Effects of maternal stress on LBW and PTB outcomes may be different for mothers living in different neighborhood contexts. Therefore, investigations that fail to examine places of residence would most likely not identify mothers at risk of LBW or PTB. Policies to improve birth outcomes need to target both places of residence and specific mediating or moderating factors associated with deprived neighborhoods of residence.

Effects of income inequality on health and other social systems have been a subject of considerable debate, but only a few studies have used multilevel models to evaluate these relationships. The main objectives of the study were to (1) Evaluate the relationships among neighborhood income inequality, social support and birth outcomes (low birth weight, and preterm delivery) and (2) Assess variations in racial disparities in birth outcomes across neighborhood contexts of income distribution and maternal social support. We evaluated these relationships by using South Carolina Pregnancy Risk Assessment and Monitoring System (PRAMS) survey for 2000-2003 geocoded to 2000 US Census data for South Carolina. Multilevel analysis was used to simultaneously evaluate the association between income inequality (measured as Gini), maternal social relationships and birth outcomes (low birth weight and preterm delivery). The results showed residence in neighborhoods with medium levels of income inequality was independently associated with low birth weight (OR: 2.00; 95% CI 1.14-3.26), but not preterm birth; low social support was an independent risk for low birth weight or preterm births. The evidence suggests that non-Hispanic black mothers were at increased risks of low birth weight or preterm birth primarily due to greater exposures of neighborhood deprivations associated with low income and reduced social support and modified by unequal income distribution.

To evaluate the consistency of the relationship between early drug use in adolescence and illegal drug use in adulthood as proposed in the “gateway theory” and to determine whether pre-existing depressive symptoms modifies this relationship. We used contractual data from the National Longitudinal Study of Adolescent to Adult health data spanning a 14 year period. We assessed the relationship between gateway drugs at baseline (age 11–20 years) and drug use in adulthood using generalized estimating equation (GEE) regression models. Gateways drugs used in early adolescence were significantly associated with marijuana use, illegal drugs and cocaine in older adolescence, but over time these relationships were not consistent in adulthood. Changes in the pattern of psychoactive drug use were important predictors of drug use in adulthood. A history of higher depressive symptoms was associated with higher frequencies of psychoactive drug use over time. Users of mental health services in adolescence were less likely to use drugs in older adolescence and in adulthood. Relationships between early drug use and later drug use in adulthood cannot be solely explained by the gateway hypothesis. Collectively, adolescent drug prevention and treatment programs should apply theory-based and evidence-proven multisectoral intervention strategies rather than providing a brief counseling on individual's behaviors. This evidence should include understanding that changes in behavior should involve broader analyses of the underlying social context for drug use and in particular the role of the community social norms in driving a group's behaviors.

Interventions seeking to improve maternal and child health by reducing smoking during pregnancy need to engage specific community factors that encourage maternal quitting behaviors and reduce smoking relapse rates. Inclusion of maternal-level covariates in neighborhood models without careful consideration of the causal pathway might produce misleading interpretation of the results.