Built environment and women's psychosocial health

The built environment (BE) to which pregnant women are exposed has been associated with adverse maternal and reproductive health. Limited research has identified psychosocial status as a mechanism through which the BE influences health. We assess this relationship using directly observed neighborhood characteristics and psychosocial attributes from an ongoing pregnancy cohort study. BE variables assessed on Durham city tax parcels (n=17,239) were summed into five domains: housing damage, property disorder, nuisances, territoriality and vacancy. Analyses include 595 non-Hispanic black and 178 white or Hispanic participants. Generalized linear latent and mixed models were run with binomial family and multinomial links. Outcomes–including perceived stress, partner support and active coping–were constructed as defined in the literature. Living in areas with more property disorder or more rental or vacant housing was associated with more active coping and perceived stress as well as less positive partner support. For example, living in areas with more housing damage was associated with 50% higher odds of women reporting moderate perceived stress, compared to women with low perceived stress (OR =1.5; 95% CI: 1.1, 2.1). Following adjustment for covariates, the relationship was attenuated, but still significant (OR=1.4; 95% CI: 1.0, 2.1). Since we may be explaining a portion of the BE effect we are trying to observe, the unadjusted models may be a more accurate depiction of the ‘built environment effect.' The BE, an important aspect of a woman's mental and physical health, is modifiable and thus an important target for interventions designed to improve public health.