title: A study of the association between characteristics of CLSCs and the risk of small for gestational age births among term and preterm births in Quebec, Canada.
abstract: OBJECTIVE
  The objective of this study was to describe whether the social environment of the territory of residence is associated with indicators of foetal growth retardation.
  
  
  METHODS
  All newborns (n = 667,254) from 143 Centres locaux de services communautaires (CLSC) territories of Quebec, Canada, 2000-2008 were included in this study. Small for gestational age (SGA), very small for gestational age (VSGA) and SGA-preterm births were identified. Social characteristics and access to medical services of the population in the CLSCs were obtained from the Canadian Community Health Survey. Data on material deprivation, racial diversity and social isolation were obtained from the 2001 and 2006 Canadian censuses. A compromise between two methods, stepwise and best subset, was used to select variables for multivariate logistic modelling. The model was fitted on each studied outcome: SGA, VSGA and SGA among preterm births.
  
  
  RESULTS
  When investigating material deprivation, racial diversity, social isolation, proportion of sedentary residents and proportion with fair or poor availability of health care services in the CLSC territories, material deprivation, racial diversity, social isolation and sedentary residents showed increased adjusted risk of SGA. Results of the model fit on VSGA birth and on SGA among preterm births were similar.
  
  
  CONCLUSIONS
  CLSC characteristics of material deprivation, racial diversity, social isolation as well as the contextual variable of sedentary lifestyle were associated with indicators of foetal growth retardation. Further work on features of the CLSCs could help understand how the outcome of SGA is associated with contextual factors and identify groups for intervention.
authors.affiliation: Department of Social and Preventive Medicine, Université Laval, Institut national de santé publique du Québec, QC. nathalie.savard@inspq.qc.ca
authors.forename: Nathalie
authors.initials: N
authors.lastname: Savard
authors.forename: Patrick
authors.initials: P
authors.lastname: Levallois
authors.forename: Louis-Paul
authors.initials: LP
authors.lastname: Rivest
authors.forename: Suzanne
authors.initials: S
authors.lastname: Gingras
mesh_terms: D000328:Adult; D005260:Female; D005317:Fetal Growth Retardation / Q000453:epidemiology*; D006297:Health Services Accessibility; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007236:Infant, Small for Gestational Age; D016015:Logistic Models; D011247:Pregnancy; D011792:Quebec / Q000453:epidemiology; D012306:Risk; D012931:Social Environment; D012934:Social Isolation