Violent crime exposure classification and adverse birth outcomes: a geographically-defined cohort study

BACKGROUND: Area-level socioeconomic disparities have long been associated with adverse pregnancy outcomes. Crime is an important element of the neighborhood environment inadequately investigated in the reproductive and public health literature. When crime has been used in research, it has been variably defined, resulting in non-comparable associations across studies. METHODS: Using geocoded linked birth record, crime and census data in multilevel models, this paper explored the relevance of four spatial violent crime exposures: two proximal violent crime categorizations (count of violent crime within a one-half mile radius of maternal residence and distance from maternal residence to nearest violent crime) and two area-level crime categorizations (count of violent crimes within a block group and block group rate of violent crimes) for adverse birth events among women in living in the city of Raleigh NC crime report area in 1999–2001. Models were adjusted for maternal age and education and area-level deprivation. RESULTS: In black and white non-Hispanic race-stratified models, crime characterized as a proximal exposure was not able to distinguish between women experiencing adverse and women experiencing normal birth outcomes. Violent crime characterized as a neighborhood attribute was positively associated with preterm birth and low birth weight among non-Hispanic white and black women. No statistically significant interaction between area-deprivation and violent crime category was observed. CONCLUSION: Crime is variably categorized in the literature, with little rationale provided for crime type or categorization employed. This research represents the first time multiple crime categorizations have been directly compared in association with health outcomes. Finding an effect of area-level violent crime suggests crime may best be characterized as a neighborhood attribute with important implication for adverse birth outcomes

2009 H1N1 and Seasonal Influenza Immunization Among Pregnant Women: a Comparison of Different Sources of Immunization Information

Validity of prenatal immunization data from different sources has not been assessed. We evaluated prenatal 2009 H1N1 and seasonal influenza (FLU) data obtained from state immunization information systems (IIS), medical record abstraction (MRA), and participant recall using medical care logs (NCS-MCL). 2009 H1N1 and FLU data were obtained from IIS and MRA for 325 pregnant women participating in the National Children\u27s Study at three locations (SD/MN, NC, WI). Women recalled immunizations at first pregnancy visit and at 16-17 and 36 weeks\u27 gestation (NCS-MCL). The proportion of women with vaccine information obtainable from each data source was determined, and proportions immunized as determined using different data sources were compared. IIS data were available for 82%, MRA for 97%, and NCS-MCL for 93% of women. No mention of either vaccine occurred in 29% (range 4-48%) of IIS, 40% of MRA (25-59%), and 59% (43-82%) in NCS-MCL. Best agreement between sources was 2009 H1N1 vaccine in MRA versus IIS [kappa (95% CI) of 0.44 (0.32-0.55)], with poorest agreement for FLU in IIS versus NCS-MCL [0.11 (-0.03 to 0.25)]. IIS was the most sensitive method for identifying women receiving 2009 H1N1 vaccine (92%); MRA was most sensitive for FLU vaccine (81%). IIS provided the most complete and sensitive data for 2009 H1N1 immunizations and MRA the most complete and sensitive data for FLU; IIS data were available for a smaller percent of population than MRA. NCS-MCL was the least sensitive method for identifying vaccinated women

Psychosocial Determinants of Adequacy of Gestational Weight Gain

Pregnancy is a critical time window for evaluating weight gain on subsequent risk for obesity among women of childbearing age. The purpose of this investigation was to determine if symptoms of depression, anxiety, stress, self-esteem and fetal health locus of control beliefs were significant risk factors for adequacy of gestational weight gain (GWG) when maternal sociodemographic characteristics and health behaviors were considered

Direct observation of neighborhood attributes in an urban area of the US south: characterizing the social context of pregnancy

BACKGROUND: Neighborhood characteristics have been associated with poor maternal and child health outcomes, yet conceptualization of potential mechanisms is still needed. Census data have long served as proxies for area level socioeconomic influences. Unique information captured by neighborhood inventories, mostly conducted in northern US and Canadian urban areas, has shown important aspects of the community environment that are not captured by the socioeconomic and demographic aggregated individual statistics of census data. In this paper, we describe a neighborhood data collection effort tailored to a southern urban area. METHODS: This study used data from the Pregnancy, Nutrition and Infection (PIN) prospective cohort study to describe neighborhoods where low- and moderate-income pregnant women reside. Women who participated in the PIN study and who resided in Raleigh, NC and its surrounding suburbs were included (n = 703). Neighborhood attributes captured by the inventory included litter, housing condition, road condition, and social interactions that informed theoretical constructs of physical incivility, territoriality and social spaces. US Housing and Population Census 2000 data at the block group level were also assessed to identify the unique contribution of directly observed data. We hypothesize that neighborhood environments can influence health through psychosocial mediated pathways that lead to increased stress, or through disadvantage leading to poor neighborhood resources, or by protective attributes through increased social control. RESULTS: Findings suggest that directly observed neighborhood attributes distinguished between different types of areas in which low-income pregnant non-Hispanic white and non-Hispanic black women lived. Theoretically informed scales of physical incivilities, territoriality and social spaces were constructed and found to be internally consistent. Scales were weakly associated indicating that these constructs capture distinct information about these neighborhoods. Physical incivilities, territoriality and social spaces scales were poorly explained by traditional census variables used to proxy neighborhood environment. CONCLUSION: If neighborhoods influence health through psychosocial mediated pathways then careful detailing of neighborhood attributes that contribute to stress or deterioration, beyond traditional socioeconomic status, are needed. We believe that measuring physical incivility, territoriality and social spaces as expressions of underlying issues of maintenance and social communication make important contributes to this field

The role of body image in prenatal and postpartum depression: a critical review of the literature

Maternal depression increases risk of adverse perinatal outcomes, and recent evidence suggests that body image may play an important role in depression. This systematic review identifies studies of body image and perinatal depression with the goal of elucidating the complex role that body image plays in prenatal and postpartum depression, improving measurement, and informing next steps in research. We conducted a literature search of the PubMed database (1996– 2014) for English language studies of (1) depression, (2) body image, and (3) pregnancy or postpartum. In total, 19 studies matched these criteria. Cross-sectional studies consistently found a positive association between body image dissatisfaction and perinatal depression. Prospective cohort studies found that body image dissatisfaction predicted incident prenatal and postpartum depression; findings were consistent across different aspects of body image and various pregnancy and postpartum time periods. Prospective studies that examined the reverse association found that depression influenced the onset of some aspects of body image dissatisfaction during pregnancy, but few evaluated the postpartum onset of body image dissatisfaction. The majority of studies found that body image dissatisfaction is consistently but weakly associated with the onset of prenatal and postpartum depression. Findings were less consistent for the association between perinatal depression and subsequent body image dissatisfaction. While published studies provide a foundation for understanding these issues, methodologically rigorous studies that capture the perinatal variation in depression and body image via instruments validated in pregnant women, consistently adjust for important confounders, and include ethnically diverse populations will further elucidate this association

Pregravid BMI is associated with dietary restraint and psychosocial factors during pregnancy

The objective was to investigate the association of pregravid weight status, dietary restraint and psychosocial factors during pregnancy. We used data from the Pregnancy, Infection and Nutrition study, that recruited 2,006 women at prenatal clinics before 20 weeks’ gestation who were >16 years and English speaking. Institute of Medicine BMI cutpoints of underweight (26.0–29.0), obese (>29.0–34.9) and an additional category morbidly obese (≥ 35.0), were used to categorize weight status. Eight psychosocial measures and dietary restraint were assessed with regard to BMI; perceived stress, trait anxiety, depression symptoms, and internal locus of control (LOC), chance LOC, powerful others LOC, self-esteem and mastery. Linear regression was used to estimate associations, controlling for potential confounders. A significant test for trend was found between increasing pregravid weight categories and perceived stress, trait anxiety, depression symptoms, powerful others LOC, self-esteem, mastery and dietary restraint. In adjusted models, pregravid obesity was independently associated with perceived stress, trait anxiety and depression. Morbidly obese status was independently associated with all measures except internal LOC. A strong linear association was found between increasing weight categories and dietary restraint. A consistent association was found between pregravid weight status, psychosocial factors and dietary restraint. If corroborated, these findings suggest that with increasing pregravid weight, pregnant women are at greater risk for experiencing negative psychological states, are less likely to experience positive personal dispositions, and may need additional support to prevent adverse maternal complications and pregnancy outcomes

The Association Between Physical Activity and Maternal Sleep During the Postpartum Period

Physical activity is associated with improved sleep quality and duration in the general population, but its effect on sleep in postpartum women is unknown

State-Level Immunization Information Systems: Potential for Childhood Immunization Data Linkages.

Objectives Sources of immunization data include state registries or immunization information systems (IIS), medical records, and surveys. Little is known about the quality of these data sources or the feasibility of using IIS data for research. We assessed the feasibility of collecting immunization information for a national children\u27s health study by accessing existing IIS data and comparing the completeness of these data against medical record abstractions (MRA) and parent report. Staff time needed to obtain IIS and MRA data was assessed. Methods We administered a questionnaire to state-level IIS representatives to ascertain availability and completeness of their data for research and gather information about data formats. We evaluated quality of data from IIS, medical records, and reports from parents of 119 National Children\u27s Study participants at three locations. Results IIS data were comparable to MRA data and both were more complete than parental report. Agreement between IIS and MRA data was greater than between parental report and MRA, suggesting IIS and MRA are better sources than parental report. Obtaining IIS data took less staff time than chart review, making IIS data linkage for research a preferred choice. Conclusions IIS survey results indicate data can be obtained by researchers using data linkages. IIS are an accessible and feasible child immunization information source and these registries reduce reliance on parental report or medical record abstraction. Researchers seeking to link IIS data with large multi-site studies should consider acquiring IIS data, but may need strategies to overcome barriers to data completeness and linkage

Risk Factors for Prenatal Depressive Symptoms Among Hispanic Women

Prior studies of risk factors for depressive symptoms during pregnancy are sparse and the majority have focused on non-Hispanic white women. Hispanics are the largest minority group in the US and have the highest birth rates

Correlates of High Perceived Stress Among Pregnant Hispanic Women in Western Massachusetts

Prenatal psychosocial stress has been associated with adverse pregnancy outcomes, even after controlling for known risk factors. This paper aims to evaluate correlates of high perceived stress among Hispanic women, a group with elevated rates of stress during pregnancy