Skip to main content

Advertisement

SpringerLink
Log in

Is Neighborhood Deprivation Independently Associated with Maternal and Infant Health? Evidence from Florida and Washington

  • Published:
Maternal and Child Health Journal Aims and scope Submit manuscript

Abstract

Objectives

To determine whether a widely used measure of neighborhood-level socioeconomic deprivation was associated with unintended pregnancy, delayed/no prenatal care, low birth weight (LBW), and not breastfeeding, after adjusting for a more comprehensive set of individual-level socioeconomic factors than previously reported.

Methods

Data from CDC’s Pregnancy Risk Assessment Monitoring System (PRAMS) in Washington and Florida (1997–1998) were linked with census tract-level data (2000) based on birth certificate addresses. For each state, logistic regression models were estimated for associations between neighborhood deprivation measured by the Townsend Index and each dependent variable, unadjusted and then adjusting for maternal age, parity, racial/ethnic group, and education; paternal education; and family income. Similar models were estimated for each racial/ethnic group separately.

Results

Despite significant unadjusted associations between neighborhood deprivation and all dependent variables except LBW in Washington, few statistically significant associations were found in the adjusted models overall. In stratified models, African American women in low-deprivation Florida neighborhoods had higher odds of delayed/no prenatal care compared with their moderate-deprivation counterparts, and only among European American women were high-deprivation neighborhoods associated with increased odds of delayed/no prenatal care.

Conclusions

These results, which may not be generalizable beyond Florida and Washington or to other health indicators, suggest that some previously reported associations between neighborhood characteristics and the selected health indicators may reflect residual confounding by individual-level socioeconomic status/position. Until methodological and conceptual challenges regarding mediation (“over-controlling”) and measurement of neighborhood exposure are overcome, conclusions regarding independent neighborhood associations should be made with caution.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Culhane, J. F., & Elo, I. T. (2005). Neighborhood context and reproductive health. American Journal of Obstetrics and Gynecology, 192(5 Suppl), S22–S29.

    Article  PubMed  Google Scholar 

  2. Yen, I. H., & Syme, S. L. (1999). The social environment and health: a discussion of the epidemiologic literature. Annual Review Public Health, 20, 287–308.

    Article  CAS  Google Scholar 

  3. Robert, S. A. (1999). Socioeconomic position and health: the independent contribution of community socioeconomic context. Annual Review of Sociology, 25, 489–516.

    Article  Google Scholar 

  4. Pickett, K. E., & Pearl, M. (2001). Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review. Journal of Epidemiology and Community Health, 55, 111–122.

    Article  PubMed  CAS  Google Scholar 

  5. Sampson, R. J., et al. (2002). Assessing “neighborhood effects”: social processes and new directions in research. Annual Review of Sociology, 28, 443–478.

    Article  Google Scholar 

  6. Ellen, I. G., et al. (2001) Neighborhood effects on health: Exploring the links and assessing the evidence. Journal of Urban Affairs, 23, 391–408.

    Article  Google Scholar 

  7. Macintyre, S. A., et al. (2002) Place effects on health: How can we conceptualise, operationalise and measure them? Social Science and Medicine, 55, 125–139.

    Article  PubMed  Google Scholar 

  8. Jessop, E. G. (1992) Individual morbidity and neighbourhood deprivation in a non-metropolitan area. Journal of Epidemiology and Community Health, 46, 543–546.

    PubMed  CAS  Google Scholar 

  9. Smith, G. D., et al. (1997) Lifetime socioeconomic position and mortality: prospective observational study. BMJ, 314, 547–552.

    PubMed  CAS  Google Scholar 

  10. Humphreys, K., & Carr-Hill, R. (1991). Area variations in health outcomes: artefact or ecology. International Journal of Epidemiology, 20, 251–258.

    Article  PubMed  CAS  Google Scholar 

  11. Krieger, N., et al. (1997). Measuring social class in US public health research: concepts, methodologies, and guidelines. Annual Review Public Health, 18, 341–378.

    Article  CAS  Google Scholar 

  12. Liberatos, P., et al. (1988). The measurement of social class in epidemiology. Epidemiologic Reviews, 10, 87–121.

    PubMed  CAS  Google Scholar 

  13. Braveman, P. A., et al. (2001). Measuring socioeconomic status/position in studies of racial/ethnic disparities: maternal and infant health. Public Health Reports, 116, 449–463.

    PubMed  CAS  Google Scholar 

  14. Braveman, P. A., et al. (2005) Socioeconomic status in health research: One size does not fit all. The Journal of American Medical Association, 294, 2879–2888.

    Article  CAS  Google Scholar 

  15. Diez-Roux, A. V. (1998) Bringing context back into epidemiology: variables and fallacies in multilevel analysis. American Journal of Public Health, 88, 216–222.

    PubMed  CAS  Google Scholar 

  16. Buka, S. L., et al. (2003) Neighborhood support and the birth weight of urban infants. American Journal of Epidemiology, 157, 1–8.

    Article  PubMed  Google Scholar 

  17. Jaffee, K. D., & Perloff, J. D. (2003) An ecological analysis of racial differences in low birthweight: implications for maternal and child health social work. Health & Social Work, 28, 9–22.

    Google Scholar 

  18. Morenoff, J. D. (2003) Neighborhood mechanisms and the spatial dynamics of birth weight. American Journal of Sociology, 108, 976–1017.

    Article  Google Scholar 

  19. O’Campo P, et al. (1997) Neighborhood risk factors for low birthweight in Baltimore: a multilevel analysis. American Journal of Public Health, 87, 1113–1118.

    PubMed  CAS  Google Scholar 

  20. Pickett, K. E., et al. (2002) Neighborhood socioeconomic status, maternal race and preterm delivery: a case-control study. Annals of Epidemiology, 12, 410–418.

    Article  PubMed  Google Scholar 

  21. Roberts, E. M. (1997) Neighborhood social environments and the distribution of low birthweight in Chicago. American Journal of Public Health, 87, 597–603.

    PubMed  CAS  Google Scholar 

  22. Pearl, M., et al. (2001) The relationship of neighborhood socioeconomic characteristics to birthweight among 5 ethnic groups in California. American Journal of Public Health, 91, 1808–1814.

    PubMed  CAS  Google Scholar 

  23. Perloff, J. D., & Jaffee, K. D. (1999) Late entry into prenatal care: The neighborhood context. Social Work, 44, 116–128.

    PubMed  CAS  Google Scholar 

  24. Colley Gilbert, B. J., et al. (1999) Prevalence of selected maternal and infant characteristics, Pregnancy Risk Assessment Monitoring System (PRAMS), 1997. MMWR CDC Surveillance Summaries, 48, 1–37.

    CAS  Google Scholar 

  25. Adams, M. M., Shulman, H. B., Bruce, C., Hogue, C., & Brogan, D. (1991) The Pregnancy Risk Assessment Monitoring System: Design, questionnaire, data collection and response rates. PRAMS Working Group. Paediatric and Perinatal Epidemiology, 5(3), 333–346.

    Article  PubMed  CAS  Google Scholar 

  26. Gilbert, B. C., Shulman, H. B., Fischer, L. A., & Rogers, M. M. (1999) The Pregnancy Risk Assessment Monitoring System (PRAMS): methods and 1996 response rates from 11 states. Maternal and Child Health Journal, 3(4), 199–209.

    Article  PubMed  CAS  Google Scholar 

  27. Kotelchuck, M. (2006) Pregnancy Risk Assessment Monitoring System (PRAMS): Possible new roles for a national MCH data system. Public Health Reports, 121(1), 6–10.

    PubMed  Google Scholar 

  28. Lu, M. C., & Chen, B. (2004) Racial and ethnic disparities in preterm birth: the role of stressful life events. American Journal of Obstetrics and Gynecology, 191(3), 691–699.

    Article  PubMed  Google Scholar 

  29. Naimi, T. S., Lipscomb, L. E., Brewer, R. D., & Gilbert, B. C. (2003) Binge drinking in the preconception period and the risk of unintended pregnancy: Implications for women and their children. Pediatrics, 111(5 Part 2), 1136–1141.

    PubMed  Google Scholar 

  30. Williams, L. M., Morrow, B., Lansky, A., et al. (2003) Surveillance for selected maternal behaviors and experiences before, during, and after pregnancy. Pregnancy Risk Assessment Monitoring System (PRAMS), 2000. MMWR CDC Surveillance Summaries, 52(11), 1–14.

  31. Martin, S. L., Mackie, L., Kupper, L. L., Buescher, P. A., & Moracco, K. E. (2001) Physical abuse of women before, during, and after pregnancy. The Journal of American Medical Association, 285(12), 1581–1584.

    Article  CAS  Google Scholar 

  32. Townsend, P., et al. (1988). Health and deprivation: Inequality and the North. London: Routledge.

    Google Scholar 

  33. Cubbin, C., et al. (2001) Neighborhood context and cardiovascular disease risk factors: The contribution of material deprivation. Ethnicity & Disease, 11, 687–700.

    CAS  Google Scholar 

  34. Cubbin, C., & Winkleby, M. A. (2005) A multilevel analysis examining the influence of neighborhood-level deprivation on health knowledge, behavior changes, and risk of coronary heart disease: findings from four cities in northern California. American Journal of Epidemiology, 162, 559–568.

    Article  PubMed  Google Scholar 

  35. Stjarne, M. K., et al. (2004) Contextual effects of social fragmentation and material deprivation on risk of myocardial infarction—esults from the Stockholm Heart Epidemiology Program(SHEEP). International Journal Epidemiology, 33, 732–741.

    Article  Google Scholar 

  36. Gilthorpe, M. S., & Wilson, R. C. (2003) Rural/urban differences in the association between deprivation and healthcare utilisation. Social Science & Medicine, 57, 2055–2063.

    Article  Google Scholar 

  37. Lorant, V., et al. (2001) Deprivation and mortality: The implications of spatial autocorrelation for health resources allocation. Social Science and Medicine, 53, 1711–1719.

    Article  PubMed  CAS  Google Scholar 

  38. Granovetter, M. (1978) Threshold models of collective behavior. American Journal of Sociology, 83, 1420–1443.

    Article  Google Scholar 

  39. Crane, J. (1991) The epidemic theory of ghettos and neighborhood effects on dropping out and teenage childbearing. American Journal of Sociology, 96, 1226–1259.

    Article  Google Scholar 

  40. Skinner, C. N., et al. (1989) Analysis of complex surveys. New York, NY: John Wiley and Sons.

    Google Scholar 

  41. Soobader, M. (1998). Effects of income inequality on morbidity. Doctoral dissertation, University Professors Program, Boston University, Ann Arbor, MI: UMI, 85–88.

  42. Goldstein, H. (April 1999). Multilevel statistical models. London: Arnold Publishers. Internet edition, April 1999.

  43. Hox, J. J. (1995). Applied multilevel analysis. Amsterdam: TT-Publikaties.

    Google Scholar 

  44. Bryk, A. S., & Raudenbush, S. W. (1992) Hierarchical linear models: Applications and data analysis methods. Newbury Park, CA: Sage.

    Google Scholar 

  45. LeClere, F. B., et al. (1998). Neighborhood social context and racial differences in women’s heart disease mortality. Journal of Health and Social Behavior, 39, 91–107.

    Article  PubMed  CAS  Google Scholar 

  46. Soobader, M. J., & LeClere, F. B. (1999). Aggregation and the measurement of income inequality: Effects on morbidity. Social Science & Medicine, 48, 733–744.

    Article  CAS  Google Scholar 

  47. Robert, S. A. (1998) Community-level socioeconomic status effects on adult health. Journal of Health and Social Behavior, 39, 18–37.

    Article  PubMed  CAS  Google Scholar 

  48. Winkleby, M. A., & Cubbin, C. (2003). Influence of individual and neighbourhood socioeconomic status on mortality among black, Mexican-American, and white women and men in the United States. Journal of Epidemiology and Community Health, 57, 444–452.

    Article  PubMed  CAS  Google Scholar 

  49. Diez-Roux, A. V., et al. (2001) Neighborhood of residence and incidence of coronary heart disease. The New England Journal of Medicine, 345, 99–106.

    Article  PubMed  CAS  Google Scholar 

  50. Collins, J. W., et al. (1998) African-American mothers’ perception of their residential environment, stressful life events, and very low birthweight. Epidemiology, 9, 286–289.

    Article  PubMed  Google Scholar 

  51. Cubbin, C., et al. (2000) Socioeconomic status and fatal injuries: Individual and neighborhood determinants. Journal of Epidemiology and Community Health, 54, 517–524.

    Article  PubMed  CAS  Google Scholar 

  52. LeClere, F. B, et al. (1997). Ethnicity and mortality in the United States: Individual and community correlates. Social Forces, 76, 169–198.

    Article  Google Scholar 

  53. Blakely, T. A., & Woodward, A. J. (2000) Ecological effects in multi-level studies. Journal of Epidemiology and Community Health, 54, 367–374.

    Article  PubMed  CAS  Google Scholar 

  54. Fell, D. B., et al. (2004) Residential mobility during pregnancy. Paediatric and Perinatal Epidemiology, 18, 408–414.

    Article  PubMed  Google Scholar 

  55. Laraia, B. A., et al. (2004) Proximity of supermarkets is positively associated with diet quality index for pregnancy. Preventive Medicine, 39, 869–875.

    Article  PubMed  Google Scholar 

  56. Forna, F., et al. (2003) Pregnancy outcomes in foreign-born and US-born women. International Journal of Gynaecology and Obstetrics, 83, 257–265.

    Article  PubMed  CAS  Google Scholar 

  57. Singh, G. K., & Yu, S. M. (1996) Adverse pregnancy outcomes: Differences between US- and foreign-born women in major US racial and ethnic groups. American Journal of Public Health, 86, 837–843.

    PubMed  CAS  Google Scholar 

  58. Alexander, G. R., et al. (1996) Pregnancy outcomes of US-born and foreign-born Japanese Americans. American Journal of Public Health, 86, 820–824.

    Article  PubMed  CAS  Google Scholar 

  59. David, R. J., & Collins, J. W. (1997) Differing birth weight among infants of U.S.-born blacks, African-born blacks, and U.S.-born whites. The New England Journal of Medicine, 337, 1209–1214.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

This work was supported by the Division of Reproductive Health of the U.S. Centers for Disease Control and Prevention (Sub-award Agreement TS-521). The authors wish to acknowledge Ms. Pinal Shah and Ms. Mercedes Dekker for technical assistance and the Florida and Washington state departments of health for their participation and technical support.

Author information

Authors and Affiliations

  1. Department of Family and Community Medicine, University of California, 500 Parnassus Avenue, MU-3E, Box 0900, San Francisco, CA, 94143–0900, USA

    Catherine Cubbin, Kristen Marchi & Paula Braveman

  2. School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA

    Michael Lin

  3. Washington Department of Health, Olympia, WA, USA

    Thomas Bell

  4. Florida Department of Health, Tallahassee, FL, USA

    Helen Marshall & Curt Miller

Authors
  1. Catherine Cubbin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kristen Marchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Thomas Bell
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Helen Marshall
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Curt Miller
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Paula Braveman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Catherine Cubbin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cubbin, C., Marchi, K., Lin, M. et al. Is Neighborhood Deprivation Independently Associated with Maternal and Infant Health? Evidence from Florida and Washington. Matern Child Health J 12, 61–74 (2008). https://doi.org/10.1007/s10995-007-0225-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-007-0225-0

Keywords

Search

Navigation