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Relationships among Neighborhood Environment, Racial Discrimination, Psychological Distress, and Preterm Birth in African American Women

https://doi.org/10.1111/j.1552-6909.2012.01409.xGet rights and content

ABSTRACT

Objectives

To (a) examine the relationships among objective and perceived indicators of neighborhood environment, racial discrimination, psychological distress, and gestational age at birth; (b) determine if neighborhood environment and racial discrimination predicted psychological distress; (c) determine if neighborhood environment, racial discrimination, and psychological distress predicted preterm birth; and (d) determine if psychological distress mediated the effects of neighborhood environment and racial discrimination on preterm birth.

Design

Descriptive correlational comparative.

Setting

Postpartum unit of a medical center in Chicago.

Participants

African American women (n1 = 33 with preterm birth; n2 = 39 with full‐term birth).

Methods

Women completed the instruments 24 to 72 hours after birth. Objective measures of the neighborhood were derived using geographic information systems (GIS).

Results

Women who reported higher levels of perceived social and physical disorder and perceived crime also reported higher levels of psychological distress. Women who reported more experiences of racial discrimination also had higher levels of psychological distress. Objective social disorder and perceived crime predicted psychological distress. Objective physical disorder and psychological distress predicted preterm birth. Psychological distress mediated the effect of objective social disorder and perceived crime on preterm birth.

Conclusion

Women's neighborhood environments and racial discrimination were related to psychological distress, and these factors may increase the risk for preterm birth.

Section snippets

Neighborhood Environment

We examined three aspects of the neighborhood environment: physical disorder, social disorder, and violent crime. Disorder is “visible cues indicating a lack of order and social control” in the community (Ross & Mirowsky, 2001, p. 413). Cues are physical and social (Skogan, 1990). Physical disorder includes physical conditions of the neighborhood, such as vacant housing, vacant lots, and vandalism. Social disorder refers to activities involving people, such as drug dealing, prostitution, and

Design

In this pilot study, we used a cross‐sectional comparative design.

Sample

A sample of 72 self‐identified African American women was enrolled in the study. They were recruited into two groups: 33 women with preterm birth (<37 weeks gestation) and 39 women with full‐term birth (≥37 weeks gestation). Selection criteria included (a) at least 18 years of age, (b) singleton pregnancy, (c) at least 24 weeks gestation at the time of birth, (d) at least 24 hours after birth, and (e) medically stable. Also, the

Sample Characteristics

The women's mean age was 23 years and the mean gestational age was 36.7 weeks. Women with preterm birth had infants with a mean gestational age of 33.5 weeks, and women with full‐term birth had infants with a mean gestational age of 39.4 weeks. The majority of women were single (82%), employed (53%), had household annual incomes of &lt;$10,000 (42%), and had either some college (39%) or graduated high school (38%) (Table 1).

Relationships among Variables

Objective neighborhood social disorder was positively related to

Discussion

Our results show that objective physical disorder was the only neighborhood environment variable that predicted preterm birth. Our findings regarding objective physical disorders were similar to the findings from Reagan and Salsberry (2005) that for African American women only, housing vacancy rates increased the risk of preterm birth at fewer than 33 weeks gestation. Furthermore, objective social disorder increased the level of psychological distress and indirectly affected the risk for

Conclusion

The results of this study suggest that psychological distress mediated the effects of objective social disorder and perceived crime on preterm birth. Health care providers need to assess women's perception of their neighborhoods and their influence on women's psychological distress. Nurses need to advocate for public policies that improve women's living conditions. By incorporating assessment of neighborhood environment during prenatal care and developing relevant interventions, nurses may

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