Protective Places: Neighborhood Quality and Preterm Birth among Black Women in Oakland, California (2007-2011)

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Interdisciplinary Association for Population Health Science 2020 Annual Meeting

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Preterm birth (PTB) (birth before 37-weeks) is a leading cause of infant mortality and risk factor for adverse health outcomes. In the United States, Non-Hispanic Black women (hereafter Black women) are at higher risk for PTB than other racial/ethnic groups. Considering place as a possible point of intervention for addressing the inequity, scholars have turned to examining how neighborhoods matters for PTB. Many studies of neighborhood quality and PTB examine multiple neighborhood characteristics in a single model to assess independent effects. This approach masks the complexity of neighborhoods (where multiple characteristics influence and are influenced by each other) and potentially misclassifies a place’s overall health-promoting quality. Our study examined whether living in a higher quality neighborhood was associated with reduced risk of PTB among Black women in Oakland, California. The study population (N=5416, ages 13-47) drew from California birth records of all singleton births in 2007-2011 to Black women in Oakland. Neighborhood quality was defined by the California Healthy Places Index (HPI), the weighted sum of eight domains: economic, education, housing, healthcare, transportation, neighborhood, environment, and social. Log-linear generalized estimating equation models assessed relationships between the HPI and PTB, each domain and PTB, and all domains and PTB, adjusting for maternal age, parity, nativity, education, WIC, and public insurance. In fully adjusted models, living in a neighborhood with a one-unit higher HPI score (range: -1.03,1.34) was associated with 23% lower risk of PTB (aRR: 0.77, 95% CI: 0.63,0.94). Four domains (education, housing, healthcare, and transportation) were associated with lower risk of PTB smaller in magnitude than overall HPI (e.g. housing aRR: 0.81, 95% CI: 0.67,0.99; transportation aRR: 0.80, 95% CI: 0.67,0.95). Findings have implications for place-based research and interventions to address racial inequities in PTB.


Public Health and Recreation