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Rodríguez ECA, Rodríguez EYA, Marins FAS, da Silva AF, Nascimento LFC. Spatial patterns of prematurity and its determinants in the metropolitan region of São Paulo, Brazil, 2010-2019. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2024; 27:e240008. [PMID: 38422232 PMCID: PMC10896237 DOI: 10.1590/1980-549720240008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE To analyze spatial distribution of preterm births and their association with maternal, social, and health services indicators in the metropolitan region of São Paulo, Brazil, 2010-2019. METHODS Ecological study using data on preterm newborns from 39 municipalities in the metropolitan region of São Paulo. Univariate global Moran's index (Im) was used to evaluate spatial association of prematurity, and univariate local Moran's index by using the cluster map (LISA) to identify spatial patterns and clusters. Bivariate global Moran's index was also used to analyze spatial autocorrelation with maternal, social, and health services indicators. RESULTS A total of 3,103,898 live births were registered in period 2010-2019, of which 331,174 (10.7%) were preterm. The global Moran's index showed spatial independence (Im=0.05; p-value=0.233) of the proportion of preterm births between municipalities. However, in the local spatial analysis it was possible to identify a statistically significant spatial cluster between the municipalities of Biritiba Mirim, Guararema and Salesópolis, with high proportions of preterm births. In the bivariate analysis, a significant positive spatial association was identified with proportions of mothers under 20 years old (Im=0.17; p-value=0.024) and mothers with low schooling (Im=0.17; p-value=0.020), and a significant negative spatial association with HDI (Im=-0.14; p-value=0.039). CONCLUSIONS The local spatial approach identified a spatial cluster located in the far east of the metropolitan region of São Paulo, where actions by health managers are needed to minimize occurrence of preterm births.
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Affiliation(s)
- Elias Carlos Aguirre Rodríguez
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Postgraduate Program in Engineering - Guaratinguetá (SP), Brazil
| | - Elen Yanina Aguirre Rodríguez
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Postgraduate Program in Engineering - Guaratinguetá (SP), Brazil
| | - Fernando Augusto Silva Marins
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Postgraduate Program in Engineering - Guaratinguetá (SP), Brazil
| | - Aneirson Francisco da Silva
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Postgraduate Program in Engineering - Guaratinguetá (SP), Brazil
| | - Luiz Fernando Costa Nascimento
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Postgraduate Program in Engineering - Guaratinguetá (SP), Brazil
- Universidade de Taubaté, Postgraduate Program in Environmental Sciences - Taubaté (SP), Brazil
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2
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Stansberry TT, Tran L, Myers C. Using Geographic Information Systems in health disparities research: Access to care considerations. Res Nurs Health 2023; 46:635-644. [PMID: 37840372 DOI: 10.1002/nur.22348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 09/22/2023] [Accepted: 09/30/2023] [Indexed: 10/17/2023]
Abstract
In health disparities research, Geographic Information Systems (GIS) provide nurse researchers with powerful tools to incorporate spatial factors, such as access to care and related attributes like socioeconomic and environmental characteristics, into their studies. This article educates nurse scientists about GIS-based research benefits and considerations (focusing on access-to-care factors) and the influence of various access-to-care metrics on research outcomes. We present an overview of GIS in nursing and health disparities research, along with findings from our 2022 study examining access to care's relationship with county-level mortality rates in Tennessee, especially in areas where rural hospitals closed between 2010 and 2019. We highlight three distinct access-to-care measures (Euclidean distances and road network-based travel times based on county and census tract centroids), showcasing how different calculations impact our modeling results. Our results underscore the importance of understanding the choice of access-to-care metrics in GIS-based research to draw valid conclusions.
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Affiliation(s)
| | - Liem Tran
- Department of Geography, University of Tennessee, Knoxville, Tennessee, USA
| | - Carole Myers
- College of Nursing, University of Tennessee, Knoxville, Tennessee, USA
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3
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Montoya-Williams D, Barreto A, Fuentes-Afflick E, Collins JW. Nativity and perinatal outcome disparities in the United States: Beyond the immigrant paradox. Semin Perinatol 2022; 46:151658. [PMID: 36137831 PMCID: PMC10016119 DOI: 10.1016/j.semperi.2022.151658] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In the United States (US), epidemiologists have long documented paradoxically lower rates of adverse perinatal health outcomes among immigrant birthing people than what might be expected in light of socioeconomic and language barriers to healthcare, especially as compared to their US-born racial and ethnic counterparts. However, researchers have also documented significant variability in this immigrant birth paradox when examining within and across racial and ethnic subgroups. This review paper summarizes fifty years of research regarding differences in low, preterm birth, and infant mortality in the US, according to the nativity status of the birthing person. While there is ample evidence of the importance of nativity in delineating a pregnant person's risk of adverse infant outcomes, this review also highlights the relative paucity of research exploring the intersection of acculturation, ethnic enclaves, and structural segregation. We also provide recommendations for advancing the study of perinatal outcomes among immigrants.
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Affiliation(s)
- Diana Montoya-Williams
- Assistant Professor of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Department of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Alejandra Barreto
- Department of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Research assistant, Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Elena Fuentes-Afflick
- Professor of Pediatrics and Vice Dean, University of California, San Francisco, San Francisco, CA, USA
| | - James W Collins
- Professor of Neonatology, Department of Neonatology, Northwestern Feinberg School of Medicine, Chicago, IL, USA
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4
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Peng J, Zhang J, Yuan W, Zhou X, Tian J, Fang P. The commission of crime from the perspective of decision-making differences. Front Psychol 2022; 13:937876. [PMID: 36300057 PMCID: PMC9589491 DOI: 10.3389/fpsyg.2022.937876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/23/2022] [Indexed: 11/13/2022] Open
Abstract
A criminal act can be regarded as an irrational decision-making process. Therefore, understanding differences in the criminal decision-making process would shed light on criminal behavior. We utilized dual processing theory to propose that offenders' differences in decision-making may cause them to adopt non-adaptive behaviors, such as high reference point setting, abnormal reward-punishment sensitivity, delayed discounting rate, and decision-making style. Our study compares differences in these indicators between offenders (n = 518) and non-offenders (n = 636) in a diverse sample of Chinese adults. The results showed that compared with non-offenders, offenders had higher relative deprivation, reward sensitivity, and delayed discounting rates but lower punishment sensitivity and vigilance in decision-making. A logistic regression analysis also shows that the above factors were significant predictive indicators for the commission of crimes.
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Affiliation(s)
- Jiaxi Peng
- Mental Health Education Center, Chengdu University, Chengdu, China
| | - Jiaxi Zhang
- Xi’an Research Institute of High-Technology, Xi’an, China
| | - Weizhuo Yuan
- Mental Health Education Center, Chengdu University, Chengdu, China
| | - Xuan Zhou
- Mental Health Education Center, Chengdu University, Chengdu, China
| | | | - Peng Fang
- Department of Military Medical Psychology, Air Force Medical University, Xi’an, China
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5
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Ifatunji MA, Faustin Y, Lee W, Wallace D. Black Nativity and Health Disparities: A Research Paradigm for Understanding the Social Determinants of Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9166. [PMID: 35954520 PMCID: PMC9367942 DOI: 10.3390/ijerph19159166] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/07/2022] [Accepted: 07/13/2022] [Indexed: 11/16/2022]
Abstract
After more than a century of research and debate, the scientific community has yet to reach agreement on the principal causes of racialized disparities in population health. This debate currently centers on the degree to which "race residuals" are a result of unobserved differences in the social context or unobserved differences in population characteristics. The comparative study of native and foreign-born Black populations represents a quasi-experimental design where race is "held constant". Such studies present a unique opportunity to improve our understanding of the social determinants of population health disparities. Since native and foreign-born Black populations occupy different sociocultural locations, and since populations with greater African ancestry have greater genetic diversity, comparative studies of these populations will advance our understanding of the complex relationship between sociocultural context, population characteristics and health outcomes. Therefore, we offer a conceptual framing for the comparative study of native and foreign-born Blacks along with a review of 208 studies that compare the mental and physical health of these populations. Although there is some complexity, especially with respect to mental health, the overall pattern is that foreign-born Blacks have better health outcomes than native-born Blacks. After reviewing these studies, we conclude with suggestions for future studies in this promising area of social and medical research.
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Affiliation(s)
- Mosi Adesina Ifatunji
- Departments of African American Studies and Sociology, College of Letters and Science, University of Wisconsin at Madison, Madison, WI 53706, USA
| | - Yanica Faustin
- Department of Public Health Studies, College of Arts and Sciences, Elon University, Elon, NC 27244, USA;
| | - Wendy Lee
- Department of Sociology, College of Letters and Science, University of Wisconsin at Madison, Madison, WI 54706, USA;
| | - Deshira Wallace
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
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6
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Berkowitz RL, Mujahid M, Pearl M, Poon V, Reid CK, Allen AM. Protective Places: the Relationship between Neighborhood Quality and Preterm Births to Black Women in Oakland, California (2007-2011). J Urban Health 2022; 99:492-505. [PMID: 35384585 PMCID: PMC9187821 DOI: 10.1007/s11524-022-00624-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2022] [Indexed: 11/30/2022]
Abstract
Black women have the highest incidence of preterm birth (PTB). Upstream factors, including neighborhood context, may be key drivers of this increased risk. This study assessed the relationship between neighborhood quality, defined by the Healthy Places Index, and PTB among Black women who lived in Oakland, California, and gave birth between 2007 and 2011 (N = 5418 women, N = 107 census tracts). We found that, compared with those living in lower quality neighborhoods, women living in higher quality neighborhoods had 20-38% lower risk of PTB, independent of confounders. Findings have implications for place-based research and interventions to address racial inequities in PTB.
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Affiliation(s)
- Rachel L. Berkowitz
- Department of Public Health and Recreation, College of Health and Human Sciences, San José State University, One Washington Square, San Jose, CA 95192-0052 USA
| | - Mahasin Mujahid
- School of Public Health, University of California, Berkeley, 2121 Berkeley Way, Room 5302, CA 94720-7360 Berkeley, USA
| | - Michelle Pearl
- Environmental Health Investigations Branch, California Department of Public Health, 850 Marina Bay Parkway, Building P, 3rd Floor, Richmond, CA 94804-6403 USA
| | - Victor Poon
- Environmental Health Investigations Branch, California Department of Public Health, 850 Marina Bay Parkway, Building P, 3rd Floor, Richmond, CA 94804-6403 USA
| | - Carolina K. Reid
- College of Environmental Design, University of California, 230 Bauer Wurster Hall #1820, Berkeley, CA 94720-1820 USA
| | - Amani M. Allen
- School of Public Health, University of California, Berkeley, 2121 Berkeley Way, Room 5302, CA 94720-7360 Berkeley, USA
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7
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Lefchak B, Cushwa A, Kersten H, Courts K, McPeak K. Characterization of Social Risk Factors Among Newborns Seen at an Urban Pediatric Primary Care Predictive of Appointment Nonattendance During the First 6 Months of Life. Health Equity 2022; 6:40-48. [PMID: 35112045 PMCID: PMC8804246 DOI: 10.1089/heq.2021.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose: Appointment attendance is critical in monitoring health and well-being of children. Low income Medicaid-insured families with newborns often experience social risks that may affect attendance. This project sought to characterize social risk factors present at first newborn visits predictive of future appointment nonattendance. Methods: Retrospective cohort study of minority and Medicaid-insured population at St. Christopher's Hospital for Children using a standardized social risk screener administered at first newborn visits as part of routine clinical care. In total, 720 survey responses between December 2016 and June 2017 were correlated with electronic health record-derived sociodemographic and appointment attendance data in the first 6 months of life. Nonattendance included missed and canceled appointments. Caregiver-reported social risk factors were included as covariates in linear regressions predicting proportion nonattendance outcomes. Results: Newborn caregivers identified many social risk factors including mental health diagnoses (14%), lack of child care support (45%), and food insecurity (9%). Approximately 74% had nonattendance with 41% missing or canceling a quarter or more appointments. Number of siblings (p<0.01) and maternal age (p<0.01) were most predictive for nonattendance, respectively. Other social risks were not significant except for maternal mental health (p=0.01) among those identifying number of risk factors above cohort average (16%). Conclusion: Screening of newborns at first medical visits can be used to characterize social risks. Most social risk factors at first visits were not strongly predictive of nonattendance, although our results suggested associations between non-attendance and maternal demographics, mental health and household makeup.
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Affiliation(s)
- Brian Lefchak
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Ann Cushwa
- Center for the Urban Child and General Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA
| | - Hans Kersten
- Center for the Urban Child and General Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA
| | - Kelly Courts
- Center for the Urban Child and General Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA
| | - Katie McPeak
- Center for the Urban Child and General Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA
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8
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Slaughter-Acey JC, Brown TN, Keith VM, Dailey R, Misra DP. A tale of two generations: Maternal skin color and adverse birth outcomes in Black/African American women. Soc Sci Med 2020; 265:113552. [PMID: 33277068 PMCID: PMC7781157 DOI: 10.1016/j.socscimed.2020.113552] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/17/2020] [Accepted: 11/23/2020] [Indexed: 01/03/2023]
Abstract
We examined how sociopolitical context (marked by generational cohort) and maternal skin color interacted to influence preterm delivery (PTD) rates in sample of Black women. Data were from 1410 Black women, ages 18-45 years, residing in Metropolitan Detroit, MI enrolled (2009-2011) in the Life-course Influences on Fetal Environments (LIFE) Study. Because we hypothesized that generational differences marked by changes in the sociopolitical context would influence exposure to racism, we categorized women into two cohorts by maternal birth year: a) Generation X, 1964-1983 and b) Millennial, 1984-1993. Descriptive results showed similar PTD rates by generational cohort, Generation X: 16.3% vs. Millennials: 16.1%. Yet, within each generation, PTD rates varied by women's skin tone (categorized: light, medium, and dark brown). Poisson regression models confirmed a significant interaction between generational cohort and maternal skin tone predicting PTD (P = 0.001); suggesting a salubrious association between light brown skin tone (compared to medium and dark) and PTD for Generation X. However, Millennials with medium and dark brown skin experienced lower PTD rates than their light Millennial counterparts. Research should consider sociopolitical context and the salience of skin tone bias when investigating racial health disparities, including those in perinatal health.
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Affiliation(s)
- Jaime C Slaughter-Acey
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
| | - Tony N Brown
- Department of Sociology, Rice University, Houston, TX, USA
| | - Verna M Keith
- Department of Sociology, University of Alabama Birmingham, Birmingham, AL, USA
| | - Rhonda Dailey
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Dawn P Misra
- Department of Epidemiology & Biostatistics, Michigan State University, East Lansing, MI, USA
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9
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Blebu BE, Ro A, Kane JB, Bruckner TA. An Examination of Preterm Birth and Residential Social Context among Black Immigrant Women in California, 2007-2010. J Community Health 2019; 44:857-865. [PMID: 30547281 DOI: 10.1007/s10900-018-00602-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The foreign-born black population contributes a considerable amount of heterogeneity to the US black population. In 2005, black immigrants accounted for 20% of the US black population. Compared to native-born black women, black immigrant women are at lower risk for adverse birth outcomes, including preterm birth. Some scholars posit that differential exposures to socioeconomic disadvantage and structural racism in the residential context may account for this advantage. However, to date, few studies offer comprehensive examinations of the black immigrant residential social context, particularly in settlement regions beyond predominantly black and historically segregated regions. Further, studies examining the black immigrant residential context typically use a single indicator, which limits discussion of the intersecting domains that simultaneously increase or decrease risk among black immigrants. We addressed these gaps by examining black immigrant neighborhoods in the state of California, where racial residential segregation of the black population is low. We operationalized the residential context of black immigrant women using three distinct attributes: immigrant co-ethnic density, black racial concentration, and neighborhood deprivation. We linked 2007-2010 California birth records of black immigrant women and 2010 census data on tract-level social attributes (N = 6930). OLS regression analyses showed that immigrant co-ethnic density, black racial concentration and neighborhood deprivation were not associated with preterm birth among black immigrants. Our findings indicate that in California, residential social context has little relation to black immigrant preterm birth-a finding that is unique compared to residential settings of other settlement contexts.
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Affiliation(s)
- Bridgette E Blebu
- Program in Public Health, University of California, Irvine, Irvine, CA, USA.
| | - Annie Ro
- Program in Public Health, University of California, Irvine, Irvine, CA, USA
| | - Jennifer B Kane
- Department of Sociology, University of California, Irvine, Irvine, CA, USA
| | - Tim A Bruckner
- Program in Public Health, University of California, Irvine, Irvine, CA, USA
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10
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Using a Clustering Approach to Investigate Socio-Environmental Inequality in Preterm Birth-A Study Conducted at Fine Spatial Scale in Paris (France). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15091895. [PMID: 30200368 PMCID: PMC6163167 DOI: 10.3390/ijerph15091895] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 08/23/2018] [Accepted: 08/29/2018] [Indexed: 12/13/2022]
Abstract
Background & Objectives: Today, to support public policies aiming to tackle environmental and health inequality, identification and monitoring of the spatial pattern of adverse birth outcomes are crucial. Spatial identification of the more vulnerable population to air pollution may orient health interventions. In this context, the objective of this study is to investigate the geographical distribution of the risk of preterm birth (PTB, gestational age ≤36 weeks) at the census block level in in city of Paris, France. We also aimed to assess the implication of neighborhood characteristics including air pollution and socio-economic deprivation. Material & Methods: Newborn health data are available from the first birth certificate registered by the Maternal and Child Care department of Paris. All PTB from January 2008 to December 2011 were geocoded at the mother residential census block. Each census block was assigned a socioeconomic deprivation level and annual average ambient concentrations of NO2. A spatial clustering approach was used to investigate the spatial distribution of PTB. Results: Our results highlight that PTB is non-randomly spatially distributed, with a cluster of high risk in the northeastern area of Paris (RR = 1.15; p = 0.06). After adjustment for socio-economic deprivation and NO2 concentrations, this cluster becomes not statistically significant or shifts suggesting that these characteristics explain the spatial distribution of PTB; further, their combination shows an interaction in comparison with SES or NO2 levels alone. Conclusions: Our results may inform the decision makers about the areas where public health efforts should be strengthened to tackle the risk of PTB and to choose the most appropriate and specific community-oriented health interventions.
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11
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Bloch JR, Cordivano S, Gardner M, Barkin J. Beyond bus fare: deconstructing prenatal care travel among low-income urban mothers through a mix methods GIS study. Contemp Nurse 2018; 54:233-245. [PMID: 29969975 DOI: 10.1080/10376178.2018.1492349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Guided by critical theory, this study illustrates the value of interpretative mapping to deconstruct bus travel to publicly funded prenatal care in a city marked by health and social inequities. METHODS This mixed methods study used GIS maps based on 61,305 births to study the known barrier of transportation to prenatal care among urban mothers most at risk for preterm birth. RESULTS Among 350 census tracts, 36 census tracts had preterm rates between 25 -36.9%. Modeling travel time for the case vignette for routine prenatal care took 21 visits to different geographically located facilities. This burden increased to 32 visits if the case vignette was high-risk. CONCLUSIONS Interpretative GIS mapping is an important tool to ground truth spatially linked data into real world meanings. Promoting optimal health requires innovative and feasible approaches that take into consideration daily maternal functioning as pregnant mothers care for their children and themselves.
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Affiliation(s)
- Joan Rosen Bloch
- a College of Nursing and Health Professions , Drexel University , Philadelphia , PA , USA.,b Public Health , Drexel University , Philadelphia , PA , USA
| | - Sarah Cordivano
- c College of Nursing, Data Analytics , Azavea , Philadelphia , PA , USA
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12
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Suplee PD, Bloch JR, Hillier A, Herbert T. Using Geographic Information Systems to Visualize Relationships Between Perinatal Outcomes and Neighborhood Characteristics When Planning Community Interventions. J Obstet Gynecol Neonatal Nurs 2018; 47:158-172. [PMID: 29406286 DOI: 10.1016/j.jogn.2018.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To describe maternal morbidity, birth outcomes, and neighborhood characteristics of urban women from a racially segregated city with the use of a geographic information system (GIS). DESIGN Exploratory neighborhood-level study. Existing birth certificate data were linked and aggregated to neighborhood-level data for spatial analyses. SETTING Southern city in New Jersey. SAMPLE Women and their 7,858 live births that occurred between 2009 and 2013. METHODS Secondary analyses of extant sources were conducted. Maternal health and newborn birth outcomes were geocoded and then aggregated to the neighborhood level for further exploratory spatial analyses through our GIS database. An iterative process was used to generate meaningful visual representations of the data through maps of maternal and infant health in 19 neighborhoods. RESULTS The racial and ethnic residential segregation and neighborhood patterns of associations of adverse birth outcomes with poverty and crime were illustrated in GIS maps. In 43% of the births, women had a documented medical risk. Significantly more preterm births occurred for Black women (p < .01) and women older than 35 years of age (p = .01). The rate of diabetes was greater in Hispanic women, and the rate of pregnancy-related hypertensive disorders was greater in Black women. CONCLUSION Data-driven maps can provide clear evidence of maternal and infant health and health needs based on the neighborhoods where mothers live. This research is important so that maternity care providers can understand contextual factors that affect mothers in their communities and guide the design of interventions.
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13
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Andrews GJ. Geographical thinking in nursing inquiry, part one: locations, contents, meanings. Nurs Philos 2016; 17:262-81. [DOI: 10.1111/nup.12133] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Gavin J. Andrews
- Department of Health, Aging and Society McMaster University Hamilton ON Canada
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14
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Ncube CN, Enquobahrie DA, Albert SM, Herrick AL, Burke JG. Association of neighborhood context with offspring risk of preterm birth and low birthweight: A systematic review and meta-analysis of population-based studies. Soc Sci Med 2016; 153:156-64. [PMID: 26900890 PMCID: PMC7302006 DOI: 10.1016/j.socscimed.2016.02.014] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 02/05/2016] [Accepted: 02/08/2016] [Indexed: 11/28/2022]
Abstract
Findings from studies investigating associations of residential environment with poor birth outcomes have been inconsistent. In a systematic review and meta-analysis, we examined associations of neighborhood disadvantage with preterm birth (PTB) and low birthweight (LBW), and explored differences in relationships among racial groups. Two reviewers searched English language articles in electronic databases of published literature. We used random effects logistic regression to calculate odds ratios (and 95% confidence intervals) relating neighborhood disadvantage with PTB and LBW. Neighborhood disadvantage, most disadvantaged versus least disadvantaged neighborhoods, was defined by researchers of included studies, and comprised of poverty, deprivation, racial residential segregation or racial composition, and crime. We identified 1314 citations in the systematic review. The meta-analyses included 7 PTB and 14 LBW cross-sectional studies conducted in the United States (U.S.). Overall, we found 27% [95%CI: 1.16, 1.39] and 11% [95%CI: 1.07, 1.14] higher risk for PTB and LBW among the most disadvantaged compared with least disadvantaged neighborhoods. No statistically significant association was found in meta-analyses of studies that adjusted for race. In race-stratified meta-analyses models, we found 48% [95%CI: 1.25, 1.75] and 61% [95%CI: 1.30, 2.00] higher odds of PTB and LBW among non-Hispanic white mothers living in most disadvantaged neighborhoods compared with those living in least disadvantaged neighborhoods. Similar, but less strong, associations were observed for PTB (15% [95%CI: 1.09, 1.21]) and LBW (17% [95%CI: 1.10, 1.25]) among non-Hispanic black mothers. Neighborhood disadvantage is associated with PTB and LBW, however, associations may differ by race. Future studies evaluating causal mechanisms underlying the associations, and racial/ethnic differences in associations, are warranted.
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Affiliation(s)
- Collette N Ncube
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15261, USA.
| | - Daniel A Enquobahrie
- Department of Epidemiology, School of Public Health, University of Washington, 1959 NE Pacific Street, Health Sciences Building, Seattle, WA 98195-7236, USA.
| | - Steven M Albert
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15261, USA.
| | - Amy L Herrick
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15261, USA.
| | - Jessica G Burke
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15261, USA.
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Ogneva-Himmelberger Y, Dahlberg T, Kelly K, Simas TAM. Using Geographic Information Science to Explore Associations between Air Pollution, Environmental Amenities, and Preterm Births. AIMS Public Health 2015; 2:469-486. [PMID: 29546120 PMCID: PMC5690245 DOI: 10.3934/publichealth.2015.3.469] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 08/03/2015] [Indexed: 11/22/2022] Open
Abstract
The study uses geographic information science (GIS) and statistics to find out if there are statistical differences between full term and preterm births to non-Hispanic white, non-Hispanic Black, and Hispanic mothers in their exposure to air pollution and access to environmental amenities (green space and vendors of healthy food) in the second largest city in New England, Worcester, Massachusetts. Proximity to a Toxic Release Inventory site has a statistically significant effect on preterm birth regardless of race. The air-pollution hazard score from the Risk Screening Environmental Indicators Model is also a statistically significant factor when preterm births are categorized into three groups based on the degree of prematurity. Proximity to green space and to a healthy food vendor did not have an effect on preterm births. The study also used cluster analysis and found statistically significant spatial clusters of high preterm birth volume for non-Hispanic white, non-Hispanic Black, and Hispanic mothers.
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Affiliation(s)
| | - Tyler Dahlberg
- Department of International Development, Community and Environment, Clark University, Worcester, MA,
| | - Kristen Kelly
- Departments of Obstetrics/Gynecology, University of Massachusetts Medical School, Worcester, MA,
| | - Tiffany A. Moore Simas
- Departments of Obstetrics/Gynecology and Pediatrics, University of Massachusetts Medical School/UMass Memorial Health Care, Worcester, MA
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Environmental variables as potential modifiable risk factors of preterm birth in Philadelphia, PA. Am J Obstet Gynecol 2015; 212:236.e1-10. [PMID: 25173184 DOI: 10.1016/j.ajog.2014.08.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 07/18/2014] [Accepted: 08/25/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To examine whether variation in neighborhood context is associated with preterm birth (PTB) outcomes and gestational age (GA) at delivery in Philadelphia, and to determine whether these associations might persist when considering relevant individual-level variables. STUDY DESIGN We analyzed individual-level data collected for a prospective cohort study of singleton pregnancies with preterm labor. We merged block-group level data to each individual's home address. Unadjusted analyses were performed to determine the association between block-group variables and individual-level outcomes. Block-group variables identified as potential risk factors were incorporated into multivariable individual-level models to determine significance. RESULTS We analyzed data for 817 women. The prevalence of PTB <37 weeks was 41.5%. Although in unadjusted analyses several block-group variables were associated with PTB and GA at delivery, none retained significance in individual-level multivariable models. CONCLUSION Block-group level data were not associated with PTB outcomes or GA at delivery in Philadelphia.
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Kent ST, McClure LA, Zaitchik BF, Gohlke JM. Area-level risk factors for adverse birth outcomes: trends in urban and rural settings. BMC Pregnancy Childbirth 2013; 13:129. [PMID: 23759062 PMCID: PMC3688345 DOI: 10.1186/1471-2393-13-129] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 06/05/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Significant and persistent racial and income disparities in birth outcomes exist in the US. The analyses in this manuscript examine whether adverse birth outcome time trends and associations between area-level variables and adverse birth outcomes differ by urban-rural status. METHODS Alabama births records were merged with ZIP code-level census measures of race, poverty, and rurality. B-splines were used to determine long-term preterm birth (PTB) and low birth weight (LBW) trends by rurality. Logistic regression models were used to examine differences in the relationships between ZIP code-level percent poverty or percent African-American with either PTB or LBW. Interactions with rurality were examined. RESULTS Population dense areas had higher adverse birth outcome rates compared to other regions. For LBW, the disparity between population dense and other regions increased during the 1991-2005 time period, and the magnitude of the disparity was maintained through 2010. Overall PTB and LBW rates have decreased since 2006, except within isolated rural regions. The addition of individual-level socioeconomic or race risk factors greatly attenuated these geographical disparities, but isolated rural regions maintained increased odds of adverse birth outcomes. ZIP code-level percent poverty and percent African American both had significant relationships with adverse birth outcomes. Poverty associations remained significant in the most population-dense regions when models were adjusted for individual-level risk factors. CONCLUSIONS Population dense urban areas have heightened rates of adverse birth outcomes. High-poverty African American areas have higher odds of adverse birth outcomes in urban versus rural regions. These results suggest there are urban-specific social or environmental factors increasing risk for adverse birth outcomes in underserved communities. On the other hand, trends in PTBs and LBWs suggest interventions that have decreased adverse birth outcomes elsewhere may not be reaching isolated rural areas.
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Affiliation(s)
- Shia T Kent
- Department of Environmental Health Sciences, University of Alabama at Birmingham (UAB), Ryals Public Health Building 530, 1665 University Ave, Birmingham, AL, 35294, USA
| | - Leslie A McClure
- Department of Biostatistics, University of Alabama at Birmingham (UAB), Ryals Public Health Building 327, 1665 University Ave, Birmingham, AL, 35294, USA
| | - Ben F Zaitchik
- Department of Earth and Planetary Sciences, Johns Hopkins University, 327 Olin Hal 3400 N. Charles Street, Baltimore, MD, 21218, USA
| | - Julia M Gohlke
- Department of Environmental Health Sciences, University of Alabama at Birmingham (UAB), Ryals Public Health Building 530, 1665 University Ave, Birmingham, AL, 35294, USA
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Hogue CJR, Parker CB, Willinger M, Temple JR, Bann CM, Silver RM, Dudley DJ, Koch MA, Coustan DR, Stoll BJ, Reddy UM, Varner MW, Saade GR, Conway D, Goldenberg RL. A population-based case-control study of stillbirth: the relationship of significant life events to the racial disparity for African Americans. Am J Epidemiol 2013; 177:755-67. [PMID: 23531847 PMCID: PMC3625065 DOI: 10.1093/aje/kws381] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 09/10/2012] [Indexed: 01/26/2023] Open
Abstract
Stillbirths (fetal deaths occurring at ≥20 weeks' gestation) are approximately equal in number to infant deaths in the United States and are twice as likely among non-Hispanic black births as among non-Hispanic white births. The causes of racial disparity in stillbirth remain poorly understood. A population-based case-control study conducted by the Stillbirth Collaborative Research Network in 5 US catchment areas from March 2006 to September 2008 identified characteristics associated with racial/ethnic disparity and interpersonal and environmental stressors, including a list of 13 significant life events (SLEs). The adjusted odds ratio for stillbirth among women reporting all 4 SLE factors (financial, emotional, traumatic, and partner-related) was 2.22 (95% confidence interval: 1.43, 3.46). This association was robust after additional control for the correlated variables of family income, marital status, and health insurance type. There was no interaction between race/ethnicity and other variables. Effective ameliorative interventions could have a substantial public health impact, since there is at least a 50% increased risk of stillbirth for the approximately 21% of all women and 32% of non-Hispanic black women who experience 3 or more SLE factors during the year prior to delivery.
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Affiliation(s)
- Carol J R Hogue
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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