Neighborhood Context and Preterm Delivery among African American Women: the Mediating Role of Psychosocial Factors

Abstract

Preterm delivery (PTD), or birth before 37 completed weeks of gestation, is a serious public health issue, and racial disparities persist. In a recently published study, perceptions of the residential environment (or neighborhood context) were associated with PTD rates among urban African American women with low educational attainment (≤12 years); however, the mechanisms of these associations are unknown. Given this gap in the literature, we used data from the Life Influences on Fetal Environments Study of postpartum African American women from Metropolitan Detroit, Michigan (2009Michigan ( -2011 n = 399), to examine whether psychosocial factors (depressive symptomology, psychological distress, and perceived stress) mediate associations between perceptions of the neighborhood context and PTD. Validated scales were used to measure women's perceptions of their neighborhood safety, walkability, healthy food availability (higher=better), and social disorder (higher=more disorder). The psychosocial indicators were measured with the Center for Epidemiologic Studies-Depression Scale, Kessler's Psychological Distress Scale (K6), and Cohen's Perceived Stress Scale. Statistical mediation was assessed using an unadjusted logistic regression-based path analysis for estimating direct and indirect effects. The associations between perceived walkability, food availability, and social disorder were not mediated by psychosocial factors. However, perceptions of neighborhood safety were inversely associated with depressive symptoms which were positively associated with PTD rates. Also, higher perceived neighborhood social disorder was associated with higher PTD rates, net of the indirect paths through psychosocial factors. Future research should identify other mechanisms of the perceived neighborhood context-PTD associations, which would inform PTD prevention efforts among high-risk groups.

Relationships between psychosocial factors during pregnancy and preterm birth in Puerto Rico

“…This is in line with previous work showing that women in neighborhoods with high material and social deprivation have increased perceived stress and depression [11]. It is also consistent with a study of African-American women in Michigan which showed that lower levels of perceived neighborhood safety and walkability were associated with increased feelings of perceived stress and depression [30]. Additionally, our findings are supported by a previous study showing that women in disadvantaged neighborhoods experience more stressful life events during pregnancy compared to women in advantaged neighborhoods [10].…”

“…None of these measures were associated with PTB. These findings support a growing body of literature suggesting that the qualities of one's neighborhood may be a source of increased psychosocial stress and depression [10,11,30]. Neighborhood perceptions were positively associated with all other metrics of psychosocial stress, including negative life experiences, perceived stress, and ultimately depression.…”

Relationships between psychosocial stressors among pregnant women in San Francisco: A path analysis

“…For example, a study among African American pregnant women in Detroit found that lower neighborhood quality, as measured by indicators of social and physical disorder, safety, walking environment, and overall neighborhood quality, was associated with elevated depression symptoms and that the association was partially mediated by perceived stress [42]. A second study found that lower perceived neighborhood safety and walkability was associated with increased depression symptoms during pregnancy among African American women [43]. Discrepancies in our results may be a result of how neighborhood quality was measured.…”

A Transdisciplinary Conceptual Framework of Contextualized Resilience for Reducing Adverse Birth Outcomes

“…The fourth layer of structural vulnerability describes the economic forces, institutional mechanisms, as well as the local policies that influence the quality of life and health of community members. Black, Hispanic, and Latina women are disproportionately negatively 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 F o r P e e r R e v i e w 18 impacted by structural forces, both institutionally, and through local policies that have not been created and managed to serve women of color (Bourgois et al, 2017;Krieger, 2012;Nuru-Jeter et al, 2009;Sealy-Jefferson et al, 2016;Walters et al, 2011). Structural vulnerability is an operationalized term that strongly aligns along all layers of the framework and can best inform the structural layer.…”

“…Embodiment of contemporary and historical trauma has been shown to influence both disease and adverse birth outcomes for Black women (Sealy-Jefferson et al, 2016;Prather et al, 2018;Prather, Fuller, Marshall & Jeffries, 2016;. Exposure to structural violence and threats in the form of discrimination and racism can be embodied as a higher allostatic load, or cumulative "wear and tear" on the body , which can result in weathering, an increased susceptibility of disease (Geronimus, Hicken positive trajectory but representing a process of "harnessing key resources to sustain well-being" (Panter-Brick, 2014) in which political economies, access to power, cultural norms and expectations are influenced by structural vulnerabilities, historical oppression and the ecological layers and environments of the individual, family and community.…”