title: The relationship between the neighbourhood environment and adverse birth outcomes.
abstract: Intrauterine growth retardation and preterm birth are more frequent in African-American women and women of lower socio-economic status, but the reasons for these disparities are not fully understood. The physical and social environments in which these women live may contribute to these disparities. We conducted a multilevel study to explore whether conditions of mothers' neighbourhood of residence contribute to adverse birth outcomes independent of individual-level determinants. We analysed data from 105 111 births in 1015 census tracts in Louisiana during 1997-98, merging it with data from other existing sources on neighbourhood socio-economic status, neighbourhood physical deterioration, and neighbourhood density of retail outlets selling tobacco, alcohol and foods. After controlling for individual-level sociodemographic factors, tract-level median household income was positively associated with both birthweight-for-gestational-age and gestational age at birth. Neighbourhood physical deterioration was associated with these birth outcomes in ecological analyses but only inconsistently associated with them after controlling for individual-level factors. Neither gestational age nor birthweight-for-gestational-age was associated with the neighbourhood density of alcohol outlets, tobacco outlets, fast-food restaurants or grocery supermarkets. We conclude that measures of neighbourhood economic conditions are associated with both fetal growth and the length of gestation independent of individual-level factors, but that readily available measures of neighbourhood retail outlets are not. Additional studies are needed to better understand the nature of environmental influences on birth outcomes.
authors.affiliation: Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA. tfarley@tulane.edu
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Farley
authors.forename: Karen
authors.initials: K
authors.lastname: Mason
authors.forename: Janet
authors.initials: J
authors.lastname: Rice
authors.forename: Joanna D
authors.initials: JD
authors.lastname: Habel
authors.forename: Richard
authors.initials: R
authors.lastname: Scribner
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Cohen
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000704:Analysis of Variance; D001724:Birth Weight; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008145:Louisiana / Q000453:epidemiology; D015233:Models, Statistical; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011295:Prenatal Care / Q000379:methods; D011610:Psychosocial Deprivation; D012111:Residence Characteristics; D012423:Rural Health; D012907:Smoking / Q000009:adverse effects; D012959:Socioeconomic Factors; D014504:Urban Health