title: Relationship between Structural and Intermediary Determinants of Health and Preterm Delivery.
abstract: BACKGROUND
  Preterm birth is a major health problem that leads to infant morbidity and mortality. The main goal of this study was to find the relationship between social determinants of health and preterm delivery.
  
  
  METHODS
  A prospective longitudinal cohort study was carried out on 500 pregnant women in their 24th to 28th gestational weeks in 2012. The pregnant women filled out a self-report questionnaire on the structural determinant, perceived stress, and perceived social support. The participants were followed up until labor and the data about mother and the newborn were collected after labor. The data were analyzed by SPSS 21 and Lisrel 8.8 software programs using pathway analysis.
  
  
  RESULTS
  The final path model fit well (CFI=0.96; RMSEA=0.060). Path analysis showed that among structural factors, income had a direct effect (β=0.06) and the factors of income (β=0.00594), number of children (family size) (β=-0.024), as well as mother's education (β=-0.0084) had the greatest overall effect on gestational age at birth respectively. Also, the results showed that among intermediate factors of social determinants of health, stress in the direct path (β=-0.12) and among the overall effects, the perceived stress (β=-0.12) and perceived social support (β=0.0396) affected the gestational age at birth.
  
  
  CONCLUSIONS
  The current study showed that some structural and intermediary determinants such as income and perceived stress had an effect on preterm labor.
authors.affiliation: Social Determinant of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
authors.forename: Mahrokh
authors.initials: M
authors.lastname: Dolatian
authors.affiliation: Social Determinant of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran ; Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
authors.forename: Arash
authors.initials: A
authors.lastname: Mirabzadeh
authors.affiliation: Social Determinant of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
authors.forename: Ameneh Setareh
authors.initials: AS
authors.lastname: Forouzan
authors.affiliation: Social Determinant of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
authors.forename: Homeira
authors.initials: H
authors.lastname: Sajjadi
authors.affiliation: Department of Biostatistics, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Hamid
authors.initials: H
authors.lastname: Alavimajd
authors.affiliation: Department of Midwifery, Faculty of Nursing and Midwifery, Alborz University of Medical Sciences, Karaj, Iran.
authors.forename: Zohreh
authors.initials: Z
authors.lastname: Mahmoodi
authors.affiliation: Department of Midwifery, Faculty of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran.
authors.forename: Farnoosh
authors.initials: F
authors.lastname: Moafi
keywords: Intermediary determinants of health; Perceived social support; Perceived stress; Structural determinants of health