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Weight Gain During Pregnancy and Violent Neighborhoods
Jessica Galin PHN Capstone Presentation
May 3, 2016
Neighborhood Violence
Inadequate or Excessive
Gestational Weight Gain
Poor Birth Outcomes
Pregnancy Complications
?
Background
• Hypothesis 1. Neighborhood violence will be associated with both inadequate and excessive gestational weight gain
• Hypothesis 2. The strength of the associations will differ
by race/ethnicity
• Hypothesis 3. The strength of the associations will differ by pre-pregnancy weight
What is the association between living in violent neighborhoods and GWG?
Methods • Comprehensive look at GWG in the state of California
• 2.5 million pregnancies (2007-2012)
• Exposure: Neighborhood Rates of Interpersonal Violence
• Outcomes: Inadequate GWG, Excessive GWG
• Multi-level Logistic Regressions Models • Marginal Additive Effects • Sensitivity Analyses
• Multinomial Logistic Regressions • GWG z-scores, IOM categories
Methods
Key Results
0.90
0.95
1.00
1.05
1.10
1.15
1.20
Low Violence Low-Medium Violence Medium-High Violence High Violence
Adjusted Odds Ratios for Associations Between Neighborhood Violence Exposure and Inadequate or Excessive Gestational Weight Gain
Inadequate GWG Excessive GWG
1.18
-1.0%
-0.5%
0.0%
0.5%
1.0%
Low Violence Low-Medium Violence Medium-High Violence High Violence
Additive Scale for Associations Between Neighborhood Violence Exposure and Inadequate or Excessive Gestational Weight Gain
Inadequate GWG Excessive GWG
-2.0%
-1.5%
-1.0%
-0.5%
0.0%
0.5%
1.0%
Low Violence Low-Medium Violence Medium-High Violence High Violence
Additive Scale Associations Between Neighborhood Violence Exposure and Inadequate or Excessive Gestational Weight Gain Among
non-Hispanic (NH) Asian/Pacific Islander (API) Women
Inadequate (API) Excessive (API)
1.7%
0.6%
0.00%
0.25%
0.50%
0.75%
1.00%
Low Violence Low-Medium Violence Medium-High Violence High Violence
Additive Scale Associations Between Neighborhood Violence Exposure and Inadequate or Excessive Gestational Weight Gain Among NH White (W)
Women
Inadequate (W) Excessive (W)
Summary of Findings
• Association with excessive GWG but not inadequate GWG overall
• Some subgroups show shift in weight gain
• NH-White women: increase in inadequate and excessive GWG
Discussion
Neighborhood Socio-economic Disadvantage (NSED)
• Mendez et al, 2014 • NSED inadequate GWG • NSED excessive GWG
• Current Project:
• Included zip-code level percent poverty
• Poverty as driver for inadequate GWG • Neighborhood violence accounting weight gain
Conclusions
Living in violent neighborhoods is associated with INCREASED gestational weight gain for pregnant women, particularly for some race and pre-pregnancy BMI subgroups.
Neighborhood violence is a public health issue, not just a social justice issue.
Thank you!
And a special thank you to… • Dr. Jen Ahern • Dr. Barbara Abrams • Ellie Colson • Stephanie Leonard • Dr. Lia Fernald • Maggie Rasnake • PHN 2016 Cohort
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