Dataset Information

Associations between the quality of the residential built environment and pregnancy outcomes among women in North Carolina.

ABSTRACT:

Background

The built environment, a key component of environmental health, may be an important contributor to health disparities, particularly for reproductive health outcomes.

Objective

In this study we investigated the relationship between seven indices of residential built environment quality and adverse reproductive outcomes for the City of Durham, North Carolina (USA).

Methods

We surveyed approximately 17,000 residential tax parcels in central Durham, assessing > 50 individual variables on each. These data, collected using direct observation, were combined with tax assessor, public safety, and U.S. Census data to construct seven indices representing important domains of the residential built environment: housing damage, property disorder, security measures, tenure (owner or renter occupied), vacancy, crime count, and nuisance count. Fixed-slope random-intercept multilevel models estimated the association between the residential built environment and five adverse birth outcomes. Models were adjusted for maternal characteristics and clustered at the primary adjacency community unit, defined as the index block, plus all adjacent blocks that share any portion of a line segment (block boundary) or vertex.

Results

Five built environment indices (housing damage, property disorder, tenure, vacancy, and nuisance count) were associated with each of the five outcomes in the unadjusted context: preterm birth, small for gestational age (SGA), low birth weight (LBW), continuous birth weight, and birth weight percentile for gestational age (BWPGA; sex-specific birth weight distributions for infants delivered at each gestational age using National Center for Health Statistics referent births for 2000-2004). However, some estimates were attenuated after adjustment. In models adjusted for individual-level covariates, housing damage remained statistically significantly associated with SGA, birth weight, and BWPGA.

Conclusion

This work suggests a real and meaningful relationship between the quality of the residential built environment and birth outcomes, which we argue are a good measure of general community health.

SUBMITTER: Miranda ML

PROVIDER: S-EPMC3295337 | biostudies-literature | 2012 Mar

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Associations between the quality of the residential built environment and pregnancy outcomes among women in North Carolina.

Miranda Marie Lynn ML Messer Lynne C LC Kroeger Gretchen L GL

Environmental health perspectives 20111202 3

<h4>Background</h4>The built environment, a key component of environmental health, may be an important contributor to health disparities, particularly for reproductive health outcomes.<h4>Objective</h4>In this study we investigated the relationship between seven indices of residential built environment quality and adverse reproductive outcomes for the City of Durham, North Carolina (USA).<h4>Methods</h4>We surveyed approximately 17,000 residential tax parcels in central Durham, assessing > 50 in ...[more]

PMID: 22138639

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Project description:BACKGROUND: Half the world's population lives in urban areas. It is therefore important to identify characteristics of the built environment that are beneficial to human health. Urban greenness has been associated with improvements in a diverse range of health conditions, including birth outcomes; however, few studies have attempted to distinguish potential effects of greenness from those of other spatially correlated exposures related to the built environment. OBJECTIVES: We aimed to investigate associations between residential greenness and birth outcomes and evaluate the influence of spatially correlated built environment factors on these associations. METHODS: We examined associations between residential greenness [measured using satellite-derived Normalized Difference Vegetation Index (NDVI) within 100 m of study participants' homes] and birth outcomes in a cohort of 64,705 singleton births (from 1999-2002) in Vancouver, British Columbia, Canada. We also evaluated associations after adjusting for spatially correlated built environmental factors that may influence birth outcomes, including exposure to air pollution and noise, neighborhood walkability, and distance to the nearest park. RESULTS: An interquartile increase in greenness (0.1 in residential NDVI) was associated with higher term birth weight (20.6 g; 95% CI: 16.5, 24.7) and decreases in the likelihood of small for gestational age, very preterm (< 30 weeks), and moderately preterm (30-36 weeks) birth. Associations were robust to adjustment for air pollution and noise exposures, neighborhood walkability, and park proximity. CONCLUSIONS: Increased residential greenness was associated with beneficial birth outcomes in this population-based cohort. These associations did not change after adjusting for other spatially correlated built environment factors, suggesting that alternative pathways (e.g., psychosocial and psychological mechanisms) may underlie associations between residential greenness and birth outcomes.

Project description:Objective To examine associations between neighborhood built environment (BE) variables, residential property values, and longitudinal 1- and 2-year changes in body mass index (BMI). Methods The Seattle Obesity Study III was a prospective cohort study of adults with geocoded residential addresses, conducted in King, Pierce, and Yakima Counties in Washington State. Measured heights and weights were obtained at baseline (n = 879), year 1 (n = 727), and year 2 (n = 679). Tax parcel residential property values served as proxies for individual socioeconomic status. Residential unit and road intersection density were captured using Euclidean-based SmartMaps at 800 m buffers. Counts of supermarket (0 versus. 1+) and fast-food restaurant availability (0, 1–3, 4+) were measured using network based SmartMaps at 1600 m buffers. Density measures and residential property values were categorized into tertiles. Linear mixed-effects models tested whether baseline BE variables and property values were associated with differential changes in BMI at year 1 or year 2, adjusting for age, gender, race/ethnicity, education, home ownership, and county of residence. These associations were then tested for potential disparities by age group, gender, race/ethnicity, and education. Results Road intersection density, access to food sources, and residential property values were inversely associated with BMI at baseline. At year 1, participants in the 3rd tertile of density metrics and with 4+ fast-food restaurants nearby showed less BMI gain compared to those in the 1st tertile or with 0 restaurants. At year 2, higher residential property values were predictive of lower BMI gain. There was evidence of differential associations by age group, gender, and education but not race/ethnicity. Conclusion Inverse associations between BE metrics and residential property values at baseline demonstrated mixed associations with 1- and 2-year BMI change. More work is needed to understand how individual-level sociodemographic factors moderate associations between the BE, property values, and BMI change. Highlights • Strong, inverse cross-sectional relationships between the built environment, residential property values (a proxy for individual socioeconomic status), and measured BMI were observed.• Measures of the built environment and residential property values showed modest and inconsistent associations with 1- and 2-year BMI change.• There was suggestive evidence that age may moderate the association between urban density and 1- and 2-year BMI change while education may moderate the association between residential property values and 2-year BMI change.

Project description:BackgroundsRisk factors related to the built environment have been associated with women's mental health and preventive care. This study sought to identify built environment factors that are associated with variations in prenatal care and subsequent pregnancy-related outcomes in an urban setting.MethodsIn a retrospective observational study, we characterized the types and frequency of prenatal care events that are associated with the various built environment factors of the patients' residing neighborhoods. In comparison to women living in higher-quality built environments, we hypothesize that women who reside in lower-quality built environments experience different patterns of clinical events that may increase the risk for adverse outcomes. Using machine learning, we performed pattern detection to characterize the variability in prenatal care concerning encounter types, clinical problems, and medication prescriptions. Structural equation modeling was used to test the associations among built environment, prenatal care variation, and pregnancy outcome. The main outcome is postpartum depression (PPD) diagnosis within 1 year following childbirth. The exposures were the quality of the built environment in the patients' residing neighborhoods. Electronic health records (EHR) data of pregnant women (n = 8,949) who had live delivery at an urban academic medical center from 2015 to 2017 were included in the study.ResultsWe discovered prenatal care patterns that were summarized into three common types. Women who experienced the prenatal care pattern with the highest rates of PPD were more likely to reside in neighborhoods with homogeneous land use, lower walkability, lower air pollutant concentration, and lower retail floor ratios after adjusting for age, neighborhood average education level, marital status, and income inequality.ConclusionsIn an urban setting, multi-purpose and walkable communities were found to be associated with a lower risk of PPD. Findings may inform urban design policies and provide awareness for care providers on the association of patients' residing neighborhoods and healthy pregnancy.

Project description:BackgroundAlthough previous literature suggested that several factors may be associated with higher risk of adverse health outcomes related to heat, research is limited for birth outcomes.ObjectivesWe investigated associations between exposure to heat/heat waves during the last week of gestation and preterm birth (PTB) in North Carolina (NC) and evaluated effect modification by residential greenness, urbanicity, and socioeconomic status (SES).MethodsWe obtained individual-level NC birth certificate data for May-September 2003-2014. We estimated daily mean temperature at each maternal residential address using Parameter-elevation Regressions on Independent Slopes Model (PRISM) data. We created 3 definitions of heat waves (daily temperature ≥95th, 97th, 99th percentile for NC warm season temperature, for ≥2 consecutive days). Normalized Difference Vegetation Index (NDVI) was used to assess residential greenness. Community-level modifiers (e.g., income, urbanicity) were considered. We applied Cox proportional hazard models to estimate the association between exposure to heat/heat waves and PTB, controlling for covariates. Stratified analyses were conducted to evaluate whether the association between heat and PTB varied by several individual and community characteristics.ResultsOf the 546,441 births, 8% were preterm. Heat exposure during the last week before delivery was significantly associated with risk of PTB. The hazard ratio for a 1 °C increase in temperature during the last week before delivery was 1.01 (95% CI: 1.00, 1.02). Higher heat-PTB risk was associated with some characteristics (e.g., areas that were urbanized, low SES, or in the Coastal Plain). We also found significant PTB-heat risk in areas with low greenness for urbanized area. For heat waves, we did not find significantly positive associations with PTB.DiscussionFindings provide evidence that exposure to heat during pregnancy increases risk of PTB and suggest disparities in these risks. Our results have implications for future studies of disparity in heat and birth outcomes associations.

Dataset Information

Associations between the quality of the residential built environment and pregnancy outcomes among women in North Carolina.

Background

Objective

Methods

Results

Conclusion

Publications

Associations between the quality of the residential built environment and pregnancy outcomes among women in North Carolina.

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