Neighborhood effects on birthweight: an exploration of psychosocial and behavioral pathways in Baltimore, 1995--1996

Soc Sci Med. 2009 Jan;68(1):100-10. doi: 10.1016/j.socscimed.2008.10.006. Epub 2008 Nov 6.


Neighborhood characteristics have been proposed to influence birth outcomes through psychosocial and behavioral pathways, yet empirical evidence is lacking. Using data from an urban, low-income sample, this study examined the impact of the neighborhood environment on birthweight and evaluated mediation by psychosocial and behavioral factors. The sample included 726 women who delivered a live birth at Johns Hopkins Hospital in Baltimore, Maryland, USA between 1995 and 1996. Census-tract data were used to create a principal component index of neighborhood risk based on racial and economic stratification (% Black, % poverty), social disorder (violent crime rate), and physical deterioration (% boarded-up housing) (alpha=0.82). Information on sociodemographic, psychosocial, and behavioral factors was gathered from a postpartum interview and medical records. Random intercept multilevel models were used to estimate neighborhood effects and assess potential mediation. Controlling for sociodemographic characteristics, a standard deviation increase in neighborhood risk conferred a 76g birthweight decrement. This represents an approximate 300g difference between the best and worst neighborhoods. Although stress (daily hassles), perceived locus-of-control, and social support were related to birthweight, their adjustment reduced the neighborhood coefficient by only 12%. In contrast, the neighborhood effect was reduced by an additional 30% and was no longer statistically significant after adjustment for the behavioral factors of smoking, drug use, and delayed prenatal care. These findings suggest that neighborhood factors may influence birthweight by shaping maternal behavioral risks. Thus, neighborhood level interventions should be considered to address multiple maternal and infant health risks. Future studies should examine more direct measures of neighborhood stress, such as perceived neighborhood disorder, and evaluate alternative mechanisms by which neighborhood factors influence behavior (e.g., social norms and access to goods and services).

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Baltimore
  • Birth Weight*
  • Female
  • Health Behavior
  • Hospitals, University
  • Housing / standards
  • Housing / statistics & numerical data
  • Humans
  • Infant, Newborn
  • Maternal Welfare / economics
  • Maternal Welfare / ethnology
  • Maternal Welfare / psychology*
  • Poverty Areas*
  • Pregnancy
  • Pregnancy Outcome / economics
  • Pregnancy Outcome / ethnology
  • Pregnancy Outcome / psychology*
  • Pregnant Women / ethnology
  • Pregnant Women / psychology*
  • Residence Characteristics / classification*
  • Residence Characteristics / statistics & numerical data
  • Risk Assessment*
  • Risk-Taking
  • Social Class
  • Social Environment
  • Social Support
  • Violence / statistics & numerical data
  • Vulnerable Populations / ethnology
  • Vulnerable Populations / psychology*
  • Young Adult