O'Campo, P., Burke, J. G., Culhane, J., Elo, I. T., Eyster, J., Holzman, C., et al. (2008). American Journal of Epidemiology, 167, 155-163.

We all learned as nursing students the four aspects of human health: physical, emotional, social, and spiritual. Physical and emotional aspects of health and preterm birth have been well studied. Recently, a growing body of research has focused on the influence of societal factors on human health. This research by O'Campo and her research team examines the impact of neighborhood factors on preterm birth. They scrutinized birth certificate and US Census data from eight geographic areas in four states (Maryland, Michigan, North Carolina, and Pennsylvania). In brief, they created a neighborhood deprivation index using income/poverty, education, employment, housing, and occupation factors in each of the neighborhoods. Because preterm birth varies by race and ethnic group (with black women having the highest rates), special attention was also paid to racial differences in these neighborhoods.

Not surprisingly, a significant association was found between neighborhood deprivation and the risk of preterm birth (birth before 37 weeks) among non-Hispanic white women and non-Hispanic black women. The mechanisms that cause this to occur, however, were not studied, so we don't know which factors in neighborhoods (e.g., environmental pollutants, high-risk health behaviors, violence, stress) may be responsible. Another challenge posed by this social research is that interventions are beyond the individual, are broader, and are harder to imagine. If the social environment does contribute to preterm birth, the implication is that to "fix" preterm birth we must focus not only on the individual but also on the larger social environment. Income/poverty, education, employment, and housing are also pieces of the preterm birth puzzle. It is time we attend to them.

Linda Beth Tiedje