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Published on: January 12, 2018
Understanding the role of violence as a social determinant of preterm birth
Saba W Masho1, Susan Cha2, Derek A Chapman3
1Division 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.
Insights
Neighborhood youth violence is linked to a higher risk of very preterm birth. This finding highlights the need for community-level interventions to reduce both violence and preterm birth rates in at-risk populations.
Area of Science:
- Public Health
- Sociology
- Epidemiology
Background:
- Preterm birth is a significant cause of infant mortality and morbidity.
- Understanding the complex interplay of social and individual risk factors for preterm birth remains a challenge.
Purpose of the Study:
- To investigate the association between neighborhood youth violence and preterm birth.
- To explore the impact of community violence on adverse birth outcomes.
Main Methods:
- Analysis of a 10-year live birth registry dataset (N=27,519) from Richmond, VA.
- Geocoding of birth data and integration with census tract and police report data on youth violence.
- Multilevel logistic regression models were used to assess the association between youth violence rates and preterm birth, adjusting for multiple covariates.
Main Results:
- Nearly 20% of births occurred in areas with the highest youth violence rates.
- Census tracts with the highest violence levels showed a 38% increased odds of very preterm birth (<32 weeks) compared to the lowest violence areas.
- The association remained significant after adjusting for numerous maternal and socioeconomic factors.
Conclusions:
- A significant association exists between high rates of neighborhood youth violence and very preterm birth.
- Findings suggest community violence may be a modifiable risk factor for preterm birth.
- This research can inform targeted interventions to reduce community violence and improve birth outcomes in vulnerable populations.
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.
Study Design:
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.
Conclusion:
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.
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