Neighborhood-Level Characteristics as Predictors of Preterm Birth: Examples from Wake County, North Carolina

Reference Type:
Journal Article

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Author(s):
Messer, Lynne C.
Buescher, Paul A.
Laraia, Barbara A.
Kaufman, Jay S.

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Year Published:
2005

Date Published:

Journal Name:
SCHS Studies

Volume Number:

Issue Number:
148

Start Page Number:
1-9

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Reference ID:
2846

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Abstract:

Objectives: This study uses recent North Carolina data to demonstrate that multiple factors influence preterm
birth risk, and particularly to show the effect of neighborhood context on the incidence of preterm birth.
Previous studies have shown that neighborhood environments influence health, even after adjustment for
individual characteristics and behaviors.

Methods: Approximately 24,300 1999-2001 singleton live birth records for white non-Hispanic and African
American non-Hispanic residents of Wake County, North Carolina were used in the analysis. Addresses from
the birth certificates were geo-coded to census tracts and tract-level variables from the 2000 U.S. Census were
used as measures of the neighborhood environment. Four neighborhood indexes were created from the census
tract measures: neighborhood education, residential stability, neighborhood poverty, and neighborhood
deprivation. A random effects multivariate regression model was used to estimate the effect of these
neighborhood-level factors on preterm birth, controlling for three individual-level characteristics: maternal
age, education, and marital status.

Results: White women residing in a census tract with the lowest level of education had an odds of preterm
birth 1.47 times that for white women residing in a census tract with the highest level of education. This
relationship was statistically significant at the 95 percent confidence level and independent of the three
individual-level risk factors that were controlled in the regression model. Other results showed a significantly
higher odds of preterm birth among African Americans who live in neighborhoods with higher poverty levels,
and a significantly higher odds of preterm birth among whites who reside in neighborhoods with the highest
level of deprivation.

Conclusions: Disadvantaged neighborhoods are associated with a higher odds of preterm birth, even after
adjusting for individual risk factors. Neighborhoods are units where interventions can be targeted. Improving
women’s health through neighborhood interventions can be an effective way to reduce adverse birth outcomes.
Structural changes may have a stronger effect on health than programs designed to modify individual behaviors
or risk factors.

Keyword(s):
Sexual Behavior, Contraceptive Use, and Reproductive Health
Place, Space, and Health

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Citation:

Messer, Lynne C.; Buescher, Paul A.; Laraia, Barbara A.; & Kaufman, Jay S. (2005). Neighborhood-Level Characteristics as Predictors of Preterm Birth: Examples from Wake County, North Carolina. SCHS Studies, 148, 1-9.