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Testing a sociomedical model for preterm delivery
D P Misra1, P O'Campo, D Strobino
1Department of Population and Family Health Sciences, Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD 21205, USA. dmisra@jhsph.edu
Insights
Social and financial difficulties significantly increase preterm birth risk, particularly for low-income women. Psychosocial factors like stress and locus of control also play a role, with biomedical factors mediating some effects.
Area of Science:
- Social Epidemiology
- Maternal Health
- Reproductive Health
Background:
- Preterm birth remains a significant public health concern.
- Existing models often focus on biomedical factors, potentially overlooking social and psychosocial influences.
Purpose of the Study:
- To develop a comprehensive model for preterm birth risk.
- To investigate the interplay of social, psychosocial, and biomedical factors in preterm delivery.
- To identify key predictors of preterm birth in a low-income population.
Main Methods:
- Study involved 739 low-income Black non-Hispanic women.
- Data collected via interviews post-delivery and medical record abstraction.
- Statistical analyses examined the influence of social, psychosocial, and biomedical variables.
Main Results:
- Inadequacy of time and money for non-essentials were strong predictors of preterm delivery.
- Psychosocial factors, including stress and locus of control, independently predicted preterm birth.
- Biomedical factors partially mediated the effects of social and psychosocial factors on preterm delivery risk.
Conclusions:
- Social and psychosocial factors are critical determinants of preterm birth.
- Interventions addressing financial strain and psychosocial well-being may reduce preterm delivery rates.
- Further research is needed to explore these complex relationships in diverse populations.
Abstract:
The study purpose was to contribute to the development of a model for preterm birth that brings together social, psychosocial and biomedical factors. The three research questions were: (a) Which social and psychosocial factors influence the risk of preterm delivery? (b) Are the effects of social and psychosocial factors independent? (c) Do the biomedical factors identified and measured here explain the effect of social and psychosocial factors? The sample comprised 739 low-income black non-Hispanic women. Interviews were conducted after delivery, and medical records were abstracted. Nearly a quarter of the women delivered preterm (23.5%). Two social factors strongly predicted risk of preterm delivery: inadequacy of time and money for non-essentials. The effect of both was stronger than expected from each alone and was partially mediated by psychosocial factors. Several psychosocial factors also predicted preterm delivery risk but only stress and locus of control were independent predictors. With the inclusion of biomedical factors, stress (OR = 1.86, P = 0.005) and locus of control (OR = 1.75, P = 0.007) continued to be strongly associated with preterm delivery. The effect of inadequate resources for non-essentials was no longer significant, suggesting mediation. These strong effects of social and psychosocial factors should be examined in future studies.