Conceptualizing neighborhood space: Consistency and variation of associations for neighborhood factors and pregnancy health across multiple neighborhood units

• Published in: Health & place 2012-07, Vol.18 (4), p.805-813
• Main Authors: Messer, Lynne C., Vinikoor-Imler, Lisa C., Laraia, Barbara A.
• Format: Article
• Language: English
• Subjects: Adult; African Americans - statistics & numerical data; Civility; Cohort Studies; Environment Design; Estimate precision; European Continental Ancestry Group - statistics & numerical data; Female; Geographic Information Systems; Health Behavior; Health technology assessment; Humans; Hypertension; Hypertension, Pregnancy-Induced - epidemiology; Hypertension, Pregnancy-Induced - ethnology; Models, Statistical; Neighborhood effects; Neighbourhoods; North Carolina - epidemiology; Physical activity; Pregnancy; Pregnancy behaviors; Pregnancy Outcome; Pregnancy outcomes; Public health; Residence Characteristics; Smoking; Smoking - epidemiology; Social conditions; Spatial analysis; U.S.A; Weight Gain; Women; Young Adult
• ISSN: 1353-8292; 1873-2054
• DOI: 10.1016/j.healthplace.2012.03.012

The purpose of this research was to assess the consistency of associations between neighborhood characteristics and pregnancy-related behaviors and outcomes across four nested neighborhood boundaries using race-stratified fixed-slope random-intercept multilevel logistic models. High incivilities was associated with increased smoking, inadequate weight gain and pregnancy-induced hypertension (PIH), while walkability was associated with decreased smoking and PIH for white women across all neighborhood definitions. For African American women, high incivilities was associated with increased smoking and inadequate gestational weight gain, while more walkable neighborhoods appeared protective against smoking and inadequate weight gain in all but the smallest neighborhoods. Associations with neighborhood attributes were similar in effect size across geographies, but less precise as neighborhoods became smaller. ► Neighborhood effects occur across seamless geography but research within administrative units. ► The way boundaries are drawn across space may have implications for the observed research results. ► We found that neighborhood scale or definition matters for some exposures, but not for all. ► We also found that census-defined units are good proxies for many neighborhood exposures.