INTEGRATING SOCIAL AND NEIGHBORHOOD CONTEXTS TO UNDERSTAND LOW BIRTHWEIGHT INEQUALITIES
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Date
2024-12-19
Authors
Erickson, Natasha
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Publisher
University of Oregon
Abstract
This dissertation explores the ways in which social and spatial contexts interact to affect the patterning of low birthweight (LBW) inequalities. I utilize a fundamental causes perspective and ecosocial theory to look at how race/ethnicity and socioeconomic status operate as social determinants of low birthweight at multiple levels. To address these research aims, I complete three empirical analyses. First, I conduct a neighborhood level spatial analysis to look at the relationships between racial/ethnic composition, family structure, neighborhood deprivation, and LBW rates across California census tracts. Findings show that LBW rates are patterned by racial/ethnic composition, percent female headed households and neighborhood deprivation. However, these relationships are not uniform across racial/ethnic composition groups. Next, I build on this with a multilevel analysis of nationally representative Add Health data on births to look at the relationship between race/ethnicity and LBW at the individual level and the neighborhood level separately, additively, and interactively. Black racial identity and higher Black neighborhood composition are both associated with higher risk of LBW, but the compositional effect appears to be driven by an accumulation of individual effects. Further, Black mothers appear to experience a protective effect from living in higher percent Black neighborhoods. Finally, I again use Add Health birth data and I employ innovative intersectional multilevel models to look at the intersectional patterning of LBW by race/ethnicity and socioeconomic status and consider how the effect of neighborhood median household income on LBW varies across intersectional groups. Results indicate that there is considerable inequality in the risk of LBW across intersectional groups. Further, the effect of median household income on LBW risk varies across these groups. Taken as a whole, the findings in this dissertation demonstrate that low birthweight inequalities are patterned by race/ethnicity and socioeconomic status at both the individual and the neighborhood level. Black mothers and communities experience particularly high risk of LBW. Further, neighborhood contextual effects vary for individuals from different social groups. These findings highlight the importance of multilevel thinking when looking at health inequalities and highlight the need for programs and policies that support high risk mothers, infants, and communities.
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Keywords
health inequalities, intersectionality, low birthweight, multilevel analysis, neighborhood context, spatial analysis