contrast, the neighborhood effect was reduced by an additional 30% and was no longer significant after adjustment for the behavioral factors of smoking, drug use, and delayed prenatal care. These findings suggest that neighborhood factors may influence birth weight by shaping maternal behavioral risks. Neighborhood level interventions should be considered as a population-based strategy to address multiple maternal and infant health risks.

Learning Objectives:
Recognize that neighborhood conditions may influence birth outcomes above and beyond the sociodemographic composition of residents. Describe the multiple pathways through which neighborhood characteristics may operate. Identify policy relevant neighborhood features that may be amenable to intervention.

Keywords: Birth Outcomes, Urban Women's Health Issues

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.