title: Violent crime exposure classification and adverse birth outcomes: a geographically-defined cohort study.
abstract: BACKGROUND
  Area-level socioeconomic disparities have long been associated with adverse pregnancy outcomes. Crime is an important element of the neighborhood environment inadequately investigated in the reproductive and public health literature. When crime has been used in research, it has been variably defined, resulting in non-comparable associations across studies.
  
  
  METHODS
  Using geocoded linked birth record, crime and census data in multilevel models, this paper explored the relevance of four spatial violent crime exposures: two proximal violent crime categorizations (count of violent crime within a one-half mile radius of maternal residence and distance from maternal residence to nearest violent crime) and two area-level crime categorizations (count of violent crimes within a block group and block group rate of violent crimes) for adverse birth events among women in living in the city of Raleigh NC crime report area in 1999-2001. Models were adjusted for maternal age and education and area-level deprivation.
  
  
  RESULTS
  In black and white non-Hispanic race-stratified models, crime characterized as a proximal exposure was not able to distinguish between women experiencing adverse and women experiencing normal birth outcomes. Violent crime characterized as a neighborhood attribute was positively associated with preterm birth and low birth weight among non-Hispanic white and black women. No statistically significant interaction between area-deprivation and violent crime category was observed.
  
  
  CONCLUSIONS
  Crime is variably categorized in the literature, with little rationale provided for crime type or categorization employed. This research represents the first time multiple crime categorizations have been directly compared in association with health outcomes. Finding an effect of area-level violent crime suggests crime may best be characterized as a neighborhood attribute with important implication for adverse birth outcomes.
authors.affiliation: US Environmental Protection Agency/National Human Environmental Effects Research Laboratory, Human Studies Division, MD 58A, Research Triangle Park, NC 27711, USA. lmesser@email.unc.edu
authors.forename: Lynne C
authors.initials: LC
authors.lastname: Messer
authors.forename: Jay S
authors.initials: JS
authors.lastname: Kaufman
authors.forename: Nancy
authors.initials: N
authors.lastname: Dole
authors.forename: Amy
authors.initials: A
authors.lastname: Herring
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Laraia
mesh_terms: D000704:Analysis of Variance; D044383:Black People / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D006801:Humans; D009657:North Carolina / Q000453:epidemiology / Q000208:ethnology; D016017:Odds Ratio; D011203:Poverty / Q000208:ethnology / Q000706:statistics & numerical data*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology / Q000208:ethnology; D014754:Violence / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American