title: Understanding the role of violence as a social determinant of preterm birth.
abstract: BACKGROUND
  Preterm birth is one of the leading causes of infant morbidity and mortality. Although major strides have been made in identifying risk factors for preterm birth, the complexities between social and individual risk factors are not well understood.
  
  
  OBJECTIVE
  This study examines the association between neighborhood youth violence and preterm birth.
  
  
  METHODS
  A 10-year live birth registry data set (2004 through 2013) from Richmond, VA, a mid-sized, racially diverse city, was analyzed (N = 27,519). Data were geocoded and merged with census tract and police report data. Gestational age at birth was classified as <32 weeks, 32-36 weeks, and term ≥37 weeks. Using police report data, youth violence rates were calculated for each census tract area and categorized into quartiles. Hierarchical models were examined fitting multilevel logistic regression models incorporating randomly distributed census tract-specific intercepts assuming a binary distribution and a logit link function.
  
  
  RESULTS
  Nearly a fifth of all births occurred in areas with the highest quartiles of violence. After adjusting for maternal age, race/ethnicity, education, paternal presence, parity, adequacy of prenatal care, pregnancy complications, history of preterm birth, insurance, and tobacco, alcohol, and drug use, census tracts with the highest level of violence had 38% higher odds of very preterm births (adjusted odds ratio, 1.38; 95% confidence interval, 1.06-1.80), than census tracts with the lowest level of violence.
  
  
  CONCLUSIONS
  There is an association between high rate of youth violence and very preterm birth. Findings from this study may help inform future research to develop targeted interventions aimed at reducing community violence and very preterm birth in vulnerable populations.
authors.affiliation: Division of Epidemiology, Department of Family Medicine and Population Health, School of Medicine, Virginia Commonwealth University in Richmond, Richmond, VA; Department of Obstetrics and Gynecology, Medical Center, Virginia Commonwealth University in Richmond, Richmond, VA; Institute for Women's Health, Virginia Commonwealth University in Richmond, Richmond, VA. Electronic address: saba.masho@vcuhealth.org.
authors.forename: Saba W
authors.initials: SW
authors.lastname: Masho
authors.affiliation: Division of Epidemiology, Department of Family Medicine and Population Health, School of Medicine, Virginia Commonwealth University in Richmond, Richmond, VA.
authors.forename: Susan
authors.initials: S
authors.lastname: Cha
authors.affiliation: Division of Epidemiology, Department of Family Medicine and Population Health, School of Medicine, Virginia Commonwealth University in Richmond, Richmond, VA; Center on Society and Health, Virginia Commonwealth University in Richmond, Richmond, VA.
authors.forename: Derek A
authors.initials: DA
authors.lastname: Chapman
authors.affiliation: Department of Obstetrics and Gynecology, Medical Center, Virginia Commonwealth University in Richmond, Richmond, VA.
authors.forename: David
authors.initials: D
authors.lastname: Chelmow
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000428:Alcohol Drinking / Q000453:epidemiology; D002648:Child; D004522:Educational Status; D000069581:Exposure to Violence / Q000706:statistics & numerical data; D005260:Female; D005865:Gestational Age; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D016015:Logistic Models; D008423:Maternal Age; D055361:Multilevel Analysis; D016017:Odds Ratio; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D047928:Premature Birth / Q000453:epidemiology*; D011295:Prenatal Care / Q000706:statistics & numerical data; D012042:Registries; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D064890:Social Determinants of Health / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000453:epidemiology; D014505:Urban Population; D014754:Violence / Q000706:statistics & numerical data*; D014768:Virginia / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
keywords: multilevel analysis; prematurity; preterm birth; violence